Intro to OBRA and the Nursing Assistant

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Intro to OBRA and the Nursing Assistant
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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.

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Course Information

• After completing this course, participants will
  be able to
• Provide basic care to residents of long-term care
  facilities.
• Communicate and interact effectively with
  residents and their families, with sensitivity to
  the psychosocial needs of the residents.
• Assist residents in attaining and maintaining
  maximum functional independence.
• Protect, support and promote the rights of
  residents.
• Provide safety and preventative measures in the
  care of residents.
• Demonstrate skill in observing, reporting and
  documentation.
• Function effectively as a member of the health
  care team.

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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. Paschals 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

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Course Information

• Textbooks/Resources
• Hartmans Nursing Assistant Care (Long-Term Care)
• Also available for download on iTunes
• Hartmans Nursing Assistant Care Workbook
• Diversified Health Occupations
• NNAAP Texas Nurse Aid Candidate Handbook

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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

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INTRODUCTION

• You need to know
• What you can and cannot do
• What conduct is right wrong
• Your legal limits
• Actions are defined / shaped by
• Patients condition
• The amount of supervision you need

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HISTORY OF CNAS

• 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

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TRENDS

• In 1980s primary nursing was introduced
• RNs gave care in
• CNAs gave care in

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TRENDS

• Home care increased in 1980s
• Insurance caused decrease in
• Reducing medical costs became political issue
• Hospital closings mergers
• Managed care
• CNAs joined RNs at hospitals
• CNAs

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STATE FEDERAL LAWS

• Tasks CNAs 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

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NURSE PRACTICE ACTS

• Defines RNs and LPNs
• Describes their
• Lists education and licensing requirements
• Protects public from a nurse
• Allows license to be

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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

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REASONS TO REVOKE A LICENSE

1. Convicted of crime in any state
3. Using patient drugs for self
4. Place person in danger from overuse of drugs /
   alcohol
5. Convicted of abuse or neglect of
6. Violating or assisting someone else to violate
   the nurse practice act
7. behaviors
8. Making medical diagnosis
9. Prescribing

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OBRA

• Omnibus 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

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REMIND ME AGAIN.

• What was the intent of the OBRA Act of 1987???

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OBRA

• OBRA facility regulations focus on
• , restorative care, psychosocial care and
  preventative care to maintain maximum physical
  and mental wellness of residents.
• State inspection of facilities for compliance
  with regulations with penalties for .

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OBRA

• OBRA nurse aid training regulations include
• 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.

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OBRA

• OBRA nurse aid training regulations include
• 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
• 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

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Tell me.

• How does the training previously mentioned
  benefit residents, the nurse aide themselves, and
  the LTC facility??

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OBRA

• State registry requirements include
• Each individual listed on the registry must keep
  the department informed of his/her current
  address and telephone number
• Nurse aid certification expired after being
  entered into the registry
• Must submit verification of pain employment prior
  to the expiration date to continue verification
• If renewing after Sept 1, 2013 you must complete
  of continuing education every 2 years
• 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
• 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

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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
• (LPNs may in some states)
• Must be available for questions

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ROLE LIMITS FOR CNAS
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DELEGATION

• Authorize another person to perform a task
• Delegation decisions must protect persons health
  and safety
• Person must be
• RN legally (responsible) for all nursing
  care-decide what is best for patient
• Decision is based upon pts circumstances
• Must make sure it is done correctly
• CNAs cannot delegate roles or responsibilities

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5 RIGHTS OF DELEGATION

• Right
• Right
• Right
• Right
• Right

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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

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Intro to Residents in LTC Facilities

• Types of residents of LTC facilities
• 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
• Terminal care resident will probably die in the
  facility
• Rehabilitation residents recover and return to
  the community
• A limitation on a persons physical
  functioning, mobility, dexterity, or stamina
• A disease that affects a persons ability to
  function at a normal level in the family, home,
  or community

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Intro to Residents in LTC Facilities

• Types of residents of LTC facilities (cont)
• Individuals requiring skilled nursing
• Most often the lack of ability to care for
  oneself and the lack of a support system
• Post acute care
• Other

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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

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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.

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Residents in LTC Facilities

• Normal 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

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Residents in LTC Facilities

• Not normal changes of aging
• SHOULD BE REPORTED TO THE NURSE
• Signs of depression
• Loss of ability to think logically
• Poor nutrition
• Incontinence