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Nurse Assistant Training Introduction to the Course Welcome 2 Introductions Facility policies and procedures Facility layout Emergency contact information | Nurse Assistant Training Student Handout I-1: Find Someone Who… 3 Has three children Doodles when talking on the phone Knows someone who uses a wheelchair Has an older brother Would like to be oldest Would like to be youngest Knows what range-of-motion exercises are Sleeps with two pillows | Nurse Assistant Training Student Handout I-1: Find Someone Who… 4 Feels nervous about being a nurse assistant Participated in natural childbirth Knows first aid for choking Has stayed in a hospital for several days Knows someone over 80 years old Has lost a parent Likes to sing | Nurse Assistant Training Course Overview and Materials Instructor’s role Textbook 5 Goals and key terms Case studies Figures, boxes and tables Special features Skill sheets Questions for review; questions to ask yourself | Nurse Assistant Training Course Requirements 6 Classroom instruction Skills practice Clinical practicum Expectations of students Ground rules | Nurse Assistant Training Nurse Assistant Training Unit 1: THE ART OF CAREGIVING UNIT 1 CONTENTS 8 GO GO GO GO GO Lesson 1: Being a Nurse Assistant Lesson 2: Working in the Health Care System Lesson 3: Understanding Legal and Ethical Aspects of Health Care Lesson 4: Understanding the People in Our Care Lesson 5: Communicating with People | Nurse Assistant Training LESSON 1 Being a Nurse Assistant 9 | Nurse Assistant Training TOC What Is a Nurse Assistant? Works under the supervision of a licensed registered nurse (RN) or licensed practical nurse (LPN) Provides basic nursing care Addresses the whole person 10 | Nurse Assistant Training TOC Responsibilities Assisting with activities of daily living Obtaining routine measurements Assisting with admissions, transfers and discharges Maintaining a safe, clean environment 11 | Nurse Assistant Training TOC Requirements Completion of state-approved training course Classroom learning Hands-on skill practice Clinical practicum Successful completion of state’s certification examination Multiple choice written examination Skills test 12 | Nurse Assistant Training TOC Health Care Team Person receiving care—“captain” of the team Person’s family members Staff members Other professionals 13 | Nurse Assistant Training TOC Health Care Team Continued Nursing team Licensed nurse Nurse assistant Other members, such as advanced practice nurse, nurse practitioner 14 | Nurse Assistant Training TOC Scope of Practice Tasks legally permitted to do State- and employer-defined Tasks usually outside the nurse assistant’s scope of practice: Supervising/delegating nursing responsibilities to other nurse assistants Analyzing or interpreting data Receiving verbal orders Diagnosing illness Administering medications and oxygen Inserting/removing medical equipment 15 | Nurse Assistant Training TOC The Art of Caregiving Skills performed with kindness, empathy and compassion Getting the job done versus providing quality care 16 | Nurse Assistant Training TOC The Art of Caregiving Continued Five principles of care Safety Dignity Independence Privacy Communication 17 | Nurse Assistant Training TOC Professionalism Person with training and knowledge to perform a certain role Positive attitude toward the job Performance to the best of one’s ability at all times 18 | Nurse Assistant Training TOC Professionalism Continued Actions promoting professionalism: Dependability Accountability Integrity Conscientiousness Courtesy Stewardship Willingness to help Ability to communicate Ability to problem solve Professional appearance 19 | Nurse Assistant Training TOC LESSON Working in the Health Care System 20 | Nurse Assistant Training 2 TOC Health Care Settings Acute care settings such as hospitals Sub-acute care settings Top image © Monkey Business Images 2012. Used under license from Shutterstock.com 21 | Nurse Assistant Training TOC Health Care Settings Continued Long-term care settings such as nursing homes and assisted-living facilities Home settings 22 | Nurse Assistant Training TOC Payment for Health Care Personal earnings or savings Health insurance Government programs Medicare: people over age 65 Medicaid: people with low incomes 23 | Nurse Assistant Training TOC Protection of Health Care Recipients Regulations and agencies in existence to define standards of quality and ensure care provided meets standards Patients, residents and clients have certain rights: Right to competent care delivered with respect Right to know the kind of care they will receive and its cost Right to participate in decisions made about care and who will provide it Right to confidentiality and privacy Right to be free from restraints