Foundations of Resident Lecture Notes 1-4 Part 1

Chapter 2: Audio #1- Foundations of Resident Care Notes: o o o o o o o o o o o o o o Effective communication is a critical part of a nursing assistant’s job Nursing assistants have to communicate with supervisors, the care team, residents, and family members A resident’s health depends on how well an NA communicates observations and concerns to the nurse Communication – the process of exchanging information with others; process of sending and receiving messages People communicate with signs and symbols, such as words, drawings, and pictures --> also can communicate through their behavior Verbal communication – uses spoken or written words ▪ Ex: oral reports Nonverbal communication – communicating without using words; also includes how a person says something ▪ Ex: person shrugging his shoulders Body language is another form of nonverbal communication ▪ Movements, facial expressions, and posture can express different attitudes or emotions When caring for residents, NAs should speak in a language that residents can understand, or find an interpreter (someone who speaks the resident’s language) Picture cards or gestures can help with communication NAs should not use another language when speaking to staff in front of residents NAs must make brief and accurate oral and written reports to residents and staff ▪ Careful observations are used to make these reports and are important to the health and well-being of all residents Some observations will need to be reported immediately to the nurse --> deciding what to report immediately involves critical thinking Anything that endangers residents should be reported immediately, including the following: ▪ Falls ▪ Chest pain ▪ Severe headache ▪ Trouble breathing ▪ Abnormal pulse, respiration, or blood pressure ▪ Change in mental status ▪ Sudden weakness or loss of mobility ▪ Fever ▪ Loss of consciousness ▪ Change in level of consciousness ▪ Bleeding ▪ Swelling of body part ▪ Change in resident’s condition o o o o ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Bruises, abrasions, or other signs of abuse When making reports about residents, NAs must remember that all resident information is confidential, and information should only be shared with the care team When residents report symptoms, events, or feelings, the NA should have them repeat what they have said --> they should ask for more information The NA should ask open-ended questions --> encourages the residents to give facts and details When communicating with residents, the NA should remember to use these tips: ▪ Always greet the resident by his or her preferred name ▪ Identify yourself ▪ Focus on the topic to be discussed ▪ Face the resident while speaking and avoid talking into space ▪ Talk with the resident, not other staff members, while giving care ▪ Listen and respond when the resident speaks ▪ Praise the resident and smile often ▪ Encourage the resident to interact with yourself and others ▪ Be courteous ▪ Tell the resident when you are leaving the room NAs should call residents by the names that they prefer NAs should not refer to residents by their first names, unless a resident has asked them to do so Terms such as sweetie, honey, or dearie are disrespectful and should not be used When making any report, the right information must be collected before documenting it ▪ Facts, not opinions, are most useful to the care team Two kinds of factual information are needed in reporting: ▪ Objective information: based on what a person sees, hears, touches, or smells; collected by using the senses --> “signs” ▪ Subjective information: something a person cannot or did not observe; it is based on something the resident reported that may or may not be true --> “symptoms” Both objective and subjective reports are valuable In any report, what is observed, signs, and what the resident reports, symptoms, need to be clearly noted NAs are not expected to make diagnoses based on signs they observe --> their observations, however, can alert the care team to possible problems In order to report accurately, NAs must observe residents accurately ▪ To observe accurately, as many senses as possible should be used to gather information The Senses: ▪ Sight – the NA should look for changes in the resident’s appearance ▫ Ex: rashes, redness, paleness, swelling, discharge, weakness, sunken eyes, or posture or gait walking; changes ▪ Hearing – the NA should listen to what the resident says about his condition, family, or needs ▫ Is the resident speaking clearly and making sense? ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▫ Does he show emotion, such as anger, frustration, or sadness? ▫ Is his breathing normal? ▫ Does he wheeze, gasp, or cough? ▫ Is the area quiet enough for him to rest as needed? ▪ Touch – the NA can feel for varying things ▫ Does the resident’s skin feel hot or cool, moist or dry? ▫ Is the pulse rate normal? ▪ Smell - the NA can smell for varying things ▫ Are there any odors coming from the resident’s body? ▫ Odors can suggest poor bathing, infection, or incontinence ▫ Breath odor could suggest the use of alcohol or tobacco, indigestion, or poor mouth care Incontinence – the inability to control the bladder or bowels For oral reports, the NA should write down observations so that important details are not forgotten When needing to give an oral report, unless the situation is urgent, the NA should approach the nurse and wait for the nurse to complete the task she is currently doing --> wait for the nurse to be finished before giving the report ▪ Waiting until the nurse is done helps reduce the risk of error Following an