Lesson 1 Objectives: - PowerPoint Presentation

Slide1

Lesson 1 Objectives:Introduction to the Role of the Nurse Aide

Refer to Page 1 in TextbookSlide2

Facilities

A. Long

Term Care/Certified Nursing Facilities-receives Medicaid, Medicare, and/or private pay

(person doesn't

need to be hospitalized, but can no longer live at home)

~Skilled Nursing Facilities (SNF): provide nursing services on a 24

hr

basis for chronic illnesses or conditions

AKA

: Nursing home, nursing center, nursing facility, care center, healthcare center

“Resident’s”-not always elderlySlide3

Facilities

B. Hospitals-Acute

Care (short term illnesses)

~Transitional Care Units-located within an acute care facility, accepts private pay and Medicare. Provides lower level care while needs are assessed and arrangements made to be discharged.

~Trauma Centers-Life threatening illnesses

~Emergency Department-conditions that occur suddenly and require immediate attention

~Intensive Care Units-Continuous care for

pts

with serious illnesses/injuries

~Cardiac Care Units-serious heart conditions

~General Units-ill, but don’t need high level of specialized care and continuous nursing care.

The Joint Commission of Health (JCOH)-accredits many types of health care facilities; private, nonprofit organizationSlide4

FacilitiesC. Skilled or Sub-acute Care: person does not need to be hospitalized, but cannot go home yet

(Rehabilitation/Convalescent Centers-services to help recover from significant injury)

-Found in hospitals or long-term care facilities on specialized unitsSlide5

FacilitiesD. Adult Day Care- to provide social and some health services outside the home to persons 18 years and older during the day

Allows for caregivers to still work and provides respite (a break) for caregiversSlide6

FacilitiesE. Assisted Living Center: Provide supervision or assistance with ADL, coordination of services with doctors, and monitoring activities that promote health and ensure safety.

Person needs some assistance and supervision, but not 24 hour medical care. Slide7

Facilities

F. Home

Health Care Providers-care provided in patient/client home (accepts Medicare, Medicaid, private pay, and other insurance)

G. Hospice-care

and support for dying patients and their families; accepts Medicare, Medicaid, and private

pay/insurance

(Life expectancy of 6 months or less)

H. Palliative Care-goal for comfort rather than measures to prolong lifeSlide8

FacilitiesAll that utilize CNA’s are licensed by ISDH

(Indiana State Department of Health)

Must meet state and federal requirements known as Code of Federal Regulations

Annual surveys conducted:

~Might observe care and ask questions

~Tell truth and answer to best of your ability

~Not breaking confidentiality with surveysSlide9

Who pays for Services?Medicare

-Financial assistance for the elderly

Medicaid

-Financial assistance for low income/disabled

Private

Pay-

out of own pocket

Insurance

- Various Companies

This is why we should be cost conscious and have to be sure to document effectively…

REGULATIONS, REGULATIONS, REGULATIONSSlide10

Scope of Practice

STANDARD 14: NURSE AIDE SCOPE OF PRACTICE

The nurse aide will perform only

the tasks in the course standards and

Resident Care Procedures

manual, unless trained appropriately by licensed staff of the facility with policies and procedures and a system for ongoing monitoring to assure compliance with the task, i.e., (see supplements for examples). This additional training would only apply for tasks, which are not prohibited by paragraphs 2 and 3 of this section and by current rule, which prohibits the giving of injections.

The nurse aide will not perform

any invasive procedures, including enemas and rectal temperatures, checking for and/or removing fecal impactions, instillation of any fluids, through any tubing, administering vaginal or rectal installations.

The nurse aide will not administer

any medications, perform treatment or apply or remove any dressings. Exception to the above would be the application of creams/ointments to intact skin, such as moisture barrier cream.Slide11

Role of CNAHygiene, safety, nutrition, exercise, and elimination needs of residents (Varies from state to state)

Help residents/patients with ADL’s (Activities of Daily Living)

Examples: bathing, dressing, eating, toileting, Slide12

Indiana Requirements

Criminal Background of candidates: Felonies in theft, battery, abuse, substance abuse within the previous 5 yeas are prohibited from employment and enrollment in a NA training program.

2. Physical/Health Screen

3. TB/

Mantoux

testing

4. Successfully completing approved training program and the state competency evaluationSlide13

Professionalism

Respect (do not be prejudice based on personal values)

Loyal/Dependable

Teamwork-resident focused

Helping any resident within the facility

Accountable

D

o Not accept or give money/gifts to residents

Appearance- Take Care of Yourself

Smile, leave personal problems at home.

