1.03 presentation

UnderstandUnderstand residents’residents’
rightsrights, advocacy, and, advocacy, and
grievance procedures.grievance procedures.
Unit A
Nurse Aide Workplace Fundamentals
Essential Standard 1.00
Understand the range of function, legal and ethical responsibilities of the nurse aide within the healthcare system.
Indicator 1.03
Understand residents’ rights, advocacy, and grievance procedures.
11.03 Nursing Fundamentals

Residents’ RightsResidents’ Rights
Nursing Fundamentals 7243 21.03

Nursing Fundamentals 7243 3
Basic Human RightsBasic Human Rights
– Protected by ConstitutionProtected by Constitution
– Laws clarify these rights:Laws clarify these rights:
• Right to be treated withRight to be treated with respectrespect
• Right to live inRight to live in dignitydignity
• Right toRight to pursue a meaningful lifepursue a meaningful life
• Right to beRight to be free of fearfree of fear
1.03

Nursing Fundamentals 7243
4
Basic Human RightsBasic Human Rights
Behaviors that infringe on humanBehaviors that infringe on human
rights:rights:
• addressing residents as childrenaddressing residents as children
• using demeaning nicknames forusing demeaning nicknames for
residentsresidents
• leaving door open during bathleaving door open during bath
• threatening a resident with harmthreatening a resident with harm
1.03

• Ethical and legal basisEthical and legal basis
• States have adopted orStates have adopted or
codified these rights into lawcodified these rights into law
• Posted in facilityPosted in facility
• Distributed on admission inDistributed on admission in
many facilitiesmany facilities
OBRA 1987
Residents’ Bill of Rights
1.03

Residents have the right to:Residents have the right to:
1.1.Be treated withBe treated with
consideration, respect,consideration, respect,
and full recognition ofand full recognition of
personal dignity.personal dignity.
OBRA 1987
1.03

2.2.receive care, treatment,receive care, treatment,
and services which areand services which are
adequate and inadequate and in
compliance with rulescompliance with rules
OBRA 1987
1.03

3.3.receive a statement ofreceive a statement of
services and chargesservices and charges
OBRA 1987
1.03

4.4.have on file the attendinghave on file the attending
physician’s proposedphysician’s proposed
schedule of medicalschedule of medical
treatment.treatment.
OBRA 1987
1.03

5.5.privacyprivacy
OBRA 1987
1.03

6.6.Be free from mental andBe free from mental and
physical abuse, and freephysical abuse, and free
from restraint (except in anfrom restraint (except in an
emergency)emergency)
OBRA 1987
1.03

7.7.receive reasonablereceive reasonable
response to all requestsresponse to all requests
OBRA 1987
1.03

8.8.associate andassociate and
communicate privatelycommunicate privately
OBRA 1987
1.03

9.9.manage financial affairsmanage financial affairs
OBRA 1987
1.03

10.10.private visits fromprivate visits from
spousespouse
OBRA 1987
1.03

11.11.privacy in the residentprivacy in the resident
room. Personal itemsroom. Personal items
should not be searched.should not be searched.
OBRA 1987
1.03

12.12.present grievances andpresent grievances and
recommend changesrecommend changes
OBRA 1987
1.03

Residents have the rightResidents have the right NOTNOT to:to:
13.13.perform services for theperform services for the
facilityfacility
OBRA 1987
1.03

14.14.retain, store, and useretain, store, and use
personal clothing andpersonal clothing and
possessionspossessions
OBRA 1987
1.03

1.03 Nursing Fundamentals 7243 20

16.16.be notified if the facilitybe notified if the facility
is given a provisionalis given a provisional
licenselicense
OBRA 1987
1.03

Behaviors That Uphold
Residents’ Rights
• Address as Mr., Mrs., or Miss unlessAddress as Mr., Mrs., or Miss unless
asked to use a specific nameasked to use a specific name
• Never withhold social responsivenessNever withhold social responsiveness
• Never ignore residentsNever ignore residents
• Make eye contactMake eye contact
1.03

Behaviors That UpholdBehaviors That Uphold
–Make eye contactMake eye contact
–Allow to complete sentences prior toAllow to complete sentences prior to
leaving roomleaving room
–Don’t shut or slam door to quietDon’t shut or slam door to quiet
residentresident
–Never threaten or intentionally hurtNever threaten or intentionally hurt
1.03

