SOUTH CAROLINA NURSE AIDE TRAINING PROGRAM PACKET

Transcription

1 SOUTH CAROLINA NURSE AIDE TRAINING PROGRAM PACKET GUIDELINES FOR NURSE AIDE TRAINING PROGRAM APPROVAL SCOPE OF SERVICE SOUTH CAROLINA NURSE AIDE CURRICULUM APPLICATION FOR APPROVAL OF A NURSE AIDE TRAINING PROGRAM INSTRUCTOR RESUME FACT SHEET CLASS/LAB EQUIPMENT SUPPLY LIST CLINICAL CONTRACTUAL GUIDELINES/SUGGESTIONS SAMPLE SKILLS CHECKLIST/CLINICAL COMPETENCY EVALUATION FOR NURSE AIDE SAMPLE CERTIFICATE OF COMPLETION SOUTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES Department of Facility Services, 7th Floor PO Box 8206 Columbia, SC Phone: Fax: SCNAR@scdhhs.gov

2 TABLE OF CONTENTS GUIDELINES FOR NURSE AIDE TRAINING PROGRAM APPROVAL... 1 I. Program... 1 II. Instructor... 3 III. Clinical... 4 SCOPE OF SERVICE... 5 I. Objective of Nurse Aide Training Program... 5 II. Staffing... 5 III. Administration... 5 IV. Physical Facilities... 6 V. Application Process... 6 VI. Prerequisites for Nurse Aide Training Program Approval... 7 SOUTH CAROLINA NURSE AIDE CURRICULUM... 8 I. Introduction... 8 A. Communication and Interpersonal Skills... 8 B. Infection Control... 8 C. Safety/Emergency Procedures... 8 D. Promoting Resident s Independence... 9 E. Respecting Resident s Rights... 9 II. Core Curriculum... 9 A. Role of the Nurse Aide... 9 B. Resident s Rights... 9 C. Basic Nursing Skills D. Care of Cognitively Impaired Residents E. Mental Health and Social Service Needs F. Personal Care Skills G. Basic Restorative Services APPLICATION FOR APPROVAL OF A NURSE AIDE TRAINING PROGRAM INSTRUCTOR RESUME FACT SHEET CLASS/LAB EQUIPMENT SUPPLY LIST CLINICAL CONTRACTUAL GUIDELINES/SUGGESTIONS I. Nurse Aide Training Program Guidelines II. Long-Term Care Facility Guidelines SAMPLE SKILLS CHECKLIST/CLINICAL COMPETENCY EVALUATION FOR NURSE AIDE SAMPLE OF CERTIFICATE OF COMPLETION... 27

3 South Carolina Department of Health and Human Services Department of Facility Services, 7th Floor PO Box 8206 Columbia, SC Fax: I. Program Guidelines for Nurse Aide Training Program Approval 1. The Application for Approval of a Nurse Aide Training Program is to be completed and submitted to the Department of Health and Human Services (DHHS), Department of Facility Services, upon request for certification of a nurse aide training program (NATP). 2. All prerequisite materials outlined in this Training Program Packet must be submitted to the DHHS, Department of Facility Services, 7th Floor, prior to the initial on-site evaluation of an NATP. 3. The training of nurse aide students must be performed by or under the general supervision of a registered nurse who possesses a minimum of two years of nursing experience, at least one year of which must be in the provision of services at a long-term care facility. a. It is required that all potential instructors for classroom and clinical training be pre-approved by the DHHS, Department of Facility Services. b. Resumes and a copy of current nursing licenses must be submitted for review. It is requested that the information contain inclusive dates of work and educational experience. It should be noted whether work experiences were full-time or part-time. If part-time, list the number of hours worked per week and the total number of weeks worked. An Instructor Resume Fact Sheet is provided within this packet for the use of potential instructors. c. A licensed practical nurse (LPN) or licensed vocational nurse (LVN) under the supervision of the primary instructor may provide skills training instruction and supervision if he or she has one (1) year of experience in caring for the elderly and/or the chronically ill of any age. d. Resource personnel from health-related fields with a minimum of one (1) year of current experience in caring for the elderly or the chronically ill of any age may be utilized upon approval from the DHHS, Department of Facility Services. 4. Upon approval of an NATP, the DHHS, Department of Facility Services, must be informed of substantive changes made to the program. a. The clinical contract must be renewed annually and/or upon any change of facility or school administration and submitted to the DHHS, Department of Facility Services. Information pertaining to the development of the Clinical Contractual Guidelines/Suggestions are included in this packet. b. The DHHS, Department of Facility Services, reserves the right to conduct unannounced evaluations of its certified NATPs. The State Operations Manual states that the approval of an NATP may be withdrawn if the program refuses to permit unannounced state visits. page 1

