Sorrentino's Canadian Textbook for the Support Worker 5th Edition PDF

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YOU’VE JUST PURCHASED MORE THAN A TEXTBOOK! Enhance your learning with Evolve Student Resources. These online study tools and exercises can help deepen your understanding of textbook content so you can be more prepared for class, perform better on exams, and succeed in your course. Activate the complete learning experience that comes with each http://evolve.elsevier.com/Canada/Sorrentino/SupportWorker If your school uses its own Learning Management System, your resources may be delivered on that platform. Consult with your instructor. has already been revealed, the code may have been used and cannot be re-used for registration. To purchase a new code to access these Place valuable study resources, simply follow the link above. Sticker Here REGISTER TODAY! You can now purchase Elsevier products on Evolve! Go to evolve.elsevier.com/shop to search and browse for products. 2019v1.0 The content and procedures in this book are based on information currently available. They were reviewed by instructors and practising professionals in various regions of Canada. However, employer policies and proce- dures may vary from the information and procedures in this book. In addition, research and new information may require changes in standards and practices. Standards and guidelines from Health Canada may change as new information becomes available. Other federal and provincial or territorial organizations and agencies also may issue new standards and guidelines. Government legislation also may change. You are responsible for following the policies and procedures of your employer and the most current stan- dards, practices, and guidelines as they relate to the safety of your work. Contents    Instructor Preface, xvii 25 Medical Terminology, 557 Student Preface, xxii 26 Planning, Reporting, and Recording Client 1 The Role and Responsibilities of the Support Care, 568 Worker, 1 27 Nutrition and Fluids, 591 2 The Canadian Health Care System, 20 28 Enteral Nutrition and Intravenous Therapy, 3 Workplace Settings, 34 624 4 Ethics, 48 29 Urinary Elimination, 636 5 Legislation: The Client’s Rights and Your 30 Bowel Elimination, 679 Rights, 59 31 Growth and Development, 698 6 Health, Wellness, Illness, and Disability, 77 32 Body Structure and Function, 718 7 Caring About Culture and Diversity, 96 33 Common Diseases and Disorders, 752 8 Managing Stress, 112 34 Hearing and Vision Disorders, 812 9 Interpersonal Communication, 129 35 Speech and Language Disorders, 829 10 Working With Others: Teamwork and 36 Developmental Disorders and Disabilities, 839 Delegation, 149 37 Mental Health Disorders, 856 11 Working With Clients and Their Families, 164 38 Disorientation, Delirium, and Dementia, 891 12 Abuse, Bullying, and Harassment Awareness, 39 Promoting Oxygenation, 927 174 40 Heat and Cold Applications, 959 13 Starting Your Career, 194 41 Caring for Infants and Their Parents, 976 14 Body Mechanics, 215 42 Caring for the Young, 1005 15 Exercise and Activity, 259 43 Caring for Older Persons, 1019 16 Rehabilitation and Restorative Care, 282 44 Home Management, 1033 17 Personal Hygiene, 296 45 Medication Management, 1055 18 Grooming and Dressing, 337 46 Working in Acute Care, 1086 19 Preventing Infection, 376 47 End-of-Life Care, 1110 20 Safety, 416 Appendix, 1131 21 Beds and Bed Making, 458 Glossary, 1133 22 Skin Care and Prevention of Wounds, 480 References, 1161 23 Promoting Client Comfort, Pain Management, Index, 1175 and Sleep, 511 Procedures, 1186   24 Measuring Height, Weight, and Vital Signs, 528 i This page intentionally left blank        Sorrentino’s CANADIAN TEXTBOOK for the SUPPORT WORKER FIFTH EDITION Mary J. Wilk RN, GNC(C), BA, BScN, MN Professor and PSW Program Coordinator Fanshawe College, London, Ontario Sheila A. Sorrentino RN, PhD Delegation Consultant Anthem, Arizona Leighann N. Remmert RN, MS Certified Nursing Assistant Instructor Williamsville, Illinois SORRENTINO’S CANADIAN TEXTBOOK FOR THE ISBN: 978-­0-­323-­70939-­2 SUPPORT WORKER, FIFTH EDITION Copyright © 2022 by Elsevier Inc. All rights reserved. Adapted from Mosby’s Textbook for Nursing Assistants, 10th Edition, by Sheila A. Sorrentino and Leighann N. Remmert. Copyright © 2021 by Elsevier Inc. Previous editions copyrighted 2017, 2013, 2009, 2005, 2001, and 1997. 978-­0-­323-­65560-­6 (softcover) All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Reproducing passages from this book without such written permission is an infringement of copyright law. Requests for permission to make copies of any part of the work should be mailed to: College Licensing Officer, access ©, 1 Yonge Street, Suite 1900, Toronto, ON, M5E 1E5. Fax: (416) 868-­1621. All other inquiries should be directed to the publisher: www.elsevier.com/permissions. Every reasonable effort has been made to acquire permission for copyright material used in this text and to acknowledge all such indebtedness accurately. Any errors and omissions called to the publisher’s attention will be corrected in future printings. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices The content and procedures in this book are based on information currently available. They were reviewed by instructors and practising professionals in various regions of Canada. However, agency policies and procedures may vary from the information and procedures in this book. In addition, standards and guide- lines may change as new information becomes available. Other federal, provincial, and territorial agencies also may issue new standards and guidelines, as may accrediting agencies and national organizations. You are responsible for following the policies and procedures of your employer and the most current standards, practices, and guidelines as they relate to the safety of your work. To the fullest extent of the law, neither the Publisher nor the authors or editors assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence, or otherwise or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. The Publisher Library of Congress Control Number: 2021936695 We are honoured to have received permission to reproduce the work “Harmony and the Universe” by Order of Canada award-winning Indigenous artist Dr. Daphne Odjig on our textbook cover. Dr. Odjig’s art, which seeks to open doors and build community between the Indigenous and non-Indigenous community in Canada, reinforces the valuable message that we are one community in looking out for and caring for one another. In 2007, Dr. Odjig received the Governor General’s Award in Visual and Media Arts. In 2009, Dr. Odjig was the first female Indigenous artist to have her own show at the National Gallery of Canada. “Harmony and the Universe” is copyright © Daphne Odjig, artist, courtesy of Odjig Arts and Stan Somerville (Odjig) and the estate of Daphne Odjig. VP, Education Content: Kevonne Holloway Senior Content Strategist (Acquisitions, Canada): Roberta A. Spinosa-­Millman Director, Content Development: Laurie Gower Content Development Specialist: Martina van de Velde Publishing Services Manager: Julie Eddy Senior Project Manager: Clay S. Broeker Design Direction: Margaret Reid Printed in Canada Last digit is the print number: 9 8 7 6 5 4 3 2 1 I wish to dedicate this book to my loving parents, Michael and Natalia Wilk; my husband, Gord, and children, Andrew, Julie, and Brett; my granddaughters, Natalia (Tilly) and Michaela (Mikey); and my siblings, Carol and Mike. You are my supports, my inspirations, and my best friends. Thank you for your patience, your love, and your laughter. You have helped me be a better nurse and become the person I am today. Mary Wilk Loved ones are lost, and children are born, bringing joy and new memories …   Kylie Brooke, Weston Anthony, Emma Rose, Mason Anthony, and all those yet to be... With much love, Aunt Sheila   To the ones I cherish most...   