Introduction to Nursing Assisting

Life Changing Academy Jamaica

Introduction to Nursing Assistant

UNIT 1- Community Health Care

UNIT 2 - Role of the Nursing Assistant

UNIT 3 - Consumer Rights and Responsibilities in Health Care

UNIT 4 - Ethical and Legal Issues Affecting the Nursing Assistant

UNIT 1 - COMMUNITY HEALTH CARE

Objectives:

After completing this unit, you should be able to:

● Spell and define terms.

● List the five basic functions of health care facilities.
● Describe four changes that have taken place in health care in the past few years.
● Describe the differences between acute care and long term care.
● Name the departments within a hospital.
● Describe the functions of the departments within a hospital.
● Explain three ways by which health care costs are paid.
● State the purpose of health care facility surveys.
Vocabulary

Acute illness Facility Long-term acute Orthopedic

care hospital

Chronic illness Healthcare Obstetric Pathology

consumer

Client Hospice Occupational safety Patient focused care

and health
administration

Community Hospital Occupational Patient

therapy
Vocabulary

Pediatric Prenatal Resident Survey

Physical therapy Psychiatric Respiratory therapy surveyor

Post anesthesia Quality assurance Skilled Care facility License

recovery

Postpartum Rehabilitation Speech therapy Certification

Introduction
Nursing assistants play an important role in the care of people who are ill or injured. Care is
given to these individuals by the nursing assistant under the direction and the supervision of
licensed professional health care workers, such as doctors and nurses. Care may be provided in
various types of healthcare facilities.
● The term facility refers to a place in which care is given. Healthcare facilities provide
routine, emergency, and surgical services to many different types of patients.
● A hospital is a complex organization that provides a full range of healthcare services.
Highly sophisticated equipment and treatments are available there. Some hospitals
provide general care for patients with many conditions while others only do specialized
services example, treatment for cancer or rehabilitation care.
● A skilled care facility provides care to persons whose conditions are stable but who need
monitoring, nursing care, and treatments.
Introduction continued
All healthcare facilities have five basic functions:

1. Providing services for the ill and injured.

2. Preventing disease.
3. Promoting individual and community health.
4. Educating health care workers.
5. Promoting research in medicine and nursing.
Overview of Healthcare
● Patient focused care is based on the fact that each patient is a unique individual
and has different needs. Attention must be given to the physical, mental and
emotional aspects of the person's being if that person is to lead a fulfilling and
satisfying life. See Maslow's hierarchy of needs below. Suggested reading
Overview of Healthcare continued
People are living longer, quality of life has become an important consideration in healthcare delivery.
Some healthcare decisions are made with the patient’s future quality of life in mind. Quality of Life
policies and requirements focus on creating and maintaining an environment that humanizes and
individualizes each patient. In some situations, preserving the quality of the patient's life is viewed as
more important than increasing the length or duration of life. Within the past few years many changes
have occurred in healthcare, there are several reasons for these changes:

● As people age, their need for health care increases, so more services are needed to manage illness
and disability.
● Advanced technology means that more lives are saved.
● The cost of healthcare has increased tremendously because of the demand for services and
because of advances in technology. Science has created many ethical (moral) questions that must
be answered by Healthcare providers and consumers.
Overview of Healthcare continued
To reduce the cost of healthcare, patients are discharged earlier from the hospitals. These
patients may still require healthcare. This care can be given more economically in skilled care
facilities and in the patients home. More diagnostic tests and procedures are provided in
outpatient facilities to further decrease costs. Surgicenters, urgent Care centers, and clinics
are examples of such facilities. It is less expensive, for example, to receive treatment for a
throat infection in an urgent care center than in a hospital emergency room.

Most Healthcare is paid for with insurance. Insurance companies use managed care to provide
the services in the most efficient manner at the lowest cost. Briefly, this means that the
insurance company will:
Overview of Healthcare continued
● Not permit certain procedures or diagnostic tests until they have been approved
by the insurer.
● Negotiate with specific physicians, hospitals, pharmacies, and other care providers
to render services at a lower cost to the company’s members.
● Approve only a certain number of days of hospitalization for specific diagnoses. A
woman giving birth, for example, maybe allowed up to 48 hours of hospitalization.
● Require that specific procedures be done on an outpatient basis rather than having
the patient admitted to the hospital
Needs of the Community
People who live in a common area and share common health needs form a community.
Provisions for disposal of garbage, assurance of safe drinking water, availability of healthful
food, protection from disease, and Healthcare are important to every person within a
community. Public health laws regulate these services and are enforced by government
agencies. Healthcare is needed throughout the lifespan. The care may be short-term or
long-term and includes:
● Preventive care- eg. Prenatal care for pregnant mothers, well-baby checks and
immunization, health education to teach individuals how to avoid disease and injury,
physical examination throughout life.
● Emergency care-short-term care for a sudden illness or injury.
● Surgery-to repair an injured body part or remove a disease organ.
Needs of the Community continued
● Rehabilitation- to help a patient to regain abilities after illness and injury.
● Long-term care- for patients who have chronic or incurable conditions.
● Hospice care- for patients who are dying and their families. Persons receiving
healthcare are called Healthcare consumers. They are identified by the type of care
they need:
1. Patient is a term used for persons in acute care facilities such as hospitals.
2. Client is a term used for persons receiving care in their own homes.
3. Resident is a term for people in long-term care facilities
Community Healthcare Services
There are two types of healthcare facilities:

● Short-term care - is given to patients who have a routine or minor problem, such as a urinary tract
infection. The care may be given in the physicians office, and outpatient clinic, or an urgent care center.
Uncomplicated surgeries, such as hernia repair require only short-term care and maybe done in a
surgicenter. General hospitals also provide short-term care for acute illnesses.

*An acute illness or injury comes on suddenly and requires intense immediate treatment. For example heart
attacks, severe burns, through, and uncontrolled diabetes.

● Long-term care is necessary for persons who have chronic conditions. This may be given in a skilled care
facility, adult Day Care setting, respite care facility, assisted living facility, or the patient's home.

*A chronic illness is one that is treatable but not curable and is expected to require a lifelong care. For example
cardiovascular disease, Alzheimer's disease, multiple sclerosis, Parkinson's disease, and diabetes.
Types of healthcare facilities
Short-term care Long-term care

Hospitals Long-term acute care hospital

Subacute and transitional care facilities
Skilled care facilities

Urgent care facilities Adults daycare

Surgicenters Assisted living facilities

Rehabilitation centers
Psychiatric hospitals

Outpatient clinics Respite care

Psychiatric hospitals

Physician's offices Home Care

Healthcare Systems
Types of Patient Care
There are several different types of care for patients, depending on their need. Types of patient
care are listed below.
● Primary Care
● Specialty Care
● Emergency Care
● Urgent Care
● Long-term Care
● Hospice Care
● Mental Healthcare
(Colorado Patient Navigator Training Collaborative, n.d.)
Primary Care
Primary care should be the first place patients go for medical care. Patients may get primary care in a
doctor's office or in a community health center. One focus of primary care is to prevent disease
through regular physical exams and health screening. Another focus is to care for a patient's general
health by diagnosing and treating a wide variety of conditions. If a patient has a health problem that
requires special knowledge or skill, a primary care doctor will refer the patient to a specialist.
Primary care doctors follow a patient's care while they see a specialist.

Primary care members include:

● Primary care doctors, also called general practice, general internists or family doctors
● Pediatricians (doctors for babies and children)
● Nurses
● Physician assistants
● Nurse practitioners

(Colorado Patient Navigator Training Collaborative, n.d.)

Specialty Care
Specialty care is care for a patient who has a health problem or illness that
requires special knowledge in one medical area. Specialty care can be ongoing
or preventative care around a specific system of the body. Specialists have
knowledge or skill related to a specific disease or organ system of the body.
Specialists must complete special training, be certified or licensed in their area
of specialty. They can be doctors, nurses or other healthcare team members.
Examples of specialists include: cardiologists, gynecologists, physical
therapists or social workers.
(Colorado Patient Navigator Training Collaborative, n.d.)
Emergency Care
Emergency care involves diagnosing and treating life-threatening
illnesses or injuries that need immediate attention. Emergency
care may take place in ambulances or other transportation
vehicles, hospital emergency rooms or intensive care units.
Examples of emergencies are chest pain, difficulty breathing,
heart attack, serious injury, bleeding that will not stop or mental
crisis.
(Colorado Patient Navigator Training Collaborative, n.d.)
Urgent Care
Urgent care is not life threatening, but is care for an illness or
injury that needs immediate attention. Examples of urgent
care are minor cuts or burns, stomachaches, sprains and ear or
throat infections.
(Colorado Patient Navigator Training Collaborative, n.d.)
Long-term Care

When someone is not able to perform daily living

activities due to an injury, disability, chronic condition or
dementia. Long-term care is a combination of medical,
nursing and social care. It can be provided in a person's
home, long-term care facility or assisted living facility.
(Colorado Patient Navigator Training Collaborative, n.d.)
Hospice Care

Hospice care focuses on "palliative" care to ease

symptoms rather than cure a disease toward the end of
life. The philosophy of hospice care is give physical,
emotional, spiritual or social to support a patient and
their family. Hospice care may be provided in a person's
home or in a hospice care facility.
(Colorado Patient Navigator Training Collaborative, n.d.)
Mental Healthcare

Mental Healthcare can help when patients need help

with a mental illness or emotional crisis. Mental health
treatment may include medication, psychotherapy
("talk therapy") or both. Mental health professionals
include psychiatrists, counselors or psychologists.
(Colorado Patient Navigator Training Collaborative, n.d.)
Health Promotion and Illness Prevention
Health promotion is the behavior of an individual that is motivated by a personal desire to increase well-being
and health potential. In contrast, illness or disease prevention is behavior motivated by a desire to avoid or
detect disease or to maintain functioning within the constraints of illness or disability (Pender, Murdaugh, &
Parsons, 2006). Health promotion and illness prevention activities may be described as: primary, secondary, and
tertiary levels.

