Chapter 1: Lecture (1:26hr)

Chapter one,

the nursing assistant in long term care,

learning objective one

compare long term care to other health care settings.

Welcome to the world of health care.

Health care happens in many places.

Nursing assistants work in many of these settings.

In each setting, similar tasks will be performed.

However, each setting is also unique.

This textbook will focus on long term care.

Long term care. LTC

is given in long term care facilities for people who need 24 hour skilled care.

Skilled care is medically necessary care given by a skilled nurse or therapist.

It is available 24 hours a day.

It is ordered by a doctor and involves a treatment plan.

This type of care is given to people who

need a high level of care for ongoing conditions.

The term nursing homes was once widely used to refer to these facilities.

Now, they are often known as long term care facilities.

LTCFS,

skilled nursing facilities, S NFS

rehabilitation centers

or extended care facilities.

People who live in long term care facilities may be disabled.

They are often elderly

but younger adults sometimes require long term care too.

They may arrive from hospitals or other health care settings,

their length of stay,

the number of days a person stays in a health care facility

may be short such as a few days or months

or longer than six months.

Some of these people will have a terminal illness.

This means that the illness will eventually cause death.

Other people may recover and return to their

homes or to other care facilities or situations.

Most people who live in long term care facilities have chronic conditions.

This means the conditions last a long period of time.

Even a lifetime

chronic conditions include physical disabilities,

heart disease and dementia.

Chapters. Four and five have more information.

People who live in these facilities are usually referred to as residents

because the facility is where they reside or live.

These places are their homes for the duration of their stay.

Figure 1-1

caption

people who live in long term care facilities are called residents

because the facility is where they reside for the duration of their stay.

People who need long term care

will have different diagnoses or medical conditions determined by a doctor.

The stages of illness or disease affect how sick people are

and how much care they will need.

The tasks nursing assistants perform will also vary.

This is due to each resident's different symptoms, abilities and needs.

Other health care settings include the following

home health care or home care

is provided in a person's home.

This type of care is generally given to people who are older

and are chronically ill

but who are able to and wish to remain at home.

Home health care may also be needed when a person is weak.

After a recent hospital stay

home care includes many of the services offered in other settings.

Figure 1-2

caption

home care is performed in a person's home

assisted living.

Facilities are residences for people who need some help with daily tasks

such as showering meals and dressing

help with medications may also be given

people who live in. These facilities do not need 24 hour skilled care,

assisted living facilities allow more independent

living in a home like environment.

A resident can live in a single room or an apartment.

An assisted living facility may be attached to a

long term care facility or it may stand alone.

Adult day services are for people who need

some help and supervision during certain hours,

but who do not live in the facility where care is provided.

Generally adult day services are for people who need some help

but are not seriously ill or disabled.

Adult day services can also provide a break for family members and friends.

Acute care is 24 hour skilled care

given in hospitals and ambulatory surgical centers.

It is for people who require short term immediate care for illnesses or injuries.

People are also admitted for short stays for surgery.

Figure 1-3

caption

acute care is performed in hospitals for

illnesses or injuries that require immediate care.

Subacute care is given in hospitals or long term care facilities.

It is used for people who need less care than for an acute

sudden onset short term illness.

But more care than for a chronic long term illness

treatment usually ends when the condition has stabilized or

after the set time for treatment has been completed.

The cost is usually less than for acute care

but more than for long term care.

Outpatient care is given to people who have had treatments,

procedures or surgeries and need short term skilled care.

Patients do not require an overnight stay in a hospital or other care facility.

Rehabilitation is care given by specialists and professionals,

physical occupational and speech therapists help restore or

improve function after an illness or injury.

Information about rehabilitation is located in Chapter nine.

Hospice care is given in facilities or homes for

people who have six months or less to live.

Hospice. Workers give physical and emotional care and comfort until a person dies.

They also support families during this process.

There is more information about hospice care. In chapter three,

learning objective two,

describe a typical long term care facility.

Long term care facilities are businesses that provide

skilled nursing care 24 hours a day.

These facilities may offer assisted living housing,

dementia care

or subacute care.

Some facilities offer specialized care,

others care for all types of residents.

The typical long term care facility

offers personal care for all residents and

focused care for residents with special needs.

Personal care includes bathing,

skin, nail and hair care,

mouth care

and assistance with walking,

eating and drinking, dressing,

transferring

and elimination.

All of these daily personal care tasks are called activities of daily living

ad

LS.

Other common services offered at these facilities include the following

physical

occupational and speech therapy,

wound care

care of different types of tubes such as catheters,

thin tubes inserted into the body to drain fluids or inject fluids,

nutrition therapy,

management of chronic diseases such as Alzheimer's disease,

acquired immunodeficiency syndrome A I DS,

diabetes,

chronic obstructive pulmonary disease,

COPD

cancer,

and congestive heart failure.

Chf

when specialized care is offered at long term care facilities,

the employees must have special training.

Residents with similar needs may be placed in units together,

nonprofit companies or for profit companies can own these facilities.

Residence rights

box 1-1

person centered and trauma informed care.

Many long term care facilities promote meaningful

environments with individualized approaches to care.

Person centered care emphasizes the individuality of the person who needs care

and recognizes and develops the person's capabilities.

Person centered care revolves around the resident

and promotes her individual preferences, choices, dignity and interests

each person's background, culture,

language, beliefs and traditions are respected,

improving each resident's quality of life is an important goal.

Giving person centered care will be an ongoing focus. Throughout this textbook,

trauma informed care is an approach to patient care that

recognizes that people may have experienced trauma in their lives.

Trauma can come from witnessing or experiencing abuse or neglect,

violence,

prison or military combat,

unstable home environments,

poverty and discrimination can also cause trauma.

As can a life threatening illness

or negative experiences in a medical setting.

Trauma informed care seeks to consider each person's trauma

experiences and preferences

and provide a person centered approach to care.

