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Nursing Assistant Course


Title: Long Term Care Nursing Assistant/ Home Health Aide Course Author: Continuing Education Created Date: 7/23/2002 3:39:47 PM Document presentation format – PowerPoint PPT presentation

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Title: Nursing Assistant Course

Nursing Assistant Course
  • Upon completion of this course, students are
    eligible for the Minnesota Nursing Assistant
    Competency Exam.
  • Completion of course includes completion of 18
    hours clinical experience.

Unit One
  • Introduction to Nursing Assistant/ Home Health

Upon Completion of this Unit Students will
  • List personal qualifications of a Nursing
  • Discuss Productive work Habits for NARs
  • Describe how federal and State regulations are
    related to Nursing Assistant Responsibilities

Objectives for unit one
  • Define Ethics and Etiquette for the Nursing
  • Describe the Residents Bill of Rights
  • Describe the Vulnerable Adult Law
  • Describe Patient Self- Determination Act
  • Discuss legal implications for the NARs
  • Describe the need for individualized care
    compared to institutionalized care.

List Personal Qualifications of Nursing Assistants
  • Behavior
  • Honest - will not lie
  • Patient- self controlled
  • Caring- feel concern
  • Courteous - polite/respectful
  • Dependable - reliable
  • Sensitive - responsive
  • Accountable for actions/manage assignments

  • Positive Attitude
  • of respect and dignity towards individuals
  • of pride in what you do
  • of maturity/ control your own emotions
  • of cooperation and team work
  • of practicing high standards

  • Personal Health
  • good general health
  • free from back injury or problems with lifting
  • good personal hygiene, grooming
  • clean neat appearance
  • practice stress reducing exercises

  • The Role of the nursing assistant is to provide
    or assist with personal care for residents under
    direct supervision of the licensed nurse
  • Male and female nursing assistants care for both
    male and female residents
  • Nursing assistants are expected to care for any
    resident in a facility

Define Organizational Chart
  • A diagram showing levels and lines of authority
    in a long term care facility
  • Line of responsibility include the nursing
    assistant being responsible to the charge nurse
    who may be an LPN or RN.

Team work Concept
  • The goal is to provide the best care for the
    residents with cooperation of the entire staff of
    the facility
  • The NAR is usually assigned to a specific group
    of residents to provide continuity of care

Describe Responsibilities of NARs
  • Getting the job
  • Must complete NAR course
  • Must pass competency exam
  • Complete interview process including criminal
    background check.

Examining a job description
  • A job description is a detailed listing of tasks
    and responsibilities expected of the nursing
  • Review copy

Responsibilities include job limitations
  • DO
  • provide personal care
  • measure vital signs
  • practice safety measures
  • practice infection control measures
  • practice effective communications
  • assist residents with ADLs
  • DO NOT
  • give medications
  • take doctors orders
  • perform procedures requiring sterile technique
  • perform procedures not taught
  • perform tasks prohibited by facility

Keeping your NAR job
  • Keep nursing assistant registration current
  • work at least 8 hours in a long term care
    facility every two years providing nursing or
    nursing related services for compensation.
  • Complete continuing inservice education, a
    minimum of 12 hours per year.
  • Practice attribute listed in personal

  • Focus on resident
  • Be on time
  • Be flexible
  • Avoid absences
  • No drug or alcohol use
  • Prioritize duties

Describe team approach in Health care
  • Nursing Assistants work with other staff members
    to provide a team approach in caring for the
    resident. All work together, support each other
    to achieve resident goals.

Members of the Team
  • Resident
  • nursing assistant
  • licensed nurses
  • activity staff
  • occupational therapist
  • physical therapist
  • housekeeping staff

Team members
  • Licensed social workers
  • family
  • clergy
  • doctor
  • volunteers
  • laundry staff
  • maintenance staff

Describe the purpose of Resident care Plans
  • The Care Plan
  • Is a written plan designed for each resident
  • Is developed in a care conference where the
    resident and family is invited to participate.
    The care plan is reviewed and updated
  • Has long and short term goals defined and who is
    responsible for goal implementation.