4 5. The coordinator or primary instructor and the nursing facility with which he or she has contracted are responsible for verifying that clinical facilities used in the training of nurse aide students are in good standing with the State Licensure and Certification Division of the Department of Health and Environmental Control. This verification must be documented in the NATP s files and must be available during the DHHS evaluation process. This is to ensure that the status of the facility is current and that the facility is in compliance with the mandates of appropriate regulatory agencies. This verification must be obtained at least one (1) week prior to the beginning of each clinical session with all scheduled classes. In the event that a program is non-compliant, it may lose state approval (i.e., may be de-certified) for a period of one (1) year. 6. The specific focus of the evaluation process as it relates to the curriculum is the integration of the South Carolina Nurse Aide Curriculum into a teaching format that emphasizes both teaching and evaluation of basic skills. These basic theory topics and skills are the minimal requirements mandated by federal regulations and are listed in the Federal Registry, September 26, 1991, Section If programs are teaching information additional to that contained in the South Carolina Nurse Aide Curriculum, they must send an addendum stating the additional information that is being taught in their program. 7. Program policies are to be developed and submitted with the prerequisite items prior to an on-site evaluation. Additions and/or changes should be submitted to the DHHS, Department of Facility Services, as applicable. Suggested policies are policies for attendance, grading, uniforms, confidentiality, etc. 8. Lab equipment must be in the skills lab at all times for demonstration, practice, and return student demonstration. 9. Competency with respect to all clinical lab skills is to be verified by the instructor prior to the beginning of the clinical rotation, and a record should be placed in the student s file. 10. Students should be oriented to the various forms used to document resident information during classroom and lab instruction prior to clinical experiences. Documentation on the appropriate flow sheets/forms must be completed with instructor supervision during the clinical rotation. 11. To maintain certification status, all class/clinical schedules must be submitted to the DHHS, Department of Facility Services, prior to their occurrence. The schedules should be ed to SCNAR@scdhhs.gov or faxed to (803) (include name, program, and Attention to: Nurse Aide Coordinator) 12. A sample copy of a Clinical Competency Evaluation for Nurse Aides (Skills Checklist) is provided in this packet and may be used in its entirety or revised to meet the instructor s need based on the curriculum guidelines. 13. The area designated as the classroom/lab in a facility-based program must be an area that is not designated for resident care. 14. The size of the classroom/lab is not specified; however, the classroom/lab will be evaluated for adequacy based on the number of students enrolled and how the space is utilized. 15. Student records must be maintained on file for a period of five (5) years and/or according to school policy. The records must include a record of attendance for each trainee, the trainee s name and Social Security Number, the nursing facility sponsor, and the dates and hours of attendance. 16. The program must provide all students, upon successful completion, with a certificate of completion and/or transcript, or a letter on the program s letterhead certifying the student s successful completion of the program. The total number of program hours must be on the certificate of completion. Sample of Certificate enclosed in packet. page 2

5 17. South Carolina requires that a certified NATP consist of a minimum of one-hundred (100) hours. This is to include forty (40) hours of classroom instruction, twenty (20) hours of documented skills practicum and forty (40) hours of clinical experience in a long-term care (LTC) facility. 18. A program that does not meet the requirements for certification after the second revisit to assess the implementation of the plan of correction will not be recertified and cannot reapply to the DHHS, Department of Facility Services, for a period of one (1) year. 19. A program must utilize an application that informs the trainees of the policies of the program and must provide notification to trainees sponsored by Medicaid-certified nursing facilities that they are not responsible for any costs associated with training, including deposits for textbooks and/or supplies used. 20. Students may be employed after sixteen (16) hours of classroom training if the following topics have been covered in class: a. Communication and interpersonal skills b. Infection control c. Safety/emergency procedures, including the Heimlich maneuver d. Promoting resident independence e. Respecting resident rights 21. The program must provide the employer with verification that the program has provided the above instruction. II. Instructor 1. The instructor/student ratio must be 1:8 in the clinical area. 2. Instructors must not be involved in more than one role while supervising students in the clinical area. 3. Clinical assignments are to be made by the primary instructor with the approval of the facility staff. A review of the residents charts to retrieve pertinent information needed by the students in providing care is to be completed also. It is suggested that a worksheet be developed that contains information to be given to the students. Care plan information is to be reviewed at the beginning of each experience and should include new orders or changes in resident status. 4. Student assignments should be posted on the appropriate unit 24 hours in advance of the arrival of the students and should include the name of the school, the names of the students, and the room numbers of the residents. During at least one clinical experience it is recommended that students care for a minimum of two and not more than four residents during a specified clinical day. Students should be given individual assignments. More than one student should not be assigned to the same resident at the same time. Clinical assignments should provide the following: a. Care of residents with varied levels of care needs b. The opportunity to be evaluated on organizational skills and time management page 3

