Handouts- Section 1
PURPOSE OF TCEP
- Prepare NA in LTCF’s to care for residents
- Prepare NA to pass the state test
- Prepare the NA to function as a member of the team
- Make NA aware of the principles of nursing delegation
ROLES AND RESPONSIBILITY
- PI-primary instructor
- PC-program coordinator
- OF THE PI\PC
ú Provide class room & clinical knowledge
ú Follow rules to meet state compliance
ú Provide students with handouts, manuals, training tools
ú Facilitate learning and evaluate competency
ú Attend class
ú Follow program rules
ú Provide care for LTC residents under direct supervision of PC/PI
ú Protect LTC residents
ú Review materials provided
ú Function as a part of the team
PURPOSE OF THE STATE TEST
- Test knowledge gained via written exam
- Test skills via skills demonstration test
After 3 failures, you must retake the class
HOW TO BE RECORDED ON THE NAR
ú Pass both written and clinical examination
ú NA working in a nonfacility based employment must provide proof of working Q2 yrs
ú Name and address changes must be sent in writing to NAR
ú State DOES NOT issue duplicate cards- you must contact testing center
ABUSE, NEGLECT, AND MISAPPROPRIATION
- Abuse-knowingly causing physical harm or recklessly causing serious harm by physical contact with the resident or by use of physical or chemical restraint, medication or isolation as punishment, for staff convenience, excessively, as a substitute for treatment.
- Neglect- recklessly failing to provide resident with any treatment, goods, care, or service necessary that may result in serious harm to the resident.
- Misappropriation- depriving, defrauding, or otherwise obtaining the personal property of the resident for the benefit of staff.
- If an allegation of any of the above
- Investigation
- Removal from schedule
- Reported to state (ODH)
- Consequences
- If allegation of abuse is substantiated, will never be removed from the registry
- Must report immediately
WORK ENVIRONMENT
- NA- important member of team because YOU spend the MOST time with the resident
- Charge nurse-LPN, RN. Your direct report
- Nurse supervisor- usually an RN
- ADON/unit manager-usually RN
- Medical director/CNP-medical doctor,
- DON-always an RN
- Administrator-oversees all operation of facility
ú Dietary, social services, spiritual care team, therapy department, activity department, respiratory department, pharmacist, psychologist, music therapist
ú Ombudsman, surveyors, dogs and other pets
ú Levels of care
ú Acute
ú Sub-acute
ú Long term care
ú Hospice
ú Homecare
ú Assisted living
ú Adult day care
ú Alzheimers/dementia care
ú Mental health care
ú Primary purpose of LTCF of to assist the res achieve and maintain a maximum level of functioning and maintain their sense of individuality
ú Restorative and rehab
ú End of life care
ú Comfort
ú palliative
ROLE OF NURSING ASSISTANT
- Activities of daily living (ADL’s)
ú Dress and undress
ú Bath and maintain hygiene
ú Mobility/Walking
ú Elimination/toilet use
ú Eating and drinking
ú Bed mobility
ú Make Bed
ú Maintain a safe and clean environment
ú Assure each resident receives correct diet
ú Feed or assist the resident
ú Fill the resident’s water pitcher or assist the resident to obtain water and fluids
ú Calculate and record meal percentage on dietary record sheet
ú Assist residents to and from the dining room
- Record keeping and communication
ú Record intake and output
ú Record vital signs
ú Assist in the admissions, discharges, and transfers
ú Document care delivered
ú Report on and off duty
- Confidentiality
- Care of the resident is only to be discussed with appropriate staff in the appropriate facility
- All records are confidential
- Do not discuss residents outside of the facility
- Organizing and prioritizing
- Several call lights going off at same time
- Resident safety
- Proper safety devices in place and functioning
- In-service requirements
- 12 hrs in a 1yr
- Monitored by the facility
- Audited by ODH
Policy and Procedure Manuals
- Policy-what or why the facility does something
- Procedure – how we do it, step by step instructions
- NA is responsible to know where they are
- Follow them
Behavior and Appearance
ú Dependability
Be there, be on time, keep promises, report, completion
ú Accuracy
Follow instructions, document what you see
ú Sensitivity
Respect feelings and needs of others
ú Cooperation
Team work
ú Communicate
Ask for help, report what you see, good shift to shift report
ú Honesty
ú Follow safe work practices
Do what is right when no one is looking
ú Avoid slang phrases
- Keep personal matters away from work
ú Remember that your resident will pick up on your non-verbal
- Reserve cell phone use to break time
ú Your attention will not be on your res if you are talking on the phone in the work area
- Do not use resident belongings for personal use
ú May be considered misappropriation
ú Personal cleanliness
Deodorant, bathe, no strong perfumes
ú Professional uniform
Clean, neat, ironed, dress code
ú Fingernails short, clean, and painted according to facility policy
Not over top of fingertips
ú Hair should be neat and back
ú Jewelry limited
Cover with band aid
ú Facial hair neat and clean beards and mustache
ú Name tag
This is a residents right to know who is caring for them, this is mandatory
Communication and Interpersonal Skills
- Two way process
- Requires sender, receiver, and a message
- Can be oral, written, body language
- NA’s talk with families, residents, visitors, and co-workers
ú Verbal
May be oral not verbal
Tips: control volume, speak slowly, clearly, avoid slang, repeat as needed, position at eye level
ú Nonverbal
More accurately reflects feelings, remember gestures, eye contact, posture, is involuntary & more difficult to control, touch is important!
