Certified Nursing Assistant Unit I Introduction to Healthcare.

Certified Nursing AssistantCertified Nursing Assistant

Unit IUnit I

Introduction to HealthcareIntroduction to Healthcare

Federal and State Federal and State RegulationsRegulations

OBRA (Omnibus Budget and OBRA (Omnibus Budget and Reconciliation Act) 1987 – identifies Reconciliation Act) 1987 – identifies skills and establishes minimum skills and establishes minimum standardsstandards


Federal law is implemented by state Federal law is implemented by state agencies; States identify standards agencies; States identify standards for all residents of long term care for all residents of long term care facilities; Standards monitored by facilities; Standards monitored by annual survey of the facility.annual survey of the facility.


Individuals taking CNA course must Individuals taking CNA course must complete a background study. If complete a background study. If disqualified, no direct care may be disqualified, no direct care may be given to a resident, client, or patient. given to a resident, client, or patient. The Department of Human Services The Department of Human Services website website http://www.dhs.state.mn.us/licensinghttp://www.dhs.state.mn.us/licensing

has complete information.has complete information.

http://www.dhs.state.mn.us/licensing

Personal Qualifications for Personal Qualifications for Being a Nursing AssistantBeing a Nursing Assistant* Appropriate Behavior** Appropriate Behavior*

Honesty: will not lieHonesty: will not lie Patience: calmPatience: calm Caring: concernCaring: concern Courteous: politeCourteous: polite

Dependable: reliableDependable: reliable Accountable: Accountable:

responsible for one’s responsible for one’s own actionsown actions

Respectful: shows Respectful: shows considerationconsideration

Personal Qualifications for Personal Qualifications for Being a Nursing AssistantBeing a Nursing Assistant* Positive Attitude** Positive Attitude*

Respect yourselfRespect yourself Display dignity toward all individualsDisplay dignity toward all individuals Take pride in what you doTake pride in what you do

Personal Qualifications for Personal Qualifications for Being a Nursing AssistantBeing a Nursing Assistant* Positive Attitude** Positive Attitude*

Demonstrate maturity by controlling Demonstrate maturity by controlling emotions appropriatelyemotions appropriately

Display cooperationDisplay cooperation Practice high standards in your role as a Practice high standards in your role as a

nursing assistantnursing assistant

Personal Qualifications for Personal Qualifications for Being a Nursing AssistantBeing a Nursing Assistant* Personal Health** Personal Health*

Maintain good general healthMaintain good general health Free from back injuryFree from back injury Ability to lift residentsAbility to lift residents


Good personal hygiene: bathe or showerGood personal hygiene: bathe or shower


Clean and neat appearanceClean and neat appearance Clean uniformClean uniform Shoes cleanShoes clean Short clean fingernailsShort clean fingernails No artificial nailsNo artificial nails


Practice stress reducing activitiesPractice stress reducing activities Wear appropriate clothing for the Wear appropriate clothing for the

workplaceworkplace

Productive Work Habits for the Nursing Assistant * CNA Role *

Care performed under direct supervision of a licensed nurse

Male and female nursing assistants care for both male and female residents


Nursing assistants expected to care for any resident in a facility regardless of cultural, personal or ethnic differences


When giving care, must safely:– Follow facility policies and procedures– Work within guidelines of the job description– Provide personal care– Measure vital signs– Be proactive about safety measures– Follow infection control standards– Practice effective communication– Assist with daily living activities


It is NOT appropriate for the CNA to:– Give medications– Take doctor’s orders– Perform sterile procedures– Perform any procedure that the nursing assistant has not

been taught– Perform a task prohibited by the facility

Refer to Handout

Sample Organizational Chart Health Care Team

Productive Work Habits for the Nursing Assistant * Awareness of Organizational Structure of facility *

Organizational chart shows the levels and lines of authority or responsibility in a nursing home

CNA is responsible to the charge nurse who will be RN (registered nurse) or LPN (licensed practical nurse

Productive Work Habits for the Nursing Assistant * Functions of a team *

Focus on providing care to the residents Achieve goals Work together Support each other Coordinate work

Productive Work Habits for the Nursing Assistant * Team-work benefits *

Continuity of care to the resident Higher quality of care to the resident Personal job satisfaction

