Chapter 1 - The Nursing Assistant in Long-Term Care

1The Nursing Assistant in Long-Term Care

TheNursingAssistantinLong-TermCare
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1. Define important words in this chapter
accountable
answerable for one’s actions.
activities of daily living (ADLs)
daily personal care tasks, such as bathing; caring for skin, fingernails, and
hair; eating; drinking; caring for the mouth and teeth; dressing; walking;
transferring; eliminating; and communicating.
acute care
24-hour skilled care given in hospitals and ambulatory surgical centers for
short-term, immediate illnesses or injuries.
adult day services
care for people who need some assistance or supervision during certain
hours, but who do not live in the facility where care is given.
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allergies
a condition in which the body’s immune response is triggered after exposure
to a substance called an allergen; reactions such as sneezing, difficulty
breathing, and skin issues may result.
animal-assisted therapy (AAT)
the practice of bringing pets into a facility or home to provide stimulation
and companionship.
assisted living
residences for people who do not need 24-hour skilled care, but who do
require some help with daily care.
assistive devices
special equipment that helps a person who is ill or disabled perform
activities of daily living.
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care team
the group of people with different kinds of education and experience who
provide resident care.
chain of command
the order of authority within a facility.
charge nurse
a nurse responsible for a team of healthcare workers.
chronic
long-term or long-lasting.
cite
in a long-term care facility, to find a problem through a survey.
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conscientious
guided by a sense of right and wrong; principled.
continuity of care
an ongoing coordination of a resident’s care over time, during which the
care team regularly exchanges information and works toward shared goals.
courteous
polite, kind, considerate.
delegation
transferring responsibility to a person for a specific task.
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dementia
the serious loss of mental abilities, such as thinking, remembering,
reasoning, and communicating.
diagnosis
the identification of disease or condition by its signs and symptoms and
through test results.
empathetic
Being able to identify with and understand the feelings of others.
first impression
a way of classifying or categorizing someone or something at the first
meeting.
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functional nursing
method of nursing care that involves assigning specific tasks to each team
member.
holistic care
care that involves the whole person; this includes his or her physical, social,
emotional, and spiritual needs.
home health care
health care that is provided in a person’s home.
hospice care
holistic, compassionate care for people who have approximately six months
or less to live; care is available until the person dies.
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intergenerational care
caring for children and the elderly in the same setting.
Joint Commission
a independent, not-for-profit organization that evaluates and accredits
different types of healthcare facilities.
length of stay
the number of days a person stays in a healthcare facility.
liability
a legal term that means a person can be held legally responsible for harming
someone else.
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licensed practical nurse (LPN) or licensed vocational nurse (LVN)
a licensed nurse who provides skilled nursing care and gives treatments and
medications.
long-term care (LTC)
24-hour skilled care provided in long-term care facilities for people with
ongoing conditions.
Medicaid
a medical assistance program for people who have low incomes, as well as
for people with disabilities.
Medicare
a federal health insurance program for people who are 65 or older, have
certain disabilities or permanent kidney failure, or are ill and cannot work.
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nursing assistant (NA)
person who performs assigned nursing tasks and gives personal care.
outpatient care
care given to people who have had treatments, procedures, or surgeries and
need short-term skilled care.
person-centered care
A type of care that places the emphasis on the person needing care and his
or her individuality and capabilities.
policy
a course of action to be followed every time a certain situation occurs.
primary nursing
a method of nursing care in which the registered nurse provides much of the
daily care to residents.
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procedure
a method or way of doing something.
professionalism
the use of proper standards of behavior at work and in work-related settings.
registered nurse (RN)
a licensed nurse who assesses residents, creates care plans, monitors progress,
provides skilled nursing care, administers treatments and medications, and
supervises the care given by nursing assistants and other members of the care team.
rehabilitation
a program of care given by a specialist or a team of specialists, such as physical
therapists, to restore or improve function after an illness or injury.
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resident
a person living in a long-term care facility.
sandwich generation
people responsible for the care of both their children and aging relatives.
skilled care
medically necessary care given by a skilled nurse or therapist.
subacute care
care given in hospitals or in long-term care facilities for people who need
less care than for an acute (sudden onset, short-term) illness or injury but
more than for a chronic (long-term) illness.
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team leader
a nurse in charge of a group of residents for one shift of duty.
team nursing
method of nursing care in which a nurse acts as a leader of a group of
people giving care.
trustworthy
deserving the trust of others.
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2. Describe healthcare settings
Define the following terms:
long-term care (LTC)
24-hour skilled care provided in long-term care facilities for people with
ongoing conditions.
skilled care
medically necessary care given by a skilled nurse or therapist.
chronic
long-term or long-lasting.
resident
a person living in a long-term care facility.