- Factors that promote good communication
ú Understand res is a person
Respect limitations, accept cultures & religion
ú Provide opportunity to express feelings
Listen and allow time for them to express
ú Observe their non-verbals
Facial expression, body position
ú Listen carefully to expressed feelings and tone of voice
Be an attentive listener
- Encourage focus on res concerns
ú Do not point fingers @ other staff
ú Be responsive to resident needs
- Avoid gossip
- Assist the res with personal communication
ú Writing letters, making phone calls
- Control your emotion
- Develop empathy
- Be courteous
- Be gentle
- Factors that promote good interpersonal skills
ú Kindness, patience, listening, non-interference, confidence
- Factors that block effective comm.
ú Guilt, grief, anger, worry, language, cultural differences, changing subject, interrupting, giving opinion, excessive talking, pat answers, illness, stress
- Factors that promote effective comm.
ú Report information about a res. that may result in harm to them.
ú Report changes in resident behavior or condition
ú Report information about NA that ma affect work performance
ú Report complaints from the families and res.
- Procedures for answering call light
ú Answer promptly
ú Turn off as soon as soon as you are in the rm
ú Complete task for res. Before leaving
- Procedures for answering phone
ú State your location, your name and position, speak slowly, clearly and politely
ú When taking message date, time, your initials, name and return # of caller
ú Only for facility use
ú Do not give info re res out over phone
COMMUNICATING WITH RESIDENTS WITH IMPAIRMENTS
ú Impairment
- § Any loss or abnormality of physiological, psychological, or anatomical structure or function
ú Vision
- § Keep eye glasses clean and with in reach
- § Keep environment clean and clear from clutter
- § Do not re-arrange
- § Put belongings away
- § Introduce self and explain
- § Tell residents when you are leaving and entering the rm
- § Talk to the res not their companions
- § Use proper lighting i.e. night light
- § Position your self in front of the res
- § Use clock positioning when serving meals
- § Keep doors open/shut per res wishes
- § Keep drawers closed
- § Remember that helper pets are working when in the harness
ú Hearing impaired
- § Face the res when talking
- § Shine lights on speakers face not eyes of res
- § Speak in a normal voice without shouting (words spoken slow and clear are better understood than those that are shouted or exaggerated)
- § Keep hands away from face
- § Avoid lengthy sentences and sudden topic changes
- § Turn TV, radio, or other noise source down
- § Use hearing aides and make sure they are in proper placement and batteries are working
- § Stand, sit, or talk into good ear
- § Sit in front of the resident
- § Provide aides such as picture boards, note pads
ú Speech impaired
- § Listen and give the res your FULL attention
- § Ask the res ?’s that you know answers to
- § Watch lips and non-verbals
- § Ask for repeats, and clarification as needed
- § Use aides as needed
- § Dentures may assist with clarity
ú Physical impairments
- § Listen and give res your FULL attention
- § Speak directly to the res
- § Identify the impairment
- § Be patient and allow extra time
- § Be sensitive to non-verbals
- § Avoid giving own non-verbals of impatients, annoyance or dislike
ú Confused (memory impaired)
- § Use simple sentences, one step directions
- § Identify self and call res by name
- § Communicate at eye level
- § Maintain pleasant and calm facial expression as well as body language
- § Touch
- § Use low tone of voice
- § Use aides if needed
- § Respect res feelings
ú Depressed
- § Spend quality time, provide safety, diversion activity
- § Listen, be patient, no pity, make good on promises
ú Restless, agitated, combative
- § Stay calm and use confident tone of voice
- § Be patient, stay neutral- emotions are contagious
- § Be mindful of gestures that startle
- § Maintain safe distance, do not confront or accuse
- § Use pillow to keep you safe
- § Leave in safe and re-approach
ú Non-English speaking
- § Speak slowly and clearly
- § Keep messages short and simple
- § Be alert for words that res may understand
- § Use gestures, pictures, and photo’s
- § Ask for help from family
- § Be patient and calm
- § Avoid using medical terms
- § Be alert for signs that res is pretending to understand
COMPREHENSIVE ASSESSMENT, CARE PLAN, AND CONFERENCES
