Chapter 2: The Nursing Assistant Pages14-30 Health Tech Prep 1 Lancaster High School Shelly...

Chapter 2: The Nursing AssistantChapter 2: The Nursing AssistantPages14-30Pages14-30

HealthHealth Tech Prep 1Tech Prep 1Lancaster High School Lancaster High School

Shelly CarpenterShelly Carpenter

ObjectivesObjectives Define the key terms listed in this chapterDefine the key terms listed in this chapter Explain the history and current trends affecting nursing assistantsExplain the history and current trends affecting nursing assistants Explain the laws that affect nursing assistantsExplain the laws that affect nursing assistants Explain what nursing assistants can do and their role limitsExplain what nursing assistants can do and their role limits Explain why you need a job descriptionExplain why you need a job description Describe the educational requirements for nursing assistantsDescribe the educational requirements for nursing assistants

The Nursing AssistantThe Nursing Assistant

Federal and state laws and agency policies combine to define the Federal and state laws and agency policies combine to define the roles and functions of each health team member.roles and functions of each health team member.

As NA You need to know:As NA You need to know:1. What you can and cannot do1. What you can and cannot do2. What is right and wrong conduct2. What is right and wrong conduct3. Your legal limits3. Your legal limits

-determined by-determined by1.Laws-local, state, and federal1.Laws-local, state, and federal2. Job descriptions-lists tasks expected of you on the job 2. Job descriptions-lists tasks expected of you on the job

sitesite3. The patients condition3. The patients condition4. supervision you need4. supervision you need

Protecting persons from harm involves a complex set of rules andProtecting persons from harm involves a complex set of rules andstandards of conduct that form the legal and ethical aspects of care.standards of conduct that form the legal and ethical aspects of care.

HISTORY AND CURRENT TRENDSHISTORY AND CURRENT TRENDS

nursing assistants have helped nurses nursing assistants have helped nurses with basic nursing care.with basic nursing care.

Until the 1980s, training was not required Until the 1980s, training was not required by law.by law.

RNs gave on-the-job training.RNs gave on-the-job training. Some facilities offered nursing assistant Some facilities offered nursing assistant

courses courses

Home careHome care

-increased during the 1980s.-increased during the 1980s.

1. Hospital stays are limited.1. Hospital stays are limited.

2. Patients are discharged earlier 2. Patients are discharged earlier

3. Patients often still quite ill.3. Patients often still quite ill.

Reducing Health Care CostsReducing Health Care Costs

Efforts to reduce health care costs include:Efforts to reduce health care costs include:– Hospital closingsHospital closings– Hospital mergersHospital mergers– Health care systemsHealth care systems– Managed careManaged care– Staffing mixStaffing mix

** Most hospitals require a state-approved ** Most hospitals require a state-approved nursing assistant training program for nursing assistant training program for employment of nursing assistants.employment of nursing assistants.

STATE AND FEDERAL LAWSSTATE AND FEDERAL LAWS

Tasks performed by nursing assistants Vary from state Tasks performed by nursing assistants Vary from state to state and among and within agenciesto state and among and within agencies

State nurse practice acts and the Omnibus Budget State nurse practice acts and the Omnibus Budget Reconciliation Act of 1987 (OBRA) provide direction.Reconciliation Act of 1987 (OBRA) provide direction.

Nurse practice actsNurse practice acts– Each state has a nurse practice act to regulate nursing Each state has a nurse practice act to regulate nursing

practicepractice– purposepurpose

Defines RN and LPN/LVNDefines RN and LPN/LVN Describes the scope of practice for RNs and LPNs/LVNsDescribes the scope of practice for RNs and LPNs/LVNs Describes education and licensing requirements for RNs and Describes education and licensing requirements for RNs and

LPNs/LVNsLPNs/LVNs Protects the public from persons practicing nursing without a Protects the public from persons practicing nursing without a

licenselicense

Nurse Practice Act-cont’Nurse Practice Act-cont’ Allows for revoking or suspending a nurse’s license due toAllows for revoking or suspending a nurse’s license due to

– Being convicted of a crime in any stateBeing convicted of a crime in any state– Selling or distributing drugsSelling or distributing drugs– Using the person’s drugs for oneselfUsing the person’s drugs for oneself– Placing a person in danger from use of alcohol or drugsPlacing a person in danger from use of alcohol or drugs– Demonstrating grossly negligent nursing practiceDemonstrating grossly negligent nursing practice– Being convicted of abuse or neglect of children or elderlyBeing convicted of abuse or neglect of children or elderly– Violating the nurse practice act Violating the nurse practice act – Demonstrating incompetent behaviorsDemonstrating incompetent behaviors– Aiding or assisting another person to violate the nurse practice actAiding or assisting another person to violate the nurse practice act– Making medical diagnosesMaking medical diagnoses– Prescribing drugs and treatmentsPrescribing drugs and treatments

A state’s nurse practice act is also used to decide what nursingA state’s nurse practice act is also used to decide what nursing assistants can do.assistants can do.

