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DESCRIBE HOW FEDERAL AND STATE REGULATIONS RELATE TO THE NURSING ASSISTANT. A. The Omnibus Budget and Reconciliation Act (OBRA): 1. 1987 Federal law a. sets the standards for NA training and registration b. identifies skills and establishes minimum requirements. B. The federal law (OBRA) identifies...

DESCRIBE HOW FEDERAL AND STATE REGULATIONS RELATE TO THE NURSING ASSISTANT. A. The Omnibus Budget and Reconciliation Act (OBRA): 1. 1987 Federal law a. sets the standards for NA training and registration b. identifies skills and establishes minimum requirements. B. The federal law (OBRA) identifies standards of care: 1. For all residents of long-term care facilities 2. Requires an annual survey of the facility to monitor the standards 3. Implemented by state agencies. C. Individuals taking the NA or the home health aide (HHA) course: 1. Must complete a background study and fingerprinting 2. Background and fingerprinting information is on the Department of Human Services (DHS) website 3. The DHS website has information on what will disqualify a person a. if disqualified, no direct care may be given to a resident, client, or patient. II. LIST PERSONAL QUALIFICATIONS FOR BEING A NURSING ASSISTANT. A. Appropriate Behavior: 1. Honesty: will not lie 2. Patience: calm 3. Caring: concern 4. Courteous: polite 5. Dependable: reliable 6. Accountable: responsible for ones' own actions 7. Respectful: shows consideration. B. Positive Attitude: 1. Respect yourself 2. Display dignity toward all individuals 3. Take pride in what you do 4. Show maturity by controlling emotions 5. Display cooperation 6. Practice high standards in your role as a NA. Personal Health: 1. Maintain good general health a. Keep free from back injuries b. Need the ability to lift residents 2. 3. Keep good personal hygiene: bath or shower Maintain a clean and neat appearance which includes a. clean uniform shoes clean C. short clean fingernails - no artificial nails 4. Practice stress-reducing activities 5. Wear appropriate clothing for the workplace. Ill. DISCUSS PRODUCTIVE WORK HABITS FOR THE NURSING ASSISTANT. deur de concre Rest wry to 1u\K to resident A. Define the role of the NA: 1. Care is performed under the direct supervision of a nurse 2. Male and female NAs care for both male and female residents 3. NAs are expected to care for any resident in a facility a. care is given regardless of gender, cultural, spiritual, personal or ethnic differences 4. When caring for a resident, the NA must be able to a. follow facility policies and procedures b. work within guidelines of the job description C. provide personal care d. measure vital signs e. be proactive about safety measures f. follow infection control standards g. practice effective communication h. assist with daily living activities 5. It is NOT appropriate for the NA to a. give medications b. take doctor's orders c. perform sterile procedures d. perform any procedure that the NA has not been taught e. perform a task prohibited by the facility. B. Define the organizational chart: 1. Shows the levels and lines of authority 2. Shows who handles distinct functions in a nursing home 3. The NA is responsible to the charge nurse 4. The charge nurse is a registered nurse (RN) or a licensed practical nurse (LPN).C. Functions of a team include: 1. Providing the best possible care to meet the emotional, physical and social needs of the resident 2. Achieving goals 3. Working together with others such as the resident, family, nurses, doctors, dietitians, etc. 4. Supporting each other on the team 5. Coordinating work. D. Benefits of working as a team include: 1. Continuity of care for the resident 2. Quality care for the resident 3. Personal job satisfaction. E. Describe the process of becoming a NA: To get a position as a NA you must a. pass a NA course b. pass the NA written and skills competency test c. get placed on the Minnesota NA Registry (NA/R) 2. Complete a job application a some job applications may be completed online b. the job application should be neat with no spelling errors honest accurate 3. Some job openings may need a a. cover letter b. resume 4. When you attend a job interview а. arrive early b. have a clean and neat appearance c. have a positive attitude d. give honest answers e. have good posture 5. Examine the job description a. a job description is a detailed list of tasks and responsibilities b. includes a list of what is expected of the NA c. ask questions if the job description is not understood. F. The following are expectations of the employer: 1. Focus on the resident 2. Report for work on time 3. Avoid excessive absence from work 4. Be flexible 5. Observe break and meal times 8 / Unit 1 Updated 2019杰 6. If ill, report illness according to facility policy 7. 8. Be free of drugs and alcohol use Prioritize duties 9. Complete in-service education a. according to facility requirements b. annual requirements are at least 12 hours. G. You must keep your NA registration current by: 1. Working at least 8 hours every 24 months as a NA a. includes performing paid NA tasks for a licensed health care provider 2. Notify NA Registry of name or address change 3. Report employment to the NA Registry. IV. INCORPORATE PERSONAL VALUES WITH ETHICS AND ETIQUETTE. A. Ethics are rules and principles: 1. Ethics assists one in making decisions about what is right and wrong. B. The Code of Ethics is a formal guideline that: 1. Governs the behavior of caregivers 2. Ensures the welfare of the individuals in their care. C. The following make up ethical behaviors for the NA: 1. Promote health, independence, safety, and quality of life for each resident 2. Respect the resident's area as his/her home by taking care of the resident's belongings 3. Do not discuss personal problems with residents and/or the resident's family Do not discuss facility issues with the residents and/or residents' families 5. Do not discuss personal opinions such as a religion/spiritual beliefs b. politics c. cultural beliefs d. customs e. living conditions f. financial situations 6. Work within the job description 7. Maintain confidentiality 8. Do not accept "tips" for care given to a resident 9. Accept responsibility for job performance and behavior 10. Accept constructive criticism and suggestions kindly a. understand that it is a learning experience. Updated 2019 9 | Unit 1 D. Etiquette refers to good manners: 1. Maintain a polite, courteous, and kind attitude 2. Show respect in references to a. patients b. residents C. nurses d. doctors e. family f. visitors g. co-workers 3. Show respect by using the person's preferred name 4. Knock on the resident's door and request permission