● Primary health promotion and Illness prevention is directed towards promoting health and preventing the
development of disease processes or injury. Nursing activities at the primary level may focus on
individuals or groups. Examples of primary levels of activities are: immunization clinics, family planning
services, providing poison control information, and accident prevention education. Other nursing
interventions include: teaching about a healthy diet, the importance of regular exercise, safety in industry
and farms, using seat belts, and safer sex practices. Health risk assessments are an important part of health
promotion and preventive care. Health-risk assessment is an assessment of the total person, the resulting
picture of the individual indicates areas of risk for disease or injury as well as areas that support health.
Health Promotion and Illness Prevention continued
● Secondary health promotion and illness prevention focuses on screening for early
detection of disease with prompt diagnosis and treatment of those found. The
goals of secondary preventive care are to the identify an illness, reverse or reduce
the severity of the disease or provide a cure, and thereby return to the individual
to maximum health, as quickly as possible. Examples of nursing activities at this
level are assessing children for normal growth and development, and encouraging
regular medical, dental, and vision examination. Other activities include screening
example blood pressure cholesterol and skin cancer recommending gynecological
examinations and mammograms for women as age appropriate, and teaching
testicular self examinations to men.
Health Promotion and Illness Prevention continued
● Tertiary health promotion and disease prevention begins after an illness is
diagnosed and treated to reduce disability and to help rehabilitate patients to a
maximum level of functioning. Nursing activities on a tertiary level include
teaching a patient with diabetes how to recognize and prevent complications,
using physical therapy to prevent contractors in a patient who has had a stroke or
spinal cord injury, and referring a woman to a support group after removal of
breast because of breast cancer.
Hospitals
Most hospitals are licensed to care for patients of all ages and for patients
with a variety of problems. Some hospitals take care of patients with
special conditions or care for specific age groups:
● Pediatric hospitals care for only children from birth to 18 years of age.
● Psychiatric hospitals provide care for persons with mental illness.
● Rehabilitation hospitals provide restorative services to patients after
disease illness or injury. The services are designed to assist the patient
with regaining the ability to function at the highest level possible,
considering the patient’s illness or injury.
Hospitals continued
● Long-term acute care hospitals are a rapidly growing
segment of the healthcare market in the US. The facility is
licensed as a hospital but designed for patients who are
expected to have a lengthy stay. To be accepted patient must
have a medical complex condition, need acute care services,
and have a good chance of improvement. The level of care is
higher than provided in long term care (nursing homes) are
some acute care facilities.
Hospital Organization
Hospitals are organized in ways that provide the most efficient delivery of services.
Major departments are established within each facility to meet the needs of patients
with specific conditions. These units provide nursing care 24 hours a day, 7 days a
week.
● Medical department: cares for patients with medical condition such as pneumonia
or heart disease.
● Surgical department: cares for patients before, during, and after their surgery.
There may be many operating rooms where surgical procedures are performed,
and a post-anesthesia recovery area where patients are closely monitored after
surgery. Patients remain in this area until they are stable enough to leave the
surgical department.
Hospital Organization continued
● Pediatric department: cares for a sick or injured children.
● Obstetric department: cares for newborns and their mothers. This department
includes the labor and delivery unit, the postpartum unit (for mothers who have
given birth), and the nursery for the newborns.
● Emergency department: cares for victims of trauma, natural disasters (tornadoes,
earthquakes accidents for example), or medical emergencies.
● Critical care department: cares for seriously ill patients who require constant
monitoring and care.
Hospital Organization continued
Larger hospitals have many specialized units staffed by nurses and therapists who
provide care for persons with problems such as cancer, cardiovascular disease, or
kidney disease, or for those requiring orthopedic (bone and muscles) surgery.
Specialized healthcare workers provide direct or indirect services to the patients in
these units. Specialized services include:
● Dietary services. A registered dietitian plans the meals for all patients and provides
educational services to patients on special diets. The hospitals food services
department prepares meals and delivers them to patients.
● Pharmacy services. Registered pharmacists prepare and provide all medications
and intravenous therapy solutions.
Hospital Organization continued
● Diagnostic services. The laboratory department is equipped to perform diagnostic
tests and investigative procedures various specimens taken from body tissue are
sent to the lab for analysis. Diagnostic imaging and radiology. X-ray and other
specialized procedures are done. The results of theses tests are used by the
physicians to assist in making a diagnosis and by others in the care of patients.
● Rehabilitation services.
1. Physical therapy assists patients to regain mobility skills.
2. Occupational therapy helps patients to regain a self-care skills.
3. Speech therapy helps patients to regain the ability to communicate and works
with patients who have swallowing disorders.
4. Respiratory therapy provides care for patients who have disorders of the
cardiopulmonary system, and sleep disorders that affect the patient's breathing.
Hospital Organization continued
● Social services. Staff members provide counseling for patients and their families, help
needy families get financial assistance, plan for patient discharge, and a for patient
transfers from one facility to another.
● Environmental services.
1. Housekeeping
2. Maintenance
3. Laundry services
● Business services are responsible for patient billing, employee payroll, and other financial
matters.
● Medical records department transcribes and catalogs all patient records.
● Volunteers provide services free of charge.
● Pastoral care helps meet patients’ is religious and spiritual needs and provides counseling.
Financing Healthcare
Healthcare is paid for in the US by:

● Insurance.
● Out of pocket payments.
● Medicare
● Medicaid

According to Anya Cushnie, “Jamaica's health financing system uses a system of

general and earmarked taxes, prepaid premiums and out of pocket expenses to finance
the range of health services. Jamaica has a primarily tax-funded system with general
taxation providing 90% of the MOH budget (PIOJ, 2008)”.
Regulatory Agencies
Many external agencies regulate health care facilities. Some regulatory agencies are
branches of the state and federal government, but several are voluntary, private
organizations.

Healthcare facilities must meet certain quality standards to operate. The various
agencies inspect the facility periodically to ensure that it meets health and safety
regulations and complies with accepted standards.

*A survey is a review and evaluation to ensure that facilities are maintaining acceptable
standards of practice many different agencies established quality standards for
healthcare facilities. Different types of facilities must meet different quality standards.
Regulatory Agencies continued
Each facility holds a state license, which permits it to conduct business.
Most facilities also possess a certification. Certification is necessary to
collect Medicare and Medicaid payments. Licensure and certification
surveys are done by the State health department or human service
agency. During a survey, a number of surveyors inspect conditions in
the facility. Surveyors are representatives of the agency that reviews the
facility.
OSHA Surveys
The Occupational Safety and Health Administration (OSHA) also surveys health care
facilities. OSHA is a government agency that protects the health and safety of
employees. OSHA inspectors review infection control, isolation practices, employee
tuberculin testing, material safety data sheets, and other policies and facility practices.
An OSHA survey involves interviews with employees and the tour of all areas of the
facility. The inspector will ask questions about health and safety practices. OSHA
inspectors will make recommendations for correcting unsafe conditions. If the
inspector notes dangerous or unsafe conditions during the survey, the agency may
receive a citation or fine. A citation is a written notice that informs the facility of the
violation of OSHA rules. The employer must post the written report of each citation, at
or near the place where the violation occurred, for 3 days, or until the unsafe condition
is corrected.
Quality Assurance
All healthcare facilities have a program called quality assurance (QA). Some facilities call this
program continuous quality improvement (CQI). You may be asked to participate on the
quality assurance committee. The purpose of quality assurance is the conduct internal reviews
to identify problems and find ways to improve. The quality assurance committee meets
periodically to evaluate care provided and practices in the facility. Restraint use, infections,
pressure ulcers, and infection control are some of the areas commonly reviewed. Committee
members audit practices on each unit and make recommendations to administration to
improve care. Patient care should be continuously evaluated by the facility and adjusted to
meet patient needs. The quality assurance program performs this important function. The
quality assurance committee is very important to the operation of the facility and to the
facilities success in surveys. The committee identifies problems and correct them. The
self-improvement process prevents problems with regulatory agencies and improves the
quality of care delivered.
Review
True or false

1. Nursing assistant work under the supervision of licensed professional health Care
workers.
2. Patient focused care means treating all patients as unique individuals.
3. Persons receiving care in hospital are called residents.
4. A chronic illness comes on suddenly and is usually curable.
5. The general term for a person needing Healthcare is Healthcare consumer.
6. Hospice Care is provided to people who need rehabilitation.
References
Acello, B., Hegner, B. R., & Caldwell, E. (2008). Nursing assistant: A nursing process approach (10th
ed.). Cengage Learning.

Cushnie, A. (2010). A Case Study of Jamaica’s Health Financing System and its Impact on the
Performance of the General Health System [Master's thesis].
https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.bibalex.org/Search4Dev/
files/396315/338388.pdf&ved=2ahUKEwi-iN2YzZn6AhVktoQIHU_JCS8QFnoECAUQBg&usg=
AOvVaw3i6ZUpqbOsoVGrclEjcTq2

Colorado Patient Navigator Training Collaborative. (n.d.). Types of patient care. Patient Navigator
Training Collaborative | Navigate to new knowledge and skills.
https://www.patientnavigatortraining.org/healthcare_system/module1/2_typesofpatientcare.htm

Suggested reading: https://www.simplypsychology.org/maslow.html

Objectives:
UNIT 2 - Role of the Nursing Assistant
After completing this unit, you should be able to:

● Spell and define terms.

● Identify the members of the interdisciplinary health care team.
● Identify the members of the nursing team.
● List the job responsibilities of the nursing assistant.
● Make a chart showing your facility’s line of authority.
● Describe the legal importance of working within the established scope of nursing
assistant practice.
UNIT 2 - Role of the Nursing Assistant
● Discuss the potential for career growth and advancement, and identify
opportunities for expanding the scope of nursing assistant practice.
● Describe the importance of good human relationships and list ways of building
productive relationships with patients, families, and staff.
● List the rules of personal hygiene and explain the importance of good human
relationships and list ways of building productive relationships with patients,
families, and staff.
● List the rules of personal hygiene and explain the importance of a healthy mental
attitude.
● Describe the appropriate dress for the job.
Vocabulary

Attitude Licensed practical nurse Omnibus Budget

Reconciliation Act

Burnout Licensed vocational nurse Partners in practice

Cross trained Nurse aide competency Registered nurse

evaluation program

Empathy Nursing assistant Scope of practice

Interdisciplinary Healthcare Nursing team

team
The Interdisciplinary Healthcare Team
The nursing assistant is an important member of the interdisciplinary Healthcare team.
This team includes the patient, members of the patient's family, the physician, the
nursing team, and other specialists trained to meet with general and specific patient
needs. The physician names the condition or illness (make a diagnosis) and prescribe
treatment. Physicians frequently specialize in one area of medical practice the table will
show common medical specialties the name for the physician who practices each
specialty, and a description of the care provided by each specialist.
Specialty Physician Type of care

Allergy Allergist Diagnoses and treats patients with hypersensitivities.

Cardiovascular diseases Cardiologist Diagnoses and treats patients with disorders of the heart and
blood vessels.

Critical Care Intensivist Specializes in intensive care and treats critically ill and injured
patients.

Dermatology Dermatologist Diagnoses and treats patients with disorders of the skin.

Endocrinology Endocrinologist Specializes in diabetes; diagnoses and treats other disorders of

the endocrine system and glands that make hormones.

Gastroenterology Gastroenterologist Diagnoses and treats patients with disorders of the digestive
system.

Gerontology Gerontologist Diagnoses and treats disorders of the aging person.

Gynecology Gynecologist Diagnoses and treats disorders of the female reproductive tract

Hematology Hematologist Diagnoses and treats disorders of the blood and blood forming
organs.
Specialty Physician Type of care

Hospital care Hospitalist Specializes in hospital care. The primary practice of these doctors is in the
hospital rather than an office. The doctor admits patients through the
emergency department and directs, managers, and reports on the hospital
course of treatment to the patient's primary physician.

Internal medicine Internist Diagnoses and treats patients with disorders of the internal organs.

Neurology Neurologist Diagnoses and treat patients with disorders of the nervous system.

Obstetrics Obstetrician Provides care to woman during pregnancy, childbirth, and right after.

Oncology Oncologist Diagnoses and treats patients with cancerous tumors.

Ophthalmology Ophthalmologist Diagnoses and treats patients with disorders of the eyes.

Pediatrics Pediatrician Diagnoses, treats, and prevents disorders in children.

Psychiatry Psychiatrist Diagnoses and treats disorders of the mind.

Radiology Radiologist Diagnoses and treats disorders with x-rays and other imaging technology.