Shane, Olivia, and Ava. With all my love, Leighann (Mom)    Contents    7 Caring About Culture and Diversity 96 Diversity: Ethnicity and Culture 98 Support Work and Its Impact on Society The Effect of Culture 103 Providing Culturally Sensitive Care and Support 108 1 The Role and Responsibilities of the Support Worker 1 Support Work Across Canada 3 8 Managing Stress 112 The Health Care Team 10 Stress 113 Being a Professional 14 Time Management 120 The Goal of Support Work: Improved Quality of Decision Making 121 Life Through Client-Centred Care 16 Problem Solving 122 Critical Thinking, Decision Making, and Dealing With Conflict 124 Problem-Solving 17 9 Interpersonal Communication 129 2 The Canadian Health Care System 20 Factors That Influence Communication 131 Canada’s Current Health Care System 21 Verbal Communication 132 The Provincial or Territorial Role in Health Nonverbal Communication 134 Care 28 Communication Methods 136 Health Care Challenges, Supplementary Professional Communication 138 Services, and Trends 29 Communication Barriers 139 Communicating With Angry People 142 Communicating Assertively 143 3 Workplace Settings 34 Explaining Procedures and Tasks 143 Workplace Settings and Services Provided 36 Communicating With Clients Living With Working in Community-Based Settings 37 Dementia 145 Working in Facility-Based Settings 38 Working in a Facility 42 10 Working With Others: Teamwork and Delegation 149 4 Ethics 48 The Health Care Team 150 The Influence of Culture on Beliefs, Values, Working Under Supervision 154 Morals, and Ethics 49 Assigning and Delegating 156 Codes of Ethics 49 The Principles of Health Care Ethics 50 11 Working With Clients and Their Families 164 Providing Compassionate Care While 5 Legislation: The Client’s Rights and Your Maintaining a Professional Relationship With Rights 59 the Client 165 Understanding Rights 61 The Client’s Family 170 Basic Human Rights in Canada 61 Basic Rights of People Receiving Health Services 61 12 Abuse, Bullying, and Harassment Understanding Legal Issues 69 Awareness 174 Your Legal Rights 72 Canadian Charter of Rights and Freedoms 176 Types of Abuse 176 6 Health, Wellness, Illness, and Disability 77 Abusive Relationships 179 Health and Wellness 79 Recognizing the Signs of Abuse 180 Illness and Disability 87 Supporting Clients With Illness and Disability 88 vi  CO N T E N T S vii The Cycle of Abuse 182 18 Grooming and Dressing 337 What to Do When Clients Speak of Abuse 187 Hair Care 338 Your Legal Responsibilities in Reporting Shaving 347 Abuse 187 Care of Nails and Feet 349 How to Report Abuse 188 Changing Clothing, Incontinence Briefs, and Abuse of Health Care Workers 188 Hospital Gowns 356 Applying Elastic Anti-Embolic Stockings and 13 Starting Your Career 194 Bandages 368 Compassionate Care 372 Getting Organized 195 Setting Priorities and Goals 195 Preparing Your Resumé and Professional 19 Preventing Infection 376 Portfolio 196 Microorganisms 378 Finding and Following Leads 201 The Spread of Pathogens 382 Preparing a Letter of Application 202 Medical Asepsis 389 Completing a Job Application Form 206 Hand Hygiene 392 The Interview 207 Isolation Precautions 401 The Employment Offer 211 Surgical Asepsis 411 Body Mechanics and Movement 20 Safety 416 14 Body Mechanics 215 Accident Risk Factors 417 Identifying the Client 420 Helping to Prevent Personal Injuries 217 Safety Measures at Home and in the Body Mechanics 218 Workplace 422 Positioning the Client 231 Preventing Poisoning 430 Transferring the Client 240 Preventing Burns 431 Lifting a Client 242 Preventing Accidents With Equipment 431 Preventing Fires 431 15 Exercise and Activity 259 Preventing Suffocation 440 Restraints and How to Avoid Using Them 441 Bed Rest 260 Promoting Your Personal Safety 448 Ambulation 266 16 Rehabilitation and Restorative Care 282 21 Beds and Bed Making 458 The Client’s Bed 460 Rehabilitative Care Versus Restorative Care 283 Linen 464 Goals of Rehabilitative and Restorative Care 283 Bed Making 467 Rehabilitation Settings 284 The Rehabilitation Process 287 Assisting With Rehabilitation and Restorative 22 Skin Care and Prevention of Wounds 480 Care 290 Types of Wounds 483 Overall Benefits of Rehabilitation and Restorative Skin Tears 485 Care 293 Pressure Injuries 486 Leg and Foot Ulcers 493 Assisting Clients With Basic Care Needs Wound Healing 496 Dressings 499 17 Personal Hygiene 296 Oral Hygiene 297 23 Promoting Client Comfort, Pain Management, Bathing 311 and Sleep 511 The Back Massage 326 Perineal Care 328 Promoting Client Comfort and Well-Being 512 Menstrual Care 334 Pain and Its Impact on a Client’s Well-Being 513 Rest and Sleep 520 viii CO N T E N T S 24 Measuring Height, Weight, and Vital Signs 528 The Client With a Ureterostomy or an Ileal Conduit 673 Measuring Height and Weight 529 Compassionate Care 675 Measuring and Reporting Vital Signs 530 Body Temperature 534 Pulse 540 30 Bowel Elimination 679 Respirations 544 Normal Bowel Movements 680 Blood Pressure 544 Factors Affecting Bowel Movement 681 Common Challenges Affecting Bowel 25 Medical Terminology 557 Movement 682 Bowel Training 684 Word Elements 558 Enemas 685 Combining Word Elements 562 Rectal Tubes 685 Abdominal Regions 562 The Client With an Ostomy 689 Directional Terms 562 Stool Specimens 690 Abbreviations 563 Understanding Body Systems and Disorders 26 Planning, Reporting, and Recording Client Care 568 31 Growth and Development 698 The Care-Planning Process in Facilities 569 The Care-Planning Process in Community Principles 700 Settings 572 Selected Theories of Human Development 700 Your Role in the Care-Planning Process 574 Growth and Development 703 Verbal Reporting 576 Client Records or Charts 577 32 Body Structure and Function 718 Anatomical Terms 720 Assisting Clients With Nutrition and Elimination Cells, Tissues, Organs, Body Cavities, and Organ Systems 720 27 Nutrition and Fluids 591 The Integumentary System 723 The Musculoskeletal System 724 Basic Nutrition 592 The Nervous System 729 Canada’s Dietary Guidelines 594 The Sense Organs 733 Nutrition Throughout the Life Cycle 599 The Endocrine System 735 Factors That Affect Eating and Nutrition 601 The Circulatory System 736 Food Labels 602 The Respiratory System 741 Caffeine Intake 603 The Immune System 742 Meal Planning and Preparation 604 The Digestive System 743 Special Diets 606 The Urinary System 746 Assisting Clients With Eating 610 The Reproductive System 748 Fluid Balance 614 33 Common Diseases and Disorders 752 28 Enteral Nutrition and Intravenous Therapy 624 Communicable Diseases 755 Enteral Nutrition 625 Cancer 766 Intravenous Therapy 629 Integumentary System Disorders 768 Subcutaneous Infusion Therapy 632 Musculoskeletal System Disorders 773 Nervous System Disorders 781 29 Urinary Elimination 636 Endocrine System Disorders 788 Cardiovascular System Disorders 790 Normal Urination 638 Respiratory System Disorders 797 Urinary Incontinence 648 Immune System Disorders 800 Catheters 650 Digestive System Disorders 802 Bladder Training 663 Urinary System Disorders 805 Collecting Urine Specimens 663 Reproductive System Disorders 807 Testing Urine 669  CO N T E N T S ix 34 Hearing and Vision Disorders 812 Supporting Clients Who Are Living With Dementia 906 Ear Disorders and Hearing Impairment 813 Managing Responsive Behaviours 914 Eye Disorders and Vision Impairment 818 Caregiver Needs 923 Service Dogs for People with Hearing or Vision Challenges 825 Providing and Promoting Safe Care for Clients of All Ages 35 Speech and Language Disorders 829 Aphasia 830 Apraxia of Speech 831 39 Promoting Oxygenation 927 Dysarthria 831 Factors Affecting Oxygen Needs 929 Emotional Effects of Speech and Language Altered Respiratory Function 931 Disorders 831 Promoting Oxygenation 933 Treatment for Speech and Language Assisting With Oxygen Therapy 935 Disorders 833 Assisting With Assessment and Diagnostic Supporting and Communicating With Testing 943 Clients 834 Artificial Airways 947 Suctioning an Airway 952 Mechanical Ventilation 952 36 Developmental Disorders and Disabilities 839 Chest Tubes 954 Caring for a Client Who is Living with a Developmental Disability or Disorder 840 Types of Developmental Disorders and 40 Heat and Cold Applications 959 Disabilities 841 Heat Applications 961 The Impact of Developmental Disorders and Cold Applications 969 Disabilities on the Family 851 41 Caring for Infants and Their Parents 976 37 Mental Health Disorders 856 Caring for New Birth Parents 977 Mental Health and Mental Health Disorders 859 Caring for Infants 982 Acquired Brain Injuries 865 Anxiety Disorders 866 Bipolar and Related Disorders 869 42 Caring for the Young 1005 Depressive Disorders 870 Supporting the Infant, Child, or Teen 1006 Disruptive, Impulse-Control, and Conduct Assisting Infants and Children to Meet Nutritional Disorders 873 Needs 1007 Feeding and Eating Disorders 876 Reye’s Syndrome 1010 Obsessive–Compulsive and Related Discipline 1011 Disorders 878 Supporting the Child Who Demonstrates Personality Disorders 880 Challenging Behaviours 1012 Schizophrenia Spectrum Disorders 881 Preventing Infections 1012 Self-Harm Disorders 882 Sleep–Wake Disorders 883 Substance-Related and Addictive Disorders 884 43 Caring for Older Persons 1019 Suicidal Behaviour Disorder 885 Caring for Older Clients 1020 Emotional and Social Changes 1022 Depression in Older Persons 1024 38 Disorientation, Delirium, and Dementia 891 Physical Changes 1025 Disorientation 893 The Older Person and