6 5. The primary instructor is responsible for the supervision of the clinical performance of all LPN instructors. III. Clinical 1. Students may not give care to unassigned residents. Students are not to be assigned to or supervised by facility aides at any time during their clinical rotation. All clinical instruction must be with instructor supervision. 2. At all times students must maintain safe practice and infection control and respect resident rights. 3. Students must demonstrate knowledge regarding the assigned residents diagnoses and identified needs. 4. Students and instructors must wear the appropriate uniform for the performance of resident care and must be in compliance with school policy. The uniform must include a name tag that designates the name of the NATP and the individual s status (i.e., student or instructor). 5. The scheduled clinical hours must provide experiences that meet expected outcomes outlined in the South Carolina Nurse Aide Curriculum. 6. It is suggested that the length of the clinical day not exceed eight (8) hours. 7. It is the responsibility of the instructor to inform the facility administrator/director of nurses of the date of the evaluation and the arrival of the DHHS evaluator(s) both to perform the evaluation and to obtain clinical assignment/resident information. 8. DHHS evaluators request approximately 10 to 15 minutes during the preclinical conference to inform students of their role in the evaluation process. 9. Certain residents will be visited and the care administered by nurse aide students will be observed by evaluators, with the permission of the residents. 10. Observations of student performances will include, but will not be limited to, the expected outcomes of the curriculum. page 4

7 South Carolina Department of Health and Human Services Department of Facility Services, 7th Floor PO Box 8206 Columbia, SC Fax: I. Objective of Nurse Aide Training Program SCOPE OF SERVICE To provide a basic level of both knowledge and demonstrable skills for individuals who provide nursing or nursing-related services to residents in a skilled nursing facility (SNF) or nursing facility (NF) and who are not licensed health professionals or volunteers who provide services without monetary compensation. II. Staffing 1. Program coordinator/primary instructor: The training of nurse aides is required to be performed by or under the general supervision of an RN who has a minimum of two (2) years of nursing experience, at least one (1) year of which must be in the provision of long-term care services. 2. Other instructors: a. Qualified resource personnel from health-related fields with a minimum of one (1) year of current experience in caring for the elderly or chronically ill of any age b. Instructors who are licensed, registered, or certified in their field, where applicable c. An LPN or LVN under the supervision of the primary instructor may provide skills training instruction and supervision if he or she has one (1) year of experience in caring for the elderly/or the chronically ill of any age. d. The ratio of instructors to students in a clinical setting is 1:8. III. Administration 1. The program records must include a record for attendance (dates and hours) for each trainee, the trainee s name and Social Security number, and the name of the nursing facility sponsor. 2. The program must provide all students, upon successful completion, with a certificate of completion and/or transcript, or a letter on the program s letterhead certifying the student s successful completion of the program and the number of hours of completion must be on the certificate. 3. A program must utilize an application that informs the trainees of the policies of the program and must provide notification to trainees sponsored by Medicaid-certified nursing facilities that they are not responsible for any costs associated with the training, including deposits for textbooks and/or supplies used. page 5

8 IV. Physical Facilities 1. The classroom and skills training facilities will provide adequate temperature controls, clean and safe conditions, adequate space to accommodate students, adequate lighting, and all equipment needed, including audiovisual equipment and any equipment needed for simulating resident care. Refer to items 13 and 14 in the Program section of the Guidelines for Nurse Aide Training Program Approval. 2. Facilities utilized for clinical instruction must be in good standing with the State Licensure and Certification Division. Refer to item 5 in the Program section of the Guidelines for Nurse Aide Training Program Approval. V. Application Process 1. The individual agency, through written correspondences to the DHHS, Department of Facility Services, expresses interest in becoming an approved NATP. 2. This Training Program Packet is provided to the applicant, which includes the following: a. Guidelines for Nurse Aide Training Program Approval b. Scope of Service c. South Carolina Nurse Aide Curriculum d. Application for Approval of a Nurse Aide Training Program e. Instructor Resume Fact Sheet f. Class/Lab Equipment Supply List g. Clinical Contractual Guidelines/Suggestions h. Sample Skills Checklist/Clinical Competency Evaluation for Nurse Aides i. Sample Certificate of Completion 3. The applicant returns the prerequisite items and application form to the DHHS, Department of Facility Services, for review. 4. The material is reviewed and the following determinations are made: a. The completeness of the information received is determined and a notice of preliminary approval is mailed to the director/coordinator or owner of the program. b. If the material is deemed incomplete, additional information is requested. c. When prerequisites are met, an on-site evaluation is scheduled during the clinical portion of a class. 5. The evaluation schedule is as follows: a. Initial (on-site) b. Every two (2) years thereafter c. As deemed necessary by the DHHS page 6