Productive Work Habits for the Nursing Assistant * Understand process of becoming a CNA *

Acquiring the position of a nursing assistant– Successfully complete CNA course– Pass the Nursing Assistant Competency Test


Correctly complete job application– Some may be done online– Neat– No spelling errors– Be honest– Accurate


Attend job interview– Arrive early– Clean and neat appearance– Positive attitude– Honest answers– Good posture

Refer to Handout

Sample Job Description


Examine the job description– A job description is a detailed list of the tasks and

responsibilities– A list of what is expected of the nursing assistant– Ask questions if the job description is not

understood

Productive Work Habits for the Nursing Assistant * Expectations of Employers *

Focus on the resident Report for work on time Avoid excessive absence from work Be flexible Carefully observe break and meal times

Productive Work Habits for the Nursing Assistant * Expectations of Employers *

If ill, report illness according to facility policy Be free of drugs and alcohol use Prioritize duties Complete in-service education according to

facility requirements, annual requirements of at least 12 hours

Productive Work Habits for the Nursing Assistant * Keep nursing assistant registration current *

Work at least 8 hours every 24 months, performing nursing assistant tasks for a licensed health care provider for pay

Productive Work Habits for the Nursing Assistant * Keep nursing assistant registration current *

Notify Nursing Assistant Registry of a name or address change

Report employment to the Nursing Assistant Registry

Refer to Handout

Rules of Ethics for Nursing Assistants

Personal Values, Ethics & Personal Values, Ethics & EtiquetteEtiquette

Ethics:Ethics: the rules and principles that the rules and principles that assist one to make decisions relating assist one to make decisions relating to what is right and wrongto what is right and wrong


Code of Ethics:Code of Ethics: a formal guideline a formal guideline that governs the behavior of that governs the behavior of caregivers to ensure the welfare of caregivers to ensure the welfare of those individuals in their carethose individuals in their care


*Ethical behaviors in the CNA**Ethical behaviors in the CNA* Promote health, independence, Promote health, independence,

safety and quality of life for each safety and quality of life for each residentresident

Respect the resident’s area as Respect the resident’s area as his/her home by taking care of the his/her home by taking care of the resident’s belongingsresident’s belongings


*Ethical behaviors in the CNA**Ethical behaviors in the CNA* Do not discuss personal problems Do not discuss personal problems

with residents or the resident’s with residents or the resident’s familyfamily

Do not discuss facility issues with the Do not discuss facility issues with the residents and/or resident’s familyresidents and/or resident’s family


*Ethical behaviors in the CNA**Ethical behaviors in the CNA* Do not share or discuss personal Do not share or discuss personal

opinions regarding religious, political, opinions regarding religious, political, or cultural beliefs/customs, living or cultural beliefs/customs, living conditions, or financial situationsconditions, or financial situations


*Ethical behaviors in the CNA**Ethical behaviors in the CNA* Work within the job descriptionWork within the job description Maintain confidentialityMaintain confidentiality Do not accept “tips” for care given to Do not accept “tips” for care given to

a residenta resident


*Ethical behaviors in the CNA**Ethical behaviors in the CNA* Accept responsibility for job Accept responsibility for job

performance and behavior.performance and behavior. Accept constructive criticism and Accept constructive criticism and

suggestions graciously and suggestions graciously and understand that it is a learning understand that it is a learning experienceexperience


*Etiquette = Good Manners**Etiquette = Good Manners* Maintain a polite, courteous and kind Maintain a polite, courteous and kind

attitudeattitude Be respectful in reference to Be respectful in reference to

patients, residents, nurses, doctors, patients, residents, nurses, doctors, family, visitors and co-workers. family, visitors and co-workers. Show respect by using their Show respect by using their preferred name.preferred name.


