understand residents’ rights, advocacy, and grievance ... residents...understand residents’...

Understand Understand residents’ residents’ rightsrights , advocacy, and , advocacy, and

Unit ANurse Aide Workplace Fundamentals

Essential Standard 1.00Understand the range of function, legal and ethical responsibilities of the nurse aide within the heal thcare system.

Indicator 1.03Understand residents’ rights, advocacy, and grievan ce procedures.

rightsrights , advocacy, and , advocacy, and grievance procedures. grievance procedures.

11.03 Nursing Fundamentals

Residents’ RightsResidents’ Rights

Nursing Fundamentals 7243 21.03

Basic Human RightsBasic Human Rights

–– Protected Protected by Constitutionby Constitution

–– Laws clarify these rights:Laws clarify these rights:

•• Right to be treated with Right to be treated with respectrespect

•• Right to live in Right to live in dignitydignity

Nursing Fundamentals 7243 3

•• Right to live in Right to live in dignitydignity

•• Right to Right to pursue a meaningful lifepursue a meaningful life

•• Right to be Right to be free of fearfree of fear

1.03

Basic Human Basic Human RightsRights

Behaviors Behaviors that that infringe infringe on on human human rightsrights::

•• addressing residents as childrenaddressing residents as children

•• using demeaning nicknames for using demeaning nicknames for

Nursing Fundamentals 72434

•• using demeaning nicknames for using 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 Ethical and legal basisand legal basis

•• States have adopted or States have adopted or codified these rights into lawcodified these rights into law

Posted in facilityPosted in facility

OBRA 1987 Residents’ Bill of Rights


•• Posted in facilityPosted in facility

•• Distributed on admission in Distributed on admission in many facilitiesmany facilities

1.03

Residents have the right to:Residents have the right to:

1.1. Be treated with Be treated with consideration, consideration,



consideration, consideration, respect, and full respect, and full recognition of recognition of personal dignity.personal dignity.

1.03


2.2. receive care, treatment, receive care, treatment, and services which are and services which are



and services which are and services which are adequate and in adequate and in compliance with rulescompliance with rules

1.03


3.3. receive a statement of receive a statement of services and chargesservices and charges



services and chargesservices and charges

1.03


4.4. have on file the have on file the attending physician’s attending physician’s



attending physician’s attending physician’s proposed schedule of proposed schedule of medical treatment.medical treatment.

1.03


5.5. privacyprivacy




6.6. Be free from mental and Be free from mental and physical abuse, and free physical abuse, and free



physical abuse, and free physical abuse, and free from restraint (except in from restraint (except in an emergency)an emergency)

1.03


7.7. receive reasonable receive reasonable response to all requestsresponse to all requests



response to all requestsresponse to all requests

1.03


8.8. associate and associate and communicate privatelycommunicate privately



communicate privatelycommunicate privately

1.03


9.9. manage financial affairsmanage financial affairs




10.10.private visits from private visits from spousespouse



spousespouse

1.03


11.11.privacy in the resident privacy in the resident room. Personal items room. Personal items



room. Personal items room. Personal items should not be searched.should not be searched.

1.03


12.12.present grievances and present grievances and recommend changesrecommend changes



recommend changesrecommend changes

1.03

Residents have the right Residents have the right NOTNOT toto::

13.13.perform services for the perform services for the facilityfacility



facilityfacility

1.03

Residents have the right Residents have the right toto::

14.14.retain, store, and use retain, store, and use personal clothing and personal clothing and



personal clothing and personal clothing and possessionspossessions

1.03

Residents have the right Residents have the right NOT toNOT to::

15.15.be randomly discharged be randomly discharged or transferred from the or transferred from the



or transferred from the or transferred from the facilityfacility

1.03

Residents have the right Residents have the right toto::

16.16.be notified if the facility be notified if the facility is given a provisional is given a provisional



is given a provisional is given a provisional licenselicense

1.03

Behaviors That Uphold Residents ’ Rights

•• Address Address as Mr., Mrs., or Miss unless as Mr., Mrs., or Miss unless asked to use a specific asked to use a specific namename