Learning objective. Three,

explain Medicare and Medicaid.

The centers for Medicare and Medicaid services,

C MS

C. Ms.gov

is a federal agency within the US Department of Health and Human Services.

CMS runs two national health care programs.

Medicare

and Medicaid.

They both help pay for health care and health insurance for millions of Americans.

CMS has many other responsibilities as well.

Medicare.

Medicare.gov

is a federal health insurance program that was established

in 1965 for people aged 65 or older.

It also covers people of any age

with permanent kidney failure

or certain disabilities.

Medicare has four parts

part A helps pay for care in a hospital or skilled nursing facility

or for care from a home health agency or hospice.

Part B helps pay for doctor services and other medical services and equipment.

Part C allows private health insurance companies to provide Medicare benefits.

Part D helps pay for medications prescribed for treatment.

Medicare will only pay for care, it determines to be medically necessary.

Medicaid,

medicaid.gov

is a medical assistance program for people who have a low income

as well as for people with disabilities.

It is funded by both the federal government and each state

eligibility is determined by income and special circumstances.

People must qualify for this program.

Medicare and Medicaid pay long term care facilities, a fixed amount for services.

This amount is based on the resident's needs upon admission

and throughout his stay at the facility

learning objective four,

describe the nursing assistant's role.

A nursing assistant

N A

performs assigned nursing tasks such as measuring a resident's temperature.

A nursing assistant also provides personal care

such as bathing residents and helping with hair care.

Common nursing assistant duties include the following

bathing residence,

helping with elimination needs,

assisting with range of motion, exercises and ambulation,

walking,

transferring residents from a bed to a chair or wheelchair

measuring vital signs, temperature, pulse rate,

respiratory rate and blood pressure,

assisting with meals.

Figure 1-4

caption,

helping residents eat and drink is an important part of an Na's job

helping residents dress and undress,

giving back rubs,

helping with mouth care

making and changing beds,

keeping residence areas neat and clean,

caring for supplies and equipment,

promoting independence and self care.

While performing these duties is a very

important part of the nursing assistant's job.

Nursing assistants are not allowed to insert or remove tubes,

give tube feedings or change sterile dressings.

Some states allow nursing assistants to give medications

if they have completed an additional specialized course

and meet the requirements of the individual facility.

Nursing assistants spend more time with residents than other care. Team members

observing and reporting changes in a resident's condition

is a very important duty of the N A

A resident's care can be revised or updated as conditions change.

Another duty of the N A is noting

and recording important information about the resident.

This is called charting

or documenting.

Nursing assistants are part of a team of health professionals.

The team includes doctors, nurses, social workers, therapists,

dietitians and specialists.

The resident and residents family are part of the team.

Everyone including the resident works closely together to meet goals.

Goals include helping residents recover from illnesses and

do as much as possible for themselves.

A nursing assistant can have many different titles,

nurse aid, certified nurse aide,

patient care, technician,

and certified nursing assistant are some examples.

The title given varies by state requirements.

This textbook uses the term nursing assistant,

residence rights box 1-2.

Responsibility for residents.

All residents are the responsibility of each nursing assistant

and N will receive assignments to perform tasks,

care and other duties for specific residents.

If an N A sees a resident who needs help,

even if the resident is not on his assignment sheet,

the N A should provide the needed care,

learning objective. Five,

describe the care team and the chain of command.

Residents have different needs and problems,

health care professionals with a wide range of education.

And experience help care for them together.

This group is known as the care team.

Members of the care team include the following

nursing assistant N A.

The nursing assistant performs assigned tasks such as measuring vital signs.

The N A also provides or assists with personal care

such as bathing residents and helping with elimination needs.

Nursing assistants must have at least 75 hours of training

and in many states,

training exceeds 100 hours

after completing an approved training course.

NS

must pass a competency evaluation,

registered nurse

RN

in a long term care facility.

A registered nurse coordinates manages and provides skilled nursing care.

This includes giving special treatments and medication

as prescribed by a doctor.

A registered nurse also assigns tasks and supervises

daily care of residents by nursing assistants.

A registered nurse is a licensed professional who has graduated from a 2

to 4 year nursing program.

RNS have diplomas or college degrees.

They have passed a national licensure examination.

Registered nurses may have additional academic

degrees or education in specialty areas,

licensed practical nurse, LP N

or licensed vocational nurse.

LVN.

A licensed practical nurse or licensed

vocational nurse gives medications and treatments.

An LPN or LVN

is a licensed professional who has completed 1 to 2 years of education

and has passed a national licensure examination,

Advanced practice registered nurse. APR N,

an advanced practice registered nurse,

sometimes called an advanced practice nurse or a PN

is a registered nurse who has completed training at the postgraduate level,

master's or doctoral.

APR

NS

can make diagnoses and prescribe treatment.

Nurse practitioners are one type of APR

N

physician or doctor

MD or do

doctor of osteopathy.

A doctor is a licensed professional who diagnoses disease

or disability and prescribes treatment and medication.

A doctor has graduated from a four year medical

school which they attended after receiving a bachelor's degree.

Many doctors also attend specialized training programs after medical school.

Figure 1-5

caption,

a doctor makes a diagnosis and prescribes treatment.

Physician assistant

P A,

a physician assistant is a licensed

professional who diagnoses disease or disability

and develops treatment plans as well as prescribes medication.

A P works under the supervision of a doctor

pas

have received master's degrees and have to pass

a national licensure examination before they can practice

physical therapist.

PT or DPT.

A physical therapist evaluates a person and

develops a treatment plan to increase movement,

improve circulation,

promote healing, reduce pain,

prevent disability

and regain or maintain mobility.

A PT or DPT

doctor of physical therapy

gives therapy in the form of heat,

cold massage,

ultrasound,

electrical stimulation

and exercise to muscles, bones and joints.

