CNA Textbook PDF

Nurse Assistant Training Third Edition  American Red Cross Nurse Assistant Training Textbook This textbook is part of the American Red Cross Nurse Assistant Training program. By itself, it does not constitute complete and comprehensive training. Visit redcross.org to learn mo...

Nurse Assistant Training Third Edition  American Red Cross Nurse Assistant Training Textbook This textbook is part of the American Red Cross Nurse Assistant Training program. By itself, it does not constitute complete and comprehensive training. Visit redcross.org to learn more about this program. The emergency care procedures outlined in this book reflect the standard of knowledge and accepted emergency practices in the United States at the time this book was published. It is the reader’s responsibility to stay informed of changes in emergency care procedures. The infection control procedures outlined in this book reflect the current standards and guidelines of the Centers for Disease Control (CDC) and Occupational Safety and Health Administration (OSHA) in the United States at the time this book was published. Because regulations influencing these standards and guidelines change frequently and because laws are redefined, it is the reader’s responsibility to stay current with information such as infection control by attending in-service courses offered by employers or through other sources. PLEASE READ THE FOLLOWING TERMS AND CONDITIONS BEFORE AGREEING TO ACCESS AND DOWNLOAD THE AMERICAN RED CROSS MATERIALS. BY DOWNLOADING THE MATERIALS, YOU HEREBY AGREE TO BE BOUND BY THE TERMS AND CONDITIONS. The downloadable electronic materials, including all content, graphics, images, and logos, are copyrighted by and the exclusive property of The American National Red Cross (“Red Cross”). Unless otherwise indicated in writing by the Red Cross, the Red Cross grants you (“recipient”) the limited right to download, print, photocopy and use the electronic materials, subject to the following restrictions: The recipient is prohibited from selling electronic versions of the materials. The recipient is prohibited from revising, altering, adapting, or modifying the materials. The recipient is prohibited from creating any derivative works incorporating, in part or in whole, the content of the materials. The recipient is prohibited from downloading the materials and putting them on their own website without Red Cross permission. Any rights not expressly granted herein are reserved by the Red Cross. The Red Cross does not permit its materials to be reproduced or published without advance written permission from the Red Cross. To request permission to reproduce or publish Red Cross materials, please submit your written request to the American National Red Cross. © 2013 American National Red Cross. ALL RIGHTS RESERVED. The Red Cross emblem, American Red Cross® and the American Red Cross logo are trademarks of The American National Red Cross and protected by various national statutes. Published by Krames StayWell Strategic Partnerships Division Printed in the United States of America ISBN: 978-1-58480-582-3 This textbook is dedicated to the employees and volunteers of the American Red Cross who contribute their time and talent to supporting and teaching caregiving skills worldwide, and to the students who have decided to make a career out of helping others. How far you go in life depends on your being tender with the young, compassionate with the aged, sympathetic with the striving, and tolerant of the weak and strong—because someday in life you will have been all of these. —George Washington Carver  C O NTE NTS UNIT 1 THE ART OF CAREGIVING 1 1 Being a Nurse Assistant 2 2 Working in the Health Care System 12 3 Understanding Legal and Ethical Aspects of Health Care 22 4 Understanding the People in Our Care 31 5 Communicating with People 44 UNIT 2 PROMOTING SAFETY 57 6 Controlling the Spread of Infection 58 7 Preventing Injuries 76 8 Responding to Emergencies 89 UNIT 3 PROVIDING CARE 102 9 Measuring Vital Signs, Weight and Height 103 10 Maintaining a Comfortable Environment 125 11 Providing Restorative Care 140 12 Assisting with Positioning and Transferring 158 13 Assisting with Personal Cleanliness and Grooming 187 14 Assisting with Meals and Fluids 228 15 Assisting with Elimination 245 16 Promoting Comfort and Rest 274 17 Assisting with Admissions, Transfers and Discharges 287 iv | | Nurse Assistant Training  UNIT 4 SPECIAL CARE SITUATIONS 294 18 Providing Care for People with Specific Illnesses 295 19 Providing Care for People with Cognitive Changes and Dementia 311 20 Providing Care for People at the End of Life 327 21 Providing Care to Infants and Children 338 22 Providing Care for People in Their Homes 356 UNIT 5 TRANSITIONING FROM STUDENT TO EMPLOYEE 372 23 Entering the Workforce 373 24 Enjoying Professional Success 382 Appendices 400 A Medical Terminology and Abbreviations 401 B Body Basics 405 C Math and Measurements Review 417 D Additional Skills 429 E Answers to Questions for Review 434 Glossary 437 Resources 451 Index 462 Contents | v ACKNOWLEDGMENTS Many individuals shared in the development and revision process in various supportive, technical and creative ways. The American Red Cross Nurse Assistant Training textbook was developed through the dedication of both employees and volunteers. Their commitment to excellence made this manual possible. The following members of the American Red Cross Scientific Advisory Council provided guidance and review: Jean Johnson, PhD, RN, FAAN Marie Etienne, DNP, ARNP, PLNC Chair, Nursing and Caregiving Sub-Council Professor Dean, School of Nursing Miami Dade College, School of Nursing The George Washington University Miami, Florida Washington, District of Columbia Susan M. Heidrich, PhD, RN Christy Blackstone, MSW, LCSW Helen Denne Schulte Emeritus Professor Department of Veterans Affairs University of Wisconsin–Madison, School of VA Health Care System Nursing Nurse Scientist Alexandria, Louisiana William S. Middleton Memorial Veterans Administration Hospital Barbara J. Burgel, RN, ANP, PhD, FAAN Madison, Wisconsin Professor of Nursing University of California, San Francisco School Deanna Colburn Hostler, DPT, PhD (ABD) of Nursing Senior Physical Therapist San Francisco, California Presbyterian Hospital, University of Pittsburgh Medical Center Pittsburgh, Pennsylvania Susan L. Carlson, MSN, APRN, ACNS-BC, GNP-BC, FNGNA Carla M. Tozer, MSN, APN/CPN, ACHPH, Neurology Nurse Practitioner ANP-BC, GNP-BC South Texas Veterans Health Care System Visiting Nursing Practice Specialist San Antonio, Texas Visiting Clinical Instructor University of Illinois–Chicago, College of Nursing Chicago, Illinois The following individuals also provided guidance and review throughout the manuscript development process: Nelly Azizi, LVN Linda Carter, RN Instructor, Nurse Assistant Training Program Instructor, Nurse Assistant Training Program American Red Cross Southern California Territory American Red Cross Northern Ohio Territory Commerce, California Cleveland, Ohio Anika Bailey, MSN, MEd, RN Nancy Daly, RN Health Care Training Programs Manager Instructor, Nurse Assistant Training Program American Red Cross of Southeastern Michigan American Red Cross of Eastern Massachusetts Detroit, Michigan Cambridge, Massachusetts Melissa C. Beadle, MBA Abigail Filius, LVN Program Manager II, Nurse Assistant Training Instructor, Nurse Assistant Training Program American Red Cross Northern Ohio Territory American Red Cross Southern California Territory Cleveland, Ohio Commerce, California Mary Jane Carpenter, RN Sharon Garwood, RN, BSN Instructor, Nurse Assistant Training Program Instructor, Nurse Assistant Training Program American Red Cross Northern Ohio Territory American Red Cross of Southeastern Michigan Cleveland, Ohio Detroit, Michigan vi | | Nurse Assistant Training Jason Kang, LVN Diane M. Minor, RN, BSN Instructor, Nurse Assistant Training Program Program Manger I, Nurse Assistant Training American Red Cross Southern California Territory American Red Cross Northern Ohio Territory Commerce, California Cleveland, Ohio Jane Lash, RN Loralyn Penzella, MPA Instructor, Nurse Assistant Training Program Program Manager, Nurse Assistant Training/Competency American Red Cross Evaluation Program Testing Cambridge, Massachusetts American Red Cross Southern California Territory Commerce, California Agnes Liclican, RN Interim Director of Nurses, Nurse Assistant Training Program Marion Reed, RN American Red Cross Southern California Territory Instructor, Nurse Assistant Training Program Commerce, California American Red Cross of Southeastern Michigan Detroit, Michigan Marianne Mastrangelo, BSN, RN Director, Health Care Training Lula Robinson, RN American Red Cross of Eastern Massachusetts Instructor, Nurse Assistant Training Program Cambridge, Massachusetts