This document provides an overview of key concepts for certified nursing assistants (CNAs) related to healthcare settings, long-term care facilities, the nursing care team, residents' rights, and the CNA's role and responsibilities. It discusses different types of healthcare facilities including long-term care, assisted living, home health care, acute care, subacute care, rehabilitation, and hospice care. It also covers topics like policies and procedures, annual surveys, Medicaid vs Medicare, culture change, person-centered care, charting, professionalism, time management, legal/ethical issues, and abuse/neglect reporting requirements for CNAs.

1. INTRODUCTION TO NURSING
For
Certified Nursing Assistants
Chapters 1-4
*Information is primarily based from Hartman’s Nursing Assistant Care/Long
term Care textbook, 4th edition.

2. Understanding Healthcare Settings
1. Long-term care - facilities that provide 24 hour skilled care.
2. Skilled care - facilities provide medically necessary care given by a skilled nurse
or therapist. These residents require a high level of care for ongoing/chronic
conditions.
3. Assisted living - Facilities that promote independence and minimal care is
required.
4. Home health care - Residents who prefer to stay at home, they may have
varying degrees of medical issues.
5. Acute care - Residents require short-term, immediate care usually provided in a
hospital.

3. Understanding Healthcare Settings
6. Subacute care - specialized care that can be provided in a hospital or LTC
examples include, dialysis, injuries, cancer txs.
7. Rehabilitation - is care provided by a specialist to restore prior function. The
team may include physical, occupational and speech therapy.
8. Hospice care - Specialized care for individuals in the final phase of a terminal
illness.

4. What Exactly Is A Long-term Care Facility?
LTC facilities provide 24 hours skilled nursing care. Residents generally requires
partial or total assistance with ADLs (bathing & hygiene, transferring, toileting and
meals).
Most residents in LTC are over the age of 65, 67% are female, 76% are white and
non-Hispanic. 50% of the newly admitted residents come from the hospital.
The average monthly cost of LTC in NY state is $11,000.00!!

5. Hospice Care
Hospice care can be provided in the home or a facility for residents who have 6
months or less to live.
Hospice care involves physical and emotional care and support. Hospice is designed
to help the resident and the family as they transition from this life.

6. Young Residents
You will encounter young residents.
The developmentally disabled are the group who reside in LTC the longest.
You will also encounter young physically disabled (ex MCH).

7. Policies & Procedures
● Policy - is a course of action that should be taken every time a situation occurs
Ex. An incident report must be completed for all residents falls.
● Procedure - is a method, or way of doing something.
Ex. Instructions given on how to complete the incident report and what forms to
complete.

8. Annual Survey
Each facility undergoes an annual survey/inspection by the NYS Dept of Health.
The survey is a study of how well the resident is cared for and the overall
environment of the physical. They focus on the overall health of the resident,
physical, emotional, nutritional, spiritual and emotional.

9. Medicaid vs Medicare
Medicare is a federally funded insurance programs that covers the following
● Residents aged 65 or older
● Residents with kidney failure
● Certain disabilities
Medicaid is federally and state funded insurance program that covers the following
● Low income residents
● Residents with disabilities
Health Maintenance Organizations (HMOs) are managed care designed to control cost.

10. Culture Change
The purposeful act of changing the culture or way of providing healthcare. The
industry now attempts to honor the values and practices of the resident.
Small Homes and Shabazz training is one way to improve the culture of healthcare.

11. Person Centered Care
The resident is at the center of the care plan and all care is individually designed for
the needs of that resident.
Person centered care is aimed to promote the residents individual preferences,
choices, dignity and interests.
Each residents background, culture, beliefs, language and traditions are respected.

12. The Nursing Care Team
● Resident and the resident’s family
● CNA
● LPN
● RN
● MD, PA, NP
● PT/OT/ST
● Dietician

13. Nursing Chain of Command
The chain of command helps protect nursing assistants and their employers from
liability.
● Administrator
● Medical Team
● DON
● ADON
● Supervisor
● Charge nurse
● Staff nurses
● Last but certainly not least is the Nursing Assistant

14. The Role of the CNA
Nursing assistants provide personal, nutritional, emotional, spiritual, and
recreational care. Below are some examples……..
Bathing, backrubs, ambulation, mouth/denture care, assisting with meals, toileting,
exercise, transport to activities/religious services, cleaning residents supplies,
equipment and living space.

