Nurse Aide Training Program Handbook

Transcription

1 Health Occupations Education In Cooperation with the NC Dept. Health and Human Services Division of Health Service Regulation Center for Aide Regulation and Education Nurse Aide Training Program Handbook Public Schools of North Carolina Department of Public Instruction Academic Services and Instructional Support Career and Technical Education July 2010

2 Nurse Aide Training Program Handbook Agnes Moore, RN, BSN HOE Nurse Aide Program Manager 6358 Mail Service Center Raleigh, NC Office: Fax: TABLE OF CONTENTS Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Introduction to Health Occupations - Nurse Aide Training 2 Forward Nurse Aide in Review and What's Ahead 4 Who Does What in Nurse Aide? Enrollment Memo To C&TE Administrators 7 Nurse Aide Training Program Eligibility Critieria*** Nurse Aide Training Master Outline / DHSR / CARE Supplements 11 Why Teach Nurse Aide Supplements? 12 Master Outline for Nurse Aide Training 17 Unit O Supplements Faculty and Program Coordinator Information Program Coordinator Information Program Coordinator Summative Primary Teacher Information Additional Teacher Information Supplemental Instructor Information Faculty Approval Request Classroom Training Laboratory Skill Acquisition Process Skill Acquisition is Muscle Memory! Skills Perspective / Curriculum vs NNAAP Nurse Aide Training Laboratory Requirements and Layout Equipment Required for NA Training per DHHS/DHSR/CARE Skills to be Mastered in the Lab (MSSS Part I and II) Optional Worksheet for Documenting Class Skill Mastery Clinical Experience Information 49 Student Clinical Preparation Checklist 50 Criminal Background Checks - Policies 53 Healthcare Personnel Vaccination Recommendations 54 Varicella - Chicken Pox Assessment 55 Clinical Experience Options for AHSII/Nurse Aide 56 Clinical Site Planning 57 Clinical Site Change Request 58 Clinical Time Summary 59 Nurse Aide Clinical Supervision 62 Board of Nursing on Supervision of Nurse Aide Students 63 HOE Student Nurse Aide Function / HOE Observation Function 65 Cell Phone Use in the Clinical Area 66 Emergency Action Plan

3 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter Clinical Rotation Schedule - Template (Excel) Clinical Rotation Schedule - Template (Word) Skills for Clinical Site - MSSS Part III Journaling in the Nursing Home Journaling in the Nursing Home - Writing a Paragraph Health Agency Affiliation Agreement (from AHSII SC CD 2000) NACES Evaluation Ordering NNAAP / PearsonVUE Candidate Handbooks Purchasing Vouchers for NNAAP from Pearson VUE Completion of Nurse Aide Training - Requirements*** Completion of Nurse Aide Training Certificate - Template 1 Completion of Nurse Aide Training Certificate - Template 2 NNAAP Application Hardcopy - Instructions NNAAP Application NNAAP Online Application DHSR Memo: New Online Testing Application and Fee Changes Candidate Identification Requirements for the NNAAP Exam Atypical Social Security Cards FYI In-Facility Test Site Process In-Facility Test Site Application Criteria for Testing Rooms Equipment/Supply Requirements for NNAAP Exam/Evaluation NNAAP Results - How They are Obtained Pearson VUE Letter Regarding Passwords and Account Login Guidelines COMPLAINT PROCESS for NACES testing PearsonVUE Results for North Carolina - Summary Accountability Class File Checklist Student File Checklist HOE/Nurse Aide Instructional Make Up Plan AHSII/Nurse Aide Training Verification Form for Nurse Aide Training Program Audit/Review Process Nurse Aide Training Program Audit/Review SAMPLE REPORT Helpful Tools Handling Challenging Situations in NA training - Attitudes Parent Contact Log Handling Challenging Situations in NA training - Pregnancy Media Resources "Why Do They Do That?" by Teepa Snow Good Hair Day (Inspirational) Who Will Help Me? (Inspirational) NCDPI Nurse Aide Webpage DVD Order Form DHSR / Health Care Personnel Registry Section Webpage DHSR Nurse Aide I Registry Webpage DHSR Licensed Facilities Webpage NC Board of Nursing Website PearsonVUE Nurse Aide I Webpage for Test Takers Faculty and Program Coordinator Information Completing and Printing the NA Training Program Application Nurse Aide I Training Program Application Updates and Memos 145 DHSR - CARE Newsletter / Vol.1 Issue 1 May/June National Practitioner Data Bank - HIPDB 150 Using Bookmarks to Navigate PDF NA Handbook

