Ch 1 + Index

The Nursing Assistant in Long Term Care

Five First Steps for Beginning Care Procedures

1. Knock and wait for permission to enter. Identify yourself by name. Identify the resident according to facility policy.

2. Wash your hands

3. Explain the procedure to the resident. Speak slowly, clearly, and directly. Maintain face-to-face contact whenever possible.

4. Provide privacy for the resident using a curtain, screen, or door.

5. Adjust the bed to a safe level, usually waist height. Lock the bed wheels.

6. Always follow infection prevention (gloves) and note guard rails.

Four Concluding Steps for Ending Care Procedures

1. Return the bed to its lowest position. Remove privacy measures that you may have put up.

2. Place the call light within the resident’s reach (of stronger hand).

3. Wash your hands

4. Report any changes in the resident to the nurse. Document the procedure using facility guidelines (do not document care before it is performed, if care is not documented it did not legally happen).

5. Always follow infection prevention (gloves) and note guard rails.

Long-term Care (LTC)

is given in LTC facilities for people who need 24-hour skilled care

Skilled Care

is medically necessary care given by a skilled nurse or therapist, available 24-hours a day (ordered by a doctor and includes a treatment plan for ongoing conditions) Also called “Nursing Home”, “Long-term Care Facilities(LTCFs)”, “Skilled Nursing Facilities(SNFs)”, “Rehabilitation Centers”, “Extended Care Facilities”

Length of Stay

the number of days a person stays in a healthcare facility

Terminal illness

the illness will eventually cause death

Chronic Conditions

lasts a long period of time, even a lifetime (ex: physical disabilities, heart disease, dementia) These patients are called “residents”, this is now their home

Diagnoses

medical conditions determined by a doctor

Home Health Care/Home Care

provided in a person’s care

Assisted Living

for people who need some help with daily tasks (showering, meals, dressing, medications) do not need 24-hour skilled care (single room or apartment style, more independent)

Adult Day Services

for people who need some help and supervision during certain hours, but do not live in the facility where care is provided, can be used as a break for family members and friends

Acute Care

24-hour skilled care given in hospitals and ambulatory surgical centers, for people who require short-term, immediate care for illnesses or injuries, also admitted for short stays for surgeries

Subacute Care

care given in hospitals or long-term care facilities. Used for people who need less care than for an acute (sudden onset, short-term) illness, but more care than for a chronic (long-term) illness

Outpatient Care

given to people who have had treatments, procedures, or surgeries and need short-term skilled care, patients do not require overnight stay

Rehabilitation

is care given by specialists and professionals (physical, occupational, speech) help restore/improve function after illness or injury

Hospice Care

is given in facilities or homes for people who have six months or less to live, give physical and emotional care and comfort until a person dies, also supporting families through the process

Activities of Daily Living (ADLs)

bathing, mouth care, assistance walking, etc.

Catheter

Small tube inserted into body to drain or inject fluids

Person-centered Care

emphasizes the individuality of the person who needs care

Trauma-informed Care

Approach to care that recognizes that people may have experienced trauma in their lives (ex:abuse, neglect)

Medicare provided by CMS

is a federal health program established in 1965 for people aged 65 and older, or a person at any age with permanent kidney failure or certain disabilities, Medicare will only pay for care if medically necessary.

Part A: helps pay for care in a hospital or skilled nursing facility or for care from a home health agency or hospice.

Part B: helps pay for doctor services and other medical services and equipment.

Part C: allows private health insurance companies to provide Medicare services.

Part D: helps pay for medications prescribed fro treatment.

Medicaid provided by CMS

a medical assistance program for people who have a low income, as well as for people with disabilities - funded by both federal government and each state. Eligibility is determined by income and special circumstances.

Nursing Assistant (NA)

performs assigned tasks, have responsibility of all residents, provide personal care, charting, etc.