  • The Nursing Assistant is responsible to know the
    content of the care plan. If you have difficulty
    understanding anything in the care plan, its
    YOUR responsibility to ask the charge nurse.

Observation Skills Required
  • Use all your senses when observing the residents
  • Listen to what the residents says
  • Look - observe residents skin, movements and
  • feel the residents skin for warmth and texture
  • Smell -changes in odor

Its YOUR Responsibility to
  • Report accurately
  • Record information per facility policy
  • Review copy of Care plan/ assignment

Federal and State Regulations related to Nursing
  • OBRA 87 - In 1987 the Federal government passed a
    law called the Omnibus Reconciliation Act, which
    regulates the education and registration of
    Nursing Assistants.
  • Federal Law also regulates care of residents in
    long term care. Standards are monitored by an
    annual survey process.

Ethics vs Etiquette
  • Ethics is a moral code (knowing right/ wrong)
    which guides the behavior of health care workers.
    An ethical worker is one who
  • Promotes health, independence, safety and quality
    of life for each resident.
  • Respects the residents area as his/her home.
  • Does not discuss personal problems with resident
    and family

The Ethical worker
  • Does not discuss facility issues with resident
    and family.
  • Does not share or discuss own personal opinions
    regarding religious, political, cultural beliefs
    or customs, or living or financial conditions.
  • Works within job description, know limitations of
    job and self, seeks help, advice and
    clarification when needed

The Ethical worker
  • Maintains confidentiality
  • Accepts no tips for service to the resident
  • Accepts responsibility for job and own behavior
    and is willing to accept constructive criticism
    and suggestions graciously

Etiquette is
  • Good manners and maintaining a polite, courteous,
    kind attitude to resident, visitors, and other
  • Practice the Golden Rule. Do for others as you
    would want done for you.
  • Address others by preferred name.
  • Knock on residents door before entering.
  • Close door and privacy curtain.

  • Ask family and visitors to leave when giving
    personal care.
  • Work quietly. Avoid unnecessary noise.
  • Use respectful/appropriate language
  • Never whisper outside a patients room.

  • The standards that assist one to make decisions
    and guide ones behavior
  • Personal values include
  • Culture, religion, education, rules, language,
    lifestyle, belief systems.

Legal implications for Nursing
  • Neglect Failure to provide goods and services
    necessary to avoid physical or mental harm.
  • Example Failure to residents bed in low
  • Liability Responsibilities according to law.
  • Know standards of care qualifications

Legal implications ( cont)
  • Malpractice Negligence is the basis for mal
  • Court will decide
  • Nursing assistants are responsible to work within
    your job description and understand legal

  • This Minnesota and Federal law provides nursing
    home residents with the same rights given to all

Resident Bill of Rights
  • This Federal law provides nursing home residents
    with the same rights given to all citizens.
  • ALL MEMBERS of the health care team must respect
    the Bill of Rights,
  • Resident rights are preserved when the nursing
    assistant uses skills which maintain and protects
    the residents dignity

Residents have the right to
  • Be informed about rights
  • Exam state or Federal survey reports
  • Be accorded dignity in personal relationships
    with staff.
  • Be given in writing their doctors name and number
  • Receive quality care regardless of age, race,
    color, ethnic origin, religion, marital status,
    sexual preference or handicap.