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Nursing assistants do important work and have many different career
opportunities. Long-term care (LTC) facilities employ many nursing assistants.
• LTC facilities provide 24-hour skilled care
• LTC assists people with ongoing, chronic medical conditions
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REMEMBER:
The LTC facility is the resident’s home.
The resident’s room must be treated with respect.
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Critical Thinking: Conversation Starter
How would you feel if someone touched your personal belongings or moved
your things around without asking?
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assisted living
residences for people who do not need 24-hour skilled care, but who do
require some help with daily care.
home health care
health care that is provided in a person’s home.
adult day services
care for people who need some assistance or supervision during certain
hours, but who do not live in the facility where care is given.
sandwich generation
people responsible for the care of both their children and aging relatives.
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intergenerational care
caring for children and the elderly in the same setting.
acute care
24-hour skilled care given in hospitals and ambulatory surgical centers for
short-term, immediate illnesses or injuries.
subacute care
care given in hospitals or in long-term care facilities for people who need
less care than for an acute (sudden onset, short-term) illness or injury but
more than for a chronic (long-term) illness.
outpatient care
care given to people who have had treatments, procedures, or surgeries and
need short-term skilled care.
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rehabilitation
a program of care given by specialists, such as physical therapists, to restore
or improve function after an illness or injury.
hospice care
holistic, compassionate care for people who have approximately six months
or less to live; care is available until the person dies.
animal-assisted therapy (AAT)
the practice of bringing pets into a facility or home to provide stimulation
and companionship.
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3. Explain Medicare and Medicaid
Medicare
a federal health insurance program for people who are 65 or older, have
certain disabilities or permanent kidney failure, or are ill and cannot work.
Medicaid
a medical assistance program for people who have low incomes, as well as
for people with disabilities.
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Medicare (www.medicare.gov) is a federal health insurance program for people
who are
• 65 or older
• Of any age with permanent kidney failure or certain disabilities
Medicare will only pay for care that it deems medically necessary.
Medicaid (www.medicaid.gov) is a medical assistance program for people who
have a low income, as well as for people with disabilities. It is funded by the
federal government and each state.
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Key Material 1-1: Facts about Medicare and Medicaid
Medicare
• Medicare is for people 65 or older and people of any age with permanent kidney failure or
certain disabilities.
• Part A helps pay for care in a hospital or skilled nursing facility or for care from a home health
agency or hospice.
• Part B helps pay for doctor services and other medical services and equipment.
• Part C allows private health insurance companies to provide Medicare benefits.
• Part D helps pay for medications prescribed for treatment.
Medicaid
• Medicaid is a medical assistance program for people who have a low income and for people
with disabilities.
• People qualify based on income and special circumstances.
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Remember these facts about long-term care coverage under Medicare and
Medicaid:
• Pays LTC facilities a fixed amount for services
• Services are based on the resident’s needs upon admission
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4. Describe the residents in long-term care facilities
REMEMBER:
Understanding each individual’s specific needs, illnesses, and preferences is far
more important than understanding facts about the entire long-term care
population.
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length of stay
the number of days a person stays in a healthcare facility.
dementia
the serious loss of mental abilities, such as thinking, remembering,
reasoning, and communicating.
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Key Material 1-2: Residents in LTC Facilities
• 84.9% are over 65
• 67% are female
• More than 76% are white and non-Hispanic
• About 1/3 come from a private residence
• Over 50% come from a hospital
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What might influence a resident’s length of stay at a LTC facility?
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These facts are true of those residents in LTC with a length of stay of six months
or more:
• They make up over 2/3 of facility residents
• They require 24-hour care
• They did not have caregivers available to give enough care at home
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These facts are true of those residents in LTC with a length of stay of less than six
months:
• They may have been admitted for terminal care (will die in the facility)
• They may have been admitted for rehabilitation or temporary illness (will
recover and return to the community)
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REMEMBER:
Many different kinds of care are needed in a facility. Residents in LTC often lack
outside support, and it is very important to care for the whole person.
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5. Describe the nursing assistant’s role
nursing assistant (NA)
person who performs assigned nursing tasks and gives personal care.
activities of daily living (ADLs)
daily personal care tasks, such as bathing; caring for skin, fingernails, and
hair; eating; drinking; caring for the mouth and teeth; dressing; walking;
transferring, eliminating; and communicating.
