Nurse Aide Tasks and Limitations

Nurse Aide Tasks and Responsibilities

• Caring for the resident's living space
• Maintaining resident's nourishment record
• Keeping records and communicating with the team
• Promoting resident rights
• Maintaining confidentiality
• Understanding time management and its importance
• Identifying role in resident's safety
• Attending in-services and training

Limitations of a Nurse Aide

• Not allowed to insert or remove tubes
• Not allowed to give tube feedings
• Not allowed to change sterile dressings
• Not allowed to diagnose illnesses or prescribe treatment or medications
• If unsure, do not perform the task

Work Ethics and STNA Behaviors

• Dependability: reporting to work on time and keeping absences to a minimum
• Keeping promises to residents and others
• Completing assigned tasks promptly
• Reporting on/off duty and breaks per facility policy
• Being respectful: watching tone and avoiding swearing
• Maintaining personal cleanliness and neatness

Rehabilitation and Restorative Care

• Goal: to help residents regain and maintain their highest level of functioning
• Acute Care: goal is to provide temporary care until the resident's condition improves

Nurse Aide Reporting

• Reports to the nurse

Communication with Team Members

• Communicating resident conditions, changes, and complaints
• Communicating urgently when necessary
• Considering cultural differences in communication, including language barriers, religion, and personal space

Infection Control

• Breaking the chain of infection
• Preventing the transmission of bloodborne pathogens

Bloodborne Pathogens

• Transmitted through blood
• Examples: AIDS, hepatitis

Symptoms and Signs of Infection

• Reviewing the elderly and their susceptibility to infections
• Understanding the chain of infection:
  • Infectious agent
  • Reservoir
  • Portal of exit
  • Mode of transmission
  • Portal of transmission
  • Portal of entry
  • Host

Hand Washing and Gloving

• Steps for handwashing:
  • Before and after contact with resident
  • Using enough soap to produce lather
  • Rubbing soap vigorously over all surfaces of hand and wrists
  • Holding hands lower than elbows
  • Rinsing hands and wrists thoroughly
  • Drying hands and wrists with clean paper towel
  • Using clean towel to turn off faucet
• Steps for using an alcohol-based hand sanitizer:
  • Applying rub to palm of one hand
  • Rubbing hands together
  • Covering all surfaces of hands
  • Rubbing until hands are completely dry
• When to use an alcohol-based hand rub:
  • When hands are not visibly soiled
  • Before direct contact with resident
  • After contact with resident's care setting
  • After removing gloves
• When to handwash:
  • When hands are visibly dirty or soiled with blood, body fluids, secretions, or excretions
  • Before eating
  • After using the restroom

Personal Protective Equipment (PPE)

• Using PPE during precautions
• Types of PPE:
  • Mask
  • N95
  • Gown
  • Gloves
  • Face shields
  • Goggles
• Donning and doffing PPE:
  • Putting on and taking off PPE correctly

Isolation Types

• Knowing the types of isolation and when each is necessary

Standard Precautions

• Infection control practices that apply to care of all residents, regardless of infection status

Role and Responsibilities of Nurse Aide (NA)

• Purpose of NA role in Activities of Daily Living (ADLs)
• Responsible for:
  • Caring for the resident's living space
  • Residents' nourishment
  • Record keeping and communication
  • Promoting resident rights
  • Maintaining confidentiality
  • Time management and importance
  • Residents' safety
  • Attending in-services and training

Activities of Daily Living (ADLs)

• Dress and undress
• Bathe and maintain hygiene
• Assist with mobility needs
• Assist with elimination needs
• Eating and drinking
• Bed mobility

Care of the Resident's Living Space

• Make bed
• Maintain a safe and clean environment
• Ask permission to enter
• Arrange for comfort and convenience to promote independence
• Create homelike environment

Nourishment

• Assure each resident receives correct diet
• Assist the resident with meals
• Fill the resident's water pitcher or assist the resident to obtain water and fluids
• Calculate and record meal percentage on dietary record sheet
• Assist residents to and from the dining room