Sexuality 1029 Delirium 895 Dementia 896 Primary Dementias 898 44 Home Management 1033 Secondary Dementias 901 The Support Worker’s Role in Home Depression and Dementia 902 Management 1035 Stages of Dementia 903 Getting Organized 1038 x CO N T E N T S Equipment and Supplies 1038 47 End-of-Life Care 1110 Using Cleaning Products Safely 1040 Life-Threatening Conditions 1111 Cleaning Bedrooms, Living Rooms, Kitchens, Attitudes Toward Death and Dying 1111 and Bathrooms 1040 Caring for a Client Who is Dying 1112 Doing Laundry 1045 Palliative Care 1116 Recycling Items and Composting 1049 Legal Issues Surrounding Death and Dying 1118 Performing Tasks Not Included on the Client’s Grief 1119 Care Plan 1051 Signs of Death 1123 45 Medication Management 1055 Appendix 1131 Scope of Practice: the Support Worker’s Role 1057 Glossary 1133 How Medications Work in the Body 1059 References 1161 Types of Medications 1063 Index 1175 Performing Simple Medication Math 1069 Documentation 1069 Procedures 1186 The 10 “Rights” of Medication    Management 1071 Medication Labelling Requirements 1072 Reporting Medication Errors 1072 46 Working in Acute Care 1086 Supporting the Client During Transitions 1087 Assisting With Physical Examinations 1090 Preparing the Client for a Physical Exam 1093 Supporting the Client Who Is Having Surgery 1096 About the Authors MARY J. WILK, RN, GNC(C), BA, BScN, MN Mary J. Wilk is currently a professor and coordinator of the Personal Support Worker (PSW) program within the School of Nursing at Fanshawe College, where she has been instrumental in the design and implementation of Fanshawe’s PSW ­program curriculum, which is taught throughout the college’s seven cam- puses. In addition, she was actively involved in the Ontario PSW Subcommittee for the Heads of Health Sciences and served as chair of the Canadian Association of Continuing Care Educators (CACCE). Mary has taught at Fanshawe College for over 35 years in the School of Nurs- ing, teaching pharmacology, anatomy and physiology, health promotion, psy- chiatric nursing, communication, nursing theory, nursing accountability, and clinical nursing in a variety of settings. During her teaching career, she has taught in the PSW, Practical Nurse, Diploma Nurse, Developmental Service Worker, Paramedic, and Recreation and Leadership programs. She was also involved in curriculum development for the Collaborative Nursing program, in affiliation with the University of Western Ontario. Her nursing career includes work expe- rience in emergency, coronary care, intensive care, orthopedic, gynecological, medical–surgical, psychiatric, and gerontological nursing. Mary has earned a Bachelor of Arts degree, a Bachelor of Science in Nursing degree, and a Master of Nursing degree from the University of Windsor, where she graduated from each program with honours. She also holds a Gerontology Nurse Certificate through the Canadian Nurses Association. She has been a guest speaker numerous times on a variety of nursing and related topics at conferences and workshops at the local, provincial, and national levels. SHEILA A. SORRENTINO, RN, PhD Sheila A. Sorrentino was instrumental in the development and approval of CNA-PN-ADN career-ladder programs in the Illinois community college system and has taught at various levels of nursing education—nursing assistant, practi- cal nursing, and baccalaureate and higher degree programs. Her career includes experiences in nursing practice and higher education—nursing assistant, staff nurse, charge and head nurse, nursing faculty, program director, assistant dean, and dean. A Mosby author and co-author of several assistant titles since 1982, Dr. Sor- rentino’s titles include: Mosby’s Textbook for Nursing Assistants (eds. 1–10) Mosby’s Essentials for Nursing Assistants (eds. 1–6) Mosby’s Textbook for Long-Term Care Nursing Assistants (eds. 1–6) Mosby’s Textbook for Nursing Assistive Personnel (eds. 1–2) Mosby’s Basic Skills for Nursing Assistants Mosby’s Textbook for Medication Assistants xi xii A B O U T T H E AU T H O R S She was also involved in the development of and early version of Mosby’s Nurs- ing Assistant Video Skills and Mosby’s Nursing Video Skills, winner of the 2003 American Journal of Nursing Book of the Year Award (electronic media). An earlier version of the nursing assistant skills videos won an International Films Award on caregiving. Dr. Sorrentino has a Bachelor of Science degree in nursing, a Master of Arts degree in education, a Master of Science degree in nursing, and a PhD in higher education administration. She is a member of Sigma Theta Tau International, the Honor Society of Nursing. Her past community activities include the Rotary Club of Anthem (Anthem, Arizona), the Provena Senior Services Board of Direc- tors (Mokena, Illinois), the Central Illinois Higher Education Health Care Task Force, the Iowa–Illinois Safety Council Board of Directors, and the Board of Directors of Our Lady of Victory Nursing Center (Bourbonnais, Illinois). She received an alumni achievement award from Lewis University for out- standing leadership and dedication in nursing education. She is also a member of the Illinois State University College of Education Hall of Fame. LEIGHANN N. REMMERT, RN, MS Leighann N. Remmert is a nursing assistant instructor in central Illinois. She has taught adult learners and high school nursing assistant students in the classroom and clinical settings. Ms. Remmert has a Bachelor of Science degree in nursing from Bradley Uni- versity (Peoria, Illinois) and a Master of Science degree in nursing education from Southern Illinois University Edwardsville (Edwardsville, Illinois). Her clinical background includes the roles of nursing assistant/tech, nurse extern, staff nurse, charge nurse, nurse preceptor, and trauma nurse specialist. She acquired diverse clinical experience as a nursing assistant/tech and extern at St. John’s Hospital (Springfield, Illinois). As an RN, she concentrated in the area of emergency nurs- ing at Memorial Medical Center (Springfield, Illinois). A former Basic Life Sup- port instructor, Ms. Remmert taught CPR courses for the community. Currently, Ms. Remmert instructs students in vocational and community col- lege nursing assistant programs in central Illinois. Through her teaching, she emphasizes the importance of professionalism and work ethics, safety, teamwork, communication, and accountability. Valuing the role of the nursing assistant and treating the person with dignity, care, and respect are integral to her instruction. Leighann is co-author of Mosby’s Textbook for Nursing Assistants (eds. 8–10), Mosby’s Essentials for Nursing Assistants (eds. 4–6), and Mosby’s Textbook for Medi- cation Assistants. She was a consultant on Mosby’s Textbook for Long-Term Care Nursing Assistants (ed. 6) and served as a content advisor for Mosby’s Nursing Assis- tant Video Skills (version 4.0). Ms. Remmert is a member of Sigma Theta Tau International, the Honor Soci- ety of Nursing, and the Certified Nursing Assistant Educator’s Association (Illi- nois, Central Region). Canadian Editorial Advisory Board and Reviewers Elsevier and the author are grateful to our Editorial Advisory Board and reviewers for sharing their knowledge and expertise, for providing their insights about support work and making many valuable content suggestions, and for their diligence in meeting very tight deadlines. Without their efforts, this textbook would not be the true representation of support work across Canada that it is. Their valuable feedback has improved the text immeasurably, and we wish to acknowledge their efforts. EDITORIAL ADVISORY BOARD Heather Klein-Horsman, RN, MN PSW and PN Program Coordinator Susana Burgos-Sewlal, RN, MN Professor, Nursing Studies Coordinator/Professor Algonquin College Personal Support Worker Program Pembroke, Ontario Centennial College Toronto, Ontario Deborah Schuh, RN, BN, PNC Coordinator, PSW Program Kim Diamond Faculty, School of Health and Community Services Instructor/Coordinator Durham College Health Care Assistant Program Oshawa, Ontario School of Health, Education, and Human Services Yukon University Karla Wolsky, RN, PhD Whitehorse, Yukon Chair Schools of Health Sciences and Allied Health Laurie Hopkins, RN, BScN Centre for Health and Wellness Moncton, New Brunswick Lethbridge College Lethbridge, Alberta xiii xiv C A N A D I A N E D I TO R I A L A DV I S O RY B OA R D A N D R E V I E W E R S REVIEWERS Jody MacDonald, BSc, RN Certificate in Adult Education Ashley Cesar, LPN CCA RPL Navigator Licensed Practice Nurse CCA Program Practice Coordinator and Instructor Boularderie, Nova Scotia Center for Health and Wellness Lethbridge College Jillian