1.03 NF
Understand residents rights, advocacy, and grievance procedures.
Unit A Nurse Aide Workplace FundamentalsEssential Standard 1.00
Understand the range of function, legal and ethical
responsibilities of the nurse aide within the healthcare system.
Indicator 1.03 Understand residents rights, advocacy, and grievance
procedures.
11.03Nursing Fundamentals7243 Nursing Fundamentals1Nursing
Fundamentals 72433Basic Human RightsProtected by ConstitutionLaws
clarify these rights:Right to be treated with respectRight to live
in dignityRight to pursue a meaningful lifeRight to be free of
fear1.03
Nursing Fundamentals 72434Basic Human RightsBehaviors that
infringe on human rights:addressing residents as childrenusing
demeaning nicknames for residentsleaving door open during
baththreatening a resident with harm1.03
Nursing Fundamentals 72435Ethical and legal basisStates have
adopted or codified these rights into lawPosted in
facilityDistributed on admission in many facilitiesOBRA 1987
Residents Bill of Rights
1.03
Nursing Fundamentals 72436Residents have the right to:Be treated
with consideration, respect, and full recognition of personal
dignity.OBRA 1987 Residents Bill of Rights
1.03 Nursing Fundamentals 72437Residents have the right
to:receive care, treatment, and services which are adequate and in
compliance with rulesOBRA 1987 Residents Bill of Rights
1.03 Nursing Fundamentals 72438Residents have the right
to:receive a statement of services and chargesOBRA 1987 Residents
Bill of Rights
1.03 Nursing Fundamentals 72439Residents have the right to:have
on file the attending physicians proposed schedule of medical
treatment.OBRA 1987 Residents Bill of Rights
1.03 7243 Nursing Fundamentals1.03 Understand residents' rights,
advocacy, and grievance procedures9Nursing Fundamentals
724310Residents have the right to:privacyOBRA 1987 Residents Bill
of Rights
1.03 7243 Nursing Fundamentals1.03 Understand residents' rights,
advocacy, and grievance procedures10Nursing Fundamentals
724311Residents have the right to:Be free from mental and physical
abuse, and free from restraint (except in an emergency)OBRA 1987
Residents Bill of Rights
1.03 7243 Nursing Fundamentals1.03 Understand residents' rights,
advocacy, and grievance procedures11Nursing Fundamentals
724312Residents have the right to:receive reasonable response to
all requestsOBRA 1987 Residents Bill of Rights
1.03 7243 Nursing Fundamentals1.03 Understand residents' rights,
advocacy, and grievance procedures12Nursing Fundamentals
724313Residents have the right to:associate and communicate
privatelyOBRA 1987 Residents Bill of Rights
1.03 7243 Nursing Fundamentals1.03 Understand residents' rights,
advocacy, and grievance procedures13Nursing Fundamentals
724314Residents have the right to:manage financial affairsOBRA 1987
Residents Bill of Rights
1.03 7243 Nursing Fundamentals1.03 Understand residents' rights,
advocacy, and grievance procedures14Nursing Fundamentals
724315Residents have the right to:private visits from spouseOBRA
1987 Residents Bill of Rights
1.03 7243 Nursing Fundamentals1.03 Understand residents' rights,
advocacy, and grievance procedures15Nursing Fundamentals
724316Residents have the right to:privacy in the resident room.