and abuse 24 | Nurse Assistant Training TOC Protection of Health Care Recipients Continued Nurse assistant plays a major role in ensuring rights are upheld Five principles of care: one way to ensure respect for the person’s rights 25 | Nurse Assistant Training TOC Protection of Health Care Recipients Continued OBRA legislation: standards for staffing and operations for nursing homes receiving federal funding Comfortable and fulfilling lifestyle Promotion of physical, mental, emotional and spiritual well-being Training requirements for nurse assistants Facility’s physical environment Basic rights of nursing home residents Routine inspections—surveys 26 | Nurse Assistant Training TOC Protection of Health Care Recipients Continued Ombudsman programs: volunteers advocating for nursing home residents and family members to resolve problems related to quality of care 27 | Nurse Assistant Training TOC Protection of Health Care Recipients Continued Government oversight: federal, state and local governments involved in establishing regulations and monitoring quality of care; standard setting Accrediting organizations: professional organizations and nongovernmental organizations working to ensure quality health care; for example, The Joint Commission 28 | Nurse Assistant Training TOC Protection of Health Care Workers Occupational Safety and Health Administration (OSHA): government agency that protects workers in all industries from on-the-job injuries Standards for employers to follow to protect employees from hazards: Prevention of employee exposure to harmful substances and chemicals Provision of equipment and environmental standards for employee safety Training to ensure employee safety Monitoring of hazards with record-keeping of workplace injuries 29 | Nurse Assistant Training TOC Understanding Legal and Ethical Aspects of Health Care 30 | Nurse Assistant Training TOC LESSON 3 Introduction Decisions about behavior made every day Some behaviors guided by laws Others guided by ethics 31 | Nurse Assistant Training TOC Patient Self-Determination Act The right of the person to make decisions about care Right to accept or refuse care Right to develop advance directives 32 | Nurse Assistant Training TOC Patient Self-Determination Act Continued Informed consent required before any treatment or procedure Thorough understanding of benefits and risks of proposed treatment or procedure Explanation of why treatment or procedure being done Review of the risks Explanation of risks if person decides not to have treatment or procedure 33 | Nurse Assistant Training TOC Patient Self-Determination Act Continued Signature on a document indicating consent Person has the right to withdraw consent at any time and refuse treatment or procedure Nurse assistant responsible for obtaining verbal consent before providing care, not written consent 34 | Nurse Assistant Training TOC Patient Self-Determination Act Continued Advance directives: legal documents stating how person wants health care decisions made if unable to make or communicate decisions independently in the future Durable power of attorney—responsibility for decisions on person’s behalf given to someone else Living will—specific directions about steps to take or not take to prolong a person’s life when death seems near Health care facilities and agencies required to teach people about the purpose of advance directives and assist in putting them in place 35 | Nurse Assistant Training TOC Health Insurance Portability and Accountability Act (HIPAA) Legal right to have medical information kept secure and private Specifies who can look at and receive information about a person’s health status and care 36 | Nurse Assistant Training TOC Health Insurance Portability and Accountability Act (HIPAA) Continued Nurse assistants responsible for protecting this right Sharing information only with those needing to know or directly involved in person’s care Avoiding conversations in places where information can be overheard Never discussing person’s condition or care in casual conversations with others Securing tools used for documentation per employer’s policy Following employer’s policies and procedures about handling and securing private information 37 | Nurse Assistant Training TOC Behaviors Resulting in Legal or Disciplinary Action Certain behaviors could result in legal or disciplinary action Consequences ranging from employer disciplinary action to loss of job to criminal prosecution Consequences may be recorded on nurse assistant’s record in state registry Negative impact on ability to get another job in health care 38 | Nurse Assistant Training TOC Behaviors Resulting in Legal or Disciplinary Action Continued Abuse: willful infliction of injury or harm Many forms: actively doing something to harm another person or failing