L. Penny, RN, BN, BSc Lethbridge, Alberta Health Sciences College of the North Atlantic Natalie Clark, BScN St. John’s, Newfoundland Personal Support Worker Program Coordinator Health Sciences—PSW Cailleagh Sharples, BSc St. Lawrence College, Cornwall Campus Early Childhood Education Cornwall, Ontario Certificate in Adult Education National Association of Regulatory Accreditation Elizabeth Hann, BN RN, MEd Recognition of Prior Learning Personal Care Attendant and Home Support CCA Certification Coordinator ­Worker Instructor CCA Program Faculty of Health Sciences, College of the North Bedford, Nova Scotia Atlantic St. John’s, Newfoundland Heather Smith-Hudson, RN, GNC(C), BScN, BA, BEd, MEd, OCT Laurie Hopkins, BScN, RN Personal Support Worker Program Coordinator Bachelor Science Nursing Personal Support Worker Program Registered Nurse London, Ontario Past Instructor Continuing Care Assistant Program Janet Szczukocki, RN Futureworx Society Member of College of Nurses of Ontario Dartmouth, Nova Scotia Retired Manager, PSW Education Rhonda Jackson, RN, CCEDP, BN Karla Wolsky, PhD, RN Faculty, School of Health and Human Services Chair School of Health and Human Services School of Health Sciences and Allied Health Nova Scotia Community College (NSCC) Lethbridge College Amherst, Nova Scotia Lethbridge, Alberta Acknowledgements This textbook represents the combined efforts of many people at the planning, manuscript development, review, writing, design, and production development levels, and I am most grateful for their contributions. I would like to begin by thanking the experienced health care professionals who make up the team of reviewers, contributors, and editorial advisory board members for their valuable suggestions. In particular, I would also like to thank Martina van de Velde, freelance Content Development Specialist; Roberta Spinosa-Millman, Content Strate- gist (Acquisitions, Canada); and Jerri Hulbutt, freelance copyeditor, for helping me stay sane and focused and for their tireless assistance throughout this entire journey. Mary J. Wilk xv This page intentionally left blank       Instructor Preface In keeping with the approach of the previous editions, example, in the section on dementia care, mental the fifth edition of Sorrentino’s Canadian Textbook health specialists and the Alzheimer Society of Can- for the Support Worker serves the needs of students ada were consulted and asked for input. Such consul- and instructors in educational programs taught in tation has resulted in a correct, current, and accurate community colleges, secondary schools, and private reflection of today’s educational trends and content colleges. This textbook has been written to prepare for support workers. students to function in the role of support worker in communities and facility settings across Canada. It NEW TO THE FIFTH CANADIAN has been prepared entirely by Canadians for Canadi- ans. Similar to the last edition, this textbook has been EDITION written in language that is interesting, easy to read, Since the last edition was published, educational and and easy to understand for most students, regardless vocational standards for support workers have been of their previous educational background. Because released both nationally and within many provinces. this book is used throughout the country, great care To reflect these new standards, as well as anticipated has been taken to use terminology and content that is practice trends across Canada, Sorrentino’s Canadian common and not specific to any one area or province Textbook for the Support Worker, fifth edition, has or territory. been revised, updated, and reorganized while keep- Health care workers of today will continue to face ing the features that students and instructors have legal, ethical, and physical challenges in our diverse benefited from and depended on. Based on feedback and constantly evolving country and world. This from both students and instructors, the order of the textbook is also designed to be an excellent resource chapters has been revised to make them easier and for support workers already working in the field— more intuitive for both instructors and students to whether in facilities or in community settings—who follow. may have questions about issues they have encoun- tered in their clinical practice. Support workers will learn many new things, experience new situations, Pedagogical Features and even acquire new skills in the course of their The pedagogy of Sorrentino’s Canadian Textbook for work. Whatever the setting, they will find that learn- the Support Worker, fifth edition, has been brought up ing is an ongoing process, and this textbook and its to date and enriched with the addition of new pho- available learning tools will be a valuable resource tos and figures reflecting current practice. Another that will aid them in that process. addition has been the Critical Thinking in Prac- While writing this textbook, we consulted a num- tice questions at the end of each chapter. Each ques- ber of legal and health care experts because we rec- tion presents students with a realistic, practice-based ognize the importance of using terminology and challenge and encourages them to find a reasonable concepts that are both accurate and appropriate to solution to the scenario, incorporating their learned Canada. For example, lawyers were consulted to knowledge. ensure the accuracy of the legal concepts relating to The very popular Supporting boxes that present wills, powers of attorney, and end-of-life care. At the real-life scenarios embodying the concepts covered time of writing, COVID-19 has impacted the entire in the chapters have been retained. These Support- world, and infectious diseases experts and Health ing boxes have been valuable tools for students try- Canada have been consulted to provide the most ing to understand the impact that a particular client’s updated information possible. In regard to the con- health challenge or issue may have on that client, on tent on medication delivery techniques, pharmacists his or her family or significant others, and on the and medical doctors were consulted. In yet another health care that is required. The scenarios and clients xvii xviii I N ST RU C TO R PR E FAC E discussed in each of these boxes are adapted from geographical, and geopolitical backgrounds. To that real-life situations, describing clients from different end, throughout this text, great effort has been made ethnic and cultural backgrounds. Instructors will find to capture this mosaic and spectrum of peoples. these boxes very useful to elicit discussion and dia- There has been a move away from a cis norm–focused logue from the class on various issues that students are mindset, and binary terms such as he/she have been likely to encounter in the field. The portrayal of these replaced with the more inclusive they. realistic situations allows students to empathize more easily with the clients and, in doing so, adapt these lessons to their own practice. Instructors who would Trends in Support Work like more information on the issues that are presented Health care is constantly changing, and this textbook in the Supporting boxes are encouraged to refer to has been revised to reflect new trends and policies the instructor resources that accompany the textbook. that affect support workers throughout Canada. The chapters on body structure and function and diseases and conditions have been significantly enhanced to Indigenous Issues ensure that students have the suitable background Indigenous peoples represent a significant and expand- of anatomy, physiology, physical changes related to ing group within Canada and include three groups: aging, and disease processes. The scope of the chap- First Nations, Métis, and Inuit. First Nations refers ters on mental health disorders and disorientation, to Status, Non-Status, and Treaty Indian peoples of delirium, and dementia have been almost completely Canada. These include the nations, bands, or groups rewritten to reflect the changes in the Diagnostic and of people who were originally living in Canada before Statistical Manual of Mental Disorders, fifth edition the European explorers began to arrive in the 1600s. (DSM-5). For example, names of the various disor- Indigenous issues have been at the forefront of ders have been updated, and the chapters have been Canadian politics and policy over the past few years. In expanded to include important discussions on suicide 2016, Canada adopted the United Nations Declara- among older persons, post-traumatic stress disorder, tion on the Rights of Indigenous Peoples (UNDRIP) and the types of primary and secondary dementias. and