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Intro to OBRA and the Nursing Assistant

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Intro to OBRA and the Nursing Assistant Residents in LTC Facilities Not normal changes of aging: SHOULD BE REPORTED TO THE NURSE Signs of depression Loss of ability ... – PowerPoint PPT presentation

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Title: Intro to OBRA and the Nursing Assistant


1
Intro to OBRA and the Nursing Assistant
2
Course Information
  • Course Objectives
  • To prepare nurse aids with the knowledge, skills,
    and abilities essential for the provision of
    basic care to residents in long-term care
    facilities.

3
Course Information
  • After completing this course, participants will
    be able to
  • Provide basic care to residents of long-term care
    facilities.
  • Communicate and interact effectively with
    residents and their families, with sensitivity to
    the psychosocial needs of the residents.
  • Assist residents in attaining and maintaining
    maximum functional independence.
  • Protect, support and promote the rights of
    residents.
  • Provide safety and preventative measures in the
    care of residents.
  • Demonstrate skill in observing, reporting and
    documentation.
  • Function effectively as a member of the health
    care team.

4
Course Information
  • Each class period will be split in to 2 different
    groups (A and B group)
  • Only 10 students are allowed to visit the nursing
    home at a time under Mrs. Paschals supervision
  • You will travel to the nursing home every-other
    class period
  • If your group is staying at the school, you will
    learn and practice skills with Mrs. Bernard
  • A calendar will be posted of the rotation
    schedule
  • The first week of rotations at The Summit will be
    October 6th, 2014 and we will finish the week of
    January 26th, 2015

5
Course Information
  • Textbooks/Resources
  • Hartmans Nursing Assistant Care (Long-Term Care)
  • Also available for download on iTunes
  • Hartmans Nursing Assistant Care Workbook
  • Diversified Health Occupations
  • NNAAP Texas Nurse Aid Candidate Handbook

6
Course Information
  • Requirements and Assignments
  • Attendance is REQUIRED for this course
  • You must complete 40 hours of clinical rotations
    and 60 hours of classroom instruction before you
    are eligible to take the exam
  • You will sign in each class period in order to
    document hours DO NOT BE LATE!
  • Grades will be based on participation, daily
    assignments, skills check-offs, exams, and
    projects

7
INTRODUCTION
  • You need to know
  • What you can and cannot do
  • What conduct is right wrong
  • Your legal limits
  • Actions are defined / shaped by
  • Patients condition
  • The amount of supervision you need

8
HISTORY OF CNAS
  • Worked for decades helping nurses
  • Until the 1980s, training was not required by law
  • On-the-job training by
  • Some schools and hospitals offered training

9
TRENDS
  • In 1980s primary nursing was introduced
  • RNs gave care in
  • CNAs gave care in

10
TRENDS
  • Home care increased in 1980s
  • Insurance caused decrease in
  • Reducing medical costs became political issue
  • Hospital closings mergers
  • Managed care
  • CNAs joined RNs at hospitals
  • CNAs

11
STATE FEDERAL LAWS
  • Tasks CNAs able to perform vary from state to
    state within agencies
  • Attempt to regulate nursing practice
  • Nurse practice acts
  • The (OBRA) of 1987
  • Applies to all 50 states

12
NURSE PRACTICE ACTS
  • Defines RNs and LPNs
  • Describes their
  • Lists education and licensing requirements
  • Protects public from a nurse
  • Allows license to be

13
NURSE PRACTICE ACT
  • Also defines what the Nursing Assistant may do
  • If perform act beyond scope of CNA, can be found
    of practicing nursing without a license

14
REASONS TO REVOKE A LICENSE
  1. Convicted of crime in any state
  2. Using patient drugs for self
  3. Place person in danger from overuse of drugs /
    alcohol
  4. Convicted of abuse or neglect of
  5. Violating or assisting someone else to violate
    the nurse practice act
  6. behaviors
  7. Making medical diagnosis
  8. Prescribing

15
OBRA
  • Omnibus Budget Reconciliation Act of 1987
  • Federal law that establishes regulations for
    nursing facilities and nurse aid training in
    facilities
  • Intent is to improve quality of life for
    residents in nursing facilities

16
REMIND ME AGAIN.
  • What was the intent of the OBRA Act of 1987???

17
OBRA
  • OBRA facility regulations focus on
  • , restorative care, psychosocial care and
    preventative care to maintain maximum physical
    and mental wellness of residents.
  • State inspection of facilities for compliance
    with regulations with penalties for .

18
OBRA
  • OBRA nurse aid training regulations include
  • The facility must assure that nurse aids complete
    an approved NATCEP and be placed on the Nurse Aid
    Registry within 4 months of their hire date.
  • The first of training must be completed prior
    to any direct contact with a resident.
  • After the first 16 hours, nurse aids can perform
    only those skills for which they have been and
    found to be by the instructor.

