WORK PROCESSES
NURSING ASSISTANT I CERTIFIED
O*NET-SOC CODE: 31-1012.00 RAPIDS CODE: 0824CB
Description: Performs any combination of following duties: care of residents/clients in nursing home, or other medical facility, under direction of nursing and medical staff. Responds to signal lights or call system to determine resident/client needs. Assist with Activities of Daily Living (ADL’s) as indicated by plan of care utilizing adaptive equipment as indicated. Maintain respect and dignity in all aspects of care. Interacts with residents/clients, directs visitors, and answers telephone. Takes and records vital signs and food and fluid intake and output as directed. May be assigned to a specific area of a nursing home or medical facility.
Federal and State Certification: Federal and State Certification: As part of 0824-C apprentices will complete or demonstrate, as required by 42 CFR 483 and the regulations of the state in which they work, 16 hours of practical training in the following occur prior to any direct contact with a resident: communication and interpersonal skills; infection control; safety/emergency procedures, including the Heimlich maneuver; promoting residents' independence; and respecting residents' rights. Apprentices may complete only those tasks for which they have had prior training. The competencies described below are, in some cases, in addition to the basic certified nursing assistant standards and require demonstration of competence in the performance of specific skills. Term: Competency Based (310 Minimum Hours)
On-The-Job Learning: The following competency areas have been identified to lend focus and direction to the professional development of nursing assistants. The apprentice will attain a basic level of mastery across all competency areas before receiving certification. Basic mastery will be represented by the apprentices being able to articulate their learning with each competency area and demonstrate that they have successfully integrated all competencies in their work. The order in which apprentices learn will be determined by the flow of work on-the-job and will not necessarily be in the order listed. Times allotted to various processes are estimated for the average apprentice to learn each phase of the occupation and demonstrate competency. They are intended only as a guide to indicate the quality of training being provided and the ability of an apprentice to absorb this training in an average amount of time.
Skills training: Ensure that minimum competencies are demonstrated in: (Min/Max) A. Monitoring Body Functions and personal cares ... 40 - 70
1. Promotes highest level of self-care related to personal cleanliness including hair and nail care, dressing and grooming, and incorporating use of assistive devices and adaptations without rushing the resident and with a respectful, caring attitude.
2. Assists residents with a positive, complete bathing, dressing/grooming experience with regard for each resident's individual preference. 3. Obtains vital signs & records accurately.
respirations
pulse (radial and apical)
temperature (oral, rectal, tympanic, axillary) blood pressure
4. Measures and records height and weight accurately.
5. Recognizes and reports changes in resident condition including abnormal changes in body function.
6. Tests urine specimens for sugar and acetone. 7. Measures and records intake and output. 8. Observe and record bowel movements. 9. Collect urine and stool specimens.
B. Meeting Emergency Needs ... 15 - 30 1. Respond proficiently to an individual’s emergency needs related to choking,
convulsions, and falls.
2. Applies and monitors mobility and egress alarms.
3. Demonstrates knowledge of facility safety procedures including use of fire extinguishers.
4. Position call lights properly and responds to call lights promptly. 5. Handles oxygen safely.
C. Promoting Highest Level of Nutrition and Hydration ... 40 - 70 1. Assists residents with a positive dining experience with regard for residents'
individual preferences, medical conditions, nutritional and hydration needs. 2. Monitors oral status and completes denture/oral care according to plan of
care.
3. Promote optimal level of nutrition and hydration related to use of assistive devices and assistance with eating according to plan of care.
4. Verifies resident receives ordered diet type and consistency.
5. Provide residents with fresh water at bedside according to resident needs recognizing special needs for thickened or limited liquids.
D. Restorative Care (mobility, skin integrity and elimination) ... 40 - 70 1. Promotes highest level of mobility functioning through use of assistive
devices/adaptations.
2. Encourages resident self-care as distinguished by the resident care plan. 3. Reinforces bowel and bladder training and implements scheduled toileting
plans according to the plan of care.
4. Encourage resident self-care related to positioning, transferring and ambulation; including the use of assistive devices / adaptations
5. Use transfer equipment (gait belt, mechanical lifts, slide boards, lift/slip sheets, etc.) and handling techniques in a manner that makes residents feel safe. Transfer from bed to wheelchair and wheelchair to bed.
6. Promotes optimal level of skin integrity by incorporating preventive measures and restorative measures to promote healing of skin injuries.
7. Incorporates use of assistive devices and therapeutic aides to promote highest level of self care related to toileting and elimination.
