Understand residents’ rights , advocacy, and grievance procedures.

1.03 NF

Understand residents rights, advocacy, and grievance procedures. Unit A Nurse Aide Workplace FundamentalsEssential Standard 1.00 Understand the range of function, legal and ethical responsibilities of the nurse aide within the healthcare system. Indicator 1.03 Understand residents rights, advocacy, and grievance procedures.

11.03Nursing Fundamentals7243 Nursing Fundamentals1Nursing Fundamentals 72433Basic Human RightsProtected by ConstitutionLaws clarify these rights:Right to be treated with respectRight to live in dignityRight to pursue a meaningful lifeRight to be free of fear1.03

Nursing Fundamentals 72434Basic Human RightsBehaviors that infringe on human rights:addressing residents as childrenusing demeaning nicknames for residentsleaving door open during baththreatening a resident with harm1.03

Nursing Fundamentals 72435Ethical and legal basisStates have adopted or codified these rights into lawPosted in facilityDistributed on admission in many facilitiesOBRA 1987 Residents Bill of Rights

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Nursing Fundamentals 72436Residents have the right to:Be treated with consideration, respect, and full recognition of personal dignity.OBRA 1987 Residents Bill of Rights

1.03 Nursing Fundamentals 72437Residents have the right to:receive care, treatment, and services which are adequate and in compliance with rulesOBRA 1987 Residents Bill of Rights

1.03 Nursing Fundamentals 72438Residents have the right to:receive a statement of services and chargesOBRA 1987 Residents Bill of Rights

1.03 Nursing Fundamentals 72439Residents have the right to:have on file the attending physicians proposed schedule of medical treatment.OBRA 1987 Residents Bill of Rights

1.03 7243 Nursing Fundamentals1.03 Understand residents' rights, advocacy, and grievance procedures9Nursing Fundamentals 724310Residents have the right to:privacyOBRA 1987 Residents Bill of Rights

1.03 7243 Nursing Fundamentals1.03 Understand residents' rights, advocacy, and grievance procedures10Nursing Fundamentals 724311Residents have the right to:Be free from mental and physical abuse, and free from restraint (except in an emergency)OBRA 1987 Residents Bill of Rights

1.03 7243 Nursing Fundamentals1.03 Understand residents' rights, advocacy, and grievance procedures11Nursing Fundamentals 724312Residents have the right to:receive reasonable response to all requestsOBRA 1987 Residents Bill of Rights

1.03 7243 Nursing Fundamentals1.03 Understand residents' rights, advocacy, and grievance procedures12Nursing Fundamentals 724313Residents have the right to:associate and communicate privatelyOBRA 1987 Residents Bill of Rights

1.03 7243 Nursing Fundamentals1.03 Understand residents' rights, advocacy, and grievance procedures13Nursing Fundamentals 724314Residents have the right to:manage financial affairsOBRA 1987 Residents Bill of Rights

1.03 7243 Nursing Fundamentals1.03 Understand residents' rights, advocacy, and grievance procedures14Nursing Fundamentals 724315Residents have the right to:private visits from spouseOBRA 1987 Residents Bill of Rights

1.03 7243 Nursing Fundamentals1.03 Understand residents' rights, advocacy, and grievance procedures15Nursing Fundamentals 724316Residents have the right to:privacy in the resident room. Personal items should not be searched.OBRA 1987 Residents Bill of Rights

1.03 7243 Nursing Fundamentals1.03 Understand residents' rights, advocacy, and grievance procedures16Nursing Fundamentals 724317Residents have the right to:present grievances and recommend changesOBRA 1987 Residents Bill of Rights

1.03 7243 Nursing Fundamentals1.03 Understand residents' rights, advocacy, and grievance procedures17Nursing Fundamentals 724318Residents have the right NOT to:perform services for the facilityOBRA 1987 Residents Bill of Rights

1.03 7243 Nursing Fundamentals1.03 Understand residents' rights, advocacy, and grievance procedures18Nursing Fundamentals 724319Residents have the right to:retain, store, and use personal clothing and possessionsOBRA 1987 Residents Bill of Rights

1.03 7243 Nursing Fundamentals1.03 Understand residents' rights, advocacy, and grievance procedures19Nursing Fundamentals 724320Residents have the right NOT to:be randomly discharged or transferred from the facilityOBRA 1987 Residents Bill of Rights