•• Never Never withhold social responsivenesswithhold social responsiveness


•• Never Never withhold social responsivenesswithhold social responsiveness

•• Never ignore residentsNever ignore residents

•• Make eye contactMake eye contact

1.03

Behaviors Behaviors That That UpholdUpholdResidents’ RightsResidents’ Rights

––Make eye contactMake eye contact

–– Allow to complete sentences prior to Allow to complete sentences prior to leaving roomleaving room


leaving roomleaving room

–– Don’t shut or slam door to quiet Don’t shut or slam door to quiet residentresident

–– Never threaten or intentionally hurtNever threaten or intentionally hurt

1.03

Behaviors Behaviors That That UpholdUpholdResidentsResidents ’ Rights’ Rights

•• Encourage socialization (mealEncourage socialization (meal--time)time)

•• Assist to activities/meetings/churchAssist to activities/meetings/church


•• Participate Participate in planned activitiesin planned activities

•• Help with phone calls, cards, mailHelp with phone calls, cards, mail

1.03

Behaviors Behaviors That That Uphold Uphold ResidentsResidents ’ Rights’ Rights

•• Explain care you plan to give Explain care you plan to give

•• Observe safety precautionsObserve safety precautions


•• Obtain proper consent after identifying Obtain proper consent after identifying

residentresident

1.03

Behaviors Behaviors That That Uphold Uphold ResidentsResidents ’ Rights’ Rights

•• Treat all residents equallyTreat all residents equally

•• Promote positive attitudesPromote positive attitudes


•• Report errors to supervisor immediatelyReport errors to supervisor immediately

1.03

Behaviors That Uphold Behaviors That Uphold Residents’ RightsResidents’ Rights

•• Handle personal items Handle personal items

carefullycarefully

•• Add new items to list of Add new items to list of


•• Add new items to list of Add new items to list of

resident’s belongingsresident’s belongings

•• Mark all items with Mark all items with

resident’s nameresident’s name

1.03


•• Sit when feeding a residentSit when feeding a resident

•• Offer a clothing protector; do NOT Offer a clothing protector; do NOT

automatically place clothing protector automatically place clothing protector


automatically place clothing protector automatically place clothing protector

on the resident prior to eatingon the resident prior to eating

•• Give resident centered, not task Give 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 adult Converse with resident in an adult

mannermanner

•• Respect resident’s privacyRespect resident’s privacy

1.03

Behaviors That Uphold Behaviors That Uphold Residents’ Residents’ RightsRights

•• Adult residents must be Adult residents must be treated as treated as

adults. Give age appropriate care.adults. Give age appropriate care.

•• AgeAge--appropriate appropriate considerationsconsiderations::


•• AgeAge--appropriate appropriate considerationsconsiderations::–– Style of dressStyle of dress

–– Hair style and groomingHair style and grooming

–– Recreational activitiesRecreational activities

–– Social activitiesSocial activities

1.03

Age Appropriate CareAge Appropriate CareGuidelinesGuidelines

•• 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 be Treat resident as you would want to be

treated treated

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 Recognize value of past experience experience

(validate the resident)(validate the resident)


(validate the resident)(validate the resident)

•• Praise age Praise age appropriate accomplishmentsappropriate accomplishments

•• Encourage adult behaviorEncourage adult behavior

1.03

Right to be Free from Right to be Free from RestraintRestraint

•• Under Under OOmnibus mnibus BBudget udget

RReconciliation econciliation AAct 1987 ct 1987 (OBRA)(OBRA), ,


RReconciliation econciliation AAct 1987 ct 1987 (OBRA)(OBRA), ,

•• residents have a right to be residents have a right to be free free

from restraints. from restraints.

1.03

Resident RestraintsResident RestraintsResident RestraintsResident Restraints


Facts Regarding RestraintsFacts Regarding Restraints

RESTRAINTSRESTRAINTSrestrict restrict

voluntary movement voluntary movement or behavioror behavior


CHEMICALCHEMICAL PHYSICALPHYSICAL

1.03


Physical Physical RestraintsRestraints

also known as


also known as

•• postural postural supportssupports

•• protective devicesprotective devices

1.03


RestraintRestraint::

Any manual method, physical or Any manual method, physical or

mechanical device, material, or mechanical device, material, or

equipment attached or next to the equipment attached or next to the


equipment attached or next to the equipment attached or next to the

resident’s body that the individual resident’s body that the individual

cannot remove easily, which restricts cannot remove easily, which restricts

freedom of movement or normal freedom of movement or normal

access to one’s bodyaccess to one’s body


IN THE PAST!IN THE PAST!