8. Follows gradual reduction plans for physical restraints and ensures that restraints are released and residents are repositioned and exercised at least every 2 hours. Visually check resident every 30 minutes if restrained. 9. Implements turning and repositioning as well as other preventative and
restorative measures to prevent skin breakdown and promote healing of skin injuries.
E. Meeting Special Needs (Mental Health/Coping, Comfort, Rest, Sensory, Etc.)... 60 - 90 1. Recognize developmental tasks associated with the aging process.
2. Orients resident and family to the facility.
3. Communicates with the resident in a respectful and patient manner conveying understanding and empathy.
4. Can identify psychosocial characteristics of residents with cognitive and/or mental disorders.
5. Recognizes behavior patterns that interfere with mentor and social functions and responds in a therapeutic, non-judgmental manner.
6. Interacts with resident families and significant others as a source of emotional support.
7. Assist in the enhancement of resident’s cognitive functioning. 8. Assist the resident who chooses to participate in group activities. 9. Recognize resident’s need for sexual expression assist the resident to
maintain sexual identity.
10. Recognize signs and symptoms of discomfort and report to appropriate person.
11. Adapt the physical environment in response to resident’s individual comfort needs.
12. Utilize measures that relieve discomfort and promote rest and sleep. 13. Accommodate individual patterns of rest and sleep.
14. Adapt the physical environment in response to resident’s individual rest and sleep needs.
15. Meeting the needs of residents experiencing loss – Promote the optimal level of well-being when coping with loss by:
Recognize the potential for loss among residents. Describe responses to loss.
Allow residents to express grief related to experiences such as
institutionalization, loss of significant other(s), and loss of body part(s). Utilize therapeutic communication with resident who is experiencing loss. Describe responses to dying and death.
Provide physical and emotional support to the dying resident and resident’s family.
16. Promote optimal level of sensory stimulation including: • Vision/Hearing
♦ Recognize resident’s individual need for sensory stimulation.
♦ Utilize available resources to meet visual/auditory stimulation needs. ♦ Maintain and utilize assistive devices for visual and hearing
impairment.
♦ Communicate effectively with sensory impaired residents. • Touch
♦ Recognize the resident’s individual need for touch and utilize therapeutic use of touch.
17. Monitors residents with various tubing (gastrostomy, NG, catheters, intravenous, etc.,) and recognizes and reports concerns promptly.
F. Examinations, Procedures and Assistance to Nurse ... 10 - 25 1. Meeting special needs by assisting the nurse.
2. Assist with positioning for examinations and procedures. 3. Provide resident support during examinations and procedures. 4. Assist with postmortem care, respecting the dignity of the resident.
5. Assures labeling of property / belongings (clothing, glasses, dentures, etc.,) and ensures safekeeping by handling with care and storing properly.
6. Monitor/report lingering odors throughout the facility and take appropriate corrective action.
7. Provide residents with clean towels and washcloths. 8. Provides post-mortem care.
G. Resident Rights ... 30 - 50 1. Respects the privacy of residents and demonstrates they are guests in the
resident's home.
2. Recognizes and respects resident individuality and preference for wake, bedtime, clothing, bath type & time, etc.
3. Respects the confidentiality of resident information and adheres to HIPAA and facility confidentiality guidelines.
4. Recognizes potential abuse/neglect and reports promptly - verbal, mental, property, neglect, etc.
H. Documentation ... 15 - 30 1. Completes documentation of cares/behaviors according to facility guidelines.
2. Assists with admission and discharge procedure.
I. Infection Control ... 30 - 50 1. Demonstrates adherence to OSHA and CDC guidelines to minimize
infections by following aseptic techniques including those that apply to blood borne pathogens.
2. Demonstrates consistent and appropriate hand-washing techniques including use of hand sanitizing agents.
3. Describe and give examples of standard precautions as described by the Occupational Safety and Health Administration.
4. List conditions that promote the growth of bacteria. 5. Describe clean versus dirty areas.
6. Handle linens properly to prevent contamination.
J. Communication, Problem Solving, and Organizational Skills 40 - 70
1. Demonstrates use of validation therapy when communicating with residents with dementia.
2. Communicates in a non-judgmental manner minimizing the use of assumptions or bias.
3. Demonstrates organizational skills. For example: prepares equipment and supplies to prevent backtracking prior to care delivery.