The Omnibus Reconciliation Act of 1987 The Omnibus Reconciliation Act of 1987 (OBRA)(OBRA)

OBRA applies to all 50 states.OBRA applies to all 50 states. purpose of OBRApurpose of OBRA1. improve the quality of life of nursing center residents.1. improve the quality of life of nursing center residents.2. Set minimum training and competency evaluation 2. Set minimum training and competency evaluation

requirements for narequirements for na3. Requires each state to have a NATCEP3. Requires each state to have a NATCEP4. home care requirements for many states.4. home care requirements for many states.*** If the agency receives Medicare funds, workers must *** If the agency receives Medicare funds, workers must

meet OBRA’s requirements***meet OBRA’s requirements***

OBRA-The training programOBRA-The training program requires at least 75 hours of instruction/16 practical trainingrequires at least 75 hours of instruction/16 practical training A nurse supervises this practical training.A nurse supervises this practical training. Specific Areas of study Specific Areas of study

CommunicationCommunication Infection controlInfection control Safety and emergency proceduresSafety and emergency procedures Resident rightsResident rights Basic nursing skillsBasic nursing skills Personal care skillsPersonal care skills Feeding methodsFeeding methods Elimination proceduresElimination procedures Skin careSkin care Transferring, positioning, and turning methodsTransferring, positioning, and turning methods DressingDressing Ambulating the personAmbulating the person Range-of-motion exercisesRange-of-motion exercises Signs and symptoms of common diseasesSigns and symptoms of common diseases How to care for cognitively impaired personsHow to care for cognitively impaired persons

OBRA-the testOBRA-the test

A written test and a skills test are included.A written test and a skills test are included. multiple-choice questions -the number of varies multiple-choice questions -the number of varies The skills test involves performing nursing skills.The skills test involves performing nursing skills.

You take the competency evaluation after your training You take the competency evaluation after your training program.program.

See Appendix A on page 821 in the textbook.See Appendix A on page 821 in the textbook. OBRA allows at least three attempts to OBRA allows at least three attempts to

successfully complete the evaluation.successfully complete the evaluation. Nursing assistant registry.Nursing assistant registry.

Nursing Assistant RegistryNursing Assistant Registry

nursing assistant registry nursing assistant registry – required by OBRArequired by OBRA– has information about each nursing assistant,has information about each nursing assistant,

(1) Full name, including maiden name and any married names(1) Full name, including maiden name and any married names(2) Last known home address(2) Last known home address(3) Registration number and its expiration date(3) Registration number and its expiration date(4) Date of birth(4) Date of birth(5) Last known employer, date hired, and date employment ended(5) Last known employer, date hired, and date employment ended(6) Date the competency evaluation was passed(6) Date the competency evaluation was passed(7) Information about findings of abuse, neglect, or dishonest use of (7) Information about findings of abuse, neglect, or dishonest use of propertyproperty

Nursing Assistant RegistryNursing Assistant Registry

information stays in the registry for at least 5 information stays in the registry for at least 5 years.years.

Any agency can access registry information.Any agency can access registry information. a copy of your registry information to correct a copy of your registry information to correct

wrong information.wrong information. Other OBRA requirementsOther OBRA requirements

– Retraining and a new competency evaluation Retraining and a new competency evaluation program are program are required for nursing assistants who required for nursing assistants who have not worked for 2 consecutive years as a have not worked for 2 consecutive years as a nursing assistant.nursing assistant.

– Regular in-service educationRegular in-service education– performance reviews while on the jobperformance reviews while on the job

Other OBRA RequirementsOther OBRA Requirements

Must work one 8 hour shift within 2 years to Must work one 8 hour shift within 2 years to keep on the registry.keep on the registry.