•• Restraints commonly used to Restraints commonly used to

safeguard residents who wander, safeguard residents who wander,

prone to falls, are prone to falls, are violentviolent, , at at risk of risk of


prone to falls, are prone to falls, are violentviolent, , at at risk of risk of

hurting hurting themselves, or pulling tubes themselves, or pulling tubes

outout

•• Abuse of restraints Abuse of restraints led to led to new new

restrictions and laws on use of restrictions and laws on use of

restraintsrestraints1.03


Tucking in top Tucking in top

sheetsheet so tightly so tightly

that resident that resident

NEVERNEVER


that resident that resident

cannot movecannot move


Placing wheelchair Placing wheelchair

so close to a wall so close to a wall

that the wall that the wall


that the wall that the wall

prevents resident prevents resident

from getting out from getting out

of chairof chair


Pulling up full Pulling up full

side rails to side rails to

prevent patient prevent patient


prevent patient prevent patient

from voluntarily from voluntarily

getting out of getting out of

bedbed


Restraints Restraints MUST MUST

not be usednot be used


not be usednot be used

for conveniencefor convenience

or discipline or discipline


Unnecessary use of restraint is Unnecessary use of restraint is

FALSE FALSE


IMPRISONMENTIMPRISONMENT


Acceptable Reasons for Use Acceptable Reasons for Use of Restraints: of Restraints:

Temporarily Temporarily for life threatening medical for life threatening medical

conditionsconditions


conditionsconditions

Brief periods to allow medical treatment Brief periods to allow medical treatment

to proceed if there is documented to proceed if there is documented

evidence of resident or legal approval of evidence of resident or legal approval of

treatmenttreatment


Acceptable Reasons for Use of Restraints Acceptable Reasons for Use of Restraints

When alternatives to restraints are not When alternatives to restraints are not

effective, however, and the physician effective, however, and the physician

orders restraints, it becomes essential orders restraints, it becomes essential


orders restraints, it becomes essential orders restraints, it becomes essential

for the nurse aide to know the risks for the nurse aide to know the risks

involved in caring for these residents.involved in caring for these residents.


Types of acceptable physical restraints if ordered Types of acceptable physical restraints if ordered

appropriatelyappropriately

•• Side Side rails on a bedrails on a bed

•• Special Special chairs such as geriatric chairschairs such as geriatric chairs


•• Special Special chairs such as geriatric chairschairs such as geriatric chairs

•• Lap Lap cushions or lap traycushions or lap tray

•• Vests Vests and jacket restraintsand jacket restraints

•• Safety Safety belt restraintsbelt restraints

•• Soft Soft ties for wrist and anklesties for wrist and ankles


RestraintRestraint--free facility:free facility:

Restraints are not used for Restraints are not used for


Restraints are not used for Restraints are not used for

any reason and not kept in any reason and not kept in

the facilitythe facility

Restraint AlternativesRestraint AlternativesRestraint AlternativesRestraint Alternatives


Restraint AlternativesRestraint Alternatives

Restraint alternative:Restraint alternative:

Interventions used instead of Interventions used instead of


Interventions used instead of Interventions used instead of

using restraintsusing restraints


Using friends, family, volunteers or

resident directed care provider



Interesting activities and diversions Interesting activities and diversions

such as games, movies or music such as games, movies or music

distract residentsdistract residents



Answering call signal promptlyAnswering call signal promptly



Exercise and outdoor activitiesExercise and outdoor activities



Consistent reality orientation or Consistent reality orientation or

validation and staff assignmentsvalidation and staff assignments



Having resident’s room close to Having resident’s room close to

nurses’ stationnurses’ station



Barriers such as STOP SIGNS Barriers such as STOP SIGNS

posted on doors discourages posted on doors discourages

confused residents from confused residents from

wandering into the areawandering into the area


confused residents from confused residents from

wandering into the areawandering into the area

1.03


PartialPartial bed rails prevent residents bed rails prevent residents

from rolling out of bed while from rolling out of bed while

allowing them freedom to get up allowing them freedom to get up

if they wish toif they wish to


if they wish toif they wish to

1.03


Positioning devices and wedges such as Positioning devices and wedges such as

wedge cushions placed in wheelchairs wedge cushions placed in wheelchairs

to prevent forward slidingto prevent forward sliding



Furniture such as low beds, rocking

chairs, or recliners



Easy Easy ––release belts reminds release belts reminds

resident of safety but the resident resident of safety but the resident

can release if desiredcan release if desired



Floor cushion or pads next to the Floor cushion or pads next to the

bed bed –– decreases injuries if a decreases injuries if a

resident does fall when getting resident does fall when getting

out of bedout of bed


out of bedout of bed

1.03


Electronic warning devices on beds, Electronic warning devices on beds,

wheelchairs, and doors alert staff if wheelchairs, and doors alert staff if

patient gets up without help*patient gets up without help*


SKILLSKILL 1.03A1.03A

Apply Personal Electronic Apply Personal Electronic

Training Lab AssignmentTraining Lab AssignmentEngage in the Skill Acquisition Process for:Engage in the Skill Acquisition Process for:

1.03 Nursing Fundamentals 7243 65

Apply Personal Electronic Apply Personal Electronic

Warning DeviceWarning Device

The Last Resort!The Last Resort!

Occasionally, alternatives do not


alternatives do not work and restraints are ordered.

1.03

Using RestraintsUsing Restraints

Ordered by the physician…Ordered by the physician…•• when when necessary to treat a medical necessary to treat a medical symptom or provide emergency symptom or provide emergency medical treatmentmedical treatment


medical treatmentmedical treatment•• choice choice of restraint based on of restraint based on multidisciplinary evaluation for the multidisciplinary evaluation for the least restrictive measureleast restrictive measure

1.03


Safety Measures Safety Measures and Considerations and Considerations


and Considerations and Considerations When When APPLYINGAPPLYING

RestraintsRestraints

1.03


Safety measures and Considerations APPLYING Restrai nts:

••Use reassurance in an attempt to Use reassurance in an attempt to calm agitated residentscalm agitated residents


Using RestraintsUsing RestraintsSafety measures and Considerations APPLYING Restrai nts:

Be Be sure there is a physician’s order sure there is a physician’s order for restraint use and that it is in the for restraint use and that it is in the care plan before applying restraintcare plan before applying restraint


care plan before applying restraintcare plan before applying restraint

1.03



Use the correct type of restraint and Use the correct type of restraint and apply according to manufacturer’s apply according to manufacturer’s directions and only after you have directions and only after you have


directions and only after you have directions and only after you have received instructions in its usereceived instructions in its use

1.03



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




Attach restraints to bed frame Attach restraints to bed frame (immovable part of bed), not to (immovable part of bed), not to side rails or other parts of the side rails or other parts of the bedbed


side rails or other parts of the side rails or other parts of the bedbed

Leave an 8 inch tailLeave an 8 inch tail

1.03



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


quick releasequick release

1.03



Protect bony areas and skin by Protect bony areas and skin by padding them prior to applying padding them prior to applying


padding them prior to applying padding them prior to applying restraintrestraint

1.03



Adjust restraint so that it allows Adjust restraint so that it allows some movement, but is secure some movement, but is secure


some movement, but is secure some movement, but is secure and comfortable and comfortable –– place open place open flat hand between the resident flat hand between the resident and the restraint for restraints and the restraint for restraints around the around the torso.torso.

1.03



Make sure breasts or Make sure breasts or skin are not caught in skin are not caught in


skin are not caught in skin are not caught in the restraint.the restraint.

1.03


Safety Measures Safety Measures and Considerations and Considerations


and Considerations and Considerations AFTERAFTER Restraints Restraints

are appliedare applied

1.03


Safety measures and Considerations AFTER Applying Restraints:

Be sure resident Be sure resident


Be sure resident Be sure resident NEEDS are METNEEDS are MET

1.03

Using RestraintsUsing RestraintsSafety measures and Considerations AFTER Applying Restraints:

Special attention must be paid Special attention must be paid to basic needsto basic needs


•• EliminationElimination -- assist in assist in toiletingtoileting

•• Hydration Hydration –– offer fluidsoffer fluids

1.03



Call signal must be in reach and the resident’s signal for


and the resident’s signal for help must be answered immediately (STAT)

1.03



Check on resident Check on resident


every 15 minutesevery 15 minutes

1.03



Every 15 minutes:Every 15 minutes:


��Pulse, color, and temperature Pulse, color, and temperature of any restrained extremityof any restrained extremity

1.03



Every 15 minutes:Every 15 minutes:


��Breathing of resident with Breathing of resident with vest (torso) restraintvest (torso) restraint

1.03



Every 2 hours:Every 2 hours:


��Remove restraint for 10 Remove restraint for 10 minutes and reposition residentminutes and reposition resident

1.03



In an emergency, notify supervisor immediately


supervisor immediatelyvia call bell, stay with the resident, and loosen restraint.