1.03 7243 Nursing Fundamentals1.03 Understand residents' rights, advocacy, and grievance procedures20Nursing Fundamentals 724321Residents have the right to:be notified if the facility is given a provisional licenseOBRA 1987 Residents Bill of Rights

1.03 7243 Nursing Fundamentals1.03 Understand residents' rights, advocacy, and grievance procedures21Nursing Fundamentals 724322Behaviors That Uphold Residents RightsAddress as Mr., Mrs., or Miss unless asked to use a specific nameNever withhold social responsivenessNever ignore residentsMake eye contact1.03

Nursing Fundamentals 724323

Behaviors That UpholdResidents Rights

Make eye contactAllow to complete sentences prior to leaving roomDont shut or slam door to quiet residentNever threaten or intentionally hurt1.03


Behaviors That UpholdResidents Rights

Encourage socialization (meal-time)Assist to activities/meetings/churchParticipate in planned activitiesHelp with phone calls, cards, mail

1.03 7243 Nursing Fundamentals1.03 Understand residents' rights, advocacy, and grievance procedures24Nursing Fundamentals 724325

Behaviors That Uphold Residents Rights

Explain care you plan to give Observe safety precautionsObtain proper consent after identifying resident

1.03 Nursing Fundamentals 724326


Treat all residents equallyPromote positive attitudesReport errors to supervisor immediately1.03 Nursing Fundamentals 724327


Handle personal items carefullyAdd new items to list of residents belongingsMark all items with residents name

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Sit when feeding a residentOffer a clothing protector; do NOT automatically place clothing protector on the resident prior to eatingGive resident centered, not task centered care

1.03 Nursing Fundamentals 724329Behaviors That Uphold Residents RightsAddress resident in a dignified wayListen to what resident has to sayConverse with resident in an adult mannerRespect residents privacy

1.03 Nursing Fundamentals 724330Behaviors That Uphold Residents RightsAdult residents must be treated as adults. Give age appropriate care.Age-appropriate considerations:Style of dressHair style and groomingRecreational activitiesSocial activities

1.03 7243 Nursing Fundamentals1.03 Understand residents' rights, advocacy, and grievance procedures30Nursing Fundamentals 724331Age Appropriate CareGuidelinesDont ignore or humor residentExplain what care you are going to givePromote resident independenceTreat resident as you would want to be treated

1.03 Nursing Fundamentals 724332Age Appropriate CareGuidelinesEncourage resident to make choices:select clothing to wearselect books to readselect television programs to watch

1.03 Nursing Fundamentals 724333Age Appropriate CareGuidelinesEncourage resident to make choices:select food and nourishmentsselect activities of interestselect friends

1.03 Nursing Fundamentals 724334Age Appropriate CareGuidelinesRecognize value of past experience (validate the resident)Praise age appropriate accomplishmentsEncourage adult behavior

1.03 Nursing Fundamentals 724335Right to be Free from RestraintUnder Omnibus Budget Reconciliation Act 1987 (OBRA), residents have a right to be free from restraints. 1.03 Nursing Fundamentals 724338Facts Regarding Restraints

Physical Restraintsalso known as postural supports protective devices1.03 Nursing Fundamentals 724340Facts Regarding Restraints

IN THE PAST! Restraints commonly used to safeguard residents who wander, prone to falls, are violet, at risk of hurting themselves, or pulling tubes out Abuse of restraints led to new restrictions and laws on use of restraints1.03

Nursing Fundamentals 724347Facts Regarding Restraints

1.03 Acceptable Reasons for Use of Restraints When alternatives to restraints are not effective, however, and the physician orders restraints, it becomes essential for the nurse aide to know the risks involved in caring for these residents.Nursing Fundamentals 724348Facts Regarding Restraints

1.03 Types of acceptable physical restraints if ordered appropriatelySide rails on a bed Special chairs such as geriatric chairs Lap cushions or lap tray Vests and jacket restraints Safety belt restraints Soft ties for wrist and anklesNursing Fundamentals 724354Restraint AlternativesAnswering call signal promptly

1.03 Nursing Fundamentals 724355Restraint AlternativesExercise and outdoor activities

1.03 Nursing Fundamentals 724356Restraint AlternativesConsistent reality orientation or validation and staff assignments

1.03 Nursing Fundamentals 724358Restraint AlternativesBarriers such as STOP SIGNS posted on doors discourages confused residents from wandering into the area

