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Understand Understand residents’ residents’ rightsrights , advocacy, and , advocacy, and
Unit ANurse Aide Workplace Fundamentals
Essential Standard 1.00Understand the range of function, legal and ethical responsibilities of the nurse aide within the heal thcare system.
Indicator 1.03Understand residents’ rights, advocacy, and grievan ce procedures.
rightsrights , advocacy, and , advocacy, and grievance procedures. grievance procedures.
11.03 Nursing Fundamentals
Residents’ RightsResidents’ Rights
Nursing Fundamentals 7243 21.03
Basic Human RightsBasic Human Rights
–– Protected Protected by Constitutionby Constitution
–– Laws clarify these rights:Laws clarify these rights:
•• Right to be treated with Right to be treated with respectrespect
•• Right to live in Right to live in dignitydignity
Nursing Fundamentals 7243 3
•• Right to live in Right to live in dignitydignity
•• Right to Right to pursue a meaningful lifepursue a meaningful life
•• Right to be Right to be free of fearfree of fear
1.03
Basic Human Basic Human RightsRights
Behaviors Behaviors that that infringe infringe on on human human rightsrights::
•• addressing residents as childrenaddressing residents as children
•• using demeaning nicknames for using demeaning nicknames for
Nursing Fundamentals 72434
•• using demeaning nicknames for using demeaning nicknames for residentsresidents
•• leaving door open during bathleaving door open during bath
•• threatening a resident with harmthreatening a resident with harm
1.03
•• Ethical Ethical and legal basisand legal basis
•• States have adopted or States have adopted or codified these rights into lawcodified these rights into law
Posted in facilityPosted in facility
OBRA 1987 Residents’ Bill of Rights
Nursing Fundamentals 7243 5
•• Posted in facilityPosted in facility
•• Distributed on admission in Distributed on admission in many facilitiesmany facilities
1.03
Residents have the right to:Residents have the right to:
1.1. Be treated with Be treated with consideration, consideration,
OBRA 1987 Residents’ Bill of Rights
Nursing Fundamentals 7243 6
consideration, consideration, respect, and full respect, and full recognition of recognition of personal dignity.personal dignity.
1.03
Residents have the right to:Residents have the right to:
2.2. receive care, treatment, receive care, treatment, and services which are and services which are
OBRA 1987 Residents’ Bill of Rights
Nursing Fundamentals 7243 7
and services which are and services which are adequate and in adequate and in compliance with rulescompliance with rules
1.03
Residents have the right to:Residents have the right to:
3.3. receive a statement of receive a statement of services and chargesservices and charges
OBRA 1987 Residents’ Bill of Rights
Nursing Fundamentals 7243 8
services and chargesservices and charges
1.03
Residents have the right to:Residents have the right to:
4.4. have on file the have on file the attending physician’s attending physician’s
OBRA 1987 Residents’ Bill of Rights
Nursing Fundamentals 7243 9
attending physician’s attending physician’s proposed schedule of proposed schedule of medical treatment.medical treatment.
1.03
Residents have the right to:Residents have the right to:
5.5. privacyprivacy
OBRA 1987 Residents’ Bill of Rights
Nursing Fundamentals 7243 101.03
Residents have the right to:Residents have the right to:
6.6. Be free from mental and Be free from mental and physical abuse, and free physical abuse, and free
OBRA 1987 Residents’ Bill of Rights
Nursing Fundamentals 7243 11
physical abuse, and free physical abuse, and free from restraint (except in from restraint (except in an emergency)an emergency)
1.03
Residents have the right to:Residents have the right to:
7.7. receive reasonable receive reasonable response to all requestsresponse to all requests
OBRA 1987 Residents’ Bill of Rights
Nursing Fundamentals 7243 12
response to all requestsresponse to all requests
1.03
Residents have the right to:Residents have the right to:
8.8. associate and associate and communicate privatelycommunicate privately
OBRA 1987 Residents’ Bill of Rights
Nursing Fundamentals 7243 13
communicate privatelycommunicate privately
1.03
Residents have the right to:Residents have the right to:
9.9. manage financial affairsmanage financial affairs
OBRA 1987 Residents’ Bill of Rights
Nursing Fundamentals 7243 141.03
Residents have the right to:Residents have the right to:
10.10.private visits from private visits from spousespouse
OBRA 1987 Residents’ Bill of Rights
Nursing Fundamentals 7243 15
spousespouse
1.03
Residents have the right to:Residents have the right to:
11.11.privacy in the resident privacy in the resident room. Personal items room. Personal items
OBRA 1987 Residents’ Bill of Rights
Nursing Fundamentals 7243 16
room. Personal items room. Personal items should not be searched.should not be searched.
