Intro to OBRA and the Nursing

Assistant

Course Information

Course Objectives:

To prepare nurse aids with the knowledge, skills, and abilities essential for the provision of basic care to residents in long-term care facilities.

Course Information

After completing this course, participants will be able to:

1. Provide basic care to residents of long-term care facilities.

2. Communicate and interact effectively with residents and their families, with sensitivity to the psychosocial needs of the residents.

3. Assist residents in attaining and maintaining maximum functional independence.

4. Protect, support and promote the rights of residents.

5. Provide safety and preventative measures in the care of residents.

6. Demonstrate skill in observing, reporting and documentation.

7. Function effectively as a member of the health care team.

Course Information•Each class period will be split in to 2 different groups (A and B group)

•Only 10 students are allowed to visit the nursing home at a time under Mrs. Paschal’s supervision

•You will travel to the nursing home every-other class period

•If your group is staying at the school, you will learn and practice skills with Mrs. Bernard

•A calendar will be posted of the rotation schedule

•The first week of rotations at The Summit will be October 6th, 2014 and we will finish the week of January 26th, 2015

Course InformationTextbooks/Resources:

•Hartman’s Nursing Assistant Care (Long-Term Care)

•Also available for download on iTunes

•Hartman’s Nursing Assistant Care Workbook

•Diversified Health Occupations

•NNAAP Texas Nurse Aid Candidate Handbook

Course Information

Requirements and Assignments•Attendance is REQUIRED for this course

•You must complete 40 hours of clinical rotations and 60 hours of classroom instruction before you are eligible to take the exam

•You will sign in each class period in order to document hours – DO NOT BE LATE!

•Grades will be based on participation, daily assignments, skills check-offs, exams, and projects

INTRODUCTIONYou need to know:

•What you can and cannot do•What conduct is right & wrong•Your legal limits

Actions are defined / shaped by:

•*•Patient’s condition•The amount of supervision you need

HISTORY OF CNA’S

•Worked for decades helping nurses•Until the 1980s, training was not required by law•On-the-job training by *•Some schools and hospitals offered training

TRENDSIn 1980’s primary nursing was introduced

•RN’s gave care in *•CNA’s gave care in *

TRENDS•Home care increased in 1980’s•Insurance caused decrease in *•Reducing medical costs became political issue•Hospital closings & mergers•Managed care•*•CNA’s joined RN’s at hospitals •CNA’s *

STATE & FEDERAL LAWS

•Tasks CNA’s able to perform vary from state to state & within agencies•Attempt to regulate nursing practice•Nurse practice acts•The * (OBRA) of 1987•Applies to all 50 states

NURSE PRACTICE ACTS

•Defines RN’s and LPN’s•Describes their *•Lists education and licensing requirements •Protects public from a nurse *•Allows license to be *

NURSE PRACTICE ACT

•Also defines what the Nursing Assistant may do•If perform act beyond scope of CNA, can be found * of practicing nursing without a license

REASONS TO REVOKE A LICENSE

1. Convicted of crime in any state2. *3. Using patient drugs for self4. Place person in danger from overuse

of drugs / alcohol5. Convicted of abuse or neglect of *6. Violating or assisting someone else to

violate the nurse practice act7. * behaviors8. Making medical diagnosis9. Prescribing *

OBRAOmnibus Budget

Reconciliation Act of 1987 •Federal law that establishes regulations for nursing facilities and nurse aid training in facilities•Intent is to improve quality of life for residents in nursing facilities

REMIND ME AGAIN….

What was the intent of the OBRA Act of

1987???

OBRAOBRA facility regulations focus on:

1. *, restorative care, psychosocial care and preventative care to maintain maximum physical and mental wellness of residents.

2. State inspection of facilities for compliance with regulations with penalties for *.

OBRAOBRA nurse aid training regulations include:

1.The facility must assure that nurse aids complete an approved NATCEP and be placed on the Nurse Aid Registry within 4 months of their hire date.

• The first * of training must be completed prior to any direct contact with a resident.

• After the first 16 hours, nurse aids can perform only those skills for which they have been * and found to be * by the instructor.