4 Chapter 1 AHSII / NURSE AIDE TRAINING 1

5 AHSII / Nurse Aide Training Program Forward North Carolina Health Occupations Education teachers have the opportunity to offer Nurse Aide Level I training to qualified students. The Department of Public Instruction signed a Memorandum of Understanding (MOU) with the North Carolina Division of Health Service Regulation that gives management responsibility for Nurse Aide Level I training of Allied Health Sciences II completers to the Health Occupations Education Nurse Aide office. Nurse aide training within Allied Health Science II is optional. You may offer this option to some, all, or none of your students. In view of recent Perkins IV legislation and continued emphasis on the credentialing of students, local education units and schools should give serious consideration to offering nurse aide training as an option. In fact, student credentialing is a significant criteria for North Carolina s accountability plan to justify some of the funding. Currently, in Health Occupations, Nurse Aide certification is the primary credentialing opportunity for our students. Increasing the numbers of students who receive certification is extremely important. The sole purpose for AHS II Nurse Aide Training Programs is to provide nurse aide training. Competency evaluation is done by Pearson VUE, a nationally recognized provider of assessment services. Pearson VUE, together with the National Council of State Boards of Nursing, Inc., has developed the National Nurse Aide Assessment Program (NNAAP TM ) to meet the nurse aide evaluation requirement of federal and state laws and regulations. Nurse Aide Competency Evaluation Service (NACES) works with Pearson VUE to score and report the results of the NNAAP TM Examination for the North Carolina Nurse Aide I Registry. Third party testing began July 1, Candidates receive a hardcopy of the faxed pass/fail report on the day of testing while at the test site. Quarterly reports are sent to the training facility. The candidate s results can also be viewed on the Pearson VUE Business Intelligence Portal. Instruction on how to access reports on the Pearson VUE Business Intelligence Portal will be given later in this handbook. Teachers should share the NACES competency test results with CTE Directors/Coordinators. This data can be used in the CTE Director s local plan. Teachers should do everything possible to encourage students to follow through with competency testing so that the credential is achieved. Perkins IV (2006) reads, Core indicators for secondary students shall include: a proficiency credential in conjunction with a secondary diploma. Funding is tied to meeting Perkins indicators. You will receive confirmation from the nurse aide office as soon as your program is approved. If you have not received a notification within 3-4 weeks after submitting your application, call the DPI nurse aide office at or amoore@dpi.state.nc.us. Much of the communication during the year, including program approval confirmations, is done via . This nurse aide handbook contains a wealth of information and should be read thoroughly and kept in close proximity for reference. Clarifications and changes are communicated throughout the year via the nurse aide e-group. It is your responsibility to stay abreast of updates. You are encouraged to use Chapter 10 in the back of the nurse aide handbook for s and updates. Revised awm 2

6 NA in Review and What s Ahead NCHOE/Nurse Aide training programs have just completed the fourth year of state competency testing. North Carolina has renewed the contract with PearsonVUE so our relationship with PearsonVUE and NACES will continue. Many HOE/nurse aide teachers have discovered the benefits of participating in in-facility testing and working as nurse aide evaluators (NAEs). A big thank you goes to those who went the extra mile to provide in-facility testing (IFT) for students! As of , 62 high schools have been identified as IFT sites. This has been another year of economic challenge and uncertainty. However, our mission of training caring and competent health care workers has not wavered. According to the State of NC Workforce Assessment of the State s Labor Force 2007 to 2017, the need for Home Health Aides is expected to rise 3.9% by The need for Nurse Aides is expected to grow 2.5% by Nurse aide competency certification makes it possible for some to secure jobs and serves as a pathway to higher education for others. There have been significant improvements in compliance with standards for equipment and supplies. Seventy-five Health Occupations Education Nurse Aide Programs were reviewed on location between January, 2010 and May, Some stipulations were sited but overall training program compliance is improving. Many CTE Directors have been a part of the program audits. This has resulted in an increased understanding of nurse aide training regulations and increased rapport will be the pilot year for Health Science II and Nursing Fundamentals. The course description for Nursing Fundamentals reads as follows: Course Number: NAXXX Fixed Maximum Enrollment: 10 Recommended Hours of Instruction: (Two units of credit) Prerequisites: Health Science I and Health Science II Nursing Fundamentals is designed for students who are interested in medical careers where personal care and basic nursing care skills are used. This course is an enhanced adaptation of the North Carolina Division of Health Service Regulation Nurse Aide I curriculum. Students who successfully complete the course will be prepared to take the National Nurse Aide Assessment Program (NNAAP) competency exam for Certified Nurse Aide I. Clinical internship in a long term facility is required. Health care clinical sites may require tuberculosis and/or drug screenings, evidence of immunizations, and criminal background checks. HOSA activities support networking with health care agencies and professionalism through the development of clinical expertise and volunteerism. PearsonVUE will be implementing an online application for candidates effective July 1, You will receive a letter from PearsonVUE about these changes. As always be sure you are using the most recent NACES documents. Thank you for preparing students to care for the most vulnerable and most needy! 3

7 Who Does What in Nurse Aide Division of Health Service Regulation Health Care Personnel Registry Section Center for Aide Regulation and Education The National Nurse Aide Assessment Program National Council of State Boards of Nursing Pearson VUE Nurse Aide Competency Evaluation Service Plus Foundation Reviewed for inclusion by Kris Winning , DHSR CARE NNAAP NCSBN Pearson VUE NACES This state agency has been given authority by the Board of Nursing to regulate Nurse Aide I training and registry in North Carolina This examination program is designed to determine minimal competency required to become listed on the registry as a Nurse Aide I Developers of the NNAAP competency examination designed to meet the nurse aide evaluation requirement of federal and state laws and regulations Pearson VUE is the authorized administrator of the NNAAP in North Carolina. This company scores, and reports the results of the NNAAP Examination to NC Nurse Aide I Registry This company contracts with Pearson VUE to administer the NNAAP written and skills examinations North Carolina nurse aide candidates 4

