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Understand Understand residents’ residents’ rightsrights, advocacy, and , advocacy, and grievance procedures. grievance procedures.
Unit A Nurse Aide Workplace FundamentalsEssential Standard 1.00 Understand the range of function, legal and ethical responsibilities of the nurse aide within the healthcare system. Indicator 1.03 Understand residents’ rights, advocacy, and grievance procedures.
11.03 Nursing Fundamentals
Nursing Fundamentals 7243 3
Basic Human RightsBasic Human Rights
– Protected by ConstitutionProtected by 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• Right to Right to pursue a meaningful lifepursue a meaningful life• Right to be Right to be free of fearfree of fear
1.03
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Basic Human RightsBasic Human Rights
Behaviors that infringe on human Behaviors that infringe on human rights:rights:
• addressing residents as childrenaddressing residents as children• 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
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• Ethical and legal basisEthical and legal basis• States have adopted or States have adopted or
codified these rights into lawcodified these rights into law• Posted in facilityPosted in facility• Distributed on admission in Distributed on admission in
many facilitiesmany facilities
OBRA 1987 Residents’ Bill of Rights
1.03
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Residents have the right to:Residents have the right to:
1.1.Be treated with Be treated with consideration, respect, consideration, respect, and full recognition of and full recognition of personal dignity.personal dignity.
OBRA 1987 Residents’ Bill of Rights
1.03
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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 adequate and in adequate and in compliance with rulescompliance with rules
OBRA 1987 Residents’ Bill of Rights
1.03
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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
1.03
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Residents have the right to:Residents have the right to:
4.4.have on file the attending have on file the attending physician’s proposed physician’s proposed schedule of medical schedule of medical treatment.treatment.
OBRA 1987 Residents’ Bill of Rights
1.03
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Residents have the right to:Residents have the right to:
5.5.privacyprivacy
OBRA 1987 Residents’ Bill of Rights
1.03
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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 from restraint (except in an from restraint (except in an emergency)emergency)
OBRA 1987 Residents’ Bill of Rights
1.03
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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
1.03
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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
1.03
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Residents have the right to:Residents have the right to:
9.9.manage financial affairsmanage financial affairs
OBRA 1987 Residents’ Bill of Rights
1.03
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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
1.03
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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 should not be searched.should not be searched.
OBRA 1987 Residents’ Bill of Rights
1.03
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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
1.03
Nursing Fundamentals 7243 18
Residents have the right Residents have the right NOTNOT to: to:
13.13.perform services for the perform services for the facilityfacility
OBRA 1987 Residents’ Bill of Rights
1.03
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Residents have the right to:Residents have the right to:
14.14.retain, store, and use retain, store, and use personal clothing and personal clothing and possessionspossessions
OBRA 1987 Residents’ Bill of Rights
1.03
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Residents have the right to:Residents have the right to:
16.16.be notified if the facility be notified if the facility is given a provisional is given a provisional licenselicense
OBRA 1987 Residents’ Bill of Rights
1.03
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Behaviors That Uphold Residents’ Rights
• Address as Mr., Mrs., or Miss unless Address as Mr., Mrs., or Miss unless asked to use a specific nameasked to use a specific name
• Never withhold social responsivenessNever withhold social responsiveness• Never ignore residentsNever ignore residents• Make eye contactMake eye contact
1.03
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Behaviors That UpholdBehaviors That UpholdResidents’ RightsResidents’ Rights
–Make eye contactMake eye contact–Allow to complete sentences prior to Allow to complete sentences prior to
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
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Behaviors That UpholdBehaviors That UpholdResidents’ RightsResidents’ Rights
• Encourage socialization (meal-time)Encourage socialization (meal-time)• Assist to activities/meetings/churchAssist to activities/meetings/church• Participate in planned activitiesParticipate in planned activities• Help with phone calls, cards, mailHelp with phone calls, cards, mail
1.03
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Behaviors That Uphold Behaviors That Uphold Residents’ RightsResidents’ Rights
• Explain care you plan to give Explain care you plan to give • Observe safety precautionsObserve safety precautions• Obtain proper consent after identifying Obtain proper consent after identifying
residentresident
1.03
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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 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
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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• Converse with resident in an adult Converse with resident in an adult
mannermanner• Respect resident’s privacyRespect resident’s privacy
1.03
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Behaviors That Uphold Behaviors That Uphold Residents’ RightsResidents’ Rights
• Adult residents must be treated as adults. Give age appropriate Adult residents must be treated as adults. Give age appropriate care.care.
