1. 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

2. 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.

3. 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

4. Health Care Team Members
Figure 2.1 – Health Care Team Members

5. 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

6. Nursing Services Licensed Practical Nurse (LPN)
• Length of training 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

7. 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

8. 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

9. 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)

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

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

17. 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.

18. 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.