15. Charting
Charting is an essential part of your work day. It is required that you take credit
for the care you have provided. Your charting is a record of the care the resident
received. Each shift you work you must chart all your ADLs.
CNAs are the eyes and ears of the healthcare team so report all abnormal findings
promptly.

16. Professionalism
Professionalism means behaving properly when on the job which includes…….
● Reporting to work on time
● Dressing appropriately
● Having good communication skills
● Completing all tasks and following the care plan.
● Charting all care provided
● Reporting observations accurately

17. Qualities of Great Nursing Assistants
Compassionate: being caring, concerned, understanding, considerate.
Empathy: to identify with the feelings of others.
Sympathy: to share in the feelings and difficulties of others.
Honest: never saying or doing anything that is not true.
Tactful: showing sensitivity and having a sense of what is appropriate when dealing
with others.

18. Qualities of Great Nursing Assistants
Conscientious: always trying to do one’s best.
Dependable: being trustworthy and reliable.
Patient: the ability to accept or tolerate delays, problems, or suffering without
becoming annoyed or anxious.
Respectful: treating others kindly and politely.
Unprejudiced: providing quality care regardless of age, gender, religion, race,
ethnicity, sexual orientation or condition.
Tolerate: respecting others.

19. Proper Personal Grooming Habits
Do not report to work appearing unkept! Your grooming habits and appearance may
be a perceived indication of the care you will provide to the resident. CNAs who are
professional follow the theses proper personal grooming habits…..
● Bath (soap & H20)
● Mouth care (toothpaste, brush, mouthwash)
● Clean, pressed, appropriately fitting clothes, closed toe, comfortable walking shoe
● Clean, neat hair, minimal makeup
● Clean, short nails
● Identification badge
● Minimal jewelry

20. Scope of Practice
Every state regulates what care a CNA can provide. In New York state CNAs are
not permitted to ……
● Pass medication
● DX illness or prescribe TXs or medications
● Inform the resident or family any DX or TXs
● Perform procedures that require sterile technique
● Insert or remove tubes
● Change bandages or dressings

21. The Residents’ Care Plan
The care plan is an individualized treatment plan consisting of tasks the team must
complete and how they must complete them. The residents’ care plan also consists
of goals the pt is expected to meet. The care plan must be updated yearly and as
needed. CNA input is essential when developing the care plan and making
adjustments.

22. The Nursing Process

23. Delegation
Delegation means transferring responsibility to a person for a specific task. CNAs do
not delegate task. Licensed nurses are accountable for care and delegate tasks to
CNAs. There are 5 Rights of Delegation to consider before a nurse assigns tasks.
● Is the CNA competent to care for the resident? (Right Task)
● What is the residents condition? ( Right Circumstance)
● Is the CNA the right person for the job? ( Right Person)
● Can the nurse provide appropriate direction and communication? (Right D & C)
● Is the nurse available to provide supervision, support and help? (Right
Supervision/Evaluation)

24. Time Management, the key to success!!
PLAN AHEAD
PRIORITIZE
MAKE A SCHEDULE
COMBINE ACTIVITIES
GET HELP

25. Legal & Ethical Issues
Ethics and laws guide behavior. ETHICS is the knowledge of right and wrong and
tell you what you should do. Laws are rules that are established by the community
or government. Laws are usually based on ethics and they must be followed.
Violation of laws are punishable by fines or jail/prison time.
Code of ethics promote proper conduct and high standard of practice. The code of
ethics revolve around the idea that a resident deserves ethical care.

26. Omnibus Budget Reconciliation Act (OBRA)
● Was passed in 1987 in response to poor care and abuse in LTC facilities.
● Requires Nurse Aide Training & Competency Evaluation Program (NATCEP)
states CNA training must be at least 75 hours.
● CNAs must pass both written and demonstrated skills.
● CNAs must have 12 hours of inservice education a year.
● Each state must have a CNY registry.
● Minimum Data Set (MDS) must be done within 14 days of admission and every
year thereafter. The MDS is a resident assessment.

