CNA Chapter Two

Unit 1Unit 1Introduction to Health Introduction to Health

CareCareCNACNA

Introduction to Health CareIntroduction to Health Care

As a member of the Nursing Department, the nurse aide plays an important role in resident care.

The nurse aide spends more time in direct contact with the resident than any other member of the health care team.

Introduction to Health CareIntroduction to Health Care(continued)(continued)

A knowledge of the role, function, legal limitations, expected qualities, personal habits and obligations is important to provide quality care. This unit also explores the types, purposes and organizational structure of health care facilities that employ nurse aides.

CNACNA

Role of the Nurse AideRole of the Nurse Aide

• Important in the care of people who are ill & unable to care for themselves

• Assistant to the licensed nurse• Provide physical care and

emotional support

• Contribute to the resident’s comfort

• Make observations and report• Directed and supervised by

licensed nurses

Role of the Nurse AideRole of the Nurse Aide(continued)(continued)

The Nurse Aide Works In A The Nurse Aide Works In A Variety Of SettingsVariety Of Settings

• Hospitals• Long term care

facilities• Rehabilitation centers• Clinics• Hospices• Psychiatric facilities• Home care

Discuss the functions of the nurse aide in providing care to residents.Identify 22 functions of the nurse aide.

Functions of Nurse AideFunctions of Nurse Aide

• Hygiene• Safety• Nutrition• Exercise• Elimination• Mobility

Help residents with personal needs:

Functions of Nurse AideFunctions of Nurse Aide(continued)(continued)

• Communication• Socialization activities• Comfort measures• Restorative procedures

Help residents with personal needs (continued):


Assist with resident care responsibilities:

•Collecting specimens•Measuring and recording vital signs•Transporting residents•Environmental cleanliness•Cleaning and care of equipment


Assist with resident care responsibilities (continued):

•Standard precautions•Fire drills and disaster drills•Answering call signals•Observation of resident response to care

Functions of the Nurse AideFunctions of the Nurse Aide(continued)(continued)

Assist with resident care responsibilities (continued):

•Measuring and recording height/weight

•Intake and output•Admission and discharge of residents

List eight legal limitations for the nurse aide.

Legal Limitations of Nurse Legal Limitations of Nurse AideAide

• Nurse aides do not do sterile procedures.

• Nurse aides do not give information about the diagnosis or treatment plans to the resident or his/her family.

• Nurse aides do not give medications.• Nurse aides do not insert or remove

tubes from the resident’s body.


(continued)(continued)• Nurse aides do not take oral or

telephone orders from a physician

• Nurse aides do not diagnose or prescribe treatments or medications for residents.

• Nurse aides do not supervise the work of other nurse aides.


(continued)(continued)

• Nurse aides do not agree to do something beyond the nurse aide’s scope of practice as defined by the North Carolina Board of Nursing.

Describe the personal qualities and characteristics of the nurse aide.Discuss the importance of punctuality and commitment on the job.

Qualities and Characteristics Qualities and Characteristics of the Nurse Aideof the Nurse Aide

• Cheerful• Enthusiastic• Responsible• Considerate• Courteous• Cooperative

Qualities and Characteristics Qualities and Characteristics of the Nurse Aide of the Nurse Aide (continued)(continued)

• Dependable• Empathetic• Honest• Patient• Respectful• Trustworthy

Qualities and Characteristics Qualities and Characteristics of the Nurse Aide of the Nurse Aide (continued)(continued)

• Willing to learn• Tactful• Competent• Committed to

job• Punctual• Self-aware

Suggest ways for the nurse aide to maintain acceptable personal hygiene and exhibit appropriate dress practices.

Factors That Promote Good Factors That Promote Good HealthHealth

• Rest and sleep• Diet• Exercise• Good posture and body mechanics• Eye examinations• Dental care• No use of drugs, alcohol or

cigarettes

Personal Hygiene PracticesPersonal Hygiene Practices

• Taking a daily bath or shower• Using

deodorants/antiperspirants• Brushing teeth and using

mouthwash• Keeping hair clean and neatly

styled• Cleaning and maintaining short,

smooth nails

Personal Hygiene PracticesPersonal Hygiene Practices(continued)(continued)

• Washing hands after using bathroom

• Wearing clean underwear, socks or stockings and uniform daily

• Do not use products having odors that might be offensive to residents

Professional Dress PracticesProfessional Dress Practices

• Uniform clean, pressed• Shoes polished and

comfortable• Shoe laces clean• Stockings without holes/runs• Jewelry limited to watch and

wedding ring

Professional Dress PracticesProfessional Dress Practices(continued)(continued)

• Name tag or photo ID tag worn• Make-up worn in moderation• Strong perfumes/aftershave

lotions not used

List obligations of the nurse aide as a member of the health care team.