oral report, the NA must document when, why, about what, and to whom an oral report was given --> documentation should always occur after the report is given Taking notes helps NAs remember facts and report accurately Sometimes a nurse or another member of the care team will give the NA a brief oral report on one of the NA’s residents ▪ The NA should listen carefully and take notes ▪ Ask about anything that you don’t understand Medical words are often made up of roots, prefixes, and suffixes Root – a part of a word that contains its basic meaning Prefix – word part that comes before the root to help form a new word Suffix – the word part added to the end of the root that helps form a new word Prefixes and suffixes are called “affixes” because they are attached, or affixed, to a root When speaking with residents and their families, NAs should use simple, nonmedical terms ▪ Medical terms should not be used because they may not be understood When speaking with the care team, using medical terminology will help give more complete information Abbreviations are another way to help the care team communicate more efficiently with each other ▪ PRN = as necessary NAs may need to know abbreviations to understand assignments and tasks or care plans Nursing assistants might be asked to make a call, or answer the telephone at their facility Guidelines for telephone communication: ▪ Always identify your facility’s name, your name, and your position ▪ ▪ ▪ ▪ ▪ ▪ ▪ o o o o o o o o o o o o o o o Be friendly and professional Place the caller on hold if you need to find the person they're looking to speak with If the caller must leave a message, write it down and repeat it to make sure you have the right message Ask for proper spellings of names Do not ask for more information that the person needs to return the call ▫ Name, phone number, and short message is enough Do not give out any information about staff or residents Thank the person for calling and say goodbye LTC facilities are required to have a call system, often called “call lights”, so that residents can call for help whenever they need it Call lights are in resident rooms and bathrooms ▪ Some have strings for residents to pull and others are buttons that need to be pushed The signal is usually both a light outside the room and a sound that can be heard in the nurse’s station Call lights are the primary way a resident can call for help NAs must respond immediately after seeing the light or hearing the sound --> do so even if the resident is not on your assignment sheet NAs should respond to call lights in a courteous and respectful manner Make sure the call light is in reach of the resident before leaving the room and make sure the resident knows how to use it Communication can be blocked or disrupted in many ways These are some barriers to communication and ways that an NA can avoid them: ▪ Resident does not hear NA, does not hear correctly, or does not understand ▫ The NA should face the resident, speak slowly and clearly, and not shout, whisper or mumble ▫ Speak in a low voice using a pleasant tone ▫ Check if the resident’s hearing aids are on and working if necessary ▪ Resident is difficult to understand ▫ Be patient and take time to listen ▫ Ask the resident to repeat or explain the message ▫ State the message in your own words again to make sure you understand An NA should not use medical terms with residents or their families --> speak in simple, everyday words, and ask what a word means if he or she is not sure The NA should avoid using slang words, as they are unprofessional and may not be understood NAs should not use profanity, even if the resident does Cliches – phrases that are used repeatedly and that do not really mean anything ▪ NAs should not use them --> listen to what the resident is really saying and respond with a meaningful message The NA should avoid asking, “Why?” when a resident makes a statement --> these questions make people feel defensive NAs should not offer their opinions or give advice o o o o o o o o o o o o ▪ Giving medical advice is not within an NA’s scope of practice Don’t ask yes/no questions --> ask open-ended questions to get more details If a resident speaks a different language than the NA, the NA should speak slowly and clearly, keep messages short and simple, be alert for words that the resident understands, as well as signs that the resident is only pretending to understand ▪ May need to use pictures or gestures to communicate ▪ Be patient and calm NAs should be aware of their body language and gestures NAs should look for nonverbal signs from residents and clarify them Defense mechanisms may be considered barriers to communication Defense mechanisms – unconscious behaviors used to release tension or cope with stress ▪ Help to block uncomfortable or threatening feelings Common defense mechanisms include: ▪ Denial ▪ Completing denying thoughts or feelings ▪ Projection – seeing feelings in others that are really one’s own feelings ▪ Displacement – transferring a strong, negative feeling to a safer situation ▪ Rationalization – making excuses to justify a situation ▪ Repression – blocking painful thoughts or feelings from the mind ▪ Regression – going back to an old, usually immature, behavior Culture can affect communication Culture – a system of learned beliefs and behaviors that is practiced by a group of people ▪ Each culture might have different knowledge, behaviors, practices, beliefs, values, attitudes, religions, and customs When an NA communicates with residents from different cultures, she should ask herself these questions: ▪ What information do I need to communicate with this