Can requireCan require– New competency evaluation (retesting)New competency evaluation (retesting)– Retraining and new testingRetraining and new testing

Working in Another StateWorking in Another State

EdorsementEdorsement ReciprocityReciprocity EquivalencyEquivalency

ROLES AND RESPONSIBILITIESROLES AND RESPONSIBILITIES

Directed byDirected by– Nurse practice actsNurse practice acts– OBRAOBRA– state lawsstate laws– legal and advisory opinions legal and advisory opinions

To protect persons from harm, you must understand:To protect persons from harm, you must understand:– What you can doWhat you can do– What you cannot doWhat you cannot do– The legal limits of your roleThe legal limits of your role

In some states, this is called scope of practiceIn some states, this is called scope of practice..


functions and responsibilities vary among functions and responsibilities vary among states and agencies. states and agencies.

Before you perform a procedure, make sure Before you perform a procedure, make sure that:that:– Your state allows nursing assistants to perform the Your state allows nursing assistants to perform the

procedure.procedure.– The procedure is in your job description.The procedure is in your job description.– You have the necessary training and education.You have the necessary training and education.– A nurse is available to answer questions and to A nurse is available to answer questions and to

supervise you.supervise you.


Perform tasks and procedures that Perform tasks and procedures that 1.1. meet hygiene, safety, comfort,meet hygiene, safety, comfort,2.2. nutrition, exercise, and elimination needsnutrition, exercise, and elimination needs3.3. Lift and move personsLift and move persons4.4. Collect specimensCollect specimens5.5. Observe the personObserve the person6.6. includes measuring temperatures, pulses, includes measuring temperatures, pulses,

respirations, and blood pressures.respirations, and blood pressures.7.7. Assist with admitting and discharging patients and Assist with admitting and discharging patients and

residentsresidents8.8. Promote psychological comfortPromote psychological comfort

Roles and Responsibilities Roles and Responsibilities in Home Carein Home Care

Services may include:Services may include:

(1) Laundry(1) Laundry

(2) Shopping for groceries and household (2) Shopping for groceries and household itemsitems

(3) Preparing and serving meals(3) Preparing and serving meals

(4) Light housekeeping(4) Light housekeeping

Job descriptionJob description

job descriptions reflect state laws and job descriptions reflect state laws and rules.rules.

is a list of responsibilities and functions is a list of responsibilities and functions that the agency expects you to performthat the agency expects you to perform

must know what you can do in the state must know what you can do in the state in which you are working.in which you are working.

JOB DESCRIPTION-CON’TJOB DESCRIPTION-CON’T

Do not take a job that:Do not take a job that:– Causes you to Act beyond the legal limits of Causes you to Act beyond the legal limits of

your roleyour role– Function beyond your training limitsFunction beyond your training limits– Perform acts that are against your morals or Perform acts that are against your morals or

religionreligion

WORKBOOKWORKBOOK#1-35, 44, 45, 48#1-35, 44, 45, 48

CHAPTER 3CHAPTER 3

OBJECTIVESOBJECTIVES

Explain how to prevent negligent actsExplain how to prevent negligent acts Give examples of false imprisonment, Give examples of false imprisonment,

defamation, assault, battery, and frauddefamation, assault, battery, and fraud Describe how to protect the right to privacyDescribe how to protect the right to privacy Explain the purpose of informed consentExplain the purpose of informed consent Explain your role in relation to willsExplain your role in relation to wills Describe child, elder, and domestic abuseDescribe child, elder, and domestic abuse

ETHICAL ASPECTSETHICAL ASPECTS

Ethical behavior involves not being prejudiced Ethical behavior involves not being prejudiced or biased. or biased.

make judgments and have views before make judgments and have views before knowing the facts.knowing the facts.

Judgments and views are based on the Judgments and views are based on the person’sperson’s

CultureCulture ReligionReligion EducationEducation experiences.experiences.

THINK ABOUT ITTHINK ABOUT IT

How can prejudices or biases affect the care How can prejudices or biases affect the care YOU provide?YOU provide?

How can YOU deal with YOUR prejudices How can YOU deal with YOUR prejudices and biases when providing care?and biases when providing care?

LEGAL ASPECTSLEGAL ASPECTS

Laws tell you what you can and cannot Laws tell you what you can and cannot do.do.

A law is a rule of conduct made by a A law is a rule of conduct made by a government body.government body.

Enforced by the government, laws Enforced by the government, laws protect the public welfare.protect the public welfare.


Criminal laws are concerned with offenses Criminal laws are concerned with offenses against the public and against society in against the public and against society in general.general.

