This document discusses the roles and responsibilities of nursing assistants in various care settings. It covers the types of facilities such as assisted living where residents are more independent, nursing homes which provide 24-hour care for those with chronic conditions, and acute care facilities like hospitals that care for patients during medical emergencies or surgery. The document also outlines the healthcare team members, importance of care plans, policies, procedures, documentation standards, and legal issues related to providing care.

1. The Nursing Assistant and
various care settings

2. ◦ a. 24 hour care available
◦ b. Chronic conditions (lasts a long time)
◦ c. Dementia, developmentally disabled (DD)
◦ d. Mainly elderly
◦ e. Residents

3.  a. Residents more independent. Do not need
24 hour care.
 b. Help is given with:
1. showers
 2. Meals
 3. Transportation to appointments, if needed

4.  1. Same-day surgeries
 2. Clinics
 3. For people who need less than 24 hour
care.

5.  Hospital
 a. Emergencies
 b. More serious surgeries
 c. Flare-up of chronic conditions
 d. Need more skilled nursing care
 e. Very temporary

6.  1. Sub-acute
 2. Adult Day care
 3. Hospice
 4. Home Health

7.  Members:
◦ a. Nursing Assistant, RN, LPN
◦ b. PT, OT, ST
◦ c. MSW, Activities Director, RD
◦ d. Doctor
◦ e. Resident and Family
◦ Everyone works together to restore as much
function back to the resident as possible.

8.  Created by RN, highlights tasks and
information specific to the resident.
 Very important to familiarize yourself with the
Care plan and to follow it.
 Chain of Command – line of authority
a. Very important to follow this and be
aware of who supervises you.
◦ b. Protects from liability.

9.  Policy – states what should be done in the
facility.
 a. confidentiality of health information
 b. Not taking gifts from residents.
 c. Reporting change in resident status

10.  Procedure – A way of doing something
◦ 1. Resident complaint forms – give to DNS
◦ 2. Documenting VS
◦ 3. Filling out belongings checklist upon admit
Medicare: Health insurance for people 65 and older
or disabled individuals.
Medicaid: Based on income – for people who cannot
afford health insurance.

11.  Help with ADLs.
 If not long-term, then PT, OT, ST, RD
 Assistance to do for the residents what they
cannot do.

12.  Be competent
 Be professional in conduct and appearance
◦ a. Limit talk about personal issues.
◦ b. Be kind, shower, shave, brush teeth, wear
appropriate clothing to work.
 Show respect and provide dignity to residents.
 Honest and ethical behavior
Be aware of residents rights.

13.  Let’s review! Pages 11 and 12.
 Abuse and Neglect. Let’s review pgs 12
& 13
 Mandatory reporting…let’s discuss this

14.  1. Obra or Omnibus Budget Reconciliation Act
◦ a. Training hours requirement
◦ b. Minimum staffing requirement
◦ c. Registry established…states are required to have
◦ d. Designated services to be provided
◦ e. Established resident rights and survey time: every 9 –
15 months
 2. Older Americans Act
 a. Ombudsman-legal advocate for residents
◦
 3. HIPPA – confidentiality of health
information

15.  1. When and what to document
◦ a. Care you give, flowsheets, facility documents
◦ b. Incidents: falls, inappropriate behaviors
◦ c. Medical Record – legal document
◦ d. Guarantees clear communication between
members of the health care team.
◦ e. Confidentiality is required.

16.  Guidelines
a. Use fact, not opinion.
b. Be concise, not wordy.
c. Use black ink. Only one line through
mistakes
d. Make sure to initial when correcting errors.
e. Do not use “white out” or correction fluid.
f. Record immediately after care, not before.
g. “If you do not document, you didn’t do it.”

17.  Health care documentation always in military
time.
 1. Add 12 to any “regular” time statement.
◦ a. 3 o’clock a.m. + 12 = 1500 or 3 p.m.
◦ b. 1700 (5 o’clock p.m.) – 12 + 0500 a.m.
◦ Military time is more precise – daytime or nighttime