Slide 2 Understand residents rights, advocacy, and grievance
procedures. Unit A Nurse Aide Workplace Fundamentals Essential
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 Fundamentals Slide 3 Residents Rights
Nursing Fundamentals 724321.03 Slide 4 Nursing Fundamentals 72433
Basic Human Rights Protected by Constitution Laws clarify these
rights: Right to be treated with respect Right to be treated with
respect Right to live in dignity Right to live in dignity Right to
pursue a meaningful life Right to pursue a meaningful life Right to
be free of fear Right to be free of fear 1.03 Slide 5 Nursing
Fundamentals 7243 4 Basic Human Rights Behaviors that infringe on
human rights: addressing residents as children addressing residents
as children using demeaning nicknames for residents using demeaning
nicknames for residents leaving door open during bath leaving door
open during bath threatening a resident with harm threatening a
resident with harm 1.03 Slide 6 Nursing Fundamentals 72435 Ethical
and legal basis Ethical and legal basis States have adopted or
codified these rights into law States have adopted or codified
these rights into law Posted in facility Posted in facility
Distributed on admission in many facilities Distributed on
admission in many facilities OBRA 1987 Residents Bill of Rights
1.03 Slide 7 Nursing Fundamentals 7243 6 Residents have the right
to: 1.Be treated with consideration, respect, and full recognition
of personal dignity. OBRA 1987 Residents Bill of Rights 1.03 Slide
8 Nursing Fundamentals 7243 7 Residents have the right to:
2.receive care, treatment, and services which are adequate and in
compliance with rules OBRA 1987 Residents Bill of Rights 1.03 Slide
9 Nursing Fundamentals 7243 8 Residents have the right to:
3.receive a statement of services and charges OBRA 1987 Residents
Bill of Rights 1.03 Slide 10 Nursing Fundamentals 7243 9 Residents
have the right to: 4.have on file the attending physicians proposed
schedule of medical treatment. OBRA 1987 Residents Bill of Rights
1.03 Slide 11 Nursing Fundamentals 7243 10 Residents have the right
to: 5.privacy OBRA 1987 Residents Bill of Rights 1.03 Slide 12
Nursing Fundamentals 7243 11 Residents have the right to: 6.Be free
from mental and physical abuse, and free from restraint (except in
an emergency) OBRA 1987 Residents Bill of Rights 1.03 Slide 13
Nursing Fundamentals 7243 12 Residents have the right to: 7.receive
reasonable response to all requests OBRA 1987 Residents Bill of
Rights 1.03 Slide 14 Nursing Fundamentals 7243 13 Residents have
the right to: 8.associate and communicate privately OBRA 1987
Residents Bill of Rights 1.03 Slide 15 Nursing Fundamentals 7243 14
Residents have the right to: 9.manage financial affairs OBRA 1987
Residents Bill of Rights 1.03 Slide 16 Nursing Fundamentals 7243 15
Residents have the right to: 10.private visits from spouse OBRA
1987 Residents Bill of Rights 1.03 Slide 17 Nursing Fundamentals
7243 16 Residents have the right to: 11.privacy in the resident
room. Personal items should not be searched. OBRA 1987 Residents
Bill of Rights 1.03 Slide 18 Nursing Fundamentals 7243 17 Residents
have the right to: 12.present grievances and recommend changes OBRA
1987 Residents Bill of Rights 1.03 Slide 19 Nursing Fundamentals
7243 18 Residents have the right NOT to: 13.perform services for
the facility OBRA 1987 Residents Bill of Rights 1.03 Slide 20
Nursing Fundamentals 7243 19 Residents have the right to:
14.retain, store, and use personal clothing and possessions OBRA
1987 Residents Bill of Rights 1.03 Slide 21 Nursing Fundamentals
7243 20 Residents have the right NOT to: 15.be randomly discharged
or transferred from the facility OBRA 1987 Residents Bill of Rights
1.03 Slide 22 Nursing Fundamentals 7243 21 Residents have the right
to: 16.be notified if the facility is given a provisional license
OBRA 1987 Residents Bill of Rights 1.03 Slide 23 Nursing
Fundamentals 724322 Behaviors That Uphold Residents Rights Address
as Mr., Mrs., or Miss unless asked to use a specific name Address
as Mr., Mrs., or Miss unless asked to use a specific name Never
withhold social responsiveness Never withhold social responsiveness