person? ▪ Does this person speak English as a first or second language? ▪ Do I speak this person’s language, or do I need an interpreter? ▪ Does this person have any cultural practices about touch or gestures that I should adapt to? It is important for NAs to be sensitive to each resident’s needs --> key to providing professional, person-centered care Learning each residents' preferences is an important part of effective communication Chapter 2: Audio #2- Communicating with Residents with Special Needs Notes: ▪ ▪ Due to illness or impairments, some residents need special techniques to aid in communication Impairment – loss of function or ability --> can be a partial or complete loss ▪ Hearing impairment – there are many kinds of hearing loss ▪ ▪ ▪ ▪ o o o A person may be born with hearing impairment, or it may happen gradually May use hearing aids, read lips, or use sign language Also closely observe the facial expressions and body language of others to add to their knowledge of what is being said Guidelines for caring for residents with hearing impairment: ▪ If the person has a hearing aid, make sure that he or she is wearing it and that it is turned on ▪ Clean the resident’s hearing aids daily ▫ Wipe with special cleaning solution and a soft cloth ▫ Do not put the hearing aid in water ▪ Handle the hearing aid carefully and make sure not to drop it ▪ Store the hearing aids inside of a case if not being worn ▪ Remove the hearing aids from a resident before bathing them or washing their hair ▪ Reduce or remove noise, such as TVs, radios, and loud speech and close doors if needed ▪ Get the resident’s attention before speaking ▪ Do not approach residents from behind ▪ Speak clearly, slowly, and in good lighting ▫ Ask if the resident can hear and understand you ▪ Do not shout or mouth the words in an exaggerated way ▪ Keep the pitch of your voice very low ▪ Do not chew gum while speaking ▪ Keep your hands away from your face while talking ▪ Use short sentences and simple words ▪ Avoid sudden topic changes ▪ Repeat what you have said using different words when needed ▪ Be patient and empathetic ▪ Avoid long, tiring conversations ▪ Be understanding and supportive Some residents with hearing impairments might have speech problems, making them difficult to understand ▪ Do not pretend to understand if you do not ▪ Ask them to repeat themselves ▪ Observe their lips, facial expressions, and body language ▪ Request that the resident writes down their thoughts Vision impairment – can affect people of all ages; can exist at birth or develop gradually; can occur in one eye or both Guidelines for caring for residents with vision impairment: ▪ Encourage the use of glasses or contact lenses if worn ▪ Make sure the resident’s eyeglasses are clean and in good condition ▪ Knock on the door and identify yourself as soon as you enter the room ▪ Explain why you are in the room and what you would like to do ▪ Let the resident know when you are leaving the room ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ o o o o o o o o o o Face the resident when speaking Make sure there is proper lighting in the room Orient the resident to where things are when bringing them to a new room Describe things around you without using words such as “see”, “look”, and “watch” Always tell the resident what you are doing while caring for them Talk directly to the resident Do not move the resident’s personal items, objects, or furniture --> put everything back where you found it Tell the resident where the call light is and make sure it is in their reach Give assistance with cutting food and opening containers as needed Walk in front of the resident Leave doors completely open or completely closed Do not play with, distract, or feed a resident’s guide dog if they have one Encourage the use of the other senses Mental health – normal health and functioning of intellectual abilities A person who is mentally healthy can: ▪ Get along with others ▪ Adapt to change ▪ Care for himself and others ▪ Give and accept love ▪ Deal with situations that cause anxiety, disappointment, and frustration ▪ Take responsibility for decisions, feelings, and actions ▪ Control impulses appropriately The ability to interact well with other people is a characteristic of mental health Although it involves emotions and mental functions, a mental health disorder is like any physical disorder --> it is a condition that produces signs and symptoms, and affects the body’s ability to function A mental health disorder disrupts a person’s ability to function in the family, home, or community ▪ Often causes inappropriate behavior Some signs and symptoms of a mental health disorder are: ▪ Confusion ▪ Disorientation ▪ Agitation ▪ Anxiety People with a mental health disorder cannot simply choose to “be well” ▪ Have a harder time controlling their thoughts and actions Different types of mental health disorders affect how well residents communicate NAs should treat each resident as an individual and tailor their approach to the situation Guidelines for caring for a resident with a mental health disorder: ▪ Do not talk to adults as if they are children ▪ Use simple, clear statements and an even tone of voice ▪ ▪ ▪ ▪ ▪ ▪ o o o o o o o o o o Be sure that what you say, and how you say it, show respect and concern Sit or stand at a normal distance from the resident Be aware of body language Be honest and direct Avoid arguments Maintain eye contact and listen carefully Residents may display combative behavior (violent or hostile behavior) ▪ Such behavior may include hitting, pushing, kicking, or verbal attacks ▪ May be a result of the disease affecting the brain ▪ May also be due to frustration ▪ May just be part of someone’s personality Combative behavior is usually not a reaction to the caregiver and should not be taken personally NAs should always report and document combative behavior Guidelines for caring for a resident with combative behavior: ▪ Block physical blows or step out of the way ▪ Never hit back a resident under any circumstance ▪ Allow the resident time to calm down before the next interaction ▪ Ensure the resident is safe and give them space ▪ Stand at least an arm’s length away ▪ Remain calm and lower the tone of your voice ▪ Be flexible and patient ▪ Stay neutral ▪ Do not respond to verbal attacks ▪ Do not argue or accuse the resident of wrongdoing ▪ Do not use gestures that could frighten or startle the resident ▪ Keep your hands open and in front of you ▪ Be reassuring and supportive ▪ Consider what might have provoked the resident ▪ Report inappropriate behavior to the nurse Anger is a natural emotion that has many different causes Possible causes include: ▪ Disease ▪ Fear ▪ Pain ▪ Loneliness ▪ Loss of independence Anger may be a part of someone’s personality People express anger in different ways Angry behavior should always be reported to the nurse Guidelines for caring for a resident with angry behavior: ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ o o o o o o o o Stay calm Do not argue or respond to verbal attacks Empathize with the resident Try to find the cause of the anger Listen attentively and remain silent when they are speaking Treat the resident with dignity and respect Explain what you are going to do and when you are going to do it Answer call lights promptly Inappropriate behavior from a resident includes trying to establish a person relationship with an NA Examples include: ▪ Asking personal questions ▪ Requesting visits on personal time ▪ Asking for or doing favors ▪ Giving tips or gifts ▪ Lending or borrowing money ▪ Making sexual advances and comments Illness, dementia, confusion, or medication may cause this kind of behavior Confused residents may have problems that mimic sexual behavior NAs should address inappropriate behavior directly Always remain professional and do not overreact --> distract the resident Report on any inappropriate behavior Be comforting and kind and listen if residents want to talk Chapter 2: Audio #3- Identifying Ways to Promote Safety and Handle Nonmedical Emergencies Notes: o o o o o All staff members, including NAs, are responsible for the safety of all residents It is very important to try to prevent accidents before they occur Prevention is the key to safety As NAs work, they should watch for safety hazards and report unsafe conditions to the supervisor promptly Before leaving a resident’s room, an NA should do a final check and ask themselves: ▪ Is the call light within reach of the resident’s stronger hand? ▪ Is the room tidy? ▪ Are the resident’s items in their proper places? ▪ Is the furniture in the same place that I found it? ▪ Is the bed in its lowest position? ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Does the resident have a clear walkway around the room and into the bathroom? Back strain or injury can be a serious problem for NAs Body mechanics – the way the parts of the body work together when a person moves Using proper body mechanics helps save energy and prevent injury Alignment – whether standing, sitting, or laying down, the body should be in alignment and have good posture ▪ Means that the two sides of the body are mirror images of each other, with body parts lined up naturally Posture – the way a person holds and positions their body A person can maintain proper body alignment when lifting or carrying an object by keeping it close to their body --> their feet and body should be pointed in the direction that they are moving --> avoid twisting at the waist Base of support – the foundation that supports an object ▪ The feet are the body’s base of support The wider the support, the more stable a person is ▪ Standing with the feet shoulder width apart allows for a greater base of support --> more stable than standing with the feet together Center of gravity – the center of gravity in the body is the point where the most weight is concentrated --> point depends on the position of the body ▪ When a person stands, weight is centered in the pelvis ▪ A low center of gravity gives a stronger base of support ▪ Bending the knees when lifting an object lowers the pelvis, and therefore, lowers a person’s center of gravity --> gives a person more stability and makes them less likely to fall or strain the working muscles Guidelines for using proper body mechanics: ▪ Assess the situation first ▪ Clear the path and remove any obstacles ▪ Use both arms and hands to lift --> push or carry objects ▪ When lifting a heavy object from the floor, spread your feet shoulder width apart, bend your knees, and use the strong, large muscles in your thighs, upper arms, and shoulders to lift the object ▪ Raise your body and the object together ▪ Hold objects close to you when you are lifting or carrying them --> keeps the object closer to your center of gravity and base of support ▪ Avoid bending and reaching as much as possible ▪ If making the bed, adjust the height to a safe, working level ▪ Avoid bending at the waist ▪ When a task requires bending, use a good stance --> bend your knees to lower yourself ▪ Do not twist when you are moving or lifting an object ---> turn your whole body ▪ Get help from coworkers ▪ Talk to residents before moving them ▪ Lift or move on the count of three so that everyone moves together ▪ Never try to catch a falling resident