8 DATE: 07/17/2009 TO: FROM: Career and Technical Education Administrators Rebecca Payne, State Director, Career and Technical Education Mary Jo Nason, Interim Section Chief, Curriculum Re: Allied Health Science II/Nurse Aide Class Enrollment For students to deliver safe, competent personal care in a sound educational environment and maintain good relationships within the medical community, enrollment expectations must be met. Enrollment Standards Recommended classroom enrollment cap is 16 for Allied Health Sciences II. (Standard Course of Study) The North Carolina Board of Nursing Administrative Rule 21 NCAC (i) requires the ratio of one teacher to 10 Nurse Aide students or less while in the clinical area. (i) Nurse faculty members shall be sufficient in number to implement the curriculum as demanded by the course objectives, the levels of the students, and the nature of the learning environment, and shall be sufficient to provide for teaching, supervision and evaluation. The faculty-student clinical ratio shall be 1:10 or less for Nurse Aide students. Health Occupations Education (non Nurse Aide) students must have clearly delineated supervision. Classes with 16 or less students enrolled Allied Health Sciences II/Nurse Aide programs with one full time teacher must limit enrollment to 16 in one section and provide adequate supervision for both Nurse Aide and non Nurse Aide students for Nurse Aide program approval to occur. The Nurse Aide teacher who has Nurse Aide students in the clinical area cannot leave those students to physically monitor other Health Occupations Education students in separate observational areas. Schools may utilize medical facility personnel to supervise Health Occupations Education (non Nurse Aide) students when appropriate and approved arrangements are made between the school and the medical facility. In situations where appropriate and approved medical facility supervision for non Nurse Aide students is not possible, additional faculty, local education agency employee approved by the host medical facility, must be provided to monitor Health Occupations Education students in observational areas while Nurse Aide students are simultaneously in long-term type care facilities with the other teacher. CAREER AND TECHNICAL EDUCATION DIVISION Rebecca Payne, State Director rpayne@dpi.state.nc.us 6358 Mail Service Center, Raleigh, North Carolina (919) Fax (919) AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER 5

9 Classes with more than 16 enrolled As the enrollment number increases, so do the responsibilities of the instructor to ensure that every student entering a clinical facility can provide safe, competent, and quality care to clients. Allied Health Sciences II/Nurse Aide classes with an enrollment greater than 16 will require an additional teacher. Schools may utilize medical facility personnel to supervise Health Occupations Education (non Nurse Aide) students when appropriate and approved arrangements are made between the school and the medical facility. In situations where appropriate and approved medical facility supervision is not possible, additional faculty, local education agency employee approved by the host medical facility, must be provided to monitor Health Occupations Education students in observational areas concurrently while Nurse Aide students are in long-term type care facilities with the other teacher. For more information or technical assistance contact Agnes Moore, Nurse Aide Program Manager at or amoore@dpi.state.nc.us. C: Greg Gift Regional Coordinators Joan Thompson Agnes Moore 6

10 Nurse Aide Training Program Eligibility Criteria Criteria #1 TRAINING PROGRAM SCHEDULING & ENROLLMENT Nurse aide training should be scheduled at a time that allows for adequate clinical experiences Morning classes provide better personal care opportunities to apply nurse aide skills Afternoon classes should be avoided if at all possible. If afternoon classes are scheduled, care must be taken to assure adequate skill application opportunities for students. 16 is the absolute enrollment limit for one section/class of AHSII/Nurse Aide Refer to memo to Career and Technical Administrators from Rebecca Payne, CTE Director and Mary Jo Nason, Section Chief Curriculum Re: Allied Health Science II/Nurse Aide Class Enrollment (10 is the absolute enrollment limit for the Nursing Fundamentals PILOT) There are no exceptions Criteria #2 FACULTY Teachers must be approved by the DPI/HOE/Nurse aide office Registered Nurse, with unencumbered license, licensed to practice in North Carolina Minimum of two years work experience as a registered nurse Completed a course in teaching adults or experience in teaching adults or experience in supervising nurse aides Teachers must be present and teach the nurse aide class 90 % of the total class time Faculty must be adequate for the enrollment of the AHSII/Nurse Aide class 16 is the absolute enrollment limit for one section/class of AHSII/Nurse Aide 10 is the absolute enrollment limit for the Nursing Fundamentals pilot There are no exceptions Criteria #3 HOE SCOPE/SEQUENCE HOE scope and sequence is clearly followed as outlined in the Programs of Study in regard to course content, sequence and satisfaction of recommended prerequisites. Inclusion of NA I competency instruction as outlined by the Division of Health Service Regulation/Center for Aide Regulation and Education and the Department of Public Instruction is apparent. Use of current HOE curriculum guides, course blueprints and test item banks for AHS I or (MS I) & AHS II apparent Master Skills Summary Sheet Part II (MSSS Part II) completed Master Outline completed with special attention to Unit O supplemental materials that must be taught for nurse aide training Criteria #4 PROGRAM TRAINING LABORATORY Simulated patient care unit, equipment and supplies outlined in the DHSR list are readily available to the students for skill acquisition, refinement, and retention. Simulated patient care unit includes bed, hanging curtains with 360 privacy, bedside stand or functional equivalent, bedside chair, over bed table in an area of at least 100 square feet for one bed and 80 square feet for two beds Hanging curtains must be substantial and functional Sink in the laboratory with hot and cold running water Consumable supplies adequate, organized, easily accessible for practice Equipment functional, safely stored, accessible for practice Students must demonstrate 100% skills proficiency in all 69 curriculum skills prior 7