Never ignore residents Never ignore residents Make eye contact Make
eye contact 1.03 Slide 24 Nursing Fundamentals 724323 Behaviors
That Uphold Residents Rights Make eye contact Allow to complete
sentences prior to leaving room Dont shut or slam door to quiet
resident Never threaten or intentionally hurt 1.03 Slide 25 Nursing
Fundamentals 724324 Behaviors That Uphold Residents Rights
Encourage socialization (meal-time) Encourage socialization
(meal-time) Assist to activities/meetings/church Assist to
activities/meetings/church Participate in planned activities
Participate in planned activities Help with phone calls, cards,
mail Help with phone calls, cards, mail 1.03 Slide 26 Nursing
Fundamentals 724325 Behaviors That Uphold Residents Rights Explain
care you plan to give Explain care you plan to give Observe safety
precautions Observe safety precautions Obtain proper consent after
identifying resident Obtain proper consent after identifying
resident 1.03 Slide 27 Nursing Fundamentals 724326 Behaviors That
Uphold Residents Rights Treat all residents equally Treat all
residents equally Promote positive attitudes Promote positive
attitudes Report errors to supervisor immediately Report errors to
supervisor immediately 1.03 Slide 28 Nursing Fundamentals 724327
Behaviors That Uphold Residents Rights Handle personal items
carefully Handle personal items carefully Add new items to list of
residents belongings Add new items to list of residents belongings
Mark all items with residents name Mark all items with residents
name 1.03 Slide 29 Nursing Fundamentals 724328 Behaviors That
Uphold Residents Rights Sit when feeding a resident Sit when
feeding a resident Offer a clothing protector; do NOT automatically
place clothing protector on the resident prior to eating Offer a
clothing protector; do NOT automatically place clothing protector
on the resident prior to eating Give resident centered, not task
centered care Give resident centered, not task centered care 1.03
Slide 30 Nursing Fundamentals 724329 Behaviors That Uphold
Residents Rights Address resident in a dignified way Address
resident in a dignified way Listen to what resident has to say
Listen to what resident has to say Converse with resident in an
adult manner Converse with resident in an adult manner Respect
residents privacy Respect residents privacy 1.03 Slide 31 Nursing
Fundamentals 724330 Behaviors That Uphold Residents Rights Adult
residents must be treated as adults. Give age appropriate care.
Adult residents must be treated as adults. Give age appropriate
care. Age-appropriate considerations: Age-appropriate
considerations: Style of dress Hair style and grooming Recreational
activities Social activities 1.03 Slide 32 Nursing Fundamentals
724331 Age Appropriate Care Guidelines Dont ignore or humor
resident Dont ignore or humor resident Explain what care you are
going to give Explain what care you are going to give Promote
resident independence Promote resident independence Treat resident
as you would want to be treated Treat resident as you would want to
be treated 1.03 Slide 33 Nursing Fundamentals 724332 Age
Appropriate Care Guidelines Encourage resident to make choices:
select clothing to wear select clothing to wear select books to
read select books to read select television programs to watch
select television programs to watch 1.03 Slide 34 Nursing
Fundamentals 724333 Age Appropriate Care Guidelines Encourage
resident to make choices: select food and nourishments select food
and nourishments select activities of interest select activities of
interest select friends select friends 1.03 Slide 35 Nursing
Fundamentals 724334 Age Appropriate Care Guidelines Recognize value
of past experience (validate the resident) Recognize value of past
experience (validate the resident) Praise age appropriate
accomplishments Praise age appropriate accomplishments Encourage
adult behavior Encourage adult behavior 1.03 Slide 36 Nursing
Fundamentals 724335 Right to be Free from Restraint Under Omnibus
Budget Reconciliation Act 1987 (OBRA), Under Omnibus Budget
Reconciliation Act 1987 (OBRA), residents have a right to be free
from restraints. residents have a right to be free from restraints.
