1.01

Unit ANurse Aide Workplace FundamentalsEssential Standard 1.00Understand the range of function, legal and ethical responsibilities of the nurse aide within the healthcare system. Indicator 1.01Understand healthcare facilities and organizational structure with focus on LTC.

11.01 Nursing Fundamentals HN43

Understand Understand healthcare healthcare facilitiesfacilities and and organizational organizational structure with structure with focus on focus on LTCLTC. .

FF YY II - - Intentional RepeatIntentional Repeat

There is intentional repeat of some HSII There is intentional repeat of some HSII course content in Nursing Fundamentals. course content in Nursing Fundamentals.

Repeating course content distributes Repeating course content distributes learning over time and increases long learning over time and increases long term memory. term memory.

Academic and skill competence must be Academic and skill competence must be maintained at a maintained at a very high level for direct very high level for direct resident careresident care. .


BRAIN STORMBRAIN STORM

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ThinkThinkWhere do you think Nurse Aides work? Where do you think Nurse Aides work?

ActActRaise your hand and share your Raise your hand and share your thoughts!thoughts!


Provide care for individuals of all Provide care for individuals of all ages with a broad range of health ages with a broad range of health problemsproblems


HospitalsHospitals

HospitalsHospitalsServices varied and extensiveServices varied and extensive

• DiagnosticDiagnostic• TherapeuticTherapeutic• MedicalMedical• SurgicalSurgical• EmergencyEmergency


So what does So what does DiagnosticDiagnostic mean?mean?

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Remind me from HSII…Remind me from HSII…

Pertaining to the Pertaining to the IdentificationIdentification of of a medical condition or disease as a medical condition or disease as determined by a physician. A determined by a physician. A statement of what is wrong with a statement of what is wrong with a resident. resident.


So what does So what does TherapeuticTherapeutic mean?mean?

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aaaand….aaaand….

Pertains to treating, Pertains to treating,

fixingfixing, or correcting a , or correcting a medical or surgical medical or surgical problemproblem


So what does So what does MedicalMedical mean? mean?

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• Pertaining to the science of treatment that Pertaining to the science of treatment that includes drugs, diet, exercise and other includes drugs, diet, exercise and other non-surgical means.non-surgical means.

aaaaaaaand ….aaaaaaaand ….


Surgical …

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Pertains to the treatment of injury, Pertains to the treatment of injury, deformity, and disease by manual deformity, and disease by manual

and and instrumental instrumental operationsoperations. .


So what does So what does EmergencyEmergency mean?mean?

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and last but not least….

Sudden occurrence of a Sudden occurrence of a serious and urgent nature serious and urgent nature that demands immediate that demands immediate attention.attention.


Stick diagnostics

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Open your mouth and say aaaaaanswer

DiagnosticDiagnostic TherapeuticTherapeutic MedicalMedical SurgicalSurgical EmergencyEmergency


BRAIN STORMBRAIN STORM

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ThinkThinkConsider situations that are Consider situations that are NOT NOT emergenciesemergencies that may be considered that may be considered emergencies by some people.emergencies by some people.

ActActRaise your hand and share your Raise your hand and share your thoughts! Wait to be called on.thoughts! Wait to be called on.


HospitalsHospitals


So what does So what does AcuteAcute mean?mean?

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OK so…..remind meOK so…..remind me

• An acute illness has a An acute illness has a sudden onsetsudden onset from from which the resident is expected to recover.which the resident is expected to recover.

• Acute therapy is Acute therapy is short-termshort-term medical medical treatment, usually in a hospital, for patients treatment, usually in a hospital, for patients having an acute illness or injury or recovering having an acute illness or injury or recovering from surgery.from surgery.


ChronicChronic means…. means….

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Then…Then…

• A chronic illness has slow or gradual on set, for A chronic illness has slow or gradual on set, for which there is no known cure, the illness can be which there is no known cure, the illness can be controlled and complications prevented.controlled and complications prevented.

• Chronic care is medical and nursing services that Chronic care is medical and nursing services that focus on long term care of people with chronic focus on long term care of people with chronic diseases or conditions, either at home or in a diseases or conditions, either at home or in a medical facility. It includes measures specific to the medical facility. It includes measures specific to the problem, as well as others to encourage self-care, problem, as well as others to encourage self-care, promote health, and prevent loss of function. promote health, and prevent loss of function.


What does What does TerminalTerminal mean? mean?

