Study Notes for Nursing Assistant Essentials
Chapter 1: Introduction to Health Care
Objectives * Define the key terms and key abbreviations in this chapter. * Describe the purposes and types of health care agencies. * Describe the persons cared for in nursing centers. * Describe the health team and nursing team members. * Describe 5 nursing care patterns. * Describe the programs that pay for health care. * Explain how government agencies and health care agencies ensure safe, quality care. * Explain your role in meeting standards. * Explain how to promote PRIDE in the person, the family, and yourself.
Key Terms * acute illness: An illness of rapid onset and short duration; the person is expected to recover. * admission: The official entry of a person into a health care setting. * assisted living residence (ALR): Provides housing, personal care, support services, health care, and social activities in a home-like setting to persons needing some help with daily activities. * chronic illness: A long-term health condition that may not have a cure; it can be controlled and complications prevented with proper treatment. * discharge: The official departure of a person from a health care setting. * health team: The many health care workers whose skills and knowledge focus on the person's total care; interdisciplinary health care team. * hospice: A health care agency or program that promotes comfort and quality of life for the dying person and the person's family. * licensed practical nurse (LPN): A nurse who has completed a practical nursing program and has passed a licensing test; called licensed vocational nurse (LVN) in California and Texas. * licensed vocational nurse (LVN): See "licensed practical nurse (LPN)". * nursing assistant: A person who has passed a nursing assistant training and competency evaluation program (NATCEP); performs delegated nursing tasks under the supervision of a licensed nurse. * nursing team: Those who provide nursing care—RNs, LPNs/LVNs, and nursing assistants. * registered nurse (RN): A nurse who has completed a 2-, 3-, or 4-year nursing program and has passed a licensing test. * regulations: Rules made by government agencies. * survey: The formal review of an agency through the collection of facts and observations. * surveyor: A person who collects information by observing and asking questions. * terminal illness: An illness or injury from which the person will not likely recover.
Key Abbreviations * ALR: Assisted living residence * APRN: Advanced practice registered nurse * LPN: Licensed practical nurse * LVN: Licensed vocational nurse * DON: Director of nursing * RN: Registered nurse * HHS: U.S. Department of Health & Human Services * SNF: Skilled nursing facility
Chapter 2: The Person's Rights
Objectives * Explain the purpose of The Patient Care Partnership: Understanding Expectations, Rights, and Responsibilities. * Describe the purposes and requirements of the Omnibus Budget Reconciliation Act of 1987 (OBRA). * Identify the person's rights under OBRA. * Explain how to protect the person's rights. * Explain the ombudsman role.
Key Terms * advocate: Someone who acts or speaks on behalf of another person. * involuntary seclusion: Separating a person from others against the person's will, keeping the person to a certain area, or keeping the person away from his or her room without consent. * ombudsman: Someone who supports or promotes the needs and interests of another person. * representative: Someone with the legal right to act on the patient's or resident's behalf when the person cannot do so alone. * treatment: The care provided to maintain or restore health, improve function, or relieve symptoms.
Key Abbreviation * OBRA: Omnibus Budget Reconciliation Act of 1987
Patient Rights and OBRA * Patient Care Partnership: This document from the American Hospital Association explains a person's rights and expectations during hospital stays, focusing on the relationship between the doctor, health team, and patient. * OBRA Standards: OBRA is a federal law that sets minimum standards for quality of care in nursing centers. * CMS Enforcement: The Centers for Medicare & Medicaid Services (CMS) enforces OBRA through the survey process. * Quality of Life: OBRA requires centers to provide care in a manner and setting that maintains a person's quality of life, health, and safety.
Chapter 3: The Nursing Assistant
Objectives * Describe training and competency evaluation requirements. * Identify information in the nursing assistant registry. * List reasons for denying, suspending, or revoking certification. * Explain reciprocity (endorsement) for other states. * Describe role limits and state standards. * Explain why a job description is important. * Describe the delegation process and your role.
Key Terms * accountable: To answer to one's self and others about one's choices, decisions, and actions. * certification: Official recognition by a state that standards or requirements have been met. * delegate: To authorize or direct a nursing assistant to perform a nursing task. * delegation: The process a nurse uses to direct a nursing assistant to perform a nursing task; allowing a nursing assistant to perform a nursing task that is beyond the nursing assistant's usual role and not routinely done by the nursing assistant. * endorsement: A state recognizes the certificate, license, or registration issued by another state; reciprocity or equivalency. * job description: A document that describes what the agency expects you to do. * nursing task: Nursing care or a nursing function, procedure, skill, or activity.
Key Abbreviations * ANA: American Nurses Association * BON: Board of nursing * NATCEP: Nursing assistant training and competency evaluation program * NCSBN: National Council of State Boards of Nursing
Chapter 4: Ethics and Laws
Objectives * Describe ethical conduct and a code of conduct for nursing assistants. * Explain professional boundaries and boundary violations. * Define negligence and malpractice. * Distinguish between unintentional and intentional torts. * Describe protections for privacy and electronic communications. * Explain informed consent and abuse (elder, child, IPV).