9 VI. Prerequisites for Nurse Aide Training Program Approval The following items are to be completed and returned to the DHHS, Department of Facility Services, 7th Floor, prior to the scheduling of an on-site evaluation. All documents must be sent either by to or fax to (803) (include cover sheet with name, address, phone, , Attention to: Nurse Aide Coordinator) 1. Application for Approval of a Nurse Aide Training Program 2. Resumes for primary and clinical instructors, copies of a current license for each instructor, copy of SLED criminal background check, and a completed Instructor Resume Fact Sheet for each instructor. Program Coordinators, if different than the primary instructor, must submit a SLED criminal background. 3. Signed contracts between the teaching site and the long-term care facility being utilized for clinical instruction 4. An addendum to the South Carolina Nurse Aide Curriculum if additional information is to be taught in the program 5. Program policies regarding attendance, grading, uniforms, confidentiality, etc. 6. Private based programs only must contact the South Carolina Commission on Higher Education at Please forward a copy of your license from the Commission or a letter stating that the license is in process or is not necessary. page 7

10 South Carolina Department of Health and Human Services Department of Facility Services, 7th Floor PO Box 8206 Columbia, SC Fax: I. Introduction 16 hours as required South Carolina Nurse Aide Curriculum A. Communication and Interpersonal Skills 1. Explain the purpose of communication between members of the health team 2. Discuss correct methods of reporting information such as accidents, errors, and injuries 3. Describe changes in the resident s condition 4. Describe how communication skills of the nurse aide affect the quality of care provided to residents 5. Describe the chain of command and interaction with supervision and staff B. Infection Control 1. Describe blood-borne pathogens and Standard Precautions as described by the Occupational Safety and Health Administration (OSHA) 2. Describe and give examples of Standard Precautions as described by the Occupational Safety and Health Administration 3. List conditions that promote the growth of bacteria 4. Describe and demonstrate proper handwashing techniques 5. Describe clean versus dirty areas C. Safety/Emergency Procedures 1. List reasons for immediate call light response and appropriate action to be taken by the nurse aide 2. Explain rationales for the statement All residents are my responsibility 3. List ways to prevent falls, burns, and other accidents 4. Describe the immediate response to and observations of a resident who has fallen 5. Identify ways to control bleeding 6. List emergency response to and observation of residents with bleeding, fainting, and seizures 7. Demonstrate management of obstructed airway (Heimlich maneuver) 8. Identify procedures for disaster/fires 9. Demonstrate the use of good body mechanics for the nurse aide page 8

11 D. Promoting Resident s Independence 1. Describe the nurse aide s role in promoting resident s independence, such as allowing resident to make personal choices and reinforcing other behavior consistent with the resident s dignity 2. Describe and give examples of ways to provide care, according to resident s abilities, to promote independence and self-esteem E. Respecting Resident s Rights 1. Describe the Resident s Bill of Rights and list examples of each right 2. Define and describe the resident s rights to protection and confidentiality 3. Define and discuss abuse (mental, verbal, and physical), neglect, and misappropriation of resident property 4. Describe the allegations leading to and process for revoking the certification of a nurse aide 5. Describe measures and importance of avoiding the need for restraints II. Core Curriculum 16 to 40 hours A. Role of the Nurse Aide hours 1. Identify the nurse aide s role in the long-term care setting (e.g., job description, in-service training) 2. Describe requirements for nurse aide training and competency evaluation 3. Describe ethical and legal behaviors 4. Describe and demonstrate good health and hygiene practices 5. Describe guidelines for dependability, punctuality, resignation, and job seeking 6. Describe the role of the nurse aide in reporting identified changes in resident s condition 7. Describe and demonstrate the appropriate methods of answering the telephone B. Resident s Rights hours 1. Describe the nurse aide s role in protecting and maintaining the dignity of each resident 2. Discuss the role of the nurse aide as it relates to protecting the resident s rights 3. Discuss various myths and stereotypes associated with aging/older adults 4. Define confidentiality 5. Discuss the nurse aide s responsibilities in relation to confidentiality 6. Describe the protection of the resident s right to privacy 7. Describe the protection of the resident s personal items (clothing; assistive devices such as hearing aids, dentures, glasses; flowers/food; etc.) 8. Describe the purpose of informed consent 9. Explain the difference between a will, a living will, and an advanced directive 10. Describe the role of the nurse aide regarding a resident s living will page 9