Guidelines For Working With Guidelines For Working With OthersOthers

• Know the responsibilities, functions and role expectations listed in job description

• Display qualities and characteristics befitting a nurse aide

• Be prompt in reporting to work



• Notify facility of absence ASAP• Display good health and hygiene

practices• Follow facility dress code policy• Practice ethical & legal actions• Direct questions about things you

don’t understand to supervisor



• Follow instructions and directions of supervisor

• Display pride in appearance • Promptly report unusual

observations to the supervisor• Make supervisor aware of family

and resident complaints

Guidelines For Working With Guidelines For Working With Others (COthers (Continued)ontinued)

• Perform duties in spirit of cooperation• Do not waste supplies and equipment• Follow facility rules and regulations• Be accurate in measuring, recording

and reporting• Notify supervisor when leaving and

returning to unit

• Assist other health care workers willingly

• Never use supplies or equipment belonging to the facility or resident

• Never discuss personal problems with the residents



Resident Care ConferencesResident Care Conferences

• Assist to develop/revise care plans

• Share care suggestions• Report observations

Explain the necessity for planning work assignments.

Work AssignmentsWork Assignments

• Made by a licensed nurse• Based on needs of residents

and availability of staff• Allows staff to work as team• Includes being cooperative

and helping others when asked

Work AssignmentsWork Assignments(continued)(continued)

• Includes never ignoring a resident that needs help, is uncomfortable or in danger

Work AssignmentsWork Assignments(continued)(continued)

• Includes notifying the supervisor of unfinished assignments

• Includes answering call signals even though not assigned to the resident

Considerations For Planning Considerations For Planning A Work AssignmentA Work Assignment

• Workload• Resident

condition• Time• Support services

assigned

Identify the need to establish priorities when providing resident care.

Establishing Priorities for CareEstablishing Priorities for Care• Activities of daily living

–Meeting hygiene needs

–Positioning and providing for exercise

–Maintaining proper nutrition

–Providing for elimination of wastes

Establishing Priorities for CareEstablishing Priorities for Care(continued)(continued)

• Examples of special procedures –Taking vital signs

–Measuring urine


• Support services–Providing drinking water–Delivering and picking up meal trays

–Providing clean linen and making beds

–Cleaning and caring for equipment


• Documentation/reporting–Presenting oral reports to supervisor

–Writing on record if directed to do so

Differentiate among the various types of health care facilities and agencies.

Long-term Care FacilitiesLong-term Care Facilities(Nursing Homes)(Nursing Homes)

• Provide health care services to individuals unable to care for themselves:–elderly persons–disabled or handicapped persons

–people with chronic illness



• Services provided–Medical–Nursing–Nutritional–Recreational/religious

–Rehabilitative



• Types of care–Home care– Intermediate care

–Skilled care

HospitalsHospitals

• Provide care for individuals of all ages with a broad range of health problems

HospitalsHospitals(continued)(continued)

• Services varied and extensive

–Diagnostic

–Medical

–Surgical

–Emergency

• Types of care: acute, chronic and terminal care

Home Care AgenciesHome Care Agencies(continued)(continued)

• Services provided include:– Nursing– Physical therapy– Occupational therapy– Speech therapy– Social services– Nutritional and food services– Respiratory therapy– Homemaker services

Identify the organizational structure of health care facilities.