to enter a. as you would before entering a friend or neighbors home 5. Provide privacy when giving personal cares a. if it is appropriate, ask friends and family to step outside the room 6. Work quietly, gently, and efficiently 7. Do not whisper outside the resident's room 8. Always use appropriate language. E. Define values: 1. The standards that assist one to make decisions and guide one's behavior 2. Personal values include a. culture b. religion c. education d. rules e. language f. lifestyle g. belief system h. spirituality. V. DISCUSS LEGAL IMPLICATIONS FOR THE NURSING ASSISTANT. A. Define neglect: 1. A failure to provide adequate medical or personal care. 2. Neglect results in physical harm, pain, mental anguish, or emotional distress a. example: failure to leave the residents bed in a low position b. example: failure to change soiled briefs right away. B. Define liability: 1. The responsibility to know the standards of care and safety according to the law 2. The standards pertain to your qualifications as a NA. 10 / Unit 1 Updated 2019 C. Malpractice in healthcare: 1. Is a failure to take reasonable care to avoid causing injury or loss to another person 2. 3. Negligence is the basis for malpractice Courts will rule if the act appears to be malpractice. D. Define Involuntary Seclusion: 1. Isolating a senior adult to his/her room or to a specific area in a nursing home 3. The isolation is against the resident or legal representatives consent Examples include but are not limited to a. resident confined by placing furniture, carts, or chairs in front of door b. holding the door shut to prevent resident movement c. placing a resident in darkened room as a punishment d. placing a resident without access to call lights or communication 4. Emergency or short-term monitored isolation from other residents a. will not be considered involuntary seclusion and may be permitted IF used for a limited period of time as a therapeutic interventions or to reduce agitation until staff can develop a plan of care to meet the resident's needs. E. NA responsibilites include: 1. Performing duties within the training guidelines and job description 2. Understanding what the law allows in those guidelines. VI. DESCRIBE THE NURSING HOME RESIDENT'S BILL OF RIGHTS. (MN Statutes 144.651 - 144.652) A. Define the Resident's Bill of Rights: 1. MN and Federal law 2. Provides residents with the same rights given to all citizens. B. All members of the healthcare team must respect the Bill of Rights. C. Each resident has the right to be treated with dignity and respect. The NA must 1. Maintain and protect basic human rights of the resident 2. Respect each resident's individuality 3. Honor and value the resident's input 4. Examples of treating residents with dignity and respect include a knock on the resident's door and request permission to enter before entering b. address residents with the name or pronoun of resident's choice encouraging and assisting residents to dress in their own clothes, rather than hospital-type gowns Updated 2019 11 / Unit 1 Unit 1 d. place labels on the resident's clothing where it is not easily seen (place labels on the inside of shoes and clothing or using a color coding system) e. avoid bibs or clothing protectors instead of napkins (except by resident choice) f. 9. h. i. j. sit rather than stand over resident while assisting to eat talk to the resident rather than other staff while assisting with meals assist the resident's to the bathroom during meal times if requested do not use the term "feeders" or "walkers" provide residents with privacy during care, such as when using the bathroom k. 1. keep the resident's urinary catheter bags covered do not restrict the use of common areas by a resident unless restricted by care plan. D. Residents have the right to: 1. Be informed of their rights 2. Examine Federal or State survey reports 3. 4. Be given dignity in his/her personal relationship with staff Be given in writing the physician contact information responsible for their care a. name b. business address C. telephone number 5. Receive quality care regardless of a. race b. color c. ethnic origin d. age e. religion f. spirituality g. marital status h. sexual preference i. handicap 6. Receive encouragement and support in making personal choices to accommodate individual needs 7. 8. Be respected and protected from physical and verbal harm Have continuity of care 9. Refuse treatment 10. Have privacy during procedures and when requested 11. Be addressed by the name preferred 12. Be informed about the cost and services available 13. Have confidentiality maintained of a. medical condition b. medical records c. other information related to the resident's care 14. Be free from non-therapeutic chemical and physical restraints Updated 2019 15. Wear his/her own clothing a. keep appropriate personal possessions b. be allowed to spend his/her own money 16. Have family or significant others take part in care conferences 17. Receive help in exercising citizenship rights 18. Receive help and privacy in personal communications a. mail, phone calls, visitors, etc. 19. Have personal possessions treated with respect and safeguarded 20. Be informed in terms that he/she can understand about the a. diagnosis b. treatments c. alternatives 22 so m d. risks 21. Be informed of the procedures for filing confidential complaints a. be informed about resolving grievances b. be given references of available sources 22. Take part in religious, spiritual, or political activities a. if activities do not infringe on other resident's rights 23. Organize, maintain, and take part in resident and family councils. E. The Resident's Bill of Rights must be posted in an easily seen area of the care facility. F. A copy of the Resident's Bill of Rights must be given to all residents or guardian upon admission. G. The Bill of Rights gives the resident the right to voice grievances without fear of reprisal: 1. When conflicts between residents occur a. maintain safety of each resident b. safety must be the primary consideration of the healthcare team 2. Report information about resident conflicts accurately and immediately to the charge nurse a. resolution of conflicts can often be worked out by the skilled nursing and caring staff 3. State Ombudsman a. is the person who handles complaints between a resident and the facility b. provides services to facilities to assists residents and their families to resolve conflicts. Updated 2019 12 | Unit 1 VII. DESCRIBE ABUSE AND NEGLECT A. Define Abuse: 1. Any intentional action that harms or injures another person. a. can include physical, psychological, verbal, elder, financial abuse b. can include rape and sexual assault C. can include abuse by technology 2. 