to provide necessary care • Physical abuse: deliberately hurting another person’s body • Emotional abuse: degrading, belittling or threatening another • Sexual abuse: forcing the person to take part in sexual activity of any kind • Financial exploitation: taking or misusing another person’s money or assets • Neglect: failing to provide for a dependent person’s basic needs 39 | Nurse Assistant Training TOC Behaviors Resulting in Legal or Disciplinary Action Continued Abuse continued Anyone can be a victim of abuse; anyone can be an abuser Never acceptable behavior Nurse assistant legally responsible for reporting concern of abuse to supervisor or another person based on employer policy 40 | Nurse Assistant Training TOC Behaviors Resulting in Legal or Disciplinary Action Continued Assault and battery Assault: action causing a person to fear being touched in a harmful or unwelcome way Battery: actual touching of another in a harmful or unwelcome way • Hitting, pinching, slapping • Inappropriate use of restraints • Beginning a procedure without person’s verbal consent 41 | Nurse Assistant Training TOC Behaviors Resulting in Legal or Disciplinary Action Continued Negligence Failure to do what a “reasonable and careful” person would be expected to do in a given situation Example: nurse assistant performs a task not trained to do 42 | Nurse Assistant Training TOC Behaviors Resulting in Legal or Disciplinary Action Continued Fraud and larceny Fraud: lying to gain profit or advantage, such as Medicare fraud Larceny: theft Accurate and honest documentation as a safeguard against fraud Prompt reporting of a person’s missing items or of seeing someone take a person’s belongings to help prevent larceny 43 | Nurse Assistant Training TOC Ethical Behavior Actions guided by knowledge of what is right or what is good or moral Five ethical principles important in health care: Autonomy: right to make decisions Justice: fair and equal treatment Beneficence: actions to promote well-being Nonmaleficence: avoidance of harm Fidelity: truthfulness and trustworthiness Ethical dilemmas: situations involving more than one good or moral solution 44 | Nurse Assistant Training TOC Ethical Behavior Continued Guidelines Practice the five principles of care Know the rights of people receiving care Be aware of legislation protecting persons’ rights Familiarize self with employer’s policies and procedures and scope of practice Avoid tasks or decisions outside the scope of practice Refrain from accepting gifts or money Seek help from supervisor if unsure 45 | Nurse Assistant Training TOC Ethical Behavior Continued Scenario 1 Miss A. needs to go to the bathroom three or four times each night. She feels that if she tips the night staff, they will answer her call signal faster and she won’t have to worry about wetting the bed. Mr. W., a nurse assistant who has just been hired, goes into Miss A.’s room for the first time to help her to the bathroom. Miss A. offers him money. What should he do? 46 | Nurse Assistant Training TOC Ethical Behavior Continued Scenario 2 Mr. S. continually calls Ms. L., a nurse assistant, abusive names. He tells her she can’t do anything right and he wishes she would leave him alone to die. Ms. L. is tempted to do just that. What should she do? 47 | Nurse Assistant Training TOC Ethical Behavior Continued Scenario 3 You and a few other nurse assistants are eating lunch together in the dining room. You begin to tell your friends about your unpleasant experience with Mrs. T. As you are telling them about Mrs. T.’s angry outburst, the visitors at the next table interrupt and ask whether you are talking about that sweet little lady in Room 106. What should you do? 48 | Nurse Assistant Training TOC Ethical Behavior Continued Scenario 4 Mr. P.’s family has gathered in the waiting room. You overhear them discussing whether or not to tell Mr. P. about the car crash his grandson was in yesterday. They are afraid that the shock of hearing his grandson is in a coma will be too great and that his condition might get worse. Later, as you are helping him get ready for bed, Mr. P. begins talking to you about his grandson. You realize that the family has not told him about the crash. You believe that it’s not fair to withhold information like that. You certainly would be upset if no one told you about something so important. What should you do? 49 | Nurse Assistant Training TOC LESSON Understanding the People in Our Care 50 | Nurse Assistant Training 4 TOC Introduction Each person is unique However, we all share some common experiences and needs 51 | Nurse Assistant Training TOC Human Growth and Development Human growth: physical changes Human development: social, emotional and cognitive changes 52 | Nurse Assistant Training TOC Human Growth and Development Continued