1.03 Nursing Fundamentals 724359Restraint AlternativesPartial bed rails prevent residents from rolling out of bed while allowing them freedom to get up if they wish to

1.03 Nursing Fundamentals 724360Restraint AlternativesPositioning devices and wedges such as wedge cushions placed in wheelchairs to prevent forward sliding

1.03 Nursing Fundamentals 724361Restraint AlternativesFurniture such as low beds, rocking chairs, or recliners

1.03 7243 Nursing Fundamentals1.03 Understand residents' rights, advocacy, and grievance procedures61Nursing Fundamentals 724362Restraint AlternativesEasy release belts reminds resident of safety but the resident can release if desired

1.03 1.03Nursing Fundamentals 724365 SKILL 1.03AApply Personal Electronic Warning Device

Training Lab AssignmentEngage in the Skill Acquisition Process for:Nursing Fundamentals 724366The Last Resort!Occasionally, alternatives do not work and restraints are ordered.1.03 Nursing Fundamentals 724367Using RestraintsOrdered by the physician when necessary to treat a medical symptom or provide emergency medical treatment choice of restraint based on multidisciplinary evaluation for the least restrictive measure

1.03 Nursing Fundamentals 724368Using RestraintsSafety Measures and Considerations When APPLYING Restraints1.03 Nursing Fundamentals 724369Using RestraintsSafety measures and Considerations APPLYING Restraints:Use reassurance in an attempt to calm agitated residents

1.03 Nursing Fundamentals 724370Using RestraintsSafety measures and Considerations APPLYING Restraints:Be sure there is a physicians order for restraint use and that it is in the care plan before applying restraint

1.03 Nursing Fundamentals 724371Using RestraintsSafety measures and Considerations APPLYING Restraints:Use the correct type of restraint and apply according to manufacturers directions and only after you have received instructions in its use

1.03 Nursing Fundamentals 724372Using RestraintsSafety measures and Considerations APPLYING Restraints:Secure enough assistance to apply restraints quickly to avoid injury

1.03 Nursing Fundamentals 724373Using RestraintsSafety measures and Considerations APPLYING Restraints:Attach restraints to bed frame (movable part of bed), not to side rails or other parts of the bed

Leave an 8 inch tail

1.03 Nursing Fundamentals 724374Using RestraintsSafety measures and Considerations APPLYING Restraints:Use slip knot to tie restraint for quick release

1.03 Nursing Fundamentals 724375Using RestraintsSafety measures and Considerations APPLYING Restraints:Protect bony areas and skin by padding them prior to applying restraint

1.03 Nursing Fundamentals 724376Using RestraintsSafety measures and Considerations APPLYING Restraints:Adjust restraint so that it allows some movement, but is secure and comfortable place open flat hand between the resident and the restraint for restraints around the torso.1.03 Nursing Fundamentals 724377Using RestraintsSafety measures and Considerations APPLYING Restraints:Make sure breasts or skin are not caught in the restraint.

1.03 Nursing Fundamentals 724378Using RestraintsSafety Measures and Considerations AFTER Restraints are applied1.03 Nursing Fundamentals 724379Using RestraintsSafety measures and Considerations AFTER Applying Restraints:Be sure resident NEEDS are MET1.03 Nursing Fundamentals 724380Using RestraintsSafety measures and Considerations AFTER Applying Restraints:Special attention must be paid to basic needsElimination- assist in toiletingHydration offer fluids

1.03 Nursing Fundamentals 724381Using RestraintsSafety measures and Considerations AFTER Applying Restraints:Call signal must be in reach and the residents signal for help must be answered immediately (STAT)1.03

Nursing Fundamentals 724382Using RestraintsSafety measures and Considerations AFTER Applying Restraints:Check on resident every 15 minutes

1.03 Nursing Fundamentals 724383Using RestraintsSafety measures and Considerations AFTER Applying Restraints:Every 15 minutes:Pulse, color, and temperature of any restrained extremity

1.03 7243 Nursing Fundamentals1.03 Understand residents' rights, advocacy, and grievance procedures83Nursing Fundamentals 724384Using RestraintsSafety measures and Considerations AFTER Applying Restraints:Every 15 minutes:Breathing of resident with vest (torso) restraint