Urology Urologist Diagnoses and treats disorders of the urinary tract and main reproductive
tract.
The Interdisciplinary Healthcare Team continued
The nursing team provides skilled nursing care. The team consists of registered nurses,
license practical (or vocational) nurses, and nursing assistant. Registered nurses plan
and direct to the nursing care of patients according to the physicians orders. All
members of the team provide direct patient care. Care provider specialists who may
also be part of the team included dietitian, physical therapist, occupational therapist,
speech therapist, respiratory therapist, and pharmacist.
The Nursing Team

● The Registered Nurse

They becomes registered by passing a national licensure examination given by the state. The
nurse has a 4-year college education with a bachelorette degree, or an associate in applied
science degree from a 2-year Community college or technical schools program, or a diploma
from a hospital School of nursing. Because they have taken and successfully passed your
licensing examination and are registered, all these nurses use the initials RN after their names.
Registered nurses have been educated to assess, plan for, evaluate, and coordinate the many
aspects of patient care. Registered nurses teach patients and their families about good health
practices. They also provide nursing care and supervise any duties they delegate to others.
The Nursing Team continued
Nurses may specialize in a specific area of nursing practice. Some of the common
nursing specialties are:
● Maternal and child health ● Telemetry

● Anesthesiology ● Surgery

● Gerontology ● Home Care

● Oncology ● Cardiac Care

● Administration ● Independent practice (nurse practitioner)

● Public health ● Research

● Teaching ● Infection control

The Nursing Team continued
● The license practical/vocational nurse

The licensed practical or licensed vocational nurse has generally completed a one-year
to 18 months training program and has passed a national licensure examination
administered by the state. She or he is identified by the initials LPN or LVN. This nurse
works under the supervision of the registered nurse, a physician, or a dentist. The
licensed practical nurse is able to provide most of the care when the patient’s nursing
needs are not complex, and also assist the registered nurse in more complicated
situations.
The Nursing Team continued
● The Nursing Assistant
The nursing assistant assists with the care of patients under the supervision of either a
registered nurse or an licensed practical nurse. Because the assistant’s responsibilities and
skills are not as great as those of the registered nurse or licensed practical nurse or license
vocational nurse, the basic preparation is shorter. However, growth and learning will continue
throughout your career. In the healthcare facility, the assistant is called by one of the
following names: patient care attendant, nurse’s aide, nurse assistant, or nursing assistant,
clinical support associate, nurse extender, Healthcare assistant, personal care assistant, patient
care technician, unlicensed assistive personnel, ________ care technician (the first word
designates the unit on research assistant works example surgical care technician, critical care
technician etc).
Organization of Nursing Care
Each facility selects a method of providing nursing care to meet its patients needs. No
single delivery system is ideal. Each facility determines job duties and the model of
care based on cost effectiveness and the maximum patient benefit. The education,
competency, and teamwork of nursing assistance staff are key to the success of these
systems. Nursing care is commonly organized in one of several ways:
● Primary nursing
● Functional nursing
● Team nursing
● Partners in practice
The nursing assistant has a functional role in each.
Organization of Nursing Care continued
● Primary Nursing

In primary nursing, care is given by a registered nurse. This nurse is responsible for an
assigned patient's care for that patient's entire hospitalization. Licensed staff and
assistants help with the care when the RN is not on duty. The nurse plans and
coordinates the nursing care, teaches, carries out treatments, gives direct nursing care,
and plans for the patients discharge. Patients appreciate primary nursing because it
enables them to relate directly to one specific nurse. Each RN is assigned to and
responsible for six to eight patients in the primary nursing situation.
Organization of Nursing Care continued
● Functional nursing

This is a task-oriented way to organize care. It is an older method that is once again
being used more frequently. In this method of practice, the charge nurse is the one
person responsible for all patients. All other staff members are assigned specific tasks,
such as giving medications, administering treatments, or providing hygienic care.
Patients may find this type of nursing confusing because many people are involved in
their care. However, some facilities feel that this method uses available, qualified
personnel to best advantage.
Organization of Nursing Care continued
● Team Nursing
This is one of the most common methods of delivering nursing care. In this system, a registered nurse
team leader determines the nursing needs of all the patients assigned to the team for care. In some
work settings, the LPN or LVN is a team leader. He or she is supervised by a registered nurse. Team
members receive instructions and assignments from, and report back to, the team leader. The team
approach is successful when:
● Team members understand the philosophy, goals, and purposes of restorative care. Restorative
care helps patients reach their highest possible level of functioning.
● Team members understand their responsibilities.
● All team members, including the patient, and family members if the patient desires, attend the
care plan conference.
Organization of Nursing Care continued
● Partners in practice
This method of providing care, a registered nurse or primary nurse is paired with a nursing
assistant or other team member. The team members work together to meet the needs of their
assigned patients. In many facilities, they work on the same schedule. There are many
variations in this type of care. All involved partnering a registered nurse with a nursing
assistant. In some hospitals, the assistants are taught to perform advanced clinical skills, such
as drawing blood. In others, they provide only assistance with activities of daily living. The
partners in practice and other similar methods of care combine positive aspects of Team
nursing and primary nursing into the partnership model. This method of care delivery is
effective for providing patient care, communicating with physicians and staff from other
departments, and coordinating care among staff members.
Organization of Nursing Care continued
● Teamwork

The various alternative models of patient care are successful because they emphasize
and promote cooperation and teamwork, and provide many opportunities for personal
growth. Learning to work with others as a member of a team is one of the most
important skills to master during your nursing assistant education.
Patient Focused Care
In addition to the models of care described the trend in healthcare has
moved toward the patient-focused method of care delivery. This method of
care emphasizes the needs of the patient rather than the convenience of
the various departments involved with patient care. Team members on the
unit make decisions jointly, and plan and deliver care promptly to meet
patient needs. This is faster and involves fewer individuals than other
methods of care that require coordination of service among different
departments. Thus, the patient is the focus of the service.
Patient Focused Care Continued
The patient is a fully functional member of the team. Nursing staff build caring
relationships with each patient. Nurses work with patients to teach them to be fully in
control of and responsible for their own health and Healthcare. Even the medical
records are patient focused instead of occupationally oriented. When is
patient-centered, nursing personnel focus on the caring aspects of their jobs. The goals
of patient-focused care are to:

● Limit the number of people involved in patient care.

● Contain costs.
● Meet patients need or needs efficiently.
Patient Focused Care Continued
Staff members are prepared as multiskilled workers by cross training them to
perform special skills. This enables staff to carry out selected duties that are
usually performed by other workers such as drawing blood, giving special
treatment, working in specialty departments, and using more sophisticated
instruments to perform tests. For example a multi-skilled nursing assistants
may be cross-trained to draw blood, get respiratory treatments or perform an
electrocardiogram. These tasks can be done without calling a technician from
another department or moving the patient out of the unit.
Patient Focused Care Continued
You can be an effective member of the interdisciplinary team by:
● Recognizing the importance of all team members.
● Appreciating each members contribution to the team.
● Learning as much as possible about patients and their families, to help you
understand their feelings and concerns.
● Attending care plan conferences and giving the team your observations and ideas.
● Attending in-service sessions to increase your knowledge.
● Becoming cross-trained, if possible, to increase your skills.
● Cooperating with other team members to provide patient-focused care.
Regulation of Nursing Assistant Practice
Nursing assistants must understand the scope of the specific tasks they will be expected to carry out.
They should also know the state regulations that govern their clinical practice. Federal regulations
require that all states spell out the duties and responsibilities of the assistant, as well as the basic
education and level of competency required for practice. In 1987 a federal law was passed that
regulates the education and certification of nurses aides. The law is called the Omnibus Budget
Reconciliation Act (OBRA) . OBRA established the minimum requirements for nurse aide
competency evaluation program.
Effective October 1, 1990, all persons working as a nurse aides had to complete a competency
evaluation program or approved course. The education of nursing assistants is under individual State
jurisdiction, guided by Federal Regulation. The National Council of State Boards of Nursing, Inc., then
developed the Nurse Aide Competency Evaluation Program (NACEP). NACEP meets the
requirements of OBRA. NACEP is a guide for individual programs that register and award credentials
to nursing assistants. NACEP specifies the minimum skillss to be achieved. Programs may exceed these
minimums.
Regulation of Nursing Assistant Practice Continued
Nursing assistants who wish to be certified must complete a minimum of 75 hours of
theory and practice. Some states require a minimum of 80 to 150 program hours in
written or oral and clinical skills in several areas these areas. These areas include:

● Basic nursing skills, including infection control

● Basic restorative services
● Mental Health and Social Service needs.
● Personal Care skills
● Residents rights and good communication
● Safety and Emergency Care
Regulation of Nursing Assistant Practice Continued
Other rules that guide nursing assistant practice require:

● Completion of a competency evaluation program by October 1, 1990, of all

persons who were working as nurse aides prior to July 1989.
● At least three opportunities for non certified nursing assistants to meet
requirements.
● Completion of a new training and competency program or retesting by persons
who wish to work as nursing assistant but who have not given nursing care for a
continuous 24 month after completing a basic nursing assistant program.
● Continuing education (12 to 48 hours per year, in some states).
Regulation of Nursing Assistant Practice Continued
The OBRA regulations are important because they:

● Give nursing assistants recognition through registration.

● Help define the scope of nursing assistant practice.
● Provide uniformity in the care provided by nursing assistants.
● Promote educational standards for nursing assistant. Be sure you are familiar with
any specific state laws that relate to your role as an assistant.
Lines of all Authority
Nursing assistants receive their assignments from the team leader or charge nurse, nurse
manager, or unit manager. When they finish their assignments, they report to this same
person. This represents the assistants immediate line of authority and communication.

The assistant will work with a team whose leader is a licensed practical nurse or a registered
nurse. In this case, the assistant’s immediate superior is the team leader. The team leaders
receive their instructions from the charge nurse. The charge nurse is responsible for the total
care of a certain number of patients. Sometimes this includes all the patients on a wing, a unit,
or a floor of the facility. Supervisors are responsible for several charge nurse units. They
receive their authority and direction from the director of nursing. Healthcare facilities vary in
the complexity of their staffing.
Lines of all Authority Continued
Assistants should learn the lines of authority in their health care facility. As a student,
your immediate authority is your teacher or the person designated as your supervisor.
The physician directs the patient's medical care. The registered nurse carries out the
physician's orders and plans the patient's nursing care. The authority for nursing care
passes from the registered nurse supervisor to the charge nurse, to the team leader, and
then to the nursing assistant. When you accept the responsibility for an assignment,
you must fully understand the assignment and be capable of handling it. If there is any
doubt, you should discuss it with the team leader or charge nurse.
Note: Typical model of the nursing department lines of authority. The diagram may
vary slightly from one facility to the next.
TYPICAL MODEL OF NURSING DEPARTMENT LINES OF AUTHORITY
Guidelines for the Nursing Assistant
Only performed tasks that you have been taught to do. If you are unsure how to carry out a procedure,
inform the nurse. Do not feel embarrassed. It is better to ask for help than to make an error and injure
a patient.

Seeking Higher Authority

Sometimes a report you make to your immediate supervisor is not taken seriously. Make very sure of
your facts and try again to make your supervisor understand. If you fail and your information is very
important, you can move up the chain of command.

For example, if you report that a person is being harmed by a co-worker’s inattention, but your
supervisor does not listen to your report of the situation, for your patient’s safety you must try again. If
the second attempt also fails, the next step is to bring the problem to the attention of the next level of
authority. This situation should not occur often if there are good staff relations, but it can happen.
Roles and Responsibilities of the Nursing Assistant
The nursing assistant works directly with the patient, giving physical care and emotional support. This
care is always given under the direction of the license nurse. The nursing assistant has an important
role and can contribute much to the patient's comfort and safety. Observations made during the
delivery of care are reported to the nurse and are recorded on the patient’s chart.

Not everyone can be a nursing assistant. Nursing assistants are special people: they are interested in
others, they take pride in themselves, and they are willing to learn the skills necessary to care for those
who are ill.