An act that violates a criminal law is called a An act that violates a criminal law is called a crime.crime.– MurderMurder– RobberyRobbery– Assault and batteryAssault and battery


Civil laws are concerned with relationships Civil laws are concerned with relationships between people.between people.

TortsTorts– Torts are part of civil law.Torts are part of civil law.– wrong committed against a person or the wrong committed against a person or the

person’s property.person’s property.


Unintentional tortsUnintentional torts– Negligence Negligence

The negligent person failed to act in a reasonable The negligent person failed to act in a reasonable and careful manner.and careful manner.

harm was caused to the person or property of harm was caused to the person or property of another.another.

The person did not mean or intend to cause harm.The person did not mean or intend to cause harm.

– Malpractice Malpractice negligence by a professional person professional negligence by a professional person professional

status because of training, education, and the service status because of training, education, and the service provided.provided.


Intentional TortIntentional Tort– DefamationDefamation

injuring a person’s name or reputation byinjuring a person’s name or reputation by

making false statements to a third person.making false statements to a third person.

– Libel Libel making false statements in print, writing, or through making false statements in print, writing, or through

pictures or drawings.pictures or drawings.

– Slander Slander making false statements orally making false statements orally


Intentional Tort –con’tIntentional Tort –con’t– False imprisonmentFalse imprisonment

the unlawful restraint or restriction of a person’s the unlawful restraint or restriction of a person’s freedom of movement.freedom of movement.

involves:involves:– Threatening to restrain a personThreatening to restrain a person– Restraining a personRestraining a person– Preventing a person from leaving the agencyPreventing a person from leaving the agency


Intentional Tort –con’t Intentional Tort –con’t – Invasion of privacy Invasion of privacy

violating a person’s right not to have his or her name, violating a person’s right not to have his or her name, picture, or private affairs exposed or made public picture, or private affairs exposed or made public without giving consent. without giving consent.

The Health Insurance Portability and AccountabilityThe Health Insurance Portability and Accountability

Act of 1996 (HIPAA)Act of 1996 (HIPAA)protects the privacy and security of a patient’s health protects the privacy and security of a patient’s health

information.information.You must follow agency policies and procedures. You must follow agency policies and procedures.


Intentional Tort –con’tIntentional Tort –con’t Fraud Fraud

– saying or doing something to trick, fool, or saying or doing something to trick, fool, or deceivedeceive

a person.a person.

-is fraud if it does or may cause harm to a person -is fraud if it does or may cause harm to a person or the person’s property.or the person’s property.


Intentional Tort –con’tIntentional Tort –con’t– Assault and battery Assault and battery

may result in both civil and criminal charges.may result in both civil and criminal charges. Assault Assault

– intentionally attempting or threatening to touch a person’s body intentionally attempting or threatening to touch a person’s body without the person’s consent. without the person’s consent.

BatteryBattery– touching a person’s body without his or her consent.touching a person’s body without his or her consent.

The person must consent to any procedure,The person must consent to any procedure,treatment, or other act that involves touching thetreatment, or other act that involves touching thebody.body.

Informed consentInformed consent

the person clearly understands:the person clearly understands:– The reason for a treatmentThe reason for a treatment– What will be doneWhat will be done– How it will be doneHow it will be done– Who will do itWho will do it– The expected outcomesThe expected outcomes– Other treatment optionsOther treatment options– The effects of not having the treatmentThe effects of not having the treatment

****Persons under legal age and mentally incompetent ****Persons under legal age and mentally incompetent persons cannot give consent.persons cannot give consent.

Informed ConsentInformed Consent

the person clearly understands:the person clearly understands:– The reason for a treatmentThe reason for a treatment– What will be doneWhat will be done– How it will be doneHow it will be done– Who will do itWho will do it– The expected outcomesThe expected outcomes– Other treatment optionsOther treatment options– The effects of not having the treatmentThe effects of not having the treatment

****Persons under legal age and mentally incompetent ****Persons under legal age and mentally incompetent persons cannot give consent.persons cannot give consent.

REPORTING ABUSEREPORTING ABUSE AbuseAbuse

mistreatment or harm of another person.mistreatment or harm of another person.