1.03 Slide 37 Resident Restraints Nursing Fundamentals 7243361.03
Slide 38 Nursing Fundamentals 724337 Facts Regarding Restraints
RESTRAINTSrestrict voluntary movement or behavior CHEMICALPHYSICAL
1.03 Slide 39 Nursing Fundamentals 724338 Facts Regarding
Restraints Physical Restraints a lso k nown a s postural supports
postural supports protective devices protective devices 1.03 Slide
40 Nursing Fundamentals 724339 Facts Regarding Restraints 1.03
Restraint: Any manual method, physical or mechanical device,
material, or equipment attached or next to the residents body that
the individual cannot remove easily, which restricts freedom of
movement or normal access to ones body Slide 41 Nursing
Fundamentals 724340 Facts 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 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 restraints Abuse of restraints led to new
restrictions and laws on use of restraints 1.03 Slide 42 Nursing
Fundamentals 724341 Facts Regarding Restraints 1.03 Tucking in top
sheet so tightly that resident cannot move NEVER Slide 43 Nursing
Fundamentals 724342 Facts Regarding Restraints 1.03 Placing
wheelchair so close to a wall that the wall prevents resident from
getting out of chair Slide 44 Nursing Fundamentals 724343 Facts
Regarding Restraints 1.03 Pulling up full side rails to prevent
patient from voluntarily getting out of bed Slide 45 Nursing
Fundamentals 724344 Facts Regarding Restraints 1.03 Restraints MUST
not be used for convenience or discipline Slide 46 Nursing
Fundamentals 724345 Facts Regarding Restraints 1.03 Unnecessary use
of restraint is FALSEIMPRISONMENT Slide 47 Nursing Fundamentals
724346 Facts Regarding Restraints 1.03 Acceptable Reasons for Use
of Restraints: Temporarily for life threatening medical conditions
Brief periods to allow medical treatment to proceed if there is
documented evidence of resident or legal approval of treatment
Slide 48 Nursing Fundamentals 724347 Facts 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. Slide 49 Nursing
Fundamentals 724348 Facts Regarding Restraints 1.03 Types of
acceptable physical restraints if ordered appropriately Side rails
on a bed Side rails on a bed Special chairs such as geriatric
chairs Special chairs such as geriatric chairs Lap cushions or lap
tray Lap cushions or lap tray Vests and jacket restraints Vests and
jacket restraints Safety belt restraints Safety belt restraints
Soft ties for wrist and ankles Soft ties for wrist and ankles Slide
50 Nursing Fundamentals 724349 Facts Regarding Restraints 1.03
Restraint-free facility: Restraints are not used for any reason and
not kept in the facility Slide 51 Restraint Alternatives Nursing
Fundamentals 7243501.03 Slide 52 Nursing Fundamentals 724351
Restraint Alternatives 1.03 Restraint alternative: Interventions
used instead of using restraints Slide 53 Nursing Fundamentals
724352 Restraint Alternatives Using friends, family, volunteers or
resident directed care provider 1.03 Slide 54 Nursing Fundamentals
724353 Restraint Alternatives Interesting activities and diversions
such as games, movies or music distract residents 1.03 Slide 55
Nursing Fundamentals 724354 Restraint Alternatives Answering call
signal promptly 1.03 Slide 56 Nursing Fundamentals 724355 Restraint
Alternatives Exercise and outdoor activities 1.03 Slide 57 Nursing
Fundamentals 724356 Restraint Alternatives Consistent reality
orientation or validation and staff assignments 1.03 Slide 58
Nursing Fundamentals 724357 Restraint Alternatives Having residents
room close to nurses station 1.03 Slide 59 Nursing Fundamentals
724358 Restraint Alternatives Barriers such as STOP SIGNS posted on
doors discourages confused residents from wandering into the area
1.03 Slide 60 Nursing Fundamentals 724359 Restraint Alternatives
Partial bed rails prevent residents from rolling out of bed while
allowing them freedom to get up if they wish to 1.03 Slide 61
Nursing Fundamentals 724360 Restraint Alternatives Positioning
devices and wedges such as wedge cushions placed in wheelchairs to
prevent forward sliding 1.03 Slide 62 Nursing Fundamentals 724361