1.03
Residents have the right to:Residents have the right to:
12.12.present grievances and present grievances and recommend changesrecommend changes
OBRA 1987 Residents’ Bill of Rights
Nursing Fundamentals 7243 17
recommend changesrecommend changes
1.03
Residents have the right Residents have the right NOTNOT toto::
13.13.perform services for the perform services for the facilityfacility
OBRA 1987 Residents’ Bill of Rights
Nursing Fundamentals 7243 18
facilityfacility
1.03
Residents have the right Residents have the right toto::
14.14.retain, store, and use retain, store, and use personal clothing and personal clothing and
OBRA 1987 Residents’ Bill of Rights
Nursing Fundamentals 7243 19
personal clothing and personal clothing and possessionspossessions
1.03
Residents have the right Residents have the right NOT toNOT to::
15.15.be randomly discharged be randomly discharged or transferred from the or transferred from the
OBRA 1987 Residents’ Bill of Rights
Nursing Fundamentals 7243 20
or transferred from the or transferred from the facilityfacility
1.03
Residents have the right Residents have the right toto::
16.16.be notified if the facility be notified if the facility is given a provisional is given a provisional
OBRA 1987 Residents’ Bill of Rights
Nursing Fundamentals 7243 21
is given a provisional is given a provisional licenselicense
1.03
Behaviors That Uphold Residents ’ Rights
•• Address Address as Mr., Mrs., or Miss unless as Mr., Mrs., or Miss unless asked to use a specific asked to use a specific namename
•• Never Never withhold social responsivenesswithhold social responsiveness
Nursing Fundamentals 7243 22
•• Never Never withhold social responsivenesswithhold social responsiveness
•• Never ignore residentsNever ignore residents
•• Make eye contactMake eye contact
1.03
Behaviors Behaviors That That UpholdUpholdResidents’ RightsResidents’ Rights
––Make eye contactMake eye contact
–– Allow to complete sentences prior to Allow to complete sentences prior to leaving roomleaving room
Nursing Fundamentals 7243 23
leaving roomleaving room
–– Don’t shut or slam door to quiet Don’t shut or slam door to quiet residentresident
–– Never threaten or intentionally hurtNever threaten or intentionally hurt
1.03
Behaviors Behaviors That That UpholdUpholdResidentsResidents ’ Rights’ Rights
•• Encourage socialization (mealEncourage socialization (meal--time)time)
•• Assist to activities/meetings/churchAssist to activities/meetings/church
Nursing Fundamentals 7243 24
•• Participate Participate in planned activitiesin planned activities
•• Help with phone calls, cards, mailHelp with phone calls, cards, mail
1.03
Behaviors Behaviors That That Uphold Uphold ResidentsResidents ’ Rights’ Rights
•• Explain care you plan to give Explain care you plan to give
•• Observe safety precautionsObserve safety precautions
Nursing Fundamentals 7243 25
•• Obtain proper consent after identifying Obtain proper consent after identifying
residentresident
1.03
Behaviors Behaviors That That Uphold Uphold ResidentsResidents ’ Rights’ Rights
•• Treat all residents equallyTreat all residents equally
•• Promote positive attitudesPromote positive attitudes
Nursing Fundamentals 7243 26
•• Report errors to supervisor immediatelyReport errors to supervisor immediately
1.03
Behaviors That Uphold Behaviors That Uphold Residents’ RightsResidents’ Rights
•• Handle personal items Handle personal items
carefullycarefully
•• Add new items to list of Add new items to list of
Nursing Fundamentals 7243 27
•• Add new items to list of Add new items to list of
resident’s belongingsresident’s belongings
•• Mark all items with Mark all items with
resident’s nameresident’s name
1.03
Behaviors That Uphold Behaviors That Uphold Residents’ RightsResidents’ Rights
•• Sit when feeding a residentSit when feeding a resident
•• Offer a clothing protector; do NOT Offer a clothing protector; do NOT
automatically place clothing protector automatically place clothing protector
Nursing Fundamentals 7243 28
automatically place clothing protector automatically place clothing protector
on the resident prior to eatingon the resident prior to eating
•• Give resident centered, not task Give resident centered, not task
centered carecentered care
1.03
Behaviors That Uphold Behaviors That Uphold Residents’ RightsResidents’ Rights
•• Address resident in a dignified wayAddress resident in a dignified way
•• Listen to what resident has to sayListen to what resident has to say
Nursing Fundamentals 7243 29
•• Converse with resident in an adult Converse with resident in an adult
mannermanner
•• Respect resident’s privacyRespect resident’s privacy
1.03
Behaviors That Uphold Behaviors That Uphold Residents’ Residents’ RightsRights
•• Adult residents must be Adult residents must be treated as treated as
adults. Give age appropriate care.adults. Give age appropriate care.