• Encourage socialization (meal-time)Encourage socialization (meal-time)
• Assist to activities/meetings/churchAssist to activities/meetings/church
• Participate in planned activitiesParticipate in planned activities
• Help with phone calls, cards, mailHelp with phone calls, cards, mail
1.03

• Explain care you plan to giveExplain care you plan to give
• Observe safety precautionsObserve safety precautions
• Obtain proper consent after identifyingObtain proper consent after identifying
residentresident
1.03

• Sit when feeding a residentSit when feeding a resident
• Offer a clothing protector; do NOTOffer a clothing protector; do NOT
automatically place clothing protectorautomatically place clothing protector
on the resident prior to eatingon the resident prior to eating
• Give resident centered, not taskGive resident centered, not task
centered carecentered care
1.03

• Address resident in a dignified wayAddress resident in a dignified way
• Listen to what resident has to sayListen to what resident has to say
• Converse with resident in an adultConverse with resident in an adult
mannermanner
• Respect resident’s privacyRespect resident’s privacy
1.03

• Adult residents must be treated asAdult residents must be treated as
adults. Give age appropriate care.adults. Give age appropriate care.
• Age-appropriate considerations:Age-appropriate considerations:
– Style of dressStyle of dress
– Hair style and groomingHair style and grooming
– Recreational activitiesRecreational activities
– Social activitiesSocial activities
1.03

Age Appropriate CareAge Appropriate Care
GuidelinesGuidelines
• Don’t ignore or humor residentDon’t ignore or humor resident
• Explain what care you are going to giveExplain what care you are going to give
• Promote resident independencePromote resident independence
• Treat resident as you would want to beTreat resident as you would want to be
treatedtreated
1.03

Encourage resident to make choices:Encourage resident to make choices:
•select clothing to wearselect clothing to wear
•select books to readselect books to read
•select television programs to watchselect television programs to watch
1.03

Encourage resident to make choices:Encourage resident to make choices:
•select food and nourishmentsselect food and nourishments
•select activities of interestselect activities of interest
•select friendsselect friends
1.03

• Recognize value of past experienceRecognize value of past experience
(validate the resident)(validate the resident)
• Praise age appropriate accomplishmentsPraise age appropriate accomplishments
• Encourage adult behaviorEncourage adult behavior
1.03

Right to be Free fromRight to be Free from
RestraintRestraint
• UnderUnder OOmnibusmnibus BBudgetudget
RReconciliationeconciliation AAct 1987ct 1987 (OBRA)(OBRA),,
• residents have a right to be freeresidents have a right to be free
from restraints.from restraints.
1.03

Resident RestraintsResident Restraints

Facts Regarding RestraintsFacts Regarding Restraints
RESTRAINTSRESTRAINTS
restrictrestrict
voluntary movementvoluntary movement
or behavioror behavior
CHEMICALCHEMICAL PHYSICALPHYSICAL
1.03

Physical RestraintsPhysical Restraints
also known as
• postural supportspostural supports
• protective devicesprotective devices
1.03

1.03
Restraint:Restraint:
Any manual method, physical orAny manual method, physical or
mechanical device, material, ormechanical device, material, or
equipment attached or next to theequipment attached or next to the
resident’s body that the individualresident’s body that the individual
cannot remove easily, which restrictscannot remove easily, which restricts
freedom of movement or normalfreedom of movement or normal
access to one’s bodyaccess to one’s body

IN THE PAST!IN THE PAST!
• Restraints commonly used toRestraints commonly used to
safeguard residents who wander,safeguard residents who wander,
prone to falls, are violet, at risk ofprone to falls, are violet, at risk of
hurting themselves, or pulling tubeshurting themselves, or pulling tubes
outout
• Abuse of restraints led to newAbuse of restraints led to new
restrictions and laws on use ofrestrictions and laws on use of
restraintsrestraints
1.03

1.03
Tucking in topTucking in top
sheetsheet so tightlyso tightly
that residentthat resident
cannot movecannot move
NEVERNEVER

1.03
Placing wheelchairPlacing wheelchair
so close to a wallso close to a wall
that the wallthat the wall
prevents residentprevents resident
from getting outfrom getting out
of chairof chair