Common stages Infancy (birth to 1 year) Toddlerhood (1 to 3 years) Preschool (3 to 5 years) School age (5 to 12 years) Adolescence (12 to 20 years) 53 | Nurse Assistant Training TOC Human Growth and Development Continued Common stages Young adult years (20 to 45 years) Middle adult years (45 to 65 years) Young-old years (65 to 75 years) Middle-old years (75 to 85 years) Old-old years (85 years and beyond) Age as a common point of reference but important not to confuse ages with stages 54 | Nurse Assistant Training TOC Maslow’s Hierarchy of Human Needs Five levels of needs Physical: basic requirements for life Safety and security: being and feeling safe Social: feelings of being liked, loved and accepted Self-esteem: feeling good about self and worthy of others’ respect Self-fulfillment: satisfaction with self and with life Lower-level needs must be met before meeting higherlevel needs 55 | Nurse Assistant Training TOC Sexuality and Intimacy All persons as sexual beings with a need for sexual expression Sexuality: perception and expression of self sexually Sexual behaviors: physical activities for obtaining sexual pleasure and reproducing Gender identity: person's inner sense of being male or female Transgender individuals Transsexual individuals 56 | Nurse Assistant Training TOC Sexuality and Intimacy Continued Sexual identity: person’s sexual orientation and preferences for sexual partners Heterosexual individuals Homosexual individuals Bisexual individuals Intimacy: need and ability to feel emotionally close to another human being and have that closeness returned 57 | Nurse Assistant Training TOC Sexuality and Intimacy Continued Sexual behaviors: activities to derive sexual pleasure or to reproduce Sexual intercourse Masturbation Nurse assistant’s responsibilities Respect for the right of the person to engage in sexual behaviors and provision of privacy Protection of those in your care from unwanted sexual advances Protection of self from unwanted sexual advances Care not to misread something possibly looking like sexual attraction Nonjudgmental approach for people whose feelings and beliefs differ from own 58 | Nurse Assistant Training TOC Culture Shared set of beliefs, values, customs and practices characterizing a group or society Influence on behavior and preferences such as: Food intake, preparation and serving Personal care rituals Acceptable caregivers Acceptable types of touch Acceptable eye contact Social customs Management and treatment of illnesses Rituals before and after birth or death 59 | Nurse Assistant Training TOC Culture Continued Nurse assistant responsible for respecting person’s preferences based on culture 60 | Nurse Assistant Training TOC Spirituality Belief in something greater than oneself that helps give meaning and purpose to life Organized religion closely linked to spirituality Possible to be spiritual without participating in a formal, organized religion Strong sense of spirituality as a means to strengthen coping Nurse assistant’s role—support for and fostering of person’s sense of spirituality 61 | Nurse Assistant Training TOC LESSON 5 Communicating with People 62 | Nurse Assistant Training TOC Introduction Communication: process of giving and receiving information Essential for providing quality care 63 | Nurse Assistant Training TOC Communication Basics Communication model Sender: providing information Receiver: person to whom information is sent Message: information Confirmation: receiver's acknowledgment of receipt of message 64 | Nurse Assistant Training TOC Communication Basics Continued Communication methods Verbal: spoken and written language Nonverbal: body language 65 | Nurse Assistant Training TOC Communication Basics Continued Strategies for effective communication Be clear in message. Provide and seek confirmation. Actively participate in conversation. Be aware of nonverbal messages. Remember importance of touch. 66 | Nurse Assistant Training TOC Communicating with Those Receiving Care Communicating with those who are visually impaired Knock first to avoid startling person. Stand where person can see you. Call person by name. Describe person’s surroundings, people and/or events. Describe each skill step while doing it, including equipment used. Encourage person to hold your arm just above the elbow when helping person move around. Describe where you are going, including items in the path. 67 | Nurse Assistant Training TOC Communicating with Those Receiving Care Continued Communicating with those who are hearing impaired Learn what the person can and cannot hear. Encourage use of hearing aid if the person has one. Check to make sure it is working properly. Approach person from the front, gently touching person on hand or arm to gain attention. Position self near ear that provides clearer hearing. 