12 11. Discuss the resident s right to refuse care 12. Describe ways the nurse aide can provide assistance to residents in resolving grievances and disputes 13. Describe the role of the ombudsman in long-term care 14. Describe promotion of resident s right to make personal choices C. Basic Nursing Skills hours 1. Demonstrate oral and written reporting of resident information 2. Demonstrate the proper technique for obtaining and recording vital signs: a. Temperature: oral, axillary, rectal, and tympanic membrane method using glass and electronic thermometers b. Pulse: locate various sites and characteristics of pulses c. Respiration: normal respirations, rate and rhythm, and the terminology for variations in breathing d. Blood pressure: hypotension/hypertension, factors affecting blood pressure e. Height and weight: techniques for ambulatory and non-ambulatory residents 3. Discuss the normal range of vital signs 4. Describe changes in resident s condition (signs and symptoms) 5. Describe observations and reporting of signs of acute illness, including: a. shortness of breath b. rapid respiration c. fever d. coughs e. chills f. pains in chest g. blue color to lips h. pain i. nausea j. vomiting k. drowsiness l. excessive thirst m. sweating n. pus o. blood or sediment in urine p. difficulty urinating page 10

13 q. frequent urination in small amounts r. pain or burning on urination s. urine with dark color or strong odor 6. Demonstrate the collection, labeling, and transportation of specimens of urine, stool, and sputum 7. Discuss importance of proper hydration 8. Describe proper hydration, including intake, output, and restricting and forcing fluids 9. Describe warning signs of dehydration 10. Describe observation and recording of types of bowel movements 11. Describe the procedure for changing a colostomy bag of a resident with an established colostomy (no irrigations) 12. Describe and demonstrate the procedure for catheter care (no irrigations) 13. Define the commonly used abbreviations and terminology used in the long-term care setting 14. Describe the ABCs of emergency care 15. Describe the procedure for assisting residents with bedpan/urinal 16. Describe the types of isolation techniques and the use of personal protective equipment (PPEs) 17. Describe the signs and symptoms of an infection 18. Define nosocomial infection 19. Define medical and surgical asepsis, and disinfection versus sterilization 20. Demonstrate the proper use of gloves 21. Describe and give examples of biohazardous waste, and the symbols and disposal of such waste 22. Describe end-of-life care of a resident whose death is imminent 23. Describe postmortem care 24. Describe the nurse aide s role in caring for the resident s environment and for resident care equipment 25. Describe therapeutic diets and the use of supplemental and in-between meal feedings D. Care of Cognitively Impaired Residents hours 1. Define Alzheimer s disease, dementia, and cognitive impairment, including impact on team and family 2. Describe differences between normal aging and dementia 3. Describe symptoms related to the three stages of dementia 4. Describe how basic communication differs between those with dementia and those without dementia 5. Describe communication strategies appropriate for the three stages of dementia 6. Differentiate between verbal and non-verbal communication page 11

14 7. List barriers to communication (hearing and visual, and speech loss) 8. Demonstrate knowledge of recognizing pain in the cognitively impaired resident 9. Describe validation techniques versus reality orientation 10. Identify and describe behaviors associated with Alzheimer s disease and dementia, including agitation, confusion, sundowning, paranoia, wandering, hiding and hoarding, eloping, catastrophic reactions, hallucinations, delusions, and hyperorality 11. Discuss and apply the concept that behavior is a means of communicating and requires examination for an appropriate response 12. Recognize the concept that behaviors related to dementia are not deliberate but due to the disease 13. Describe appropriate responses to behaviors associated with cognitive impairment based on recognizing a particular behavior, identifying what triggered the behavior, and associating what resulted from the behavior 14. Identify and demonstrate appropriate responses to the behaviors associated with cognitive impairment, including agitation, confusion, sundowning, paranoia, wandering, hiding and hoarding, catastrophic reactions, hallucinations, delusions, hyperorality 15. Define reality orientation and describe its possible effect on individuals with cognitive impairment 16. Identify environmental factors that affect the individual with cognitive impairment 17. Describe basic underlying principles of care, including encouraging remaining skills, simplifying and breaking down tasks, eliminating choices, providing encouragement, and establishing daily routines E. Mental Health and Social Service Needs hours 1. Describe the various behavior patterns residents display, the rationale for these patterns, and the appropriate response 2. List ways the nurse aide can assist with feelings of loneliness and sensory deprivation 3. Define ageism and list losses 4. Define self-worth, self-esteem, and stress as it relates to the nurse aide, resident, and family 5. Describe ways the nurse aide can use the resident s family as a source of emotional support 6. Describe methods of reality orientation 7. Describe memory changes and how they impact the resident s plan of care 8. List ways the nurse aide can recognize and intervene with confusion in a resident 9. Describe the nurse aide s role with social/activity staff 10. Describe the nurse aide s role in providing needed assistance in getting to and participating in resident and family groups and other activities page 12

