Nursing Assistant Training Notes from Transcript

Roles of CNAs and Nurses

• The CS skills check-off form is printed and used to document competencies; skills marked with an asterisk (the ones highlighted) indicate required competencies to be reviewed before graduation.
• When you graduate and become a nurse, a good CNA is invaluable because they:
  • See patients more often and can notice early changes (e.g., skin breakdown, back issues).
  • Keep the nurse informed about patient status and daily needs.
  • Help with day-to-day tasks and monitoring, making the nurse’s job easier.
• Nursing assistants (CNAs) play an essential role in the care team; the CNA-patient relationship is foundational for quality care.

Care Team, Chain of Command, and Delegation

• The care team includes CNAs, nurses, therapists, administrators, and other staff; each has roles and responsibilities.
• Chain of Command: Understand who to report to in a facility (e.g., CNA -> nurse -> charge nurse/supervisor -> unit manager -> administrator).
• Five Rights of Delegation (critical for safe task assignment):
  • Right Task
  • Right Circumstances
  • Right Person
  • Right Direction/Communication
  • Right Supervision/Evaluation
• Policy and Procedures: Staff should be familiar with facility policies and long-term care survey processes; these documents guide daily practice and compliance.
• The goal is to delegate tasks safely while maintaining patient dignity and safety.

Policy, Procedures, and Long-Term Care Survey Process

• Expect to review policy and procedures; you won't memorize every word, but you should recognize the concepts.
• Read through terms you know and revisit unfamiliar ones so you can recall meanings when you encounter them.
• Long-term care surveys assess quality of care, safety, and compliance with regulations; understanding this process helps you recognize how care is monitored and improved.

Key Terms and Concepts to Know

• ADLs (Activities of Daily Living): essential self-care tasks (e.g., feeding, bathing, dressing, toileting, transferring, continence).
• Allergies vs. side effects: Always verify reported allergies; many reported allergies are actually side effects (e.g., sedation, nausea). When in doubt, clarify with the patient and cross-check records.
• “Nursing assistants” vs. “student nurses”: In this context, the term refers to CNAs; for students, the role is different but related in the care team.
• LTC (Long-Term Care): Facilities (LTC facilities) that may provide therapy or ongoing care; residents may stay temporarily for therapy or long-term if it’s their home.

Long-Term Care Facilities and the Resident Experience

• LTC facilities may provide therapy (e.g., rehab after injury) and may host residents for extended periods; some stay only temporarily for rehabilitation, others for ongoing care.
• For residents whose room is their home, privacy and personal space matter; treat residents as you would treat guests in your own home.
• Respect and dignity are central; many residents may not have regular visitors, family, or external support for daily needs (laundry, clothing, meals).
• Staff often become caregivers beyond formal duties (e.g., lending a hand with clothing or supplies) because residents rely on staff for daily needs.
• Residents with cognitive, physical, or emotional changes may require additional patience and understanding from staff.
• Examples of caregiver interactions:
  • Morning routines can be loud; be mindful of waking residents gently.
  • Breakfast choice matters; if a resident dislikes a preferred breakfast, staff may offer alternatives (e.g., grits if that’s what’s available).
  • Daily activities may include physical therapy, arts and crafts; staff should facilitate participation respectfully.

Rehabilitation and Special Care Scenarios

• Rehabilitation facilities: Some residents require more intensive medical treatment than a general unit; rehab focuses on restoring function after injury or illness.
• Traumatic Brain Injury (TBI): Head injuries can alter personality and behavior; care teams must adjust approaches to safety and communication.
• Parkinson’s Disease: Characterized by tremors and motor control challenges; rehabilitation and adaptive strategies help maintain independence.
• Outings in rehab: Therapeutic activities (e.g., fishing) can be part of care plans to promote recovery and engagement.
• Safety considerations: Be vigilant about safety during activities and transitions; address changing needs promptly.

Medicare and Medicaid: What They Cover (and Don’t)

• Medicare: Federal program primarily for people 65+ or with certain disabilities; Medicare has several parts:
  • Part A: Hospital and skilled facilities coverage.
  • Part B: Doctor services and outpatient care.
  • Part C: Medicare Advantage plans; private insurers that provide traditional Medicare benefits.
  • Part D (not mentioned in detail in the transcript) typically covers prescriptions through private plans.
• Near-term practical note: Medicare does not cover all personal items or daily living supplies in long-term care.
• Costs in nursing homes: Living costs (room, basic care) are deducted from a resident’s check; remaining funds may be used for other needs if applicable.
• Personal items not covered by Medicare: Diapers, deodorant, soap, toothpaste, clothing, and similar personal hygiene or basic supplies are generally not covered by Medicare; families or other sources must provide these.
• Medicaid: Federal/state programs that provide assistance for individuals with low incomes; coverage varies by state and may complement Medicare for those who qualify.
• Cross-state issues: Medicaid eligibility and coverage can differ between states; moving between states can affect eligibility and coverage.
• Special considerations for families:
  • Many residents rely on donations for clothing, supplies, and basic needs because facilities’ funding may be limited.
  • Family members or advocates often assist with purchases (e.g., diapers, clothing) when needed.
• Real-world example from the transcript: A resident’s daughter helped stockpile and distribute diapers to residents in need after seeing the limitations in care funding.

Ethical, Practical, and Emotional Implications

• Ethical imperative: Preserve dignity, respect, and autonomy; ensure residents are treated as family and given appropriate care, not neglected due to resource constraints.
• Practical reality: Facilities may struggle to provide all desired items; staff often go above and beyond (e.g., shopping at Goodwill to meet a resident’s needs).
• Emotional aspects: Staff may experience frustration due to systemic limitations, but the focus should remain on making each day better for residents.
• Personal boundaries and resilience: It’s acceptable to express emotion privately when needed, but care providers should maintain composure around residents to provide stable, reassuring care.
• Community and support: In the absence of family, CNAs and staff may become primary sources of companionship and support for residents.

Practical Takeaways for Nursing Practice

• Get familiar with the CS skills check-off form and review any items marked with an asterisk; know what competencies you are expected to demonstrate.
• Build strong collaboration with CNAs: they provide essential daily observations; establish clear lines of communication and respect within the care team.
• When in doubt, refer to policy and procedures and seek clarification on the Five Rights of Delegation before performing tasks.
• Always approach residents with a person-centered mindset: treat their room as their home, respect routines and preferences, and maintain privacy.
• Be mindful of safety and basic supplies: ensure urinary and fecal incontinence care is properly managed (e.g., avoid leaving pads unattended and ensure timely changes when required).
• Understand the limits of coverage: know what Medicare covers and what it does not (e.g., personal hygiene items and clothing are typically not covered) and how Medicaid may assist based on eligibility.
• Advocating for residents is part of care: when resources are limited, prioritize needs, seek donations or community support, and document care plans and needs.
• Reflect on real-world scenarios and continue to build empathy and practical problem-solving skills to improve daily care for residents.