A physical therapist has graduated from a doctoral degree program.

After receiving an undergraduate degree.

PTS have to pass national licensure examinations before they can practice

occupational therapist.

Ot,

an occupational therapist helps residents learn to adapt to disabilities.

An ot may help train residents to perform

activities of daily living such as bathing,

dressing and eating.

This often involves the use of equipment called assistive devices.

The ot evaluates the residents needs and plans a treatment program.

Occupational therapists have earned a master's or doctoral degree.

OTs must pass a national licensure examination before they can practice

figure 1-6

caption.

A physical therapist helps exercise, muscles,

bones and joints to improve strength or restore abilities,

speech language, pathologist,

S LP

A speech language pathologist or speech therapist

identifies communication disorders, addresses factors involved in recovery

and develops a plan of care to meet goals.

An SLP teaches exercises to help the resident improve or overcome speech problems.

An SLP also evaluates a person's ability to swallow food and drink

speech language. Pathologists have earned a master's degree

in speech language pathology

and are licensed or certified to work

registered dietitian

RD

or RDN.

A registered dietitian RD

or registered dietitian nutritionist

RDN

assesses a resident's nutritional status

and develops a treatment plan to improve health and manage illness.

An RD creates diets to meet residents' special needs

and may also supervise the preparation of food and educate people about nutrition.

Registered dietitians have completed a bachelor's degree or master's degree

and must pass a national licensure examination.

Medical Social Worker,

MS

W

A medical social worker determines residents' needs and helps get

them support services such as counseling and financial assistance.

He may help residents obtain clothing and personal items

if the family is not involved or does not visit. Often

a medical social worker may book appointments and transportation.

MS

Ws have usually earned a master's degree in social work

activities director,

the activities director plans activities for residents

to help them socialize and stay active.

These activities are meant to improve and maintain residents' well being

and to prevent further complications from illness or disability

games,

performances and arts and crafts are some types of

activities that the activities director may plan or lead.

An activities director has usually earned a bachelor's degree.

However,

she may have an associate's degree or qualifying work experience.

An activities director may be called

a recreational therapist or recreation worker

depending on education and experience,

resident and residents family.

The resident is an important member of the care team.

Providing person centered care

means placing the resident's well being first

and giving her the right to make decisions and choices about her own care.

The resident helps plan care

and the resident's family may also be involved in these decisions.

The family is a great source of information.

They know the residents, personal preferences,

history,

diet habits and routines,

residence rights box 1-3.

The resident as a member of the care team,

all members of the care team should focus on the resident.

The team revolves around the resident and her condition goals, priorities,

treatment and progress.

Without the resident, there is no care team.

A nursing assistant carries out instructions given to her by a nurse,

the nurse is acting on the instructions of a doctor or other member of the care team.

This is called the chain of command.

It describes the line of authority

and helps to make sure that residents get proper health care.

The chain of command also protects employees and employers from liability.

Liability is a legal term.

It means that someone can be held responsible for harming someone else.

For example,

an N A harms a resident by performing a task.

However,

the task was in the care plan and was done according to policy and procedure.

In this case,

the N A may not be liable

or responsible for hurting the resident.

However,

if the N A does something not in the care plan that harms a resident,

she could be held responsible.

That is why it is important for the team to follow instructions

and for the facility to have a chain of command

figure 1-7

caption.

The chain of command describes the line of authority

and helps ensure that the resident receives proper care.

Nursing assistants must understand what they can and cannot do.

This is so that they do not harm residents

or involve themselves or their employers in lawsuits.

Some states certify that nursing assistants are qualified to work.

However,

nursing assistants are not licensed health care providers,

everything they do in their job is assigned

to them by a licensed health care professional.

That is why these professionals will show great interest in what NAS

do

and how they do it.

Every state grants the right to practice

various jobs in health care through licensure.

Examples include a license to practice nursing

medicine or physical therapy.

Each member of the care team works within a scope of practice.

Scope of practice defines the tasks that health

care providers are legally allowed to do.

According to state or federal law,

laws and regulations about what NAS

can and cannot do.

Vary from state to state.

It is important that NAS know which tasks are outside their scope of practice

and not perform them.

The care plan is individualized for each resident.

It is developed to help achieve the goals

of care and meet the residents' specific needs.

It lists the tasks, services and treatments that team members including NS

must perform.

It states how often these tasks should be performed

and how they should be carried out.

The care plan also includes the residents diagnoses and limitations,

goals and interventions such as medications,

monitoring treatments

and nutritional requirements.

It also details the needed supplies and equipment

permitted activities and specific safety measures.

Care planning should involve input from the resident and or the family

as well as from health professionals.

Person centered care

places special emphasis on the importance of the resident's input.

The care plan is a guide to help the resident be as healthy as possible.

It must be followed carefully.

It is critical that NAS make observations and report them to the nurse.

Even simple observations can be very important.

The information that NAS collect and the changes they observe,

help determine how care plans may need to change.

N A spend a lot of time with residents.

They are likely to have valuable information that will help in care planning.

If NS are asked to attend care planning meetings,

they should share their observations of residents

learning objective. Six

define policies, procedures and professionalism.

All facilities have policies and procedures

that all staff members are expected to follow.

A policy is a course of action that should

be taken every time a certain situation occurs.

For example,

a very basic policy is that health care information must remain confidential.

A procedure is a method

or way of doing something.

For example,

a facility has a procedure for reporting information about residents.

The procedure explains what form to complete

when and how often to complete it

and to whom it is given

common policies at long term care facilities include the following.

All resident information must remain confidential.

Keeping information confidential means not telling anyone about it.

This is not only a facility rule

but it is also the law.

More information about confidentiality including the

Health Insurance Portability and Accountability Act

H IP A A

HIPAA

can be found later in the chapter.

The care plan must always be followed.

Tasks not listed in the care plan or approved by the nurse should not be performed.