Abuse is a crime.Abuse is a crime. one or more of the following elements presentone or more of the following elements present

– Willful causing of injuryWillful causing of injury– Unreasonable confinementUnreasonable confinement– IntimidationIntimidation– PunishmentPunishment– Depriving the person of goods or services needed Depriving the person of goods or services needed

for physical, mental, or psychosocial well beingfor physical, mental, or psychosocial well being

Reporting AbuseReporting Abuse

Abuse causes physical harm, pain, or Abuse causes physical harm, pain, or mental anguish mental anguish

Protection against abuse extends to Protection against abuse extends to persons in a coma persons in a coma

REPORTING ABUSEREPORTING ABUSE

Elder abuseElder abuse Elder abuse can take the following formsElder abuse can take the following forms Physical abusePhysical abuse

(1) Grabbing, hitting, slapping, kicking, (1) Grabbing, hitting, slapping, kicking, pinching, hairpulling, or beatingpinching, hairpulling, or beating

(2) Corporal punishment(2) Corporal punishment– Punishment inflicted directly on the bodyPunishment inflicted directly on the body


Neglect Neglect – The person is deprived of needed health The person is deprived of needed health

care or treatment.care or treatment.– Failure to provide food, clothing, hygiene, Failure to provide food, clothing, hygiene,

and other needsand other needs


Verbal abuseVerbal abuse– Using oral or written words or statements Using oral or written words or statements

that speak badly of, sneer at, criticize, or that speak badly of, sneer at, criticize, or condemn the personcondemn the person

– Unkind gesturesUnkind gestures

Involuntary seclusionInvoluntary seclusion– Confining the person to a certain areaConfining the person to a certain area


Financial abuseFinancial abuse– The person’s money is stolen or used by The person’s money is stolen or used by

another person.another person.– A person’s property is misused.A person’s property is misused.

Mental abuseMental abuse– Humiliation, harassment, ridicule, and Humiliation, harassment, ridicule, and

threats of punishmentthreats of punishment

SIGNS OF ABUSESIGNS OF ABUSE

Box 2-7 on page 28 Box 2-7 on page 28

Child abuseChild abuse

Risk factors for child abuse include:Risk factors for child abuse include: StressStress Family crisisFamily crisis Drug or alcohol abuseDrug or alcohol abuse Abuser history of being abused as a childAbuser history of being abused as a child Discipline beliefs that include physical punishmentDiscipline beliefs that include physical punishment Lack of emotional attachment to the childLack of emotional attachment to the child A child with birth defects or chronic illnessA child with birth defects or chronic illness A child with a personality or behaviors that the abuser A child with a personality or behaviors that the abuser

considers “different” or unacceptableconsiders “different” or unacceptable Unrealistic expectations for the child’s behavior or Unrealistic expectations for the child’s behavior or

performanceperformance Families that move often and do not have other family Families that move often and do not have other family

members or friends nearbymembers or friends nearby

ABUSEABUSE

Abuse differs from neglect.Abuse differs from neglect. Types of child abuseTypes of child abuse

– Physical neglectPhysical neglect to deprive the child of food, clothing, shelter, and medical care.to deprive the child of food, clothing, shelter, and medical care.

– Emotional neglectEmotional neglect not meeting the child’s need for affection and attention.not meeting the child’s need for affection and attention.

– Physical abuse Physical abuse injuring the child on purpose.injuring the child on purpose.

– Sexual abuse Sexual abuse using, persuading, or forcing a child to engage in sexual using, persuading, or forcing a child to engage in sexual

conduct.conduct.

ABUSEABUSE

– Rape Rape forced sexual intercourse with a person who is not of legal forced sexual intercourse with a person who is not of legal

age to give consent.age to give consent.

– MolestationMolestation sexual advances toward a child.sexual advances toward a child.

– Incest Incest sexual activity between family members.sexual activity between family members.

– Child pornography Child pornography taking pictures or video taping a child involved in sexual taking pictures or video taping a child involved in sexual

acts.acts.

– Child prostitution Child prostitution forcing a child to engage in sexual activity for moneyforcing a child to engage in sexual activity for money..

ABUSEABUSE

The health team must be alert for signs The health team must be alert for signs and symptoms of child abuse.and symptoms of child abuse.

State laws require the reporting of State laws require the reporting of suspected child abuse.suspected child abuse.

If you suspect child abuse, share your If you suspect child abuse, share your concerns with the RN.concerns with the RN.

The RN contacts health team members The RN contacts health team members and child protection agencies as needed.and child protection agencies as needed.

ASSIGNMENT:ASSIGNMENT:WORKBOOK WORKBOOK

#1-81#1-81

Chapter 2: The Nursing Assistant Pages14-30 Health Tech Prep 1 Lancaster High School Shelly...

Documents

Transcript of Chapter 2: The Nursing Assistant Pages14-30 Health Tech Prep 1 Lancaster High School Shelly...