*Etiquette = Good Manners**Etiquette = Good Manners*

Knock on resident Knock on resident door before door before entering as you entering as you would before would before entering a friend’s entering a friend’s or neighbor’s homeor neighbor’s home



Provide privacy when giving personal Provide privacy when giving personal cares. If it is appropriate, ask friends cares. If it is appropriate, ask friends and family to step outside the roomand family to step outside the room



Work quietly, gently and efficientlyWork quietly, gently and efficiently



Do not whisper Do not whisper outside the outside the resident’s roomresident’s room



Use appropriate Use appropriate language at all language at all timestimes

Personal Values, Ethics & Personal Values, Ethics & EtiquetteEtiquette*Values**Values*

Values are the standards that assist Values are the standards that assist a person in making decisions and a person in making decisions and guiding their behaviorguiding their behavior


Personal values are influenced by:Personal values are influenced by: CultureCulture ReligionReligion EducationEducation RulesRules


Personal values are influenced by:Personal values are influenced by: LanguageLanguage LifestyleLifestyle Belief systemBelief system

Legal Implications for the CNALegal Implications for the CNA

Neglect:Neglect: Failure to provide goods and services Failure to provide goods and services

necessary to avoid physical harm, mental necessary to avoid physical harm, mental anguish, or mental illness anguish, or mental illness

Example: failure to leave the resident’s bed in Example: failure to leave the resident’s bed in low positionlow position

Example: failure to change soiled briefs in a Example: failure to change soiled briefs in a timely mannertimely manner


Liability:Liability: The expected responsibility according to The expected responsibility according to

the lawthe law You are responsible for knowing the You are responsible for knowing the

standards of care and safety as they standards of care and safety as they pertain to your qualificationspertain to your qualifications


Malpractice in health care:Malpractice in health care: Negligence is the basis for malpracticeNegligence is the basis for malpractice Courts will rule if act appears to be Courts will rule if act appears to be

malpracticemalpractice


Nursing assistant responsibility:Nursing assistant responsibility: Perform duties within the training Perform duties within the training

guidelines and job descriptionsguidelines and job descriptions Understand what is legally allowed in Understand what is legally allowed in

those guidelinesthose guidelines

Refer to Handout

Bill of Rights Resident Rights

Nursing Home Resident’sBill of RightsMinnesota Statutes 144.651-144.652

The MN and Federal law provides nursing home residents with the same rights given to all citizens http://health.state.mn.us/divs/fpc/profinfo/ib05_6.html


All members of the health care team must respect the Bill of Rights


Residents’ rights are preserved when the CNA uses skills that maintain and protect the resident’s dignity and basic human rights


Residents have the right to:1. Be informed of their rights

2. Examine Federal or State survey reports

3. Be accorded dignity in his/her personal relationships with staff.


Residents have the right to:4. Be given, in writing, the name, business,

address and telephone number of the physician responsible for their care


Residents have the right to:5. Receive quality care regardless of race,

color, ethnic origin, age, religion, marital status, sexual preference or handicap


Residents have the right to:6. Receive encouragement and support in

making personal choices to accommodate individual needs

7. Be respected and protected from harm, both physically and verbally


Residents have the right to:8. Have continuity of care

9. Refuse treatment

10. Have privacy during procedures and when requested

11. Be addressed by the name preferred


Residents have the right to:12. Be informed about the cost and services

available

13. Have confidentiality maintained regarding his/her medical condition, medical records and other information relating to his/her care


Residents have the right to:14. Be free from non-therapeutic chemical

and physical restraints

15. Wear his/her own clothing, keep appropriate personal possessions, and be allowed to spend his/her own money


Residents have the right to:16. Have his/her family or significant others

participate in care conferences

17. Receive assistance in exercising citizenship rights

18. Have assistance and privacy in personal communications (mail, phone calls, visitors, etc)


Residents have the right to:19. Have personal possessions treated with

respect and safeguarded

20. Be informed in terms that he/she can understand about the complete and current information relating to the diagnosis, treatments, alternatives, risks and prognosis concerning his/her care


Residents have the right to:21. Be informed of the procedures in filing

confidential complaints, resolving grievances and given references of available sources


Residents have the right to:22. Participate in religious or political

activities if these do not infringe on other resident’s rights

23. Organize, maintain and participate in resident and family councils


The Resident’s Bill of Rights must be posted in an easily seen area of the care facility.


A copy of the Resident’s Bill of Rights must be given to all residents or guardian upon admission


Gives right to voice grievances without fear of reprisal When conflicts between residents occur,

maintaining the safety of each resident must be the primary consideration of the healthcare team


Gives right to voice grievances without fear of reprisal Report information regarding resident

conflicts accurately and immediately to the charge nurse. Resolution of conflicts can often be worked out by the skilled nursing and caring staff.