also continued to implement the recommenda- An emerging trend in Canada is the expanding tions of the Truth and Reconciliation Commission role of the support worker in regard to performing (TRC) in an effort to address many years of legislated delegated acts and working in acute-care settings, wrongs and inequities against Indigenous people. where support workers may have the opportunity to It is known that TRC recommendations and perform increasingly advanced tasks and to problem- UNDRIP have started to influence health policies solve more than in the past. Chapter 46 focuses on and practices for the diverse Indigenous populations practice that is specific to acute care. Students who in Canada. In support of UNDRIP and the process read this textbook are frequently reminded about of healing and reconciliation, the terms Indigenous when they should be consulting the client’s care plan people(s) and Indigenous health are used throughout or their supervisor for instructions. this text to acknowledge the inherent rights and This text also recognizes that language is fluid and political views of the diverse groups of original peo- ever evolving. The author recognizes that childbirth is ples with historical and cultural ties to Canada. The not only experienced by women but may be experienced term Aboriginal does not fully recognize the diversity by others who do not identify as female or who find the of Indigenous Peoples but remains in common use. term woman to not be representative of how they iden- The term Aboriginal can be found in this textbook tify themselves. The terms client, person, or parent are when referring to specific current titles or groups. used when possible in the text. Woman/women is used when the research is specifically done with a population that identifies as women. The language and terminol- Inclusive Language ogy presented in this text endeavour to be inclusive of Canada is made up of individuals from differing all peoples and reflect what is, to the best of our knowl- socio-economic, cultural, generational, spiritual, edge, current at the time of publication.  I N ST RU C TO R PR E FAC E xix Perhaps most importantly, this new edition places speech and language disorders. Case Studies and a stronger emphasis on understanding the role of sup- other boxes throughout the text also highlight the port workers and their scope of practice. Throughout importance of clear communication. this textbook, students are reminded to check their Support workers must respect the cultural and  scope of practice and to be aware of provincial lifestyle diversity among their clients. Culture or territorial legislation related to their profes- influences people’s attitudes and beliefs. Chapter 7 sion. The Appendix at the end of the book outlines discusses the role of cultural heritage in health and the provincial and territorial differences in support illness practices as well as in other aspects of life, worker titles. such as communication. Respecting Diversity boxes throughout the text provide examples of how support care must be adapted to respect each GUIDING PRINCIPLES client’s culture and lifestyle. This textbook is structured around several key ideas Students learn best by reading about real-life  and principles: examples. Case Studies and examples that apply    concepts to the real world of support work appear Support workers provide services in a variety of  throughout the text. Supporting boxes discuss community and facility settings. Because training ways to solve the problems that may occur in sup- programs prepare students for a variety of work- port work in different settings and help students to places, multiple workplace settings—long-term understand a particular client’s health challenge or care, home care, and hospital settings—are dis- issue and to empathize with the client. cussed throughout the text, especially in the Focus Support workers need to understand their scope  on Home Care and Focus on Long-Term Care of practice and the delegation process. Because boxes and the Procedure boxes, which highlight agencies and facilities across Canada vary in the information and insights in regard to these set- way they utilize support workers, the responsibili- tings. ties and limitations of support workers are empha- Each client is an individual with dignity and  sized throughout the text. The text presents many value. Throughout this textbook, students are procedures that support workers across the coun- reminded that each client is a whole person, try need to know and points out procedures that with physical, emotional, social, intellectual, and require extra training and supervision. Students spiritual dimensions. Students are encouraged to are advised that they must understand and respect appreciate each client as a unique individual with a their employer’s policies as well as provincial or ter- past, a present, and a future and to practise client- ritorial laws governing scope of practice. Chapter 4 centred care at all times. Students are also taught focuses on ethical principles, Chapter 5 addresses to recognize a client’s basic needs and protected specific legislation that affects support workers in rights. Canada, and Chapter 10 addresses scope of prac- An essential part of a support worker’s job is  tice and delegation issues. to provide compassionate care. The acronym Providing safe care is at the core of support  DIPPS helps identify, recognize, and promote the work. Ensuring the client’s safety is one of the top six principles of support work—dignity, indepen- priorities in support work and is therefore empha- dence, individualized care, preferences, privacy, sized throughout the text. The numerous Think and safety—that are highlighted in Providing About Safety boxes throughout the textbook Compassionate Care boxes, which discuss ways list straightforward, easy-to-understand ways to to promote the principles of support work when ensure client safety. An entire chapter (Chapter 20) giving the care described in the chapter. devoted to safety discusses the major types of acci- Effective communication skills are necessary to  dental injuries among clients and measures to pre- develop good working relationships. Chapter 9 is vent them. It also discusses how support workers devoted to communication skills, and Chapter 35 can take steps to ensure their own safety on the discusses communication with clients who have job. Other safety concepts are detailed throughout xx I N ST RU C TO R PR E FAC E the book, such as how to prevent the spread of Boxes and tables—list principles, guidelines, signs  infection (Chapter 19), the impact of bullying in and symptoms, care measures, and other informa- the workplace (Chapter 12), how to recognize and tion. report abuse (Chapter 12), and the basic principles Supporting boxes—present scenarios about par-  of body mechanics and safety while moving and ticular clients and discuss how support workers transferring clients (Chapter 14). make decisions and solve problems. Following the client’s care plan is critical to pro-  Case Study boxes—apply some of the concepts  viding client-centred and thorough care. Chap- discussed in the text to real-life examples of sup- ter 26 describes the care-planning process in both port workers and clients. They complement the facilities and communities. Students are reminded Supporting boxes. throughout the text that support workers must Think About Safety boxes—provide clear, con-  follow the care plan and their supervisor’s direc- cise, easy-to-follow advice on how to provide safe tions. care to clients of all ages. Support workers need to be effective problem  Focus on Children boxes—provide age-specific  solvers. Support workers must make decisions information about the needs, considerations, and throughout their day, such as what to report to special circumstances of children. their supervisor; how to safely feed a client who Focus on Older Persons boxes—provide age-­  may have choking difficulties (Chapter 27); how specific information about the needs, consider- to safely move and reposition a client (Chapter ations, and special circumstances of older persons. 