•• AgeAge--appropriate appropriate considerationsconsiderations::
Nursing Fundamentals 7243 30
•• AgeAge--appropriate appropriate considerationsconsiderations::–– Style of dressStyle of dress
–– Hair style and groomingHair style and grooming
–– Recreational activitiesRecreational activities
–– Social activitiesSocial activities
1.03
Age Appropriate CareAge Appropriate CareGuidelinesGuidelines
•• Don’t ignore or humor residentDon’t ignore or humor resident
•• Explain what care you are going to giveExplain what care you are going to give
Nursing Fundamentals 7243 31
•• Promote resident independencePromote resident independence
•• Treat resident as you would want to be Treat resident as you would want to be
treated treated
1.03
Age Appropriate CareAge Appropriate CareGuidelinesGuidelines
Encourage resident to make choices:Encourage resident to make choices:
•• select clothing to wearselect clothing to wear
Nursing Fundamentals 7243 32
•• select books to readselect books to read
•• select television programs to watchselect television programs to watch
1.03
Age Appropriate CareAge Appropriate CareGuidelinesGuidelines
Encourage resident to make choices:Encourage resident to make choices:
•• select food and nourishmentsselect food and nourishments
Nursing Fundamentals 7243 33
•• select activities of interestselect activities of interest
•• select friendsselect friends
1.03
Age Appropriate CareAge Appropriate CareGuidelinesGuidelines
•• Recognize value of past Recognize value of past experience experience
(validate the resident)(validate the resident)
Nursing Fundamentals 7243 34
(validate the resident)(validate the resident)
•• Praise age Praise age appropriate accomplishmentsappropriate accomplishments
•• Encourage adult behaviorEncourage adult behavior
1.03
Right to be Free from Right to be Free from RestraintRestraint
•• Under Under OOmnibus mnibus BBudget udget
RReconciliation econciliation AAct 1987 ct 1987 (OBRA)(OBRA), ,
Nursing Fundamentals 7243 35
RReconciliation econciliation AAct 1987 ct 1987 (OBRA)(OBRA), ,
•• residents have a right to be residents have a right to be free free
from restraints. from restraints.
1.03
Resident RestraintsResident RestraintsResident RestraintsResident Restraints
Nursing Fundamentals 7243 361.03
Facts Regarding RestraintsFacts Regarding Restraints
RESTRAINTSRESTRAINTSrestrict restrict
voluntary movement voluntary movement or behavioror behavior
Nursing Fundamentals 7243 37
CHEMICALCHEMICAL PHYSICALPHYSICAL
1.03
Facts Regarding RestraintsFacts Regarding Restraints
Physical Physical RestraintsRestraints
also known as
Nursing Fundamentals 7243 38
also known as
•• postural postural supportssupports
•• protective devicesprotective devices
1.03
Facts Regarding RestraintsFacts Regarding Restraints
RestraintRestraint::
Any manual method, physical or Any manual method, physical or
mechanical device, material, or mechanical device, material, or
equipment attached or next to the equipment attached or next to the
Nursing Fundamentals 7243 391.03
equipment attached or next to the equipment attached or next to the
resident’s body that the individual resident’s body that the individual
cannot remove easily, which restricts cannot remove easily, which restricts
freedom of movement or normal freedom of movement or normal
access to one’s bodyaccess to one’s body
Facts Regarding RestraintsFacts Regarding Restraints
IN THE PAST!IN THE PAST!