Nursing assistants.

Should not do tasks that are not included in their job description.

Nursing assistants must report important events or

changes in residence to a nurse.

Nursing assistants should not discuss their

personal problems with residents or residents.

Families.

Nursing assistants should not take money or

gifts from residents or their families.

Nursing assistants must be on time for work and must be dependable.

Employers have policies and procedures for every resident care situation.

These have been developed to give quality care and protect resident safety

procedures may seem long and complicated.

But each step is important.

Ns

must become familiar with and always follow policies and procedures.

Professional means having to do with work or a job.

Personal refers to life outside a job such as family, friends and home life.

Professionalism

is behaving properly. When on the job,

it includes dressing appropriately and speaking well.

It also includes being on time, completing tasks

and reporting to the nurse

for an N A professionalism means following the care plan,

making careful observations

and reporting accurately

following policies and procedures is an important part of professionalism.

Residents coworkers and supervisors respect

employees who behave professionally.

Professionalism helps people keep their jobs.

It may also help them earn promotions and raises

a professional relationship with residents includes the following

providing person centered care,

keeping a positive attitude,

doing only the assigned tasks that are in the care plan

and that the N A is trained to do

keeping all residents information confidential.

Always being polite,

not discussing personal problems.

Figure 1-8

caption,

nursing assistants are expected to always be polite and professional

not using personal phones in residents' rooms or in any resident care area,

not using profanity. Even if a resident does

listening to the resident

calling a resident mister

Missus

Miss or Miss

and their last name

or by the name, the resident prefers

terms such as sweetie

honey Dey, et

cetera

are disrespectful and should not be used.

Using the pronouns of resident prefers

she her

he him

they them

never giving or accepting gifts,

always explaining care before providing it

following practices such as hand washing to protect oneself and residents,

a professional relationship with an employer includes the following

completing tasks efficiently,

always following policies and procedures,

documenting and reporting carefully and correctly

reporting problems with residents or tasks,

reporting. Anything that keeps an N A from completing duties,

asking questions when the N A does not know or understand something,

taking directions or feedback without getting upset,

being clean, neatly dressed and groomed.

Always being on time

telling the employer if the N A cannot report for work.

Following the chain of command,

participating in education programs

being a positive role model for the facility.

Nursing assistants must be

compassionate,

being compassionate means being caring

concerned,

empathetic and understanding,

demonstrating empathy

means identifying with the feelings of others.

People who are compassionate, understand others problems,

they care about them.

Compassionate. People are also sympathetic

showing sympathy means sharing in the feelings and difficulties of others.

Honest,

an honest person tells the truth

and can be trusted.

Residents need to feel that they can trust those who care for them.

The care team depends on honesty in planning care.

Employers count on truthful records of the care given and the observations made

tactful

being, tactful means showing sensitivity

and having a sense of what is appropriate when dealing with others,

Conscientious

people who are conscientious try to do their best.

They are guided by a sense of right and wrong.

They are alert, observant,

accurate and responsible

giving. Conscientious care means making accurate observations and reports

following the care plan

and taking responsibility for one's actions.

Dependable

ns

must be able to make and keep commitments.

They must be at work on time.

They must skillfully do tasks, avoid absences and help their peers when needed.

Figure 1-9

caption

nursing assistants must be conscientious

about documenting observations and procedures.

Patient

people who are patient do not lose their temper easily.

They do not act irritated or complain when things are hard.

Residents are often elderly and may be sick or in pain.

They may take a long time to do things.

They may become upset.

Ns must be patient and not rush residents or act annoyed.

Respectful

being respectful means valuing other people's individuality.

This includes their age, religion,

culture,

feelings, practices and beliefs.

People who are respectful, treat others politely and kindly

unprejudiced.

Nas work with people from many different backgrounds.

They must give each resident the same quality care

regardless of age, gender,

sexual orientation,

gender, identity,

religion,

race, ethnicity or condition.

Proactiv

being proactive

means anticipating potential problems and needs before they occur. Ns

who pay close attention to residents and their environments

are more likely to anticipate needs and prevent problems

rather than simply reacting after something occurs.

Observing and reporting carefully are key ways to be proactive

learning. Objective. Seven

list examples of legal and ethical behavior and explain residents' rights,

ethics and laws guide behavior.

Ethics are the knowledge of right and wrong.

An ethical person

has a sense of duty toward others.

He tries to do what is right.

Laws are rules set by the government to help people live peacefully together

and to ensure order and safety.

Ethics and laws are very important in health care.

They protect people receiving care

and guide people giving care,

ns

and all care. Team members should be guided by a code of ethics.

They must know the laws that apply to their jobs.

Guidelines,

legal and ethical behavior.

Be honest at all times,

protect residents' privacy and confidentiality,

do not discuss their cases except with other members of the care team.

Keep staff information confidential,

report abuse or suspected abuse of residents

help residents report abuse if they wish to make a complaint of abuse,

follow the care plan and assignments.

If you make a mistake report, it promptly,

do not perform any task outside your scope of practice.

Report all resident observations and incidents to the nurse.

Document accurately and promptly

follow rules for safety and infection prevention.

See, chapter two

do not accept gifts or tips.

Do not get personally or sexually involved with

residents or their family members or friends.

Figure 1-10

caption

ns

should not accept money or gifts because it

is unprofessional and may lead to conflict.

The Omnibus Budget Reconciliation Act.

BR

A.

Obra

was passed in 1987.

It has been updated several times since

Obra was passed in response to reports of poor

care and abuse in long term care facilities.

Congress decided to set minimum standards of care

which included standardized training of nursing assistants.

Obra requires that the nurse aid training and competency evaluation program.

Nat ce

set minimum standards for nursing assistant training.

N A must complete at least 75 hours

of training that covers topics such as communication,

preventing infections,

safety and emergency procedures

and promoting residents independence and legal rights

training must also include basic nursing skills, personal care

and how to observe and report changes in residents conditions.

