The Nursing Assistant and the Care Team

The Nursing Assistant and the Care Team

1. Identify the Members of the Care Team

  • Residents have diverse needs requiring a collaborative approach to healthcare, known as an interdisciplinary approach.
  • The care team consists of various healthcare professionals, including:
    • Nursing Assistant (NA)
    • Responsibilities include performing assigned tasks, measuring vital signs, and providing personal care (e.g., bathing, helping with elimination).
    • NAs spend the most time with residents, serving as the "eyes and ears" for the team by observing and reporting changes in a resident's condition.
    • Training requirements: At least 75 hours (often exceeds 100 hours). After completing training, NAs must pass a competency evaluation.
    • Registered Nurse (RN)
    • Coordinates, manages, and provides skilled nursing care in long-term care settings, including administering treatments and medications prescribed by physicians.
    • Assigns tasks and supervises NAs.
    • RNs are licensed professionals with diplomas or degrees from nursing programs who have passed a national licensure examination.
    • Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN)
    • Administers medications and treatments and possesses one to two years of education, along with a national licensure examination.
    • Advanced Practice Registered Nurse (APRN)
    • Registered nurses with postgraduate training who can make diagnoses and prescribe treatments. Includes four types:
      1. Nurse Practitioner (NP)
      2. Nurse Anesthetist (CRNA)
      3. Nurse-Midwife (CNM)
      4. Clinical Nurse Specialist (CNS)
    • Physician or Doctor (MD or DO)
    • Licensed professional responsible for diagnosing diseases/disabilities and prescribing treatments and medications after completing medical school and additional training.
    • Physician Assistant (PA)
    • Diagnoses diseases, develops treatment plans, and prescribes medication under a doctor's supervision. Must have a master's degree and pass a national licensure exam.
    • Physical Therapist (PT or DPT)
    • Evaluates individuals and creates treatment plans to improve mobility and reduce discomfort. PTs are required to have graduated from a doctoral program and pass licensure exams.
    • Occupational Therapist (OT)
    • Helps residents adapt to disabilities and perform activities of daily living (ADLs), developing treatment programs tailored to individual needs. OTs hold a master's or doctoral degree and must pass a licensure exam.
    • Speech-Language Pathologist (SLP)
    • Identifies communication disorders and develops care plans that help residents improve communication and swallowing abilities. Must hold a master's degree and be licensed.
    • Registered Dietitian (RD or RDN)
    • Assesses nutritional needs and creates treatment plans to improve health and manage illness. Requires a bachelor's or master's degree and licensure.
    • Medical Social Worker (MSW)
    • Determines residents' needs for support services and assists in obtaining resources such as counseling and financial aid. Typically requires a master’s degree in social work.
    • Activities Director
    • Plans activities to enhance socialization and mental/physical well-being. Typically has a bachelor's degree or relevant experience, and may be referred to as a recreational therapist.
    • Resident and Resident's Family
    • Residents are essential members of the care team, emphasizing person-centered care where their well-being and decision-making are prioritized. Family involvement is critical for care planning and goals.

2. Explain the Nursing Assistant's Role

  • Nursing assistants carry out specific assigned nursing tasks and provide personal care by:
    • Bathing residents
    • Supporting grooming activities
    • Assisting with elimination needs
    • Guiding residents through range of motion exercises and ambulation
    • Transferring residents safely
    • Measuring vital signs (temperature, pulse, respiration, blood pressure)
    • Assisting residents with meals
    • Helping residents dress and undress
    • Providing back rubs
    • Offering mouth care
    • Responsible for cleaning and changing bedding
    • Maintaining cleanliness in residents' living areas
    • Managing supplies and equipment carefully
    • Promoting the independence and self-care of residents
  • NAs are prohibited from:
    • Inserting/removing tubes
    • Administering tube feeding
    • Changing sterile dressings unless permitted by state regulations and additional training.
  • Observing and reporting changes are vital for updating care plans as resident conditions change, with accurate documentation being an essential responsibility.
  • Titles for nursing assistants vary, including nurse aide, certified nurse aide, and patient care technician based on state requirements.