This interest in and caring for people can be a valuable asset to the entire nursing team. You are the
person the patient sees most often. This means that you have the chance to observe and hear many
things that the other team members will not. By transmitting these observations to your nurse in
charge, you are likely to give the other team members valuable insight into the patient's illness and
attitude toward that illness.
Guidelines for the Nursing Assistant continued
Scope of Practice
This means the skills the nursing assistant is legally permitted to perform by state
regulations and facility policies. If another worker asks you to perform a task that is
clearly out of your scope of practice, such as giving medications, be prepared to refuse.
Explain in a courteous manner that this is a task for which you have not been
technically or legally prepared. Report the incident to your charge nurse so that your
scope of duties can be clearly understood by all staff members.
For the same reason, nursing assistant do not take orders from doctors or tell families
about the contents of patient care plans or records. These actions are not within the
scope of the nursing assistant practice.
Roles and Responsibilities of the Nursing Assistant continued
Nevertheless, be willing to learn new skills under the close supervision of your nurse. If
the new skill is within the scope of nursing assistant practice, this will increase your
ability to provide good, safe nursing care. If, for example, your nurse suggests a way to
lift a patient that is different from the way you learned in your program, listen and
watch carefully as the instruction is given. Seek supervision as you practice the new
technique until both you and supervisor feel you can do it safely on your own.
For example you may see that the patient's attitude toward the attending doctor or
nurse is much less relaxed than it is with you, the nursing assistant. For that same
reason, the patient is far more likely to tell you of “minor complaints” that may not be
minor at all. Competent, caring nursing assistants make a valuable contribution to the
comfort and safety of the patients.
Expanded Scope of Practice
In many states and facilities, persons who have completed the nursing assistant
program and have experience in clinical practice can expand their scope of practice by
taking additional classes to learn new skills and gain job responsibilities. These
programs provide the opportunity for career advancement. Some of these programs are
given by the employer, and enable the assistant to perform additional skills while at
work in the facility. Other classes are held by private companies that sponsor seminars
for nursing assistants. Other programs are recognized by the state. These are normally
given by community colleges. Successfully completing the program enables the
assistant to practice their advanced skills anywhere in the state.
Expanded Scope of Practice continued
Types of classes vary widely. Common types of classes include those that:

● Prepare students to provide advanced nursing skills, such as drawing blood,

inserting a urinary catheter, or performing an electrocardiogram.
● Teach the nursing assistant how to give medications in the long-term care facility.
● Expand clinical responsibilities by learning clerical skills, unit management,
supply and inventory management, or mentoring new workers.
● Provide specialized information and additional certification in specialized
subjects, such as geriatric care, therapy or restorative nursing care, or end of Life
Care.
Expanded Scope of Practice continued
As you can see, there are many opportunities for qualified health care workers. take
advantage of classes in which you will learn new information and skills. Many facilities
have special programs, such as career ladders for career growth and enhancement. You
will find that you have chosen a career with unlimited opportunities for personal
growth and satisfaction.
Typical Job Description for a Nursing Assistant
Nursing assistants commonly participate in the nursing process by carrying out the activities listed.
Note: use standard precautions while providing care.
1) Assist with patient assessment and Care planning.
a)Check on record vital signs. b)Measure height and weight. c)Measure intake and output. d)Collect
specimens. e) Test urine and feces. f) Observe patient response to care given. g) Report and record
observations of patients’ conditions.
2) Assist patients in meeting nutritional and elimination needs.
a)Check food trays. b) Pass food trays. c)Feed patients. d) Provide fresh drinking water and
nourishment. e) assist with bedpans, urinals, and commodes. f) Empty urine collection bags. g) Assist
with colostomy care. h) Give enemas. j) observe feces and urine.
Typical Job Description for a Nursing Assistant continued
3) Assist patients with mobility.

a) Turn and position. b) Provide range of motion exercises. c) Transfer to a wheelchair

or stretcher. d) Assist with ambulation.

4) Assist patients with personal hygiene and grooming.

a) Bathe patients. b) Provide nail and hair care. c) Give oral hygiene. d) Provider
denture care. e) Shave patients. f) Assist with dressing and undressing.
Typical Job Description for a Nursing Assistant continued
5) Assist with patient comfort and anxiety relief.
a) Protect patient privacy and maintain confidentiality. b) Keep call signal within
patient’s reach. c)Answer call signal promptly. d) Provide orientation to the room or
unit and to other patients and visitors. e) Assist patients with communications. f)
Provide diversional activities. g) Give back rubs. h)Provide hot and cold applications.
6) Assist in promoting patient safety environmental cleanliness.
a)Use side rails and restraints appropriately. b)Keep patient unit clean and clutter free.
c) Make beds. d)Clean and care for equipment. e)Carry out isolation precautions.
f)Observe oxygen precautions. g)Assist in keeping recreational and non-patient areas
clean and free of hazards. h)Participate in fire drills and patient evacuation procedures.
Typical Job Description for a Nursing Assistant continued
7) Assist with unit management and efficiency.
a)Transport patients. b)Takes specimens the lab. c)Assist with special
procedures. d)Do errands as required. e)Assist with cost containment
measures. f)Answer the telephone. g)Document care provided and assist
with unit record keeping.
Personal Vocational Adjustments
You will have to make some personal adjustments to your new work situation. Healthcare
facility rules and orders from supervisors must be obeyed promptly, even if you do not agree
with them. rules are written for the protection and Welfare of both the patient and the
healthcare provider. You must also learn to accept constructive criticism and profit by it. It
means you are willing to learn and grow. You show your maturity in many ways. You
demonstrate:
● Dependability and accuracy by reporting for duty on time and completing your
assignments carefully.
● Respect for your co-workers and the place you share together on the nursing team when
you are ready to help.
● Understanding of Human Relationships by being empathetic, patient, and tactful with
others.
Personal Vocational Adjustments- Interpersonal Relationships
Interpersonal relationships are simple interactions between people. You develop
interpersonal relationships with everyone you know. Some relationships are deep and
Lasting, and some are only casual. But to some degree, you react to others and they
react to you. Friendship is a good example of an interpersonal relationship that is
satisfactory to two people.

Much of the satisfaction that a nursing assistant gets from work comes from the
quality of the relationship that are developed with other staff members and patients.
some people call this the ability to get along with others.
Personal Vocational Adjustments- Interpersonal Relationships
continued
Similarly, good relationships with others begin with your own personality and
attitudes. If you are a warm and accepting person with positive attitudes, others will
respond in the same way. If you walk down the street and someone smiles at you,
without thinking, your reaction is to smile back. most human relationships are like this.

It is not necessary for you personally to like someone else to be pleasant and
cooperative with him or her as you carry out your duties.
Personal Vocational Adjustments- Attitude
Perhaps the most important single characteristic that you bring to your
job is your attitude. Your attitude is developed throughout your
lifetime, and it is shaped by the experiences you have had. Some people
think having an “attitude” means being negative or opinionated, but all
people show attitude through their behavior. Sometimes that attitude
demonstrated is good and sometimes it is poor.
Personal Vocational Adjustments- Attitude continued
All the other characteristics described are an outer reflection of your inner feelings- of
your attitude towards yourself and others. your attitude reflects:

● Caring
● Cooperation
● Empathy (Understanding)
● Patience
● Courtesy
● Emotional control
● Tact
Patients have the right and need to be cared for in a calm, unhurried atmosphere by
people with a caring attitude.
Personal Vocational Adjustments- Patient Relationships
Patients come in all sizes and shapes, and ages: young, old, and in between. Some have
major, complicated illnesses. Others have physical problems that can be helped with
rest and medication. Some patients are in the healthcare facility to begin their lives.
Others will end their lives there. A good nursing assistant shows empathy for the
patient by being eager to serve and by using a gentle touch.
Every patient entering a healthcare facility presents a unique set of problems and
concerns to the staff. These problems and concerns are important. As you compare the
conditions of patients in your own mind, however, it might seem that one has more
serious problems than another. Because patients do not share your knowledge, they
will not notice. Never forget that, to the patient, her or his own problems are the most
important.
Personal Vocational Adjustments- Meeting the Patients Needs
Patients personalities are shaped by their life experiences, which are now complicated by
illness. Their social, spiritual, and physical needs must continue to be met even though they
are in a different, more confined setting. The restrictions imposed by illness limit, to some
degree, their ability to satisfy these needs through the normal channels. This is naturally
frustrating and puts great strain on the patient's ability to establish and maintain good
interpersonal relationships.
Some patients become irritable, complaining, and uncooperative because of:
*Fears about their diagnosis, disfigurement, disability, and death. *Pain. *Unrealistic
perceptions of activities around them. *Uncertainties about the future. *Worries about family.
*The loss or lack of social support systems. *Dependence on others. *Financial concerns.
Offer emotional support, listen carefully and report these concerns to the nurse.
Personal Vocational Adjustments- Meeting the Family’s Needs
Families and friends are very concerned when one of their loved ones is in a healthcare
facility, especially when that person may have a life-threatening illness. This puts stress in
their lives too. They need to be reassured. Their anxiety sometimes makes the demanding and
uncooperative. The nursing assistant who understands human behavior makes allowances for
the stresses and realizes that ill people, co-workers, and families under stress may be touchy
and not always on their best behavior. This is why sensitivity of the needs of others are most
important at the time. It is in these situations that patience and tact are most needed.
Sometimes just quietly listening to another or rephrasing your sentences can change an entire
interaction. Try to be aware not only of the words used but also of the body language. As with
words, clues such as the tone of a voice or a hand movement reveal much about the inner
feelings of the other person. Always keep in mind that people are three-dimensional. They are
physical beings, emotional beings, and social beings.
Personal Vocational Adjustments-Staff Relationships
You are part of the staff of a healthcare facility. All workers share a single goal; to help the
patient. This single purpose welds you together into a unit that must work smoothly if your
goal is to be accomplished. Good interpersonal relationships will make your working hours
satisfying and productive. Good relationships can be formed if you:
● Remember that each of you have a specific role to fulfill and jobs to carryout.
● Do not overstep your Authority or criticize others.
● Listen to instructions from your supervisor carefully. Phrase questions about your
assignment in such a way that your supervisor knows you're looking for clarification-not
challenging authority.
● Remember that your tone of voice and body language can change the message you're
trying to convey.
● Promptly carry out orders and report any work that you are unable to finish.
Personal Vocational Adjustments-Staff Relationships continued
● Offer help to others and accept help when you need it. Coworkers can often help
one another when a task is particularly difficult are physically taxing. For example,
lifting a heavy patient or moving equipment. Simply being available when another
member of the team gets behind in his or her work is a great help.
● Have a cheerful, positive attitude. This is as important for staff members’
relationships as it is in establishing rapport ( sympathetic understanding) with
patients.
● Extend the same dignity and courtesy to every staff member that you would to
patients.
● Always keep your common goals in mind. Recognize co-workers as important
members of the total team.
Personal Vocational Adjustments-Staff Relationships continued
Professional and personal adjustments are made easier if the nursing
assistant:
● Understands and follows facility policies and procedures.
● Treats patients, co-workers, and the visitors with respect.
● Practices proper hygiene and grooming, good nutrition, and stress
reduction.
Personal Health and Hygiene
Good personal grooming is essential, because the assistant is in close
contact with patients. Because the work of the assistant, although
rewarding, can be physically challenging, it is important that all body
odors be controlled. The nursing assistant is often the last to know that he
or she has bad breath or body odor. A daily shower or bath and the use of
an antiperspirant/deodorant are essential. The most and teeth must be
kept clean. The nursing assistant should also recognize that strong
perfumes, aftershave lotions, and cigarette odors are often offensive to
patients.
Personal Health and Hygiene continued
Hair should be clean and either short or tied back in a
controlled style. Fingernails should be kept short and clean. If
nail polish is used, it should be clear, not colored. Stockings and
socks should be freshly laundered. shoes and shoelaces should be
cleaned daily. Fatigue will be lessened if shoes give proper
support To the feet and are well-fitted.
Personal Health and Hygiene continued
Jewelry is not part of the nursing assistants uniform, as it is a ready
medium for bacteria growth. Jewelry may also injure the patient or the
assistant, especially if the patient is confused or is a young child. Long,
dangling earrings can be especially dangerous to the assistant, because
they are easily caught in linen or pulled out by a combative patient.
Most health care agencies permit members of the nursing staff to wear
wedding rings and small earrings. Watches with second hands are used
to monitor the condition of patients and to measure vital signs.
Personal Health and Hygiene - Uniforms
Many Healthcare facilities allow healthcare workers great leeway in selecting the
type and style of their uniforms.Traditionally, patients were able to identify various
types of Healthcare workers by their uniforms, including caps. Today, it can be very
difficult to distinguish between a physical therapist, registered nurse, physician, or
social worker. It is no wonder that newly admitted patients are often confused as to
whom they should approach for information or help. to help avoid this confusion,
some states and many Health Care Facilities require Personnel to wear a name badge
or photo identification tag at all times while on the job. The name badge may state
only your first name and title. Some healthcare facilities do not list the last name of a
worker on the name badge as a protective security measure.
Personal Health and Hygiene - Uniforms continued
If your health care facility requires that you wear a uniform, you should wear it
only while you are on duty. If your health care agency does not provide facilities for
changing your uniform before and after going on duty, be sure to wear a cover-up as
you travel to and from work so you will not spread germs. When you get home,
remove your uniform, fold it inside out, and put it into the laundry. This helps keep the
dirtiest part of your uniform away from the other clothes in the laundry. Wearing a
fresh uniform everyday should become a habit. It should be clean and in good
condition. Torn hems and missing buttons should be repaired and replaced.
Personal Health and Hygiene - Uniforms continued
Above all, remember that your patient’s safety and comfort are your main
concerns. Try to keep in mind their needs and feelings. After all, would you feel
confident if you were ill and the assistant caring for you had long fingernails that could
scratch you, or that could collect dirt And possibly infect your surgical incision? how
would you feel if the assistant who was preparing you for surgery kept having to push
the hair out of her/his eyes? or if the assistant assigned to give you a back rub wore
clanking bracelets on her wrists?
Personal Health and Hygiene - Uniforms continued
Remember, too, that how you look reflects the pride you have in yourself and in
your work. Well groomed nursing assistants who pay attention to the details of their
person and apparent show others, especially their patients and co-workers, that they
are likely to have the same pride and caring attitude in their work. If you are well
groomed and to have good personal habits come on patients will feel more secure and
confident, and the other staff members will regard you as mature and reliable. As you
develop good health habits, you become a role model for your family, friends, and
coworkers.
Personal Health and Hygiene - Reducing Stress
Your work as a nursing assistant is physically and emotionally demanding because you
must give so much of yourself to those in your care. To stay healthy and do your best,
you will need:
● Sufficient rest
● Good nutrition
● Satisfying leisure activities
● Ways to reduce stress
Burnout is total mental, emotional, and sometimes physical exhaustion. burnout is
common among those working in healthcare facilities. You can reduce the stress that
leads to burnout by balancing your work with the rest and recreation.
Personal Health and Hygiene - Reducing Stress continued
Some facilities offer programs to help employees reduce stress. Group discussions,
exercise programs, and special counseling are available for general stress management
and to meet special circumstances, such as when a patient dies or when individual
interstaff conflicts arise.Death is always a possibility, but the staff usually focus on
Improvement and Recovery. The loss of a patient, especially a child, can be very
stressful. Caring for an abused child can take a great toll on the staff as they try to work
with a child and family.
Occasionally personality conflicts are aggravated by the daily close contact. Stress
caused by these situations can often be handled through a Stress Management Group
discussion.
Personal Health and Hygiene - Change
Experienced healthcare workers will tell you that change is ongoing in the healthcare
industry. New competitors business takeaway established customers ( patients);
technology changes constantly; the legislation changes the way Services may be
delivered; patients have increasing expectations as they learn, grow, and become more
knowledgeable. Change is never really finished. in one way or another, it is ongoing.
Change can be very disruptive and unpredictable, and the uncertainty about change
can be difficult for everyone. Venturing into unknown territory can be threatening.
Workers faced with change may feel insecure, believing that change will expose their
shortcomings and deficits. Because of this, many people resist change. When workers
are resistant to change, negative attitudes caused additional turmoil for others.
Personal Health and Hygiene - Change continued
The ability to adapt to change is an asset is that all workers must master. Try these
strategies to cope with change successfully:

● Learn all you can about the change and your responsibilities.
● Try to understand the need for and value of the change.
● Find ways to adapt and accommodate to the change.
● Try to be open-minded and flexible.
● Cooperate with others and be a team player.
Personal Health and Hygiene - Change continued
● Adjust your attitude. Look forward to the change as an opportunity for new
challenges, growth, and accomplishment.
● Try to keep your sense of humor. Make change fun. although you may take
change seriously, try to have a good time in spite of any discomfort you feel.
● Compensate for the stress and the pressure you feel by making time for activities
you enjoy when you are off duty.

Remember the old adage," change is inevitable, but growth is optional." View each
workplace change as an opportunity for growth. Doing so will do more than help you
survive. Having a positive attitude and using change as an opportunity for growth will
help you thrive in the ever-changing healthcare workplace.
Answer the following questions based on the previous video
1. Name the Book and the Author on which the video is based?
2. What is the main theme or topic of the story?
3. Name the 4 main characters on the story.
4. What can the cheese in the story be likened to?
5. What was the response of each character before the cheese was gone at cheese
station C?
6. What was the response of each character after the cheese was gone at cheese
station C?
7. Which character are you most like when it comes to change?
8. What life lesson have you learnt from this story?
Personal Health and Hygiene - Personal Stress Reduction
You can learn personal stress-reducing techniques. Food, alcohol, or other drugs are
used by some people to reduce stress, but these substances can cause serious health
problems. For example, some people use chemicals or drugs to reduce stress. This is
dangerous because chemicals and drugs alter the body's chemistry come on causing
serious changes to thought and behavior. In some cases, drug use becomes addictive
and can cause death. There are better and safer ways to prevent burnouts and relieve
stress. To reduce stress:

● Talk to your supervisor; a team conference may help.

Personal Health and Hygiene - Personal Stress Reduction continued

● 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 specific relaxation exercise.
Personal Health and Hygiene - Personal Stress Reduction continued

● Make yourself a cup of herbal tea and drink it slowly.

● Exercise.
● Devote time to hobbies such as sewing, painting,
woodworking, or playing a musical instrument.
● Go for a walk.
● Take advantage of available stress reduction programs.
Review
True or False
1. The RN plans and directs the nursing care of patients.
2. Interdisciplinary healthcare providers work as individuals.
3. Patients enjoy primary nursing because it allows them to relate directly to one specific
registered nurse.
4. Team nursing is a common way of providing patient care.
5. It is all right to perform a task even if you are unsure how to do it.
6. Patients may find strong perfumes and aftershave lotion offensive.
7. Patient safety and comfort are the main concerns for all caregivers.
8. The interdisciplinary team member who writes the medical orders for patient care is the
physician.
9. Nursing care approach that is task-oriented is called team nursing.
References
Acello, B., Hegner, B. R., & Caldwell, E. (2008). Nursing assistant: A nursing process
approach (10th ed.). Cengage Learning.

Wisdom for Life. (2020, September 3). Who moved my cheese? Animated Summary
[Video]. YouTube. https://www.youtube.com/watch?v=OvYCLxqkfvY&t=2s

Suggested reading: The Health Belief Model

UNIT 3- Consumer Rights and Responsibilities in Health Care
Objectives:

After completing this unit, you should be able to:

● Spell and define terms.

● Explain the purpose of health care consumer rights.
● Describe six items that are common to Residents’ Rights, the Patients’ Bill of
Rights, and the Clients’ Rights in Home Care.
● List three specific rights from each of the three documents.
● Describe eight responsibilities of health care consumers.
Vocabulary

Advance directives Informed consent

Clients’ rights Involuntary seclusion

Corporal punishment Patients Bill of Rights

Grievance Residents ‘rights

Consumer Rights
All citizens in the US have certain rights (for example, the right to vote) that are guaranteed by law.
Healthcare consumers have rights to ensure that they will receive quality patient care. There are
different documents for patient rights, depending on where care is given. In each setting, if the
healthcare consumer is unable to read or understand the document, the law makes provisions to
ensure that he or she is informed of these rights. for example, these are required to have the Bill of
Rights translated into languages that are common in the community. If the patient cannot understand
the information because of a mental condition, the Bill of Rights is given to his or her family. Staff are
expected to be familiar with and protect each patient's rights . a copy of the residents rights is given to
each person before he or she is admitted to a skilled Care Facility. The rights of Residents in skilled
care facilities were legislated by the federal government in the Omnibus Budget Reconciliation Act
(OBRA),1987. The resident must sign a form indicating that the resident and/or the resident’s family
have received the document. The Patient’s Bill of Rights is given patients upon admission to a hospital.
Persons receiving care in their home are given a copy of the Clients’ Rights by the nurse on the first
visit to the home. The client is asked to sign a form indicating that he or she received the document.
Consumer Rights continued
All persons working in healthcare should be familiar with the documents that pertains to the facility they work
in. Supporting the rights of the healthcare consumer contributes to more effective care. Each of these documents
are similar and emphasizes the right of the patient, resident, or client to:

● Be treated in a respectful, dignified manner-this includes the right to privacy and to confidentiality.
● Have the benefit of open and honest communication with caregivers.
● Have a role in decision-making for treatment choices and planning of care.
● Informed consent means that the consumer gives permission for care of procedures after full disclosure of
the purpose of the care or a procedure, the benefits and risks involved.
● Be advised all there right about advance directives ( documents that gave instructions about the
consumers wishes for treatment is the consumer is terminally ill or unable to communicate).
● Receive continuity of care.
● Be informed of resources for resolving conflicts or grievances. A grievance is a situation in which the
consumer feels there are grounds for complaint.
Responsibilities of Healthcare Consumers
Providing for the rights of the consumer will not ensure quality Care unless consumers are willing to fulfill
certain responsibilities. these responsibilities include:

● Maintaining personal health care records so information is readily available when needed.
● Communicating openly and honestly with the physician and other caregivers and being willing to give a
complete health and family history.
● Providing information regarding past hospitalizations and medications.
● Informing The Physician and other caregivers if they anticipate problems with following prescribed
treatment.
● Learning how to manage their own health.
● Asking for clarification if they do not fully understand instructions or explanations.
● Living a healthy lifestyle and avoiding unnecessary risks of illness or injury.
● Accepting financial responsibilities for payment of healthcare and providing information for insurance
claims.

The rights of healthcare consumers have both a legal and an ethical basis.
Residents’ Rights
This is an abbreviated version of the Resident’s Rights as set forth in the Omnibus
Budget Reconciliation Act. This document must be given to all residents and/or their
families prior to admission to a long term care facility.

The resident has the right:

1. to free choice, including the right to: - choose an attending physician - full
advance information about changes in care or treatment - participate in the
assessment and care planning process - self administer medications if the resident
is able to safely do so - consent to participate in experimental research
Residents’ Rights continued
The resident has the right:
2. to freedom from abuse and restraints, including freedom from: -physical, sexual,
mental abuse - corporal punishment (the use of physical force) and involuntary
seclusion (isolaring a resident without a medical reason) - physical and chemical
restraints
3. to privacy, including privacy for: -treatment and nursing care -receiving/sending
mail -telephone calls -visitors
4. to confidentiality of personal and clinical records.
5. to accommodation of needs, including: -choices about life - receiving assistance in
maintaining independence
Residents’ Rights continued
The resident has the right:
6. to voice grievances.
7. to organize and participate in family and resident groups.
8. to participate in social, religious, and community activities, including the right to:
-vote -keep religious items in the room -attend religious services
9. to examine survey results and correction plans.
10. to manage personal funds.
11. to information about eligibility for Medicare/Medicaid funds.
12. to file complaints about abuse, neglect, or misappropriation of property.
13. to information on advocacy groups.
Residents’ Rights continued
The resident has the right:

14. to immediate and unlimited access to family or relatives.