27. Residents’ Right
● Quality of life
● Services & activities to maintain a high level of wellness
● The right to be fully informed about rights and services
● The right to participate in their own care
● The right to make independent choices
● The right to privacy and confidentiality
● The right to dignity, respect, and freedom
● The right to security of possessions
● The right to transfer and discharge
● The right to complain

28. Residents’ Rights
● The right to visitors
● The right with regard to social services

29. Mandated Reporter
As a CNA you are considered a mandated abuse/neglect reporter. You are
REQUIRED to immediately report report issues causing harm to the resident.
Neglect is the failure to provide needed care that results in physical, mental, or
emotional harm to a person.
Negligence means your failure to act or provide the proper care resulted in an
unintended injury.

30. Abuse
Abuse is the purposeful mistreatment that causes physical, mental, or emotional pain
or injury to someone.
Physical abuse is any intentional or unintentional, that causes harm to a person’s
body.
Psychological/emotional abuse is harm caused by threatening, scaring, humiliating,
intimidating, isolation, or insulting a person, or treating him or her as a child.
Verbal abuse is the use of spoken or written words, pictures, or gestures that
threaten, embarrass, or insult a person.

31. Ombudsman
An Ombudsman is a legal advocate for residents.
The Older Americans Act (OAA) is a federal law requiring all states to have an
ombudsman program.
They visit facilities, listen to residents and attempt to settle disputes.
They monitor care and conditions.

32. Health Insurance Portability & Accountability Act (HIPPA)
It was passed in 1996 making it the law to keep health information private and
correct.
Confidentiality means to keep private things private
Protected Health Information (PHI) is information that can be used to identify a
person and relates to the residents physical or mental condition, any health care the
person has had, and payment for that health care.
HIPPA violations can lead fines and/or prison sentences up to ten years!!!!

33. Patient Self-Determination Act (PSDA)
It was passed in 1990 as an amendment to OBRA. It requires all healthcare
agencies that receive Medicaid or Medicare funds to inform residents upon their
admission or enrollment, of their rights regarding Advance Directives.
Advance Directives are legal documents that allow people to decide what medical
TXs they want in the event they are unable to make decisions. LIVING WILLS &
DURABLE POWER OF ATTORNEY FOR HEALTH CARE are examples of
advance directives.

34. Communication & Cultural Diversity
What is communication?
Verbal communication: involves the use of words, spoken or written
Nonverbal communication: communication without words (tone of voice, body
language)
There are 3 steps in the communication process, SENDING a message,
RECEIVING a message, and PROVIDING FEEDBACK.

35. Cultural Diversity
Cultural diversity refers to different groups of people with varied backgrounds and
experiences living together.
Bias: prejudice in favor of or against one thing, person, or group compared with
another, usually in a way considered to be unfair.
Culture: is a system of learned beliefs and behavior that is practiced by a group of
people.

36. Observing and Reporting Accurately
When reporting information you must be professional and state the facts not
opinions.
Objective information is based on what a person sees, hears, touches, smells.
Objective information is collected with the use of your senses, it is also called signs.
Subjective information is something a person cannot or did not observe or witness,
but is instead based on what the resident states or reports. It may or may not be
true, it is referred to as a symptom.

37. Communication
Many residents may suffer with hearing or visual impairments and require special
aids or techniques to enable them to communicate.
One way to assist a hearing impaired resident is to speak clearly, slowly while facing
the resident. Ensure there is good lighting focused on your face to enable the
resident to be able to read your lips.
The first line of communication with a stroke victim is their call bell, be sure it is
within reach. Ask yes or no questions, make questions simple.

38. Challenging Behaviors
When responding to a combative resident, remain calm and lower the tone of your
voice. Be flexible and patient. Block physical blows and stay out of the reach of the
resident.
Do NOT over-react when your resident is exhibiting inappropriate behavior, this
may actually reinforce the behavior. Remain professional in a matter-of-fact
manner.