Ns

must also know how to respond to mental health and social services needs,

rehabilitative needs

and how to care for residents who are cognitively impaired.

Oprah requires that NAS

pass a competency evaluation,

a test before they can be employed.

Ns must also attend a minimum of 12 hours per year.

Of in service education to keep their skills updated.

Brah also requires that states keep a current

list of nursing assistants in a state registry.

In addition,

Oprah identifies standards that instructors must meet

in order to train nursing assistants.

Brah sets guidelines for minimum staff requirements

and specific services that long term care facilities must provide

resident assessment requirements are another important part of

Obra.

Obra requires that complete assessments be done on every resident.

The assessment forms are the same for every facility.

Oprah made major changes in the survey process.

Surveys are inspections to help make sure that long

term care facilities follow state and federal regulations.

Surveys are done periodically by the state agency that licenses facilities.

They may be done more often if a facility has been cited for problems

to cite means to document a problem through a survey

inspections may be done less often if the facility has a good record

inspection, teams include a variety of trained health care professionals.

The results from surveys are available to the public and posted in the facility.

Brah also identifies important rights for residents in long term care facilities.

Residents' rights specify how residents must be

treated while living in a facility.

They provide an ethical code of conduct for health care workers,

facility. Staff give residents a list of these rights

and review each right with them.

In 2016

Centers for Medicare and Medicaid Services C MS

finalized a rule to improve the care and

safety of residents in long term care facilities.

It was the first comprehensive update since 1991.

It includes strengthening the rights of residents

who live in long term care facilities.

Ns

must be familiar with these legal rights.

Residents rights include the following

quality of life.

Residents have the right to the best care available,

dignity, choice and independence are important parts of quality of life.

The facility must give equal access to

quality care regardless of a resident's condition,

diagnosis or payment source

services and activities to maintain a high level of wellness.

Residents must receive the correct care.

Health care professionals at facilities must develop a care plan for residents

and this care should keep them as healthy as possible.

A baseline care plan for residents which

includes instructions for providing person centered care

must be developed within 48 hours of admission.

Residents health should not decline as a direct result of the facility's care.

The right to be fully informed about rights and services.

Residents must be told what services are offered

and what the fee is for each service.

They must be informed of charges both orally and in writing.

Residents must be given a written copy of their legal rights

along with the facility's rules.

Legal rights must be explained in a language that each resident can understand.

Residents must be given contact information for

state agencies relating to quality of care

such as the ombudsman program.

When requested survey results must be shared with. Residents.

Residents have the right to be notified about any change of room or roommate.

They have the right to communicate with someone who speaks their language.

They have the right to assistance for any sensory impairment

such as vision loss,

the right to participate in their own care.

Residents have the right to participate in

planning their treatment care and discharge.

Residents have the right to see and sign their care plans.

After all significant changes,

residents have the right to be informed of risks and benefits of care and treatment

including treatment options and alternatives

and to choose the options. They prefer

informed consent

is the process by which a person

with the help of a doctor

makes informed decisions about their health care.

This protects the patient's legal and ethical right

to direct what happens to their body.

Residents have the right to request

refuse

and or discontinue treatment and care.

They can refuse restraints

and refuse to participate in experimental research.

Residents have the right to be told of changes in their condition.

They have the right to review their medical record.

They have the right to choose and change their care providers at any time.

The right to make independent choices.

Residents can make choices about their doctors care and treatments.

They can make personal decisions such as what to wear and how to spend their time.

They can join in community activities both inside

and outside the care facility.

They have the right to a reasonable accommodation of their needs and preferences.

They can vote in federal state and local elections.

They have a right to participate in resident

or family groups such as a resident council,

a resident council

is a group of residents who meet regularly to

discuss issues related to the long term care facility.

This council gives residents a voice in facility operations

and an opportunity to provide suggestions on improving care.

The right to privacy and confidentiality.

Residents have the right to speak privately with anyone.

They have the right to privacy during care,

for example, avoiding unnecessary exposure of the resident during care

and the right to confidentiality. Regarding every aspect of their lives,

their medical and personal information cannot be

shared with any one but the care team

figure 1-11

caption,

residents have the right to privacy,

which includes private communication with anyone.

They have the right to send and receive mail that is unopened,

the right to dignity, respect and freedom.

Residents must be respected and treated with dignity by caregivers.

Residents must not be abused, mistreated or neglected in any way.

The right to security of possessions.

Residents, personal possessions must be safe at all times.

Facilities must make an effort to protect residents, property from loss or theft,

possessions cannot be taken or used by anyone without a resident's permission.

Residents have the right to file a complaint if

their possessions have been used without their consent.

Residents have the right to manage their own finances

or choose someone else to do it for them.

Residents can request that the facility handle their money.

If the care facility handles residents, financial affairs,

residents must have access to their accounts and financial records

and they must receive quarterly statements among other things.

Residents have the right to not be charged for

any care that is covered by Medicaid or Medicare

rights during transfers and discharges.

Residents have the right to be informed of

and to consent to any location changes,

residents have the right to stay in a

facility unless a transfer or discharge is needed.

Residents can be moved from the facility due to safety reasons,

their safety or others' safety.

If their health has improved or worsened

or if payment for care has not been received for a determined period of time,

the facility must develop an effective discharge plan for

residents that involves each resident's goals and preferences.

This plan must be regularly reviewed and updated as appropriate.

If the resident is planning to stay at the facility. Long term,

a discharge plan still needs to be created.

Keeping the resident's preferences in mind

the right to complain.

Residents have the right to make complaints

and voice grievances without fear for their safety

or for the quality of care. They will receive

facilities must work quickly to address their concerns.

The right to visits.