Gives right to voice grievances without fear of reprisal State Ombudsman provides services to

facilities to assist residents and their families to resolve conflicts

Refer to Handout

Vulnerable Adult Law

Vulnerable Adult LawMN Statute 626.557

The MN law which provides for protection of adults considered vulnerable due to physical, mental or emotional impairment


1. Protects adults who, because of disability, are considered vulnerable to abuse or neglect and cannot help themselves

2. Provides for the safe institutions or services for vulnerable adults


3. It is the law to REPORT abuse or neglect or suspicion of abuse or neglect

4. INVESTIGATION of reported situations must occur


5. Includes individuals 18 years of age and older

6. They may live in a licensed facility7. They receive services from a

licensed agency8. Individuals may live in a family

setting but are unable to report abuse or neglect


ABUSE “The willful infliction of injury,

unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish” (42CFR488.301)


THREATENING to harm is also considered abuse

It may be subtle


Forms of Abuse1. “physical abuse”: hitting, slapping,

pinching and kicking2. “mental abuse”: includes, but not

limited to, humiliation, threats of punishment or deprivation


Forms of Abuse3. “verbal abuse”: use of oral, written or

gestured language that willfully includes disparaging and derogatory terms TO residents or their families, or within their hearing distance, regardless of their age, ability to comprehend, or disability


Verbal abuse includes, but is not limited to: threats of harm, saying things to frighten a resident, such as telling a resident that he/she will never be able to see his/her family again


Forms of Abuse4. “sexual abuse”: includes, but is not

limited to, sexual harassment, sexual coercion or sexual assault


Forms of Abuse5. “exploitation”: means the deliberate

misplacement, or wrongful, temporary or permanent use of a resident’s belongings or money without the resident’s consent


Neglect Failure to provide goods and services

necessary to avoid physical harm, mental anguish, or mental illness


Neglect Example: taking a resident to the

bathroom and leaving the person unattended and unsafe


Neglect Providing care but not following care

plan Caregiver may be charged with

negligence


Reporting abuse and neglect Follow policy of the facility as all long

term care staff are mandated reporters, as are also professionals and professional delegates


Reporting abuse and neglect It is the law to report abuse

immediately Confidentiality of the reporter is

protected


Reporting abuse and neglect No reprisal or retaliation to the

reporter if reporting is done in good faith

An intentional failure to report abuse results in a misdemeanor with liability for damages


Responsibility of the healthcare facility

Abuse prevention plan for the facility must be developed for staff and residents


Responsibility of the healthcare facility

A written policy must be established to ensure all cases of abuse or neglect are reported promptly

Incidents of all forms of abuse must be recorded and monitored

Patient Self-Determination Act PSDA (Patient Self-Determination Act) is a

federal law implemented in 1991

Patient Self-Determination Act Requires federally funded health care

facilities to inform residents about their rights to make treatment choices

Patient Self-Determination Act Residents must be asked if they have a living

will or a Durable Power of Attorney for health care.

Institutionalized Care vs.Institutionalized Care vs.Individualized CareIndividualized Care

• Institutionalized careInstitutionalized care– Task orientedTask oriented– DepersonalizedDepersonalized– FragmentedFragmented– One size fits allOne size fits all


• Institutionalized careInstitutionalized care– Schedule drivenSchedule driven

• Nourishments offered at specific timesNourishments offered at specific times• Mealtimes set by the facilityMealtimes set by the facility• Bathing done according to facility policyBathing done according to facility policy• Residents get up and go to bed at specific Residents get up and go to bed at specific

timestimes• Toileting is often at a scheduled timeToileting is often at a scheduled time• Residents expected to adjust to routinesResidents expected to adjust to routines


• Institutionalized careInstitutionalized care– Residents lead boring, lonely and Residents lead boring, lonely and

depressing livesdepressing lives– Staff rotates, caring for different Staff rotates, caring for different

residentsresidents– Direct care staff has little involvement Direct care staff has little involvement

in decision-makingin decision-making


• Individualized (resident-centered) Individualized (resident-centered) carecare– Environment and routine focuses on Environment and routine focuses on

individual resident choices, privacy, individual resident choices, privacy, needs , interests, life-styles, needs , interests, life-styles, preferences, abilities and strengths of preferences, abilities and strengths of residentresident