OBRAOBRA nurse aid training regulations include:2.An approved NATCEP must be at least * clock hours in length

• * classroom hours

• * clinical training hours

• The nurse aid must pass the training program in order to be eligible to take the state test

3.The state Competency & Evaluation Exam (CEP)

• A written or oral exam consisting of *

• A skills test consisting of * randomly selected skills

• A nurse aid must pass the skills AND written test before being placed on the registry

• The nurse aid has 3 opportunities to pass each test and must meet competency within 2 years of his/her training completion date

• Cost = $93

TELL ME….

How does the training previously mentioned benefit residents, the nurse aide themselves, and the

LTC facility??

OBRAState registry requirements include:

1.Each individual listed on the registry must keep the department informed of his/her current address and telephone number

2.Nurse aid certification expired * after being entered into the registry

• Must submit verification of pain employment prior to the expiration date to continue verification

3.If renewing after Sept 1, 2013 you must complete * of continuing education every 2 years

4.DADS will not recertify nurse aids that are listed on the * (EMR), or have been convicted of a criminal offense listed in Texas Health and Safety Code 250.006

5.A finding of abuse, neglect, or misappropriation of resident property may be entered into the registry.

• The nurse aid will not be employable as a nurse aid in LTC facilities

ROLES & RESPONSIBILITIES

Nurse practice acts, OBRA, state laws, as well as legal and advisory opinions direct what you can do in your role as a CNA:

•Must understand what you are able or unable to do •* – called “scope of practice”•Must have had education and training to perform task•* (LPN’s may in some states) •Must be available for questions

ROLE LIMITS

FOR CNA’S:

DELEGATION•Authorize another person to perform a task •Delegation decisions must protect person’s health and safety •Person must be *•RN legally * (responsible) for all nursing care-decide what is best for patient

•Decision is based upon pt’s circumstances•Must make sure it is done correctly

CNA’s cannot delegate roles or responsibilities

5 RIGHTS OF DELEGATION

1. Right *2. Right *3. Right *4. Right *5. Right *

Intro to Residents in LTC Facilities

Purpose of LTC facilities:•Business that provide skilled nursing care *

•The term nursing home was once widely used to refer to these facilities. Now they are called long-term care facilities, skilled nursing facilities, rehabilitation centers, or extended care facilities

•People who live in LTC facilities are referred to as * because they live there

•Residents’ length of stay can be varied. Why do you think?

•A typical LTC facility offers personal care for all residents and focused care for residents with special needs. What are examples of personal care? What does ADL stand for?

•Several other services also offered in LTC facilities:• Physical, occupational, and speech therapy• *• Care of different types of tubes (catheters)• *• Management of chronic diseases

Intro to Residents in LTC Facilities

Types of residents of LTC facilities:1.*

• A survey in 2004 reported that * of LTC residents were over the age of 65

• 2/3 of residents in LTC is 6 months or longer

• 1/3 of residents in LTC is less than 6 months

1. Terminal care – resident will probably die in the facility

2. Rehabilitation – residents recover and return to the community

2.*

1. * – A limitation on a person’s physical functioning, mobility, dexterity, or stamina

2. * – A disease that affects a person’s ability to function at a normal level in the family, home, or community

Intro to Residents in LTC Facilities

Types of residents of LTC facilities (cont):

3.Individuals requiring skilled nursing• Most often the lack of ability to care for oneself and the

lack of a support system

4.*

5.Post acute care

6.Other

Intro to Residents in LTC Facilities

Needs common to residents:•What are some needs that we all have?•Physical needs•* needs•Privacy needs•Residents have the right to privacy when care is given•Their medical and personal information cannot be shared with anyone but *

Intro to Residents in LTC Facilities

Myths and feelings about aging

•Ideas and stereotypes about older people are often false.

•Most older people are active and engaged in work, volunteer activities, learning programs, and exercise regimens.

•Aging causes many *, psychological, and * changes.

Residents in LTC FacilitiesNormal changes of aging:

• Skin is thinner, drier, more fragile, less elastic• Muscles weaken and lose tone• Bones * and become more brittle• Sensitivity of nerve endings in the skin decrease• Responses and reflexes slow• *• Senses of vision, hearing, taste, touch, and smell weaken• Heart works less efficiently• Oxygen in the blood *• Appetite decreases• Urinary elimination is more *• Digestion takes longer and is less efficient• Levels of hormones *• Immunity weakens• Lifestyle changes occur

Residents in LTC FacilitiesNot normal changes of aging:•SHOULD BE REPORTED TO THE NURSE

•Signs of depression

•Loss of ability to think logically

•Poor nutrition

•*

•Incontinence