4. Demonstrates effective time-management as evidenced by cares completed in a timely manner.
5. Recognizes problems and knows when and who to ask for assistance in problem resolution.
6. Incorporates customer service skills in interactions with all – respecting differences and perspectives.
7. Demonstrates appropriate use of active listening, paraphrasing, and clarifying in all communications.
8. Recognizes & reports changes in resident condition promptly.
9. Utilize appropriate communication techniques (communication board, etc.,) with resident.
RELATED INSTRUCTION OUTLINE CERTIFIED NURSING ASSISTANT
O*NET-SOC CODE: 31-1012.00 RAPIDS CODE: 0824CB
Description: Related instruction courses supplement on-the-job learning and lists courses that provide technical ability. It is through a combination of both on-the-job learning and related instruction that an apprentice can reach a skilled level in the occupation. The following are suggested courses to be completed during the term of apprenticeship:
Core Skills Minimum Hours
A. Initial 16 hours of training prior to any direct contact with a patient/resident ... 16-32 1. Communication and interpersonal skills (2 hrs)
2. Infection control (2.5 hrs).
3. Safety/emergency procedures, including the Heimlich Maneuver, convulsions, falls (2 hrs and 1 hr ensuring environmental safety = 3 hrs).
4. Promoting residents’ independence (self care: positioning in bed or chair; transferring, ambulating, use of assistive devices/adaptations including orthotics and prosthetics) (4.5 hrs).
5. Respecting residents’ rights and personal choices (2 hrs).
6. CNA role in health care team (include assist in resolving grievances) (2 hrs).
B. Content Outline covers the areas of ... 59-118 1. Monitoring body function: data collection, specimens, I &O.
2. Meeting emergency needs: providing for environmental and personal safety. 3. Promoting self care and optimal nutrition and hydration: nutrition and hydration
needs; feeding, assistive devices, strategies to prevent dehydration; personal care needs Hygiene, dressing & grooming.
4. Restorative care: mobility, skin integrity and elimination; restorative exercises, contractures, preventative measures; elimination needs bowel and bladder, assistive devices, therapeutic aides and toileting; skin integrity maintenance prevention and treatment.
5. Meeting special needs (mental health/coping, comfort, rest, sensory); mental and social health needs – developmental tasks, orienting to facility, cognitive disorders and impairment, responding to behaviors, emotional support, activities, sexual expression, spiritual and cultural needs; comfort, rest, and sleep needs; sensory needs- vision hearing, touch; promotion of coping with loss.
6. Exams, procedures and assist to nurse: assisting the nurse with special procedures positioning for exams & procedures, post-mortem care, admit and discharge.
7. Resident rights: role responsibilities, including ethical/legal concepts, health care team roles, and communication-legal & ethical, stages and theory of disease, prevention, etc. abuse/neglect.
8. Documentation. 9. Infection control.
10. Therapeutic communication and problem solving.
Individuals who complete the CNA on-the-job learning and related instruction components shall receive a “Certificate of Training” credential. Some courses and/or work experience may be credited toward a LPN Apprenticeship Program or other viable work experience.
WORK PROCESSES
CERTIFIED NURSING ASSISTANT, ADVANCED
O*NET-SOC CODE: 31-1012.00 RAPIDS CODE: 0824A (CB)
Description: Performs any combination of the following duties: care of residents/patients in hospital, nursing home, or other medical facility under the direction of nursing and medical staff. Assist with Activities of Daily Living (ADL’s) as indicated by plan of care utilizing adaptive equipment as indicated. Incorporate appropriate individualized toileting, turning, and repositioning schedules to prevent skin breakdown. Incorporate expanded knowledge of physiology to recognize changes in maximizing functional status related to mobility and nutritional well-being. Assist with examinations, treatments, and specimen collection when needed. Maintains respect and dignity in all aspects of care and serves as resident/patient advocate according to advanced directives. Participate in care planning process and documents response to interventions according to guidelines. Demonstrate proficiency in all nursing assistant tasks. May be assigned to a specific area of a hospital, nursing home, or medical facility.
Term: Competency Based (300 Minimum Hours)
On-The-Job Learning: The following competency areas have been identified to lend focus and direction to the professional development of nursing assistants. An apprentice will attain a basic level of mastery across all competency areas before receiving certification. Basic mastery will be represented by the apprentice being able to articulate learning with each competency area and demonstrate successful integration of all the competencies relating to work. The order in which the apprentices learn will be determined by the flow of work on-the-job and will not necessarily be in the order listed. Times allotted to these various processes are estimated for an average apprentice to learn each phase of the occupation and demonstrate competency. They are intended only as a guide to indicate the quality of training being provided and ability of an apprentice to absorb this training in an average amount of time.