68 | Nurse Assistant Training TOC Communicating with Those Receiving Care Continued Communicating with those who are hearing impaired continued Position self so person can see your mouth and facial expressions. Change words, not volume, if person seems not to understand. Use gestures. Ask for confirmation for important information. 69 | Nurse Assistant Training TOC Communicating with Those Receiving Care Continued Communicating about difficult topics Keep lines of communication open. Show person you care about his or her feelings. Stop what you are doing and pay full attention, making eye contact. Encourage person to talk by asking questions, focusing on what person is telling you, or confirm the message by repeating it in your own words. Involve other health care team members if person needs answers. 70 | Nurse Assistant Training TOC Communicating with Those Receiving Care Continued Teaching and reinforcing Reinforce information person has already been given. Teach the person how to do things within your scope of practice. Report person’s need for more information to the nurse. 71 | Nurse Assistant Training TOC Communicating with Family Members Nurse assistants often the first member of the health care team that family members ask for information Manner of communicating with family members contributes to the overall impression of care their loved one is receiving Explain your role in providing care. Build a relationship with the family. Welcome their input and feedback. If family voices a concern or complaint, respond professionally and attempt to see a solution. • Avoid becoming angry or defensive. • Use communication skills to gain a full understanding of their concern. 72 | Nurse Assistant Training TOC Communicating with Other Health Care Team Members Effective communication among members of the health care team necessary for coordinated, high-quality care Knowledge of how to report and record information a necessity 73 | Nurse Assistant Training TOC Communicating with Other Health Care Team Members Continued Medical words and abbreviations important in communicating with other health care team members Medical words often long and complex; breaking words into smaller parts often easier Root: foundation of the word Prefix: before the word to make it specific Suffix: at the end of the word to make it specific Combining vowel: between root and suffix to ease pronunciation 74 | Nurse Assistant Training TOC Communicating with Other Health Care Team Members Continued Use of abbreviations for more efficient communication (saving time and space) Only use abbreviations approved by employer 75 | Nurse Assistant Training TOC Communicating with Other Health Care Team Members Continued Reporting: verbal exchange of information between team members Routinely at change of shift Throughout the shift when person’s condition changes Reporting to the supervising nurse before and after care is provided and any time nurse assistant determines it is necessary 76 | Nurse Assistant Training TOC Communicating with Other Health Care Team Members Continued Reporting of observations Objective: directly obtained using one of five senses Subjective: not detected by one of five senses or measured with equipment, such as person stating he did not sleep well Decision as to what to report: any time there is a change Rule of thumb: when in doubt, report Accurate details with a focus on the facts is important when reporting observations 77 | Nurse Assistant Training TOC Communicating with Other Health Care Team Members Continued Recording: written exchange of information between team members Use of various forms within the person’s medical record Three important forms: Care plan Flow sheet Nursing notes 78 | Nurse Assistant Training TOC Communicating with Other Health Care Team Members Continued Accuracy essential Medical record a legal document that could be used if a legal problem arises Other health care team members relying on documentation to evaluate person’s condition and make decisions Required for facility to receive payment for services provided 79 | Nurse Assistant Training TOC Communicating with Other Health Care Team Members Continued Guidelines for recording Date, time, initials or signature for every entry Information recorded in the correct person’s medical record Proper terminology and abbreviations Facts Black ink Employer’s policy for correcting mistakes—NO erasures Only care provided or observations made Key to remember: care not recorded is considered care not provided 80 | Nurse Assistant Training TOC Communicating with Other Health Care Team Members Continued Telephone use Be professional Identify self on answering Be courteous, speaking slowly and clearly in a pleasant tone Take accurate messages Respect privacy 81 | Nurse Assistant Training TOC