3. 4. Threatening to harm is also considered abuse It may be subtle There are several forms of abuse a. "Physical abuse" includes but is not limited to hitting kicking grabbing scratching pushing/shoving biting  spitting slapping pinching throwing objects threatening gestures b. "Mental abuse" is the use of verbal or nonverbal conduct which causes the resident humiliation, fear, shame, or agitation. Mental abuse includes but is not limited to frightening a resident by yelling or standing over the resident threatening to punish a resident by isolating the resident from social interaction or activities depriving resident of care or contact with family and friends posting humiliating photographs or recordings through social media such as nudity, bathing, showering, using the bathroom, providing perineal care, or recording derogatory statements to resident, etc. C. "Verbal abuse" is when a person criticizes or insults another person can be by verbal, written, or gestures may be by technology. Verbal abuse includes but is not limited to screaming and/or cursing insulting the resident's race, ethnic group, religious beliefs or sexual orientation threats of harm or saying things to frighten a resident * an example is telling a resident that he/she will never be able to see his/her family again Jnit 1 Updated 2019 B. e. f. d. "Sexual abuse" means "non-consensual sexual contact of any type" which includes, but is not limited to saying sexual things inappropriate touching/grabbing of any kind especially of the breasts or the perineal area sexual assault such as rape, oral sex, anal sex, or coerced nudity taking sexually explicit photographs/audio/video recordings nudity, fondling, or intercourse involving a resident forced observation of masturbation or pornography "Exploitation" means taking advantage of a resident for personal gain. Examples include but is not limited to using of a resident's belongings or money without the resident's consent stealing the residents' identity theft of money from bank accounts unauthorized or coerced purchases on a resident's credit card unauthorized or coerced purchase from residents' funds persuading a resident to give a gift to staff in order to receive ongoing care "Technology abuse" includes posting information about a resident on social media cell phone camera on the internet. Define neglect: 1. Neglect is the failure of the facility, its employees or service providers to provide adequate medical or personal care to a resident that are necessary to avoid a. physical harm b. pain c. mental anguish d. emotional distress 2. Examples include but are not limited to a. not getting residents out of bed or dressed when requested b. leaving a resident unattended and unsafe in the bathroom c. not taking a residents to the bathroom resulting in the resident urinating in their bed or clothing d. leaving residents in bed with soiled clothes or linens e. not responding to call lights f. not keeping the call light available to resident g. leaving the resident's lower body uncovered and exposed Updated 2019 h. leaving the catheter bag lying flat on the bed rather than hanging it on the side of the bed away from the door 4. Providing care but not following the care plan can result in the caregiver being charged with negligence. C. Describe reporting abuse and neglect: 1. Follow the policy of the facility and immediately report to a supervisor 2. All long-term care staff are mandated reporters 3. The NA may be asked to complete an incident report and sign his/her name. The facility will need the names of witnesses to investigate the incident. 4. Confidentiality of the reporter is protected. 5. No reprisal or retaliation to the reporter if reporting is done in good faith 6. An intentional failure to report abuse results in a misdemeanor a. the NA may be liable for damages if he/she fails to report abuse. D. The responsibility of the healthcare facility includes: 1. Develop an abuse prevention plan for staff and residents 2. Develop a written policy to ensure all cases of abuse or neglect are reported to a supervisor immediately 3. Recording and monitoring Incidents of all forms of abuse. E. Describe the Minnesota Vulnerable Adult act (MN Statute 626.557) Minnesota law provides protection of adults considered vulnerable: 1. Can be due to physical, mental or emotional impairment 2. Protects disabled adults who may be vulnerable to abuse or neglect and cannot help themselves 3. Provides for safe institutions or services for vulnerable adults 4. It is the law to report abuse, neglect, or suspicion of abuse or neglect 5. Investigation of reported situations must occur a. includes individuals 18 years of age and older 6. Vulnerable adults may live in a licensed facility 7. Vulnerable adults may receive services from a licensed agency 8. Individuals may live in a family setting but are unable to report abuse or neglect. 米Z VIII. DESCRIBE THE PATIENT SELF-DETERMINATION ACT. Respeethy the resident wisres '. A. The Patient Self-Determination Act (PSDA): 1. Federal law implemented in 1991 2. Requires funded facilities to tell residents about their rights to make treatment choices. B. Residents must be asked if they have a: 1. Living will or 2. Durable Power of Attorney for health care. IX. COMPARE TASK ORIENTED CARE WITH PERSON-CENTERED CARE. A. Task oriented care is Do not use in a nursing home your Depesoniking getting the Job done 2. 3. 4. Fragmented rather than Fowisng on One size fits all Is schedule-driven with the Patient resident a. nourishments offered at specific times b. mealtimes set by the facility c. bathing according to facility policy d. residents get up and go to bed at specific times e. toileting is often at a scheduled time f. residents are expected to adjust to the facility routines 5. Residents lead boring, lonely, and depressing lives 6. Staff rotate caring for different residents 7. Direct care staff have little involvement in decision making. B. Person-Centered Care: Pattent Genter care (Bused on care Pian) 1. Person-centered care focuses on individual resident choices such as a privacy b. needs C. interests d. lifestyles e. preferences f. abilities strengths of the resident Caregivers are consistent 2. 