Restraint Alternatives Furniture such as low beds, rocking chairs,
or recliners 1.03 Slide 63 Nursing Fundamentals 724362 Restraint
Alternatives Easy release belts reminds resident of safety but the
resident can release if desired 1.03 Slide 64 Nursing Fundamentals
724363 Restraint Alternatives Floor cushion or pads next to the bed
decreases injuries if a resident does fall when getting out of bed
1.03 Slide 65 Nursing Fundamentals 724364 Restraint Alternatives
Electronic warning devices on beds, wheelchairs, and doors alert
staff if patient gets up without help* 1.03 Slide 66 Nursing
Fundamentals 724365 SKILL 1.03A SKILL 1.03A Apply Personal
Electronic Warning Device Training Lab Assignment Engage in the
Skill Acquisition Process for: Slide 67 Nursing Fundamentals 724366
The Last Resort! Occasionally, alternatives do not work and
restraints are ordered. 1.03 Slide 68 Nursing Fundamentals 724367
Using Restraints Ordered by the physician when necessary to treat a
medical symptom or provide emergency medical treatment when
necessary to treat a medical symptom or provide emergency medical
treatment choice of restraint based on multidisciplinary evaluation
for the least restrictive measure choice of restraint based on
multidisciplinary evaluation for the least restrictive measure 1.03
Slide 69 Nursing Fundamentals 724368 Using Restraints Safety
Measures and Considerations When APPLYING Restraints 1.03 Slide 70
Nursing Fundamentals 724369 Using Restraints Safety measures and
Considerations APPLYING Restraints: Use reassurance in an attempt
to calm agitated residentsUse reassurance in an attempt to calm
agitated residents 1.03 Slide 71 Nursing Fundamentals 724370 Using
Restraints Safety 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 Slide 72 Nursing
Fundamentals 724371 Using Restraints Safety 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 Slide 73
Nursing Fundamentals 724372 Using Restraints Safety measures and
Considerations APPLYING Restraints: Secure enough assistance to
apply restraints quickly to avoid injury 1.03 Slide 74 Nursing
Fundamentals 724373 Using Restraints Safety 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 Slide 75 Nursing Fundamentals 724374
Using Restraints Safety measures and Considerations APPLYING
Restraints: Use slip knot to tie restraint for quick release 1.03
Slide 76 Nursing Fundamentals 724375 Using Restraints Safety
measures and Considerations APPLYING Restraints: Protect bony areas
and skin by padding them prior to applying restraint 1.03 Slide 77
Nursing Fundamentals 724376 Using Restraints Safety 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 Slide 78 Nursing Fundamentals 724377 Using
Restraints Safety measures and Considerations APPLYING Restraints:
Make sure breasts or skin are not caught in the restraint. 1.03
Slide 79 Nursing Fundamentals 724378 Using Restraints Safety
Measures and Considerations AFTER Restraints are applied 1.03 Slide
80 Nursing Fundamentals 724379 Using Restraints Safety measures and
Considerations AFTER Applying Restraints: Be sure resident NEEDS
are MET 1.03 Slide 81 Nursing Fundamentals 724380 Using Restraints
Safety measures and Considerations AFTER Applying Restraints:
Special attention must be paid to basic needs Elimination- assist
in toiletingElimination- assist in toileting Hydration offer
fluidsHydration offer fluids 1.03 Slide 82 Nursing Fundamentals
724381 Using Restraints Safety 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 Slide 83
Nursing Fundamentals 724382 Using Restraints Safety measures and
Considerations AFTER Applying Restraints: Check on resident every
15 minutes 1.03 Slide 84 Nursing Fundamentals 724383 Using
Restraints Safety measures and Considerations AFTER Applying
Restraints: Every 15 minutes: Pulse, color, and temperature of any
restrained extremity Pulse, color, and temperature of any
restrained extremity 1.03 Slide 85 Nursing Fundamentals 724384
Using Restraints Safety measures and Considerations AFTER Applying
Restraints: Every 15 minutes: Breathing of resident with vest
(torso) restraint Breathing of resident with vest (torso) restraint
