Care Facility Regulations Quiz

Quiz 1

• Acute illness: rapid onset, short duration, expected recovery
• Chronic illness: no cure, preventable
• Terminal illness: illness where recovery is unlikely
• Functional nursing: focus on tasks and jobs
• Hospital patient: person receiving care in a hospital
• Long-term care resident: person residing in a long-term care center
• Assist living residence (ALR): provides housing, personal care, home-like setting; includes personal care (bathing, dressing, grooming), meals (cooking, eating), housekeeping, personal safety, and transportation
• Delegation: nurse directs nursing assistant to perform a task; requires nurse's knowledge and judgment; process includes assessment of needs, communication, guidance & assistance, and follow-up & feedback (remember ANCGAFF)
• Registered Nurse (RN): completed 2-4 year program, passed license test, delegates to LPN, CNA
• Licensed Practical Nurse (LPN): completed practical nursing program, passed license test, can delegate to CNA; used in California and Texas
• Licensed Vocational Nurse (LVN): used in California and Texas, can delegate to CNA
• Certified Nursing Assistant (CNA): passed nursing assistant training and competency evaluation program (NATCEP), performs tasks under supervision of a licensed nurse, cannot delegate

Nursing Team and Care Patterns

• Health team: includes many health care workers with skills and knowledge focusing on total person care (interdisciplinary team)
• Nursing team: RN, LPN/LVN, CNA; part of interdisciplinary team
• Nursing care patterns: depend on number of persons needing care, staff, and cost; include functional nursing, team nursing, primary nursing, case management, and patient-focused care. (remember FTPCP)

Long-Term Care Centers and Hospices

• Long-term care centers: patients usually recovering from illness or surgery, some need home care, others need care until able to go home, some need care until death
• Memory care unit: designed for people with Alzheimer's and dementia, unit is usually separate for safety
• Hospices: health care agency promoting comfort and quality life for the dying person and family (less than 6 months to live)

Paying for Healthcare

• Private insurance: bought by individuals and families
• Group insurance: bought by groups and organizations
• Medicare: federal program for those 65+ and younger with certain disabilities; Part A (hospital, SNF, hospice, and home care), Part B (doctor services, preventive care, ambulance services, medical supplies, mental health care, and some drugs) - voluntary, monthly premium
• Medicaid: jointly funded by federal and state, for low-income people
• Health insurance marketplace: service helps people shop for and enroll in affordable insurance (ACA/Affordable Care Act of 2010)

Resident Rights

• OBRA (Omnibus Budget Reconciliation Act of 1987): sets minimum standards for care quality in nursing centers
• Surveys: surveyors observe staff behavior and actions to ensure standards are met and promote quality of life, health, and safety
• Residents rights: to be treated with dignity and respect, exercise rights, be informed of rights and rules, access their records, refuse treatment, make advance directives, know their health status, manage personal and financial affairs, and have privacy rights

Competency Evaluation and Certification

• Competency evaluation: written and skills test (3 attempts after training)
• Nursing assistant registry: official record of completed NATCEP in each state
• Registry information: full name, identifying information, date NATCEP was passed, and information about findings of abuse, neglect, or dishonest use of property
• Certification: official recognition by a state that standards have been met; recertification required after 24 months without work
• Maintaining competence: nursing assistants require 12 hours of education every year. Those not working for 24 months need a new competency evaluation

Rules for Nursing Assistants

• Role of nursing assistant: assistant to nurse; reports observations and changes; performs only trained tasks, asks nurse for guidance if unsure; performs tasks within job description and state regulations
• Delegation rights: (Right person, Right task, Right circumstance, Right directions, Right supervision, and Right evaluation - remember TCPDCSE)

Role Limits

• Never give drugs: nurses provide medication/ state-approved programs may allow exceptions
• Never insert tubes or objects: exceptions exist for training procedures
• Never take oral or phone orders: have the doctor wait for a nurse (politely)
• Never diagnose or prescribe: nurses clarify information from the doctor; doctors and advanced practice nurses diagnose and prescribe
• Never supervise others: nurses are responsible for supervising; severe legal problems result if not followed
• Never ignore an order or request: politely explain limitations; cannot neglect the person's care