19
OBRA
  • OBRA nurse aid training regulations include
  • An approved NATCEP must be at least clock hours
    in length
  • classroom hours
  • clinical training hours
  • The nurse aid must pass the training program in
    order to be eligible to take the state test
  • The state Competency Evaluation Exam (CEP)
  • A written or oral exam consisting of
  • A skills test consisting of randomly selected
    skills
  • A nurse aid must pass the skills AND written test
    before being placed on the registry
  • The nurse aid has 3 opportunities to pass each
    test and must meet competency within 2 years of
    his/her training completion date
  • Cost 93

20
Tell me.
  • How does the training previously mentioned
    benefit residents, the nurse aide themselves, and
    the LTC facility??

21
OBRA
  • State registry requirements include
  • Each individual listed on the registry must keep
    the department informed of his/her current
    address and telephone number
  • Nurse aid certification expired after being
    entered into the registry
  • Must submit verification of pain employment prior
    to the expiration date to continue verification
  • If renewing after Sept 1, 2013 you must complete
    of continuing education every 2 years
  • DADS will not recertify nurse aids that are
    listed on the (EMR), or have been convicted of
    a criminal offense listed in Texas Health and
    Safety Code 250.006
  • A finding of abuse, neglect, or misappropriation
    of resident property may be entered into the
    registry.
  • The nurse aid will not be employable as a nurse
    aid in LTC facilities

22
ROLES RESPONSIBILITIES
  • Nurse practice acts, OBRA, state laws, as well as
    legal and advisory opinions direct what you can
    do in your role as a CNA
  • Must understand what you are able or unable to do
  • called scope of practice
  • Must have had education and training to perform
    task
  • (LPNs may in some states)
  • Must be available for questions

23
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24
ROLE LIMITS FOR CNAS
25
DELEGATION
  • Authorize another person to perform a task
  • Delegation decisions must protect persons health
    and safety
  • Person must be
  • RN legally (responsible) for all nursing
    care-decide what is best for patient
  • Decision is based upon pts circumstances
  • Must make sure it is done correctly
  • CNAs cannot delegate roles or responsibilities

26
(No Transcript)
27
5 RIGHTS OF DELEGATION
  • Right
  • Right
  • Right
  • Right
  • Right

28
Intro to Residents in LTC Facilities
  • Purpose of LTC facilities
  • Business that provide skilled nursing care
  • The term nursing home was once widely used to
    refer to these facilities. Now they are called
    long-term care facilities, skilled nursing
    facilities, rehabilitation centers, or extended
    care facilities
  • People who live in LTC facilities are referred to
    as because they live there
  • Residents length of stay can be varied. Why do
    you think?
  • A typical LTC facility offers personal care for
    all residents and focused care for residents with
    special needs. What are examples of personal
    care? What does ADL stand for?
  • Several other services also offered in LTC
    facilities
  • Physical, occupational, and speech therapy
  • Care of different types of tubes (catheters)
  • Management of chronic diseases

29
Intro to Residents in LTC Facilities
  • Types of residents of LTC facilities
  • A survey in 2004 reported that of LTC residents
    were over the age of 65
  • 2/3 of residents in LTC is 6 months or longer
  • 1/3 of residents in LTC is less than 6 months
  • Terminal care resident will probably die in the
    facility
  • Rehabilitation residents recover and return to
    the community
  • A limitation on a persons physical
    functioning, mobility, dexterity, or stamina
  • A disease that affects a persons ability to
    function at a normal level in the family, home,
    or community

30
Intro to Residents in LTC Facilities
  • Types of residents of LTC facilities (cont)
  • Individuals requiring skilled nursing
  • Most often the lack of ability to care for
    oneself and the lack of a support system
  • Post acute care
  • Other

31
Intro to Residents in LTC Facilities
  • Needs common to residents
  • What are some needs that we all have?
  • Physical needs
  • needs
  • Privacy needs
  • Residents have the right to privacy when care is
    given
  • Their medical and personal information cannot be
    shared with anyone but

32
Intro to Residents in LTC Facilities
  • Myths and feelings about aging
  • Ideas and stereotypes about older people are
    often false.
  • Most older people are active and engaged in work,
    volunteer activities, learning programs, and
    exercise regimens.
  • Aging causes many , psychological, and changes.

33
Residents in LTC Facilities
  • Normal changes of aging
  • Skin is thinner, drier, more fragile, less
    elastic
  • Muscles weaken and lose tone
  • Bones and become more brittle
  • Sensitivity of nerve endings in the skin decrease
  • Responses and reflexes slow
  • Senses of vision, hearing, taste, touch, and
    smell weaken
  • Heart works less efficiently
  • Oxygen in the blood
  • Appetite decreases
  • Urinary elimination is more
  • Digestion takes longer and is less efficient
  • Levels of hormones
  • Immunity weakens
  • Lifestyle changes occur

34
Residents in LTC Facilities
  • Not normal changes of aging
  • SHOULD BE REPORTED TO THE NURSE
  • Signs of depression
  • Loss of ability to think logically
  • Poor nutrition
  • Incontinence
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