1.03 Slide 86 Nursing Fundamentals 724385 Using Restraints Safety
measures and Considerations AFTER Applying Restraints: Every 2
hours: Remove restraint for 10 minutes and reposition resident
Remove restraint for 10 minutes and reposition resident 1.03 Slide
87 Nursing Fundamentals 724386 Using Restraints Safety measures and
Considerations AFTER Applying Restraints: In an emergency, notify
supervisor immediately via call bell, stay with the resident, and
loosen restraint. 1.03 Slide 88 Nursing Fundamentals 724387 Using
Restraints EMERGENCY EXAMPLES: Unable to detect a pulse in
extremityUnable to detect a pulse in extremity Extremity cold,
pale, blue-tinged, gray, red, purple in colorExtremity cold, pale,
blue-tinged, gray, red, purple in color Resident complains of pain,
discomfort, numbness, or tingling in restrained partResident
complains of pain, discomfort, numbness, or tingling in restrained
part Breathing is impaired with vest or safety belt
restraintBreathing is impaired with vest or safety belt restraint
URGENT!!! TAKE ACTIONURGENT!!! TAKE ACTION 1.03 Slide 89 Nursing
Fundamentals 724388 Using Restraints Observations and reporting
should include: Color and condition of skin under restraint Color
and condition of skin under restraint Pulse rate, color and
temperature of skin in restrained extremity Pulse rate, color and
temperature of skin in restrained extremity 1.03 Slide 90 Nursing
Fundamentals 724389 Using Restraints Observations and reporting
should include (continued): Any complaints about restrained part
Any complaints about restrained part Red or injured skin areas
under restraint Red or injured skin areas under restraint
Respiratory rate and color of skin with vest and safety belt
restraints Respiratory rate and color of skin with vest and safety
belt restraints 1.03 Slide 91 Nursing Fundamentals 724390 SKILL
1.03B SKILL 1.03B Apply Restraints Training Lab Assignment Engage
in the Skill Acquisition Process for: Slide 92 Resident Advocates
Nursing Fundamentals 7243911.03 Slide 93 Nursing Fundamentals
724392 Resident Advocates 1.03 What does an advocate do? Plead
cause of another Plead cause of another Resolve grievances Resolve
grievances Protect residents rights Protect residents rights Slide
94 Nursing Fundamentals 724393 Resident Advocates 1.03 Advocates
can be: You and your co-workers You and your co-workers Member of
residents family/support system Member of residents family/support
system Residents guardian Residents guardian Ombudsman Ombudsman
Slide 95 Nursing Fundamentals 724394 Resident Advocates 1.03
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. Slide 96 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 Slide 97 Nursing Fundamentals 724396
Resident Right to Voice Grievances 1.03 Regarding services
furnished Regarding services furnished Regarding services not
furnished Regarding services not furnished With respect to behavior
of others With respect to behavior of others Nurse aide must report
grievances to supervisor Nurse aide must report grievances to
supervisor Slide 98 Nursing Fundamentals 724397 Facility policy
components for resident grievance 1.03 1.Acknowledgment 2.Prompt
attempt to resolve 3.Resident kept apprised Slide 99 Nursing
Fundamentals 724398 Resident Council: Advisory Group 1.03 Slide 100
Nursing Fundamentals 724399 Resident Council: Advisory Group 1.03
Provides opportunity for discussion Recommendations may be made
for: Facility policies Facility policies Decisions regarding
activities Decisions regarding activities Exploration of concerns
Exploration of concerns Resolving grievances Resolving grievances
Slide 101 Nursing Fundamentals 7243100 Resident Council: Advisory
Group 1.03 Gives residents a voice in facility operations Gives
residents a voice in facility operations Members Members residents
facility staff members to include Nurse Aides representatives from
community Slide 102 The Bottom Line Nursing Fundamentals
72431013.01 Resident has a right to voice grievances without fear
of retaliation or discrimination! Slide 103 Understand residents
rights, advocacy, and grievance procedures. 102 END 1.03
1.03Nursing Fundamentals