Never use Profanity

Personal Matters on Personal TimeSlide14

ProfessionalismNo solicitation at WorkControl Emotions (Remain calm and collected)

Confidentiality (HIPAA-Health Insurance Portability and Accountability Act): Taken Very Seriously, you could be SUED and Lose your Job indefinitely Slide15

Comprehensive Care PlanAKA- Plan of Care (POC)

-Written Plan of Action based on resident’s needs and limitations. Identifies short and long-term goals for the resident

-

Often based off of MDS (Minimum Data Set)- screening and an assessment tool for Long-Term Care Providers

OBRA

(

pg

8)-Omnibus Budget Reconciliation Act-Law passed to ensure safer/better care for residents in LTC due to high reports of abuseSlide16

Communication NA should be able to actively listen and talk with residents, family and other health care personnel.

Observe & Report:

Objective vs. Subjective Data Slide17

Observing & Reporting

Report-

verbally

inform the person in authority (often the nurse for CNA’s) about the care that has been given or observations made

Routine Report-end of each shift (every 8

hrs

)

Some observations require immediate reporting:

severe pain, falls/incidents, seizures, sudden or increased confusion, swelling, bleeding/drainage, change of LOC, behaviors, mood changes, SOB, skin issues, any change of conditionSlide18

Other Responsibilities

Participate in Care Conferences

Usually held quarterly or when there is a significant change in condition

Know the policies and procedures of the facility where you work

Policy

-written statement/rule

Procedure

-how to follow a particular rule/plan of actionSlide19

Healthcare TeamIDT-Interdisciplinary Team

Administrator, Director of Nursing (DON), Nurse Manager, Staff/Charge Nurse, Qualified Medication Aides (QMA), Certified Nursing Aide (CNA), Dietician, Speech Therapist, Occupational Therapist, Physical Therapist, Respiratory Therapy, Activity Director, Social Worker, Resident, Family Member, Responsible Party, Ombudsman,

House-keeping, Laundry, Maintenance, Information TechnologySlide20

Chain of CommandProper line of authority for reporting

*Protects

NA’s and their employers

from liability

*Nurse Aides always report to the nurse (staff nurse or charge nurse on your shift)

*Could also maybe be a unit manager or Director of Nursing (DON)

Bottom to Top=

CNA…Nurse…Nurse Manager…ADON…DON… Administrator…Executive DirectorSlide21

Communication/Interpersonal Skills

Formulate Message (Talker)

Receive Message (Active Listener)

Observe for Feedback

Communication is not always VERBAL words (written words=text, email, letter)

Also communication can be verbal and nonverbal

Body Language is HUGE (could be unintentionally sending a negative message to the receiver)Slide22

Barriers to Effective Communication

Cliches

-phrases that can be interpreted differently by people or where the meaning might not be clear.

ie

. “Opposites Attract,” “Everything will be fine/OK!”

Slang- word or phrase often used by certain generations with specific meaning, but not understood by all.

ie

. Oh Snap, LOL, OMG, TBT

Sensory Impairment-Visually Impaired, Hearing impaired (HOH), Cognitively impaired (confused or intellectual disability)

Unconscious- may not be able to communicate, but may still be able to hearSlide23

Barriers ContinuedEmotions: stress, tension, anxiety

Coping/Defense Mechanisms:

Denial- refuse the proven truth

Displacement- Transfer emotion(s) onto someone or something

Rationalization- Excuses

Regression- Revert to prior state

Repression-Block thoughts from mindSlide24

Call LightsThis is many patients/residents form of communication with staff to help meet their needs

Place on person’s unaffected side within reach at all times

Answer immediately

Never withhold as a means of punishment or retaliation=ABUSESlide25

Promote Resident Independence

Independent

- Requires minimal to limited assistance

Dependent

- Requires extensive to total assistance

Offer support, praise, encouragement

Be patient, understanding, compassionate

Out of bed at least 1-2

hrs

/day

Encourage their preferred attire, dining room for meals

Assistive Devices in working condition

Socialize-TV, activities, reading paper/magazine

Passive ROM at least 2xday

Bowel/Bladder retraining for incontinenceSlide26

Resident/Person Centered Care

Respects the voice of the resident as an individual to meet the persons specific needs and/or limitations and preferences based on lifestyle

Takes into consideration the persons Culture and/or Religious Values

**We should all do so without judgment and respect their choices regardless of our own personal beliefs!!Slide27

Review QuestionsPage 13 in your bookIf you cannot answer them, be sure to review!