American Red Cross Northern Ohio Territory Cleveland, Ohio The following individuals assisted with the creation of the content by providing subject matter expertise: Wanda Murray-Goldschmidt, RN, BSN, BC, MA Ginger Schuerger-Davison, RNBC, LNHA Clinical Faculty Long-Term Care Consultant Department of Nursing, Towson University Ohio Health Care Association Member Towson, Maryland Berea, Ohio Faculty The Copper Ridge Institute Sandra J. Soditch, RN Eldersburg, Maryland Long-Term Care Consultant Centerville, Ohio Theresa Kyle, RN, MSN, CPNP Director of Nursing Diana F. Waugh, BSN, RN El Camino College Long-Term Care Consultant Torrance, California Waugh Consulting Waterville, Ohio The American Red Cross also gives special thanks to the following organizations and individuals for their contributions to this project: The residents, staff and administrators at Roland Park Place in Baltimore, Maryland, for their assistance with the photography shoot The residents, staff and administrators at Stella Maris in Timonium, Maryland, for their assistance with the video shoot The staff of Portfolio Productions in Portland, Oregon, for their assistance with producing the photography and video assets The staff of Krames StayWell Strategic Partnerships Division, for their assistance with editing and producing the textbook Photography credit: Chapter 21, page 338 © iStockPhoto.com/Juanmonino Acknowledgments | vii P R E FAC E Nurse assistants are key members of the health care and enliven the reading, reinforce key concepts and team, providing care for patients, residents and clients promote critical thinking skills. in a variety of health care settings. The aging population, Nurse Assistant Do’s and Don’ts. These boxes longer life spans, and changes in the way health care is summarize guidelines for providing safe, efficient, provided and paid for are presenting many opportunities person-centered care. for people who want to train for a career in health care. Observations into Action. A very important role During a time when employment opportunities are of the nurse assistant is to function as the “eyes decreasing in many industries in the United States, and ears” for the rest of the health care team. employment opportunities in health care are increasing, The “Observations into Action” feature highlights and they are expected to continue to increase in the observations the nurse assistant may make that future. As a nation, we must maintain and continue to should be reported immediately. build a workforce prepared to meet the needs of the population. Elder Care Notes. Many of the people the nurse assistant will care for will be elderly. This The American Red Cross Nurse Assistant Training feature draws the student’s attention to special textbook and course are based on the belief that considerations that should be kept in mind when caregiving is an art. This textbook and course seek to caring for an elderly person. train students in the art of caregiving, focusing on five Skill Sheets. The skill sheets walk the student principles of care that should inform every decision through key nurse assistant skills step by step. the caregiver makes and every action the caregiver Photographs and illustrations are provided to clarify takes: safety, privacy, dignity, independence and written instructions and enhance understanding. communication. In addition to learning the technical Standard preparation and completion steps are skills needed to provide competent care, students included as part of every skill to help students learn learn the principles and concepts necessary to provide and remember these very important actions. All skills compassionate, person-centered care. emphasize the five principles of care: safety, privacy, dignity, independence and communication. Features Goals. Each chapter begins with a list of learning The American Red Cross Nurse Assistant Training objectives or goals. textbook was developed to help students understand, Key Terms and Glossary. Important vocabulary remember and put into practice important concepts and words to learn and remember are listed at the skills. Features of the third edition that support student beginning of each chapter and defined within the learning include a conversational, engaging writing style; context of the chapter. A glossary, included at the a completely new art program; and a clean, open page end of the book, allows students to quickly look up design. In addition, the following pedagogical features definitions for the key terms highlighted throughout were developed to aid students in acquiring the skills the book. and knowledge they need to provide safe, competent, Check Your Understanding. Each chapter compassionate care: concludes with Questions for Review (multiple- Case studies. Each chapter begins by introducing choice questions that allow students to assess a recipient of health care and providing some basic their understanding of the chapter content) and information about the person and his or her situation. Questions to Ask Yourself (short-answer, usually As students progress through the chapter, they are scenario-based questions designed to help students provided with more information about the person apply and think critically about the information they introduced in the case study, and they are given the have just learned). The answers to the multiple- opportunity to apply the concepts they have just choice Questions for Review are provided in read about. The case studies serve to personalize Appendix E. viii | | Nurse Assistant Training Organization basic principles of care in the event of common weather emergencies or disasters. The third edition of the American Red Cross Nurse Assistant Training textbook has been reorganized to Unit 3: Providing Care facilitate logical progression from one topic to another Unit 3 teaches the concepts and skills used to provide and to allow students to build and expand on previously routine care to patients, residents and clients. The unit acquired knowledge. Chapters have been organized into begins with Chapter 9, Measuring Vital Signs, Weight thematic units. and Height. In this chapter, students learn the skills they need to obtain basic measurements accurately. Unit 1: The Art of Caregiving Chapter 10, Maintaining a Comfortable Environment, In this unit, students are introduced to fundamental teaches bedmaking skills and reviews environmental concepts that are essential to working in the health care factors that can affect a person’s comfort while in a field. Chapter 1, Being a Nurse Assistant, describes the health care facility. Chapter 11, Providing Restorative nurse assistant’s roles and responsibilities as a member Care, introduces students to the important role nurse of the health care team and the educational requirements assistants play in helping those in their care maintain or necessary to become a nurse assistant, and it introduces regain function, and it reviews skills related to exercise the concept of professionalism. Chapter 2, Working in the and preventing complications of immobility. Chapter 12, Health Care System, provides an overview of the health Assisting with Positioning and Transferring, describes care system. Settings where health care is delivered, pressure ulcer prevention strategies and reviews the methods of paying for health care, and legislation and skills needed to safely assist with repositioning and organizations that serve to protect both the recipients transferring. Chapter 13, Assisting with Personal and providers of health care are described. Chapter 3, Cleanliness and Grooming, teaches personal care skills. Understanding Legal and Ethical Aspects of Health Care, Chapter 14, Assisting with Meals and Fluids, describes seeks to give students a basic understanding of legal and the concepts and skills needed to ensure adequate ethical issues that can arise in health care, and it explains nutrition and hydration. Chapter 15, Assisting with how to protect themselves from legal or ethical difficulties Elimination, describes the skills needed to assist people on the job. Chapter 4, Understanding the People in Our with elimination and describes common problems with Care, reviews qualities and experiences that all human elimination. Chapter 16, Promoting Comfort and Rest, beings have in common. Chapter 5, Communicating with is new to this edition and discusses the nurse assistant’s People, teaches students the skills they need in order to role in recognizing, reporting and managing pain and in communicate effectively with those in their care, as well as promoting adequate rest and sleep. The unit concludes with their co-workers. with Chapter 17, Assisting with Admissions, Transfers and Discharges, which describes the nurse assistant’s Unit 2: Promoting Safety responsibilities, including providing emotional