ú Single source of collection of data about res that assists in planning of care
ú Allows all care givers a place to refer to information to assist in the care of the res
- Purpose of care conferences
ú Res, family, and staff meet to discuss plan
- Role of NA in care planning process
ú You are a member of the team
ú Provides/gathers info that is very helpful for the process
- Role of NA in gathering and documenting
ú May include skin, elimination, mobility, ambulation, mood, ect…
ú Will record and report
ú Accuracy and legibility are very important
- § Correct mistakes correctly
LEGAL RESPONSIBILITY
- Legal aspects of working as a NA
ú All duties of a NA are under the delegation and supervision of a licensed nurse
ú NA is responsible for their own actions
ú Only performs the activities for which they have been trained
ú Also responsible for refusing assignments for which they have not been trained
ú NA is responsible for helping to safeguard a residents possessions
ú NA is responsible for helping to maintain a safe environment
ú NA is responsible to safeguard and respect the residents rights
ú NA cannot give medications, insert/remove tubes, take oral/telephone orders from MD’s
- Abuse – knowingly causing harm to a res
ú Verbal- you stink!
ú Physical-punching, pinching, biting ect…
ú Sexual
ú Mental/psychosocial
ú Involuntary seclusion- time out in room
- Neglect- recklessly failing to provide goods or services that may or may not result in harm
- Misappropriation – theft of res property
- REPORT
- Confidentiality
ú Personal information must be kept private
- Incident and accident reports
ú Internal tool, fill one out with any incident out of the usual i.e. fall, skin tear, review for quality assurance
- Responsibility for your own actions
ú Know the rules, know your responsibility and limitations, follow the rules, report and record observations and your actions
MEDICAL RECORD
ú Chronological record of res care and condition
ú Legal record of nursing care
ú Way for team to communicate
ú May be used in court
ú Observe, report, record, participate
ú Only use accepted abbreviations and terminology
ú Report actions and observations, document promptly, med record is facility property, if you did not document it- it wasn’t done
- General rules for charting and recording
ú Always use ink
ú Include date and time
ú Use conventional time
ú Write neatly and legibly
- General rules for charting and recording
ú Use only agency approved abbreviations
ú Use correct spelling, punctuation, and grammar
ú Never use white out
ú Follow policy for correcting errors
ú Sign with name and title
ú Do not skip lines or spaces between entries
ú Record only what you saw and did
- General rules for charting and recording
ú Never chart prior to completion of a procedure
ú Chart in logical sequential order
ú Use direct quotes in quotation marks
ú Record safety measures
ú Be sure that you are documenting in the correct chart and place in the chart
ú I&O sheets
ú Meal records
ú Restorative records
ú Vital signs and ADL records
ú Bowel and bladder records
ú Some facilities may require and training is done by them
INFECTION CONTROL
- Purpose- to reduce the number of and hinder the transfer of disease causing microorganisms
- Definitions-
ú Microorganism-small organism s that are always present in the environment
ú Pathogen- disease causing microorganisms
ú Disinfection- destroying most “bugs”
ú Sterilization- destroying ALL “bugs”
ú Contamination- presence of “bugs”
ú Nosocomial infection- an infection contracted in a facility
ú E-coli, MRSA, VRE
ú Elderly more susceptible
ú Increases safety of environment
ú Factors that promote growth of microorganisms
ú Food- bacteria need an organic source i.e. flesh, blood, food
ú Moisture- prefer moist place
ú O2- most need o2
ú Temperature- most thrive @ body temp, cold temps only slow growth
ú light – most thrive on darkness
- Factors that promote spread
ú Lack of hand washing
ú Use of artificial nails
ú Direct contact with body fluids- blood, urine, feces, semen, mucous, vaginal secretions, wound drainage
ú Indirect contact- contact with contaminated object
ú Air borne- TB or chicken pox
ú Droplet-cough/sneeze particles in air
ú Vehicle- contaminated food or water
ú Vector - insect bites
- Practices that hinder spread
ú Hand washing, cleaning unit, handle linens properly, disposing of contaminated articles correctly, keeping you, equipment, and res clean
- Reasons for correct hand washing
ú Everything has microorganisms, #1 way to stop the spread of infection