Organizational ChartOrganizational Chart

• Displays chain of command

• Shows lines of authority

• Identifies health care worker’s position

• Identifies immediate supervisor

Organizational StructureOrganizational Structure

–Responsible for provision of safe and adequate care at a reasonable cost

–Makes facility policies–Delegates management

to an administrator

• Governing body (Board of Directors)

Organizational StructureOrganizational Structure(continued)(continued)

• Department heads–Have specific areas of responsibilities

–Supervise department staff•Finance•Ancillary services•Nursing


• Medical Director–Supervises medical staff activities•Physicians•Residents•Interns


• Director of Nursing and Assistant DON–Supervises nursing staff activities

–Responsible for safe nursing care

–Registered nurses


• Nursing supervisor–Assists director of nursing

–Licensed nurse–Assigned areas of responsibility

–Assigned to specific shift


• Charge Nurse –Supervises staff in specific area

•Registered nurses (RNs)•Licensed practical nurses (LPNs)

•Nurse aides (NAs)

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Unit 2Unit 2Communication Communication

AndAndInterpersonal SkillsInterpersonal Skills

72

Communication And Communication And Interpersonal SkillsInterpersonal Skills

IntroductionIntroduction

Nurse aides communicate with residents, families, visitors and co-workers.

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Unit 2Unit 2Communication Communication

AndAndInterpersonal SkillsInterpersonal Skills

74


IntroductionIntroduction(continued)(continued)

Nurse aides must frequently send and receive information about the care and observation of residents, report thoughts and feelings as clearly and objectively as possible and interact effectively with others.

75



Nurse aides need to be aware of nonverbal communications and need to develop skills in communicating with the sensory impaired.

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In addition, nurse aides may document on the medical record, which is a legal document. Therefore, all documentation must be in legible, clear and accurate language so that there is no misunderstanding of the meaning.

78

Demonstrate appropriate and effective communication skills.

79

Elements That Influence Elements That Influence Relationships With OthersRelationships With Others

• Prejudices

• Frustrations

• Attitudes

• Life Experiences

80

Requirements For Successful Requirements For Successful CommunicationsCommunications

• A message• A sender• A receiver

81

Describe the importance of developing good listening skills.Identify nine listening skills that can be used by the nurse aide.

82

Listening SkillsListening Skills

• Show interest• Hear message• Do not interrupt• Ask appropriate questions

for clarification

83

Listening SkillsListening Skills(continued)(continued)

• Be patient and help resident express feelings and concerns

• Eliminate or reduce distractions

• Understand silence can be form of communication

84

Recognize barriers to effective communication.

85

Barriers to Effective Barriers to Effective CommunicationCommunication

• Labeling• Talking too fast• Avoiding eye contact• Belittling a resident’s feelings• Physical distance

86



• Mental or sensory impairment on the part of the resident such as:–Confusion–Blindness–Aphasia–Hearing impairment

87


(continued)(continued)• Changing the subject• False reassurance• Giving advice• Ineffective communication

–Disguised messages–Conflicting messages–Unclear meanings–Clichés

89

Explain how the nurse aide will need to modify his or her behavior in response to the resident’s behavior.Define the terms sympathy, empathy and tact.

90

Interpersonal SkillsInterpersonal Skills

• Determined by –Standards and values–Culture and environment

–Heredity– Interests

91

Interpersonal SkillsInterpersonal Skills(continued)(continued)

• Determined by –Feelings and stress

–Expectations others have for us

–Past experiences

92

Dealing With Resident Dealing With Resident BehaviorBehavior

• Accept every resident

• Listen to every resident

• Comply with reasonable requests, when possible

93

Dealing With Resident Dealing With Resident BehaviorBehavior(continued)(continued)

• Display patience and tolerance

• Make an effort to be understanding

94


• Develop acceptable ways of coping with our own negative feelings–Leave the room after providing for safety

–Talk with supervisor, in private, about negative feelings

95


• Develop acceptable ways of coping with our own negative feelings– Involve yourself in physical activity

–Learn to use relaxation techniques that ease stress

96


• Be sensitive to residents’ moods

• Be able to handle disagreements and criticism

97

Treat Residents As Unique Treat Residents As Unique IndividualsIndividuals

• Do things the residents’ way, when possible

• Anticipate their needs• Give good care• Ask for their opinions

98

Treat Residents As Unique Treat Residents As Unique IndividualsIndividuals(continued)(continued)

• Be able to see things from the other person’s point of view

100

Develop effective nonverbal and verbal communications skills.List six examples of nonverbal communication and six examples of effective verbal communication.