Approximate Hours
Competencies (Min/Max)
A. Demonstrates advanced understanding of principles of infection control ... 35 - 70 • Identifies the infectious process and modes of transmission of disease.
• Demonstrates CDC guidelines related to standard precautions. • Demonstrates general principles of asepsis.
• Reinforces appropriate hand-washing techniques including use of hand sanitizing agents.
• Influenza prevention and implications for the aged client.
• Recognizes risks of urinary tract infections and implements appropriate pericare, toileting, fluids, and other interventions to minimize risk.
B. Demonstrates effective communication ... 40 - 80 • Uses verbal and nonverbal communication to present information in a positive and
non-threatening way.
• Observes and describes client's physical and emotional condition changes, using appropriate medical terminology and abbreviations.
• Demonstrates communication skills with the client who has sensory deficits, i.e., a resident who is blind, hard of hearing, and/or who has visual field deficits.
• Uses supportive communication in client interactions.
• Demonstrates appropriate written communication to describe care interventions and resident observations.
• Interacts effectively with all facility departments.
• Answers phone identifying self and facility; upholds client confidentiality in all discussions including phone conversations.
• Provides status report on client condition to nurse as needed.
• Incorporates customer service skills in response to family and visitor requests; obtaining appropriate answers and/or referring to appropriate individuals as indicated.
• Demonstrates appropriate care and application of visual and hearing devices. C. Incorporates appropriate interventions to maximize physical functioning &
mobility, while maintaining proper body mechanics ... 40 - 80 • Turns and positions the resident in a bed or chair—side lying, supine, prone, Sim’s, high
and low Fowler’s, orthopneic, logrolling, move up in bed, dangling.
• Recognizes contractures, reports, and follows plan of care to prevent or minimize them. • Demonstrates the use of assistive devices in ambulation such as crutches, walker, cane,
and wheel chair.
• Reinforces the use of assistive devices in transferring clients—gait belt, mechanical lifters, slide board, lift sheet.
• Demonstrates passive and active range of motion exercises.
• Recognizes need for and implements appropriate use of footboards, hand rolls, bed cradles, and abductor pillows.
• Identifies complications of immobility and follows through with appropriate interventions according to the plan of care.
• Promotes resident independence in the activities of daily living. • Understands the implications of hydration related to body systems. • Understands the implications of oral care related to body systems.
D. Implements appropriate interventions to maintain continence and minimize
problems related to elimination ... 40 - 80 • Assists or provides enemas according to facility/state guidelines.
• Measures, calculates, and records fluid intake and output.
• Reinforces bowel and bladder training and implements scheduled toileting plans according to plan of care.
• Uses appropriate interventions and adaptations to maintain normal bladder and bowel routine such as high-rise toilet seat, toileting per normal routine while allowing privacy. • Monitors/troubleshoots ostomy care.
• Provides care for client with supra-pubic catheter.
E. Functions as a member of the health team within the health care facility
and/or community ... 40 - 80 • Identifies the essential functions of the health care facility and states the differences
between acute care, long-term care, assisted living, and home care.
• Identifies the essential functions of care team members and all facility staff. • Explains the essential duties of the nursing team.
• Performs and completes assignments related to workload, education, and other duties within the established facility guidelines.
• Intervenes in situations involving unsafe or inadequate care.
• Demonstrates knowledge of and reinforces facility policy and safety procedures. • Demonstrates ability to review care plan, implement interventions, and communicate
needed changes to charge nurse in support of resident's preferences. • Completes tasks promptly without “rushing” resident.
• Serves as a resource person to new nursing assistants. • Participates in care planning process.
• Participates in admission/discharge and transfer of resident; gathering and identifying personal items and documenting according to guidelines.
• Documents in medical record, according to facility guidelines, using objective information.
F. Demonstrates Ethical/Professional Practices ... 40 - 80 • Demonstrates professional behavior according to facility standards and
guidelines.
• Interprets, explains, and applies the Resident Rights and right to self-determination.
• Provides for client privacy and dignity at all times.
• Maintains client confidentiality and adheres to HIPAA regulations.
• Promotes the resident’s right to make personal choices and accommodates their needs.
• Gives assistance in resolving grievances and disputes.
• Maintains care and security of residents’ personal possessions. • Promotes the resident’s right to be free from abuse, mistreatment, and
neglect.
• Reports any instance of potential abuse, mistreatment, or neglect to the appropriate supervisor.
• Promotes client independence.
• Is aware of and respects resident’s advance directives.
• Promotes resident rights to be free from physical and chemical restraints in accordance with current federal and state standards.