14); how to dress and assist a client with activities Focus on Home Care boxes—highlight informa-  of daily living (Chapters 17, 18, 29, 30, and 45); tion necessary for safe functioning in the home and even how to respectfully communicate with setting. clients, taking into account their culture (Chap- Focus on Long-Term Care boxes—highlight  ters 7 and 9), their age (Chapters 41, 42, and 43), information unique to the long-term care setting. and existing physical or mental health challenges Providing Compassionate Care boxes—remind  (Chapters 12, 33, 34, 35, 36, 37, and 38). students of the principles of support work: respect- ing and promoting the client’s dignity, indepen- PEDAGOGICAL FEATURES AND dence, individualized care, preferences, privacy, and safety. The acronym DIPPS is used to sum- DESIGN marize these six principles. Sorrentino’s Canadian Textbook for the Support Worker, Respecting Diversity boxes—help students learn  fifth edition, is presented in an attractive, four- to appreciate the influence of culture on health colour, user-friendly design that makes the text easily and illness practices and the importance of sensi- navigable and the concepts and regulations easy to tivity to cultural diversity in support work. understand. Procedure boxes—are usually divided into Pre-     Procedure, Procedure, and Post-Procedure sec- Objectives—explain what is presented in the  tions. The format includes steps and rationales chapter and what students will learn. to help students learn how and why a procedure Key Terms—appear at the beginning of each  is performed. The Compassionate Care section at chapter, where they are defined in the context of the beginning of most of the Procedure boxes is a the subject discussed. An alphabetized list of the reminder of the principles of support work. Aster- key terms, together with their definitions, is pre- isks are used to identify steps that are usually not sented in the Glossary at the end of the book for applicable in community settings. easy reference. Key terms are set out in bold blue Key Points—are found at the end of each chap-  type in the chapters, and other important terms ter. This section summarizes the important points appear in italics for emphasis. from each chapter, providing a good framework Illustrations and photographs—are numerous  for students to study from. and presented in full colour.  I N ST RU C TO R PR E FAC E xxi Critical Thinking in Practice boxes—are found  admitted to an acute- or complex-care, continu- at the end of each chapter. Each question presents ing care, or subacute care facility—such as a hos- a realistic, practice-based challenge to students and pital—she would then be called a patient. If she encourages them to find a reasonable solution to needed to live in a continuing care (or long-term the scenario. care) facility, she would then be called a resident. Review Questions—are found at the end of each  We discuss the issue of differences in terminol- chapter after the Key Points section. Answers to ogy in Chapter 3. The chapter on medical termi- the questions are presented (upside down) at the nology (Chapter 25) reflects current vocabulary end of the section. and abbreviation practices used in health care    facilities across Canada. The authors and the Elsevier publishing team are The use of the generic term “long-term care”—  confident that this text will serve you and your stu- In this text, we have also chosen to use the more dents well by providing the information needed to generic and widely used term long-term care teach and learn safe and effective care during this (referred to as LTC in the field) in the context of dynamic time in Canadian health care. care that is ongoing and provides relatively stable assistance to people with their activities of daily liv- IMPORTANT NOTES ON ing (ADLs). It also relates to any type of home or TERMINOLOGY AND EQUIPMENT facility where clients are cared for and supported, including long-term care facilities (nursing homes) In summary, being aware of the terminology differ- and even group homes for the developmentally ences existing within this diverse country of ours, delayed who are not physically or intellectually ill instructors (and students) should use whatever term but are unable to care for themselves. While this is the choice in their particular region:    term is not the preferred term in every province The use of the generic term “support worker”—  or regional area, we use long-term care throughout Throughout the book, the generic term support the text because it does not have different (and worker has been chosen to describe a worker who therefore misleading) meanings from one region provides personal care and support to clients in a to another within Canada. variety of settings. We recognize that, throughout In contrast, the term complex care refers to the old Canada, support workers are designated a variety of terms “intermediate” and “extended” care in British titles; these titles may vary provincially, territorially, Columbia, while it can mean “acute or subacute care or even locally, and it is expected that instructors for people with multisystem failure,” a completely will explain this terminology difference to students. different meaning, in Ontario. Some provinces use The use of the generic term “client”—The prac-  the term continuing complex care to mean “ongoing tice in an area or agency might be to refer to the care,” while other provinces do not use the term at recipient of support services as a patient, resident, all. The term continuing care is being widely used consumer, or customer. However, for the purposes throughout Canada in this context, but it is a newer of this textbook, we have chosen to use the term term than long-term care and therefore is not widely client for the sake of simplicity and to make it recognized in some areas of Canada. easy for students, who are in the process of learn- The types of treatments and equipment used  ing a large number of terms related to health care throughout Canada—It should also be noted that constitute a whole new language. Depend- that we recognize that a wide range of equipment ing on the location and the context of where brands are used across the country, so it is pos- services are provided, the client who receives sible that some instructors will find within this the services of support workers may be referred textbook photographs that depict a piece of equip- to by different terms, For example, Mrs. Jones, ment that has never been used in their area. We who is receiving care in her own home (or in suggest that clinical instructors provide an oppor- an assisted-living facility) would be referred to tunity for students to observe the equipment that as a client by her caregivers. If she were to be is more familiar to their own area. Student Preface As a support worker, you are a very important mem- survey the objectives, key terms, introductory para- ber of the health care team because you probably graph, boxes, key points, and the review questions at spend more time with your clients than any other the end of the chapter. Previewing takes only a few member of the team does. Team members rely on minutes. Remember, previewing helps you become your observations, reports, and recordings, especially familiar with the material. of any changes in a client. Your clients and their fam- ilies rely on you to provide professional and safe care. You and the care you give may be the bright spots in 2 QUESTION a client’s day. After previewing, you need to form a list of questions This book was designed to help you learn by using to be answered as you read the material. Questions its special features, which are described on the follow- should relate to what might be asked on a test or how ing pages. Since the last edition was published, edu- the information applies to giving care. Use the title, cational and vocational standards for support workers headings, and subheadings to form questions. Avoid have been released both nationally and within many questions that have one-­ word answers. Questions provinces. To reflect these new standards, as well as that begin with what, how, or why are most helpful. anticipated practice trends across Canada, Sorrenti- While reading, if you find that a particular question no’s Canadian Textbook for the Support Worker, fifth does not help you understand and retain the assign- edition, has been revised, updated, and reorganized ment material, change the question to make this step to assist you, the student. Even after you graduate, more useful. the book will continue to be a useful resource to you in the field as you gain experience and expand your knowledge. 