101

Nonverbal CommunicationNonverbal Communication

• Body language–Posture–Gestures–Level of activity –Facial expressions–Appearance–Touch

102

Verbal CommunicationVerbal Communication

• Speak clearly and concisely

• Give message by tone of voice

• Face resident, at eye level, when speaking

103

Verbal CommunicationVerbal Communication(continued)(continued)

• Avoid words having several meanings

• Present thoughts in a logical, orderly manner

• Learn to paraphrase

104

Identify proper telephone communication skills.

105

Telephone Communication Telephone Communication SkillsSkills

• Speak clearly in a pleasant tone of voice

• Identify the area, yourself and your position

• Ask, “May I help you?”• Be courteous

106



Take messages:Take messages:name of individual calling

phone number (including area code)read back message for accuracy

date and time of call

107


(continued)(continued)Take messages Take messages (continued):(continued):

ask for assistance if you are unable to handle message

permit caller to hang up firstfollow proper etiquette

108

Identify actions that would facilitate communication with residents’ family and visitors

109

Actions to Facilitate Actions to Facilitate Communication with the Communication with the

Resident’s Family Resident’s Family and Visitorsand Visitors

• Ask how they are doing

• Indicate that you are glad to see them

• Tell them about activities the resident has been involved with that day

110


Resident’s FamilyResident’s Familyand Visitors and Visitors


• Be warm and friendly

• Use talking and listening skills you would use with resident

111


Resident’s FamilyResident’s Familyand Visitorsand Visitors

(continued)(continued)• Share knowledge about the unit

– Visiting hours– Restrictions to visitors– Any restrictions on bringing food– Activities that include

family

112




• Report stressful or tiring visits to supervisor

• Refer requests for information on the resident’s condition to supervisor

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(continued)(continued)• Share information from

family/visitors that would affect resident care with supervisor

• Report visitor concerns or complaints to supervisor

114

Identify actions that would facilitate communication with hearing impaired residents.

115

Actions to Facilitate Actions to Facilitate Communication with Hearing Communication with Hearing

Impaired ResidentsImpaired Residents

• Encourage to use hearing aid• Speak slowly using simple

sentences• Face resident at eye level when

speaking• Encourage resident to read lips,

if that helps

116

Actions to Facilitate Actions to Facilitate Communication with Hearing Communication with Hearing

Impaired ResidentsImpaired Residents(continued)(continued)

• Lower pitch of voice• Direct speech to stronger ear but

do not shout • Use gestures when possible to

clarify statements• Write when necessary• Learn basic signing, if appropriate

117

Identify actions that would facilitate communication with residents that have decreased vision.

118

Actions to Facilitate Actions to Facilitate Communication with Residents Communication with Residents

Who Have Who Have Decreased VisionDecreased Vision

• Sit where resident can best see you

• Make sure lighting is sufficient• Encourage resident to touch

objects and yourself• Encourage resident to wear

his/her glasses

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Who Have Who Have Decreased VisionDecreased Vision

(continued)(continued)• Use touch and talk frequently

to communicate your location• Use descriptive words and

phrases

120

Identify actions that would facilitate communication with residents that have difficulty speaking.

121


Who Have Who Have Difficulty SpeakingDifficulty Speaking

• Encourage to use hands to point out objects

• Use communication boards/card

• Repeat what you heard to be sure you understood resident

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Who Have Who Have Difficulty SpeakingDifficulty Speaking

(continued)(continued)• Encourage resident to cry

or express anger/frustration when he/she has trouble

• Ask yes and no questions• Let other staff members

know meaning of a sound or movement

123

Identify actions that would facilitate communication with depressed residents.

124

• Exercise patience• Allow time for resident

to say things• Sit quietly with resident• Return repeatedly until

resident responds

Actions to Facilitate Actions to Facilitate Communication with Communication with Depressed ResidentsDepressed Residents

125


with Memory Losswith Memory Loss

• Encourage to talk• Talk about things

resident remembers• Ask one question at a

time, containing one thought

126


with Memory Losswith Memory Loss

• Encourage to talk• Talk about things

resident remembers• Ask one question at a

time, containing one thought

127


with Memory Losswith Memory Loss(continued)(continued)

• Keep questions simple• Re-phrase questions not

understood• Avoid asking resident to

make a choice

128

Identify actions that would facilitate communication with residents based on stage of development.