Registered Nurse (RN)

coordinates, manages, provides skilling nursing care (medication, special treatments) and assigns tasks to NA - graduated from a 2-4 year nursing program

Licensed Practical Nurse (LPN)/ Licensed Vocational Nurse (LVN)

gives medications and treatments - 1 to 2 years of education

Advanced Practice Registered Nurse (APRN/APN)

completed training at the post graduate level (master’s/doctorate) can make diagnoses and prescribe treatment (nurse practitioners)

Physician or Doctor (MD/DO)

diagnoses disease or disability and prescribes treatment and medication - graduated from 4-year medical school

Physician’s Assistant (PA)

diagnoses disease or disability and develops treatment plans + prescribes medications, works under supervision of a doctor - receive master’s degree

Physical Therapist (PT/DPT - doctor)

increase movement, prevent pain - graduated from doctoral degree program

Occupational Therapist (OT)

helps residents learn to adapt to disabilities - use of assistive devices - earned masters or doctoral

Speech-Language Pathologist (SLP)

teaches exercises on how to overcome speech issues + evaluates a person’s ability to swallow food and drink - requires master’s degree

Registered Dietitian/Nutritionist (RD/RDN)

Creates meal plan/preparation - requires bachelor’s or master’s

Medical Social Worker (MSW)

determines a patient’s needs and gets them support devices like counseling or financial assistance, may book appointments or provide clothing - usually have master’s in social work

Activities Director

Plans activities for residents to help them socialize and stay active, “recreational therapist/recreation worker”, - can have bachelor’s, associate’s, or qualifying work

Chain of Command

describes the line of authority in the care team, NA carries out instructions given by nurse who carries out instructions given by doctor.

Liability

legal term, that someone can be held responsible for harming someone else

Scope of Practice

defines the tasks that healthcare providers are legally allowed to do according to state or federal laws

Care Plan

individualized for each resident, to achieve goals of care

Policy

a course of action that should be taken every time a certain situation occurs (ex: confidentiality)

Procedure

is a method, or way, of doing something

Tactful

showing sensitivity and having a sense of what is appropriate when dealing with others

Conscientious

people who try to do their best, guided by sense of right and wrong

Omnibus Budget Reconciliation Act (OBRA)

passed in 1987 in response to reports of poor care and abuse in long-term care facilities, minimum standards of care

Cite

document a problem through a survey, results are posted publicly and in the facility

Residents’ Rights

specify how residents must be treated while living in a facility, include:

• Quality of life: residents have the right to the best care availible

• Services and activities to maintain a high level of wellness: care plan must be made within 48 hours of admission

• The right to be fully informed about rights and services: informed both orally and in writing, and given contact info of state agencies related to quality of care

• The right to participate in their own care: Informed Consent

• The right to make independent choices: Resident Council is group of residents who meet to discuss issues related to long-term care

• The right to privacy and confidentiality

• The right to dignity, respect, and freedom

• The right to security of possessions

• Rights during transfers and discharges

• The right to complain

• The right to visits

• Rights to regard to social services

Types of Abuse

• Physical, Psychological, Verbal, sexual, Financial, Assault (threat to harm), Battery (intentional touching of someone w/o their consent), Domestic Violence, false imprisionment (threat or actual), involuntary seclusion, workplace violence, sexual harassment, substance abuse, neglect, negligence/malpractice

Ombudsman

in LTC in US an ombudsman is assigned by law as the legal advocated for residents

Health Insurance Portability and Accountability Act (HIPPA)

passed in 1996 to keep health information private and secure

Protected Health Information (PHI)

is information that can be used to identify a person and relates to a patient’s condition/care/payment

The Minimum Data Set (MDS)

is a detailed form with guidelines for assessing residents, and lists what to do if resident problems are identified, nurses must complete it for each resident within 14 days of admission and again each year and reviewed every three months, a new MDS must be done if any major changes occur in the resident’s condition

Incident Report

documents the incident and the response to it, intended for internal use