support, This unit focuses on topics, skills and principles that during these times of transition. are essential for ensuring the safety of everyone who lives or works in a health care setting. Chapter 6, Unit 4: Special Care Situations Controlling the Spread of Infection, gives students This unit delves deeper into specific caregiving a basic understanding of how infections can spread situations. The unit begins with Chapter 18, Providing throughout a health care facility and the methods Care for People with Specific Illnesses, which provides that are used to protect recipients of health care and an overview of commonly encountered medical health care workers from health care–associated conditions and special considerations for the nurse infections. Chapter 7, Preventing Injuries, provides assistant in caring for people with these conditions. information about maintaining a safe workplace and Chapter 19, Providing Care for People with Cognitive living environment. Principles of body mechanics and Changes and Dementia, begins by reviewing common safe lifting are reviewed, along with “no-lift” policies, causes of cognitive changes, including normal age- which seek to limit on-the-job injuries. Factors that put related changes in cognition, as well as delirium and recipients of health care at risk for injury, along with dementia. The rest of the chapter is devoted to helping common injuries and their prevention, are reviewed, students understand how a person with dementia including expanded coverage of fall-prevention experiences the world, and provides strategies for strategies. Chapter 7 also reviews the safe use of effectively communicating with and providing care for equipment, including issues related to the use of the person with dementia. Chapter 20, Providing Care side rails and restraints. Chapter 8, Responding for People at the End of Life, seeks to help students to Emergencies, gives students a brief overview of understand the very important role nurse assistants common medical emergencies, describes how to have in caring for people and their family members in prevent and respond to fire emergencies and reviews the time leading up to and following a person’s death. Preface | ix Chapter 21, Providing Care to Infants and Children, Additional Skills, provides skill sheets for skills related provides a basic overview of care considerations for the to measuring temperature with a glass thermometer pediatric population. Chapter 22, Providing Care for and the one-step method of measuring blood pressure. People in Their Homes, introduces the student to the Appendix E, Answers to Questions for Review, provides unique aspects of working as a home health aide and the answers to the multiple-choice questions in the providing care in the home. text for student self-assessment. Finally, the glossary provides an alphabetized list of all of the key terms in the book and their definitions, for quick reference Unit 5: Transitioning from and review. Student to Employee The final unit in the textbook gives students the skills they need to succeed in the workplace. Chapter 23, Instructor Support Materials Entering the Workforce, provides basic information In addition to this textbook, several items have been about identifying appropriate job opportunities, developed to assist instructors in teaching the course preparing a resume and reference list, writing and students in learning the content. cover letters and thank-you notes, and interviewing successfully. Chapter 24, Enjoying Professional American Red Cross Nurse Assistant Training Success, helps students acquire the skills and Videos. These brand-new training videos, developed knowledge they need to stay healthy and happy on in conjunction with the textbook, include step-by-step the job. Time-management strategies, interpersonal demonstrations of key nurse assistant skills. In addition skills, self-care skills and opportunities for career to step-by-step demonstrations of skills, testimonial- advancement are reviewed. based videos focusing on topics such as end-of-life care, dementia care and restorative care have been added to the series. The five principles of care—safety, Appendices and Glossary privacy, dignity, independence and communication—are The textbook concludes with five appendices and emphasized throughout. a glossary. Appendix A, Medical Terminology and American Red Cross Nurse Assistant Training Abbreviations, gives students tools they need to discern Instructor’s Manual. The Instructor’s Manual provides the meaning of unfamiliar medical words. A listing of lesson plans, classroom activities, tips for individualizing commonly used abbreviations and acronyms in health teaching methods to meet individual students’ needs, care is also provided. Appendix B, Body Basics, reviews and tools and forms for course management and the structure and function of the ten organ systems administration. and describes normal age-related changes for each. Appendix C, Math and Measurements Review, helps Instructor’s Corner. This website provides course students refresh their skills related to mathematical updates, digital materials, teaching tools, course record calculations and units of measure. Appendix D, forms and more. x | | Nurse Assistant Training  D ETAI LE D TAB LE O F C O NTE NTS Preface...............................viii Sexuality and Intimacy...................39 How to Use This Book.................xviii Culture..................................41 Spirituality...............................41 UNIT 1: THE ART OF CAREGIVING CHAPTER 5 Communicating with People............ 44 CHAPTER 1 Communication Basics...................45 Being A Nurse Assistant................. 2 Communicating with Those in Your Nurse Assistant Responsibilities Care....................................47 and Training.............................. 3 Communicating with Family Members.....50 Working as a Member of the Health Care Team................................ 5 Communicating with Other Members of the Health Care Team.................50 The Art of Caregiving..................... 7 Professionalism........................... 9 UNIT 2: PROMOTING SAFETY CHAPTER 2 Working in the Health Care System...... 12 CHAPTER 6 Health Care Settings.....................13 Controlling the Spread of Infection...... 58 Paying for Health Care...................17 What Causes Infection?..................59 Protecting the Recipients of The Chain of Infection....................59 Health Care.............................17 Health Care–Associated Infections.......60 Protecting Health Care Workers..........20 How to Recognize an Infection...........61 How to Control the Spread of Microbes...62 CHAPTER 3 Bloodborne Pathogens and Understanding Legal and Ethical Workplace Safety........................68 Aspects of Health Care................. 22 Skill 6-1: Hand Washing.................70 Legislation That Influences the Delivery of Health Care...............23 Skill 6-2: Using Personal Protective Equipment (PPE).....................72 Behaviors That Can Result in Legal or Disciplinary Action.....................25 Skill 6-3: Handling a Plastic Trash Bag...75 Using Ethics to Guide Behavior...........28 CHAPTER 7 Avoiding Legal and Ethical Difficulties Preventing Injuries..................... 76 on the Job...............................28 Protecting Your Body from Injury..........77 CHAPTER 4 Using Equipment Safely..................78 Understanding the People in Our Care... 31 Keeping the People in Your Care Safe....80 Human Growth and Development........32 A Word About Restraints.................84 Basic Human Needs.....................37 Performing Skills Safely..................85 Detailed Table of Contents | xi CHAPTER 8 Bedmaking............................ 129 Responding to Emergencies............ 89 Skill 10-1: Making an Unocccupied Medical Emergencies....................90 Bed................................ 135 Fire Emergencies........................95 Skill 10-2: Making an Occupied Bed... 137 Weather Emergencies, Disasters and Other Events with CHAPTER 11 Widespread Impact......................97 Providing Restorative Care.............140 Skill 8-1: First Aid for a Conscious Goals of Restorative Care.............. 141 Choking Adult...................... 101 The Nurse Assistant’s Role in Providing Restorative Care............. 141 UNIT 3: PROVIDING CARE Promoting Independence............... 142 Promoting Mobility..................... 144 CHAPTER 9 Skill 11-1: Helping a Person Measuring Vital Signs, Weight to Walk............................ 152 and Height........................... 103 Skill 11-2: Helping a Person with Vital Signs............................. 104 Passive Range-of-Motion Weight and Height..................... 114 Exercises.......................... 153 Skill 9-1: Using an Electronic Thermometer to Measure a CHAPTER 12 Person’s Temperature............... 