11 to direct patient contact. Master Skills Summary Sheet Part I (MSSS Part I) must be completed in ink and filed in each nurse aide student s individual file (MSSS Part I) must be kept current during skills acquisition time (MSSS Part I) must be totally completed prior to direct hands on care of patients (MSSS Part I) is a legal document showing proof of skill proficiency Curricular skills performance sheets are used in the lab for skill acquisition. A set of curricular skills must be kept in the class file for each year of nurse aide students Teacher must teach from the most current skills performance sheets available Students are given a score in the grade book for skills demonstrated in the training lab Skills in the NC Nurse Aide I Candidate Handbook are NOT taught as the standard of care. These skills are used in competency evaluation preparation only. NNAAP skills represent minimal competence and do not represent the standard of patient care Criteria #5 CLINICAL TRAINING Required immunizations and other preparation required by the host medical facility completed prior to clinical experience Use of approved clinical facilities evident Constant on unit direct supervision of 10 students or less by 1 teacher Emergency action plan for students to follow when a student on the clinical floor needs immediate (stat) assistance 40 hours of long term care as outlined in one of the four options for clinical Students demonstrate proficiently the subset of skills required by DHSR in the clinical area and same documented on the MSSS Part III Criteria #6 COMPETENCY TESTING FOLLOW UP Teacher completes certificate of completion of nurse aide training after all nurse aide training requirements are met Teacher monitors the application to test Teacher can access Pearson VUE Business Intelligence Portal results of competency testing Teacher reviews Pearson VUE reports and adjust teaching strategies accordingly Sends Pearson VUE quarterly reports to local CTE Director Criteria #7 TEACHER S UITLIZATION OF NURSE AIDE TRAINING RESOURCES Teacher has/uses a current hardcopy of the nurse aide handbook Teacher has/uses a current hardcopy of NC Nurse Aide I Candidate Handbook Teacher is able to access the nurse aide resources on the NCPublicSchools.org website Teacher receives, reads, and saves for future reference, group s from the Nurse Aide Program Manager Criteria #8 MAINTAINANCE OF RECORDS Student records and class files locked in a file cabinet Individual file or individual section of a notebook kept for each student completing nurse aide training per handbook instructions Class file for each section of AHSII/Nurse Aide training Records retained for five years and destroyed per HIPAA guidelines after that time 8

12 Criteria #9 NOTICE OF TRAINING PROGRAM CHANGE The approved training program faculty and/or administration is responsible for notifying the nurse aide office immediately when program changes occur Such changes include but are not limited to: faculty, clinical sites, location changes, school schedule changes that affect nurse aide training, program coordinator, principal, and CTE Director Revised awm 9

13 Chapter 2 MASTER OUTLINE & SUPPLEMENTS FOR NURSE AIDE TRAINING A copy of the completed Master Outline and Supplements should be placed in the CLASS FILE for each section of nurse aide training. Completed means that the teacher signs and dates the Master Outline and Supplements after each unit is taught. 10

14 Circle A = Allied Health Science II NCDPI Curriculum Circle A Employability Skills, Dental / Pharmacy Skills, Information Services, and Environmental Medical Skills. When the NCDPI Allied Health Science II curriculum is taught as outlined in the blueprint and the curriculum guide, approximately 85% of DHSR nurse aide curriculum is taught. To satisfy all requirements for state approved nurse aide training, additional competencies must be taught! COMPETENCIES MUST BED TAUGHT. See below... Supplemental Materials found in UNIT O must be taught to complete nurse aide training. Unit O includes restorative care, mental health, death and dying, legal/ethical, and foot care. Circle B Circle B = DHSR State Approved Nurse Aide Curriculum 11

15 Unit/ Comp #/Obj. AHSII / Nurse Aide Training Program Nurse Aide I Master Outline TEACHER SHOULD DATE EACH UNIT AS IT IS COMPLETED, AND SIGN WHERE INDICATED TO VERIFY THAT THE UNIT HAS BEEN COMPLETELY TAUGHT. This outline includes the basic AHSII curriculum PLUS supplemental materials needed to fulfill nurse aide training. Follow the AHS II course outline/blueprints and include all additions noted within this outline. NNAAP skills are listed in bold/italics. Some areas have additional supplemental materials which are listed in the reference column. Textbook(s) used for NA I instruction should be no older than five years. Recommended Materials/Resources: Alvare, Dugan, Fuzy. Nursing Assistant Care. Hartman Publishing, (latest edition). Simmers, Louise. Diversified Health Occupations. Delmar Publishers, (latest edition). Sorrentino, Sheila. Mosby s Textbook for Nursing Assistants, (latest edition). DHHS, DHSR. Model Curriculum NA I Training Program (supplement included). AHS II Course Outline Nurse Aide Requirements Skills for NA Certification Reference Additions Unit A Health Care Systems Entire Unit None None Unit A instruction completed on this date: Unit B Client Communications Analyze effective/ineffective communication practices Signature of teacher: Entire Unit Documenting on + medical records Demonstrates ability to communicate effectively with residents who have: Difficulty hearing Difficulty seeing Difficulty speaking Depression Confusion Memory loss Communicates based on resident s stage of development Unit B instruction completed on this date: Signature of teacher: Unit C Employability Skills None None None Unit C instruction completed on this date: Signature of teacher: Unit D Legal/Ethical Entire Unit + None Responsibilities Participates in Resident Analyze legal roles and Council. responsibilities Identifies what is considered mistreatment of elderly. Supplement From NAI State curriculum Included in this HOE 12