129

Actions to Facilitate Actions to Facilitate Communication Based on Communication Based on

Stage of DevelopmentStage of Development

• Treat all residents with dignity and respect

• Encourage residents to make choices when appropriate

• Use simple sentences• Emphasize positive

qualities

130


Stage of DevelopmentStage of Development(continued)(continued)

• Never attempt to exert power over residents

• Encourage residents to do all they can for themselves

• Be patient

131



• Take time to explain what residents are to do or what you are going to do for them

• Use age appropriate speech• Encourage residents to express

feelings, ideas and frustrations

132



• Gain resident’s attention and speak clearly, in a normal tone of voice

• Orient residents to reality when appropriate

133



• Never assume that you aren’t heard or understood

• Never address residents as if they are children.

135

Observe by using the senses to report resident behavior to the nurse.

136

Examples using sight:• Rash• Skin color• Bruising

Methods of ObservationMethods of Observation

137

Examples using hearing:• Wheezing• Moans• Words spoken by resident

Methods of ObservationMethods of Observation(continued)(continued)

138


Examples using touch:• Lump• Temperature of skin• Change in pulse

139

Examples using smell:• Odor of breath• Odor of urine• Odor of body


140

ReportingReporting

• Reports are made:– immediately– thoroughly– accurately

• Use notepad and pencil to write down information for reporting

141

Discuss differences between objective and subjective data.

142

ReportingReporting(continued)(continued)

• When reporting, consider:– care or treatment given– time of treatment– resident’s response to care

143

ReportingReporting(continued)(continued)

• When reporting, consider:–observations helpful to other health care workers

– information resident has given that would affect his or her treatment

–anything unusual about resident

145

Identify the ways in which the nurse aide communicates with other staff members.

146

Forms of CommunicatingForms of Communicating

• Body language

• Reporting or communicating orally

•Written communications

147

Written Communications: Written Communications: Resident Care PlansResident Care Plans

• Resident care plans prepared by nurse

• One for each resident• Kept at nurses’ station

148



• Working record to provide consistent, well-planned care on a daily basis

• Changed and updated as needed by licensed nurse

149



• Information included (continued):–Short-term and long-term goals–Plan to attain goals–Date plan initiated and reevaluated

150



• Nurse aides contribute by:–Helping to identify problems

–Attending care conferences

151



• Nurse aides contribute by (continued):

–Directing questions about plan to supervisor

–Reporting resident response to treatment and activities

152

Recognize the importance of maintaining the resident’s medical record.

153

Written Communications: Written Communications: Resident‘s Medical RecordResident‘s Medical Record

• Includes information from all disciplines providing direct service to residents

154

Written Communications: Written Communications: Resident’s Medical RecordResident’s Medical Record


• A record of:–assessments, implementations, evaluations

–management plans–progress notes

• Permanent legal record

155

Written Written Communications: Communications: Resident’s Medical Resident’s Medical

RecordRecord(continued)(continued)

• Purpose–Organizes all information on care in one document

–Accountability so care can be evaluated

–Documentation so there is knowledge of what each discipline is doing

156

Written Written Communications: Communications: Resident’s Medical Resident’s Medical

RecordRecord(continued)(continued)

• Confidential information available only to health care workers involved in care of resident

157

Review guidelines for charting in the resident’s medical record.

158

Guidelines For Charting Guidelines For Charting If Allowed By FacilityIf Allowed By Facility

• Make sure entries are accurate and easy to read

• Always use ink• Print, unless script is

accepted form• Do not use the term

“resident”

159



• Use short, concise phrases

• Always chart after care is performed

• Make sure writing legible and neat

communication 160



• Record in a logical and chronological manner

• Be descriptive• Make sure all forms

added to the chart contain identifying information

161



• Avoid using words that have more than one meaning

• Use resident’s exact words in quotation marks whenever possible

• Always indicate the time of care

162



• Leave no lines blank• Sign each entry with

first initial, last name and title

• Correct errors using facility procedure

164

Document observations using appropriate terms.