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An illness from which An illness from which the resident is not the resident is not expected to recover and expected to recover and will die. will die. Residents with terminal Residents with terminal illnesses are given illnesses are given PalliativePalliative (comfort) (comfort) care instead of curative care instead of curative care.care.


Acute

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Open your mouth and say aaaaaanswer

AcuteAcute ChronicChronic TerminalTerminal PalliativePalliative


LONG TERM CARE FACILITIESLONG TERM CARE FACILITIES

Referred to as:Referred to as:•Extended care facilitiesExtended care facilities•Skilled care facilitiesSkilled care facilities•Nursing homesNursing homes•CCRC – continuing care CCRC – continuing care retirement community (includes retirement community (includes skilled nursing)skilled nursing)


LONG TERM CARE FACILITIESLONG TERM CARE FACILITIES

Provide healthcare services to Provide healthcare services to individuals unable to care for individuals unable to care for themselves:themselves:

• elderly personselderly persons• disabled or handicapped disabled or handicapped

personspersons• people with chronic illnesspeople with chronic illness


Long term care…Have we got it?

Let’s check and see

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Stick diagnostics

Student Name A

Student Name B


ADULT CARE HOMES / HOMES FOR THE AGEDADULT CARE HOMES / HOMES FOR THE AGEDHHOMES FOR THE OMES FOR THE AAGED GED LLICENSE ICENSE (HAL)(HAL)

Formerly called:Formerly called:

•Rest home Rest home •Assisted livingAssisted living


ADULT CARE HOMES / HOMES FOR THE AGED

Types:•Family Care Home Family Care Home – – serves 2-6 unrelated serves 2-6 unrelated personspersons•Adult Care Home Adult Care Home – – serves 7 or more serves 7 or more unrelated personsunrelated persons•Group Home Group Home – – for developmental disabled for developmental disabled adultsadults•Multi unit housing with servicesMulti unit housing with services


ADULT CARE HOMES / HOMES FOR THE AGEDADULT CARE HOMES / HOMES FOR THE AGED

• Assists resident with medication Assists resident with medication administrationadministration

• Assists with personal care, dressing, or Assists with personal care, dressing, or groominggrooming

• Provides three meals a dayProvides three meals a day• Provides housekeepingProvides housekeeping• 24 hour supervision24 hour supervision


HOMES FOR THE AGED

• Monitored byMonitored by Adult Home Specialist within County Adult Home Specialist within County Department of Social Department of Social Services. Do most of complaint investigations. Services. Do most of complaint investigations.

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• Licensed and Licensed and inspected by inspected by


Homes for the AGEDHave we got it?


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Stick diagnostics


What are other names for homes for the aged?What are other names for homes for the aged?

How much medical supervision is given in HAs?How much medical supervision is given in HAs?

What agency issues licenses to HAs?What agency issues licenses to HAs?

What agency monitors HAs?What agency monitors HAs?

HOME CARE AGENCIES

Provide care in the Provide care in the homehome for people for people needing health services, needing health services, but not hospitalizationbut not hospitalization


HOME CARE AGENCIESHOME CARE AGENCIES

Services provided include:Services provided include:

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• Nursing / CNA / PCANursing / CNA / PCA• Physical therapyPhysical therapy• Occupational therapyOccupational therapy• Speech therapySpeech therapy• Social servicesSocial services• Nutritional and food servicesNutritional and food services• Respiratory therapyRespiratory therapy• Homemaker servicesHomemaker services


Home Care AgenciesHave we got it?


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Stick diagnostics

Student Name A

Student Name B


HEALTHCARE FACILITY HEALTHCARE FACILITY ORGANIZATIONAL STRUCTUREORGANIZATIONAL STRUCTURE

• Displays Displays chain of commandchain of command• Shows Shows lines of authoritylines of authority• Identifies health care Identifies health care

worker’s positionworker’s position• Identifies immediate Identifies immediate

supervisorsupervisor



• Responsible for provision of safe Responsible for provision of safe and adequate care at a reasonable and adequate care at a reasonable costcost

• Makes facility policiesMakes facility policies• Delegates management to an Delegates management to an

administratoradministrator

Governing bodyGoverning body = (Board of Directors)



Department headsDepartment heads– Have specific areas of responsibilitiesHave specific areas of responsibilities– Supervise department staffSupervise department staff