• Age-appropriate considerations:Age-appropriate considerations:– Style of dressStyle of dress– Hair style and groomingHair style and grooming– Recreational activitiesRecreational activities– Social activitiesSocial activities
1.03
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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• 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
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Age Appropriate CareAge Appropriate CareGuidelinesGuidelines
Encourage resident to make choices:Encourage resident to make choices:•select clothing to wearselect clothing to wear•select books to readselect books to read•select television programs to watchselect television programs to watch
1.03
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Age Appropriate CareAge Appropriate CareGuidelinesGuidelines
Encourage resident to make choices:Encourage resident to make choices:•select food and nourishmentsselect food and nourishments•select activities of interestselect activities of interest•select friendsselect friends
1.03
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Age Appropriate CareAge Appropriate CareGuidelinesGuidelines
• Recognize value of past experience Recognize value of past experience (validate the resident)(validate the resident)
• Praise age appropriate accomplishmentsPraise age appropriate accomplishments• Encourage adult behaviorEncourage adult behavior
1.03
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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), ,
• residents have a right to be free residents have a right to be free from restraints. from restraints.
1.03
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Facts Regarding RestraintsFacts Regarding Restraints
RESTRAINTSRESTRAINTSrestrict restrict
voluntary movement voluntary movement or behavioror behavior
CHEMICALCHEMICAL PHYSICALPHYSICAL
1.03
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Facts Regarding RestraintsFacts Regarding Restraints
Physical RestraintsPhysical Restraints
also known as • postural supportspostural supports
• protective devicesprotective devices1.03
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Facts Regarding RestraintsFacts Regarding Restraints
1.03
Restraint:Restraint:
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 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
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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 violet, at risk of prone to falls, are violet, at risk of hurting themselves, or pulling tubes hurting themselves, or pulling tubes outout
• Abuse of restraints led to new Abuse of restraints led to new restrictions and laws on use of restrictions and laws on use of restraintsrestraints
1.03
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Facts Regarding RestraintsFacts Regarding Restraints
1.03
Tucking in top Tucking in top sheetsheet so tightly so tightly that resident that resident cannot movecannot move
NEVERNEVER
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Facts Regarding RestraintsFacts Regarding Restraints
1.03
Placing wheelchair Placing wheelchair so close to a wall so close to a wall that the wall that the wall prevents resident prevents resident from getting out from getting out of chairof chair
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Facts Regarding RestraintsFacts Regarding Restraints
1.03
Pulling up full Pulling up full side rails to side rails to prevent patient prevent patient from voluntarily from voluntarily getting out of getting out of bedbed
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Facts Regarding RestraintsFacts Regarding Restraints
1.03
Restraints MUST Restraints MUST not be usednot be usedfor conveniencefor convenienceor discipline or discipline
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Facts Regarding RestraintsFacts Regarding Restraints
1.03
Unnecessary use of restraint is Unnecessary use of restraint is
FALSE FALSE
IMPRISONMENTIMPRISONMENT
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Facts Regarding RestraintsFacts Regarding Restraints
1.03
Acceptable Reasons for Use of Restraints: Acceptable Reasons for Use of Restraints:
Temporarily for life threatening medical Temporarily for life threatening medical 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
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Facts Regarding RestraintsFacts Regarding Restraints
1.03
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 for orders restraints, it becomes essential for the nurse aide to know the risks involved the nurse aide to know the risks involved in caring for these residents.in caring for these residents.