3. Explain Professionalism and List Examples of Professional Behavior

  • Professionalism refers to the expected behavior and conduct in a job setting, including appropriate attire, communication, punctuality, and adherence to care plans. It fosters respect and opportunities for advancement.
  • Key behaviors include:
    • Providing person-centered care
    • Maintaining a positive attitude
    • Performing only tasks defined in the care plan and allowed by training
    • Keeping residents' information confidential
    • Demonstrating politeness to residents
    • Avoiding discussions about personal issues within the workplace
    • Respectfully addressing residents (using preferred titles)
    • Communicating in the residents’ preferred pronouns
    • Refusing to give or accept gifts
    • Always explaining care procedures
    • Practicing hand hygiene to protect oneself and residents

4. Describe Proper Personal Grooming Habits

  • Personal grooming reflects professionalism and positively influences residents' confidence in care. Nursing assistants should:
    • Bathe or shower daily and avoid strong scents
    • Brush teeth regularly and use mouthwash when needed
    • Keep hair neatly styled, secured if long
    • Maintain clean and neat facial hair
    • Wear wrinkle-free uniforms, avoiding excessively tight or cropped clothing
    • Use minimal jewelry and wear identification badges as required
    • Keep fingernails short, clean, and free from artificial nails
    • Wear comfortable, closed-toe shoes, ensuring overall cleanliness and appearance that adheres to workplace standards.

5. Explain the Chain of Command and Scope of Practice

  • The chain of command delineates the hierarchical structure within healthcare settings, ensuring appropriate channels for communication and authority. It also protects staff from liability.
  • Each healthcare roles have defined scope of practice, which varies by state laws and regulations. Nursing assistants are unlicensed practitioners who operate under the direction of licensed professionals. Key scope restrictions include:
    • NAs cannot perform tasks not listed in their care plan
    • Cannot use sterile techniques for procedures such as dressing changes
    • Forbidden to diagnose or consult on conditions or treatments
    • Must refer tasks they are not trained for, even upon request from physicians or nurses.

6. Describe the Resident Care Plan and Explain Its Purpose

  • The resident care plan is tailored to each individual’s needs, specifying tasks, treatments, and schedules for care as required by the CMS, who mandates person-centered planning.
  • It comprises:
    • Diagnoses and limitations
    • Goals and interventions (medications, monitoring, nutritional guidelines)
    • Required supplies and safety measures
    • Involvement of the resident and family in development to enhance compliance and treatment engagement.
  • Regular reviews and updates ensure that care plans reflect current needs based on the resident's evolving condition and observations made primarily by nursing assistants.

7. Describe the Nursing Process

  • The nursing process comprises five steps essential for comprehensive caregiving:
    1. Assessment: Collection of information regarding health, environment, history to identify issues.
    2. Diagnosis: Health issues are diagnosed by analyzing assessment data.
    3. Planning: Goals are established, and care plans are created per resident preferences.
    4. Implementation: Care plans are enacted to provide necessary treatment and assistance.
    5. Evaluation: Ongoing review to determine if goals are met, allowing for necessary adjustments to ensure the effectiveness of care.

8. Describe the Five Rights of Delegation

  • When nurses delegate tasks, they consider the Five Rights of Delegation to ensure effective and safe care provision:
    • Right Task: Matching the task to the assistant's skill level.
    • Right Circumstance: Ensuring the environment and conditions are appropriate for the task.
    • Right Person: Confirming that the nursing assistant is the appropriate individual for the task.
    • Right Direction/Communication: Clear instructions are provided.
    • Right Supervision/Evaluation: The nurse must monitor the delegated task performance and provide support as necessary.

9. Demonstrate How to Manage Time and Assignments

  • Effective time management is vital for nursing assistants to complete their tasks effectively. Key strategies include:
    • Plan Ahead: Create lists of required tasks and ensure the necessary supplies are available.
    • Prioritize: Identify urgent tasks to be addressed first.
    • Make a Schedule: Allocate time slots for various responsibilities throughout the shift.
    • Combine Activities: Engage residents while performing care activities to enhance interactions.
    • Seek Help: Request assistance from colleagues when required to ensure safety and quality care.