16 Explains role of advocate and facility s grievance policy. Assists in resolving grievances when appropriate. Nurse Aide handbook Unit D instruction completed on this date: Signature of teacher: Unit E Safety Practices Entire Unit Observing fire safety Using body mechanics Unit E instruction completed on this date: Signature of teacher: Unit F Infection Control Entire Unit Hand washing + Standard Precautions (Don New skills listed and Remove Gown) Maintaining isolation technique Disposing of equipment from Unit With Transmission- Based precautions Unit F instruction completed on this date: Signature of teacher: Unit G Emergency Care Skills Entire Unit Performing CPR, one person Performing CPR, two person Performing CPR, infant and child Airway obstruction: conscious victim Airway obstruction: unconscious victim Demonstrating the use of an AED Unit G instruction completed on this date: Signature of teacher: Unit H Diagnostic Skills Cont. Entire Unit + Measures/records oral temp. using a glass thermometer Additional skills listed Measuring/recording temperatures electronically (oral, axillary, rectal) Measuring/recording a tympanic temperature Measuring/recording a radial pulse Measuring/recording respirations Measuring/recording blood pressure 13

17 Measuring/recording apical pulse Measuring/recording height Measuring/recording weight Unit H instruction completed on this date: Signature of teacher: Unit I Nutrition and Entire Unit + Feeds Client Who Diet Therapy Cannot Feed Self Food Guards Measuring/recording Recognizes adaptive Divided plates intake and output devices used to assist Built-up handled Measures/Records patients with eating. utensils Urinary Output Easy grip Identifies alternate mugs/glasses methods of feeding Parenteral feeding Enternal feeding Nasogastric/gastrostomy tubes NA responsibilities 2005 Food Guide Pyramid Unit I instruction completed on this date: Signature of teacher: Unit J Dental/Pharmacy Skills None None None Unit J instruction completed on this date: Signature of teacher: Unit K Nursing Skills Entire Unit Making/Opening closed bed Making an occupied bed + Provides Mouth Care Additional skills listed Cleans & Stores Dentures Giving special mouth care Giving a back rub Complete bed bath Foot care see Provides Perineal Care supplement. Provides Foot Care Provides Fingernail Care Dresses Client with Affected Arm Helping patient with a tub bath/shower Gives Modified Bed Bath (Partial) Shampooing hair in bed Shaving a patient Assisting with a bedpan Assisting with a urinal Assisting to bedside commode Assisting to bathroom Obtaining a routine urine specimen Collect specimen under Transmission-Based precautions Collect stool specimen Empty a urinary drainage unit Provides catheter care Applying/caring for condom 14

18 catheter Administer a cleansing enema Transfers Client bed to wheelchair Transferring to a stretcher Applying restraints Turns/positions with & w/o turn sheet Transferring with mechanical lift Positions Client On Side Moving patient up in bed Puts On Knee-High Elastic Applying warm/cold applications Applying elastic bandages Applying non-sterile dressing Assisting with cough/deep breath exercises Unit K instruction completed on this date: Signature of teacher: Unit L Therapy and Sports Medicine Entire Unit Performs Passive Range of motion (One Knee/One Ankle) & (Shoulder) Ambulation with a walker/cane Ambulation with a gait belt Unit L instruction completed on this date: Signature of teacher: Unit M Information Services None None None Unit M instruction completed on this date: Signature of teacher: Unit N Environmental/ Medical Careers None None None Unit N instruction completed on this date: Signature of teacher: Unit O Restorative Care Assist with care/use of prosthetic devices None Artificial eye Eyeglasses Contact lenses Hearing aid Braces Artificial limbs Breast forms Prevention of pressure ulcers Identify devices/care used to prevent pressure ulcers Review 4 stages of tissue Supplement From NAI State curriculum Included in this HOE Nurse Aide handbook 15

19 breakdown Areas pressure ulcers most frequently occur Unit O Mental Health and Social Needs Psychological Effects of Aging Identifies basic human needs and ways to meet those needs for resident Identifies developmental tasks of aging Identifies defense mechanisms residents may use in response to stress Encourages age appropriate behavior for all people Recognizes family s role in resident s emotional support Identifies ways that age, illness, and disability affect sexuality Lists symptoms displayed by residents with dementia Identifies special needs when caring for resident with Alzheimer s disease Demonstrates use of reality orientation skills Identifies skills needed to care for emotionally stressed/ demanding/ agitated/paranoid thinking and depressed residents PLUS SUPPLEMENTAL CONTENT Unit O Death/Dying Identifies special needs of dying resident and nurse aide s role Describes psychological stages of grief/loss/death Identifies signs of approaching death Respects resident s religious beliefs Considers family and attempts to meet their needs as they encounter dying process Describes hospice philosophy None Perform Postmortem care Supplement From NAI State curriculum Included in this HOE Nurse Aide handbook Unit O instruction completed on this date: Signature of teacher: Remember to review diseases/disorders of the body systems throughout the year as related information from AHS I will be included on the NA I exam. 16