3. Supports the idea that nursing homes resemble living in one's own home where a. food is always available b. food is served family style c. meal times are determined by resident choice Updated 2019 *= d. residents decide when they wish to bathe e. activities occur spontaneously in addition to planned activities f. the resident determines the time to get up and go to bed 4. The resident and those who work closest with them make the decisions that affect the resident's daily live 5. Direct care workers have a. more authority for making decisions b. a deeper commitment to residents c. flexibility d. involvement in care planning. C. The terminology used in-person-centered care includes: 1. Snacks vs. nourishments 2. Home vs. facility 3. Music vs. music therapy 4. Family room vs. resident's lounge 5. Pantry vs. nourishment room. D. Person centered care promotes: 9. Independence. E. Developing a person-centered environment involves: 1. Talking to the residents 2. Talking to family and friends 3. Asking questions 4. Learning what dreams or accomplishments were done 5. Asking if the resident had memberships in any organization 6. Looking at the resident's past history Involving other staff to help provide a stimulating environment 8. Finding solutions for personalizing activities for the residents 9. Allowing residents to do as much as possible to promote dignity and self-worth. 1. Smaller, home-like settings 2. Higher quality of life 3. Individuality 4. Privacy 5. Choice 6. Dignity 7. Respect 8. A home-like atmosphere F. NA responsibilities in a person-centered environment include: Listening to the resident 2. 3. 4. 5 6 7. 8. At all times, treating residents as adults Maintaining the dignity of the resident Adapting daily work schedule to individual resident's needs Getting involved in decision making Taking part in care planning Having a role in housekeeping, meal service, and recreation Never assuming the needs and desires of the resident. G. Resident care plans should encourage the resident to: 1. Be involved in an ongoing program of activities a. designed to appeal to the resident's interests b. enhance their highest level of physical, mental, and psychological wellbeing 2. Care plans are an interdisciplinary team effort a. based on a comprehensive assessment b. residents have individualized activity programs All facility staff need to be involved in resident-centered activity programs 3. 4. 5. Staff may take part in activity program development Residents should stay as busy as possible a. doing things they prefer b. up to the level of their own capabilities. Updated 2019 19 | Unit 1 8. 1. DESCRIBE BASIC PHYSICAL, EMOTIONAL, AND SPIRITUAL NEEDS OF THE RESIDENT. A. Define Maslow's Hierarchy of Human Needs: A pyramid that shows basic human needs 2. The needs are in order from physical needs to self-actualization 3. Listed in five levels starting at the bottom of the pyramid. Level I - - Physiological: Physical needs and ways to assist residents to meet these needs Food make mealtimes as pleasant as possible assist the resident by opening drink cartons or cutting meat feed resident if necessary Oxygen, air elevate the head of the bed for a resident with breathing problems position in chairs to allow for lung expansion assist the resident to ambulate frequently as per care plan d. assist the nurse with oxygen therapy by reporting tubing problems empty portable oxygen tanks difficulty breathing as observed by NA or reported by the resident Water a. offer fluids frequently b. make certain container is within resident reach c. keep the container filled with fresh water 5. Elimination a. assist the resident with toileting needs b. provide privacy c. be matter-of-fact in response to incontinent resident 6. Rest a. assist in preparation for sleep b. recognize changes in the pattern of sleep in residents c. alternate rest periods with activity based on individual needs 7. Activity and exercise a. perform passive range of motion as indicated in the care plan b. encourage active range of motion during ADL's c. ambulate, transfer, and move residents correctly d. encourage and assist residents to take part in activities Stimulation a. take time to listen to residents 4 / Unit 2 Updated 2019 *= b. have conversations with residents C. place residents in an area where activities can be observed and/or participated in d. provide access to mail, telephone and radio/television programs of their choice 9. Sexuality a. encourage use of gender-appropriate clothing, cosmetics, and hairstyle to maintain sexual identity b. provide privacy to residents who request it c. respond appropriately and non-judgmentally to a resident who is masturbating d. do not shame residents or make them feel foolish when they express their sexuality. C. Level 2 - Safety: 1. Safety and security needs and the way to assist residents in meeting those needs 2. Safety a. keep area safe and free of hazards b. show residents how to do activities safely c. keep call light within reach of residents d. be alert to safety at all times and in all areas of their care 3. Security a. respect resident's belongings b. orient new residents to surroundings, other residents and staff c. reassure residents by providing physical and emotional support d. become familiar with residents' family and friends e. knock before entering f. assure resident is safe from abuse g. secure resident's valuables according to the resident's wishes and facility policy. D. Level 3 - Love/Belonging: 1. Belonging needs and ways to assist the resident in meeting these needs 2. Emotional a. show caring for the resident and be aware of resident's concerns/fears b. take an interest in the resident, the resident's family, and past experiences | Unit 2 Updated 2019 6 / Unit 2 米乏 cd take time to listen and converse with residents touch in a kind and gentle manner welcome visitors, including pets include resident in activities, encouraging visiting with other residents encourage the resident to bring meaningful belongings from home as 9. Spiritual b. respect the religious/spiritual beliefs of the resident assist the resident to be involved in religious/spiritual activities of their choice welcome and provide privacy for visits from religious/spiritual d. refer the resident to the nurse if the resident requests a visit by a leaders/mentors religious/spiritual advisor. the nurse can arrange the visit e. respect and handle all religious/spiritual symbols with care. E. Level 4 - Self-esteem: 1. Self-esteem needs and ways to help residents meet these needs 2. The sense of identity (required by Resident Bill of Rights) a. b. call resident by their requested name include resident and their family in discussions about care c. encourage contact with other residents d. give choices whenever possible and within care plan groom residents as they wish to be groomed examples may include but are not limited to removal of facial hair for women maintaining the resident's personal preferences for hair length/style facial hair for men clothing style, unless clothing choices present a potential health or safety problem 3. Dignity and Self-Respect g. respect individual