•• Restraints commonly used to Restraints commonly used to
safeguard residents who wander, safeguard residents who wander,
prone to falls, are prone to falls, are violentviolent, , at at risk of risk of
Nursing Fundamentals 7243 40
prone to falls, are prone to falls, are violentviolent, , at at risk of risk of
hurting hurting themselves, or pulling tubes themselves, or pulling tubes
outout
•• Abuse of restraints Abuse of restraints led to led to new new
restrictions and laws on use of restrictions and laws on use of
restraintsrestraints1.03
Facts Regarding RestraintsFacts Regarding Restraints
Tucking in top Tucking in top
sheetsheet so tightly so tightly
that resident that resident
NEVERNEVER
Nursing Fundamentals 7243 411.03
that resident that resident
cannot movecannot move
Facts Regarding RestraintsFacts Regarding Restraints
Placing wheelchair Placing wheelchair
so close to a wall so close to a wall
that the wall that the wall
Nursing Fundamentals 7243 421.03
that the wall that the wall
prevents resident prevents resident
from getting out from getting out
of chairof chair
Facts Regarding RestraintsFacts Regarding Restraints
Pulling up full Pulling up full
side rails to side rails to
prevent patient prevent patient
Nursing Fundamentals 7243 431.03
prevent patient prevent patient
from voluntarily from voluntarily
getting out of getting out of
bedbed
Facts Regarding RestraintsFacts Regarding Restraints
Restraints Restraints MUST MUST
not be usednot be used
Nursing Fundamentals 7243 441.03
not be usednot be used
for conveniencefor convenience
or discipline or discipline
Facts Regarding RestraintsFacts Regarding Restraints
Unnecessary use of restraint is Unnecessary use of restraint is
FALSE FALSE
Nursing Fundamentals 7243 451.03
IMPRISONMENTIMPRISONMENT
Facts Regarding RestraintsFacts Regarding Restraints
Acceptable Reasons for Use Acceptable Reasons for Use of Restraints: of Restraints:
Temporarily Temporarily for life threatening medical for life threatening medical
conditionsconditions
Nursing Fundamentals 7243 461.03
conditionsconditions
Brief periods to allow medical treatment Brief periods to allow medical treatment
to proceed if there is documented to proceed if there is documented
evidence of resident or legal approval of evidence of resident or legal approval of
treatmenttreatment
Facts Regarding RestraintsFacts Regarding Restraints
Acceptable Reasons for Use of Restraints Acceptable Reasons for Use of Restraints
When alternatives to restraints are not When alternatives to restraints are not
effective, however, and the physician effective, however, and the physician
orders restraints, it becomes essential orders restraints, it becomes essential
Nursing Fundamentals 7243 471.03
orders restraints, it becomes essential orders restraints, it becomes essential
for the nurse aide to know the risks for the nurse aide to know the risks
involved in caring for these residents.involved in caring for these residents.