20 CNA SUPPLEMENT - 1 Mental Health and Social Needs Objective: Recognize how age, illness, and disability affect sexuality. Expressed by individuals of all ages Ways to show feminine or masculine qualities o Clothing styles and colors o Hairstyles o Hobbies and interests o Sexual habits (continue into old age) o Gestures Forms of sexual activity o Sexual intercourse o Caressing, touching, holding hands o Masturbation Patients have the right to be involved in sexual activity Guidelines for the nurse aide o Assist in maintaining sexual identity by dressing patients in clothing appropriate for men or women o Assist with personal hygiene as needed o Assist patients to prepare for special activities by dressing up Select attractive clothing Style hair in a special way Apply cosmetics Assist in application of special perfume or aftershave o o Help patients to develop a positive self image Show acceptance and understanding for patient s expression of love or sexuality Provide privacy Knock prior to entering a room Assure privacy when requested o Avoid exposing the patient o Accept the patient s sexual relationships o Provide protection for the non-consenting adult o Be firm but gentle in your rejection of a patient s sexual advances Injury and illness effects on sexuality o Disfiguring surgery may cause a person to feel: Unattractive and ugly to others Mutilated and deformed Unworthy of love or affection o o o Chronic illness and certain medications can affect sexual functioning Disorders that cause impotence Patients with diabetes Spinal cord injuries Multiple sclerosis Alcoholism Surgery can have both physical and / or psychological Discuss appropriate reactions of health care personnel to various sexual activities performed by patients. Instructor will discuss ways to deal with the sexually aggressive patient. Have the class consider the various illnesses and injuries that affect sexuality. 17

21 o effects on sexuality Removal of prostate, testes, uterus, ovaries, breast. Colostomy or ieostomy Disorders affecting the ability to have sex Stroke Nervous system disorder Heart disease Chronic obstructive pulmonary disease Circulatory disorders Arthritis or conditions affecting mobility and or flexibility Date of Completion: CNA SUPPLEMENT - 2 Legal / Ethical Objective: Explain the purpose and value of a patient council. Teacher Signature: Patient Council Advisory Group Provides opportunity for discussion May make recommendations for: o Facility policy o Decisions regarding activities o Exploration of patient s concerns o Resolving grievances Gives patients a voice in facility operations Members include patients, facility staff members, and representatives from the community Objective: Assure patient s freedom from abuse, mistreatment, neglect, diversion of drugs, fraud, or misappropriation of property. Mistreatment of the Elderly Federal and state definitions: o Abuse means the willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm pain or mental anguish. o Neglect means a failure to provide goods and services necessary to avoid physical harm, mental anguish or mental illness. o Misappropriations of property mean the deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a patient s belongings or money without the patient s consent. o Diverson of drugs means the unauthorized taking or use of any drug. o Drug means any chemical compound that may be used on or administered to humans or animals as an aid in the diagnosis, treatment or prevention of disease or other condition or for the relief of pain or suffering or to control or improve any physiological pathological condition. o Fraud means an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized Invite a member of a patient advisory group to speak. 18

22 benefit to him or some other person. It includes any act that constitutes fraud under applicable federal or state law. Patients Right to be Free From Abuse o Physical o Verbal o Sexual o Mental o Corporal Punishment o Involuntary Seclusion Signs of Abuse o Fractures o Bruises of face, upper arms, upper thighs, abdomen o Fearfulness o Withdrawn, paranoid Examples of Abuse o Threatening a patient o Frightening a patient o Pinching, slapping, pushing or kicking a patient o Withholding food or fluids o Restraining a patient against her/his will without an apparent reason o Leaving a patient in soiled linen or clothing o Yelling angrily at or making fun of a patient o Refusing to reposition a patient or give treatment o Not answering a call light/bell/signal o Humiliating a patient o Making disparaging derogatory remarks o Sexual coercion o Sexual harassment o Verbal harassment Advocates o Plead the cause of another o Resolve grievances o Protect patient s rights o Advocates can be: Health care workers / staff Member of a patient s family/support system Patient s guardian Ombudsman o Patient s Right to Voice Grievances concerning Services furnished Services not furnished Behavior of others Nurse aide must report grievances to nurse manager o Facility Policy Components Acknowledgement of grievance Attempt to resolve grievance Apprise patient regarding grievance resolution Teacher Signature: Date of Completion: Role play appropriate responses to behavior Review NC law and federal regulations regarding abuse Review facility grievance policy Suggest a patient grievance that might occur and role play you would help resolve the situation. 19

23 CNA SUPPLEMENT - 3 Restorative Care Objective: Assist in care and use of prosthetic devices. Course Content Artificial Eye (glass eye) Encourage patient to remove, clean and replace eye prosthesis if able and necessary. Regular removal of the prosthesis is not always recommended unless there are problems or discomfort. (Nursing Assistant Care by Alvare, Dugan and Fuzy 2005.) Some artificial eyes are surgically implanted. (NAC) If eye is removed it should be stored in an eye cup or basin with a soft cloth or a piece of 4 x 4 gauze and filled with saline or water to prevent deposits from drying on the surface. Close the container, and label with the resident s name. (NAC) Artificial eyes are held in by suction. (NAC) They will come out quickly when pressure is applied below the lower eyelid. (NAC) Artificial eyes may be washed in mild soap and warm water. (NAC) You may rub it with moist gauze to remove surface secretions. (NAC) Rinse well. (NAC) If the eye is removed, wash the eye socket with warm water or saline. Use a clean 4 x 4 gauze to clean it. Clean the eyelid. Wipe from the inner corner outward. Eyeglasses Made of plastic or glass Stored in protective case to prevent damage when not in use. Hold and handle by the frames Wash under running water using mild detergent. o Rinse well with water o Dry with tissue or soft cloth Observe tops of ears and nose for redness or irritation from glasses. Report such findings. Wash hands before and after cleaning patient s glasses. Contact Lens (hard or soft) Encourage patient to care for lenses. Report any unusual observations. o Redness, itching, swelling, complaints of pain, blurring or scratching sensations. Hearing Aid Ear piece is cleaned daily with soap and water. This is the only washable part. Ear piece and tubing should be soft. Special equipment is needed to clean wax from tubing. Batteries should be checked for power. Observe skin for redness or irritation in or around the ear. Report such findings. Report ear wax build-up to the licensed nurse. To remove a hearing aid: Learning Activities Have students collect necessary supplies for washing, and storing a prosthetic eye. Use marbles as eyes. Provide guided practice as students wash and store the eye. Provide feedback as needed for skill refinement. Have students practice cleaning eye glasses or sunglasses. 20

