1. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Unit 2 On the Job: Being a Nursing Assistant

2. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Objectives Spell and define terms. Identify the members of the interdisciplinary health care team and the nursing team. 2

3. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Objectives List the job responsibilities of the nursing assistant, explain how the Nurse Practice Act affects nursing assistant practice, and discuss the importance of working within the established scope of nursing assistant practice. 3

4. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Objectives List the federal requirements for nursing assistants working in long-term care facilities. State the purpose of evidence-based practice. Identify common nursing care delivery systems and briefly describe each. 4

5. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Objectives Describe your facility’s lines of authority and discuss the five rights of delegation. Explain why good time management is a key to successful nursing assistant success and describe methods of organizing assignments to make the best use of your time. 5

6. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Objectives Describe the importance of good human relationships and list ways of building good relationships with patients, families, and staff. Discuss professionalism and explain why projecting a professional image is important. 6

7. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Objectives List the rules of personal hygiene and appropriate dress. Describe ways to prevent physical illness and relieve stress, and the importance of a healthy mental attitude. 7

8. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Interdisciplinary Health Care Team Patient Members of patient’s family Physician Nursing team Other specialists 8

9. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Nursing Team The nursing team consists of: –Registered nurses –Licensed practical (or vocational) nurses –Nursing assistants 9

10. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The nursing team provides skilled nursing care RNs plan and direct nursing care in cooperation with the physician’s orders All members of the team provide direct patient care 10 The Nursing Team

11. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Regulation of Nursing Assistant Practice Legislatures write laws (statutes) that determine the scope of practice. State regulatory agencies write regulations (rules) based on laws. Rules set standards of conduct and are much more specific than laws because they determine how laws will be applied. 11

12. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Regulation of NA Practice Omnibus Budget Reconciliation Act (OBRA) –1987 federal law regulating the education and certification of nurse aides Nurse Aide Competency Evaluation Program (NACEP) –Minimum training standards for nurse aides 12

13. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. OBRA Gives nursing assistants recognition through registration Helps define the scope of nursing assistant practice 13

14. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Provides better uniformity in care provided by nursing assistants Promotes educational standards for nursing assistants 14 OBRA

15. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Nurse Practice Act A state board of nursing regulates nursing practice and determines the scope of practice, or skills the nursing assistant is legally permitted to carry out. Always stay within your state’s scope of practice. 15

16. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Professionalism Professionalism is the grooming and appearance, skill, good judgment, and polite behavior that is expected from a person who is trained to do a job well. Be neat and clean, and follow the dress code. 16

17. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Evidence-Based Practice (EBP) Evidence-based practice (EBP) guides decision making by identifying evidence for a practice, then rating the activity according to the strength of the evidence. 17

18. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Organization of Nursing Care Each facility selects a method of providing nursing care and determines job duties. The nursing assistant has a functional role in each delivery system. The nursing care delivery system describes how care is organized in the facility. 18

19. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Primary nursing Functional nursing Team nursing Partners in practice Nursing assistant has a functional role in each 19 Organization of Nursing Care

20. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Primary Nursing Care is given by an RN –Responsible for a patient’s care during that patient’s entire hospitalization Licensed staff and assistants help when an RN is not on duty RN is responsible for six to eight patients 20

21. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Functional Nursing Task-oriented way to organize care service Charge nurse responsible for all patients Others are assigned specific tasks –Medications, administering treatments, or providing hygienic care 21

22. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Team Nursing A team leader (usually an RN) –Determines nursing needs of patients Team members receive assignments –From and report to the team leader 22

23. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Team Nursing Team nursing is successful when members: –Understand the philosophy, purposes, and goals of restorative nursing –Understand their responsibilities –Attend the care plan conference 23

24. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Partners in Practice RN or a primary nurse –Partnered with a nursing assistant or other team member Team members –Work together to meet the needs of their assigned patients 24

25. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Method combines positive aspects of team and primary nursing into the partnership model In some facilities: –Team members work on same schedule 25 Partners in Practice

26. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Case Management The case manager helps identify services, providers, and facilities needed by the patient and ensures that resources are used in a timely and cost- effective manner. The case manager advocates for the patient and works to achieve the best possible outcomes. 26

27. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Progressive Patient Care The patient moves from one unit to the next as her health needs change. This system may be difficult and confusing for the patient. 27

28. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Patient-Focused Care Patient is focus of service Goals –Limit number of people involved in patient care –Contain costs –Meet patients’ needs efficiently Staff members are cross-trained 28

29. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Teamwork Successful alternative models of care are effective because they: –Promote cooperation and teamwork –Provide opportunities for growth 29

30. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Teamwork Learning to work with others as a member of a team –One of the most important skills to master during your nursing assistant education 30

31. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Lines of Authority Learn your role and line of authority within your facility Refer to Figure 2-4 31

32. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Lines of Authority 32

33. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Delegation Delegation is the transfer of responsibility for carrying out a nursing activity from a nurse to someone who does not already have the authority. The nurse practice act describes how nurses assign or delegate duties. 33

34. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 5 Rights of Delegation Right task Right circumstances Right person Right direction and communication Right supervision 34

35. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Delegation You may refuse the delegation: –If you believe that a procedure is not within your scope of practice –If you have not been taught to do the task –If you believe that the activity will harm the patient 35

36. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Managing an Assignment Report Patients you are assigned to care for, information, needs Make rounds, make a plan Organize time Continue making rounds throughout your shift 36

37. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Managing an Assignment Set priorities and deadlines Accept that priorities may change Help others 37

38. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Handoff Communication Occurs when responsibility for a patient changes from one person to another. Vulnerable time for the patient and is one of the places where errors are most likely to occur. 38

39. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Hand-off Communication Report: –Situation and background –Observations, findings, changes, abnormalities –Safety issues, high-risk conditions, concerns –Recommendations and special orders 39

40. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Guidelines for the Nursing Assistant Only perform tasks you have been trained to do Seek higher authority when necessary Know your scope of practice –Live by it 40

41. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Roles and Responsibilities Nursing assistant works directly with the patient –Provides physical care and emotional support Nursing assistant’s specific duties –Vary depending on his or her workplace 41

42. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Personal Vocational Adjustments Nursing assistant must be: –Willing to learn and grow –Dependable –Respectful of his or her co-workers –Empathetic, patient, and tactful with others 42

43. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Interpersonal Relationships Interactions between people Patients and staff 43

44. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Attitude Single most important characteristic you bring to your job Developed throughout your lifetime Shaped by your experiences 44

45. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Attitude Should reflect: –Caring –Courtesy –Cooperation –Emotional control –Empathy –Tact –Patience 45

46. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Patient Relationships All patients are different You should meet patients’ varying needs You should meet families’ needs 46

47. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Adapting to Change Learn all you can about the change and your responsibilities Try to understand the need for and value of the change Find ways to adapt to and accommodate the change Try to be open-minded and flexible 47

48. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Change Be a team player Adjust your attitude –Look forward to the change Keep your sense of humor –Make change fun 48

49. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Change Compensate for stress and pressure –Make time for activities you enjoy when you are off duty View change as an opportunity for growth Change is inevitable –But growth is optional 49

50. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Staff Relationships All health care workers share a single goal: – To help the patient There is much you can do to help accomplish this goal 50

51. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Personal Health and Hygiene Your uniform should be appropriate, clean, and neat You should wear an appropriate identification tag Refer to Figure 2-10 51

52. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Personal Health and Hygiene 52

53. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Reducing Stress Get sufficient rest Practice good nutritional habits Participate in satisfying leisure activities Participate in stress-reducing activities 53