• Individualized (resident-centered) careIndividualized (resident-centered) care– Caregivers are consistentCaregivers are consistent– Based on idea that nursing homes Based on idea that nursing homes

resemble living in your own homeresemble living in your own home• Food accessible at all timesFood accessible at all times• Meal times determined by resident choiceMeal times determined by resident choice• Residents decide when they wish to batheResidents decide when they wish to bathe• Spontaneous and planned activitiesSpontaneous and planned activities• Resident determines bedtime and rising timeResident determines bedtime and rising time


• Individualized (resident centered) care:Individualized (resident centered) care:– Decision-making is done by the resident Decision-making is done by the resident

and those who work most closely with and those who work most closely with them: residents direct decisions that affect them: residents direct decisions that affect their daily livestheir daily lives

– Direct care workers haveDirect care workers have• More authorityMore authority• Deeper commitment to residentsDeeper commitment to residents• FlexibilityFlexibility• Involvement in care planningInvolvement in care planning


• Terminology used in resident-Terminology used in resident-centered carecentered care– Snacks vs. nourishmentsSnacks vs. nourishments– Home vs. facilityHome vs. facility– Music vs. music therapyMusic vs. music therapy– Family room vs. residents loungeFamily room vs. residents lounge– Pantry vs. nourishment roomPantry vs. nourishment room


• Resident-centered care promotes:Resident-centered care promotes:– Smaller, home-like settingsSmaller, home-like settings– High quality of lifeHigh quality of life– IndividualityIndividuality– PrivacyPrivacy– ChoiceChoice


• Resident-centered care promotes:Resident-centered care promotes:– DignityDignity– RespectRespect– Home-like atmosphereHome-like atmosphere– Independence Independence


• Developing a resident-centered Developing a resident-centered environmentenvironment– Talk to residentsTalk to residents– Talk to family/friendsTalk to family/friends– Ask questionsAsk questions– Learn what dreams or accomplishments Learn what dreams or accomplishments

were left undonewere left undone– Ask about memberships in Ask about memberships in

organizationsorganizations


• Developing a resident-centered Developing a resident-centered environmentenvironment– Look at past historyLook at past history– Involve other staff to help provide Involve other staff to help provide

stimulating environmentstimulating environment– Find solutions to personalizing activities Find solutions to personalizing activities

for the residentsfor the residents– Allow residents to do as much as possible Allow residents to do as much as possible

to promote dignity and self-worthto promote dignity and self-worth


• Nursing assistant responsibilities in Nursing assistant responsibilities in a resident-centered environmenta resident-centered environment– Listen to the residentListen to the resident– Treat residents as adults at all timesTreat residents as adults at all times– Maintain the dignity of the residentMaintain the dignity of the resident– Adapt work schedule to individual Adapt work schedule to individual

resident’s needs resident’s needs


• Nursing assistant responsibilities in Nursing assistant responsibilities in a resident-centered environmenta resident-centered environment– Get involved in decision-makingGet involved in decision-making– Participate in care planningParticipate in care planning– Have a role in housekeeping, meal Have a role in housekeeping, meal

service, and recreationservice, and recreation– Never assume the needs and desires of Never assume the needs and desires of

the resident (ASK them)the resident (ASK them)


• Care plans – designed to enhance Care plans – designed to enhance and increase level of physical, and increase level of physical, mental and psychological well-beingmental and psychological well-being– Interdisciplinary team effortInterdisciplinary team effort– Based on a comprehensive assessmentBased on a comprehensive assessment– Residents have individualized activity Residents have individualized activity

programsprograms


• Care plansCare plans– All facility staff need to be involved in All facility staff need to be involved in

resident-centered activity programsresident-centered activity programs– Staff may participate in activity Staff may participate in activity

program developmentprogram development– Residents should stay as busy as Residents should stay as busy as

possible, doing things they prefer, up to possible, doing things they prefer, up to the level of their own capabilitiesthe level of their own capabilities

Celebrate the End of Unit 1!!!

Certified Nursing Assistant Unit I Introduction to Healthcare.

Documents

Transcript of Certified Nursing Assistant Unit I Introduction to Healthcare.