3 READ AND RECORD This preface presents some study guidelines and Reading, which is the next step, is more productive tips for using this book effectively. Your instructor after you have determined what you already know will probably assign chapters or partial chapters from and what you need to learn. The purpose of reading the textbook to read before or after class. When given is to:    a reading assignment, do you read from the first page Gain new information to the last page without stopping? How much of Connect the new information to what you already what you read do you remember? Using an efficient know study system will help you understand and retain all    the information that you read. A useful study system Break the assignment into smaller parts, and as you has these steps: read each part, try to find answers for the questions Preview or survey you had formulated earlier. Also, mark important Question information in the text by underlining, highlighting, Read and record or making notes, which will remind you later what Recite and review you need to go back to in order to review and learn. Making notes helps you remember what you have learned. When making notes, write down important 1 PREVIEW information in the text margins or in a notebook. Before you start a reading assignment, preview or Use words and summary statements that will jog survey the assignment to get an idea of what it cov- your memory about the material. ers and to recall what you already know about the After reading the assignment, in order to retain subject. Preview the chapter title, headings, subhead- the information, you need to organize it into a study ings, and terms or ideas in bold print or italics. Also, guide—in the form of diagrams or charts that show xxii  ST U D E N T PR E FAC E xxiii relationships or steps in a process. Much of the infor- you formed earlier and any others that may have come mation in this text is organized in this manner to up during the reading and as you answered the review help you learn. Note-­taking in outline format is also questions at the end of the chapter. Answer all questions very useful. out loud (recite). If you are unsure about the answers The following is a sample outline: to any of the questions, consult your instructor.    Reviewing is more about when to study than what I. Main heading to study. You already decided what to study dur- 1. Second-­level heading ing the preview, question, and reading steps. Your 2. Second-­level heading instructor may have emphasized key points from a. Third-­level heading the reading assignment in class. The best times to b. Third-­level heading review both the information in your text and your II. Main heading notes from class are (1) the same day or evening of the class, (2) right after your first study session, (3) 4 RECITE AND REVIEW 1 week later, and (4) regularly before a quiz or test, midterm, or final exam. Studying the information Finally, recite and review, using your notes and the many times will help you remember it. study guide, by finding the answers for the questions CHAPTER 7 Caring About Culture and Diversity OBJECTIVES After reading this chapter, the learner should be able to do the following: Distinguish between ethnicity and culture. Describe how culture may affect communication, family organization, religious convictions, and perceptions about illness and health care. Analyze how your own cultural biases may affect your relationships with your clients. Apply the information in this chapter in your work by providing culturally sensitive care. 96 http://evolve.elsevier.com/Canada/Sorrentino/SupportWorker xxiv ST U D E N T PR E FAC E ST U D E N T PR E FAC E xxv xxvi ST U D E N T PR E FAC E ST U D E N T PR E FAC E xxvii xxviii ST U D E N T PR E FAC E ST U D E N T PR E FAC E xxix xxx ST U D E N T PR E FAC E  CHAPTER 1 The Role and Responsibilities of the Support Worker OBJECTIVES After reading this chapter, the learner should be able to do the following: l Describe the goal of support work. l Identify the role support workers play within the health care team. l Describe the main responsibilities of the support worker. l Differentiate between activities of daily living (ADLs) and instrumental activities of daily living (IADLs). l Distinguish between regulated and unregulated health care providers. l Describe the importance of understanding the roles and responsibilities of support work. l Describe the significance of having a professional approach to support work. l List the principles of client-centred care. l Identify the things to consider when thinking critically and solving problems. http://evolve.elsevier.com/Canada/Sorrentino/SupportWorker 1 2 KEY TERMS CHAPTER 1 The Role and Responsibilities of the Support Worker activities of daily living (ADLs) Self-care activities live-in facility A facility that provides living people perform daily to remain independent and to accommodations and services; includes assisted- function in society. p. 4 living facilities, long-term care facilities, group advocate To speak or act on behalf of another homes, and retirement residences. p. 9 person or group of people. p. 3 patient A person receiving care in a hospital setting. caring Concern for clients’ and their families’ Also known as a client. p. 9 dignity, independence, preferences, privacy, and primary care nurse A primary care nurse is safety at all times. True caring requires honesty, responsible for the ongoing management of the sensitivity, comforting, discretion, and respect while health of a client. Duties include liaising with other showing this concern. p. 16 health care team members, the client, and her or client A general term for any person receiving care or his family. p. 13 support services in a community setting: hospital professionalism An approach to work that patients, facility residents, and clients in the demonstrates respect for others, commitment, community. p. 9 competence, and appropriate behaviour. p. 14 client-centred care Care that demonstrates reflective practice review A review and self- concern for the dignity, independence, evaluation of care provided with the goal of individualized care, preferences, privacy, and safety identifying ways to improve clinical performance (DIPPS) of clients and their families at all times. and caregiving. p. 13 Also known as compassionate care or person- registered nurse (RN) A health care provider who is centred care. p. 16 licensed and regulated by the province or territory compassionate care See client-centred care. to maintain overall responsibility for the planning p. 16 and provision of client care. p. 13 confidentiality Respecting, guarding, and using registered practical nurse (RPN) See licensed discretion in regard to personal and private practical nurse (LPN). p. 13 information about another person. p. 14 registered psychiatric nurse (RPN) A nurse who is critical thinking The ability to think clearly and educated and registered in his or her own province logically, using reflection and reason, based on to provide care specifically to individuals whose knowledge obtained from experience, observation, primary needs relate to mental, emotional, and or education. p. 13 developmental health. p. 12 dignity The state of feeling worthy, valued, and rehabilitation The process of restoring a person to respected. p. 15 the highest possible level of functioning through the DIPPS An acronym for the six principles of client- use of therapy, exercise, or other methods. p. 10 centred care (also known as compassionate care resident A person living in a live-in facility (often or person-centred care): dignity, independence, called a long-term care facility). p. 9 individualized care, preferences, privacy, and scope of practice The limit and extent of a health safety. p. 16 care worker’s role as determined by your province’s discretion The use of responsible judgement to educational standards and your employer’s policies avoid causing distress or embarrassment to a in order to protect clients from harm. Scope of person. p. 14 practice in a health care field varies from province empathy The ability to recognize, perceive, and to province and employer to employer. p. 12 have an understanding of another person’s social reintegration See social support. p. 3 emotions by seeing things from his or her social support Equipping a person with the skills viewpoint. p. 3 and knowledge necessary to successfully live instrumental activities of daily living (IADLs) The independently outside an institution. Also known as complex skills needed to successfully live social reintegration. p. 3 independently. p. 4 support worker A health care worker who licensed practical nurse (LPN) A health provides services to people, both in facilities and care provider licensed and regulated by the in the community, who need help with their daily province or territory to carry out nursing activities. p. 3 techniques and provide client care. Known unregulated care providers (UCPs) A broad term as a registered practical nurse (RPN) in Ontario. applied to staff members who assist nurses and p. 13 other health care providers in giving care. p. 10     CHAPTER 1 The Role and Responsibilities of the Support Worker 