165

Medical TerminologyMedical Terminology

• Medicine has a language of its own

–Historical development

–Composed mainly of Greek and Latin word parts

–Consistent and uniform

166

Medical TerminologyMedical Terminology(continued)(continued)

• Three components–Prefixes–Root words–Suffixes

• Medical dictionary–Used for reference–Spelling is important

168

Recognize abbreviations used in documenting by the health care facility.

169

AbbreviationsAbbreviations

• Help health care workers communicate quickly and effectively

• Are shortened forms of words

• Reduce time needed to chart important information

170

AbbreviationsAbbreviations(continued)(continued)

• Conserve space on medical record

• Used primarily in written communication

172

Demonstrate the ability to document accurate information following proper charting practices.

174

Ethical and Legal Ethical and Legal IssuesIssues

IntroductionIntroductionAs a member of the health care team, the nurse aide will frequently be faced with ethical and legal decisions that govern his or her actions. A knowledge of ethical standards, resident’s rights and legal issues are important for the protection of nurse aides, employers, and residents.

176

Define ethics.List at least six basic rules of ethics for the nurse aide.

177

EthicsEthics• Discipline concerned with right

or wrong conduct• Guides to moral behavior• Making choices or judgments

178

Nurse Aide Ethical Nurse Aide Ethical StandardsStandards

• Show respect for each resident as an individual

• Understand the limits of role–Perform only acts for which adequately prepared

–Perform acts only within legal scope of nurse aide

179

Nurse Aide Ethical Nurse Aide Ethical StandardsStandards(continued)(continued)

• Carry out assignments to best of ability

• Be loyal:–Maintain a positive attitude toward institution that employs you

–Support co-workers

180

Nurse Aide Ethical Nurse Aide Ethical StandardsStandards(continued)(continued)

• Be responsible citizen at all times –Respect others–Respect values that differ from yours

181

Identify the kind of information that should be kept confidential.

182

• Resident information should be kept confidential– Discuss only in appropriate places– Discuss only with proper people– Refer questions from residents

about their condition to supervisor

Nurse Aide Ethical Standards(continued)

183

• Resident information should be kept confidential (continued)

– Refer questions about resident’s death to supervisor

– Respect personal religious beliefs


184

• Respect privacy of others:– while dressing– while performing personal hygiene– during examination or treatment– during visits with clergy– during visits with spouse or

significant other


185

• Put resident’s needs ahead of your own

• Be sincere, honest and trustworthy in performance of duties– caring and concerned– “golden rule”


186

Explain why nurse aides should not accept monetary tips for a health care service.

187

• Do not accept monetary tips– Residents are paying for service– You are paid to provide service– Do not discriminate regardless of

race, creed, color, age, financial resources

– Provide care based on need


188

• Do not accept monetary tips (continued)– Display tactful and courteous

refusal of tips– Display continued desire to be

helpful


190

Demonstrate skills supporting age appropriate behavior by encouraging the resident to make personal choices, and by providing and reinforcing other resident’s dignity.

191

Age Appropriate Age Appropriate BehaviorBehavior

• Dependent elderly residents are not children– If resident seen as a child– If resident treated as a

child– Then resident behaves as

a child

192

Age Appropriate Age Appropriate BehaviorBehavior(continued)(continued)

• Residents are treated as adults in manner appropriate to person’s age

• Age-appropriate considerations:– Recreational

activities– Social activities

– Style of dress– Hair style and

grooming

193


• Guidelines for Nurse Aide– Address resident in a dignified

way– Listen to what resident has to say– Converse with resident in an adult

manner– Respect resident’s privacy

194


• Guidelines for Nurse Aide (continued)

– Don’t ignore or humor resident– Explain what care you are going

to give– Promote resident independence– Treat resident as you would want

to be treated

195



– Encourage resident to make choices:• select clothing to wear• select books to read• select television programs to

watch

196



– Encourage resident to make choices:• select food and nourishments• select activities of interest• select friends

197



– Encourage resident to make choices:• select food and nourishments• select activities of interest• select friends

199

List six legal responsibilities of a nurse aide.