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Facts Regarding RestraintsFacts Regarding Restraints
1.03
Types of acceptable physical restraints if Types of acceptable physical restraints if ordered appropriatelyordered appropriately
•Side rails on a bedSide rails on a bed
• Special chairs such as geriatric chairsSpecial chairs such as geriatric chairs
• Lap cushions or lap trayLap cushions or lap tray
• Vests and jacket restraintsVests and jacket restraints
• Safety belt restraintsSafety belt restraints
• Soft ties for wrist and anklesSoft ties for wrist and ankles
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Facts Regarding RestraintsFacts Regarding Restraints
1.03
Restraint-free facility:Restraint-free facility:
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
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Restraint AlternativesRestraint Alternatives
1.03
Restraint alternative:Restraint alternative:
Interventions used instead of Interventions used instead of using restraintsusing restraints
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Restraint AlternativesRestraint Alternatives
Using friends, family, volunteers or resident directed care provider
1.03
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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
1.03
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Restraint AlternativesRestraint Alternatives
Answering call signal promptlyAnswering call signal promptly
1.03
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Restraint AlternativesRestraint Alternatives
Exercise and outdoor activitiesExercise and outdoor activities
1.03
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Restraint AlternativesRestraint Alternatives
Consistent reality orientation or Consistent reality orientation or validation and staff assignmentsvalidation and staff assignments
1.03
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Restraint AlternativesRestraint Alternatives
Having resident’s room close to Having resident’s room close to nurses’ stationnurses’ station
1.03
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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
1.03
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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
1.03
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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
1.03
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Restraint AlternativesRestraint Alternatives
Furniture such as low beds, rocking chairs, or recliners
1.03
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Restraint AlternativesRestraint Alternatives
Easy –release belts reminds Easy –release belts reminds resident of safety but the resident resident of safety but the resident can release if desiredcan release if desired
1.03
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Restraint AlternativesRestraint Alternatives
Floor cushion or pads next to the Floor cushion or pads next to the bed – decreases injuries if a bed – decreases injuries if a resident does fall when getting resident does fall when getting out of bedout of bed
1.03
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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*
1.03
1.03 Nursing Fundamentals 7243 65
SKILLSKILL 1.03A1.03AApply Personal Electronic Apply Personal Electronic
Warning DeviceWarning Device
Training Lab AssignmentTraining Lab AssignmentEngage in the Skill Acquisition Process for:Engage in the Skill Acquisition Process for:
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The Last Resort!The Last Resort!
Occasionally, alternatives do not work and restraints are ordered.
1.03
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Using RestraintsUsing RestraintsOrdered by the physician…Ordered by the physician…• when necessary to treat a medical when necessary to treat a medical symptom or provide emergency symptom or provide emergency medical treatmentmedical treatment• choice of restraint based on choice of restraint based on multidisciplinary evaluation for the multidisciplinary evaluation for the least restrictive measureleast restrictive measure
1.03
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Using RestraintsUsing Restraints
Safety Measures Safety Measures and Considerations and Considerations
When When APPLYINGAPPLYING RestraintsRestraints
1.03
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Using RestraintsUsing RestraintsSafety measures and Considerations APPLYING Restraints:
•Use reassurance in an attempt to Use reassurance in an attempt to calm agitated residentscalm agitated residents
1.03
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Using RestraintsUsing RestraintsSafety measures and Considerations APPLYING Restraints:
Be sure there is a physician’s Be sure there is a physician’s order for restraint use and that it is order for restraint use and that it is in the care plan before applying in the care plan before applying restraintrestraint
1.03
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Using RestraintsUsing RestraintsSafety measures and Considerations APPLYING Restraints:
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 received instructions in its usereceived instructions in its use
1.03
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Using RestraintsUsing RestraintsSafety measures and Considerations APPLYING Restraints:
Secure enough assistance to apply Secure enough assistance to apply restraints quickly to avoid injuryrestraints quickly to avoid injury
1.03
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Using RestraintsUsing RestraintsSafety measures and Considerations APPLYING Restraints:
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 bedside rails or other parts of the bed
Leave an 8 inch tailLeave an 8 inch tail
1.03
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Using RestraintsUsing RestraintsSafety measures and Considerations APPLYING Restraints:
Use slip knot to tie restraint for Use slip knot to tie restraint for quick releasequick release
1.03
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Using RestraintsUsing RestraintsSafety measures and Considerations APPLYING Restraints:
Protect bony areas and skin by Protect bony areas and skin by padding them prior to applying padding them prior to applying restraintrestraint
1.03
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Using RestraintsUsing RestraintsSafety measures and Considerations APPLYING Restraints:
Adjust restraint so that it allows Adjust restraint so that it allows some movement, but is secure some movement, but is secure and comfortable – place open and comfortable – place open flat hand between the resident flat hand between the resident and the restraint for restraints and the restraint for restraints around the torso.around the torso.
1.03
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Using RestraintsUsing RestraintsSafety measures and Considerations APPLYING Restraints:
Make sure breasts or Make sure breasts or skin are not caught in skin are not caught in the restraint.the restraint.