Residents have the right to
  • Receive encouragement and support in making
    personal choices to accommodate individuals needs
  • Be protected from harm, both verbally and
  • Receive continuity of care
  • Refuse treatment
  • Privacy during procedures
  • Be addressed by name preferred
  • Be informed of costs and services

Residents have the right to
  • Confidentiality maintained regarding their
    medical condition/care
  • Be free from non-therapeutic chemical and
    physical restraints
  • Wear their own clothing, keep personal
    possessions, have own money
  • Have family or significant others participate in
    care conferences
  • exercise citizenship rights

Residents have the right to
  • Have assistance and privacy in personal
  • Have personal possessions treated with respect
    and safeguarded.
  • Be informed of diagnosis, treatment alternatives
    and risks
  • Be informed of procedures in filing complaints
    and grievances
  • Participate in religious and political activities
  • Organize, maintain and participate in resident
    and family councils

  • The residents Bill of Rights Must be posted in an
    easy to see place in the long term care facility.
  • A copy of the Bill of Rights must be given to
    all residents or guardians upon admission to the

Procedure to resolve grievances
  • The Bill of Rights gives residents the right to
    voice grievances without fear of reprisal.
  • When conflicts occur between residents the main
    concern is safety,
  • Report information regarding conflicts
    immediately to charge nurse.
  • State ombudsman services assist the residents to
    resolve conflicts with facilities.

Minnesota Vulnerable Adult Law
  • A Minnesota law which provides for protection of
    adults considered vulnerable due to physical,
    mental or emotional impairment.
  • Protects adults who cannot help themselves if
    they are hurt or misused by others,

Vulnerable Adult Act
  • Provides for safe institutions for vulnerable
    adults who have been abused.
  • Investigates reports of abuse or neglect
  • Includes person age 18 and over living in a
    licensed agency

Define abuse
  • Abuse is non-accidental harm or threatened harm
    to a residents health or welfare
  • Physical abuse Conduct that produces pain or
    injury and is not an accident
  • Verbal abuse Repeated conduct that produces
    mental or emotional stress
  • Sexual abuse Any sexual contact between staff
    and resident or client of that facility.

Define Neglect and exploitation
  • Neglect is failure to provide the vulnerable
    adult with the necessary food, clothing, shelter,
    healthcare or supervision.
  • Exploitation is the illegal use of vulnerable
    adults person or property through undue
    influence, duress deception or fraud. Absence of
    financial management that through neglect might
    lead to exploitation.

  • Reported immediately. Follow facility policy.
  • Confidentiality of reporter is protected
  • No reprisal or retaliation to reporter if done in
    good faith,
  • Persons who do not report are guilty of a
    misdemeanor and liable for damages.

Facility responsibility
  • Maintain written policies and procedures.
  • Keep records of incidents of self injury or
    aggression between residents.
  • Develop individual prevention plans

Patient Self Determination Act
  • This is a 1991 federal law which requires
    federally funded health care facilities to inform
    residents about their right to make treatment
  • Residents must be asked if they have a living
    will or a durable power of attorney for health

Institutionalized Care Vs Individual
  • Institutionalized care
  • Task oriented
  • Depersonalized
  • Fragmented
  • Schedule driven
  • One size fits alls
  • Little ivolvement in decisions by direct care

Institutionalized vs individual
  • Individualized care ( resident centered)
  • Caregivers are consistent
  • Care is focused on resident choices, interests,
    needs, life style, preferences and abilities.
  • Food, mealtime, bed time, activities are resident

Terminology for resident centered
  • Snacks vs nourishments
  • Home vs facility
  • Music vs, music therapy
  • Family room vs. resident lounge
  • Pantry vs. nourishment room
  • Goal is to provide homelike atmosphere


Introduction to HHA
  • Discuss history and goals of Home care
  • Describe Home Health Care Team
  • Discuss Role of Home Health Aide
  • Discuss Ethics and Etiquette in Home Care

History and Goals of Home Care
  • Most people received health care in their homes
    until the early 1900s. Then hospital care became
    more popular and practical due to advances in
  • Family members cared for each other
  • neighbors assisted with birth and death care
  • Doctor visited people in their homes

  • The home is returning as a place of choice for
    health care.
  • High cost of hospital care leads providers to
    look for less costly alternatives.
  • Fast growing elderly population may need some
    care, but not all services of a hospital or long
    term care facility.
  • People prefer to be cared for in their homes.