G. Assists with treatments, procedures, and specimen collection ... 40 - 80 • Recognizes dangers of oxygen therapy and safety issues.
• Performs abdominal thrusts for the choking victim (Heimlich maneuver). • Applies warm moist compress under the direction of a licensed nurse. • Applies heat pack under the direction of a licensed nurse.
• Applies cold compress under the direction of a licensed nurse.
• Collects, labels, and sends stool specimens for culture and sensitivity; ova and parasites; occult blood/guiac.
• Collects, labels, and sends sputum specimens.
• Collects, labels, and sends urine specimen for routine analysis, 24 hour specimens and clean-catch or midstream specimens.
• Strains urine.
• Applies anti-embolism stockings/devices correctly with concern for resident skin integrity.
H. Pain recognition & non-medical interventions implemented ... 25 - 50 • Demonstrates ability to recognize discomfort/pain and report to licensed
nurse.
• Implements non-medicinal interventions according to plan of care. • Uses pain scale appropriately.
RELATED INSTRUCTION OUTLINE CERTIFIED NURSING ASSISTANT, ADVANCED RAPIDS CODE: 0824A O*NET-SOC CODE: 31-1012.00
Description: Related instruction supplements on-the-job leaning and lists courses that provide technical ability. It is through a combination of both on-the-job learning and related instruction that an apprentice can reach a skilled level in the occupation. The following are suggested courses to be completed during the term of apprenticeship.
A. Advanced Infection control ... 6 B. Assertive communication, active listening, problem-solving, and interpersonal
skills; include topics on death & dying, listening skills, conflict resolution,
empathy and patience ... 16 C. Health care team responsibilities; includes understanding the aging process ... 20 D. Conditions for special care/observation: oral care, incontinence, skin, and
swallowing, fecal impaction, foot care, hydration, ostomoies & other tubes, fall
prevention and bed safety, sensory deficits ... 13 E. Federal regulations and regulatory issues impacting quality; includes quality
of care regulations F 309-330 ... 14 F. The facility's philosophy of care: "Christian Communities of Care" for the
Good Samaritan Society ... 3 Total Hours of Related Instruction ... 72
Individuals who complete the CNA, Advanced on-the-job learning and related instruction components shall receive a “Certificate of Advanced Training” credential. Some courses and/or work experience may be credited toward the LPN Apprenticeship Program and/or training depending on state regulations or other viable work experience.
WORK PROCESSES
CERTIFIED NURSING ASSISTANT, DEMENTIA SPECIALTY O*NET-SOC CODE: 31-1012.00 RAPIDS CODE: 0824D (CB)
Description: Performs duties of CNA, Advanced with proficiency and delivers, cares for, and interacts with dementia and other cognitively impaired residents by incorporating skills to maintain individual dignity and well being. Interacts with caregivers and residents and utilizes therapeutic communication and activities to maximize resident functions. Utilizes advanced knowledge of behaviors to implement interventions that minimizes adverse behavior.
Term: Competency Based (Minimum 825 Hours)
On-The-Job Learning: The following competency areas have been identified to lend focus and direction to the professional development of nursing assistants. The apprentice will attain a basic level of mastery across all competency areas before receiving certification. Basic mastery will be represented by the apprentices being able to articulate their learning with each competency area and demonstrate that they have successfully integrated all the competencies in their work. The order in which the apprentices learn will be determined by the flow of work on-the-job and will not necessarily be in the order listed. Times allotted to these various processes are estimated for the average apprentice to learn each phase of the occupation and demonstrate competency. They are intended only as a guide to indicate the quality of training being provided and the ability of an apprentice to absorb this training in an average amount of time.
Approximate Hours
Competencies (Min/Max)
A. Incorporate Interventions for the Cognitively Impaired Resident to
Facilitate Quality Care as a Member of the Healthcare Team ... 100-150 • Utilize care plan for interventions and report successful interventions to charge
nurse and document accordingly.
• Monitor and document episodes of targeted behaviors and/or new behaviors according to facility guidelines.
• Implement interventions to minimize the effects of disruptive behaviors and participates in care planning and/or behavior committees to evaluate effectiveness of these interventions.
• Assist/direct appropriate interventions of other caregivers including ancillary staff. • Recognizes signs of stress and strategies for coping with it in self and other
caregivers and family members.
B. Demonstrate Effective Communication & Interaction with Cognitively Impaired
and Their Families ... 200-250 • Demonstrate redirecting a resident.
• Demonstrate use of validation therapy.
• Verbalize and demonstrate various approaches for a resident who is resisting personal care that will maintain resident dignity and respect.