15. to share a room with the spouse if they are both residents in the same facility.
16. to perform or not perform work for the facility if it is medically appropriate for
the resident to work.
17. to remain in the facility except in certain circumstances.
18. to use personal possessions.
19. to notification of change in condition..
The Patients’ Bill of Rights
Introduction
Effective Health Care requires collaboration between patients and Physicians and
other Healthcare professionals. Respect for personal and professional values, and
sensitivity to differences are integral to Optimal patient care. As the setting for the
provision of Health Services, hospitals must provide a foundation for understanding
and respecting the rights and responsibilities of patients, their families, and other
caregivers. Hospitals must ensure a healthcare ethic that respects the role of patients in
decision-making about treatment choices and other aspects of their care. Hospitals
must be sensitive to cultural, racial, linguistic, religious, age, gender, and other
differences as well as the needs of persons with disabilities.
The Patients’ Bill of Rights continued
The American Hospital Association presents the Patients’ Bill of Rights with the
expectation that it will contribute to more effective patient care and be supported by
the hospital on behalf of the institution, its medical staff, employees, and patients. The
American Hospital Association encourages healthcare institutions to tailor this bill of
rights to their patient community by translating and/or simplifying the language of this
Bill of Rights as may be necessary to ensure that the patients and their families
understand their right and responsibilities.
The Patients’ Bill of Rights continued
1. The patient has the right to considerate and respectful care.
2. The patient has the right to and is encouraged to obtain from Physicians and other direct
caregivers relevant, current, and understandable information concerning diagnosis, treatment,
and prognosis.
Except in emergencies when the patient lacks decision-making capacity and the need for
treatment is urgent, The patient is entitled to the opportunity to discuss and request information
related to the specific procedures and/or treatments, the risks involved,the possible length of
recuperation, and the medically reasonable alternatives and their accompanying risks and
benefits.
Patients have the right to know the identity of physicians, nurses, and others involved in their
care, as well as when those individuals are students, residents, or other trainees. The patient also
has the right to know the immediate and long-term financial implications of treatment choices,
in so far as they are known.
The Patients’ Bill of Rights continued
3. The patient has the right to make decisions about the plan of care prior to and during the course of
treatment and to refuse a recommended treatment or plan of care to the extent permitted by law and
Hospital policy and to be informed of the medical consequences of this action. In case of such refusal, the
patient is entitled to other appropriate care and services that the hospital provides or transfer to another
hospital. The hospital should notify patients of any policy that might affect patient choice within the
institution.
4. The patient has the right to have an advance directive ( such as a living will, Health Care proxy, or durable
power of attorney for health care) concerning treatment or designating a surrogate decision-maker with
the expectation that the hospital will act on the intent of that directive to the extent permitted by law and
Hospital policy.

Healthcare institutions must advise patients of their rights under state law and Hospital policy to make
informed medical choices, ask if the patient has an advance directive, and include the information in the
patient record. The patient has the right to timely information about Hospital policy that may limit its
ability to fully implement a legally valid advance directive.
The Patients’ Bill of Rights continued
5. The patient has the right to every consideration of privacy. Case discussion,
consultation, examination, and treatment should be conducted so as to protect
each patient's privacy.

*These rights can be exercised on the patient’s behalf by a designated surrogate or

proxy decision maker if the patient lacks decision-making capacity, is legally
incompetent, or is a minor.
The Patients’ Bill of Rights continued
6. The patient has the right to expect that all communications and records
pertaining to his / her care will be treated as confidential by the hospital, except in
cases such as suspected abuse and public health hazards when reporting is
permitted or required by law. The patient has the right to expect that the hospital
will emphasize the confidentiality of this information when it releases it to any
other parties and entitled to review information in these records.
7. The patient has the right to review the records pertaining to his / her medical care
and to have the information explained or interpreted as necessary, except when
restricted by law.
The Patients’ Bill of Rights continued
8. The patient has the right to expect that, within its capacity and policies, the
hospital will make reasonable response to the request of a patient for appropriate
and medically indicated care and services. The hospital must provide evaluation,
service, and / or referral as indicated by the urgency of the case.When medically
appropriate and legally permissible, or when a patient has so requested, a patient
may be transferred to another facility. The institution to which the patient is to be
transferred must first have accepted the patient for transfer. The patient must also
have the benefit of complete information and explanation concerning the need
for, risk, benefits, and alternatives to such a transfer.
The Patients’ Bill of Rights continued
9. The patient has the right to ask and be informed of the existence of business
relationships among the hospital, educational institutions, other Healthcare
Providers, or payers that may influence the patient's treatment and care.
10. The patient has the right to consent to or decline to participate in proposed
research studies or human experimentation affecting care and treatment or
requiring direct patient involvement, and to have those studies fully explained
prior to consent. A patient who declines to participate in research or
experimentation is entitled to the most effective care that the hospital can
otherwise provide.
The Patients’ Bill of Rights continued
11. The patient has the right to expect reasonable continuity of care when appropriate
and to be informed by physicians and other caregivers of available and realistic
patient care options when hospital care is no longer appropriate.
12. The patient has the right to be informed of Hospital policies and practices that
relate to patient care, treatment, and responsibilities. The patient has the right to
be informed of available resources for resolving disputes, grievances, and conflict,
such as ethics committees, patient representatives, or other mechanisms available
in the institution. The patient has the right to be informed of the hospital's
charges for services and available payment methods.
The Patients’ Bill of Rights continued
The collaborative nature of healthcare requires that the patient's, or their
families/surrogates, participate in their care. The effectiveness of care and patient
satisfaction with the course of treatment depend, in part, on the patient fulfilling
certain responsibilities. Patients are responsible for providing information about past
illnesses, hospitalizations, medications, and other matters related to health status. To
participate effectively in decision-making, patients must be encouraged to take
responsibility for requesting additional information or clarification about their health
status or treatment when they do not fully understand information and instructions.
Patients are also responsible for ensuring that the healthcare institution has a copy of
their written advance directive if they have one. Patients are responsible for informing
their Physicians and other caregivers if they anticipate problems in following
prescribed treatment.
The Patients’ Bill of Rights continued
Patients should also be aware of the hospital's obligation to be reasonably efficient
and equitable in providing care to other patients and the community. The hospital's
rules and regulations are designed to help the hospital meet this obligation. Patients
and their families are responsible for making reasonable accommodations to the needs
of the hospital, other patients, medical staff, and hospital employees. Patients are
responsible for providing necessary information for insurance claims and for working
with the hospital to make payment arrangements, when necessary.

A person's health depends on much more than Healthcare Services. Patients are
responsible for recognizing the impact of their lifestyle on their personal health.
The Patients’ Bill of Rights continued
Conclusion
Hospitals have many functions to perform, including the enhancement
of health status, health promotion, and the prevention and treatment of
injury and disease; the immediate and ongoing Care and Rehabilitation
of patients; the education of health professionals, patients; and
research. All of these activities must be conducted with an overriding
concern for the values and dignity of patients.
Clients’ Rights in Home Care
The persons receiving home health care services and their families possess basic rights
and responsibilities. As a client, you have:
The right to:
● be treated with dignity, consideration, and respect.
● have your property treated with respect.
● receive a timely response from the agency to request for service
● be fully informed on admission of the care and treatment that will be provided,
how much it will cost, and how payment will be handled
● know in advance if you will be responsible for any payment
● be informed in advance of any changes in your care.
Clients’ Rights in Home Care continued
The right to:
● receive care from professionally trained personnel, and to know their names and
responsibilities
● participate in planning care
● refuse treatment and be told the consequences of your action
● expect confidentiality of all information
● be informed of anticipated termination of service
● be referred elsewhere or if you are denied services solely based on your inability to
pay
● know how to make a complaint or recommend that a change in agency policies
and services
Clients’ Rights in Home Care
The responsibility to:
● remain under a doctor's care while receiving services
● provide the agency with a complete health history
● provide the agency all requested Insurance and financial information
● sign the required consents and releases for insurance billing
● participate in your care by asking questions, expressing concerns, and stating if you do
not understand
● provide a safe home environment in which care can be given
● cooperate with your doctor, the staff, and other caregivers
● accept responsibility for any refusal of treatment
● abide by agency policies that restrict the duties our staff may perform
● advise agency administration of any dissatisfaction or problems with your care
Review
True or False

1. The rights of health care consumers are important only to patients in hospitals.
2. The client’s bill of rights is given to persons receiving home care.
3. Health care consumers in any setting have the right to prepare advance directives.

Fill in the blanks

1. ______ means that the consumer gives permission for care or procedures after full
disclosure.
2. A _______ exists when the consumer feels there are grounds for complaint.
References
Acello, B., Hegner, B. R., & Caldwell, E. (2008). Nursing assistant: A nursing process
approach (10th ed.). Cengage Learning.

Suggested reading:

Patient's Bill of Right - The Gleaner (Jamaica))

Guidelines-for-Community-and-Private-Health-Facilities.doc

A GUIDE TO ETHICAL PRACTICE IN JAMAICA (DOCTORS))

UNIT 4- Ethical and Legal Issues Affecting the Nursing Assistant
Objectives:
After completing this unit, you should be able to:
● Spell and define terms.
● Discuss ethical and legal situations in health care.
● Describe the legal and ethical responsibilities of the nursing assistant concerning
patient information.
● Describe tactful ways to refuse a tip offered by a patient.
● Describe the legal responsibilities of a nursing assistant.
● Describe how to protect a patient's right to privacy.
● Define sexual harassment and give examples of activities that may be perceived as
being sexually harassing.
Vocabulary
Abuse Ethical standards