24 o Turn the volume to lowest level or off. o Gently lift ear piece up and out to the ear. o Use tissues to wipe wax off ear piece. Applying a hearing aid o Turn volume toward maximum, until hearing aid whistles. Then, lower volume until whistling stops. o Replace batteries if whistle cannot be heard. o Gently insert ear piece into ear canal and adjust for comfort. o Tubing and body of hearing aid are looped over the ear for over-the-ear models. o Adjust volume to patient s satisfaction. Ask patient to show students how to test batteries for his/her hearing aid. Discuss ways to avoid loss of hearing aids. Braces Support a weak part of the body Prevents movement of a joint Correct deformities Prevents deformities Made of metal, leather, and or plastic Bony parts under brace require protection in order to prevent skin irritation. Report any worn, loose, or missing parts. Check custom fitted shoes for: o Broken shoe laces o Worn heels or soles o Worn or torn leather o Odor or stain damage from perspiration Amputation Definition the partial or complete removal of a body part. o Usually an arm or leg o For the leg, below the knee amputation is the most common Some prosthetic devices include artificial arm, foot, arm, and hand. Prosthetic devices are custom made to fit the individual patient. Handle device with care and store in appropriate place when not in use. When assisting residents with artificial limbs: o Have the correct device for the correct patient o Check all parts for damage o Evaluate the resident s limb for irritation and swelling o Assist in padding the area of prosthesis touching the patient s skin o Clean the prosthesis according to individual instructions o Report any needed repairs to the licensed nurse o Observe and report any skin changes to a licensed nurse Teacher Signature: Date of Completion: Suggest areas of body where a brace might be applied. Show braces used most often such as a leg brace for patients suffering from a stroke. Assign the class short reports to be researched and given orally on a fictitious patient with a below the knee amputation. Discuss the different types of artificial limbs. 21

25 CNA SUPPLEMENT - 4 Foot Care Objectives: Discuss the care of the resident s nails and feet List three purposes of nail/foot care Identify factors to be considered when giving a resident nail care Foot care is required daily and includes cleaning the feet and assuring that the toenails are trimmed and smooth Patients with diabetes have a particular need for foot care to be performed consistently Toe nails should be kept short, clean, free of rough edges Purpose of nail and foot care o Prevent infection o Prevent injury (long toe nails can get caught up in bed linens) o Prevent odors General guidelines o Trimming nails after soaking feet makes trimming easier o Nail clippers should be used to cut/trim nails o Trim/clip nails straight across o Push back cuticle with orange stick after softening nails by soaking o Use file or emery board to smooth rough edges o Use care not to injury skin when clipping o Residents with diabetes and circular problems will have their nails trimmed only by a licensed nurse or podiatrist (foot doctor) o Review resident care plan and check with supervisor prior to trimming nails Foot care procedure o Wash feet using warm water and mild soap o Dry feet carefully, especially between the toes o Apply lotion to the tops and bottoms of feet only; not between the toes o Check the feet daily for redness, warmth or constant pain, numbness or tingling, dry, cracked skin, swelling, blister, cuts, scratches, other sores, ingrown toenails, corns, calluses o DO NOT use a heating pad on resident s feet o Keep footwear on, never let resident go barefoot o Change socks and shoes daily o Foot injuries and infections can lead to gangrene and amputation, especially in patients with diabetes o Notify supervisor immediately of any unusual observations of the feet Demonstrate nail care Show pictures of patients with gangrene secondary to foot injury and diabetes Facilitate students to perform foot/nail care on each other in class Teacher Signature: Date of Completion: DFS curriculum incorporates information from the 2005 Food Pyramid and Dietary Guidelines for Americans. See website: 22