Facts Regarding RestraintsFacts Regarding Restraints
Types of acceptable physical restraints if ordered Types of acceptable physical restraints if ordered
appropriatelyappropriately
•• Side Side rails on a bedrails on a bed
•• Special Special chairs such as geriatric chairschairs such as geriatric chairs
Nursing Fundamentals 7243 481.03
•• Special Special chairs such as geriatric chairschairs such as geriatric chairs
•• Lap Lap cushions or lap traycushions or lap tray
•• Vests Vests and jacket restraintsand jacket restraints
•• Safety Safety belt restraintsbelt restraints
•• Soft Soft ties for wrist and anklesties for wrist and ankles
Facts Regarding RestraintsFacts Regarding Restraints
RestraintRestraint--free facility:free facility:
Restraints are not used for Restraints are not used for
Nursing Fundamentals 7243 491.03
Restraints are not used for Restraints are not used for
any reason and not kept in any reason and not kept in
the facilitythe facility
Restraint AlternativesRestraint AlternativesRestraint AlternativesRestraint Alternatives
Nursing Fundamentals 7243 501.03
Restraint AlternativesRestraint Alternatives
Restraint alternative:Restraint alternative:
Interventions used instead of Interventions used instead of
Nursing Fundamentals 7243 511.03
Interventions used instead of Interventions used instead of
using restraintsusing restraints
Restraint AlternativesRestraint Alternatives
Using friends, family, volunteers or
resident directed care provider
Nursing Fundamentals 7243 521.03
Restraint AlternativesRestraint Alternatives
Interesting activities and diversions Interesting activities and diversions
such as games, movies or music such as games, movies or music
distract residentsdistract residents
Nursing Fundamentals 7243 531.03
Restraint AlternativesRestraint Alternatives
Answering call signal promptlyAnswering call signal promptly
Nursing Fundamentals 7243 541.03
Restraint AlternativesRestraint Alternatives
Exercise and outdoor activitiesExercise and outdoor activities
Nursing Fundamentals 7243 551.03
Restraint AlternativesRestraint Alternatives
Consistent reality orientation or Consistent reality orientation or
validation and staff assignmentsvalidation and staff assignments
Nursing Fundamentals 7243 561.03
Restraint AlternativesRestraint Alternatives
Having resident’s room close to Having resident’s room close to
nurses’ stationnurses’ station
Nursing Fundamentals 7243 571.03
Restraint AlternativesRestraint Alternatives
Barriers such as STOP SIGNS Barriers such as STOP SIGNS
posted on doors discourages posted on doors discourages
confused residents from confused residents from
wandering into the areawandering into the area
Nursing Fundamentals 7243 58
confused residents from confused residents from
wandering into the areawandering into the area
1.03
Restraint AlternativesRestraint Alternatives
PartialPartial bed rails prevent residents bed rails prevent residents
from rolling out of bed while from rolling out of bed while
allowing them freedom to get up allowing them freedom to get up
if they wish toif they wish to
Nursing Fundamentals 7243 59
if they wish toif they wish to
1.03
Restraint AlternativesRestraint Alternatives
Positioning devices and wedges such as Positioning devices and wedges such as
wedge cushions placed in wheelchairs wedge cushions placed in wheelchairs
to prevent forward slidingto prevent forward sliding
Nursing Fundamentals 7243 601.03
Restraint AlternativesRestraint Alternatives
Furniture such as low beds, rocking
chairs, or recliners
Nursing Fundamentals 7243 611.03
Restraint AlternativesRestraint Alternatives
Easy Easy ––release belts reminds release belts reminds
resident of safety but the resident resident of safety but the resident
can release if desiredcan release if desired
Nursing Fundamentals 7243 621.03
Restraint AlternativesRestraint Alternatives
Floor cushion or pads next to the Floor cushion or pads next to the
bed bed –– decreases injuries if a decreases injuries if a
resident does fall when getting resident does fall when getting
out of bedout of bed
Nursing Fundamentals 7243 63
out of bedout of bed
1.03
Restraint AlternativesRestraint Alternatives
Electronic warning devices on beds, Electronic warning devices on beds,
wheelchairs, and doors alert staff if wheelchairs, and doors alert staff if
patient gets up without help*patient gets up without help*
Nursing Fundamentals 7243 641.03
SKILLSKILL 1.03A1.03A
Apply Personal Electronic Apply Personal Electronic
Training Lab AssignmentTraining Lab AssignmentEngage in the Skill Acquisition Process for:Engage in the Skill Acquisition Process for:
1.03 Nursing Fundamentals 7243 65
Apply Personal Electronic Apply Personal Electronic
Warning DeviceWarning Device
The Last Resort!The Last Resort!
Occasionally, alternatives do not
Nursing Fundamentals 7243 66
alternatives do not work and restraints are ordered.