• Demonstrate appropriate interventions for resident who is yelling or screaming. • Demonstrate use of distraction strategies as a therapeutic intervention.
• Demonstrate use of therapeutic activities to de-escalate a resident who is anxious.
• Demonstrate therapeutic communication with significant others.
• Demonstrate coaching techniques to help other caregivers and family members cope with the dementia process.
C. Provide Assistance With ADL’s, Mobility, and Therapeutic Activities that will Maximize Functional Well Being Including
Culturally Sensitive Dementia ... 75-100 • Demonstrate use of therapeutic activities/exercises to maintain joint function for
the cognitively impaired resident/client.
• Implements care strategies that encourage ADL’s without increase resident anxiety and respects the resident’s dignity and desire for control.
• Implements therapeutic activities appropriate for early, middle, and late states of dementia, including end of life care and culturally sensitive dementia care. • Demonstrates strategies for promoting independence in all ADL’s.
D. Apply Nutritional Interventions to Maximize/Maintain Nutritional Well Being in
the Cognitively Impaired ... 50-100 • Demonstrates adapting the dining experience to maximize nutritional intake (i.e.,
offering small servings, introducing foods one at a time, etc.,) • Explain modifications needed to maintain nutritional status.
• Demonstrates provision of finger foods, frequent meals, snacks, and fluids in a way the cognitively impaired resident will accept.
E. Demonstrate Understanding of Effects of Psychoactive Medications and
Observe for Side Effects ... 200-300 F. Maintain a Safe Environment for Cognitively Impaired ... 200-250
• Demonstrate maintaining safe environment for wandering resident.
• Demonstrate/verbalize actions to take for a resident who is striking out at another resident.
• Implement and describe system/schedule to monitor resident location/criteria for use of elopement alarms, frequency of egress door checks, and other actions to prevent wandering.
• Demonstrate maintaining safety from potential toxic substances that the confused resident may attempt to ingest.
• Implement appropriate interventions to minimize environmental stimuli that may increase a confused resident’s agitation, i.e., noise levels, large groups,
television, radio, etc.
• Maintain a safe environment for residents and staff while de-esclating combative behavior.
RELATED INSTRUCTION OUTLINE
CERTIFIED NURSING ASSISTANT, DEMENTIA SPECIALTY O*NET-SOC CODE: 31-1012.00
RAPIDS CODE: 0824D
Description: Related instruction supplements on-the-job learning and lists courses that provide technical knowledge. It is through a combination of both on-the-job learning and related instruction that an apprentice can reach a skilled level in the occupation. The following are suggested courses to be completed during the term of apprenticeship:
Related Instruction Approximate Hours
A Role of the CNA, Dementia Specialist as part of the healthcare team ... 4
B. Alzheimer’s disease and related dementias: stages, early signs, treatments, physical changes, end of life considerations, depression ... 16
C. Developing a therapeutic environment for the cognitively impaired resident including culturally sensitive dementia care ... 16
D. Support and resources for family & caregivers ... 4
E. Psychoactive medications in dementias and cognitively impaired adults ... 8
Total Hours of Related Instruction ... 48
Individuals who complete the CNA-Dementia Specialty on-the-job learning and related instruction components shall receive a “Certificate of Specialization” credential. Some courses and/or work experience may be credited toward a LPN program and/or training depending on state regulations or other viable work experience.
WORK PROCESSES SCHEDULE
CERTIFIED NURSING ASSISTANT, GERIATRIC SPECIALTY O*NET-SOC CODE: 31-1012.00 RAPIDS CODE: 0824G (CB)
Description: Performs any combination of following duties in care of residents in nursing home, or other medical facility; under direction of nursing and medical staff: incorporates expanded knowledge of age related changes in maximizing functional status related to mobility and nutritional well being; maintains respect and dignity in all aspects of care. Incorporates basic knowledge related to medications and effects on the aging adult while monitoring status and implementing strategies to prevent decline and maximize well-being. May be assigned to a specific area of a nursing home, or other medical or a senior housing environment.
Term: Competency Based (Minimum 1,000 Hours)
On-The-Job Learning: The following competency areas have been identified to lend focus and direction to the professional development of nursing assistants. The apprentice will attain a basic level of mastery across all competency areas before receiving certification. Basic mastery will be represented by the apprentices being able to articulate their learning with each competency area and demonstrate that they have successfully integrated all the competencies in their work. The order in which the apprentices learn will be determined by the flow of work on-the-job and will not necessarily be in the order listed. Times allotted to these various processes are estimated for the average apprentice to learn each phase of the occupation and demonstrate competency. They are intended only as a guide to indicate the quality of training being provided and the ability of an apprentice to absorb this training in an average amount of time.