Aiding and abetting False imprisonment

Assaults Informed consent

Battery Invasion of privacy

Coercion Involuntary seclusion

Confidential Legal standards

Defamation Liable
Vocabulary continued

Libel Psychological abuse

Malpractice Sexual abuse

Neglect Sexual harassment

Negligence Slander

Physical abuse Theft

Platinum rule Verbal abuse

Ethical Standards and Legal Standards
Each day, as you carry out your work and relate to patients, co-workers, families, and others
from the community, you will be faced with decisions to make about your actions. Some of
these decisions involve the moral right or wrong of an action. Other decisions involve the
legality of your behavior.
Two set of rules help govern the moral and legal actions you will take.
1. Ethical Standards - are guides to moral behavior. People who give health care voluntarily
agree to live up to these standards. When these rules are not followed, the nursing
assistant fails to live up to the promise to give safe, correct care, and to do no harm.
2. Legal Standards - are guides to lawful behavior. When laws are not obeyed, the nursing
assistant may be prosecuted and found liable (held responsible) for injury or damage.
Legal guilt can result in the payment of fines or imprisonment.
Ethical Standards and Legal Standards continued
The ethical standards and legal standards are established to ensure that
only safe, quality care is given. Following these standards also protects
the caregiver. Sometimes the rules that govern moral actions and the
laws that govern legal actions cover the same area.
Ethics Questions
Probably at no other time in history have the questions of medical ethics been under
such scrutiny. Questions health care providers ask include:
● When is life gone from a person on a life support system?
● How much lifesaving or resuscitation effort should be given in situations of
terminal illness?
● When does human life actually begin?
● How much assistance should be given to the conception process?
● Should the body organs of a brain-dead person be harvested for transplants for
the living?
● Does an unborn baby have rights?
● Is assisting a patient during or after an abortion right or wrong?
Ethics Questions continued
● Is euthanasia (assisted death) ever justified?
● Should animals be used in research of potential value to human life?
● Should food and water be withheld to speed death when the patient has expressed
the desire to die?
● Who makes decisions about removing life support systems when there is no direct
expression of the patient’s wishes or there is conflict within the family?
● How will a choice be made when two or more people could benefit from an organ
transplant but only one organ is available?
● How should the limited money be spent when many serious disease conditions
ought to be researched?
● Who has final authority over whether a woman will carry a pregnancy to term?
● Should marijuana be used for medicinal purposes?
Ethics Questions continued
Many facilities have ethics committees that advise the staff on ethical matters. The
members of Ethics committees often include staff, clergy, interested community
members, and advocates for the sick and elderly. The committee reviews ethical
problems and principles involved to help guide the staff and family. The committee
may be asked to make difficult decisions, such as when doctors recommend removing
life support and the patient's family members disagree with the decision.
Ethical Questions continued
The law permits Physicians and hospitals to refuse to comply with advance directives
and treatment decisions in some circumstances. An example is when the physician
believes that care that prolongs the patient's life is inappropriate or futile. In situations
like this, the family always has the option of moving the patient to another facility
within a given time frame, such as ten days. In some states, facilities may not be
required to provide a grace period in which to make arrangements.The burden is
placed on family members to petition the court to obtain an extension. Finding
placement is often very difficult and time-consuming.The required care is usually
highly technical and very expensive. resources are almost always Limited, and most
communities do not have a variety of facilities that are qualified or able to provide the
necessary care. A facility that is qualified and willing to accept the patient may be
hundreds of miles away or in another state, placing further strain on the family.
Ethical Questions continued
The Ethics Committee is responsible for resolving disputes such as this, in which one
or both opposing parties may be unhappy with the decision. As you can see, these
committees carry great responsibility, making their members’ jobs difficult, sensitive,
and very important to the operation of the facility. Respect for patient’s and their
wishes is the primary concern. Part of this respect for life is shown by having patients
actively involved in decisions about their care and future.

As a nursing assistant, you will take directions from the legal and ethical guidelines
established by your facility.
Respect for Life
One of the most basic rules of Ethics is that life is precious.

Everyone involved in the care of patients has the promotion of health and the quality
of life as primary goals. Death, however, is a natural progression of life. When death is
certain, the objective is to keep the dying person comfortable. Today, there is a greater
appreciation of individual wishes and the quality of life expected. One fact remains
clear: the major responsibilities of medicine and all members of the healthcare team is
to maintain quality of life and make comfortable those whose lives are limited.
Respect for the Individual
Respect for each patient as a unique individual is another ethical principle.
This uniqueness is demonstrated by differences in:
● Age ● Gender ● Attitudes
● Race ● Sexual preference ● Background
● Religion ● Culture ● Response to illness
You may find the differences that make the patient so special also make dealing
with the patient challenging or difficult. If you respect each patient as a valuable
person, you can learn to accept and work with each one in the best possible way.
Respect for the Individual continued
You probably learned the Golden Rule, "Do unto others as you would have them do
unto you," when you were young. The Golden Rule reflects your intent to provide
proper are. However, your good intentions are effective only when you act on them. To
provide proper care, you also have the ethical responsibility to maintain competence in
your practice. An alternative to the Golden Rule is the Platinum Rule: "Treat others the
way they want to be treated." The platinum rule shifts the focus from treating everyone
a like to providing highly individualized care . Find out what patients want and give it
to them, as much as possible, in keeping with their plans of care.
Respect for the Individual continued
Use both principles to guide your practice. Their will be times when
personal comfort and convenience could interfere with the care you give.
By placing patients' interests ahead of your own, you are fulfilling the
ethical and legal obligations of your practice, protecting patient safety,
enhancing patient comfort and satisfaction with care, and reducing your
personal risk of legal exposure.
Patient Information
The ethical code asserts that information about patients is privileged and must not be
shared with others.

1. Discuss patient information only in appropriate places.

● It is unwise to discuss a patient's condition while in the patient's room, even if the
patient is unresponsive. The patient may be able to hear everything that you said.
This would cause unnecessary worry.
● Never discuss the patients in your care with your family or others in the
community.
● Never discuss patients during lunch or coffee breaks, even with your co-workers.
Patient Information continued
2. Discuss information only with the proper people.
● At times you will be approached by others requesting information about a patient. For
example, you might be asked for such information by other patients, family members, or
members of the public, such as news reporters.
● discuss patients and their personal concerns only with your supervisor during
conference or report. Make sure you will not be overheard by visitors or other patients.
● Learn to evade inquiries tactfully by:
- Stating that you do not know all the details of the treatment or the patient's condition.
- Redirecting enquiries to the proper Authority.
- Firmly, but politely, indicating that you do not have the authority to provide the answers.
Patient Information continued
3. Refer patient requests for information about laboratory results, the patient's
condition, or course of the illness to the nurse or doctor.
4. Let the nurse or doctor relay information about a patient's death. Never give
information concerning the death of a patient to the patient’s family. When done
tactfully, a refusal of this kind is rarely resented by the family.
Patient Information continued
5. Follow the ethical code to ensure respect of patients’ personal religious beliefs. People of all faiths or
beliefs and those with no proclaimed faith are admitted for care. These differences must be respected. You
show your respect when you:
- Inform the nurse of requests for clergy visits.
- Know correct information about the type of chaplain services available in your facility.
- Know if a chapel is open for use by patients and families.
- Respectfully treat patients’ religious articles, such as Bible, crucifix, Koran, or holy pictures.
- Avoid imposing your own religious beliefs on patient.
- Assist patients to practice their religious beliefs and rituals, if requested.

When the clergy visits, you should:

- Be helpful and courteous.

- Escort the clergy person to the patient's bedside.
- Draw the curtains or close the door for privacy.
- Leave the room.
Tipping
If you follow the ethical code, the service you give will depend on need. It will not
depend on the patient’s race, creed, color, or ability to pay. There is no place for
tipping within the healthcare system.
Patients are charged for the services they receive while in the hospital. The salary you
are paid is included in that charge
Sometimes patients will offer a “little something” to you. A firm but courteous refusal
of the money is usually all that is necessary to assure the patient or your meaning.
As you can see, the ethical code ensures that each patient is treated with dignity and
respect in ways that always promote safe care.
Legal Issues
Laws are passed by governments (local, state, and federal) and are to be obeyed by
citizens. Anyone who fails to obey a law may be liable (responsible) for fines or
imprisonment. You need not fear breaking these laws if you are careful to:
● Stay within your scope of practice and do not overstep your authority.
● Do only those things that you have were taught.
● Carry out procedures carefully and as you were taught.
● Keep your skills and knowledge up-to-date.
● Request guidance from the proper person before you take action in a questionable
situation.
● Always keep the safety and well-being of the patient foremost in your mind, and
act accordingly.
Legal Issues continued
● Make sure you thoroughly understand directions for the care you are to give.
● Perform your job according to facility policy.
● Stay within OBRA guidelines.
● Maintain in-service requirements of OBRA.
● Do no harm to the patient.
● Respect the patient’s belongings (property).

Situations you must avoid are: negligence, theft, defamation, false imprisonment,
assault and battery, abuse, neglect, and invasion of privacy.
Torts
Torts are wrongful acts that cause someone to suffer harm—in nursing, this can be an
action or inaction by a nurse that causes a patient harm. Torts can be categorized as
intentional or unintentional.
Intentional Unintentional
Assault Negligence
Battery Malpractice
False Imprisonment Abandonment
Defamation of Character:
i) libel, ii) slander
Torts continued
Other examples of:

● Intentional torts - Conversion, Intentional infliction of emotional distress,

Fraud/deceit, Trespass (to land and property).
● Unintentional torts - Slip and fall accidents, Car accidents, Truck accidents,
Motorcycle accidents, Pedestrian accidents, Bicycle accidents.
Legal Issues- Negligence
Negligence is failure to exercise the degree of care considered reasonable
under the circumstances, when that failure results in an unintended injury to a
patient. Simply put, negligence is carelessness, which is often caused by
hurrying or not focusing on the task at hand. Negligence may be accidental or
deliberate. It may be the result of an action or and omission (failure to act).
For example, not feeding a confused patient lunch because she is a slow eater
and you are short on time is considered negligence. However, forgetting to
give a lunch tray to a confused patient who feeds himself is also a negligent
act. Either way, the patient is not given the expected level of care.
Legal Issues- Negligence continued
Nursing assistants are qualified care providers and are expected to perform in certain
ways. You would be guilty of negligence if you injured a patient by:

● Not performing your work as taught. For example, a patient is burned by an

enema solution that you prepared and was too hot.
● Not carrying out your job in a conscientious manner. For example, your facility
has a policy that two workers are necessary to transfer a patient with the
mechanical lift, but you fail to ask another worker to assist you in moving a
patient. The lift tips and the patient is injured.
Legal Issues- Negligence continued
Malpractice is improper, negligent, or unethical conduct that results in harm,
injury, or loss to a patient. Practicing within your scope of practice. Following
facility policies and procedures, and doing things in the way you were taught
will help protect your patients from injury. Being discreet, respecting
confidentiality, and avoiding gossip will help protect you from inadvertently
harming a patient emotionally. Be kind and polite to patients. If a patient
complains about something you have done, apologize and promptly correct
the problem without becoming defensive.
Legal Issues - Theft
Taking anything that does not belong to you makes you guilty of theft. The patients’
and residents’ rights documents refer to this action as the “misappropriation of
property.”

If you see someone stealing something and do not report it, you are guilty of aiding
and abetting the crime.

Because of the nature of their work, people working in facilities must be honest and
dependable. Despite careful screening, dishonest people are sometimes hired and
things do disappear. These things range from washcloths, money, and patients’
personal belongings to drugs.
Legal Issues - Theft
Sometimes workers are reluctant to report things that they see other
people doing. Remember, however, that you are responsible for your
own actions and must do the right things. For a nursing assistant,
opportunities for poor practice, illegal activities, and neglect are always
present. Honesty and integrity are the hallmarks of the sincere and
conscientious nursing assistant.
Legal Issues - Defamation
If you make false statements about someone to a third person and
the character of the first person is injured, you are guilty of defamation.
The is true if you make the statement verbally (slander) or in writing
(libel). For example, if you inaccurately tell a coworker that a patient
has AIDS, you have slandered that patient. If you write the same
untrue information in as note , you are guilty of libel.
Legal Issues - False Imprisonment
Restraining a person's movements or actions without proper authorization constitutes
unlawful or false imprisonment. For example, patients have the right to leave the
hospital with or without the physician's permission. You may not interfere with this
right. If you do interfere, you will be guilty of false imprisonment.

If you learn of a patient's intention to leave the hospital without permission, inform
your supervisor. The supervisor will handle the situation.