differences in culture, heredity, interests, and values a. talk with a resident about their accomplishments b. praise freely if appropriate C. d. acknowledge residents at all times talk to residents as adults f. allow residents to do as much as possible for themselves encourage resident's involvement in activity programs g. scheduling cares to allow them to take part in chosen activities h. display interest in family members i. be courteous to family members Updated 2019 assist residents to feel important by having them be responsible for tasks such as : watering plants or changing the calendar as identified in their care plan k. avoid the use of labels for residents such as "feeders." avoid discussing residents in community settings in which others can overhear private information m. labeling each resident's clothing in a way that respects his/her dignity place labels on the inside of shoes and clothing n. respecting residents' private space and property not changing radio or television station without resident permission not moving or inspecting resident's personal possessions without permission o. maintain the resident privacy of body by keeping residents sufficiently covered such as with a robe while taken to areas outside their room such as the bathing area p. avoid practices demeaning to residents such as keeping urinary catheter bags uncovered and refusing follow a resident's request for toileting help during meal times. F. Level 5 - Self-actualization: 1. Self-actualization is a. the pursuit of reaching one's highest potential as an individual and being satisfied with oneself b. a process that is on-going and may change as the resident's life experiences change 2. Look for opportunities to assist the resident to achieve their personal potential 3. To help the resident feel confidence a. look for strengths of the resident b. praise resident's strengths when appropriate С. encourage the continuation of hobbies and areas of interest d. praise resident's accomplishments e. encourage willingness to assist others; if appropriate resident could take mail to other residents become a member of the resident council. 7 | Unit 2 Updated 2019 8 / Unit 2 M 11. DESCRIBE THE COMMON CHARACTERISTICS OF GROWTH AND DEVELOPMENT. 4. Growth and development occurs in an orderty patern: 1. From simple to complex 2. One step is completed before attempting the next step. B. Growth and development: 1. Is continuous, from infancy to adult. C. Growth and development affect all body parts: 1. Different body structures may grow at varied rates and at varied times. D. Growth and development progress individually; the rate varies from person to person. E. Growth and development affects the person physically, mentally, spiritually, and emotionally. III. IDENTIFY DEVELOPMENTAL TASKS ASSOCIATED WITH AGING. A. Early adulthood: 1. Age time frame from about the late teens to the thirties 2. Developmental tasks a. establishing personal and economic independence b. forming support groups of friends and others c. developing a career d. making a commitment in a relationship e. establishing a family f. managing a healthy lifestyle. B. Middle adulthood: 1. Age time frame from approximately the thirties to the mid-sixties 2. Developmental tasks a. combine personal and social involvement with responsibility b. adjust to the physical and emotional changes of middle age c. reach and maintain job satisfaction d. observe children maturing e. prepare financially for retirement f continue to maintain a healthy lifestyle. Updated 2019 Late adulthood cphuse 7） mately the mid-sixties until death 30103. to possible dee ging tacey roes sion spouser children, and grandchildrer v change as an opportunity for new experiences 3. Developmental tasks for the 75-84-year-old individual adjust to possible chronic conditions such as arthritis o losses such as the ability to drive a car, the death of friends accept life s experiences accept one's mortality. 4. Developmental tasks of the 85-year-old and older individual accept increased physical limitations realize the potential need to depend on others for some help take part in social activities as health allows understand relocation to different living arrangements may occur realize the death of friends and loved ones is probable. IV. DISCUSS THE GENERAL CHARACTERISTICS OF AGING. A. Aging is a natural, gradual, and progressive occurrence that begins at birth. B. The basic needs of the elderly are the same as the basic needs of any of the other age groups. C. Individuals age at different rates. D. The aging process is influenced by Nutrition, lifestyle, physical, mental, emotional, and spiritual health. E. Aging is not an illness. F. Aging does not mean frailty. G. Loneliness and isolation need not be a part of aging. H. Sexuality continues in aging. 9 | Unit 2 Updated Mental impairments associated with aging are not inevitable J. Agina does not occur at a certain agg K. Aging does not pere vog idey ising has live in a nursing long term care or healthcare facility. V. DESCRIBE THE NORMAL AGING PROCESS RELATED TO BODY SYSTEMS. 1odu AFFeCt Aging A. Integumentary:C5kn） The external body surfaces skin, hair, nails, sweat and oil glands 2. Possible changes skin becomes fragile and tears easily loss of fatty tissue occurs leading to bruising easily oil and perspiration production decrease changes in temperature sensation - decreased sensitivity to not and cold f. hair may thin and change color nails thicken and harden skin becomes dry 3. NA must follow the individual resident's care plans. The care plan may what we NA?, include but is not limited to use lotions and other skin care products and LIGHT massage b. prevent pressure areas by changing the resident's body position decrease potential injuries by the safe handling of residents skin tears, bruises, dislocated shoulders, etc. select appropriate clothing use lift sheets to move residents up in bed use mechanical lifts as indicated on the care plan. B. Musculoskeletal system 1. The body parts that support our structure. 