ú Before & after contact with res, food, bathroom use, and after contact with potentially contaminated objects
- Standard precautions- safety measures used for all res and pts-treat all as if infected
- PPE- personal protective equipment
ú Gloves, masks, gown, sharps containers, face shield, goggles, biohazard bags
ú Droplet- wear PPE when coming in contact with
ú Contact - wear PPE when coming in contact with
ú Airborne- usually not in LTCF
ú Reverse- for res protection
- Signs and symptoms of infection
ú Redness
ú Warmth -chills
ú Pain -change in BM/urine
ú Swelling
ú Loss of function or movement
ú Drainage
ú Change in mental status
ú Fever
GENERAL SAFETY PRACTICES AND PROCEDURES
- Reasons for safety precautions for elderly
ú Mental confusion, impaired mobility, diminished senses: sight, hearing, touch, taste
- Precautions NA should know for fall prevention
ú Use non slip foot wear, tie laces
ú Proper lighting
ú Avoid throw rugs
ú Clean up spills promptly
- Precautions NA should know for fall prevention
ú Encourage use of hand rails
ú Use assistive devices
ú Keep walk way clutter free
ú Instruct res to use call light
ú Observe res frequently
ú Use caution with powders, lotions, oils, ect…
ú Answer call light promptly
ú Clean glasses
ú Report defective equipment
- Prevention of falls from bed, w/c, & chairs
ú Lock wheel breaks
ú Use gait belt
ú Caution with tubing
ú Bed to floor when appropriate
ú Assist with eating and drinking
ú Check bath h2o before use, never leave unattended
ú Supervise while smoking
ú Monitor equipment, frayed cords
ú Lock cabinets with chemicals in them
ú Make sure res received proper diet
ú Check with nurse before substituting
ú Appropriate bite size pieces
ú Position res properly
ú Alternate fluids and solids
ú Know the restorative program and utilize it
ú Stop feeding if any problems arise
- Abdominal thrust/ Heimlich maneuver
ú Know signs of choking
ú Do not leave victim
ú Remember hand placement, stand behind, never practice on a person that is not choking
- Prevention from ingestion of harmful substances
ú Caution what is left at bedside
ú Remove Styrofoam and plastic wrap from tray
ú Watch placement of plants
- Measures to take if ingestion occurs
ú Identify substance if possible, notify immediately
- Measures for res protection
ú Elopement-Wandering away from supervised area
- § Always know where the res is, follow P&P when missing, report immediately
ú Stairwells
- § Keep closed at all times, know where they are and when to use
ú Use of alarms
- § Facility wide alarms, fire, tornado, personal
- § INVESTIGATE!!!!
SAFETY FOR OXYGEN EQUIPMENT USE
ú Cannula, mask, trach mask, wall unit, O2 tank, concentrator, cylinder
ú Sign posted out side of room
ú No smoking or open flame near O2
ú Grounded electrical equipment
ú Avoid use of electric razors
ú Do not use equipment with frayed cords
ú Avoid static electricity
ú Follow P&P on transporting
- Conditions that could jeopardize use and application of O2
ú Security of container(not in rack)
ú Condition of the fittings
ú Pressure gauge
- Role limits of the STNA and O2 setup
ú Report repair needs to the nurse immediately
ú Report to charge nurse if a resident is operating his/her O2 equipment improperly
ú Be aware that tubing can be a fall and strangulation risk
ú NURSE adjusts settings for liter flow, however, the NA my observe for accuracy
FIRE PREVENTION AND PROCEDURES TO FOLLOW IN CASE OF FIRE DISASTER
ú smoking and inappropriate use of matches or lighters
ú Misuse of electricity
ú Incorrect disposal of trash
ú Improper storage of flammable materials
- Measures to prevent fires
ú Caused by smoking
- § Enforce smoking rules and areas
- § Use large deep ash trays
- § Empty them only in designated fire proof containers
- § Supervise all residents while smoking
ú Caused by electricity
- § Unplug label “out of service” report to maintenance and nurse
- § Never use defective outlet, frayed cords, extension cords
- § Never overload outlet
- § Never switch electric razor on/off
- § Report all problems
- Measures to prevent fires
ú Caused by O2 use
- § No open flame in room with O2
- § Caution with sparks
- § Electrical safety measures must be observed
ú Other safety measures
- § Keep equipment on one side of the hall
- § Keep all exit doors clear
- § Participate it fire drills
- Actions to take when fire is discovered
ú Follow emergency plan
- § Know floor plan, exit route, location of pull alarms and extinguishers, how to report fire, your role
ú R.A.C.E.