200

Legal IssuesLegal Issues• Authorized or based on law

– Legislated by state and federal government

– Liable if laws not obeyed• Fines• Imprisonment

201

Legal IssuesLegal Issues(continued)(continued)• No fear of breaking laws if nurse

aide:– performs only acts within scope of

nurse aide– keeps skills and knowledge current– keeps resident’s safety and well-

being in mind– understands directions for care

202

Legal IssuesLegal Issues(continued)(continued)

• No fear of breaking laws if nurse aide:– follows facility policy– does no harm to residents or their

belongings• Laws designed to protect public

welfare

CHAPT 1 203

Give examples of malpractice and negligence.

204

Legal Issues: Legal Issues: Civil Law Examples Civil Law Examples

Of TortsOf Torts• Malpractice

– Giving care for which you are not allowed legally to do

– Providing improper care

205


Of TortsOf Torts(continued)(continued)

• Malpractice– Example: nurse aide giving

medication– Example: nurse aide

performing treatment only allowed by licensed nurses

206

• Negligence– Unintentional wrong– Failure to perform in

reasonably prudent manner


Of TortsOf Torts(continued)(continued)

207

• Battery– Example: nurse aide striking

resident– Example: does procedure

resident refuses

Legal Issues: Civil Law Examples Of Torts(continued)

208

• Battery– Get informed consent

• Written – safest• Verbal• Gesture


209

• Invasion of privacy– Unnecessary exposure

of individual– Revealing personal

information without consent


210

• Invasion of privacy– Example: giving news media

information without resident’s permission

– Example: giving information to insurance company without permission


211

• False imprisonment– Restraining an individual– Restricting resident’s freedom


212

• False imprisonment– Example: use of physical

restraints without authorization or justification

– Example: preventing resident from leaving facility against resident’s will


CHAPT 1 213

• Defamation– False statements that cause a

resident to be ridiculed or cause damage to their reputation• Example: slander – spoken• Example: libel – written


………. 214

Identify the responsibilities of the nurse aide when a resident wishes to make a will.

….. 215

WillsWills• Legal document giving direction

on how resident wants property distributed after death– Refer requests to prepare will to

supervisor– Nurse aide may witness signing

of will• Check facility policy• Discuss with supervisor

217

Support the resident’s right to make personal choices to accommodate individual needs.

218

Residents’ RightsResidents’ Rights

• Basic Human Rights– Protected by Constitution– Laws clarify these rights:

• Right to be treated with respect• Right to live in dignity• Right to pursue a meaningful life• Right to be free of fear

219

Residents’ RightsResidents’ Rights(continued)(continued)

• Basic Human Rights (continued)– Behavior that infringes on these

rights:• addressing residents as children• using demeaning nicknames for

residents• leaving door open during bath• threatening a resident with harm

220

Describe the Resident’s Bill of Rights.

221

• The Resident’s Rights– Ethical and legal basis– Federal and state regulations– Posted in facility– Distributed on admission in

many facilities

Residents’ Rights(continued)

222

• Residents have the right to:– Considerate and respectful care– Obtain complete current

information concerning diagnosis, treatment and prognosis

– Receive information necessary to give informed consent prior to treatments or procedures


223

• Residents have the right to:– Considerate and respectful care– Obtain complete current

information concerning diagnosis, treatment and prognosis

– Receive information necessary to give informed consent prior to treatments or procedures


224

– Examine bill and receive explanation of charges

– Be informed of any facility rules and regulations

• Residents have the right to (continued):


225

Demonstrate behavior which maintains residents’ rights.

226

Behavior That Behavior That MaintainsMaintains

Residents’ RightsResidents’ Rights• Address as Mr., Mrs., or Miss

unless asked to use a specific name

• Never be rude or unkind– Never withhold social

responsiveness– Never ignore residents– Make eye contact

227

Behavior That Behavior That MaintainsMaintains

Residents’ RightsResidents’ Rights(continued)(continued)

• Never be rude or unkind (continued)– Allow to complete sentences prior

to leaving room– Don’t shut or slam door to quiet

resident– Never threaten or intentionally hurt

228

Maintain the resident’s environment and care through the appropriate nurse aide behavior.

229

• Explain care you plan to give

• Observe safety precautions

• Obtain proper consent after identifying resident

Behavior That MaintainsResidents’ Rights(continued)

230

• Treat all residents equally

• Promote positive attitudes

• Report errors to supervisor immediately

Behavior That MaintainsResidents’ Rights(continued)

231

Explain the purpose and value of a Resident Council.