1.03
Using RestraintsUsing Restraints
Ordered by the physician…Ordered by the physician…•• when when necessary to treat a medical necessary to treat a medical symptom or provide emergency symptom or provide emergency medical treatmentmedical treatment
Nursing Fundamentals 7243 67
medical treatmentmedical treatment•• choice choice of restraint based on of restraint based on multidisciplinary evaluation for the multidisciplinary evaluation for the least restrictive measureleast restrictive measure
1.03
Using RestraintsUsing Restraints
Safety Measures Safety Measures and Considerations and Considerations
Nursing Fundamentals 7243 68
and Considerations and Considerations When When APPLYINGAPPLYING
RestraintsRestraints
1.03
Using RestraintsUsing Restraints
Safety measures and Considerations APPLYING Restrai nts:
••Use reassurance in an attempt to Use reassurance in an attempt to calm agitated residentscalm agitated residents
Nursing Fundamentals 7243 691.03
Using RestraintsUsing RestraintsSafety measures and Considerations APPLYING Restrai nts:
Be Be sure there is a physician’s order sure there is a physician’s order for restraint use and that it is in the for restraint use and that it is in the care plan before applying restraintcare plan before applying restraint
Nursing Fundamentals 7243 70
care plan before applying restraintcare plan before applying restraint
1.03
Using RestraintsUsing Restraints
Safety measures and Considerations APPLYING Restrai nts:
Use the correct type of restraint and Use the correct type of restraint and apply according to manufacturer’s apply according to manufacturer’s directions and only after you have directions and only after you have
Nursing Fundamentals 7243 71
directions and only after you have directions and only after you have received instructions in its usereceived instructions in its use
1.03
Using RestraintsUsing Restraints
Safety measures and Considerations APPLYING Restrai nts:
Secure enough assistance to apply Secure enough assistance to apply restraints quickly to avoid injuryrestraints quickly to avoid injury
Nursing Fundamentals 7243 721.03
Using RestraintsUsing Restraints
Safety measures and Considerations APPLYING Restrai nts:
Attach restraints to bed frame Attach restraints to bed frame (immovable part of bed), not to (immovable part of bed), not to side rails or other parts of the side rails or other parts of the bedbed
Nursing Fundamentals 7243 73
side rails or other parts of the side rails or other parts of the bedbed
Leave an 8 inch tailLeave an 8 inch tail
1.03
Using RestraintsUsing Restraints
Safety measures and Considerations APPLYING Restrai nts:
Use slip knot to tie restraint for Use slip knot to tie restraint for quick releasequick release
Nursing Fundamentals 7243 74
quick releasequick release
1.03
Using RestraintsUsing Restraints
Safety measures and Considerations APPLYING Restrai nts:
Protect bony areas and skin by Protect bony areas and skin by padding them prior to applying padding them prior to applying
Nursing Fundamentals 7243 75
padding them prior to applying padding them prior to applying restraintrestraint
1.03
Using RestraintsUsing Restraints
Safety measures and Considerations APPLYING Restrai nts:
Adjust restraint so that it allows Adjust restraint so that it allows some movement, but is secure some movement, but is secure
Nursing Fundamentals 7243 76
some movement, but is secure some movement, but is secure and comfortable and comfortable –– place open place open flat hand between the resident flat hand between the resident and the restraint for restraints and the restraint for restraints around the around the torso.torso.
1.03
Using RestraintsUsing Restraints
Safety measures and Considerations APPLYING Restrai nts:
Make sure breasts or Make sure breasts or skin are not caught in skin are not caught in
Nursing Fundamentals 7243 77
skin are not caught in skin are not caught in the restraint.the restraint.