ú Never use elevators during alarm
ú Leave lights on
ú Clear halls
ú Evacuate ambulatory res first
- Examples of unsafe conditions
ú Blocked hallways and exit doors, blocked fire doors, smoking in non-designated area, using frayed cords, unexplained smoke or fire
- Devices used when fire occurs
ú Pull box, sprinkler, smoke detector, fire alarm, fire doors, fire extinguishers
P.A.S.S
NATURAL DISASTER
ú Conditions are favorable for one to happen
ú One has been sited
ú All facilities have back up generator, red outlets
ú Remain calm, reassure res, follow directions, connect needed equipment to red outlets
PRINCIPLES OF ERGONOMICS, BODY MECHANICS AND BODY ALIGNMENT
ú Definition- adapting the environment using techniques and equipment to prevent injury
ú Shared responsibility between employee and employer
ú Body movements by the staff when moving residents and objects
ú Purpose is to make the most of strength and avoid fatigue and injury
- General rules of good body mechanics
ú Use as many large muscles as poss, keep load between shoulders, use both hands rather than 1
ú Stand erect
ú Feet apart
ú Keep close
ú Push, pull, roll when poss
ú Work in the direction of your efforts, avoid twisting
ú Get help when needed
ú Use 2 people when res can’t assist you
ú Lift smoothly to avoid strain, count 1, 2, 3
ú Pivot and turn whole body when changing direction
ú Use mechanical lift and other devices per facility policy and manufacturers guidelines
- Lifting and moving the resident
ú Explain procedure
ú Protect res privacy
ú Protect all tubing
ú Give most support to heaviest part of body
ú Hold res close to you
ú Use smooth steady movements
ú Lock wheels of beds and w/c
ú Use draw sheet/gait belt
ú Head erect, spinal column in normal alignment
ú Limbs positioned in accordance to res pos
ú Feet in walking position, not slanted forward
ú Wrists not flexed or extended, fingers slightly flexed, hips in line with thighs
ú Comfort, no strain placed on joints, muscles and body tissue, prevents contractures and breakdown, sense of well-being
ALTERNATIVES TO RESTRAINTS AND SAFE RESTRAINT USE
ú Diversional activities(TV, radio)
ú Family/friend/companion visits
ú Positioning aids (pillow)
ú Back message, aromatherapy
ú Exercise, outdoor time
ú Food, fluid, and elimination needs
ú Move closer to nurses station
ú Calendars and clocks
ú Pictures
ú Consistent staff assignments
ú Promote jobs and tasks res appropriate
ú Call light within reach
ú Warning devices on
ú Allow wandering
ú Good lighting
ú Residents have the right to be restraint free and is the expectation of ODH that no resident will ever be restrained as a means of punishment
ú May be appropriate for the safe protection of the resident to prevent injuries
ú Are used as a last resort
ú Applied only at discretion of nurse with order
ú Always follow manufacturers instructions
ú Allow as much movement as possible
ú Check respiratory and circulation function
ú Pad boney prominences
ú Maintain good body alignment
- Observations that need to be reported
ú Circulation to extremities
- § Pallor, blueness, cold, tingling, pain, diminished pulses
ú Respiratory status
- § Blue lips and nails, difficulty breathing
ú If present must be loosened immediately
ú Check QH
ú Release Q2H-exercise, ambulate, offer toileting and nourishment
ú Reinforce safety
ú Full bed rails or bed against the wall
ú Partial side rails
ú Trunk
- § Vest, waist, belts used in w/c
ú Limb
ú Chair that prevents rising
- § Lap board, recliner, meri walker