116 Assisting with Positioning and Skill 9-2: Evaluating a Person’s Transferring..........................158 Radial Pulse........................ 118 Pressure Ulcers........................ 159 Skill 9-3: Evaluating a Person’s Assisting with Positioning.............. 162 Apical Pulse........................ 119 Assisting with Transferring............. 166 Skill 9-4: Evaluating a Person’s Respirations........................ 120 Skill 12-1: Lifting a Person’s Head and Shoulders off the Bed.......... 169 Skill 9-5: Measuring a Person’s Blood Pressure........................... 121 Skill 12-2: Moving a Person Up in Bed (One Nurse Assistant)....... 170 Skill 9-6: Measuring a Person’s Weight and Height Using an Upright Scale... 123 Skill 12-3: Moving a Person Up in Bed Using a Draw Sheet (Two Nurse Assistants)......................... 172 CHAPTER 10 Maintaining a Comfortable Skill 12-4: Moving a Person Up in Bed Using a Draw Sheet (One Nurse Environment......................... 125 Assistant).......................... 173 The Person’s Space.................... 126 Skill 12-5: Moving a Person to Common Furnishings in Health Care the Side of the Bed Settings............................... 128 (One Nurse Assistant).............. 174 xii | | Nurse Assistant Training  Skill 12-6: Moving a Person to Skill 13-4: Brushing and Combing the Side of the Bed a Person’s Hair..................... 208 (Two Nurse Assistants)............. 175 Skill 13-5: Shampooing a Person’s Skill 12-7: Turning a Person onto Hair in Bed......................... 209 Her Side (One or Two Skill 13-6: Helping a Man Nurse Assistants).................. 176 to Shave........................... 211 Skill 12-8: Turning a Person Using Skill 13-7: Helping a Person to a Logrolling Technique.............. 178 Change Clothes.................... 213 Skill 12-9: Repositioning a Person Skill 13-8: Helping a Person to in a Chair (Two Nurse Assistants)....... 180 Put On Compression Stockings..... 216 Skill 12-10: Transferring a Person Skill 13-9: Inserting and Removing from the Bed to a Chair (One or an In-The-Ear Hearing Aid.......... 217 Two Nurse Assistants).............. 181 Skill 13-10: Providing Hand and Skill 12-11: Transferring a Person from Foot Care.......................... 218 the Chair to a Bed (One or Two Nurse Assistants).................. 184 Skill 13-11: Providing Perineal Care............................... 220 Skill 12-12: Using a Mechanical Lift to Transfer a Person (Two Nurse Skill 13-12: Helping a Person with Assistants)......................... 185 a Complete Bed Bath............... 222 Skill 13-13: Helping a Person with CHAPTER 13 a Shower or Tub Bath............... 225 Assisting with Personal Cleanliness Skill 13-14: Giving a Back Rub......... 227 and Grooming........................ 187 Mouth Care............................ 190 CHAPTER 14 Assisting with Meals and Fluids........ 228 Hair Care.............................. 192 What Is Good Nutrition?................ 229 Shaving................................ 193 Planning a Healthy Diet................ 230 Dressing and Undressing............... 194 Factors That Affect What and Vision and Hearing Aids................ 195 How We Eat........................... 231 Hand and Foot Care................... 196 Special Orders Concerning Perineal Care.......................... 197 Nutrition............................... 231 Skin Care.............................. 198 Meal Time When a Person Is Skill 13-1: Brushing and Flossing a Receiving Health Care................. 233 Person’s Teeth...................... 202 The Importance of Fluids............... 238 Skill 13-2: Providing Denture Other Ways of Providing Nutrition Care............................... 204 and Fluids............................. 240 Skill 13-3: Providing Mouth Care for Skill 14-1: Helping a Person an Unconscious Person............. 206 to Eat.............................. 243 Detailed Table of Contents | xiii CHAPTER 15 Skill 16-2: Assisting with a Warm Soak... 284 Assisting with Elimination............. 245 Skill 16-3: Applying an Aquathermia Introduction to Elimination.............. 246 Pad................................ 285 Promoting Normal Elimination.......... 247 Skill 16-4: Applying a Warm Water Bottle or Ice Bag................... 286 Assisting the Person to Use a Toilet, a Portable Commode, a Bedpan or a Urinal............................. 249 CHAPTER 17 Assisting with Admissions, Problems with Elimination.............. 250 Transfers and Discharges.............. 287 Special Tasks Related to Assisting with Elimination........................ 254 Assisting with Admissions.............. 288 Skill 15-1: Helping a Person to Use Assisting with Transfers................ 290 a Portable Commode............... 261 Assisting with Discharges.............. 291 Skill 15-2: Helping a Person to Use a Bedpan.......................... 262 UNIT 4: SPECIAL CARE Skill 15-3: Helping a Man to Use a Urinal............................ 264 SITUATIONS Skill 15-4: Applying a Condom Catheter........................... 265 CHAPTER 18 Skill 15-5: Collecting a Routine Providing Care for People with Urine Specimen or Stool Specific Illnesses..................... 295 Specimen.......................... 266 Musculoskeletal Conditions............ 296 Skill 15-6: Collecting a Clean Cardiovascular Conditions.............. 299 Catch (Midstream) Urine Specimen.......................... 267 Respiratory Conditions................. 299 Skill 15-7: Providing Catheter Care.... 268 Neurologic Conditions................. 302 Skill 15-8: Emptying a Urine Diabetes.............................. 304 Drainage Bag...................... 270 Kidney Failure......................... 305 Skill 15-9: Changing an Ostomy Cancer................................ 305 Appliance.......................... 271 HIV/AIDS............................. 306 Skill 15-10: Giving a Person an Enema... 272 Mental Health Conditions.............. 308 CHAPTER 16 Promoting Comfort and Rest........... 274 CHAPTER 19 Promoting Comfort.................... 275 Providing Care for People with Promoting Rest........................ 280 Cognitive Changes and Dementia...... 311 Skill 16-1: Applying a Warm or Types of Cognitive Changes............ 312 Cold Compress..................... 283 Dementia.............................. 316 xiv | | Nurse Assistant Training  Challenging Behaviors................. 320 UNIT 5: TRANSITIONING FROM Communicating with a Person with Dementia......................... 322 STUDENT TO EMPLOYEE The Needs of the Caregiver............ 323 CHAPTER 23 Entering the Workforce................373 CHAPTER 20 Planning Your Job Search.............. 374 Providing Care for People at the End Applying for Jobs...................... 375 of Life................................. 327 Going on Job Interviews................ 378 A Peaceful and Comfortable Death................................. 328 Responding to a Job Offer............. 379 Providing End-of-Life Care............. 329 Becoming a New Employee............ 380 Providing Care in the Hours CHAPTER 24 Immediately Before and After Enjoying Professional Success.........382 Death................................. 334 Basic Expectations for Those Skill 20-1: Providing Postmortem Employed as Nurse Assistants......... 383 Care............................... 337 Dealing with Violence and Harassment in the Workplace....................... 384 CHAPTER 21 Contributing to a Positive Work Providing Care to Infants Environment........................... 385 and Children.........................338 Managing Time........................ 387 General Childhood Responses Caring for Yourself..................... 396 to Illness, Injury and Hospitalization..... 339 Developing Your Career................ 397 Factors Affecting a Child’s Response to Illness, Injury Making a Difference................... 398 and Hospitalization..................... 340 Caring for Infants and Children......... 343 APPENDICES Specific Care Responsibilities.......... 349 Appendix A: Medical Terminology and Abbreviations...................... 401 Appendix B: Body Basics............... 405 CHAPTER 22 Providing Care for People in Appendix C: Math and Measurements Their Homes.........................356 Review................................ 417 Overview of Home Appendix D: Additional Skills........... 429 Health Care............................ 357 Appendix E: Answers to Questions The Home Health Aide’s Role.......... 359 for Review............................. 434 The Home Health Care Glossary................................... 437 Environment........................... 360 Resources................................. 451 Caregiving Skills in the Home.......... 364 Index...................................... 