1.03
Using RestraintsUsing Restraints
Safety Measures Safety Measures and Considerations and Considerations
Nursing Fundamentals 7243 78
and Considerations and Considerations AFTERAFTER Restraints Restraints
are appliedare applied
1.03
Using RestraintsUsing Restraints
Safety measures and Considerations AFTER Applying Restraints:
Be sure resident Be sure resident
Nursing Fundamentals 7243 79
Be sure resident Be sure resident NEEDS are METNEEDS are MET
1.03
Using RestraintsUsing RestraintsSafety measures and Considerations AFTER Applying Restraints:
Special attention must be paid Special attention must be paid to basic needsto basic needs
Nursing Fundamentals 7243 80
•• EliminationElimination -- assist in assist in toiletingtoileting
•• Hydration Hydration –– offer fluidsoffer fluids
1.03
Using RestraintsUsing Restraints
Safety measures and Considerations AFTER Applying Restraints:
Call signal must be in reach and the resident’s signal for
Nursing Fundamentals 7243 81
and the resident’s signal for help must be answered immediately (STAT)
1.03
Using RestraintsUsing Restraints
Safety measures and Considerations AFTER Applying Restraints:
Check on resident Check on resident
Nursing Fundamentals 7243 82
every 15 minutesevery 15 minutes
1.03
Using RestraintsUsing Restraints
Safety measures and Considerations AFTER Applying Restraints:
Every 15 minutes:Every 15 minutes:
Nursing Fundamentals 7243 83
��Pulse, color, and temperature Pulse, color, and temperature of any restrained extremityof any restrained extremity
1.03
Using RestraintsUsing Restraints
Safety measures and Considerations AFTER Applying Restraints:
Every 15 minutes:Every 15 minutes:
Nursing Fundamentals 7243 84
��Breathing of resident with Breathing of resident with vest (torso) restraintvest (torso) restraint
1.03
Using RestraintsUsing Restraints
Safety measures and Considerations AFTER Applying Restraints:
Every 2 hours:Every 2 hours:
Nursing Fundamentals 7243 85
��Remove restraint for 10 Remove restraint for 10 minutes and reposition residentminutes and reposition resident
1.03
Using RestraintsUsing Restraints
Safety measures and Considerations AFTER Applying Restraints:
In an emergency, notify supervisor immediately
Nursing Fundamentals 7243 86
supervisor immediatelyvia call bell, stay with the resident, and loosen restraint.
1.03
Using RestraintsUsing RestraintsEMERGENCY EXAMPLES:EMERGENCY EXAMPLES:
•• Unable Unable to detect a pulse in extremityto detect a pulse in extremity
•• Extremity cold, pale, blueExtremity cold, pale, blue--tinged, gray, red, tinged, gray, red, purple in colorpurple in color
Nursing Fundamentals 7243 87
purple in colorpurple in color
•• Resident complains of pain, discomfort, Resident complains of pain, discomfort, numbness, or tingling in restrained partnumbness, or tingling in restrained part
•• Breathing is impaired with vest or safety Breathing is impaired with vest or safety belt restraintbelt restraint
•• URGENT!!! TAKE ACTIONURGENT!!! TAKE ACTION1.03
Using RestraintsUsing Restraints
Observations and reporting should Observations and reporting should
include:include:
•• Color and condition of skin under Color and condition of skin under
restraintrestraint
Nursing Fundamentals 7243 88
restraintrestraint
•• Pulse rate, color and temperature of Pulse rate, color and temperature of
skin in restrained extremityskin in restrained extremity
1.03
Using RestraintsUsing Restraints
Observations and reporting should Observations and reporting should include include (continued):(continued):
•• Any complaints about restrained partAny complaints about restrained part
•• Red or injured skin areas under Red or injured skin areas under restraintrestraint
Nursing Fundamentals 7243 89
•• Red or injured skin areas under Red or injured skin areas under restraintrestraint
•• Respiratory rate and color of skin with Respiratory rate and color of skin with vest and safety belt restraintsvest and safety belt restraints
1.03
SKILLSKILL 1.03B1.03B
Training Lab AssignmentTraining Lab AssignmentEngage in the Skill Acquisition Process for:Engage in the Skill Acquisition Process for:
1.03 Nursing Fundamentals 7243 90
SKILLSKILL 1.03B1.03B
Apply RestraintsApply Restraints
Resident AdvocatesResident AdvocatesResident AdvocatesResident Advocates
Nursing Fundamentals 7243 911.03
Resident AdvocatesResident Advocates
What does an advocate do?What does an advocate do?
