Unit 2: On the Job: Being a Nursing Assistant – Flashcards

act of evaluating

specific list of duties; tells you which patients you will care for during your shift and the specific procedures to be performed

an external expression of inner feelings about oneself or others

loss of enthusiasm for and interest in an activity

transfer of the responsibility for the completion of a procedure or nursing activity from a nurse to another person

understanding how someone else feels

a means of decision making based on the strength of the evidence. Using EBP ensures that patient care practices are scientifically sound

essential communication that must occur when patient care is transferred from one worker or department to another worker or department

group of professionals from different health care disciplines who each contribute their expertise to the care of a single patient

how people interact with each other

graduate of a certificate nursing program, who must pass a state exam before being permitted to practice nursing

training program culminating in a test taken by the nursing assistant which, when passed successfully, entitles the nursing assistant to certification

a legal document from a state board of nursing (or a piece of legislation passed by a state legislature) that describes the nursing scope of practice in that state. Facilities use these acts as a guide to develop job descriptions and determine which skills nursing assistants can perform in the facility

person who provides personal care and assists with ADLs under nursing supervision

members of the nursing staff who provide patient care

law that regulates the education and certification of nursing assistants in acute care and long-term care facilities

specially educated person who is licensed to plan and direct the nursing care of patients

extent or range of permissible activities

information about patients passed from outgoing shift to oncoming shift

This team includes the patient, the physician, the nursing team, and others who provide services to patients. Members of the patient's family are also included, with the patient's permission.

The nursing team consists of registered nurses, licensed practical (or vocational nurses), and nursing assistants.

Scope of practice means the skills the nursing assistant is legally permitted to perform by state regulations and facility policies. If someone asks you to perform a task that is clearly out of your scope of practice, such as giving medications, explain in a courteous manner that you are not technically or legally prepared to do the task.

Nursing assistants commonly participate in the nursing process by carrying out these activities: 1. Assist with patient assessment and care planning. • Check and record vital signs. • Measure height and weight. • Measure intake and output. • Collect specimens. • Test urine and feces. • Observe patient response to care. • Report and record observation of patients' conditions. 2. Assist patients in meeting nutrition and elimination needs. • Check food trays. • Pass food trays. • Feed patients. • Provide fresh drinking water and nourishments. • Assist with bedpan, urinals, and commodes. • Empty urine collection bags. • Assist with colostomy care. • Give enemas. • Observe feces and urine. • Monitor intake and output. 3. Assist patients with mobility. • Turn and position patients. • Provide range-of-motion exercises. • Transfer patients to wheelchair or stretcher. • Assist with ambulation. 4. Assist patients with personal hygiene and grooming. • Bathe patients. • Provide nail and hair care. • Give oral hygiene. • Provide denture care. • Shave patients. • Assist with dressing and undressing. 5. Assist with patient comfort and anxiety relief. • Protect patient privacy and maintain confidentiality. • Keep call signal within patients reach. • Answer call signal promptly. • Provide orientations to the room or unit and two other patients and visitors. • Assist patients with communications. • Protect personal possessions. • Provide diversional activities. • Give back rubs. • Prepare hot and cold applications. 6. Assist in promoting patient safety and environmental cleanliness. • Used side rails and restraints appropriately. • Keep patient unit clean and free of clutter. • Make beds. • Clean and care for equipment. • Carry-out isolation precautions. • Practice medical asepsis and infection control. • Practice standard precautions. • Observe oxygen precautions. • Assist in keeping recreational and non-patient areas clean and free of hazards. • Participate in fire drills and patient evacuation procedures. 7. Assist with unit management and efficiency. • Admit, transfer, and discharge patients. • Transport patients. • Take specimens to lab. • Assist the special procedures. • Do errands as required. • Assist with cost containment measures. • Answer the telephone. • Document care provided and assist with unit record-keeping.