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NAs provide services for residents in two ways:
• By performing assigned nursing tasks
• By providing personal care or assisting with self-care
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Common nursing assistant tasks include the following:
• Serving trays and helping residents eat and drink
• Helping residents dress and undress
• Bathing, shaving, and shampooing residents
• Bedmaking
• Tidying living areas
• Measuring vital signs (temperature, pulse, respiration, blood pressure and
observing and reporting pain levels)
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Common nursing assistant tasks (cont’d):
• Helping residents with elimination needs
• Assisting with mouth care
• Giving back rubs
• Observing and reporting changes in conditions and complaints
• Helping residents move safely around the facility
• Caring for supplies and equipment
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Tasks which nursing assistants usually do not perform include the following:
• Inserting or removing tubes
• Giving tube feedings
• Changing sterile dressings
• Giving medications
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All of these job titles can mean the same thing as nursing assistant:
• Nurse aide
• Certified nurse aide
• Patient care technician
• Certified nursing assistant
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6. Discuss professionalism and list examples of professional behavior
Define the following term:
professionalism
the use of proper standards of behavior at work and in work-related settings.
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What are some examples of professional behavior as it relates to nursing
assistants?
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Professional behavior for a nursing assistant includes following these guidelines:
• Be neatly dressed, groomed, and clean.
• Do not discuss personal problems with residents.
• Do not use your personal phone in resident care areas.
• Be at work on time and avoid unnecessary absences.
• Never leave work early without permission.
• Do not report to work under the influence of drugs and/or alcohol
• Keep a positive attitude.
• Do not gossip about coworkers.
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Guidelines for professional behavior for nursing assistants (cont’d):
• Be polite and respectful.
• Address residents and visitors in the way they wish to be addressed.
• Do not use profanity.
• Keep resident information confidential.
• Follow procedures and policies.
• Report problems to the supervisor.
• Maintain educational requirements.
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Guidelines for professional behavior for nursing assistants (cont’d):
• Ask questions when you do not understand something.
• Be honest and document carefully.
• Accept and learn from constructive feedback.
• Do not accept tips or gifts.
• Be loyal to your facility and be a positive role model.
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REMEMBER:
Whenever you are unsure about care, be sure to ask questions or to review the
policy manual about policies or procedures you do not understand.
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REMEMBER:
Performing a job with professionalism is best for residents and is also best for the
nursing assistant. It earns the respect of others and helps an NA advance in her
career.
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7. List the qualities that nursing assistants must have
The best nursing assistants have certain traits. As you review these traits, ask
yourself, “Do I have these traits?” and, “Is there a way I can better develop
them?”
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trustworthy
deserving the trust of others.
conscientious
guided by a sense of right and wrong; principled.
courteous
polite, kind, and considerate.
empathetic
being able to identify with and understand the feelings of others.
accountable
answerable for one’s actions.
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Nursing assistants should be:
• Patient and understanding
• Honest and trustworthy
• Conscientious
• Enthusiastic
• Courteous and respectful
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Nursing assistant traits (cont’d):
• Empathetic
• Dependable and responsible
• Humble and open to growth
• Tolerant
• Unprejudiced
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8. Discuss proper grooming guidelines
Choose one of the qualities that nursing assistants must have. Can you imagine
a situation on the job where that quality is needed? Can you describe a time that
you used that quality in a previous job, or in your personal life?
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first impression
a way of classifying or categorizing someone or something at the first
meeting.
allergies
a condition in which the body’s immune response is triggered after exposure
to a substance called an allergen; reactions such as sneezing, difficulty
breathing, and skin issue may result.
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REMEMBER:
Making a positive first impression is very important, and proper grooming is an
essential part of making a positive first impression.
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Nursing assistants should do these things to be properly groomed:
• Keep your uniform clean and neat.
• Bathe and wear deodorant every day.
• Brush your teeth at least twice a day.
• Do not wear or use scented products.
• Keep your hair neatly tied back.
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Proper grooming for nursing assistants (cont’d):
• Keep beards trimmed and clean.
• Apply makeup lightly.
• Keep nails short, filed, and clean.
• Do not wear artificial nails.
• Keep your shoes and laces clean and in good condition.
• Wear as little jewelry as possible, except for a simple waterproof watch
and identification badge.
• Keep your tattoos covered by clothing.
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REMEMBER:
Keep in mind that residents may dislike or be allergic to certain scents. Scents
should be avoided. This is an important part of meeting residents’ needs.
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9. Define the role of each member of the care team
care team
the group of people with different kinds of education and experience who
provide resident care.
registered nurse (RN)
a licensed nurse who assesses residents, creates care plans, monitors
progress, provides skilled nursing care, administers treatments and
medications, and supervises the care given by nursing assistants and other
members of the care team.
