The Nursing Assistant and various care settings

Chapter 1

◦ a. 24 hour care available

◦ b. Chronic conditions (lasts a long time)

◦ c. Dementia, developmentally disabled (DD)

◦ d. Mainly elderly

◦ e. Residents

Nursing Home/Long-term care

a. Residents more independent. Do not need 24 hour care.

b. Help is given with: 1. showers

2. Meals 3. Transportation to appointments, if needed

Assisted Living

1. Same-day surgeries

2. Clinics

3. For people who need less than 24 hour care.

Outpatient Setting

Hospital

a. Emergencies b. More serious surgeries c. Flare-up of chronic conditions d. Need more skilled nursing care e. Very temporary

Acute Care

1. Sub-acute 2. Adult Day care 3. Hospice 4. Home Health

Other settings

Members:

◦ a. Nursing Assistant, RN, LPN◦ b. PT, OT, ST◦ c. MSW, Activities Director, RD◦ d. Doctor◦ e. Resident and Family

◦ Everyone works together to restore as much function back to the resident as possible.

The Health Care Team

Created by RN, highlights tasks and information specific to the resident.

Very important to familiarize yourself with the Care plan and to follow it.

Chain of Command – line of authority a. Very important to follow this and be aware of who supervises you.◦ b. Protects from liability.

Care Plan & Chain of Command

Policy – states what should be done in the facility.

a. confidentiality of health information b. Not taking gifts from residents. c. Reporting change in resident status

Definitions

Procedure – A way of doing something◦ 1. Resident complaint forms – give to DNS◦ 2. Documenting VS◦ 3. Filling out belongings checklist upon admit

Medicare: Health insurance for people 65 and older or disabled individuals.

Medicaid: Based on income – for people who cannot afford health insurance.

Definitions (continued)

Help with ADLs.

If not long-term, then PT, OT, ST, RD

Assistance to do for the residents what they cannot do.

Typical care in a Nursing Home

Be competent Be professional in conduct and appearance

◦ a. Limit talk about personal issues.◦ b. Be kind, shower, shave, brush teeth, wear

appropriate clothing to work.

Show respect and provide dignity to residents.

Honest and ethical behavior

Be aware of residents rights.

Expectations of CNAs

Let’s review! Pages 11 and 12.

Abuse and Neglect. Let’s review pgs 12 & 13

Mandatory reporting…let’s discuss this

Resident Rights

1. Obra or Omnibus Budget Reconciliation Act◦ a. Training hours requirement◦ b. Minimum staffing requirement◦ c. Registry established…states are required to have◦ d. Designated services to be provided◦ e. Established resident rights and survey time: every 9 –

15 months 2. Older Americans Act a. Ombudsman-legal advocate for residents

◦ 3. HIPPA – confidentiality of health

information

Laws that protect the elderly

1. When and what to document

◦ a. Care you give, flowsheets, facility documents◦ b. Incidents: falls, inappropriate behaviors◦ c. Medical Record – legal document◦ d. Guarantees clear communication between

members of the health care team.◦ e. Confidentiality is required.

Documentation-Medical Record

Guidelinesa. Use fact, not opinion.b. Be concise, not wordy.c. Use black ink. Only one line through mistakesd. Make sure to initial when correcting errors.e. Do not use “white out” or correction fluid.f. Record immediately after care, not before.g. “If you do not document, you didn’t do it.”

Documentation

Health care documentation always in military time.

1. Add 12 to any “regular” time statement.◦ a. 3 o’clock a.m. + 12 = 1500 or 3 p.m.◦ b. 1700 (5 o’clock p.m.) – 12 + 0500 a.m.

◦ Military time is more precise – daytime or nighttime

Military Time