Evidence-based practice is an approach that guides decision-making by identifying evidence for a treatment or particular way of doing things, then rating that practice according to the strength of the evidence. This approach opposes the use of tradition and rules of thumb. With EBP, workers consider individual patient variables when selecting approaches to patient care. The goal of EBP is to improve patient outcomes by eliminating scientifically unsound, unsafe, and risky practices. Research must be done and solid evidence of effectiveness must be present for a method to be included in EBP. The EBP approach encourages professionals to use the stronger and best evidence possible when making clinical decisions. EBP involves developing guidelines for best practices based on the strength of the evidence instead of tradition, gut feelings, or rules of thumb (estimation). Professionals also use EBP for developing procedures, practices, and guidelines, and for educating health care workers. This results in safe, cost-effective patient care. The information and procedures you are learning in your nursing assistant class have been proven valid and effective, based on the strength of the available evidence.

• The nursing assistant is permitted to perform the procedure in the facility. - The nursing assistant has been taught to perform the procedure correctly. - If asked, the assistant can demonstrate the procedure safely and efficiently. • The patient does not need frequent nursing assessments during the procedure. • The nurse believes the patient's response to the procedure is reasonably predictable. - In the nurses opinion, the nursing assistant will obtain the same or similar results from performing the procedure as an RN/LVN would. • The nurse is certain that delegating the activity to a nursing assistant is not against the law.

• Right Task -- The task is one that can legally be done by a nursing assistant who has been taught the proper way to do the procedure. • Right Circumstances --The nursing assistant understands the purpose of the procedure, can perform it safely, and has the right supplies or equipment to perform the procedure safely. • Right Person -- The right person delegates the right task to the right nursing assistant, to be performed on the right patient. • Right Direction/Communication -- The nurse delegating the activity has given complete instructions, has describe the procedure clearly, and has identified the limits (if any) and expected outcomes of the procedure. • Right Supervision -- The nurse delegating the activity has answered the nursing assistant's questions and is available to manage changes in the patient's condition. The nursing assistant reports completion of the task and the patient's response to the nurse who delegated the activity.

Lack of good organizational skills plague health care workers at all levels. Avoid becoming so focused on tasks that you fail to see the larger picture of things for which you are responsible, such as: • Making important or significant observations as you circulate around the unit. • Overseeing your patients; noticing if certain patients are becoming sick, having behavior problems, or developing other abnormalities. • Informing the nurse of patients' problems, complaints, and changes in condition.

Perfecting good organization and time management skills will make a difference in your personal life and the care that you give. • Establish and develop a systematic daily routine for things. - Make rounds as soon as possible after report to identify patient needs and problems. • Practice good communication skills with patients and families while making rounds, this will save you time and prevent them from calling you to the room later. Let them know that you are on top of things. Ask questions and obtain patient input on the plan you are mentally formulating. • Determine which patients need frequent monitoring. • Plan and organize your work. Be sure the plan is realistic. • List your main goals for the day. Your goals will help ensure that the most important tasks are done. Review each item on your list and ask yourself if it makes the best use of your time. • Schedule your breaks into the plan. Take breaks at the assigned times. These are important to reduce stress and prevent injury. Avoid overloading yourself. Avoid taking work with you on your breaks. • Be flexible. Expect the unexpected. Except that you may have to change your plan if conditions and patient needs change. • Identify events that must be done by specific times, and distinguish them from things that you can take care of later. • Identify the what, where, when, why, who, and how of your priorities; this will help you devise a strategy and plan for completing your priority items first. • Emergencies, new admissions, and patient or family demands are imposed on you by others, and you cannot control them. Accept this as a fact, and learn to remain calm when things change suddenly. On most days, these things will not be a burden if you do a good job organizing and managing your time regarding events that you can control. • Focus on the patients' needs instead of tasks that must be done; by focusing on needs, you will complete the necessary tasks with far less stress. • Avoid repetition. Plan to do like jobs at the same time. Do them right the first time to avoid having to redo them. • Plan to do things simultaneously. For example, you must remain in the patient's room while she washes at the sink. Use that time productively! Make the bed or do another task instead of waiting impatiently. • When you have a task to complete, set a time limit for yourself. Be reasonable. • Break tasks and responsibilities into smaller, more manageable pieces, if possible. • Constantly evaluate your efficiency and time management skills and always work on improving them.