• FinanceFinance• Ancillary servicesAncillary services• NursingNursing


HEALTHCARE FACILITHEALTHCARE FACILITY Y ORGANIZATIONAL STRUCTUREORGANIZATIONAL STRUCTURE

Medical DirectorMedical DirectorSupervises medical staff Supervises medical staff activitiesactivities

• PhysiciansPhysicians• ResidentsResidents• InternsInterns


HEALTHCARE FACILITY ORGANIZATIONAL STRUCTURE

Director of Nursing and Director of Nursing and Assistant DONAssistant DON

• Supervises nursing staff Supervises nursing staff activitiesactivities

• Responsible for safe Responsible for safe nursing carenursing care

• Registered nursesRegistered nurses


HEALTHCARE FACILITY ORGANIZATIONAL STRUCTURE

Nursing supervisorNursing supervisor• Assists director of nursingAssists director of nursing• Licensed nurseLicensed nurse• Assigned areas of responsibilityAssigned areas of responsibility• Assigned to specific shiftAssigned to specific shift



Charge Nurse Charge Nurse –Has specific areas of Has specific areas of

responsibilityresponsibility–Responsible for resident Responsible for resident

care in specific areacare in specific area



Charge Nurse Charge Nurse Supervises staff in specific Supervises staff in specific areaarea

• Registered nurses (RNs)Registered nurses (RNs)• Licensed practical nurses Licensed practical nurses

(LPNs)(LPNs)• Nurse aides (NAs)Nurse aides (NAs)


LTC Healthcare organization structure…

Have we got it?Let’s check and see

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Stick diagnostics


LTC FACILITIES REGULATIONLTC FACILITIES REGULATION

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Federal Level

State Level


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Federal Level

• Federal agency that works Federal agency that works with state agencieswith state agencies

• Runs two national care Runs two national care programsprogramsMedicareMedicareMedicaidMedicaid


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Federal Level

• Helps pay for health care Helps pay for health care including nursing home careincluding nursing home care

• Sets quality standards for Sets quality standards for long term care facilitieslong term care facilities

• Nursing homes must be Nursing homes must be certified to receive Medicare certified to receive Medicare and Medicaid fundsand Medicaid funds


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Federal Level

Nursing Home Compare for Consumers http://www.cms.gov/CertificationandComplianc/Downloads/consumerppt.pdf

•Five Star rating systemFive Star rating system•Quality of care informationQuality of care information•Characteristics of nursing homesCharacteristics of nursing homes



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State Level

Two Sections of DHSR:Two Sections of DHSR:

•Nursing Home Licensure and Certification Section•Health Care Personnel Registry Section


LTC FACILITIES REGULATION

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Nursing Home Licensure and Nursing Home Licensure and Certification SectionCertification Section•Determines location and number of nursing homes Determines location and number of nursing homes needed in NCneeded in NC•Issues licenses to nursing homes giving permission Issues licenses to nursing homes giving permission to operate and provide careto operate and provide care•"Surveyors" conduct inspections to find out whether "Surveyors" conduct inspections to find out whether the nursing home meets federal rulesthe nursing home meets federal rules

Routine inspections take place in nursing homes Routine inspections take place in nursing homes that receive payment through Medicare and that receive payment through Medicare and Medicaid every 9 to 15 monthsMedicaid every 9 to 15 months

Surveys take three days on averageSurveys take three days on average



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Responsibilities of the nurse aide during the survey process

• Provide quality careProvide quality care• Protect residents rightsProtect residents rights• Provide for resident and personal safetyProvide for resident and personal safety• Keep center clean and safeKeep center clean and safe• Conduct yourself in a professional Conduct yourself in a professional

mannermanner• Demonstrate good work ethicsDemonstrate good work ethics• Follow center policies and proceduresFollow center policies and procedures• Answer surveyor questions honestly Answer surveyor questions honestly

and completelyand completely



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LTCs can be put on LTCs can be put on

““SANCTION”SANCTION” because because of:of:

• Substandard careSubstandard care• CMPCMP – – CCivil ivil MMoney oney PPenaltyenalty



CMP-Civil Money PenaltyCMP-Civil Money Penalty

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• Fines collected as a result of Fines collected as a result of nursing home violationsnursing home violations

• Fines are redirected back in the Fines are redirected back in the nursing home industry to improve nursing home industry to improve the quality of carethe quality of care

• In NC – Win A Step Up is funded by In NC – Win A Step Up is funded by CMP CMP



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Health Care Personnel Registry Health Care Personnel Registry SECTIONSECTION