462 Detailed Table of Contents | xv S K I LLS Skills are numbered according to chapter number and sequence within the chapter. CHAPTER 6 CHAPTER 12 Controlling the Spread of Infection Assisting with Positioning and Transferring Skill 6-1: Hand Washing Skill 12-1: Lifting a Person’s Head and Shoulders Skill 6-2: Using Personal Protective Equipment off the Bed (PPE) Skill 12-2: Moving a Person Up in Bed Skill 6-3: Handling a Plastic Trash Bag (One Nurse Assistant) Skill 12-3: Moving a Person Up in Bed Using CHAPTER 8 a Draw Sheet (Two Nurse Assistants) Responding to Emergencies Skill 12-4: Moving a Person Up in Bed Using a Draw Sheet (One Nurse Assistant) Skill 8-1: First Aid for A Conscious Choking Adult Skill 12-5: Moving a Person to the Side of the Bed (One Nurse Assistant) CHAPTER 9 Skill 12-6: Moving a Person to the Side of Measuring Vital Signs, Weight and Height the Bed (Two Nurse Assistants) Skill 9-1: Using an Electronic Thermometer Skill 12-7: Turning a Person onto Her Side to Measure a Person’s Temperature (One or Two Nurse Assistants) Skill 9-2: Evaluating a Person’s Radial Pulse Skill 12-8: Turning a Person Using a Logrolling Technique Skill 9-3: Evaluating a Person’s Apical Pulse Skill 12-9: Repositioning a Person in a Chair Skill 9-4: Evaluating a Person’s Respirations (Two Nurse Assistants) Skill 9-5: Measuring a Person’s Blood Pressure Skill 12-10: Transferring a Person from the Skill 9-6: Measuring a Person’s Weight Bed to a Chair (One or Two Nurse Assistants) and Height Using an Upright Scale Skill 12-11: Transferring a Person from the Chair to a Bed (One or Two Nurse Assistants) CHAPTER 10 Skill 12-12: Using a Mechanical Lift to Maintaining a Comfortable Environment Transfer a Person (Two Nurse Assistants) Skill 10-1: Making an Unocccupied Bed Skill 10-2: Making an Occupied Bed CHAPTER 13 Assisting with Personal Cleanliness CHAPTER 11 and Grooming Providing Restorative Care Skill 13-1: Brushing and Flossing a Person’s Teeth Skill 11-1: Helping a Person to Walk Skill 13-2: Providing Denture Care Skill 11-2: Helping a Person with Passive Skill 13-3: Providing Mouth Care for Range-of-Motion Exercises an Unconscious Person xvi | | Nurse Assistant Training Skill 13-4: Brushing and Combing Skill 15-5: Collecting a Routine Urine a Person’s Hair Specimen or Stool Specimen Skill 13-5: Shampooing a Person’s Hair in Bed Skill 15-6: Collecting a Clean Catch Skill 13-6: Helping a Man to Shave (Midstream) Urine Specimen Skill 13-7: Helping a Person to Change Clothes Skill 15-7: Providing Catheter Care Skill 13-8: Helping a Person to Put On Skill 15-8: Emptying a Urine Drainage Bag Compression Stockings Skill 15-9: Changing an Ostomy Appliance Skill 13-9: Inserting and Removing Skill 15-10: Giving a Person an Enema an In-The-Ear Hearing Aid Skill 13-10: Providing Hand and Foot Care CHAPTER 16 Skill 13-11: Providing Perineal Care Promoting Comfort and Rest Skill 13-12: Helping a Person with Skill 16-1: Applying a Warm or Cold Compress a Complete Bed Bath Skill 16-2: Assisting with a Warm Soak Skill 13-13: Helping a Person with Skill 16-3: Applying an Aquathermia Pad a Shower or Tub Bath Skill 16-4: Applying a Warm Water Bottle or Skill 13-14: Giving a Back Rub Ice Bag CHAPTER 14 CHAPTER 20 Assisting with Meals and Fluids Providing Care for People at the End of Life Skill 14-1: Helping a Person to Eat Skill 20-1: Providing Postmortem Care CHAPTER 15 APPENDIX D Assisting with Elimination Additional Skills Skill 15-1: Helping a Person to Use Skill D-1: Cleaning a Glass Thermometer a Portable Commode Skill D-2: Using a Glass Thermometer to Skill 15-2: Helping a Person to Use a Bedpan Measure a Person’s Temperature Skill 15-3: Helping a Man to Use a Urinal Skill D-3: Measuring a Person’s Blood Pressure Skill 15-4: Applying a Condom Catheter (One-Step Method) Skills | xvii HOW TO USE TH IS BOOK The American Red Cross Nurse Assistant Training textbook is designed with you, the student, in mind. Let’s look at some of the features that have been included to help you learn and retain key information and skills. GOALS The goals listed at the beginning of each chapter provide a road map for the chapter; they tell you which ideas are most important to learn. Before you begin reading, review the list of goals. This will give you an overview of the concepts and skills that will be covered in the chapter. After you finish reading the chapter, review the goals again. Can you meet each goal? If not, review the sections of the chapter where that information is covered. KEY TERMS At the beginning of each chapter, you will also find a list of key terms, or vocabulary words. These words are boldfaced and defined in the chapter. You can also look up the definitions of these words in the glossary that appears at the end of the textbook. Familiarize yourself with these words before you begin reading the chapter. When you are finished reading the chapter, review the list of key terms again. Can you define each one? CASE STUDY At the beginning of each chapter, you will be introduced to a person who is receiving care in a health care setting, and you will be given a little bit of information about the person and his or her situation. Throughout the chapter, you will be prompted to pause and think about how the concepts and skills you are learning would apply to the person you met. Take these opportunities to reflect on what you are learning, and think about how this knowledge could apply to situations you will encounter on the job. xviii | | Nurse Assistant Training NURSE ASSISTANT DO’S AND DON’TS Throughout the text, you will see boxes that summarize guidelines for key nurse assistant responsibilities. Learning and following these guidelines will help you provide safe, efficient, person-centered care. OBSERVATIONS INTO ACTION As a nurse assistant, you will get to know the people in your care well. Knowing what is “normal” for each of them gives you the ability to recognize changes in their condition. These boxes summarize changes in a person’s condition that are important to report to the nurse. ELDER CARE NOTES Many of the people you will care for will be elderly. Elder Care Notes placed throughout the text raise your awareness of special considerations you must take into account when caring for people who are older. How to Use This Book | xix SKILL SHEETS At the end of each chapter that contains skills, you will find illustrated skill sheets. These skill sheets guide you step by step through the skills you must learn to be a nurse assistant. The skill sheets are divided into three parts. The first part, the preparation section, lists the steps you should follow before beginning any skill. Similarly, the last part, the completion section, lists the steps you should perform after finishing any skill. These preparation and completion steps emphasize the five principles of care—safety, privacy, dignity, independence and communication—and help to promote safe, efficient, person- centered care. In between, in the procedure section, you will find the steps you take that are specific to the particular skill. CHECK YOUR UNDERSTANDING The Check Your Understanding section at the end of each chapter gives you an opportunity to see how well you learned and understood the chapter content. Questions for Review are multiple-choice questions. Each has one best answer. Try answering these questions and then check the answers in Appendix E at the end of the book. If you answered any of the questions incorrectly, go back and review the appropriate sections of the chapter. The Questions to Ask Yourself section poses real-life situations that encourage you to apply your knowledge and decision-making skills. These questions may have several correct answers. Think about the situations posed in the questions and how you would respond. Because there may be many different ways to approach the situation, try discussing your answers with your instructor, your classmates or both. xx | | Nurse Assistant Training APPENDICES, GLOSSARY, RESOURCES AND INDEX The appendices at the end of the book provide additional information that may be useful to you. Appendix A, Medical Terminology, will help you become familiar with the “language of caregiving.” A listing of common abbreviations is also provided. Appendix B, Body Basics, gives you an overview of how the human body works, and changes that normally occur with aging. Appendix C, Math and Measurements Review, will help you refresh your skills related to mathematical calculations and units of measure. Appendix D, Additional Skills, provides skill sheets for skills that are taught in some states, but not all. Your instructor will tell you if you need to learn these skills. Appendix E, Answers to Questions for Review, provides the answers to the multiple-choice questions at the end of each chapter, so that you can check your understanding of what you have learned. Also at the end