1.03
Pulling up fullPulling up full
side rails toside rails to
prevent patientprevent patient
from voluntarilyfrom voluntarily
getting out ofgetting out of
bedbed

1.03
Restraints MUSTRestraints MUST
not be usednot be used
for conveniencefor convenience
or disciplineor discipline

1.03
Unnecessary use of restraint isUnnecessary use of restraint is
FALSEFALSE
IMPRISONMENTIMPRISONMENT

1.03
Acceptable Reasons for Use of Restraints:Acceptable Reasons for Use of Restraints:
Temporarily for life threatening medicalTemporarily for life threatening medical
conditionsconditions
Brief periods to allow medical treatmentBrief periods to allow medical treatment
to proceed if there is documentedto proceed if there is documented
evidence of resident or legal approval ofevidence of resident or legal approval of
treatmenttreatment

1.03
Acceptable Reasons for Use of RestraintsAcceptable Reasons for Use of Restraints
When alternatives to restraints are notWhen alternatives to restraints are not
effective, however, and the physicianeffective, however, and the physician
orders restraints, it becomes essential fororders restraints, it becomes essential for
the nurse aide to know the risks involvedthe nurse aide to know the risks involved
in caring for these residents.in caring for these residents.

1.03
Types of acceptable physical restraints ifTypes of acceptable physical restraints if
ordered appropriatelyordered appropriately
•Side rails on a bedSide rails on a bed
• Special chairs such as geriatric chairsSpecial chairs such as geriatric chairs
• Lap cushions or lap trayLap cushions or lap tray
• Vests and jacket restraintsVests and jacket restraints
• Safety belt restraintsSafety belt restraints
• Soft ties for wrist and anklesSoft ties for wrist and ankles

1.03
Restraint-free facility:Restraint-free facility:
Restraints are not used forRestraints are not used for
any reason and not kept inany reason and not kept in
the facilitythe facility

Restraint AlternativesRestraint Alternatives

1.03
Restraint alternative:Restraint alternative:
Interventions used instead ofInterventions used instead of
using restraintsusing restraints

Using friends, family, volunteers or
resident directed care provider
1.03

Interesting activities and diversionsInteresting activities and diversions
such as games, movies or musicsuch as games, movies or music
distract residentsdistract residents
1.03

Answering call signal promptlyAnswering call signal promptly
1.03

Exercise and outdoor activitiesExercise and outdoor activities
1.03

Consistent reality orientation orConsistent reality orientation or
validation and staff assignmentsvalidation and staff assignments
1.03

Having resident’s room close toHaving resident’s room close to
nurses’ stationnurses’ station
1.03

Barriers such as STOP SIGNSBarriers such as STOP SIGNS
posted on doors discouragesposted on doors discourages
confused residents fromconfused residents from
wandering into the areawandering into the area
1.03

PartialPartial bed rails prevent residentsbed rails prevent residents
from rolling out of bed whilefrom rolling out of bed while
allowing them freedom to get upallowing them freedom to get up
if they wish toif they wish to
1.03

Positioning devices and wedges such asPositioning devices and wedges such as
wedge cushions placed in wheelchairswedge cushions placed in wheelchairs
to prevent forward slidingto prevent forward sliding
1.03

Furniture such as low beds, rocking
chairs, or recliners
1.03

Easy –release belts remindsEasy –release belts reminds
resident of safety but the residentresident of safety but the resident
can release if desiredcan release if desired
1.03

Floor cushion or pads next to theFloor cushion or pads next to the
bed – decreases injuries if abed – decreases injuries if a
resident does fall when gettingresident does fall when getting
out of bedout of bed
1.03

Electronic warning devices on beds,Electronic warning devices on beds,
wheelchairs, and doors alert staff ifwheelchairs, and doors alert staff if
patient gets up without help*patient gets up without help*
1.03

SKILLSKILL 1.03A1.03A
Apply Personal ElectronicApply Personal Electronic
Warning DeviceWarning Device
Training Lab AssignmentTraining Lab Assignment
Engage in the Skill Acquisition Process for:Engage in the Skill Acquisition Process for:

The Last Resort!The Last Resort!
Occasionally,
alternatives do not
work and restraints
are ordered.
1.03