Approximate Hours
Competencies (Min/Max)
A. Provides appropriate assistance with ADL’s to maximize independence and well- being incorporating expanded understanding of aging considerations
and client preferences ... 150 - 200 • Provides bathing assistance with consideration of resident’s physical,
mental and cognitive status based on individual preferences and/or needs.
• Provides assistance with oral and denture care, recognizing and reporting problems such as loose fitting dentures, missing teeth, dry mouth, and
plaque build up.
• Gives nail care according to plan of care, monitoring condition & reporting abnormalities.
• Gives foot care and monitors condition for any early signs of breakdown. • Provides assistance with dressing and undressing as needed based
on individual needs and uses of assistive devices as per plan of care.
• Demonstrates use and care of prosthetic and orthotic devices and reports problems. • Incorporates task segmentation with ADL’s as outlined in care plan.
• Provides assistance with bowel/bladder elimination based on individual needs. • Demonstrates care of suprapubic and ostomy appliances per facility procedure.
• Assists to maintain personal hygiene needs by providing hair care, shaving, pericare, applying make-up, washing and drying face and hands based on resident needs. B. Provides therapeutic interventions in caring for cognitively impaired and
meeting psychosocial and mental health needs of residents. ... 100 - 200 • Demonstrates techniques for addressing the unique needs and behaviors of
individuals with dementia (Alzheimer’s and others).
• Communicates effectively with cognitively impaired residents.
• Communicates understanding of the behavior of cognitively impaired residents and verbalizes techniques to circumvent negative behaviors.
• Responds appropriately to the behavior of cognitively impaired residents.
• Utilizes interventions to reduce the effects of cognitive impairments, incorporating therapeutic interventions according to plan of care.
• Provides support to families and significant others of cognitively impaired residents.
• Recognizes and reports signs and symptoms of depression and anxiety. • Identifies and promptly reports mental status and behavioral changes.
• Implements interventions to support resident coping mechanisms according to the plan of care.
• Implements support for spiritual well-being according to individual wishes.
C. Assists in identifying the social needs of residents ... 150 - 200 • Assists in identifying, basic human needs throughout the lifespan,
including physical (security, shelter, food, clothing), socio-cultural (family, friends), psychological (emotional, self-esteem, and self -actualization) and spiritual needs. • Documents and describes mental status and behavior changes.
• Assists in identifying sources of stress common to residents.
• Describes how cultural attitudes contribute to psychological problems. • Modifies own behavior in response to resident behavior.
• Ensures that residents are not subject to abuse by anyone.
• Ensures that all incidences of alleged or suspected abuse/neglect are promptly reported.
• Identifies normal sexuality and common myths related to sexuality and aging. • Facilitates the client's expression of needs and provides supportive communication. • Assists and instructs clients to be independent in the activities of daily living.
• Modifies care to accommodate client values, customs or habits. • Uses family members as a source of resident emotional support.
• Provides appropriate care for residents with depression, schizophrenia, and mental retardation.
D. Incorporates appropriate interventions in caring for dying residents ... 100 - 150 • Identifies and recognizes the stages of dying.
• Assists in care of dying client and their family members considering spiritual and cultural beliefs.
• Observes, records and reports cessation of vital signs. • Provides post-mortem care according to facility guidelines.
E. Applies nutritional interventions to maximize/maintain nutritional health ... 100 - 150 • Assists resident with thickened liquids and identify consistencies as needed.
• Recognizes thickened liquid consistency and demonstrates ability to mix and administer appropriately.
• Identifies therapeutic diets, the foods included in each specific diet, and the conditions where specific diets are prescribed.
• Recognizes personal, cultural, and religious variations in diet. • Describes dietary problems of the aging.
• Identifies why a client may need to be encouraged to drink fluids as ordered and recognizes symptoms of dehydration and reports promptly. • Provides and restricts fluids as ordered, verbalizing rationale for restrictions. • Prepares and positions the client appropriately for meals.
• Identifies clients at nutritional risk and implements measures to minimize weight loss as per care plan.
• Assists the client with eating using effective feeding techniques. • Demonstrates use of assistive eating devices.
• Observes and records the amount/percentage consumed. • Recognizes potential problems associated with feeding tubes.
F. Maintains a safe, homelike environment for geriatric residents ... 100 - 120 • Establishes a safe, clean, comfortable and homelike environment with regard for the
resident's preferences.
