Ch 2 / Nurse Aide Training – 0520

Chapter 2
Working in Long-Term Care

GOALS

  • Discuss regulations in OBRA '87 that affect nurse assistants.
  • Describe the people who live in a long-term care facility.
  • List three qualities of a good nurse assistant.
  • Name four parts of your role as a nurse assistant.
  • List five members of the health care team and explain their roles.
  • Describe the six principles of care and explain why you should practice them.
  • Discuss how to put the individual first in caregiving.
  • Discuss upward mobility for nurse assistants.

Key Terms

activities of daily living (ADLs)
Daily self-care activities that help keep a person independent and healthy.
certification
Having skills that have been tested and approved.
cognitive impairment
A condition that decreases a person's ability to think clearly.
compassion
A feeling of sorrow for another person's hardship that leads to help.
competency evaluation program
State program to certify skills of persons wanting to work as nurse assistants.
health care team
Group headed by the person receiving care. Includes doctors, nurses, assistants, therapists, etc.
Medicaid
State-administered federal program providing health coverage for low-income persons.
Medicare
Federal health insurance program for people over 65 or disabled.
nurture
To promote and encourage good care.
OBRA '87
1987 Omnibus Budget Reconciliation Act, providing standards for nursing homes.
patient-focused care
Treating each patient as an individual when providing care.
principles of care
Basic rules of caregiving that guide caregivers in individualized care.
regulation
A rule that must be followed.

What is OBRA '87?

OBRA regulations are a way to improve the quality of care in nursing facilities. They set standards nurse assistants must meet in order to work in Medicare- and Medicaid-reimbursed facilities. This law requires completing a state-approved training program or passing a competency exam. It emphasizes respect for resident rights, dignity, and promoting well-being.

Box 2-1 — Summary of OBRA Regulations for Nursing Assistants
  • Pass a competency evaluation and/or complete a state-approved training program.
  • Learn basic nursing skills, restorative services, resident rights, safety and emergency care.
  • Understand mental health and social needs of residents.
  • Provide care for people with cognitive impairment.
  • Practice infection control.
  • Work at least 8 hours in a 12-month period.
  • Complete 12 hours of in-service per year.

Who are the People in Nursing Facilities?

Average resident age is 85, mostly women. Residents may have multiple conditions such as Alzheimer's, circulatory disease, diabetes, cancer, or fractures. Some children and younger people also live in nursing homes due to serious injuries or disabilities. All residents share the need for special health care that cannot be met at home.

The Health Care Team

Every staff member contributes to care. The person receiving care is the "captain" of the team. Members include doctors, nurses, assistants, therapists, dietitians, social workers, and more.

See Table 2-1 in the source for detailed roles of each health care team member.

Qualities of a Good Nurse Assistant

Box 2-2 — Basic Qualities
  • Health/hygiene: balanced diet, rest, exercise, professional appearance.
  • Social: good listener, able to work with families and staff.
  • Character: truthful, polite, respectful, dependable, professional, protects confidentiality.

Role of a Nurse Assistant

Includes four parts: providing direct care, providing emotional support, participating as a team member, and promoting six principles of care.

Box 2-3 — Activities of Daily Living
  • Eating
  • Bathing
  • Dressing
  • Grooming
  • Using the toilet
  • Walking/moving
  • Communicating

Six Principles of Care

Box 2-5 — Principles
  • Safety
  • Privacy
  • Dignity
  • Communication
  • Independence
  • Infection Control

Putting the Person First

Modern caregiving encourages individuals to do as much as possible for themselves, restoring independence and dignity.

Upward Mobility

Nurse assistants may move up via career ladders into LPN, RN, or other health care roles. Facilities offering growth opportunities help retain quality staff.

Converted to responsive HTML while preserving the PDF’s layout and hierarchy.