Using RestraintsUsing Restraints
Ordered by the physician…Ordered by the physician…
• when necessary to treat a medicalwhen necessary to treat a medical
symptom or provide emergencysymptom or provide emergency
medical treatmentmedical treatment
• choice of restraint based onchoice of restraint based on
multidisciplinary evaluation for themultidisciplinary evaluation for the
least restrictive measureleast restrictive measure
1.03

Safety MeasuresSafety Measures
and Considerationsand Considerations
WhenWhen APPLYINGAPPLYING
RestraintsRestraints
1.03

Safety measures and Considerations APPLYING Restraints:
•Use reassurance in an attempt toUse reassurance in an attempt to
calm agitated residentscalm agitated residents
1.03

Be sure there is a physician’sBe sure there is a physician’s
order for restraint use and that it isorder for restraint use and that it is
in the care plan before applyingin the care plan before applying
restraintrestraint
1.03

Use the correct type of restraint andUse the correct type of restraint and
apply according to manufacturer’sapply according to manufacturer’s
directions and only after you havedirections and only after you have
received instructions in its usereceived instructions in its use
1.03

Secure enough assistance to applySecure enough assistance to apply
restraints quickly to avoid injuryrestraints quickly to avoid injury
1.03

Attach restraints to bed frameAttach restraints to bed frame
(immovable part of bed), not to(immovable part of bed), not to
side rails or other parts of the bedside rails or other parts of the bed
Leave an 8 inch tailLeave an 8 inch tail
1.03

Use slip knot to tie restraint forUse slip knot to tie restraint for
quick releasequick release
1.03

Protect bony areas and skin byProtect bony areas and skin by
padding them prior to applyingpadding them prior to applying
restraintrestraint
1.03

Adjust restraint so that it allowsAdjust restraint so that it allows
some movement, but is securesome movement, but is secure
and comfortable – place openand comfortable – place open
flat hand between the residentflat hand between the resident
and the restraint for restraintsand the restraint for restraints
around the torso.around the torso.
1.03

Make sure breasts orMake sure breasts or
skin are not caught inskin are not caught in
the restraint.the restraint.
1.03

Safety MeasuresSafety Measures
and Considerationsand Considerations
AFTERAFTER RestraintsRestraints
are appliedare applied
1.03

Safety measures and Considerations AFTER Applying
Restraints:
Be sure residentBe sure resident
NEEDS are METNEEDS are MET
1.03

Restraints:
Special attention must be paidSpecial attention must be paid
to basic needsto basic needs
• Elimination-Elimination- assist inassist in
toiletingtoileting
• Hydration –Hydration – offer fluidsoffer fluids
1.03

Restraints:
Call signal must be in reach
and the resident’s signal for
help must be answered
immediately (STAT)
1.03

Restraints:
Check on residentCheck on resident
every 15 minutesevery 15 minutes
1.03

Restraints:
Every 15 minutes:Every 15 minutes:
Pulse, color, and temperaturePulse, color, and temperature
of any restrained extremityof any restrained extremity
1.03

Restraints:
Every 15 minutes:Every 15 minutes:
Breathing of resident withBreathing of resident with
vest (torso) restraintvest (torso) restraint
1.03

Restraints:
Every 2 hours:Every 2 hours:
Remove restraint for 10Remove restraint for 10
minutes and reposition residentminutes and reposition resident
1.03

Restraints:
In an emergency, notify
supervisor immediately
via call bell, stay with the
resident, and loosen
restraint.
1.03

EMERGENCY EXAMPLES:EMERGENCY EXAMPLES:
•Unable to detect a pulse in extremityUnable to detect a pulse in extremity
•Extremity cold, pale, blue-tinged, gray, red,Extremity cold, pale, blue-tinged, gray, red,
purple in colorpurple in color
•Resident complains of pain, discomfort,Resident complains of pain, discomfort,
numbness, or tingling in restrained partnumbness, or tingling in restrained part
•Breathing is impaired with vest or safety beltBreathing is impaired with vest or safety belt
restraintrestraint
•URGENT!!! TAKE ACTIONURGENT!!! TAKE ACTION
1.03

Observations and reporting shouldObservations and reporting should
include:include:
• Color and condition of skin underColor and condition of skin under
restraintrestraint
• Pulse rate, color and temperature ofPulse rate, color and temperature of
skin in restrained extremityskin in restrained extremity
1.03