2. Possible changes muscles, joints, and bones b. bones become brittle and may fracture easily muscles reduce in size and may weaken 10 / Unit 2 Updated ← joints and ligaments become less flexible d. range of motion is reduced 3. NA responsibilities include following the resident's care plan. The care plan may include: a. encourage exercise and assist as indicated balance activity with rest periods encourage good nutrition d. assure assistive devices are available as needed. C. /Digestive system: The body parts we use to process food a. the stomach and intestines 2. Possible changes a. gradual slowing of the entire system b. decrease in ability to taste sweet, sour, salty and bitter C. saliva and other secretions reduced d. difficulty chewing, or swallowing may be due to missing teeth or poorly fitted dentures e. appetite may decrease f. constipation may occur 3. NA must follow the resident's care plans. The care plan may include a. provide pleasant mealtime b. encourage smaller bites of food and chewing slowly C. observe for choking encourage fluids when appropriate ef inform nurse about eating difficulties assist with eating as indicated g. ensure that adaptive devices to help with independent eating are available h. report and record bowel movements. Circulatory system: 1. The body parts that move blood through your body a. the heart and blood vessels 2. Possible changes a. the heart may not pump as effectively b. blood vessels become less elastic c. heart disease is common as aging occurs d. blood pressure may be elevated e. changing position may cause sudden dizziness f. fatigue may occur 1 | Unit 2 Updated 2019 3. NA must follow the resident's care plans. Care plan may include la exerciseriods refully when changing their position participating in activities すっpっ check blood pressure and pulse as per care plan evor edemal monitor and report shortness of breath cinese cyanosis (blue color) of lips or nails weigh the resident using the same scale, clothing and time of day assist with application and removal of support stockings. E.Respiratory system? 1. The body parts that we use to breathe a. the lungs and air passages 2. Possible changes decreased exchange of oxygen and carbon dioxide due to loss of elasticity of lungs cough reflex may weaken may be more difficult to take a deep breath may be more susceptible to respiratory infections respiratory changes may result in increased fatigue f. shortness of breath may occur 4. NA must follow the resident's care plans. The care plan may include pace activities b. practice infection control observe and report shortness of breath, dizziness, cyanosis, fatigue d. assist the nurse with oxygen therapy or other respiratory equipment. F. Urinary system: 1. The body parts involved in elimination the kidney and bladder Possible changes kidney function may be reduced bladder elasticity may decrease stress incontinence from coughing, sneezing or laughing d. urgency males often have prostate enlargement emptying the bladder may be less effective Updated 3* urinary infections may occur frequently 3. NA must follow the resident's care plans. The care plan may include a. b. encourage fluids provide good peri care, using appropriate infection control follow bowel and bladder program according to facility policies provide catheter care f. measure intake and output if directed observe and report signs/symptoms of bladder infection. G. Nervous system: 1. Body parts that control our nerves: a. The brain and spinal cord 2. Possible changes nerve messages are slower b. C. blood flow to the brain is decreased diseases of the nervous system may cause abnormalities or personality changes d. forgetfulness may occur e. reaction time to stimuli decreases 3. NA must follow the resident's care plans. The care plan may include d. provide adequate time for residents to complete activities b. be alert to safety needs C. orient as indicated d. provide appropriate environment e promote independence; assist as needed. H. Reproductive system 1. Body parts that reproduce life a. male and female internal and external sex organs 2. Possible changes a. females: the menstrual cycle ceases b. females: vaginal walls become thinner and drier C. males: scrotum is less firm d. males: prostate gland may enlarge 3. NA must follow the resident's care plans. The care plan may include a. provide or assist with cleaning the perineum as needed b. for menstruating females change the sanitary pad carefully clean the perineum c. be aware and report signs of infection such as fever, pain, or drainage 13 | Unit 2 d, plan car round resident's doctor appointments for ts that assist in sight, hearing, smell, taste, and touch sand ears are discussed below 2. Possible decrease of vision: reduction of tears resulting in irritated, dry eyes decrease in hearing: reduced or excess earwax 3. NA must follow the resident's care olans The care plan for visual problems may include resident with vision problems provide good lighting ACCe 9atWavree 020ter 4. The care plan for hearing problems may include speak clearly and slowly face residents when speaking be alert to safety needs reduce background noise. Endocrine system: 1. Body parts that regulate the body glands 2. Possible changes insulin production is less efficient resulting in diabetes weight gain or loss C. increased thirst, urination, hunger, and fatigue are common symptoms of high blood sugar d. confusion, tremors, sweating, hunger/ and anxiety are common symptoms of low blood sugar 3. NA must follow the resident's care plans. The care plan may include a. report any behavioral changes to the charge nurse b. report any physical changes to the charge nurse. Updated VI. DESCRIBE THE EMOTIONAL, SPIRITUAL AND SOCIAL NEEDS OF THE RESIDENT'S A. Define family: 1. Two or more people who live together and a- share interests b. roles resources d. commitment e. love 2. Resident's family may include a. opposite-sex b. same-sex partners domestic partners d. siblings or friends. B. Family emotions may include: 1. Anxiety 2. Fear 3. Sadness 4. Anger 5. Relief 6 Confusion 7. Quiet. C. Role of the NA working with the resident's family: 1. Acknowledge the resident's presence when visiting loved ones. Have a a. non-judgmental attitude b. display a pleasant manner c. be sensitive to their emotions d. quietly listen e. show patience f. include in cares when appropriate under the direction of the charge nurse g. Plan resident care around the family visit. UP VII. DISCUSS RESPECTING RESIDENT'S CULTURAL DIVERSITY AND INDIVIDUALITY. A. Personal guidelines for developing cultural sensitivity; Think about your personal belief system and the belief system of others examine how your culture influences your behavior view residents as individuals within their own culture asking a resident about their culture is not offensive it shows interest and concern d. avoid grouping people based on your belief (stereotyping) e. the way that residents relate to others and behave is influenced by their culture attend staff development activities that promote cultural awareness and sensiuvin it is an expected that you develop cultural awareness and cultural sensitivity. B. Cultural influences: Personal space preferred distance while giving cares may vary b. some cultures will not permit members of the opposite sex to provide coreし c. if uncertain, check with