Personal items should not be searched.OBRA 1987 Residents Bill of
Rights
1.03 7243 Nursing Fundamentals1.03 Understand residents' rights,
advocacy, and grievance procedures16Nursing Fundamentals
724317Residents have the right to:present grievances and recommend
changesOBRA 1987 Residents Bill of Rights
1.03 7243 Nursing Fundamentals1.03 Understand residents' rights,
advocacy, and grievance procedures17Nursing Fundamentals
724318Residents have the right NOT to:perform services for the
facilityOBRA 1987 Residents Bill of Rights
1.03 7243 Nursing Fundamentals1.03 Understand residents' rights,
advocacy, and grievance procedures18Nursing Fundamentals
724319Residents have the right to:retain, store, and use personal
clothing and possessionsOBRA 1987 Residents Bill of Rights
1.03 7243 Nursing Fundamentals1.03 Understand residents' rights,
advocacy, and grievance procedures19Nursing Fundamentals
724320Residents have the right NOT to:be randomly discharged or
transferred from the facilityOBRA 1987 Residents Bill of Rights
1.03 7243 Nursing Fundamentals1.03 Understand residents' rights,
advocacy, and grievance procedures20Nursing Fundamentals
724321Residents have the right to:be notified if the facility is
given a provisional licenseOBRA 1987 Residents Bill of Rights
1.03 7243 Nursing Fundamentals1.03 Understand residents' rights,
advocacy, and grievance procedures21Nursing Fundamentals
724322Behaviors That Uphold Residents RightsAddress as Mr., Mrs.,
or Miss unless asked to use a specific nameNever withhold social
responsivenessNever ignore residentsMake eye contact1.03
Nursing Fundamentals 724323
Behaviors That UpholdResidents Rights
Make eye contactAllow to complete sentences prior to leaving
roomDont shut or slam door to quiet residentNever threaten or
intentionally hurt1.03
Nursing Fundamentals 724324
Behaviors That UpholdResidents Rights
Encourage socialization (meal-time)Assist to
activities/meetings/churchParticipate in planned activitiesHelp
with phone calls, cards, mail
1.03 7243 Nursing Fundamentals1.03 Understand residents' rights,
advocacy, and grievance procedures24Nursing Fundamentals 724325
Behaviors That Uphold Residents Rights
Explain care you plan to give Observe safety precautionsObtain
proper consent after identifying resident
1.03 Nursing Fundamentals 724326
Behaviors That Uphold Residents Rights
Treat all residents equallyPromote positive attitudesReport
errors to supervisor immediately1.03 Nursing Fundamentals
724327
Behaviors That Uphold Residents Rights
Handle personal items carefullyAdd new items to list of
residents belongingsMark all items with residents name
1.03
Nursing Fundamentals 724328
Behaviors That Uphold Residents Rights
Sit when feeding a residentOffer a clothing protector; do NOT
automatically place clothing protector on the resident prior to
eatingGive resident centered, not task centered care
1.03 Nursing Fundamentals 724329Behaviors That Uphold Residents
RightsAddress resident in a dignified wayListen to what resident
has to sayConverse with resident in an adult mannerRespect
residents privacy
1.03 Nursing Fundamentals 724330Behaviors That Uphold Residents
RightsAdult residents must be treated as adults. Give age
appropriate care.Age-appropriate considerations:Style of dressHair
style and groomingRecreational activitiesSocial activities
1.03 7243 Nursing Fundamentals1.03 Understand residents' rights,
advocacy, and grievance procedures30Nursing Fundamentals 724331Age
Appropriate CareGuidelinesDont ignore or humor residentExplain what
care you are going to givePromote resident independenceTreat
resident as you would want to be treated
1.03 Nursing Fundamentals 724332Age Appropriate
CareGuidelinesEncourage resident to make choices:select clothing to
wearselect books to readselect television programs to watch
1.03 Nursing Fundamentals 724333Age Appropriate
CareGuidelinesEncourage resident to make choices:select food and
nourishmentsselect activities of interestselect friends
1.03 Nursing Fundamentals 724334Age Appropriate
CareGuidelinesRecognize value of past experience (validate the
resident)Praise age appropriate accomplishmentsEncourage adult
behavior
1.03 Nursing Fundamentals 724335Right to be Free from
RestraintUnder Omnibus Budget Reconciliation Act 1987 (OBRA),
residents have a right to be free from restraints. 1.03 Nursing
Fundamentals 724338Facts Regarding Restraints
Physical Restraintsalso known as postural supports protective