Observations and reporting shouldObservations and reporting should
includeinclude (continued):(continued):
• Any complaints about restrained partAny complaints about restrained part
• Red or injured skin areas underRed or injured skin areas under
restraintrestraint
• Respiratory rate and color of skin withRespiratory rate and color of skin with
vest and safety belt restraintsvest and safety belt restraints
1.03

SKILLSKILL 1.03B1.03B
Apply RestraintsApply Restraints
Training Lab AssignmentTraining Lab Assignment
Engage in the Skill Acquisition Process for:Engage in the Skill Acquisition Process for:

Resident AdvocatesResident Advocates

1.03
What does an advocate do?What does an advocate do?
•Plead cause of anotherPlead cause of another
•Resolve grievancesResolve grievances
•Protect resident’s rightsProtect resident’s rights

1.03
Advocates can be:Advocates can be:
• You and your co-workersYou and your co-workers
• Member of resident’sMember of resident’s
family/support systemfamily/support system
• Resident’s guardianResident’s guardian
• OmbudsmanOmbudsman

1.03
Ombudsman Program - History
The national network of long term care ombudsman programs was established in
response to the many problems found in nursing homes. The program was first
introduced in 1971 as part of President Nixon’s eight-point plan to improve nursing
home conditions. This plan established several demonstration ombudsman projects,
funded and supervised in the beginning through the U.S. Public Health Service.
In 1973, administration responsibility for these projects was transferred within the
Department of Health, Education and Welfare to the Administration on Aging, within
the Office of Human Development Services. By 1975, all state agencies on aging were
invited to submit proposals to promote effective statewide ombudsman programs.
Money was then made available for this voluntary state program.
The Long Term Care Ombudsman Program has been in
existence in North Carolina since 1976.

A favorable response to the ombudsman program led to its formal adoption
in the 1978 Amendments to the Older Americans Act. The Older Americans
Act (federal law) requires that each state establish and maintain a Long Term
Care Ombudsman Program to advocate on behalf of residents in nursing and
adult care homes (rest homes, assisted living). In 1989, the North Carolina
General Assembly enacted legislation for the Long Term Care Ombudsman
Program (G.S. 143B-181.15-25) which incorporated federal mandates in the
Older Americans Act for the Program and clearly define the roles and
responsibilities of the state and regional long term care ombudsmen. In
North Carolina, the State Long Term Care Ombudsman Program is located in
the Department of Health and Human Services, Division of Aging and Adult
Services. The Regional Long Term Care Ombudsman Programs are housed in
the 17 Area Agencies on Aging.
Last updated June 2, 2010
LTC Ombudsman Program

Resident Right toResident Right to
Voice GrievancesVoice Grievances
1.03
• Regarding services furnishedRegarding services furnished
• Regarding services not furnishedRegarding services not furnished
• With respect to behavior of othersWith respect to behavior of others
• Nurse aide must report grievances toNurse aide must report grievances to
supervisorsupervisor

Facility policy components for
resident grievance
1.03
1.1. AcknowledgmentAcknowledgment
2.2. Prompt attempt to resolvePrompt attempt to resolve
3.3. Resident kept apprisedResident kept apprised

Resident Council:
Advisory Group
1.03

Resident Council:
Advisory Group
1.03
Provides opportunity for discussionProvides opportunity for discussion
Recommendations may be made for:Recommendations may be made for:
• Facility policiesFacility policies
• Decisions regarding activitiesDecisions regarding activities
• Exploration of concernsExploration of concerns
• Resolving grievancesResolving grievances

Resident Council:
Advisory Group
1.03
• Gives residents a voice in facilityGives residents a voice in facility
operationsoperations
• MembersMembers
– residentsresidents
– facility staff members to includefacility staff members to include
Nurse AidesNurse Aides
– representatives from communityrepresentatives from community

The
Bottom
Line
Resident has a right to
voice grievances
without fear of
retaliation or
discrimination!

UnderstandUnderstand resident’s rightsresident’s rights,,
advocacy, and grievance procedures.advocacy, and grievance procedures.
102
 ENDEND 
1.031.03
1.03 Nursing Fundamentals

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