3 work settings, job responsibilities, and terms used to describe support workers. Some sections of this text may not apply to support work in your particular city, province, or territory. If you are unsure about which parts apply to your area, ask your instructor or employer. The term support worker refers to the worker who provides personal care and support services. However, assisted-living worker, personal support worker, personal attendant, patient care assistant, resi- dent care aide, resident care attendant, health care aide, home care attendant, home support worker, nursing FIGURE 1.1 A support worker comforts a client. (iStock- photo/FG Trade.) aide, nursing attendant, community health worker, or continuing care assistant—among other titles—may Support workers provide care and assistance to clients be used in your province or territory to describe simi- of any age who have defined health care needs and who lar (but not always equivalent) jobs. The Appendix at require help with their daily activities, whether they live the end of this book lists the support worker’s titles in a facility or in the community.1 Client is a general in each province and territory. Because of the wide term for any person receiving care or support services in variety of titles, the general public may not be aware a community setting, such as hospital patients, facility of what support workers are called in their own prov- residents, and clients in the community. The ultimate ince or territory or even within a facility they use. It goal of support work is to improve the quality of life of is the role of support workers, their employing agen- the client and family by offering client-centred care and cies, other health care providers, and their province’s support in a safe, kind, sensitive, caring, and understand- or territory’s Ministry of Health to inform others of ing manner. Support workers can make a difference in their role and how it fits in their current health care people’s lives by alleviating loneliness, providing empa- structure. thy, ensuring comfort, encouraging independence, and This list may also include several titles that are promoting the client’s self-respect (FIGURE 1.1). They not equivalent to one another. For example, in support the client and family in a holistic manner by Ontario, developmental service workers (DSWs) addressing the client’s physical, psychological, social, play a different role and follow different educa- cognitive, cultural, and spiritual needs and advocate for tional standards than personal support workers the client by speaking or acting on the client’s behalf. (PSWs), and yet both are considered to be support Support workers may work as part of a health care workers within the health care team. In some parts team or work individually with a client. Legislation, of Canada, the term personal attendant refers to a employer policies, and a client’s condition all influence worker who is supervised directly by the person how support workers function and how much supervi- for whom they provide support services; personal sion they need. They may collaborate with health care attendants support people with physical disabili- providers or with professionals outside of the health care ties. Educational programs to become a personal sector, depending on the needs of their clients. Support attendant are generally shorter than those for sup- workers must use discretion at all times and honour port workers. the client’s right to confidentiality whenever discussing Support workers work in a variety of settings (see the client’s case with co-workers. Support workers are Chapter 3 for definitions and details of workplace expected to adapt their work style to the setting and to settings). In all settings, support workers ensure the the needs and wishes of the client receiving care. safety of their clients, including those who are living with cognitive or mental health challenges. Services provided by support workers to clients in their homes SUPPORT WORK ACROSS CANADA can enable some clients to live independently or with The nature of support work varies across the coun- their families. Support workers may also assist cli- try. There are differences in educational programs, ents with social support, or social reintegration, as 4 CHAPTER 1 The Role and Responsibilities of the Support Worker they prepare to move into an assisted-living facility for each client; for instance, they may be required or group home. In long-term care facilities, support to clean equipment, measure and report vital signs, workers assist clients with complex health challenges. or assist with simple wound care. Support workers Support workers also provide comfort and end-of-life might also assist with oxygen therapy, heat or cold care to dying clients so that they can die with dignity. applications, and range-of-motion (ROM) exercises. They are often the supervisor’s “eyes and ears,” mean- ing that because they are the person who spends the Support Worker Responsibilities most time with the client, they are most likely to A support worker’s general responsibilities, depend- observe or hear things that should be reported to the ing on the jurisdiction in which they work, can be supervisor, who may be a nurse or another type of grouped into six categories: (1) personal care, (2) health care worker. Observing and reporting are very support for nurses and other health care providers, important parts of the support worker’s role and can (3) family support, (4) social support, (5) housekeep- have a great impact on a client’s care. ing or home management, and (6) documenting and Support workers may have to consult with other reporting any basic assessments, observations, and health care providers, such as social workers or phys- care provided in the client’s record or chart. iotherapists, and may also have to consult with other professionals, such as the client’s employers, clergy, Personal Care or teachers, depending on the client’s individual care Personal care responsibilities include assisting with plan. activities of daily living (ADLs). These are the self-care actions that people perform every day to remain inde- Family Support pendent and to function effectively in society. Support In many facilities, support workers assist with admis- workers help with daily activities such as eating, bath- sions and discharges by introducing the client and ing, grooming, dressing, and toileting (“elimination”). family to the facility and helping the client unpack They assist clients with limited mobility to change posi- and settle in. In private homes, support workers help tions or move from one place to another and also help families care for loved ones who are living with health promote the client’s safety and physical comfort. issues or need assistance with ADLs. Some fami- In community settings, support workers also assist lies may need help with preparing meals and doing clients with instrumental activities of daily living household chores; other families may need help with (IADLs), which are the complex and necessary skills child care. Support worker services often give family needed to successfully live independently. These IADLs caregivers a break from their duties. may include assisting the client with handling finances, assisting with management of medications, arranging Social Support transportation, shopping, preparing meals, assisting Support workers may help clients participate in with using a telephone or other communication devices, social activities. These activities provide the client and doing housework and basic home maintenance.2,3 with enjoyment, recreation, and a chance to meet The support worker is not responsible for decid- with friends. They may organize games and outings ing what should or should not be done for the client. or may be hired privately to be a client’s companion. However, while providing personal care, the support Support workers may also be responsible for teaching worker observes for and reports any changes in the cli- clients to learn to live independently and to cook, ent’s behaviour or health. Such information is impor- clean, or shop by themselves. tant to share with the appropriate person (either the charge nurse or the client’s primary care nurse). Housekeeping or Home Management Support workers often do a variety of housekeeping Support for Nurses and Other Health Care tasks in a facility setting, including making beds, deliv- Providers ering meals, tidying up living areas, and maintaining Support workers assist nurses or other health care supplies. In a private home, housekeeping is called team members by following the established care plan home management