the charge nurse or refer to the individual's care plan 2. Gestures or eye contact gestures may have different meanings in other cultures eye contact may be offensive check body language, eye contact, gestures while giving cares if uncertain, check with the charge nurse or refer to an individual's care plan 3. Pain b. some cultures demonstrate pain by being very emotional other cultures view displays of pain as being weak if uncertain, check with the charge nurse 4. Personal hygiene bathing may not be done routinely or may be asked for frequently women may not remove body hair 5. Clothing 2 roreran fict wi fhetate nuse of ter to care plen men may cover their heads 16 | Unit 2 Updated 2019 b. women may cover their heads and only have their face and hands in view C. make accommodations when possible 6. Health practices friends and family may practice cultural remedies on the resident b. a resident may ask for herbs, spices, teas, or wraps that are familiar to them c. herbs, spices, teas, or wraps may interfere with the resident treatment plan d. check with the charge nurse or the resident's care plan. DESCRIBE COMMUNICATION. A. The exchange of thoughts, feelings, and information. B. Communication may be accomplished verbally, non-verbally, in written form, or electronically: Non-verbal includes facial expressions, gestures, and body movements. II. IDENTIFY COMPONENTS OF VERBAL COMMUNICATION. A. Convey messages using words: Spoken 2.3 Written Sign language a. not to be confused with common gestures such as pointing, shaking, or nodding the head. B. Sender. C. Receiver. D. Feedback: 1. Make certain message is understood 2. May need to repeat message. E. Communication awareness includes: 1. Choice of words used 2. Tone of voice when speaking 3. Speed of voice while talking 4. Receiver's ability to understand the spoken word 5. Receiver's ability to understand the written word. III. IDENTIFY COMPONENTS OF NON-VERBAL COMMUNICATION. A. Examples of non-verbal communication: 1. Facial expressions 2. Posture Gestures a. movement of the hands, head, or other parts of the body that expresses a thought or feeling b. shaking, nodding the head, or shrugging the shoulders are so common that they are generally understood by everyone 4. 5. Touch Dress 67 Arm movement Pacing Silence. B. Be aware of non-verbal behavior when interacting with residents and their families: 1. "Actions speak louder than words." V. DESCRIBE EFFECTIVE COMMUNICATION. A. Effective communication: 1. Occurs when the receiver gets the information in the way the sender intended. B. Effective communication techniques: (100), glow i clear ) 1. Reduce background noise 2. Awareness of body language 3. Pace speech to accommodate the receiver 4. Allow time for talking or for response 5 Express an interest in what the resident says 6. Maintain eye contact as culturally appropriate 7. Speak clearly and loudly as needed 8. Refer to resident by the name he/she prefers 9. Listen attentively 10. Keep conversation resident-centered. C. Barriers to effective communication: 1. Not listening 2. Background noise 3. Belittling a person 4. Inappropriate environment 5. Avoiding eye contact 6. Appearing too busy or in a hurry 7. Making judgments 8. Not acknowledging what was said 9. Giving false or inappropriate reassurances 10. Speaking in a language other than receiver's primary language 11. Dominating the conversation. 5 | Unit 3 Updated 201 D. Listening skills vital to effective communication: Clear mind of distractions Face the individual speaking Maintain good eye contact if appropriate Do not interrupt Focus on resident's needs, not your own needs. E. Describe communication techniques for a resident who has trouble seeing or is blind: Introduce yourself and make yourself known when approaching a resident Knock before entering room Call resident by their desired name Encourage and assist resident with use of eyeglasses clean eyeglasses as needed 5. Do not change the placement of resident belongings Offer your arm to guide and walk slightly ahead of resident Speak clearly and slowly and be aware of your tone of voice 8. If conversing in a group, say the name of the person to whom you are speaking 9. Notify resident when you leave their presence. F. Techniques to use when communicating a resident who is hard of hearing or deaf: 1. Find out how the resident best communicates 2. Face the resident when talking to him/her 3. Speak clearly and distinctly 4. Show patience if asked to repeat Keep hands away from your mouth while talking to allow for lip reading Stand or sit near resident 7. Help the resident with the use of a hearing aid or an assistive listening device Reduce background noise Refrain from eating or chewing gum 10. Work with a qualified sign language interpreter to communicate with deaf people or when resident uses American Sign Language (ASL) 11. If an interpreter is present, address the resident, not the interpreter. G. Communication techniques to use for the resident with speech difficulties: 1. verbally Give unhurried attention when talking to a resident that cannot communicate 3. Be patient Ask the resident to repeat the message rather than pretending to understand 4. Let resident complete their own sentences 6 / Unit 3 Updated 2019 5. When possible, ask short questions that require short answers 5. If necessary, incorporate writing into the form of communication. H. Communication techniques to use when caring for a resident in a wheelchair. 1. If appropriate, make eye contact with the resident 2. When offering help, wait for the resident to accept the help before starting 3. Ask how to help; what works best 4. Make sure the resident is ready before beginning to push their wheelchair 5. If there are obstacles in the way, take care to avoid them. Electronic Communication: 1. Resident rights a. residents have the right to have access to and privacy in their use of electronic communications b. includes email, video communications and the use of the internet. V. IDENTIFY CULTURAL VARIATIONS IN COMMUNICATION. A. Verbal communication: 1. Choice of words a. shows the degree of formality b. recognize that words may have different meanings to other people 2. Emotions are expressed by tone of voice as in a a. controlled soft tone of voice or b. loud tone of voice 3. Directness of speech may be seen as a. polite or b. impatient 4. Use of silence a. essential in some cultures or b. may indicate anger in other cultures. B. Non-verbal communication: 1. Gestures a. may mean respect in some cultures but b. may indicate anger or disrespect in other cultures 2. Eye contact a. some cultures consider eye contact to be rude b. some cultures avoid eye contact to show modesty c. other