26 Chapter 3 FACULTY & PROGRAM COORDINATOR INFORMATION 23

27 HOE/NA Program Coordinator Information Program Requirement Regarding PCs All HOE-NA programs must have a qualified Program Coordinator. The Program Coordinator Agreement Form must be completed as part of the program application and must be submitted to the nurse aide office with the program application. If a program does not have an instructor that meets the criteria for coordinator, a Registered Nurse that meets the criteria must be secured. Requirements Registered Nurse, with unencumbered license, licensed to practice in North Carolina Minimum of two years experience as a registered nurse At least one year experience (2,000 hrs. Full Time Equivalent) in the provision of long term care facility services demonstrated by: A. working in a long term care facility licensed as a skilled nursing facility or a skilled nursing facility* which is a distinct part of a hospital. *Skilled nursing facility is defined as: a nursing facility which is a distinct part of a hospital eligible for federal program certification under Medicare/Medicaid OR B. experience supervising or teaching of students in a long term care facility or a skilled nursing facility* which is a distinct part of a hospital. NOTE: Chronic care is not the same as long term care in a skilled nursing home. The Program Coordinator (PC), must have had good NA program audits, clear of stipulations if the PC teaches HOE/AHSII/Nurse Aide The PC may serve as PC for their individual program as well as other schools/programs in or out of county Responsibilities Ensures that the NCDPI/HOE/NA training policies/procedures are implemented and followed. Serves as a liaison between the HOE-NA Office, the school(s) and the LEAs. Designs a plan that reflects how the program(s) being covering will be monitored. PCs may hold periodic meetings with the program instructors, periodic phone checks, and or attend on site audits. Reads and applies the policies and procedures outline in the Nurse Aide Training Handbook and on the HOE e-group. Completes and submits a separate faculty application for Program Coordinator if the individual has never served as a PC. Submits a RN verification print out from the NC Board of Nursing Website. ALL instructors; primary, additional, supplemental and the PC must submit verification of an unencumbered RN license annually. Go to and click on Verify License. You may search by entering social the security number or the RN nursing license number. Print verifications for all teachers in your program and attach them to the program application. Completes a PC SUMMATIVE AGREEMENT FORM indicating all the nurse aide training programs the PC is responsible for. The electronic file of this form can be found on the summer conference program CD. 24

28 AHSII/Nurse Aide Training Program PROGRAM COORDINATOR (PC) SUMMATIVE AGREEMENT FORM Listed below are the high school nurse aide programs you have agreed to serve as program coordinator. Review/complete the list and notify the Health Occupations Education Nurse Aide office if you see an error or have a question. Call or amoore@dpi.state.nc.us Review/complete your personal information and correct any errors Sign and mail to: Agnes Moore, RN HOE/Nurse Aide Office 6358 Mail Service Ctr. Raleigh, NC (PC) Name Home Address Employer Work Address Work Work Phone RN License # Name of School (training program) County or School System Signature of Program Coordinator Date 25

29 AHSII / Nurse Aide Training Program HOE/NA Primary Instructor Requirements: Registered Nurse, with unencumbered license, licensed to practice in North Carolina. Minimum of two years experience as a registered nurse. Completed a course in teaching adults or experience in teaching adults or experience in supervising nurse aides. If provisionally certified, continue to work toward a clear teaching certificate. The Primary Teacher Agreement Form must be completed as part of the program application and must be submitted to the nurse aide office with the program application. Responsibilities: Serve as a contact person and disseminate information as needed to the program faculty and administration. Ensure that your school s nurse aide training program is in good standing. Confirm that a Registered Nurse instructs the AHSII/nurse aide training program at least 90% of the time. Report any instructor or clinical facility changes or additions to the HOE Nurse Aide office immediately! For example: teachers out on extended leave, teachers leaving their teaching post, new instructor(s) in the program. Assure that only approved nurse aide instructors sign the Application for Registration by Competency Evaluation. If a signature on the application is not an approved instructor, students will not be allowed to take the state competency evaluation. Facilitate the submission of completed student applications to test to PearsonVUE per PearsonVUE guidelines. Stay updated concerning nurse aide education matters by reading and applying the policies and procedures outline in the Nurse Aide Training Handbook and through participation in the HOE e-group. Encourage students to follow through with state competency evaluation and assist students as needed in the completion and submission of the NACES application. Complete and submit a separate faculty application. (FOR NEW TEACHERS ONLY) Submit a RN verification print out from the NC Board of Nursing Website. ALL instructors; primary, additional and supplemental must submit verification of an unencumbered RN license annually. Go to and click on Verify License. You may search by entering social the security number or the RN nursing license number. Print verifications for all teachers in your program and attach them to the program application. 26

30 AHSII / Nurse Aide Training Program HOE/NA Additional Instructor Requirements: Registered Nurse, with unencumbered license, licensed to practice in North Carolina. Minimum of two years experience as a registered nurse. Completed a course in teaching adults or experience in teaching adults or experience in supervising nurse aides. If provisionally certified, continue to work toward a clear teaching certificate. The Additional Teacher Agreement Form must be completed as part of the program application and must be submitted to the nurse aide office with the program application. Responsibilities: Help ensure that your school s nurse aide training program is in good standing. Help ensure that a Registered Nurse instructs the AHSII/nurse aide training program at least 90% of the time. Help in reporting any instructor or clinical facility changes for your program to the HOE Nurse Aide office immediately! For example: teachers out on extended leave, teachers leaving their teaching post, new instructor(s) in the program. Assist in the completion and submission of the Nurse Aide Application for Registration by Competency Evaluation to PearsonVUE. If a teacher signature on the application is not an approved instructor, students will not be allowed to take the state competency evaluation. Stay updated concerning nurse aide education matters by reading and applying the policies and procedures outline in the Nurse Aide Training Handbook and on the HOE e-group. Encourage students to follow through with state competency testing and assist students as needed in the completion and submission of the NACES application. Complete and submit a separate faculty application. (FOR NEW TEACHERS ONLY) Submit a RN verification print out from the NC Board of Nursing Website. ALL instructors; primary, additional and supplemental must submit verification of an unencumbered RN license annually. Go to and click on Verify License. You may search by entering social the security number or the RN nursing license number. Print verifications for all teachers in your program and attach them to the program application. 27