1.03 Nursing Fundamentals 724385Using RestraintsSafety measures and Considerations AFTER Applying Restraints:Every 2 hours:Remove restraint for 10 minutes and reposition resident

1.03 Nursing Fundamentals 724386Using RestraintsSafety measures and Considerations AFTER Applying Restraints:In an emergency, notify supervisor immediately via call bell, stay with the resident, and loosen restraint.1.03 Nursing Fundamentals 724387Using RestraintsEMERGENCY EXAMPLES:Unable to detect a pulse in extremityExtremity cold, pale, blue-tinged, gray, red, purple in colorResident complains of pain, discomfort, numbness, or tingling in restrained partBreathing is impaired with vest or safety belt restraintURGENT!!! TAKE ACTION1.03 Nursing Fundamentals 724388Using RestraintsObservations and reporting should include:Color and condition of skin under restraintPulse rate, color and temperature of skin in restrained extremity1.03

Nursing Fundamentals 724389Using RestraintsObservations and reporting should include (continued):Any complaints about restrained partRed or injured skin areas under restraintRespiratory rate and color of skin with vest and safety belt restraints1.03

1.03Nursing Fundamentals 724390 SKILL 1.03BApply Restraints

Training Lab AssignmentEngage in the Skill Acquisition Process for:Resident AdvocatesNursing Fundamentals 7243911.03Nursing Fundamentals 724392Resident Advocates1.03 What does an advocate do?Plead cause of anotherResolve grievancesProtect residents rights

Nursing Fundamentals 724393Resident Advocates1.03 Advocates can be:You and your co-workersMember of residents family/support systemResidents guardianOmbudsmanNursing Fundamentals 724394Resident Advocates1.03 Ombudsman Program - History The national network of long term care ombudsman programs was established in response to the many problems found in nursing homes. The program was first introduced in 1971 as part of President Nixons eight-point plan to improve nursing home conditions. This plan established several demonstration ombudsman projects, funded and supervised in the beginning through the U.S. Public Health Service.

In 1973, administration responsibility for these projects was transferred within the Department of Health, Education and Welfare to the Administration on Aging, within the Office of Human Development Services. By 1975, all state agencies on aging were invited to submit proposals to promote effective statewide ombudsman programs. Money was then made available for this voluntary state program.

The Long Term Care Ombudsman Program has been in existence in North Carolina since 1976.

A favorable response to the ombudsman program led to its formal adoption in the 1978 Amendments to the Older Americans Act. The Older Americans Act (federal law) requires that each state establish and maintain a Long Term Care Ombudsman Program to advocate on behalf of residents in nursing and adult care homes (rest homes, assisted living). In 1989, the North Carolina General Assembly enacted legislation for the Long Term Care Ombudsman Program (G.S. 143B-181.15-25) which incorporated federal mandates in the Older Americans Act for the Program and clearly define the roles and responsibilities of the state and regional long term care ombudsmen. In North Carolina, the State Long Term Care Ombudsman Program is located in the Department of Health and Human Services, Division of Aging and Adult Services. The Regional Long Term Care Ombudsman Programs are housed in the 17 Area Agencies on Aging.Last updated June 2, 2010 LTC Ombudsman Program Nursing Fundamentals 7243951.03 Nursing Fundamentals 724396Resident Right to Voice Grievances1.03 Regarding services furnishedRegarding services not furnishedWith respect to behavior of othersNurse aide must report grievances to supervisorNursing Fundamentals 724397Facility policy components for resident grievance1.03 AcknowledgmentPrompt attempt to resolveResident kept apprised

Nursing Fundamentals 724398Resident Council: Advisory Group1.03

Nursing Fundamentals 724399Resident Council: Advisory Group1.03 Provides opportunity for discussionRecommendations may be made for:Facility policiesDecisions regarding activitiesExploration of concernsResolving grievances Nursing Fundamentals 7243100Resident Council: Advisory Group1.03 Gives residents a voice in facility operationsMembersresidentsfacility staff members to include Nurse Aidesrepresentatives from communityThe Bottom LineNursing Fundamentals 72431013.01Resident has a right to voice grievances without fear of retaliation or discrimination!

Understand residents rights, advocacy, and grievance procedures. 102 END 1.031.03Nursing Fundamentals7243 Nursing Fundamentals1021.03 Understand residents' rights, advocacy, and grievance procedures

Understand residents’ rights , advocacy, and grievance procedures.

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