devices1.03 Nursing Fundamentals 724340Facts Regarding
Restraints
IN THE PAST! Restraints commonly used to safeguard residents who
wander, prone to falls, are violet, at risk of hurting themselves,
or pulling tubes out Abuse of restraints led to new restrictions
and laws on use of restraints1.03
Nursing Fundamentals 724347Facts Regarding Restraints
1.03 Acceptable Reasons for Use of Restraints When alternatives
to restraints are not effective, however, and the physician orders
restraints, it becomes essential for the nurse aide to know the
risks involved in caring for these residents.Nursing Fundamentals
724348Facts Regarding Restraints
1.03 Types of acceptable physical restraints if ordered
appropriatelySide rails on a bed Special chairs such as geriatric
chairs Lap cushions or lap tray Vests and jacket restraints Safety
belt restraints Soft ties for wrist and anklesNursing Fundamentals
724354Restraint AlternativesAnswering call signal promptly
1.03 Nursing Fundamentals 724355Restraint AlternativesExercise
and outdoor activities
1.03 Nursing Fundamentals 724356Restraint AlternativesConsistent
reality orientation or validation and staff assignments
1.03 Nursing Fundamentals 724358Restraint AlternativesBarriers
such as STOP SIGNS posted on doors discourages confused residents
from wandering into the area
1.03 Nursing Fundamentals 724359Restraint AlternativesPartial
bed rails prevent residents from rolling out of bed while allowing
them freedom to get up if they wish to
1.03 Nursing Fundamentals 724360Restraint
AlternativesPositioning devices and wedges such as wedge cushions
placed in wheelchairs to prevent forward sliding
1.03 Nursing Fundamentals 724361Restraint AlternativesFurniture
such as low beds, rocking chairs, or recliners
1.03 7243 Nursing Fundamentals1.03 Understand residents' rights,
advocacy, and grievance procedures61Nursing Fundamentals
724362Restraint AlternativesEasy release belts reminds resident of
safety but the resident can release if desired
1.03 1.03Nursing Fundamentals 724365 SKILL 1.03AApply Personal
Electronic Warning Device
Training Lab AssignmentEngage in the Skill Acquisition Process
for:Nursing Fundamentals 724366The Last Resort!Occasionally,
alternatives do not work and restraints are ordered.1.03 Nursing
Fundamentals 724367Using RestraintsOrdered by the physician when
necessary to treat a medical symptom or provide emergency medical
treatment choice of restraint based on multidisciplinary evaluation
for the least restrictive measure
1.03 Nursing Fundamentals 724368Using RestraintsSafety Measures
and Considerations When APPLYING Restraints1.03 Nursing
Fundamentals 724369Using RestraintsSafety measures and
Considerations APPLYING Restraints:Use reassurance in an attempt to
calm agitated residents
1.03 Nursing Fundamentals 724370Using RestraintsSafety measures
and Considerations APPLYING Restraints:Be sure there is a
physicians order for restraint use and that it is in the care plan
before applying restraint
1.03 Nursing Fundamentals 724371Using RestraintsSafety measures
and Considerations APPLYING Restraints:Use the correct type of
restraint and apply according to manufacturers directions and only
after you have received instructions in its use
1.03 Nursing Fundamentals 724372Using RestraintsSafety measures
and Considerations APPLYING Restraints:Secure enough assistance to
apply restraints quickly to avoid injury
1.03 Nursing Fundamentals 724373Using RestraintsSafety measures
and Considerations APPLYING Restraints:Attach restraints to bed
frame (movable part of bed), not to side rails or other parts of
the bed
Leave an 8 inch tail
1.03 Nursing Fundamentals 724374Using RestraintsSafety measures
and Considerations APPLYING Restraints:Use slip knot to tie
restraint for quick release
1.03 Nursing Fundamentals 724375Using RestraintsSafety measures
and Considerations APPLYING Restraints:Protect bony areas and skin
by padding them prior to applying restraint
1.03 Nursing Fundamentals 724376Using RestraintsSafety measures
and Considerations APPLYING Restraints:Adjust restraint so that it
allows some movement, but is secure and comfortable place open flat
hand between the resident and the restraint for restraints around
the torso.1.03 Nursing Fundamentals 724377Using RestraintsSafety
measures and Considerations APPLYING Restraints:Make sure breasts
or skin are not caught in the restraint.