Residents have the right to visit

from doctors, family members including spouses and domestic partners,

friends,

ombudsmen,

clergy members, legal representatives or any other person

visits cannot be restricted, limited or denied on the basis of race, color,

national origin

religion,

sex, gender, identity,

sexual orientation or disability,

right. With regard to social services,

the facility must provide residents with access to social services.

This includes counseling, assistance in solving problems with others

and help contacting legal and financial professionals

guidelines,

protecting residents' rights

never abuse a resident physically, psychologically, verbally or sexually

watch for and immediately report any signs of abuse or neglect.

Call the resident by the name, the resident prefers

use pronouns. The resident prefers

he him,

she her

or they them

involve residents in planning

allow residents to make as many choices as possible

about when where and how care is performed.

Always explain a procedure to a resident before performing. It

do not unnecessarily expose a resident while giving care

respect. A resident's refusal of care,

residents have a legal right to refuse treatment and care.

However, report the refusal to the nurse immediately

tell the nurse if a resident has questions,

concerns or complaints about treatment or the goals of care,

be truthful. When documenting care,

do not talk or gossip about residents,

keep all resident information, confidential

knock and ask for permission before entering a residence room.

Figure 1-12

caption

always respect residents' privacy

knock before entering their rooms. Even if the door is open,

do not accept gifts or money from residents

do not open a residents' mail or look through his belongings,

respect residents, personal possessions,

handle them gently and carefully.

Keep personal items labeled and stored. According to facility policy,

report, observations about a resident's condition or care

help resolve disputes by reporting them to the nurse,

residence rights box 1-4.

Maintaining boundaries

in professional relationships,

boundaries must be set.

Boundaries are the limits to or within relationships.

Nursing assistants are guided by ethics and laws

that set limits for their relationships with residents.

These boundaries help support a healthy resident staff relationship

working closely with residents on a regular basis

may make it more difficult to honor the boundaries of professional relationships.

Residents may feel that NS are their friends.

If a staff member and resident become personally involved with each other,

it becomes more difficult to enforce rules.

The resident may expect the N A to break

the rules because she thinks they are friends,

emotional attachments to residents are unprofessional

and may weaken an na's judgment

N

should be friendly, warm and caring with residents,

but they should behave professionally and stay

within the limits of set boundaries.

Facility rules and the care plans instructions should be followed.

They are in place for everyone's protection.

A very important part of protecting residents' rights

is preventing abuse and neglect.

Abuse is purposeful mistreatment that causes physical mental

or emotional pain or injury to someone.

There are many forms of abuse

including the following

physical abuse

is any treatment, intentional or not that causes harm to a person's body.

This includes slapping bruising, cutting,

burning,

physically, restraining,

pushing, shoving or even rough handling.

Psychological abuse

is emotional harm caused by threatening, scaring, humiliating,

intimidating

isolating or insulting a person

or treating an adult as a child.

Verbal abuse

is the use of spoken or written words,

pictures or gestures that threaten embarrass or insult a person.

Sexual abuse is non consensual sexual contact of any type.

Financial abuse is the improper or illegal use of a person's money, possessions,

property or other assets.

Assault is a threat to harm a person

resulting in the person feeling fearful that they will be harmed,

telling a resident that she will be slapped if she does not stop yelling

is an example of assault,

battery is the intentional touching of a person without their consent.

An example is an na hitting or pushing a resident,

which is also considered physical abuse,

forcing a resident to eat a meal is another example of battery.

Domestic violence is abuse by spouses, intimate partners or family members.

It can be physical sexual or emotional.

The victim can be an adult or a child.

False imprisonment is unlawful restraint that

affects a person's freedom of movement.

Both the threat of being physically restrained

and actually being physically restrained are types of false imprisonment,

not allowing a resident to leave.

The facility is also considered false imprisonment.

Involuntary seclusion

is the separation of a person from others against the person's will.

An example is an N A confining a resident to his room.

Workplace violence is abuse of staff by other staff members,

residents or visitors.

It can be verbal, physical or sexual.

This includes improper touching and discussion about sexual subjects.

Sexual harassment is any unwelcome sexual advance or behavior

that creates an intimidating, hostile or offensive working environment.

Requests for sexual favors,

unwanted touching

and other acts of a sexual nature are examples of sexual harassment,

substance abuse is the repeated use of legal or illegal drugs,

cigarettes or alcohol in a way that harms oneself or others.

For the N A substance abuse can lead to unsafe practices that result in negligence,

malpractice, neglect and abuse.

It can also lead to the loss of the N A's job.

Neglect is the failure to provide needed care that results

in physical mental or emotional harm to a person.

Examples include leaving a bedridden resident alone for a long

time or denying the resident food dentures or eyeglasses.

Negligence means actions or the failure to act or provide

the proper care for a resident resulting in unintended injury.

An example of negligence is an N A forgetting

to lock a resident's wheelchair before transferring her,

the resident then falls and is injured.

Malpractice occurs when a person is injured

due to professional misconduct through negligence,

carelessness or lack of skill.

Nursing assistants must never abuse residents in any way.

They must also try to protect residents from others who abuse them.

If an N A sees or suspects that another caregiver

family member or resident is abusing a resident,

she must report this immediately to the nurse in charge.

Reporting abuse or suspected abuse is not optional.

It is the law

observing and reporting

abuse and neglect.

The following injuries are considered suspicious and should be reported

poisoning or traumatic injury,

teeth marks,

belt buckle or strap marks,

bruises, contusions or welts,

scars,

fractures or dislocations,

burns of unusual shape and in unusual locations or cigarette burns.

Scalding burns,

scratches or puncture wounds,

scalp tenderness or patches of missing hair,

swelling in the face, broken teeth

or nasal discharge,

bruises, bleeding or discharge from the vaginal area.

These signs could indicate abuse,

yelling obscenities,

fear, apprehension or fear of being alone,

poor self control,

constant pain,

threatening to hurt others,

withdrawal or apathy.