1.03

Using RestraintsUsing RestraintsEMERGENCY EXAMPLES:EMERGENCY EXAMPLES:

•• Unable Unable to detect a pulse in extremityto detect a pulse in extremity

•• Extremity cold, pale, blueExtremity cold, pale, blue--tinged, gray, red, tinged, gray, red, purple in colorpurple in color


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 Breathing is impaired with vest or safety belt restraintbelt restraint

•• URGENT!!! TAKE ACTIONURGENT!!! TAKE ACTION1.03


Observations and reporting should Observations and reporting should

include:include:

•• Color and condition of skin under Color and condition of skin under

restraintrestraint


restraintrestraint

•• Pulse rate, color and temperature of Pulse rate, color and temperature of

skin in restrained extremityskin in restrained extremity

1.03


Observations and reporting should Observations and reporting should include include (continued):(continued):

•• Any complaints about restrained partAny complaints about restrained part

•• Red or injured skin areas under Red or injured skin areas under restraintrestraint


•• Red or injured skin areas under Red or injured skin areas under restraintrestraint

•• Respiratory rate and color of skin with Respiratory rate and color of skin with vest and safety belt restraintsvest and safety belt restraints

1.03

SKILLSKILL 1.03B1.03B

Training Lab AssignmentTraining Lab AssignmentEngage in the Skill Acquisition Process for:Engage in the Skill Acquisition Process for:

1.03 Nursing Fundamentals 7243 90

SKILLSKILL 1.03B1.03B

Apply RestraintsApply Restraints

Resident AdvocatesResident AdvocatesResident AdvocatesResident Advocates


Resident AdvocatesResident Advocates

What does an advocate do?What does an advocate do?

•• Plead Plead cause of anothercause of another

•• Resolve grievancesResolve grievances


•• Resolve grievancesResolve grievances

•• Protect resident’s rightsProtect resident’s rights


Advocates can be:Advocates can be:

•• You and your coYou and your co--workersworkers

•• Member of resident’s Member of resident’s family/support systemfamily/support system


•• Member of resident’s Member of resident’s family/support systemfamily/support system

•• Resident’s guardianResident’s guardian

•• OmbudsmanOmbudsman


Ombudsman Program - HistoryThe 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 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 to Resident Right to

Voice GrievancesVoice Grievances

•• Regarding services furnishedRegarding services furnished

•• Regarding services not furnishedRegarding services not furnished


•• Regarding services not furnishedRegarding services not furnished

•• With respect to behavior of othersWith respect to behavior of others

•• Nurse aide must report grievances to Nurse aide must report grievances to supervisorsupervisor

Facility policy components for

resident grievance

1.1. AcknowledgmentAcknowledgment

2.2. Prompt attempt to resolvePrompt attempt to resolve


2.2. Prompt attempt to resolvePrompt attempt to resolve

3.3. Resident kept apprisedResident kept apprised

Resident Council:

Advisory Group


Resident Council:

Advisory Group

Provides opportunity for discussionProvides opportunity for discussion

Recommendations may be made for:Recommendations may be made for:

•• Facility policiesFacility policies


•• Facility policiesFacility policies

•• Decisions regarding activitiesDecisions regarding activities

•• Exploration of concernsExploration of concerns

•• Resolving grievances Resolving grievances

Resident Council:

Advisory Group

•• Gives residents a voice in facility Gives residents a voice in facility operationsoperations

•• MembersMembers


•• MembersMembers

–– residentsresidents

–– facility staff members facility staff members to include 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!

�� ENDEND ��

1.031.03Understand Understand resident’s rightsresident’s rights , ,

advocacy, and grievance procedures. advocacy, and grievance procedures.

102

1.031.03

1.03 Nursing Fundamentals

understand residents’ rights, advocacy, and grievance ... residents...understand residents’...

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