Record Keeping and Communication

• Record intake and output
• Record vital signs
• Record weight of resident
• Assist in admission, transfer, and discharge of residents
• Document care on flow charts or other facility documents
• Review the purpose of assignment sheets
• Complete assignment or worksheet
• Report on/off duty & breaks
• Provide input to assessment and care plan

Confidentiality

• Definition: privacy of medical and personal information
• Confidential information in Long-Term Care Facilities (LTCFs)
• Resident care is not discussed outside of the facility
• All resident records are confidential
• Federal regulation: Health Insurance Portability and Accountability Act (HIPAA)

Time Management

• Organization of work
• Prioritizing assignment
• Resident/resident safety is main priority of NA
• Guard against accidents
• Prevent fires and other emergencies
• Know what to do in an emergency

In-Service Requirement (Continuing Education)

• Each nurse aide is expected to attend in-service as required by their employer (in LTCF)
• Current requirement is 12 hours annually

Federal Law: Omnibus Budget Reconciliation Act of 1987 (OBRA)

• Applies to all 50 states
• Purpose is to improve the quality of life of nursing home residents
• Sets training and competency evaluation requirements for nursing assistants (75 hours minimum with 16 of this as clinical)
• Competency evaluation or state testing written & skills
• Nursing Assistant Registry

Delegation

• Nurse practice acts give nurses certain responsibilities and legal authority to perform nursing tasks
• Under the rules of delegation, the nurse may authorize the NA to perform certain tasks
• The nurse is legally accountable for the task
• Delegated tasks must be within the legal limits of what a NA can do

Five Rights of Delegation

• Right task
• Right circumstances
• Right person
• Right directions and communication
• Right supervision

Behaviors of NA

• Dependability
  • Reports to work on time
  • Keeps absences to a minimum
  • Keeps promises to residents and others
  • Completes assigned tasks promptly
  • Reports on/off duty & breaks per facility policy
• Accuracy
  • Follows instructions and steps of procedures according to facility's policy and procedure manual
• Sensitivity and respect for the feelings and needs of others
• Cooperation with other departments and coworkers
• Communication with charge nurse
• Honesty
• Proper speech and language
• Handles personal matters properly
• Cell phone and electronic devices use per facility policy
• Residents' phone are not used by staff

Appearance

• Personal hygiene
• Professional uniform
  • Proper fit
  • Clean and pressed (free from wrinkles)
  • Appropriate underclothing: fit, style & color
• Fingernails should be short, neat, and clean according to facility policy
• No artificial nails or nail jewelry
• Hair should be controlled (out of field of work) and of a naturally occurring color - worn according to facility policy
• Jewelry and body art should be limited according to facility policy
• Comfortable non-permeable shoes with an appropriate style
• Facial hair including mustaches and beards should be neat and trimmed
• Name tag placed appropriately

Wheelchair Safety

• Identify parts of wheelchair: footrests, armrests, seat, brakes
• Check brakes, tires, wheel spokes, and casters before use
• Ensure resident's feet are on footplates before pushing or repositioning
• Push chair forward when transporting resident, lock both brakes before transfer
• Remind resident to keep brakes locked when not moving
• Do not let resident stand on footplates or let footplates fall back onto legs
• Ensure resident has necessary wheelchair accessories per care plan

Removing and Collapsing Wheelchair

• Know how to remove footrests and collapse wheelchair
• Remove armrests (if removable) when transferring to bed, commode, tub, or car

Lifts: Types and Purposes

• Manual or hydraulic lifts, electric lifts, assist to stand lift, and many types of lifts and pads
• Lifts are used to move residents who cannot assist in their own transferring and/or are too heavy for staff to lift safely