232

Resident Council : Resident Council : advisory groupadvisory group

• Provides opportunity for discussion• Recommendations may be made

for:– Facility policies– Decisions regarding activities– Exploration of concerns– Resolving grievances

233

Resident Council : Resident Council : advisory groupadvisory group

(continued)(continued)• Gives residents a voice in

facility operations• Members

– residents– facility staff members

(you)– representatives from

community

235

Administer care which maintains the residents free from abuse, mistreatment, neglect, diversion of drugs, fraud, or misappropriation of property.

236

Mistreatment of the Mistreatment of the ElderlyElderly

Federal and State DefinitionsFederal and State Definitions

Abuse means willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish.

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Federal and State DefinitionsFederal and State Definitions (continued)(continued)

Neglect means a failure to provide goods and services necessary to avoid physical harm, mental anguish or mental illness.

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Misappropriation of property means deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a belonging or money without consent.

Mistreatment of the ElderlyFederal and State Definitions

(continued)

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Diversion of drugs means the unauthorized taking or use of any drug.

Mistreatment of the ElderlyFederal and State Definitions

(continued)

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Federal and State DefinitionsFederal and State Definitions(continued)(continued)

Drug means any chemical compound that may be used on or administered to humans or animals as an aid in the diagnosis, treatment or prevention of disease or other condition or for the relief of pain or suffering or to control or improve any physiological pathologic condition.

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Federal and State DefinitionsFederal and State Definitions(continued)(continued)

Fraud means an intentional deception or misrepresentation made by a person with knowledge that deception could result in some unauthorized benefit to himself or some other person. It includes any act that constitutes fraud under applicable Federal or State Law.

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Resident’s Right To Be Free Resident’s Right To Be Free From AbuseFrom Abuse

• Physical• Verbal• Sexual• Mental• Corporal Punishment• Involuntary Seclusion

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Signs of abuseSigns of abuse

• Fractures• Bruises of face, upper

arms, upper thighs, abdomen

• Fearfulness• Withdrawn, paranoid

behavior

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Examples of AbuseExamples of Abuse• Threatening resident• Frightening resident• Pinching, slapping, pushing,

grabbing or kicking resident• Withholding food or fluids• Restraining resident against

her/his will without apparent reason and doctor’s order

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Examples of AbuseExamples of Abuse(continued)(continued)

• Leaving resident in soiled linen or clothing

• Yelling angrily at or making fun of resident

• Refusing to reposition or give treatment

• Not answering call signal

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Examples of AbuseExamples of Abuse(continued)(continued)

• Humiliating resident• Making disparaging,

derogatory remarks• Sexual coercion• Sexual harassment• Verbal harassment

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• Identification of residents at risk for abusing other residents– Residents with history of

aggressive behavior

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• Identification of residents at risk for being abused– noisy individuals– wandering individuals– philandering individuals– socially/logistically isolated

individuals

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Report any instances of abuse to the appropriate facility/agency staff.

Reporting AbuseReporting Abuse

CHAPT 1 250

• If observed, stop abuse and report immediately to supervisor

• Cause for immediate dismissal of perpetrator and posted on NA I Registry if proven

• Know state law

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Assist in resolving grievances.

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AdvocatesAdvocates

• Plead cause of another• Resolve grievances• Protect resident’s rights

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AdvocatesAdvocates(continued)(continued)

• Advocates can be:–You and your co-workers–Member of resident’s family/support system

–Resident’s guardian–Ombudsman

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AdvocatesAdvocatesFacility policy components for Facility policy components for

resident grievanceresident grievance

• Acknowledgment• Prompt attempt to resolve• Resident kept apprised

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Discuss key elements of Federal Grievance Procedures.

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Grievance Grievance ProceduresProcedures

• Grievance Procedures

–Review federal grievance procedures

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Residents’ Personal Residents’ Personal PossessionsPossessions

• Protect personal items

• These possessions may be all they have

• Items may be impossible to replace

• Report observed thefts

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Residents’ Personal Residents’ Personal PossessionsPossessions


• Handle personal items carefully

• Add new items to list of resident’s belongings

• Mark all items with resident’s name

CNA Chapter Two

Health & Medicine

Transcript of CNA Chapter Two