15 F. Personal Care Skills hours 1. Describe and demonstrate the types of baths and the techniques for each 2. Describe and demonstrate skin care, perineal care, foot care, and care of the nails 3. Describe and demonstrate grooming measures, such as for the hair, mouth, and dentures 4. Describe and demonstrate dressing techniques used for special populations, such as those with resistive and/or combative behavior and physical disabilities 5. Describe and demonstrate the technique for administering the bedpan and urinal, and for care of the incontinent resident 6. Describe feeding techniques and hydration measures 7. Describe the warning signs that indicate a risk for unintended weight loss 8. Describe and demonstrate the technique and principles for making an occupied and an unoccupied bed 9. Discuss the nurse aide s role in preparing the resident for rest and sleep 10. Discuss the procedures for AM and PM care G. Basic Restorative Services hours 1. Demonstrate the appropriate techniques in transferring and ambulating, with or without assistive devices 2. Demonstrate the use of devices used during meals and dressing 3. Demonstrate appropriate techniques used in turning, positioning, and lifting a resident in bed (e.g., Fowler s, supine, prone, and lateral) 4. Demonstrate passive range of motion exercises 5. Demonstrate the proper technique used in applying and removing elastic stockings 6. Describe skin care for the prevention of pressure areas 7. Describe the maintenance of room temperature in the long-term care facility 8. Demonstrate the use of a manual and an electric bed 9. Describe the care and use of prosthetic and orthotic devices 10. Define bedrest, partial weight bearing, and dangling 11. Describe measures to prevent complications of bed rest using positioning and exercise 12. Describe the care of a resident who is receiving tube feedings, IV therapy, and G-tube feedings 13. Describe care and use of foot boards, trochanter rolls, handrails, bed cradles, trapeze bars, crutches, canes, and walkers 14. Describe the use of various mechanical lifts 15. Demonstrate the following positions: Fowler s, Semi-Fowler s, prone, and supine 16. Describe the care and safety of a resident receiving oxygen page 13

16 17. Define and discuss physical, speech, and occupational therapies as related to resident care 18. List non-verbal signs and symptoms suggesting pain 19. Describe and list comfort measures for residents with pain 20. Describe the goals and outcomes of rehabilitative services for resident independence 21. List members of the rehabilitative team and their role in promoting independence 22. Describe types of adaptive equipment used to promote resident independence 23. Describe and demonstrate the use of transfer (gait) belt 24. Describe bowel and bladder retraining protocol page 14

17 South Carolina Department of Health and Human Services Department of Facility Services, 7th Floor PO Box 8206 Columbia, SC Fax: APPLICATION FOR APPROVAL OF A NURSE AIDE TRAINING PROGRAM 1. Name of Training Institute or Corporation: 2. Name of Training Program (if different from name listed in number 1): 3. Training Program Code (if applicable): 4. Training Institute Address: Street: State: City: Zip: Phone (including area code): Fax Number: Address: 5. Training Program Address (if different from address listed in number 4): Street: State: City: Zip: Phone (including area code): Fax Number: Address: 6. Training Coordinator: Name/Title: Address: Phone (including area code): Address: page 15

18 7. Instructors: Primary Instructor: Classroom Instructors: Clinical Instructors: 8. Program Information: A. Total Program Hours: 1) Classroom/Lab Hours: 2) Classroom/Lab Schedule: 3) Clinical Hours: 4) Clinical Schedule: 5) Minimum/Maximum Number of Students Per Course: 6) Number of Classes Per Year: B. Clinical Contracts (name of long-term care facilities utilized for clinical training instruction, and dates of contract): Facility Name: Facility Name: Date: Date: C. Textbooks: Name/Edition: Author: Name/Edition: Author: 9. If classroom/clinical instruction is being provided entirely in a Medicaid-certified facility, is the designated classroom/clinical lab in compliance with licensure regulation R61-17, &13? Yes No Signature of School Official: Date: The course that is offered by this institution will meet the requirements established by the Division of Community and Facility Services of the Department of Health and Human Services. DHHS USE ONLY Reviewed by: Date: Course Number: page 16

19 South Carolina Department of Health and Human Services Department of Facility Services, 7th Floor PO Box 8206 Columbia, SC Fax: INSTRUCTOR RESUME FACT SHEET Name: Street: State: City: Zip: Address: Place of Employment: Business Address: Position Held: Home Phone Number: Work Phone Number: Degree: RN LPN # of Years as RN/LPN: Year of Graduation: Year of Graduation: Year of Graduation: School/College: School/College: School/College: DHHS USE ONLY Reviewed by: Approved: Yes No Date: page 17