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licensed practical nurse (LPN) or licensed vocational nurse (LVN)
a licensed nurse who provides skilled nursing care and gives treatments and
medications.
diagnosis
the identification of disease or condition by its signs and symptoms and
through test results.
assistive devices
special equipment that helps a person who is ill or disabled perform
activities of daily living.
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REMEMBER:
The care team consists of many members who each play a different role. The
resident is at the center of the care team.
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Members of the care team include the following:
• Resident and resident’s family
• Nurse (RN, LPN or LVN)
• Advanced practice nurse (APRN)
• Physician (MD or DO)
• Physical therapist (PT or DPT)
• Occupational therapist (OT or OTD)
• Speech-language pathologist (SLP)
• Registered dietitian (RDN)
• Respiratory therapist (RT)
• Medical social worker (MSW)
• Activities director
• Nursing assistant (NA) 58

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REMEMBER:
The resident is the most important member of the care team.
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10. Discuss the faculty chain of command
chain of command
the order of authority within a facility.
charge nurse
a nurse responsible for a team of healthcare workers.
liability
a legal term that means a person can be held legally responsible for harming
someone else.
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1Key Material 1-3: Chain of Command
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10. Discuss the faculty chain of command
REMEMBER:
The chain of command helps ensure that residents receive proper care, and also
protects staff from liability.
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11. Explain The Five Rights of Delegation
delegation
transferring responsibility to a person for a specific task.
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When planning care, nurses must decide which tasks to delegate to others.
The Five Rights of Delegation are
• Right Task
• Right Circumstance
• Right Person
• Right Direction/Communication
• Right Supervision/Evaluation
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NAs should consider these questions before accepting a delegated task:
• Do I have all the information I need to do this job? Are there questions I
should ask?
• Do I believe that I can do this task? Do I have the necessary skills?
• Do I have the needed supplies, equipment, and other support?
• Do I know who my supervisor is, and how to reach him/her?
• Have I told my supervisor of my special needs for help and support?
• Do we both understand who is doing what?
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REMEMBER:
Asking questions and asking for help when it is needed allows an NA to provide
the best possible care.
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What could happen if an NA did not understand something he was asked to do,
but did not ask for help?
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12. Describe methods of nursing care and discuss person-centered care
holistic care
care that involves the whole person; this includes his or her physical, social,
emotional, and spiritual needs.
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REMEMBER:
The nursing profession takes a holistic approach to caring for residents,
meaning caring for the whole person. This includes his or her physical needs as
well as other needs, such as social, emotional, intellectual, and spiritual. Meeting
all of these needs will improve the residents’ quality of life.
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team nursing
method of nursing care in which a nurse acts as a leader of a group of
people giving care.
team leader
a nurse in charge of a group of residents for one shift of duty.
primary nursing
a method of nursing care in which the registered nurse provides much of the
daily care to residents.
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continuity of care
an ongoing coordination of a resident’s care over time, during which the
care team regularly exchanges information and works toward shared goals.
functional nursing
method of nursing care that involves assigning specific tasks to each team
member.
person-centered care
a type of care that places the emphasis on the person needing care and his or
her individuality and capabilities.
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REMEMBER:
Regardless of the type of nursing care utilized, many long-term care facilities
promote person-centered care, which emphasizes the individuality of the person
who needs care and recognizes and develops his or her capabilities while
promoting the resident’s individual preferences, choices, dignity, and interests
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13. Explain policy and procedure manuals
policy
a course of action to be taken every time a certain situation occurs.
procedure
a method or way of doing something.
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13. Explain policy and procedure manuals
REMEMBER:
An NA should always ask questions or consult the policy manual or procedure
manual when she is unsure of something.
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14. Describe the long-term care survey process
cite
in a long-term care facility, to find a problem through a survey.
Joint Commission
an independent, not-for-profit organization that evaluates and accredits
different types of healthcare facilities.
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The survey process involves these steps:
• Inspections are done periodically.
• Surveyors observe and interview residents and staff to find out how well
residents’ needs are being met.
• Nursing assistants should answer any questions asked by surveyors to the
best of their ability.
• If a nursing assistant does not know the answer to a question, he should
say so and then find out.
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REMEMBER:
A nursing assistant should never guess when answering a question asked by
surveyors. If she does not know the answer, she must tell the surveyor she does
not know. She can then find out the answer and follow up with the surveyor.
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REMEMBER:
The Joint Commission is an independent, not-for-profit organization whose
standards focus on improving the quality and safety of care provided. The Joint
Commission’s surveys are separate from state inspections.
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Chapter 1 - The Nursing Assistant in Long-Term Care

Chapter 1 - The Nursing Assistant in Long-Term Care

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