cultures consider lack of eye contact as rude Updated 201' 3. Personal space some cultures may feel uncomfortable when sitting or standing close another 4. Touch b. other cultures may prefer to stand close to one another when talking may indicate aggression in some cultures but B. may be therapeutic in other cultures 5. Posture leaning toward an individual may indicate respect or b. leaning toad te tension or a threat in other cultures. VI. DESCRIBE EFFECTIVE COMMUNICATION WITHIN THE NURSING TEAM. A. NAs have frequent and close contact with residents. B. Communication is necessary for continuity of care. C. The care plan is an essential tool in communicating the care of residents. D. Individualized care plans are developed to identify: Specific cares to be provided Specific areas to observe or monitor for resident needs. E. Care plans are developed at a care conference: Residents and their families are encouraged to attend and participate with the health care team Care conferences are arranged per nursing home policy 4. Short and long-term goals are defined in the care plan It is determined which team members will put in place the goals for individual residents 5. Read and understand the care plan BEFORE caring for the resident Care plans are periodically reviewed and updated by the health care team every 3 months or b. more often with condition changes. F. NAs contribute to the resident care plan by: 1. Making careful observations Accurately reporting any d. physical mental or 8 / Unit 3 Updated 2019 1. 3. 4. emotional changes to the charge nurse Report any change in the reactions and behaviors of the resident Report resident statements regarding physical symptoms a. b. pain numbness c. dizziness. G. Respect resident's rights to privacy and confidentiality: 1. When reporting, everyone must respect a resident's right to privacy and confidentiality. H. Recognize and report objective information (signs) to the charge nurse: 1. Shortness of breath 2. Rapid respirations 3. Fever 45 Cough Vomiting 6 Cyanosis 7. Excessive drowsiness 8. Excessive sweating 9. Swelling of extremities 10. Watery or hard stool 11. Blood in stool (black or tarry consistency) 12. Blood in urine 13. Strong urine odor 14. Persistent skin redness, breaks, tears, or bruises 15. Increase in confusion or memory loss 16. Any changes observed. Recognize and report subjective symptoms (what the resident tells you): 1. Chest pain 2. Abdominal pain 3. Pain anywhere or upon movement 4. Nausea 5. Difficulty or painful urination 6. Change in appetite 7. Trouble swallowing or chewing 8. Feelings of sadness (change of mood). J. Describe an incident: 1. An event that is not part of the routine care of the resident 9 / Unit 3 NoX stert hose Updated 2019 An event that is not part of the routine of the facility May cause harm to residents, employees, or any other person K. Some examples of an incident (but not limited to) Lost or broken dentures or other personal items Missing alacent 4. Any accident or injury involving residents, staff, or visitors Any theft from residents, staff or visitors. L. NA role in prevention of incidents: Maintain a safe environment Understand policies and procedures Be competent in skills performance Honestly know your limitations 5. Attend in-services on safety issues If uncertain of procedure, ask for help. M. Describe NA responsibility if an incident occurs: 1. If you see an incident or are involved in one, report findings to the charge nurse Assist according to facility policy and procedure in filling out incident report Be honest when reporting an incident. VII. IDENTIFY THE NURSING ASSISTANT'S RESPONSIBILITY IN RECORD KEEPING. A. The NA is responsible for important record keeping regarding the resident's care. B. The NA reports and records resident behavior or changes. C. Most facilities require NAs to do checklist charting or charting on flow sheets such as: 1. Activities of Daily Living (ADL) sheets 2. Bowel and bladder records 3. Intake and output records 4. Appetite and meal records 5. 6. Temperature, pulse and respiration records Blood pressure records. D. Describe the resident's chart: 1. The resident's chart is a legal record and may be presented as evidence in a 10 / Unit 3 court of law Information must be accurate and not an opinion Entries must be written in ink Entries must be signed Entries must be legible Erasure, "white out" or scribbling out entries is not allowed Contents of the charts are confidential 8. Many charts are computerized. E. Identify commonly used abbreviations and medical terminology: 1. Communication with nursing staff will involve a. knowing some commonly used medical abbreviations 2. Knowledge of basic medical abbreviations and medical terms a. assist all healthcare givers to communicate clearly 3. Be certain to check with the facility's policy and procedure manual a. to understand which abbreviations are used at the facility 4. There is a danger of confusing similar looking abbreviations 5. If unfamiliar with an abbreviation a. consult a medical dictionary or b. consult the facility approved abbreviation list. VIII. DESCRIBE BASIC PHONE ETIQUETTE. A. Answering the phone: 1. State the name of the facility 2. State your name and title speak in a friendly voice b. speak clearly and do not chew gum when talking C. speak at a moderate rate of speed 3. Thank the caller before hanging up the phone. B. Do not use the phone for making or receiving personal calls: 1. Make sure the resident is first priority 2. Ask permission to use the phone 3. Try to limit personal calls to 3 minutes 4. Plan to make personal calls while on breaks 5. Do not have personal cell phones on while giving resident cares. 11 | Unit 3 C. Describe method for taking phone messages by including in the message: or whom the message is intended Caller's name Caller's phone number Keason for call (if appropriate) A good time to return the call. IX. DISCUSS CAUSES OF CONFLICT AND MANAGEMENT STRATEGIES. A. conflict occurs whenever people disagree on an issue. B. Causes of conflict: Tension between different groups of people such as dietary and housekeeping Increased workload Unequal job assignments Safety or security is threatened Cultural differences Job insecurity. C. Strategies for conflict management: Describe the problem accurately consider the problem to be mutual rather than one-sided Identity the problem and differences between those involved before trying to solve 1t Try to see the problem from the other person's point of view 5. 6. Use brainstorming to find a workable solution Keep an open mind Implement the best solution Evaluate the solution and plan for further action if necessary. 12 | Unit 3 Updated 2019 Updated 20