Good staff relationships can be formed if you: • Remember that each of you has a specific role to fulfill the jobs you carry out. • Do not overstep your authority or criticize others. • Listen to instructions carefully. Phrase questions in such a way that your supervisor knows you are looking for clarification, not challenging authority. • Remember that your tone of voice and body language can change your message. • Carry out your assignment and inform the nurse in advance if you cannot complete your work. • Offer help to others and accept help when you need it. Co-workers must help one another when a task is difficult or physically taxing. Simply being available when another team member gets behind in his or her work is a great help. • Have a cheerful, positive attitude. This is as important for relationships with other workers as it is in establishing rapport with patients. • Extend the same courtesy to staff members that you would to patients and their families. • Always keep your common goal in mind. Recognize co-workers as important members of the total team.

Your attitude should reflect: • Caring • Courtesy • Cooperation • Emotional control • Empathy (understanding) • Tact • Patience

Some patients become irritable, complaining, and uncooperative because of: • Fears about their diagnosis, disfigurement, disability, and death • Pain • Unrealistic or mistaken perceptions of activities around them • Uncertainties about the future • Worries about family • The loss or lack of social support systems • Dependence upon others • Financial concerns

Your work is physically and emotionally demanding because you must give so much of yourself to those in your care. To stay healthy and to do your best, you will need: • Sufficient rest • Good nutrition • Satisfying leisure activities • Ways of reducing stress

To help reduce stress: • Talk to your supervisor, a team conference may help. • Try sitting for a few moments with your feet up. • Shut your eyes and take some deep breaths. • With your eyes shut, picture a special place you like and, in your mind, take yourself there. • Take a warm, relaxing bath. • Listen to some quiet music. • Carry out a relaxation exercise. • Make yourself a cup of herbal tea and drink it slowly. • Exercise. • Devote time to hobby such as sewing, painting, or playing a musical instrument. • Go for a walk. • Take advantage of available stress reduction programs. • Sing! Singing is a good stress reducer. • Read a book. • Meditate. • Treat yourself to an activity that you enjoy.

The ability to cope with change is an asset that all workers must master. Try these strategies: • Learn all you can about the change and your responsibilities. • Try to understand the need for and value of the change. • Find ways of adapting to the change. • Be open-minded and flexible. • Cooperate with others and be a team player. • Adjust your attitude. View change as an opportunity for new challenges, growth, and accomplishment. • Keep your sense of humor. Make change fun. Try to have a good time despite the discomfort you feel. • Compensate for your stress by making time for activities you enjoy.

Good personal grooming is essential, because the nursing assistant is in close contact with patients. Your work can be physically challenging, so body odors must be controlled. The assistant may be the last to know that he or she has bad breath or body odor. A daily shower or bath and the use of antiperspirant/deodorant are essential. Keep the mouth and teeth clean. Recognize that strong perfumes, after-shave lotions, and cigarette odors are often offensive to patients. Keep your hair clean and short or tied back in a controlled style. Keep your fingernails short and clean. Avoid wearing nail polish. Jewelry is a ready medium for bacterial growth. It may also injure the patient or the assistant. Long, dangling earrings can be caught in linen or pulled out by patients. Most facilities permit staff to wear wedding rings and small earrings. A watch with a second hand is needed to measure vital signs.

physician

charge nurse

tell the nurse

reporting for duty on time

nursing assistant education

patient-focused

registered nurse

patient

with the patient's permission

feeling overwhelming stress