Terms and Definitions • Activities of daily living (ADL) – any activity that is performed on a daily basis • Ambulation – walking • Diagnosis – determining the kind of disease or medical condition • Emotion – one’s feelings • Physical – relating to the body and bodily functions • Psychological – thought processes of the brain • Rehabilitation – restoration of ill or injured residents, help them live to their highest potential

Terms and Definitions • Responsible party – a family member/friend of the resident whom the resident designates in writing to handle matters and receive reports related to the resident’s general condition • Restorative – returning a resident to health or consciousness • Social - getting along with others • Validation therapy – a technique that creates a climate of acceptance by encouraging the resident who is confused to explore his/her thoughts. The technique validates the emotions being experienced.

Health Care Team Members (See Figure 2.1) • Every member of the health care team-must ensure residents receive quality services and facility maintains high standards. (HO 1) • Resident and his/her family have particular needs that must be identified by team members. C.N.A ***The most important members of the team are the resident and his/her family. • Physician- Dx, Tx, plans care • Administrator – responsible for all aspects of operation of the long-term care facility including delivery of proper resident care

Health Care Team Members Figure 2.1 – Health Care Team Members

Nursing Services Registered Nurse (RN) • Length of training 2 to 4 years. • Must pass state board of nursing examination upon completion of educational program. R.N Duties • Plans, assigns, evaluates nursing care • Responsible for all team members working together • Reviews quality of care • Gives medication, TF, starts IVs • Assists with resident care (physical, psychological, social) • Takes and records Dr. TO, VO

Nursing Services Licensed Practical Nurse (LPN) • Length of training 12-14 months. • Must pass a state board of nursing examination upon completion of education program. L.P.N, or L.V.N. Duties • Plans, assigns, and evaluates nursing care • Gives medication, TF • Starts IVs after successful completion of IV therapy course (Cannot do IV push meds) • Takes and records Dr. T.O., V.O. • Performs most treatments

Nursing Services Certified Medication Technician (CMT) • Length of training 68 hours. • CMT must have successfully completed the “Nurse Assistant in a Long-term Care Facility” and/or met other requirements before starting training for CMT. • CMT must pass final written and practicum examination C.M.T Duties • Prepares and administers selected medications • Transcribes physician’s orders • Observes and reports effects of medications • Assists with resident care • May administer insulin after successful completion of an insulin administration course

Nursing Services Restorative Nurse Assistant (RNA) • Length of training 60 hours • RNA must have successfully completed the course“Nurse Assistant in a Long-term Care Facility” and/or met other requirements before starting training for RNA. R.N.A Duties • Performs specific restorative procedures (e.x., feeding, ambulation, exercise, observation, and reporting) • Advocate of the restorative process; assists residents in self-care • Responsible for follow-up and maintenance of restorative plans • Reports changes or observations

Nursing Services Certified Nurse Assistant (CNA) • Length of training 75 hours of classroom, 100 hours of on-the-job training and competency evaluation. • Must pass final examination before being qualified. • CNA’s name is added to certified nursing assistant registry for at least 2 years. C.N.A Duties • Assists with A.D.L • Provides bedside care that includes selected procedures under the supervision of the charge nurse (ex. Feeding, dressing, bathing)

Nursing Services C.N.A Duties • Checking and recording vital signs, observation • Weighing resident • Bowel and bladder retraining • Validation therapy, meets residents emotional needs • Maintaining safe environment for residents • Transferring and positioning • Transporting resident to activities that the activities director plans • Is aware of residents’ whereabouts at all times • Range of motion

General Housekeeping / Maintenance Housekeeping employees • Provide daily room care • Clean all other areas of facility Laundry employees • Launder linen, bedding, and clothing • Mend linen, bedding, and clothing Maintenance employees • General repair and grounds keeping

Dietary Employees Dietitian (usually a consultant) • Consults with dietary/food service supervisor • Approves menus; evaluates and counsels residents with nutritional problems Dietary/food service supervisor • Manages dietary department (orders supplies, food, etc.) • Interviews residents • Supervises dietary employees Dietary staff • Prepares and serves food • Washes dishes • Keeps dietary area clean

Activities Director • Conduct group and individual activities • Supervise volunteers • Schedule community-sponsored activities in and outside the facility • Physical therapist, occupational therapist, speech therapist (usually consultants) • Plan and provide therapy essential to promote rehabilitation based on physician’s orders • Instruct staff in restorative nursing procedures

Social services (designee and/or licensed social worker) • Receive reports related to a resident’s personal possessions and property. • Screens residents before admission to a facility to determine if the facility can meet the resident’s needs During residency • Assists with admission process; reviews rights and responsibilities of resident and facility Counseling • Has daily contact with resident to determine if social and emotional needs are being met • If qualified, provides individual or family counseling; otherwise, refers to qualified personnel for assistance

Personal services • Financial resources – assists with insurance forms, pensions, social security, etc. • Secures aids to daily living (wheelchairs, canes, etc.) • Makes arrangements for outside services to meet resident’s needs Discharge planning • Referrals (home health, another long-term health care facility, hospital) • Follow-up

Chain of Command – Lines of Authority Figure 2.2 – Chain of Command

Chain of Command – Lines of Authority • The nurse assistant should be familiar with the chain of command in his/her facility. If the nurse assistant observes or suspects a problem, he/she should direct this concern to the next responsible person (immediate supervisor) and then follow each successively higher level of the chain of command until the problem is resolved. C.N.A ***All complaints/concerns from families, residents, or visitors should be referred to the charge nurse. • Charge nurse (RN or LPN) is next in command. • Assistant director or nursing is next. • Director of nursing is next. • Administrator is the health care team member with the most responsibility and ultimate authority.

Conclusion The most important members of the health care team are the resident and his/her family. All team members must join together to identify and meet each resident’s needs. They must communicate well with one another to give the best care possible. As a nurse assistant, you must be aware of the lines of authority you are required to follow when a problem arises.