•• Plead Plead cause of anothercause of another
•• Resolve grievancesResolve grievances
Nursing Fundamentals 7243 921.03
•• Resolve grievancesResolve grievances
•• Protect resident’s rightsProtect resident’s rights
Resident AdvocatesResident Advocates
Advocates can be:Advocates can be:
•• You and your coYou and your co--workersworkers
•• Member of resident’s Member of resident’s family/support systemfamily/support system
Nursing Fundamentals 7243 931.03
•• Member of resident’s Member of resident’s family/support systemfamily/support system
•• Resident’s guardianResident’s guardian
•• OmbudsmanOmbudsman
Resident AdvocatesResident Advocates
Ombudsman Program - HistoryThe national network of long term care ombudsman programs was established in
response to the many problems found in nursing homes. The program was first
introduced in 1971 as part of President Nixon’s eight-point plan to improve nursing
home conditions. This plan established several demonstration ombudsman projects,
funded and supervised in the beginning through the U.S. Public Health Service.
Nursing Fundamentals 7243 941.03
In 1973, administration responsibility for these projects was transferred within the
Department of Health, Education and Welfare to the Administration on Aging, within
the Office of Human Development Services. By 1975, all state agencies on aging were
invited to submit proposals to promote effective statewide ombudsman programs.
Money was then made available for this voluntary state program.
The Long Term Care Ombudsman Program has been in
existence in North Carolina since 1976.
A favorable response to the ombudsman program led to its formal adoption
in the 1978 Amendments to the Older Americans Act. The Older Americans
Act (federal law) requires that each state establish and maintain a Long Term
Care Ombudsman Program to advocate on behalf of residents in nursing and
adult care homes (rest homes, assisted living). In 1989, the North Carolina
General Assembly enacted legislation for the Long Term Care Ombudsman
Program (G.S. 143B-181.15-25) which incorporated federal mandates in the
Older Americans Act for the Program and clearly define the roles and
responsibilities of the state and regional long term care ombudsmen. In responsibilities of the state and regional long term care ombudsmen. In
North Carolina, the State Long Term Care Ombudsman Program is located in
the Department of Health and Human Services, Division of Aging and Adult
Services. The Regional Long Term Care Ombudsman Programs are housed in
the 17 Area Agencies on Aging.
Last updated June 2, 2010
LTC Ombudsman Program
Nursing Fundamentals 7243 951.03
Resident Right to Resident Right to
Voice GrievancesVoice Grievances
•• Regarding services furnishedRegarding services furnished
•• Regarding services not furnishedRegarding services not furnished
Nursing Fundamentals 7243 961.03
•• Regarding services not furnishedRegarding services not furnished
•• With respect to behavior of othersWith respect to behavior of others
•• Nurse aide must report grievances to Nurse aide must report grievances to supervisorsupervisor
Facility policy components for
resident grievance
1.1. AcknowledgmentAcknowledgment
2.2. Prompt attempt to resolvePrompt attempt to resolve
Nursing Fundamentals 7243 971.03
2.2. Prompt attempt to resolvePrompt attempt to resolve
3.3. Resident kept apprisedResident kept apprised
Resident Council:
Advisory Group
Nursing Fundamentals 7243 981.03
Resident Council:
Advisory Group
Provides opportunity for discussionProvides opportunity for discussion
Recommendations may be made for:Recommendations may be made for:
•• Facility policiesFacility policies
Nursing Fundamentals 7243 991.03
•• Facility policiesFacility policies
•• Decisions regarding activitiesDecisions regarding activities
•• Exploration of concernsExploration of concerns
•• Resolving grievances Resolving grievances
Resident Council:
Advisory Group
•• Gives residents a voice in facility Gives residents a voice in facility operationsoperations
•• MembersMembers
Nursing Fundamentals 7243 1001.03
•• MembersMembers
–– residentsresidents
–– facility staff members facility staff members to include to include Nurse AidesNurse Aides
–– representatives from communityrepresentatives from community
The
Bottom
Line
Resident has a right to
voice grievances
Nursing Fundamentals 7243 1013.01
without fear of
retaliation or
discrimination!
�� ENDEND ��
1.031.03Understand Understand resident’s rightsresident’s rights , ,
advocacy, and grievance procedures. advocacy, and grievance procedures.
102
1.031.03
1.03 Nursing Fundamentals