of the book, you will find a Glossary, which is an alphabetized list of the key terms in the book, with their definitions. You will also find Resources, which provides references for the information given in the text, and an Index, which you can use to find specific topics within the book quickly and easily. How to Use This Book | xxi 1 2 3 4 5 THE ART OF CAREGIVING Being a Nurse Assistant Working in the Health Care System Understanding Legal and Ethical Aspects of Health Care Understanding the People in Our Care Communicating with People 1 UNIT Unit 1 | The Art of Caregiving | 1 C HA P T E R 1 Being a Nurse Assistant After reading this chapter, you will have the information needed to: Describe the nurse assistant’s responsibilities and the requirements that a person must meet in order to work as a nurse assistant. Describe how the nurse assistant functions as a member of the health care team and of the nursing team. Goals Describe tasks that are usually outside of the nurse assistant’s scope of practice. Explain how focusing on the person who is receiving care can lead to better care. List the five principles of care, and explain why each is important. Explain what it means to be a professional, and describe how a nurse assistant can display professionalism on the job. 2 | | Nurse Assistant Training  Key Terms: activities of daily nursing team empathy living (ADLs) delegation compassion health care team scope of practice Angus McCarthy is a 78-year-old man who was admitted to Morningside Nursing Home yesterday after being discharged from the hospital with chronic heart failure. When you enter the room today to provide care, Mr. McCarthy’s 75-year-old wife, Martha, is sitting with him. You introduce yourself and explain that you are there to help Mr. McCarthy with bathing and dressing. After talking with Mr. McCarthy and his wife for several minutes, you ask him about getting washed and dressed. He says, “Let me finish watching my favorite game show first, and then we can take care of business.” You agree and ask if you can sit with him while he watches his show. He says, “Have a seat and I’ll tell you why I like this show so much.” Figure 1-1 Many of the nurse assistant’s responsibilities involve helping people with activities of daily living (ADLs). NURSE ASSISTANT As a nurse assistant, you will have a great deal of daily RESPONSIBILITIES contact with the people in your care and their family members. Getting to know the people in your care as AND TRAINING individuals and taking a genuine interest in them are things you can do to support them emotionally. A smile, The Nurse Assistant’s a pat on the shoulder, and a willingness to listen lets the Responsibilities person know that you care, and that she is not alone (Figure 1-2). A nurse assistant works under the supervision of a licensed nurse (that is, a registered nurse [RN] or licensed practical nurse [LPN]) to provide basic nursing care to people who are ill, injured or disabled. Nursing care seeks to care for the whole person, meeting the person’s physical and emotional needs. As a nurse assistant, many of your responsibilities will have to do with helping the people in your care with activities of daily living (ADLs), such as eating, bathing, dressing, grooming, using the toilet and moving (Figure 1-1). Nurse assistants are also responsible for obtaining routine measurements (such as vital signs, height and weight); assisting with admissions, transfers and discharges; and maintaining a safe and clean environment. In addition to helping to meet the physical needs of the people in your care, you will help to meet their emotional needs. People who find themselves in need of health care, and their family members, are often frightened, Figure 1-2 Providing emotional support is an important part of the nurse worried and upset. They may feel lonely and isolated. assistant’s job too. Chapter 1 | Being a Nurse Assistant | 3 Because of the amount of time you will spend with the When you share this type of information with the nurse, people in your care, you may be the first to recognize a you promote quality care by helping to ensure that steps change in the person’s condition, or learn of a concern are taken to determine the cause of the change or to the person has. For example, you may notice that a address the person’s concerns. person’s appetite has decreased, or a person may A sample job description for a nurse assistant is shown mention to you that she is worried about a surgical in Figure 1-3. procedure she is scheduled to have the next day. Morningside Nursing Home JOB DESCRIPTION Certified Nurse Assistant (CNA) Duties 1. Reports to work as scheduled and on time. 2. Attends shift report, organizes assignments and makes rounds on residents. 3. Delivers personal care and emotional support to those under his or her care. 4. Regards all residents as under his or her care when assistance or supervision is needed; answers all requests for help promptly within 5 minutes. 5. Provides care according to the resident’s care plan in a manner that protects the resident’s dignity and privacy. 6. Assists residents to maintain or regain their maximum level of independence. 7. Works to build relationships with residents and their family members that are warm, positive and supportive. 8. Reports to supervisor/charge nurse any observations or concerns about the resident’s status in a timely fashion. 9. Documents the care provided and observations promptly and accurately. 10. Practices infection-control measures, including taking standard precautions, in accordance with facility policy and the resident’s care plan. 11. Keeps work area and residents’ environment neat, clean and orderly. 12. Measures and accurately reports and records vital signs, height and weight. 13. Monitors and records intake and output; assists in serving meals, meal supplements and fluids; assists residents with eating as necessary. 14. Assists residents with repositioning, transferring and exercise. 15. Assists residents with toileting, bathing and grooming. 16. Assists with admissions, transfers and discharges as necessary. 17. Takes initiative in delivery of services—sees what needs to be done and does it, within scope of practice. 18. Participates in providing end-of-life care to residents who are dying, and their family members. 19. Knows fire and disaster plans and personal duties in case of fire or disaster. 20. Participates in resident-care conferences. 21. Attends all mandatory in-service training sessions. Job * Must have a valid nurse assistant certification in good standing with the state Requirements * Must have current CPR certification * Must pass a criminal background check * Must complete a health screening and tuberculosis screening within 2 weeks of hire * Must pass a mandatory drug screening test within 90 days of hire * Must be able to lift, push and pull up to 30 pounds * Must possess basic computer skills * Must possess good communication skills and the ability to interact in a tactful and respectful manner with residents, family members and visitors * Must be able to multitask in a fast-paced work environment and prioritize duties * Must have the ability to understand and follow policies and procedures Figure 1-3 A sample job description for a nurse assistant. 4 | | Nurse Assistant Training Requirements to Become a After completing the training course and passing the state’s certification evaluation, a person becomes Nurse Assistant certified to work as a nurse assistant in that state. A person who wants to become a nurse assistant must Depending on the state and the employer, a person who complete a state-approved training course and pass the is certified to work as a nurse assistant may be called by state’s certification examination. The federal government many different titles, including certified nurse assistant or specifies that a minimum of 75 hours of training is certified nursing assistant (CNA), nurse aide or geriatric required, and that the training must include: nursing assistant (GNA). Classroom learning. Hands-on practice of skills in a skills lab. A clinical practicum (that is, the opportunity to gain WORKING AS A MEMBER OF supervised experience providing direct care in an THE HEALTH CARE TEAM actual health care setting). Many states require more hours of training than the The Health Care Team federally mandated 75 hours. As a nurse assistant, you will be a key member of the In addition to completing the training course, a person health care team. The health care team consists of who wants to work as a nurse assistant must pass the person receiving care, the person’s family members, the state’s certification evaluation. This evaluation and staff members and other professionals who are consists of two parts: a multiple-choice written exam, responsible for providing care and other