Safety Needs /Safety Measures

• Safety in health care: following center policy and care plan
• Patient identification: includes name, date of birth, ID number, room, and bed number
• Prevent burns: common causes include smoking, spilled hot liquids, electrical items, very hot water
• Poisoning: keep harmful substances away from containers, read labels carefully
• Choking: foreign body airway obstruction (FBAO); common cause is poorly chewed food
• Safety measures include wiping up spills, preventing unsafe situations (ex. a person sliding out of a wheelchair), offering help, following agency protocol, addressing electrical outlets or switches that don't work, water leaks, broken windows/doors/fixtures, odours or smells in patient areas, and more.

Other Important Terms

• Informed consent: process where the person receives information about a treatment or procedure and can decide whether to receive it or not
• Communication: different ways of giving consent: written, verbal, or implied; explained to the person; allowing person to refuse any procedure at any time
• Abuse: assault (attempting to touch without consent) or battery (touching without consent), boundary crossing, boundary violation (meets your needs, not the person's), defamation (false statement to a third person), libel (false statement in writing), slander (false statement verbally), false imprisonment (unlawful restraint of movement), ethics (knowing right vs wrong conduct), medical battery (giving treatment to someone who refused), malpractice (giving wrong care), unintentional torts, and intentional torts
• Criminal laws: acts violating rules like murder, rape, and robbery (harm was intended)
• Civil laws (family, relationships): concerned with relationships between people (tort); elder abuse (negligent act by a caregiver causing harm or risk of harm to an older adult) - types: physical, neglect, financial, emotional/psychological, sexual, and abandonment
• Workplace violence: actions towards persons at work, when on duty
• Cleaning procedures: including wiping spills, using paper towels, cleaning floors with a mop and disinfectant/ sanitizing agents
• Disinfection: methods of cleaning/ removing pathogenic substances (chemical disinfectants)

Professional Appearance

• Uniforms: must follow agency dress codes
• Jewelry: limited to simple, allowed jewelry
• Hair: simple style away from the face
• Nails: clean, short, and neatly shaped; no non-natural nails; light-colored polish is sometimes allowed
• Makeup: moderate in color and amount
• Fragrances: never allowed; perfumes, colognes, or aftershave are not permitted

Work Ethics

• Caring: showing concern for the person
• Cheerful: greeting others pleasantly
• Conscientious: following instructions carefully and protecting the person's property, belongings
• Considerate: respecting the person's feelings
• Cooperative: helping others willingly during busy times
• Courteous: being polite
• Dependable: arriving on time and completing tasks
• Empathy: put self in the other person's place
• Enthusiastic: being excited about the work performed
• Honest: accurately reporting care, observations, and errors
• Patient: coping calmly with problems or delays
• Respectful: treating others with dignity

Planning and Prioritization

• Planning work: deciding what to do and when; prioritizing most important tasks
• Meals and breaks: usually 30 minutes or 15 minutes, nurse should be on time when leaving or returning from breaks.
• Conflict resolution: dealing with problems or opposing ideas or conflicting interest to resolve and find solutions to problems.

Job Safety and Responsibility; Resigning

• Job safety: always prioritizing protection from harm, follow agency procedures, and know your capabilities and limitations
• Resigning from a job: providing 2 weeks’ of notice, explaining reasons behind leaving the job
• Personal matters: personal issues like making phone calls or visitors must be managed during breaktimes with no interference to training.

Other

• Chapter 5 key terms: gossip, stress, harassment (causes harm, trouble, and offense)
• Chapter 11 key terms: severe and life-threatening issues and states that have occurred such as coma, dementia, suffocation, elopement, paralysis, disaster, and others
• RACE (Rescue, Alarm, Contain, Extinguish) and PASS (Pull, Aim, Squeeze, Sweep).

Communication

• Informed consent: different ways of giving consent: written, verbal, or implied; explained to the person; allowing person to refuse any procedure at any time
• Other communication issues: (not allowed) (gossip, stress, and harassment)

Transmission-Based Precautions

• Contact: single room preferred or 3 ft separation
• Droplet: mask upon entry, other PPE as needed
• Airborne: special room (or transfer to agency with one), and respirator upon entry, other PPE as needed.