Figure 113

caption,

withdrawing from others is an important change to report

alcohol or drug abuse,

agitation, anxiety or signs of stress,

low self esteem,

mood changes, confusion or disorientation.

Private conversations not allowed or the family

member caregiver present during all conversations.

Reports of questionable care by the resident or her family.

These signs could indicate neglect,

pressure injuries,

unclean body,

body lice,

unanswered, call lights,

soiled bedding or incontinence briefs, not being changed,

poorly fitting clothing,

unmet needs relating to hearing aids, eyeglasses, et cetera,

weight loss or poor appetite,

uneaten food

dehydration,

fresh water or beverages, not being offered regularly.

Resident reports not receiving prescribed medication.

Nursing assistants are in an excellent position

to observe and report abuse or neglect.

Nas

have an ethical and legal responsibility to observe for signs of abuse

and to report suspected cases to the proper person.

Nas must follow the chain of command. When reporting abuse.

If action is not taken,

the N A should keep reporting up the chain of command until action is taken.

If no action is taken at the facility level,

she can call the state abuse hotline or contact the proper state agency

abuse can be reported anonymously.

If a life or death situation is witnessed,

the N A should remove the resident to a safe place. If possible,

the N A should get help immediately or have some one go for help.

The resident should not be left alone

if abuse is suspected or observed,

the N A should give the nurse as much information as possible.

If residents want to make a complaint of abuse, NS

must help them in every way.

This includes telling them about the process and their rights.

N must never retaliate against

punish residents complaining of abuse.

If an N A sees someone being cruel or abusive to a resident who made a complaint,

she must report it

all care. Team members are responsible for resident safety

and should take this responsibility seriously.

In long term care facilities in the United States,

an ombudsman is assigned by law as the legal advocate for residents.

LTC

ombudsman.org

the older Americans Act oa A

is a federal law that requires all states to have an ombudsman program.

Ombudsmen visit facilities and listen to residents.

They decide what action to take if there are problems.

Ombudsmen can help resolve conflicts and settle disputes concerning residents',

health safety, welfare and rights.

They gather information and try to resolve resident problems.

Ombudsmen provide an ongoing presence in care facilities.

They monitor care and conditions.

Figure 1-14

caption

an ombudsman is a legal advocate for residents.

She visits the facility and listens to residents

and may work with other agencies to resolve complaints.

To respect confidentiality

means to keep private things. Private

nursing assistants will learn confidential,

private information about residents.

They may learn about a resident's health finances and relationships

ethically and legally. They must protect this information.

N A

should not share information about residents with anyone other than the care team.

Congress passed the Health Insurance Portability and Accountability Act

H A hhs.gov/h A

in 1996.

It has been further defined and revised since then.

One reason this law was passed is to

help keep health information private and secure.

All health care organizations must take

special steps to protect health information.

Their employees can be fined and or imprisoned if

they do not follow rules to protect patient privacy.

Under this law, a person's health information

must be kept private

protected health information. Ph I

is information that can be used to identify a person

and relates to the patient's condition,

any health care that the person has had

and payment for that health care.

Examples of ph I include a person's name,

address,

telephone number, social security number,

email address and medical record number.

Only.

People who must have information to provide care or to

process records should know a person's private health information.

They must protect the information.

It must not become known or used by anyone else.

It must be kept confidential.

Hi.

A applies to all health care providers, including doctors, nurses,

nursing assistants

and any other members of the care team.

Nas cannot give out any information about a resident to

anyone who is not directly involved in the resident's care

unless the resident gives official consent

or unless the law requires it.

For example,

if a neighbor asks an N A how a resident is doing? She

should reply.

I'm sorry, but I cannot share that information.

It's confidential.

That is the correct response to anyone who does

not have a legal reason to know about the resident

guidelines, protecting privacy.

Make sure you are in a private area when you listen to or read your messages,

know with whom you are speaking on the phone.

If you are not sure, get a name and number

call back after you find out it is all right to share information with this person.

Do not talk about residents in public

public areas include elevators, grocery stores,

lounges, waiting rooms, parking garages, schools, restaurants, et cetera.

Figure 1-15

caption

do not discuss residents in public places such as restaurants and waiting rooms,

use confidential rooms for reports to other care. Team members.

If you see a resident's family member or a former resident in public,

be careful with your greeting.

The family member or former resident may not want others

to know the person is or was a resident.

Do not bring family or friends to the facility to meet residents.

Make sure nobody can see protected health or personal

information on your computer screen while you are working,

log out and or exit the browser when finished with any computer work,

do not give confidential information in emails.

Do not share resident information, photos or videos on any social networking site

such as Instagram, Twitter or Facebook,

do not share resident information via text messages.

Make sure fax numbers are correct before faxing information.

Use a cover sheet with a confidentiality statement,

do not leave documents where others may see them

store file or shred documents. According to facility policy,

if you find documents with a resident's information,

give them to the nurse.

All health care workers must follow HIPAA regulations

no matter where they are or what they are doing.

There are serious penalties for violating these rules including the following

fines ranging from $100 to $1.5 million.

Prison sentences of up to 10 years.

Maintaining confidentiality is a legal and ethical obligation.

It is part of respecting residents and their rights.

Discussing a resident's care or personal affairs with

anyone other than members of the care team

violates the law

learning objective. Eight

explain legal aspects of the residents medical record.

The resident's medical record or chart is a legal document

in court.

What is included in the chart is considered to be what actually happened

in general.

If something does not appear in a resident's chart,

it did not legally happen.

Failing to document care could cause very serious legal problems for Ns

and their employers.

It could also harm residents.

Ns must remember that if it was not documented, it was not done.

Careful charting is important for these reasons.

It is the only way to guarantee clear and complete

communication among all the members of the care team.

Documentation is a legal record of every part of a resident's treatment.