services and a skills test. During the skills test, the candidate (Figure 1-4). Each member of the health care team is required to demonstrate randomly selected nurse has specialized knowledge and skills and contributes assistant skills and must perform each skill satisfactorily equally to achieving the health care team’s goal, which in order to pass. is to provide personalized quality care that meets the Figure 1-4 The person receiving care is always the leader of the health care team. Other team members vary depending on the individual person’s needs. Chapter 1 | Being a Nurse Assistant | 5 person’s physical, emotional, social and spiritual needs. depending on the needs of the person who is receiving The person receiving care is always the “captain” of the care. Examples of staff members who may be part of the team. The other members of the health care team vary health care team are given in Table 1-1. Table 1-1 Examples of Health Care Team Members* Health Care Team Member Responsibilities Registered Nurse (RN) Performs assessments, develops care plans, provides nursing care (directly and by delegating certain tasks to other nursing team members) and supervises other members of the nursing team Licensed Practical Nurse (LPN) or Licensed Helps plan, deliver and supervise some types of nursing care under the Vocational Nurse (LVN) direction of a registered nurse Certified Nurse Assistant (CNA) or Home Provides basic nursing care under the supervision of a RN or LPN/LVN Health Aide (HHA) Doctor Determines the person’s illness or condition and supervises medical care; writes medical orders and prescribes medication and other treatments Advanced Practice Nurse (Nurse Practices independently or along with the doctor to diagnose, treat Practitioner, Clinical Nurse Specialist) and manage medical conditions; is qualified to do so by completing graduate-level education and training Discharge Planner (Continuing Care Nurse, Works with other members of the health care team to develop a plan Case Manager or Utilization Manager) for meeting the person’s care needs after the person leaves the health care setting, and assists with making the necessary arrangements Activities Director or Recreational Plans and coordinates activities that provide opportunities for Therapist socializing, spiritual support, creativity, entertainment, exercise and community and civic involvement (for example, voting) Physical Therapist Helps people improve their ability to move their bodies Occupational Therapist Helps people improve their independence in performing actions related to everyday living, such as managing a home (for example, preparing a meal or doing laundry) or functioning in a job Speech Therapist Helps people improve their ability to speak, chew and swallow Dietitian Uses knowledge of nutrition and of the person to plan a diet that the person will enjoy and that will help him maintain or regain health Social Worker Helps the person and the family solve everyday problems related to the person’s illness by putting him and his family in touch with resources that can help, such as meal-delivery services, adult day care services, and support groups Psychologist Provides mental health assessment services Pharmacist Provides medications ordered by the doctor or advanced practice nurse, and keeps a record of all medications Religious Leader (for example, priest, Provides spiritual support, as needed and requested, for the person minister, rabbi) receiving care, the family and staff members Environmental Services Employee (may Ensures a clean, safe, attractive environment by maintaining the work in laundry, housekeeping or facility building and grounds, and by maintaining the equipment used in the maintenance departments) facility (such as linens or wheelchairs) * This list of team members represents only some of the many people who could be members of the health care team. The specific members of the health care team will vary depending on the person’s needs. 6 | | Nurse Assistant Training The Nursing Team you are allowed to do, as detailed in the job description given to you by your employer. Job descriptions vary from The nursing team is a subset of the health care team employer to employer, so you must always read each (Table 1-2). The nursing team consists of, at minimum, new job description carefully to make sure you know a licensed nurse and a nurse assistant. Licensed your responsibilities. Perform only the tasks listed in your nurses may be registered nurses (RNs) or licensed job description. If the nurse delegates a task to you that practical/vocational nurses (LPN/LVNs). An advanced is outside of your scope of practice, or that you do not practice nurse (APRN), who may also be called a nurse feel qualified to perform safely, you must speak up and practitioner (NP) or clinical nurse specialist (CNS), may ask the nurse to reassign the task. Tasks that are usually also be part of the nursing team. outside of the scope of practice for a nurse assistant are Usually, nurse assistants are supervised by an RN or described in Box 1-1. LPN/LVN. The nurse who supervises you may be called the charge nurse, head nurse, primary nurse, supervisor or team leader. The nurse will give you the authority THE ART OF CAREGIVING and responsibility for completing certain tasks on his or her behalf. This is called delegation. After completing Many people learn the skills of caregiving, but not a task that has been delegated to you, it is important everyone can perform those skills with kindness, to report back to update the nurse on the person’s empathy and compassion. Empathy is the quality condition, and to let the nurse know that you have of seeking to understand another person’s situation, completed the task. point of view or feelings. Compassion is the quality of recognizing another person’s hardship, To protect yourself, the person receiving care, and your accompanied by a desire to help relieve that hardship. employer, you must always work within your scope of Providing skillful care in a thoughtful way is an practice (that is, the tasks that you are legally permitted art. As you prepare for your job, you will learn the to do). Your scope of practice is defined by the state difference between just getting your job done and and by your employer. Be very familiar with the tasks that providing quality care that goes above and beyond Table 1-2 Nursing Team Members Title Requirements to Practice Responsibilities Certified Nurse Assistant (CNA) Certificate obtained by completing Assists with the delivery of nursing care or Home Health Aide (HHA) a minimum of 75 hours of training by performing basic nursing tasks under and passing a state-administered the supervision of a registered nurse (RN) certification examination or licensed practical/vocational nurse (LPN/LVN) Licensed Practical/Vocational Certificate obtained by completing a Helps plan and deliver certain types Nurse (LPN/LVN) 12- to 18-month training program of nursing care under the direction AND a license obtained by passing a of a registered nurse (RN); may also state-administered board examination be responsible for supervising nurse assistants Registered Nurse (RN) Bachelor of science in nursing (BSN) Performs assessments, develops care degree obtained from a 4-year college plans, provides nursing care (directly and OR an associate degree (ADN) by delegating certain tasks to other nursing obtained from a 2-year college team members) and supervises other AND a license obtained by passing a members of the nursing team state-administered board examination Advanced Practice Nurse Bachelor of science in nursing (BSN) Independently or in conjunction with a (APRN) degree AND a doctorate or master’s doctor, performs medical assessments, Clinical Nurse Specialist (CNS) degree obtained from an accredited diagnoses disease and prescribes Nurse Practitioner (NP) college or university AND a license treatments obtained by passing a national specialty-based board examination Chapter 1 | Being a Nurse Assistant | 7  ▼ Box 1-1 Tasks That Are Usually Outside of the Nurse Assistant’s Scope of Practice* Supervising or delegating nursing responsibilities treatments (such as medications) for illnesses to other nurse assistants. Only a licensed nurse and injuries. (an RN or an LPN) can supervise nurse assistants and Administering medications and oxygen. delegate nursing responsibilities to them. Medications must be administered by a licensed nurse Analyzing or interpreting data. A nurse assistant may or a doctor. In some settings, such as assisted living gather data, but it is outside of the nurse assistant’s scope of facilities, nurse assistants may be permitted to help practice to determine the meaning of the data. For example, the person as he takes his own medication (but they a nurse assistant may obtain a blood