1.03
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Using RestraintsUsing Restraints
Safety Measures Safety Measures and Considerations and Considerations AFTERAFTER Restraints Restraints
are appliedare applied
1.03
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Using RestraintsUsing RestraintsSafety measures and Considerations AFTER Applying Restraints:
Be sure resident Be sure resident NEEDS are METNEEDS are MET
1.03
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Using RestraintsUsing RestraintsSafety measures and Considerations AFTER Applying Restraints:
Special attention must be paid Special attention must be paid to basic needsto basic needs
• Elimination- Elimination- assist in assist in toiletingtoileting
• Hydration – Hydration – offer fluidsoffer fluids
1.03
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Using RestraintsUsing RestraintsSafety measures and Considerations AFTER Applying Restraints:
Call signal must be in reach and the resident’s signal for help must be answered immediately (STAT)
1.03
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Using RestraintsUsing RestraintsSafety measures and Considerations AFTER Applying Restraints:
Check on resident Check on resident
every 15 minutesevery 15 minutes
1.03
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Using RestraintsUsing RestraintsSafety measures and Considerations AFTER Applying Restraints:
Every 15 minutes:Every 15 minutes:
Pulse, color, and temperature Pulse, color, and temperature of any restrained extremityof any restrained extremity
1.03
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Using RestraintsUsing Restraints
Safety measures and Considerations AFTER Applying Restraints:
Every 15 minutes:Every 15 minutes:
Breathing of resident with Breathing of resident with vest (torso) restraintvest (torso) restraint
1.03
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Using RestraintsUsing RestraintsSafety measures and Considerations AFTER Applying Restraints:
Every 2 hours:Every 2 hours:
Remove restraint for 10 Remove restraint for 10 minutes and reposition residentminutes and reposition resident
1.03
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Using RestraintsUsing RestraintsSafety measures and Considerations AFTER Applying Restraints:
In an emergency, notify supervisor immediately via call bell, stay with the resident, and loosen restraint.
1.03
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Using RestraintsUsing RestraintsEMERGENCY EXAMPLES:EMERGENCY EXAMPLES:
•Unable to detect a pulse in extremityUnable to detect a pulse in extremity
•Extremity cold, pale, blue-tinged, gray, red, Extremity cold, pale, blue-tinged, gray, red, 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 belt Breathing is impaired with vest or safety belt restraintrestraint
•URGENT!!! TAKE ACTIONURGENT!!! TAKE ACTION1.03
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Using RestraintsUsing RestraintsObservations and reporting should Observations and reporting should include:include:
• Color and condition of skin under Color and condition of skin under restraintrestraint
• Pulse rate, color and temperature of Pulse rate, color and temperature of skin in restrained extremityskin in restrained extremity
1.03
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Using RestraintsUsing RestraintsObservations 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• 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
1.03 Nursing Fundamentals 7243 90
SKILLSKILL 1.03B1.03BApply RestraintsApply Restraints
Training Lab AssignmentTraining Lab AssignmentEngage in the Skill Acquisition Process for:Engage in the Skill Acquisition Process for:
Nursing Fundamentals 7243 92
Resident AdvocatesResident Advocates
1.03
What does an advocate do?What does an advocate do?•Plead cause of anotherPlead cause of another•Resolve grievancesResolve grievances•Protect resident’s rightsProtect resident’s rights
Nursing Fundamentals 7243 93
Resident AdvocatesResident Advocates
1.03
Advocates can be:Advocates can be:• You and your co-workersYou and your co-workers• Member of resident’s Member of resident’s
family/support systemfamily/support system• Resident’s guardianResident’s guardian• OmbudsmanOmbudsman
Nursing Fundamentals 7243 94
Resident AdvocatesResident Advocates
1.03
Ombudsman Program - History The 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.
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 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
Nursing Fundamentals 7243 96
Resident Right to Resident Right to Voice GrievancesVoice Grievances
1.03
• Regarding services furnishedRegarding services furnished• 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
Nursing Fundamentals 7243 97
Facility policy components for resident grievance
1.03
1.1. AcknowledgmentAcknowledgment2.2. Prompt attempt to resolvePrompt attempt to resolve3.3. Resident kept apprisedResident kept apprised
Nursing Fundamentals 7243 99
Resident Council: Advisory Group
1.03
Provides opportunity for discussionProvides opportunity for discussionRecommendations may be made for:Recommendations may be made for:
• Facility policiesFacility policies• Decisions regarding activitiesDecisions regarding activities• Exploration of concernsExploration of concerns• Resolving grievances Resolving grievances
Nursing Fundamentals 7243 100
Resident Council: Advisory Group
1.03
• Gives residents a voice in facility Gives residents a voice in facility operationsoperations
• MembersMembers– residentsresidents– facility staff members to include facility staff members to include
Nurse AidesNurse Aides– representatives from communityrepresentatives from community
The Bottom Line
Nursing Fundamentals 7243 1013.01
Resident has a right to voice grievances without fear of retaliation or discrimination!
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