Medical charts can be used in court as legal evidence,

documentation helps protect nursing assistants

and their employers from liability

by proving what they did when caring for residents,

documentation gives an up to date record of the status and care of each resident

guidelines. Careful documentation,

document care immediately after it is given

this makes details easier to remember.

Do not record any care

before it has been done.

Think about what you want to say before documenting

be as brief and as clear as possible.

Use facts not opinions

at many facilities.

Documentation is done electronically using computers or tablets,

computers, record and store information

that can be retrieved when needed.

This is faster and more accurate than writing information by hand.

A computer may remain in a residence room for care,

team members to input information each time they visit the room.

A computer may be in the hallway or other common area.

A computer or tablet may also be carried from room to room for documentation.

Some general guidelines for electronic documentation are listed below.

If your facility uses electronic documentation,

you will be trained how to do this.

Some facilities use both handwrit

and electronic records.

Even when facilities require electronic documentation

training often includes how to document by hand in case there is a system failure.

Legal documentation rules apply to both electronic and paper, medical charts.

Hip hop privacy guidelines apply to electronic documentation.

Make sure nobody can see protected health information on your computer screen.

Do not share your login information with anyone.

Do not have someone else enter information for you even if it is more convenient,

make sure you are logged in to the

correct residence chart before beginning to document,

log out and or exit a residence chart. When finished with documentation,

some computer software automatically fills in certain

fields with information that has been entered before

autofill.

Be sure that you are documenting correctly

and that any autofill

entries are accurate.

Check your entries before exiting a residence chart,

treat computers carefully.

Do not use the facility's computers or tablets to browse the internet

or access any personal accounts

use black ink when documenting by hand

write as neatly as you can.

If you make a mistake when documenting by hand, draw one line through it,

write the correct information,

put your initials and the date.

Do not erase what you have written.

Do not use correction, fluid

documentation done on a computer is time stamped.

It can only be changed by entering another notation,

sign your full name and title.

For example, Sarah Martinez

N A

write the correct date

document as specified in the care plan.

Documentation may be done by code.

For example, when documenting activities of daily living on a flow sheet,

you may need to choose a code to explain what the resident was able to do.

Zero may be classified as independent.

One as needs supervision.

Two as needs limited assistance.

Three as needs extensive assistance

and four as total dependence.

You will be trained to document properly at your facility.

Documentation may need to be done using the 24 hour clock or military time.

Regular time uses the numbers 1 to 12

to show each of the 24 hours in a day.

The abbreviations AM and PM

are used in regular time to show what time of day it is

in military time.

The hours are numbered from 00 to 23.

The abbreviations AM and PM. Are not needed.

Midnight is expressed as 0000

or 2400

1 a.m. is 0100,

1 p.m. is 1300

and so on

figure 1-16

caption

illustration showing the divisions in the 24 hour clock

to change the hours between one pm and 11:59 p.m. to military time.

Add 12 to the regular time.

For example,

to change three pm to military time

add three plus 12.

The time is expressed as 1500,

1500 hours.

Midnight can be written as 0000

or it can be written as 2400

using 2400

follows the rule of adding 12 to the regular time.

Follow facility policy on how to express midnight.

Both regular and military time list minutes and seconds. The same way

the minutes and seconds do not change

when converting from regular to military time.

For example, to change 4:22 p.m. to military time

add four plus 12.

The time is expressed as

1622

1622 hours

to change from military time to regular time.

Subtract 12.

The minutes do not change.

For example, to change

2200 hours to standard time

subtract 12 from 22.

The result is 10 p.m.

Learning objective nine

explain the minimum data set. M DSS.

The federal government developed a resident assessment system in 1990

has revised it periodically.

It is called the minimum data set. MDS.

The MDS is a detailed form with guidelines for assessing residents.

It also lists what to do if resident problems are identified,

nurses must complete the mds for each resident within 14 days of admission

and again each year.

In addition,

the MDS for each resident must be reviewed every three months.

A new mds must be done when there is any major change in the resident's condition.

NS

contribute to the M DS by reporting

changes in residents promptly and documenting accurately

doing. This means a new mds can be completed when needed

learning objective, 10

discuss incident reports.

An incident

is an accident problem or unexpected event during the course of care.

It is something that is not part of the normal routine.

A mistake in care such as feeding a resident from the wrong meal tray

is an incident,

a resident fall or injury

is another type of incident,

accusations made by residents against staff

as well as employee injuries are other types of incidents.

State and federal guidelines require that incidents

be recorded in an incident report.

An incident report

also called an occurrence, accident

accident incident

or event report

is a report that documents the incident and the response to it.

The information in an incident report is confidential.

It is intended for internal use

to help prevent future incidents.

Incident reports should be filed when any of the following occur.

A resident falls

all falls must be reported

even if the resident says he is fine.

An N A or a resident breaks or damages something.

An N A makes a mistake in care.

A resident or a family member makes a request

that is outside the na's scope of practice,

a resident or a family member makes sexual advances or remarks.

Anything happens that makes an N feel uncomfortable,

threatened or unsafe.

An N A gets injured on the job.

An N A is exposed to blood or body fluids

reporting and documenting incidents is done to protect everyone involved.

This includes the resident, the employer

and the nursing assistant.

N

must report any incident including job related injuries

immediately to the charge nurse.

When documenting incidents,

NS

should complete the report as soon as possible

and give it to the charge nurse.

This is important so that details are not forgotten

if a resident falls and the N A did not see it.

He should not document mister Grant fell

instead

he should document found Mister Grant on the floor

or

Mister Grant states that he fell.

Ns

should write brief and accurate descriptions of the events as they happened.

They should not place blame or liability within the report

guidelines, incident reporting,

tell what happened

state the time and the mental and physical condition of the person

describe the person's reaction to the incident.

State the facts do not give opinions,

do not document on the medical record that an incident report was completed

describe the action taken to give care.

Chapter 1: Lecture (1:26hr)

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