20 List the names of long-term care facilities at which you have been employed as an RN/LPN, as well as dates of employment at each facility, and indicate if part-time or full-time (if part-time, please list the number of days and hours per week). Name of Facility Dates Employed Please indicate if position was full-time or part-time If part-time position, list number of days and hours per week. Days Hours 1. List specific job duties (attach separate page as needed): A. B. C. 2. List and describe employment in the care of the chronically ill: A. B. C. 3. List and describe home health care experiences: A. B. C. 4. Please attach a copy of your resume, SLED criminal background check, and current South Carolina nursing license. page 18

21 South Carolina Department of Health and Human Services Department of Facility Services, 7th Floor PO Box 8206 Columbia, SC Fax: Antiembolitic hose (Ted hose) CLASS/LAB EQUIPMENT SUPPLY LIST 21. Heel/elbow protectors 2. Bath basins 3. Bed linens/pillows 4. Bedpans (fracture and regular with covers) 5. Bedside commode 6. Call lights and/or tap bells 7. Canes (single/quad/or tripod) 8. Catheter equipment with drainage bag 9. Colostomy bag (other equipment for changing bag) 10. Crutches/walker 11. Dentures and oral cleaning supplies 12. Disposable briefs 13. Emesis basins 14. Face masks 15. Gait/transfer belt (man s leather belt) 16. Geri-chair or wheelchair 17. Gloves 18. Graduated measuring containers 19. Handrolls (commercial or rolled washcloth) 20. Handwashing supplies (sink, paper towels, soap) 22. Height/weight measuring equipment (includes standard scales) 23. Hospital gowns/isolation gowns 24. Hospital unit including bed with side rails, overbed table, and bedside table 25. Hot and cold compresses (commercial type) 26. Lap-n-lock and/or lap boards used with wheelchair/geri-chairs 27. Lift sheets (linen pads) 28. Mannikins (full body for medical teaching) 29. Shaving supplies 30. Specimen containers (urine, stool, and sputum) 31. Sphygmomanometers 32. Standard eating equipment (plate, cup, glass, fork, knife, spoon), non-disposable 33. Standard forms/flow sheets used for documentation by CNAs 34. Stethoscopes (regular and teaching) 35. Texas catheter 36. Thermometers 37. Urinals page 19

22 South Carolina Department of Health and Human Services Department of Facility Services, 7th Floor PO Box 8206 Columbia, SC Fax: Clinical Contractual Guidelines/Suggestions I. Nurse Aide Training Program Guidelines 1. The NATP will be responsible for all planned learning experiences as related to program objectives, and will provide appropriate faculty for this purpose. 2. The NATP is responsible for the initiation of the contract and the renewal of same annually. 3. The NATP shall provide the clinical facility with the schedule of the clinical rotation and the names of the students and instructor(s). 4. The selection of each student s assigned residents is to be made by the primary instructor of the program in cooperation with the designated facility liaison. 5. The assignments are to be posted on the appropriate unit 24 hours in advance of student arrival and contain each student s name as well as the names and room numbers of residents. 6. The LTC facility is to be notified prior to each clinical rotation. 7. The LTC facility is to be notified prior to the arrival of the DHHS evaluator(s) conducting the on-site evaluation. 8. The NATP will provide one (1) instructor for every eight (8) students in the clinical area. 9. The NATP will provide RN supervision for all LPN instructors assigned to supervise students in the clinical area. 10. Orientation to the LTC facility is to be the responsibility of the NATP instructor(s) and should include introductions to the appropriate clinical facility staff and input from them regarding specific rules and regulations for the students and instructor(s). 11. All student activities and care of residents is to be with approved instructor supervision. 12. Students are not to be assigned to facility staff to provide care or to receive instruction. 13. Instructors and students will wear uniform attire as designated by the NATP and will wear name tags that designate both their status as instructors or students and the name of the NATP. 14. The NATP is responsible for any and all accidents/incidents related to student activities. 15. The NATP will provide documentation of the required immunizations/tests and background checks for the instructor(s) and students. page 20