There are two branches:There are two branches:1.1. Investigations BranchInvestigations Branch

2.2. Center for Aide Regulation and Center for Aide Regulation and Education (CARE) BranchEducation (CARE) Branch



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Health Care Personnel Registry SECTIONHealth Care Personnel Registry SECTION

InvestigationsInvestigations BRANCH BRANCH responsible for:responsible for:

1.1. Health Care Personnel RegistryHealth Care Personnel Registry2.2. Receiving reports from health care Receiving reports from health care

facilitiesfacilities3.3. Unlicensed health care worker Unlicensed health care worker

investigationsinvestigations4.4. Listing "Pendings" and "Findings" Listing "Pendings" and "Findings"

on the Nurse Aide I and Health Care on the Nurse Aide I and Health Care Personnel RegistriesPersonnel Registries



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Health Care Personnel Registry SECTION

CCenter for enter for AAide ide RRegulation and egulation and EEducation ducation (CARE) (CARE) BRANCH is BRANCH is responsible for responsible for 1.1.Nurse Aide I Registry, training and competency Nurse Aide I Registry, training and competency programsprograms2.2.Medication Aide Registry and competency Medication Aide Registry and competency programsprograms3.3.Geriatric Aide Registry and trainingGeriatric Aide Registry and training4.4.Feeding assistant training curriculumFeeding assistant training curriculum5.5.Providing registry access and listing Providing registry access and listing verificationverification



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NC New Organizational Vision Award

~NC NOVA~http://www.ncnova.org/index.html

NC Special State License that honors excellence in the workplace for people employed by home care agencies, adult care homes, and nursing homes.



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NC NOVA facilities have the following: 1.Well trained staff, satisfied and loyal workers helping families by caring for their loved ones;2.Stronger links among workers, residents, families, and management;



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NC NOVA facilities have the following: 3.Chances for staff to better their skills and advance their careers;4.Stable, quality worker available now and for the future.


LONG TERM CARE REGULATIONS – SO WHAT?

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Nurse AidesNurse Aides must must provide provide good care good care and and comply with comply with state and federal state and federal and regulations.and regulations.


Consequences of inappropriate actions by the Nurse Consequences of inappropriate actions by the Nurse Aide Student or CNAAide Student or CNA

Name of the Nurse Aide will be listed on the Health Care Personnel Registry for a "pending" allegation or substantiated allegation "finding(s)".


Consequences of inappropriate actions by the Nurse Consequences of inappropriate actions by the Nurse Aide Student or CNAAide Student or CNA

Nursing homes and other facilities must access the NC DHSR Health Care Personnel Registry before they hire unlicensed staff. Listings include:•Name of the Nurse AideName of the Nurse Aide•Nature of the finding or allegationNature of the finding or allegation•Status of the investigationStatus of the investigation•Listings on the NC Health Care Personnel Registry will also be Listings on the NC Health Care Personnel Registry will also be listed on the National Practitioner Data Banklisted on the National Practitioner Data Bank


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NPDB-HIPDB – National Practitioner NPDB-HIPDB – National Practitioner Data Bank / Healthcare Integrity and Data Bank / Healthcare Integrity and Protection Data BankProtection Data Bank

• Nurse Aides Nurse Aides are considered are considered “practitioners”“practitioners”• Substantiated negative “Findings” for nurse Substantiated negative “Findings” for nurse

aides will appear in this national data bank!aides will appear in this national data bank!

http://www.npdb-hipdb.hrsa.gov/


http://www.npdb-hipdb.hrsa.gov/

Consequences of inappropriate actions by Consequences of inappropriate actions by the Nurse Aide Student or CNAthe Nurse Aide Student or CNA

Deficiencies may be cited against the LTC where the Nurse Aide is employed


Prevent Problems Prevent Problems

• Good resident careGood resident care• Given with a good heartGiven with a good heart• Using Good standardsUsing Good standards• Each and every dayEach and every day• Equals a Equals a GREAT CNA GREAT CNA who has nothing to who has nothing to

fear and everything to gain. fear and everything to gain.


Prevent Problems Prevent Problems


• Understand healthcare Understand healthcare facilitiesfacilities and and organizational structure with focus organizational structure with focus on on LTCLTC..

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END END 1.011.01


1.01

Education

hsii course content

treatment of injury

nurse aides work

disease asa medical

surgical problemproblem

surgical means

broad range of healthages

range of function