Lifts: Safety Precautions

• Ensure lift works and check weight limit of lift (and resident's weight)
• Check sling, straps, hooks, and chains are in good repair
• Never operate a mechanical lift without another staff member's assistance
• Lock all brakes after positioning lift (if applicable)
• Position sling pad (usually even with back of resident's knee) or per directions
• Secure resident in straps or slings and ask them to place arms across chest
• Raise lift slowly and open legs of lift before transfer (wide base of support)
• Reassure resident while transferring

Ambulation Devices: Safety Concerns

• Devices used for walking should have skid-proof tips
• Residents should wear skid-proof shoes
• Follow plan of care to determine which device resident uses
• Use resident's personal walker, cane, crutches

Safety Devices: Walker, Crutches, Canes

• Walkers: stand still, place walker forward, step forward toward walker, repeat
• Crutches: have space between top of crutch and axilla, elbows flexed slightly, weight supported on palms of hands
• Canes: many types, quad cane may be more stable, place cane on strong or unaffected side

Safety Techniques

• Resident should wear skid-proof shoes when walking
• Move slowly when assisting resident to change position to avoid dizziness
• Assist on resident's weak side and have them use strong side for holding handrails or cane
• When assisting visually impaired resident, walk slightly ahead and allow resident to hold arm
• Use a transfer (gait) belt for safety

Wheelchair Safety

• Clean the wheelchair according to facility policy.
• Keep blankets and tubing away from the wheels.
• Push the wheelchair from behind, except when entering or exiting elevators, then pull it backwards.
• When moving a resident down a steep ramp, take the wheelchair or geriatric chair down backwards.
• Glance over your shoulder to ensure direction and prevent collisions.
• Slow down at corners and look before moving the wheelchair to prevent collisions.

Lifts

• Types: manual or hydraulic lifts, electric lifts, assist to stand lift.
• Purposes: to move residents who cannot assist in their own transferring and/or for residents who are too heavy for staff to lift safely.
• Safety precautions:
  • Make sure the lift works.
  • Check the weight limit of the lift (and the resident's weight).
  • Ensure the sling, straps, hooks, and chains are in good repair.
  • Never operate a mechanical lift without the assistance of another staff member.
  • Lock all brakes after positioning the lift (if applicable).
  • Position the sling pad correctly (usually even with the back of the resident's knee).
  • Secure the resident in the straps or slings.
  • Ask the resident to place their arms across their chest.
  • Raise the lift slowly.
  • Open the legs of the lift before transfer (wide base of support).
  • Reassure the resident during transfer.

Ambulation Devices: Safety Concerns

• Devices used for walking should have skid-proof tips.
• Residents should wear skid-proof shoes.
• Follow the plan of care to determine which device the resident uses.
• Use the resident's personal walker, cane, or crutches.

Safety Devices

Walker

• Stand still, place the walker forward with all four legs solidly on the floor, step forward toward the walker, and repeat.
• Many types of walkers are available for different needs.
• Practice:
  • Walking.
  • Sitting down and standing up from a chair with a walker.
  • Assisting another to walk with a walker.
  • How to adjust the height of a walker.

Crutches

• There should be space between the top of the crutch and axilla.
• The elbows should be flexed slightly, and the weight supported on the palms of the hands.
• Practice:
  • Walking with crutches.
  • Adjusting crutches to fit.

Cane

• Many types of canes are available.
• A quad cane may be more stable for some conditions.
• The cane is placed on the strong or unaffected side.
• Practice:
  • Walking.
  • Adjusting the cane.
  • In/out of a chair.

Safety Techniques

• For walking the resident:
  • Wear skid-proof shoes.
  • Assist on the resident's weak side.
  • Have the resident use their strong side for holding handrails or a cane.
• When assisting a visually impaired resident:
  • Walk slightly ahead and allow the resident to hold your arm.
  • Explain hazards in the path as necessary.
• Use a transfer (gait) belt for safety.

Technique when Assisting to Walk

• Help the resident stand.
• Assist the resident to walk, ensuring safety and support.