Payment for Home Care services
  • Provider coverage of health care services is part
    of the decision where care will be given.
  • HMOs, health insurance companies and others vary
    regarding their coverage of home care costs.
  • Coverage is usually for short term and
    intermittent care

Payment sources
  • Medicare reimbursement requires the person to be
  • confined to the home
  • under the care of a doctor who certifies the need
    for care
  • needing skilled care
  • receiving care from a Medicare certified home
    health agency

Who receives home care?
  • Newborn to people over 100 may receive home care.
    Most fit into the following groups.
  • Chronically ill - have one or more chronic
    conditions or disease and need assitance.
  • Acutely ill - Need skilled care, sometimes high
    tech for a short time.
  • Terminal illness - death is expected.
  • Developmentally/mentally disabled.

Referral Sources
  • Hospital discharge planners identify needs and
    evaluate sites for continuing care.
  • Family members, friends, clergy, and others often
    identify people at risk and need.
  • Road to receiving home care is not always
    straight or clear.

Goals of Home Care
  • Assist to meet highest physical and mental
  • Provide service in comfort of clients home
  • Promote client control of health and lifestyle
  • Encourage family participation

Who is the Health Care Team?
  • Home care services are provided by an expanding
    network of community services.
  • Home care agencies, transportation services,
    medical equipment services, public health
    services, chore services, social services
    ,senior centers.

What does a case manager do?
  • Case managers assess the needs of a client. They
    decide and arrange services.
  • Review care plans by all team members and assures
    client is progressing according to plan of care.

What does a supervisor do?
  • The supervisor makes the first assessment visit
    to the client and directs client care.
  • The supervisor makes periodic visits to assess
    client and care being given.
  • The supervisor instructs and supervises the home
    health aide with client care.

The Supervisor is responsible to
  • Orient home health aide to client and care plan
  • Instruct home health aide regarding specific
    duties related to client care
  • Instructs home health aide on new procedures
  • Instructs HHA regarding information to be
    recorded and reported
  • Instructs HHA on limitations of duties
  • Provides HHA with annual performance evaluation

What is the role of the Home Health Aide?
  • HHA provide or assist client with ADLs and
    therapies according to care plan under the
    supervision of the nursing supervisor or case
  • A HHA will assist client with light housekeeping
    tasks to assists client in maintaining a clean
    safe environment.

Responsibilities of a HHA
  • Complete combined nursing assistant/ home health
    aide course
  • Complete state competency exam for NA/HHA
  • Complete additional training required by agency
    such as first aid or CPR.
  • Complete facility testing, evaluations and
    required inservice training.

Home Health Aids
  • Need to follow agencies policies and procedures
  • personal hygiene
  • Uniform and grooming
  • transportation use of car for travel or to
    travel between clients

Limitations of HHA
  • Do not perform services for client unless the
    agency has provided training.
  • Do not perform sterile procedures
  • Do not insert, remove or irrigate tubes
  • Do not alter care plan without supervisors
  • Do not transport client or family unless service
    is part of the plan of care.

Limitations of HHAs
  • Do not make financial transactions for client
  • HHAs care for clients needs but does not care
    for or assist entire family.

Important qualities of HHA
  • Independent and dependable worker
  • There are no other health care workers in the
  • Well organized, uses time wisely
  • willing to follow instructions
  • Good problem solver
  • Able to get the facts,see the problem, and make a
  • Flexible
  • open to changing hours and flexible
  • Dependable transportation

Qualities of HHAs
  • Good customer service attitude
  • Good communication skills
  • Adaptable
  • Will have to adjust to using skills in the home
  • will have to use a variety of equipment

Ethics and Etiquette for HHAs
  • Schedules and activities follow the home routine.
    HHAs are guests in the clients home.
  • Cultural and religious practices will be more
    evident in home vs public settings.
  • Family members/significant others will
    participate more in client care, respect their