Using physical restraints, or even threatening to do so, in order to make a patient

cooperate can also constitute false imprisonment. Restraint may be in the form of
physical devices or chemical agents.
Legal Issues - False Imprisonment continued
A physical restraint is any manual method or physical or mechanical device, materials, or equipment
attached or adjacent to patient's body that:
● A person cannot easily remove.
● Restricts a patient's movement.
● Does not allow the patient normal access to his or her own body.
Examples of physical restraints include:
● Wrist/arm and Ankle/leg restraints
● Vests
● Jackets
● Hand mitts
● Geriatric and cardiac chairs
● Wheelchair safety belts and bars
● Bed rails, which are considered physical restraints if they meet the definition listed
Legal Issues - False Imprisonment continued
In general, many devices and practices meet the definition of physical restraints if the
patient does not have the physical or mental ability to remove the device. Examples of
other practices that constitute restraint are:
● Tucking in, tying, or using velcro to hold a sheet, Fabric, or clothing tightly so that
a patient's movement is restricted.
● Using devices in conjunction with a chair (such as trays, tables, bars, or belts) that
the patient cannot remove easily and that keep the patient from rising.
● Placing a patient in a chair that prevents the patient from rising.
● Placing a chair or bed so close to the wall that the wall prevents the patient from
rising out of the chair or voluntarily getting out of bed.
Legal Issues - False Imprisonment continued
Psychoactive medications are considered chemical restraints because
they affect affect the patient’s mobility. Sometimes it is necessary to
support and restrain the movement of patients. Supports and restraints
cannot be used without a physician's order. This order must indicate
the type of restraint or support that should be used, when it is to be
used, and the reasons for it.
Legal Issues - Assault and Battery
Assault and battery are serious legal matters. Assault means intentionally
attempting to touch the body of a person or even threatening to do so. Battery means
actually touching a person without that person's permission. The care we provide is
given with the patient's permission or informed consent. This means the patient must
know and agree to what we plan to do before we start. Consent may be withdrawn at
any time. For example, you are assigned to give a patient a warm foot soak. Despite
your explanation of the reasons for the order, the patient refuses. You may not force
the patient to submit. Doing so would make you guilty of battery. You commit assault
if you threaten the patient by telling her or him you will get others to assist you if she
refuses.
Legal Issues - Assault and Battery continued
Either situation could make you liable for legal charges. you can avoid this legal pitfall
by:

● Informing the patient of what you plan to do.

● Making sure the patient understands.
● Pausing before starting, to give the patient an opportunity to ask questions or
refuse.
● Reporting refusal of care to your supervisor and documenting the facts.
● Never carry out a treatment on your own against the patient's wishes.
Legal Issues - Assault and Battery continued
Coercion means forcing the patient to do something against his or her
wishes. Refusal of treatment creates a dilemma for the nursing assistant when the
patient is mentally confused. In general, a family member or other responsible
person consents to treatment and hospital care for patients who are confused. In
this situation, we presume that the patient would agree to the care if he were
mentally able to do so. The patient may refuse a procedure, such as a bath, but the
legally responsible person has already consented to the procedure, so you may
perform it. Gaining the patient cooperation and trust is always best. You may be
able to perform the procedure if you wait a while, then return. Avoid forcing the
patient. If in doubt about how to handle refusal of care, consult your supervisor.
Legal Issues - Abuse
Abuse of a patient ( doing harm to a patient) violates ethical principles and make you
liable for legal prosecution. Ethical standards require that you do no harm to patients.
Legal standards enforce this through laws, with penalties if you are found guilty.

Abuse is defined as any act or failure to act that is nonaccidental and causes or could
cause harm or death to a patient. Some forms of abuse are subtle but nevertheless
cause the patient physical harm or mental anguish. Abuse can occur in several forms,
including: verbal, sexual, physical, and mental abuse and involuntary seclusion.
Legal Issues - Abuse continued
Verbal abuse may be directed toward the patient or expressed about the patient. You
are guilty of verbally abusing a patient if you:

● Use profanity (swearing) in dealing with the patient.

● Raise your voice in anger at the patient.
● Call the patient unpleasant names.
● Tease or embarrass the patient.
● Use threatening or obscene gestures.
● Make written threats or abusive statements.
● Use inappropriate words to describe a person's race or nationality.
Legal Issues - Abuse continued
Sexual abuse is the use of physical means or verbal threats to force a patient to perform sexual
acts. In many states, sexual abuse is any behavior that is seductive, sexually demeaning,
harassing, or reasonably interpreted as sexual by a patient. Examples of sexual abuse include:
● Tormenting or teasing a patient with sexual gestures or words.
● Touching a patient in a sexual way.
● Suggesting that the patient engage in sexual acts with you.
Physical abuse does actual physical harm to the patient. Examples of physical abuse include:
● Handling a patient roughly.
● Hitting, slapping, pushing, kicking or pinching the patient.
● Performing the wrong treatment on the patient, such as ambulating a patient who
should remain in bed.
Legal Issues - Abuse continued
Psychological abuse includes:

● Making the patient fearful of you such as threatening not to respond when the
patient calls.
● Threatening the patient with harm.
● Threatening to tell something to others that the patient does not want known.
● Threatening to withhold care.
● Making fun of or belittling the patient in any way. Calling the patient by names
such as” honey” and “grandma” is another way of belittling the patient.
● Calling the attention of others to a patient's behavior.
Legal Issues - Abuse continued
Involuntary seclusion is the separation of a patient from others against the patient's will. Examples of
involuntary seclusion are:

● Shutting the door to the patient's room when the patient is confined to bed and wants the door
open.
● Continually placing a patient Gerichair far from others.
● Leaving a patient without a form of communication, such as a signal cord or call bell.

Separation may be permitted if it is part of a therapeutic plan to reduce agitation. The decision to use
seclusion must be made by the nurse. This form of seclusion requires accurate documentation and a
plan of care. The seclusion must be effective. Note: when describing a patient's behavior, avoid the use
of words such as uncooperative, belligerent, or hostile. Instead, describe the exact action that you
observed. Often, so-called uncooperative behavior is a problem caused by faulty communication on
the part of the healthcare provider. people should not be unfairly labeled.
Legal Issues - Abuse by Others continued
● Some families provide loving, capable care for older, dependent relatives for many
years without assistance. After providing care for a long period, they may be
physically and emotionally exhausted and may also have depleted their financial
resources.
● In some cases, one spouse has abused the other for a long time.
● Self-abuse may occur when a disabled person is unable to adequately carry out
activities of daily living and is unwilling to accept help.
Legal Issues - Abuse by Others continued
It is not the responsibility of the nursing assistant to determine if an individual has been
abused or what type of abuse has been inflicted. It is the nursing assistant's responsibility to
report to the supervisor any signs or symptoms that might be the result of abuse. this includes:
● Statements by the patient that reflect neglect or abuse.
● Unexplained bruises or wounds.
● Signs of neglect such as poor personal hygiene.
● A change in personality.
Remember these do not necessarily indicate that the person is being abused. However, they
may indicate a need for further investigation by your supervisor. Any observed abusive
behavior toward patients, whether inside or outside a facility, must be reported to the
appropriate authority.
When Your PATIENCE is STRESSED
If you feel your own tolerance level is being tested, you need to find ways to safeguard
the patient and release your own stress. You might:

● Try to identify the exact cause of your irritation.

● Talk with your supervisor about your feelings.
● Consider asking to be assigned to another patient.
● Try to reduce your overall stress and fatigue so that you are more positive and
patient on the job.
● Request counseling through an employee assistance program.
Legal Issues - Neglect
Neglect is the failure to provide the services or care necessary to avoid physical harm, mental anguish,
or mental illness. Neglect can be deliberate or accidental, such as for getting an assignment and not
providing care. Neglect is also a violation of the law. The nursing assistant is not expected to determine
if neglect has occurred. You are responsible for reporting signs of neglect to your supervisor, who will
investigate the situation. Examples of neglect include:

● Failing to turn the patient as often as needed, causing impaired circulation and pressure ulcers.
● Failing to perform regular exercises so that the patient experiences pain when unused joints are
finally moved.
● Failing to carry out proper hygiene, such as not shaving the patient regularly.
● Failing to provide mealtime assistance to a patient who cannot eat Independently.
● Failing to provide water to a patient who is on bed rest and has an order to encourage fluids.
Legal Issues - Invasion of Privacy
Patients have a right to have their person and personal affairs kept confidential. To do
otherwise is an invasion of privacy. Invading the privacy of another is against the law.
You can protect the patient's privacy by:
● Protecting the patient from exposure of the body.
● Knocking and pausing before entering a room.
● Drawing curtains when providing care.
● Leaving while visitors are with the patient.
● Not listening as patients make telephone calls.
● Abiding by the rules of confidentiality.
● Not trying to force a patient to accept your personal beliefs or views.
● Not discussing the patient's condition with any outside of work.
Legal Issues - Sexual Harassment
Some people are unaware of or are insensitive to the fact that their words or
behaviour constitutes sexual harassment. A simple definition of sexual harassment is
unwelcome sexual advances, requests for sexual favors, and other verbal or physical
conduct of a sexual nature. The action may be physical, verbal, or non-verbal. The
other party may be a patient or co-worker, of the same gender or the opposite gender
as the harasser.
Legal Issues - Sexual Harassment continued
Sexual harassment is illegal. Most facilities have orientation And in service
programs to reduce the risk of sexual harassment in the workplace. However, it
sometimes occurs despite the employers best efforts. The facility has a duty to protect
both patients and staff from sexual harassment. Facilities must respond promptly and
appropriately when patients or employees make a claim of sexual harassment, whether
the source of the harassment is another employee, and independent contractor, a
patiet, visitor, guests, or other person who was invited to the facility by the employer. If
the conduct of another person unreasonably interferes with the employees work
performance or subject the employee intimidating, hostile, or offensive work
environment, and the facility has reason to know about it, the facility must take some
immediate corrective action. Your facility will have policies and procedures regarding
actions to take and penalties if harassment occurs.
Legal Issues - Sexual Harassment continued
Upon being informed that an incident of sexual harassment has occurred, the
facility is responsible for investigating the situation. During the investigation, the
facility must protect the victim from further harassment. Examples of actions that may
be considered sexual harassment include:
● Making comments about anatomy, such as the size or shape of the breasts,
genitals, or areas of the body considered sexual.
● Making suggestions of a sexual nature.
● Staring at a person's body.
● Unwanted touching, holding, grabbing, hugging, fondling, kissing, or pinching.
●
Legal Issues - Sexual Harassment continued
● “Accidental” collision or brushing up against another person.
● Making lewd or sexual suggestive comments.
● Using offensive gestures or emotions.
● Sending offensive graphic jokes or using offensive language.
● Making threats or comments, or asking questions about a person's sexual orientation or
personal sexual practices or behavior.
● Displaying or circulating sexually suggestive material (written or pictorial, including
cartoons).
If you believe you are being sexually harrassed, or suspect that a patient is being sexually
harassed, notify your supervisor promptly. Avoid conversations, gestures, and other behavior
that may be offensive and perceived to be sexually harassing by patients and co-workers.
Review
True or False
1. A patient may not refuse any treatment prescribed by the physician.
2. Lunch time is the best time to discuss your patients with others.
3. your patient has an order to encourage fluid intake, and you failed to do this. You
are guilty of neglect.
4. You forgot to put side rails up when ordered, and efficient forms. You're guilty of
negligence.
5. failure to report your observation of an illegal act makes you guilty of aiding and
abetting the action. Leaving a patient unnecessarily exposed is an invasion of the
patient's privacy.
6. Legal standards relates to moral rights and wrongs of behavior.
Reference
Acello, B., Hegner, B. R., & Caldwell, E. (2008). Nursing assistant: A nursing process approach
(10th ed.). Cengage Learning.
Babcock law firm. (n.d.). The 3 Different Types of Tort Law. The Babcock Law firm LLC.
https://www.injurylawcolorado.com/tort-law/#:~:text=Tort%20lawsuits%20are%20the%2
0biggest,%2C%20negligence%2C%20and%20strict%20liability
Level UP RN. (2021, July 12). Intentional/Unintentional Torts and Mandatory Reporting -
Fundamentals of Nursing Principles [Video]. YouTube.
https://www.youtube.com/watch?v=M73jiBgspYw&t=1s
Suggested reading: Fundamentals - Principles, part 4: Intentional vs. Unintentional Torts and
Mandatory Reporting