23 16. The NATP will abide by all policies and procedures mandated by the facility. 17. The NATP is responsible for notifying the facility of any change in schedule and for notifying the charge nurse of the need to reassign resident care in the event of a student absence. 18. The provision of resident information to students is the responsibility of the instructor(s). 19. The NATP is responsible for the selection of resident care to comply with the experiences that the students require. The selection of the unit utilized is to be made with joint approval by the NATP and the LTC facility. II. Long-Term Care Facility Guidelines 1. The LTC facility will provide space for the instructor(s) and students to store personal effects before and after conferences. 2. The LTC facility will assign a liaison/contact person to assist the program coordinator/ instructor in the coordination of the student s clinical rotation. 3. The LTC facility is responsible for notifying the staff of the rotation of students and the arrival of the DHHS evaluator(s). 4. The LTC facility will allow the DHHS evaluator(s) to review the residents charts prior to the evaluation and to observe the students performance of resident care, with the residents approval. 5. Students are utilizing the LTC facility for a learning experience and should not be utilized or requested to render care to unassigned residents. 6. The LTC facility will specify limitations with regard to the conduct of the nurse aide students during clinical rotation (e.g., no access to resident charts). 7. The LTC facility will designate the appropriate forms/flow sheets used for documentation by students with instructor supervision. 8. The facility must maintain compliance with the mandates of regulatory agencies and the South Carolina Department of Health and Environmental Control (DHEC), Bureau of Certification/Division of Long Term Care, to qualify as a clinical training site for any state-approved NATP. 9. The LTC facility is to maintain responsibility for the overall care of residents during all clinical rotations. 10. The termination of the contractual agreement is to be initiated by either party with reasonable advanced notification in order to permit the NATP to seek a contract with another LTC facility. page 21

24 South Carolina Department of Health and Human Services Department of Facility Services, 7th Floor PO Box 8206 Columbia, SC Fax: Student: SAMPLE SKILLS CHECKLIST/ CLINICAL COMPETENCY EVALUATION FOR NURSE AIDE Session Dates: Evaluator: Satisfactory Completion = (each facility decides on scores) CRITERIA FOR EVALUATION Consistently performs at exceptional level 5 Performs at high level 4 Satisfactory/expected level of performance 3 Marginal/minimal performance level; needs improvement 2 Unsatisfactory level of performance; unacceptable 1 Observed in lab Observed in clinical setting Rating Comments Performs effectively as a health care team member Recognizes signs and symptoms to report Shares observations Adheres to assigned tasks Assists other team members as needed Follows instructions page 22

25 Observed in lab Observed in clinical setting Rating Comments Reports and documents per agency policy Demonstrates knowledge of agency policies Demonstrates good personal hygiene Wears appropriate attire Demonstrates protection of patient s rights; uses privacy curtains Knocks before entering room Speaks in non-judgmental voice Assists with making choices Maintains confidentiality Addresses patients correctly Performs care in non-abusive manner Describes special needs and problems of aging individual Describes own feelings of death and dying Identifies needs of terminally ill patient Performs postmortem care Identifies stages of Alzheimer s Describes appropriate interventions with the confused client Assists with client s activities per POC page 23

26 Observed in lab Observed in clinical setting Rating Comments Assists with client s social needs per POC Assists with reality orientation of client Describes interventions for the sexually aggressive patient Demonstrates understanding of human sexuality Applies/releases restraints per policy and repositions patient Takes/records vital signs Demonstrates safety in the environment; responds to call system Implements fire drills Places call light in reach of patient Cleans spills promptly Provides comfortable environment Practices procedures to prevent spread of infection: Handwashing Handling linen Transporting linen Positioning catheter tubing Performing catheter care Utilizes good body mechanics in performance of tasks Positions patient in chair page 24

27 Observed in lab Observed in clinical setting Rating Comments Demonstrates knowledge of mechanical lift use Utilizes assistive devices as pillows and hand rolls for positioning patients Assists patient in ambulation Demonstrates use of walker or cane Assists patient with meals Describes special diets Describes nutritional needs of patients Assists patient with toileting needs Makes occupied bed Makes unoccupied bed Assists patient with dressing Assists patient with oral care Assists patient with hearing aid Assists patient with glasses Assists patient with dentures Assists patient with tub bath Performs bed bath Performs mouth/denture care Demonstrates ability to accurately: Measure and re c o rd fluid intake Measure and re c o rd food intake Measure and re c o rd fluid output page 25

28 Observed in lab Observed in clinical setting Rating Comments Documents in correct amounts (CCs, mls, or oz.) Observes and records bowel movements Measures and records height and weight of ambulatory, bed-confined patient Correctly uses abbreviations Correctly tests urine for sugar acetone Collects specimens for urine Collects specimens for stool Collect specimens for sputum Demonstrates understanding of bowel and bladder training Describes application of cold compresses Describes application of heat compresses Identifies skin care needs Prepares patient for rest and sleep page 26

29 Certificate of Completion This special honor is presented to Name of Student Upon Successful completion of the SC DHHS approved Nurse Aide Training Program provided by Name of Program Program Coordinator Number of Program Hours City, State Date of Completion