pressure measurement cannot actually give the medication to the person). and note that it is higher than normal. However, determining Nurse assistants who have received advanced training in why the blood pressure reading is higher than normal is the medication administration may be allowed to administer responsibility of the doctor and nurse. some types of medications in some states in certain Receiving verbal orders for the person’s medical settings, but this is not normally within the scope of care. The person’s primary care provider (a doctor or practice for a nurse assistant. an advanced practice nurse) may give verbal orders for Inserting or removing medical equipment. Nurse the person’s care over the telephone or in person. Only assistants are usually not allowed to insert medical licensed nurses can receive these verbal orders and act equipment (such as feeding tubes, urinary catheters or IV on them. lines) into a person’s body, or to remove these items from Diagnosing illness and injury and prescribing the person’s body once they are in place. treatments. Only doctors and advanced practice * The nurse assistant’s scope of practice may be expanded nurses (nurses who have obtained additional training in some settings and when the nurse assistant has received at the post-graduate level) can diagnose and order additional training to perform more advanced skills. basic expectations. Getting to know each person helping you to remember to put the person in your care as an individual and seeking to meet her emotional, first. The five principles of care are: social and spiritual needs, in addition to her physical Keep the person safe. As a nurse assistant, needs, is the key to providing the highest quality care you are responsible for protecting the people in possible (Figure 1-5). your care from harm. You will do this by taking Throughout this book, you will see references to “the steps to prevent the person from physical injuries five principles of care” (Figure 1-6). These principles (such as skin tears, bruises or burns) and from provide a framework for providing quality care by situations that can put the person at risk for Figure 1-5 Getting to know and appreciate each person in your care as Figure 1-6 Applying the five principles of care can help you to provide an individual is one of the keys to providing quality care. “star-quality” care. 8 | | Nurse Assistant Training  injury (such as wandering away from the facility). You will also help to keep the people in your care PROFESSIONALISM safe by practicing infection-control methods, such As a nurse assistant, you will be a professional caregiver. as washing your hands, consistently and correctly. You will have the training and knowledge to perform Protect the person’s dignity. Dignity is the quality a certain role, that of the nurse assistant. But being of being worthy of respect. In addition to treating a professional is about more than having certain the people in your care with respect, you will help training, credentials or qualifications. It is about them to maintain their sense of dignity by fostering having a positive attitude toward your job, and doing their sense of self-esteem, or self-respect. Actions your job to the best of your ability at all times. Help you can take to help protect the person’s dignity others see you as the professional that you are include taking care not to expose the person’s body through your actions and appearance. unnecessarily, avoiding talking down to the person or using baby talk, involving the person in decision Acting in a Professional Manner making about her care, encouraging the person to do as much for herself as possible, and helping the Let’s look at some of the actions that will help you excel person to have a clean and neat appearance. as a nurse assistant: Foster the person’s independence. Being able Dependability. Being dependable means that others to make decisions and do things for oneself is can count on you. For the people in your care, this important for maintaining a sense of dignity and means they can trust you to come to work on time and self-esteem. In addition, it is important to encourage to help them in a timely fashion. For your co-workers, the people in your care to do as much for this means that if they ask you to do something, they themselves as possible to maintain the abilities that can trust you to follow through on the request. they have, and to prevent future loss of function. Accountability. Being accountable means taking Protect the person’s privacy. Keep a person’s responsibility for your actions and the results of private business private, and do not allow private those actions. Sometimes, you may make a mistake things to be seen or overheard by other people. while delivering care. An accountable person takes Practice good communication skills. Be responsibility for the mistake, and looks to prevent available to talk, listen and respond to a person’s similar mistakes from occurring in the future. thoughts and feelings. Tell the person about the Integrity. Having integrity means that you behave care you plan to provide, and involve the person in according to an understanding of the right way to making decisions about her care. behave. One way to think about integrity is that it means doing the right thing even when no one is After the game show is over, Mr. McCarthy watching. Acting in an honest manner is one way smiles and says to you, “OK, I promised I would let you that you show integrity. Keeping private information do your job after my program was over, so let’s get to it. about the people in your care to yourself is another. Can you just give me a hand getting to the bathroom?” As Conscientiousness. Being conscientious means you help Mr. McCarthy walk to the bathroom, you notice paying attention to the details of your work. The that he begins to tire quickly and appears to get short of people in your care, and your co-workers, count on breath. He says, “I never realized how much work it is you to do your job the right way and to the best of sometimes just to walk.” You get to the bathroom and your ability, every day. say, “Why don’t you just sit down here on the commode Courtesy. A person who behaves professionally is and rest a bit while I get your supplies together?” courteous to everyone. Simple courtesies can make How can actions like watching the game the workplace a more pleasant environment, and show with Mr. McCarthy and listening to him increase the likelihood that others will also treat you when he explains why he likes it so much help courteously. Remember to say please and thank you. you provide better care? Address others as they prefer to be addressed. If you While you are assisting Mr. McCarthy with do not know how a person prefers to be addressed, bathing and dressing, what actions can you err on the side of formality (for example, “Mr. Johnson” take to protect his dignity and promote his instead of “Bill”). Offer to hold the door or elevator independence? How will you help to keep for others, and clean up after yourself in shared areas him safe? (such as the kitchenette or the nurses’ station). After you are finished caring for Mr. McCarthy, Stewardship. A steward safeguards something is there any information you would share with from harm. As a nurse assistant, you will be the nurse? If so, what and why? entrusted with the care of items belonging to others. You have an obligation to treat these items with the Chapter 1 | Being a Nurse Assistant | 9  same care and respect you would treat your own valued possessions. Stewardship also means using your employer’s resources wisely and avoiding waste (for example, by only taking the supplies you will use for a procedure into a person’s room). A willingness to help. A willingness to pitch in and work as part of a team makes many tasks much easier and safer, and contributes to a healthy work environment by helping to reduce stress. The ability to communicate. Being able to communicate effectively with the people in your care, their family members and your co-workers is a critical skill in health care. An effective communicator is a good listener, is able to express her own needs clearly and is able to advocate (speak up for) others when necessary. The ability to problem solve. This book provides guidelines to help you make the best decisions to provide the best care to each person. Each person receiving care is different, as is each situation. Using critical thinking skills allows you to look at a problem, identify possible solutions, name the pros and cons of each solution, decide which solution is best and then act on it. Figure 1-7 Help others see you as the professional that you are by Maintaining a Professional maintaining a professional appearance. Appearance your employer and your facility or agency. You will spend A