1.03 Nursing Fundamentals 724378Using RestraintsSafety Measures
and Considerations AFTER Restraints are applied1.03 Nursing
Fundamentals 724379Using RestraintsSafety measures and
Considerations AFTER Applying Restraints:Be sure resident NEEDS are
MET1.03 Nursing Fundamentals 724380Using RestraintsSafety measures
and Considerations AFTER Applying Restraints:Special attention must
be paid to basic needsElimination- assist in toiletingHydration
offer fluids
1.03 Nursing Fundamentals 724381Using RestraintsSafety measures
and Considerations AFTER Applying Restraints:Call signal must be in
reach and the residents signal for help must be answered
immediately (STAT)1.03
Nursing Fundamentals 724382Using RestraintsSafety measures and
Considerations AFTER Applying Restraints:Check on resident every 15
minutes
1.03 Nursing Fundamentals 724383Using RestraintsSafety measures
and Considerations AFTER Applying Restraints:Every 15
minutes:Pulse, color, and temperature of any restrained
extremity
1.03 7243 Nursing Fundamentals1.03 Understand residents' rights,
advocacy, and grievance procedures83Nursing Fundamentals
724384Using RestraintsSafety measures and Considerations AFTER
Applying Restraints:Every 15 minutes:Breathing of resident with
vest (torso) restraint
1.03 Nursing Fundamentals 724385Using RestraintsSafety measures
and Considerations AFTER Applying Restraints:Every 2 hours:Remove
restraint for 10 minutes and reposition resident
1.03 Nursing Fundamentals 724386Using RestraintsSafety measures
and Considerations AFTER Applying Restraints:In an emergency,
notify supervisor immediately via call bell, stay with the
resident, and loosen restraint.1.03 Nursing Fundamentals
724387Using RestraintsEMERGENCY EXAMPLES:Unable to detect a pulse
in extremityExtremity cold, pale, blue-tinged, gray, red, purple in
colorResident complains of pain, discomfort, numbness, or tingling
in restrained partBreathing is impaired with vest or safety belt
restraintURGENT!!! TAKE ACTION1.03 Nursing Fundamentals 724388Using
RestraintsObservations and reporting should include:Color and
condition of skin under restraintPulse rate, color and temperature
of skin in restrained extremity1.03
Nursing Fundamentals 724389Using RestraintsObservations and
reporting should include (continued):Any complaints about
restrained partRed or injured skin areas under restraintRespiratory
rate and color of skin with vest and safety belt restraints1.03
1.03Nursing Fundamentals 724390 SKILL 1.03BApply Restraints
Training Lab AssignmentEngage in the Skill Acquisition Process
for:Resident AdvocatesNursing Fundamentals 7243911.03Nursing
Fundamentals 724392Resident Advocates1.03 What does an advocate
do?Plead cause of anotherResolve grievancesProtect residents
rights
Nursing Fundamentals 724393Resident Advocates1.03 Advocates can
be:You and your co-workersMember of residents family/support
systemResidents guardianOmbudsmanNursing Fundamentals
724394Resident Advocates1.03 Ombudsman Program - History The
national network of long term care ombudsman programs was
established in response to the many problems found in nursing
homes. The program was first introduced in 1971 as part of
President Nixons eight-point plan to improve nursing home
conditions. This plan established several demonstration ombudsman
projects, funded and supervised in the beginning through the U.S.
Public Health Service.
In 1973, administration responsibility for these projects was
transferred within the Department of Health, Education and Welfare
to the Administration on Aging, within the Office of Human
Development Services. By 1975, all state agencies on aging were
invited to submit proposals to promote effective statewide
ombudsman programs. Money was then made available for this
voluntary state program.
The Long Term Care Ombudsman Program has been in existence in
North Carolina since 1976.
A favorable response to the ombudsman program led to its formal
adoption in the 1978 Amendments to the Older Americans Act. The
Older Americans Act (federal law) requires that each state
establish and maintain a Long Term Care Ombudsman Program to
advocate on behalf of residents in nursing and adult care homes
(rest homes, assisted living). In 1989, the North Carolina General
Assembly enacted legislation for the Long Term Care Ombudsman
Program (G.S. 143B-181.15-25) which incorporated federal mandates
in the Older Americans Act for the Program and clearly define the
roles and responsibilities of the state and regional long term care
ombudsmen. In North Carolina, the State Long Term Care Ombudsman
Program is located in the Department of Health and Human Services,
Division of Aging and Adult Services. The Regional Long Term Care
Ombudsman Programs are housed in the 17 Area Agencies on Aging.Last
updated June 2, 2010 LTC Ombudsman Program Nursing Fundamentals
7243951.03 Nursing Fundamentals 724396Resident Right to Voice
Grievances1.03 Regarding services furnishedRegarding services not
furnishedWith respect to behavior of othersNurse aide must report
grievances to supervisorNursing Fundamentals 724397Facility policy
components for resident grievance1.03 AcknowledgmentPrompt attempt
to resolveResident kept apprised
Nursing Fundamentals 724398Resident Council: Advisory
Group1.03
Nursing Fundamentals 724399Resident Council: Advisory Group1.03
Provides opportunity for discussionRecommendations may be made
for:Facility policiesDecisions regarding activitiesExploration of
concernsResolving grievances Nursing Fundamentals 7243100Resident
Council: Advisory Group1.03 Gives residents a voice in facility
operationsMembersresidentsfacility staff members to include Nurse
Aidesrepresentatives from communityThe Bottom LineNursing
Fundamentals 72431013.01Resident has a right to voice grievances
without fear of retaliation or discrimination!
Understand residents rights, advocacy, and grievance procedures.
102 END 1.031.03Nursing Fundamentals7243 Nursing
Fundamentals1021.03 Understand residents' rights, advocacy, and
grievance procedures