Key Terms * abuse: The willful infliction of injury, unreasonable confinement, intimidation, or punishment that results in physical harm, pain, or mental anguish; depriving a person of goods/services needed for well-being. * assault: Intentionally attempting or threatening to touch a person's body without consent. * battery: Touching a person's body without consent. * boundary crossing: A brief act or behavior of being over-involved with the person; intent is to meet the person's needs. * boundary sign: An act, behavior, or thought that warns of a boundary crossing or boundary violation. * boundary violation: An act or behavior that meets your needs, not the person's. * child abuse and neglect: Intentional harm to a child under 18 involving acts/failure to act by a caregiver resulting in harm or immediate risk. * civil law: Laws concerned with relationships between people. * crime: An act that violates a criminal law. * criminal law: Laws concerned with offenses against the public and society in general. * defamation: Injuring a person's name and reputation by making false statements to a third person. * elder abuse: Knowing, intentional, or negligent act by a caregiver causing harm or risk to an older adult. * ethics: Knowledge of what is right conduct and wrong conduct. * false imprisonment: Unlawful restraint or restriction of freedom of movement. * fraud: Saying or doing something to trick, fool, or deceive. * informed consent: Process where a person understands treatment info and decides to receive or refuse it. * intimate partner violence (IPV): Physical/sexual violence, stalking, or psychological aggression by current/former partners. * invasion of privacy: Violating a person's right to keep private affairs confidential. * law: A rule of conduct made by a government body. * libel: False statements in print, writing, pictures, or digital media. * malpractice: Negligence by a professional person. * neglect: Failure of caregiver to protect a vulnerable person or provide basics (food, water, ADLs). * negligence: Unintentional wrong where a person fails to act reasonably, resulting in harm. * professional boundary: Separates helpful behaviors from unhelpful ones. * professional sexual misconduct: Acts, behaviors, or comments of a sexual nature. * protected health information: Identifying health info in any form (paper, oral, electronic). * self-neglect: Person's own behavior threatening their health and safety. * slander: False statements via spoken word or gestures. * standard of care: Skills, care, and judgments required by health team members under similar conditions. * vulnerable adult: Adult or older at risk of harm due to disability or condition.
Code of Conduct for Nursing Assistants (Box 4-1) * Respect each person as an individual. * Know the limits of your role and knowledge; perform only tasks you are trained/legally allowed to do. * Perform no act that will harm the person. * Follow nurse's directions and agency policies. * Maintain confidentiality and protect privacy/property. * Take drugs only if prescribed by a provider. * Report errors and incidents honestly and immediately.
Chapter 5: Student and Work Ethics
Key Terms * bullying: Repeated attacks or threats toward a target. * burnout: Exhaustion and self-doubt resulting from job stress. * confidentiality: Trusting others with private info. * gossip: Spreading rumors about private matters. * harassment: Troubling or tormenting a person via behavior or comments. * priority: The most important thing at the time. * professionalism: Following laws, being ethical, having good work ethics, and possessing skills for work. * stress: Body's response to emotional or physical factors. * teamwork: Staff working together to provide safe care. * work ethics: Behavior in the workplace.
Professional Appearance & Health * Practices for good health include diet, sleep ( to hours recommended), exercise, and posture. * Hygiene: Daily bathing, deodorant, and avoiding strong scents (smoke, perfume) as they can be offensive.
Chapter 14: Preventing Infection
Key Terms * antibiotic: A drug that kills bacteria. * asepsis: Absence of disease-producing microbes. * biohazardous waste: Items contaminated with blood or OPIM. * communicable disease: Contagious disease spread by pathogens. * contamination: Process of becoming unclean. * healthcare-associated infection (HAI): Infection developing in a healthcare setting. * microorganism (microbe): Small living thing seen only with a microscope. * normal flora: Microbes that naturally live in/on a body area; they are non-pathogens in that area. * pathogen: Harmful microbe that causes infection. * sterile: Absence of all microbes. * sterilization: Process of destroying all microbes.
Microorganisms and MDROs * Common Multidrug-Resistant Organisms (MDROs): * MRSA: Methicillin-resistant Staphylococcus aureus; resistant to many antibiotics; causes wound and bloodstream infections. * VRE: Vancomycin-resistant Enterococci; found in intestines/feces; transmitted via hands or surfaces. * Microbe Requirements: Need a reservoir (host), water, nourishment, and often oxygen.
Infection Signs & symptoms (Box 14-1) * Fever, chills, increased pulse and respiratory rate. * Pain, tenderness, redness, swelling, or discharge from a site. * Older adults may not show standard signs (like fever) and may instead exhibit confusion or behavioral changes.
Chain of Infection 1. Source: A pathogen. 2. Reservoir: Place where microbe lives and grows (people, animals, food, etc.). 3. Portal of Exit: Way for pathogen to leave reservoir (respiratory, GI, urinary tracts, skin, blood). 4. Method of Transmission: Way to reach another host (hands are common transmission methods).
Chapter 15: Isolation Precautions
Types of Precautions * Standard Precautions: Used in all situations for all persons to reduce risk of spreading pathogens. Applies to blood, all body fluids (except sweat), non-intact skin, and mucous membranes. * Transmission-Based Precautions: Used when persons are known or suspected to have specific infections.
Standard Precautions Details * Apply to nasal secretions, saliva, sputum, urine, feces, vomitus, and breast-milk. * Sweat is the only body fluid that does NOT spread infection in this context.
Chapter 17: Moving the Person
Terms * bed mobility: How a person moves to/from lying positions, turns, or re-positions in bed. * friction: Rubbing of surface against another. * logrolling: Turning the person as a unit, in alignment, with motion. * shearing: Skin sticks to a surface while muscles slide in moving direction.
Safety Standards * OSHA recommends minimizing manual lifting in all cases and eliminating it when possible to prevent injury. * Frequent repositioning is required (at least every hours) to prevent pressure injuries.
Chapter 19: The Person's Unit
Terms * entrapment: Getting caught in spaces of the bed frame, rails, or mattress. * full visual privacy: Being free from public view while in bed. * person's unit: Space, furniture, and equipment used by the person.
Maintaining the Unit (Box 19-1) * Keep call light within reach. * Maintain temperature for comfort ( to is a common standard, though range varies by agency). * Control odors and noise; check for safety hazards. * Arrange personal items as the person prefers; do not discard items or move furniture without consent.