• Identifies environmental safety hazards, and methods used to prevent accidents, including falls, slips, and tripping hazards and uses safety precautions when oxygen is in use.
• Identifies disaster plans and vulnerability of residents in given situations. • Maintains and enforces safety precautions related to age of client.
• Applies and monitors mobility alarms and demonstrates appropriate application according to plan of care.
• Ensures faulty equipment is identified and lock-out tags out procedures are implemented per guidelines.
• Verbalizes appropriate interventions to prevent elopement, and implement smoking precautions.
• Considers the resident's sensory and/or cognitive impairments when planning a safe environment.
• Monitors equipment safe use and maintenance of equipment.
G. Incorporates expanded knowledge of geriatrics in care delivery, makes observations in the care of residents with complex clinical needs and alerts
nursing and medical staff to changes in condition ... 300 - 350 • Recognizes resident need for skin protectors, i.e., geri gloves, etc.,
to protect fragile skin & implements these interventions as needed.
• Demonstrates skills to minimize episodes of insomnia without medications. • Promotes sense of value incorporating past life experiences and
recognitions, encouraging appropriate activity participation and recognizing individual sense of worth.
• Serves as a resident advocate in care planning individualized interventions according to resident preferences.
• Incorporates knowledge of care of resident with complex orthopedic needs –such as: complications of replacement surgery, transfer of patient with hip-replacement surgery, logrolling of immobile resident, guidelines for the care of a resident in a cast.
• Incorporates knowledge of care of residents with complex infection-control needs including M.R.S.A. and VRE.
• Incorporates knowledge of care for residents with chronic or severe pain. • Recognizes symptoms of fecal impaction, monitors bowel function, and
promptly reports any abnormalities.
RELATED INSTRUCTION OUTLINE
CERTIFIED NURSING ASSISTANT, GERIATRIC SPECIALTY RAPIDS CODE: 0824G
O*NET-SOC CODE: 31-1012.00
Description: Related instruction supplements the on-the-job learning and lists courses that provide technical ability. It is through the combination of both on-the-job learning and the related theoretical instruction that the apprentice can reach a skilled level in the occupation. The following are suggested courses to be completed during the term of apprenticeship.
CORE SKILLS APPROXIMATE. HOURS
General concepts on aging and body system changes ... 32
• Describes the aging process and common myths of aging. • Identifies developmental tasks associated with the aging process. • Identifies the role of elderly in the home and community, including cultural and religious aspects. • Identifies major health problems found in the aging process. • Identifies major physical system changes in the aging process: ¾ Respiratory system—COPD, bronchitis, asthma, TB. ¾ Cardiac system—CHF, MI, atherosclerosis, angina, hypertension, pacemakers ¾ Urinary system—-various types of incontinence, UTI have and identify appropriate indications for catheters. ¾ Metabolic system—diabetes, dialysis issues and kidney dysfunction. ¾ Integuementary system—skin tears, skin ulcers (stasis vs. pressure), shingles, lice/scabies. ¾ Nervous system—CVA, TIA, Parkinson’s disease, spinal cord injuries, cerebral palsy. ¾ Gastrointestinal system—diverticulitis, ulcers, hernias, gall bladder disease. ¾ Musculoskeletal system—fractures, osteoporosis, arthritis and contractures. ¾ Reproductive system—AIDS, benign prostatic hypertrophy, prolapsed uterus, post menopause. ¾ Sight and hearing: cataracts, glaucoma, hearing loss. Resident assessment process and the specialty nurse assistant role in care planning and interventions ... 8
Cognition and mental health & behavioral manifestations ... 8
Medication use in the geriatric population (side effect awareness) ... 12
Total Hours of Related Instruction ... 60 Individuals who complete the CNA, Geriatric Specialty on-the-job learning and related instruction components shall receive a “Certificate of Specialization” credential. Some courses and/or work experience may be credited toward the LPN Apprenticeship Program and or training depending on state regulations-or other viable work experience.
WORK PROCESSES SCHEDULE
CERTIFIED NURSING ASSISTANT, MENTOR SPECIALTY O*NET-SOC CODE: 31-1012.00 RAPIDS CODE: 0824M (CB)
Description: Performs duties of CNA, I and provides guidance and orientation to new employees as well as those pursing higher credentials. Incorporates advanced communication, organizational and interpersonal skills into cares and interactions. Provides positive reinforcement and serves as a role model to other nursing assistants. Participate in interviewing, teaching, coaching, and evaluating apprentices.
Term: Competency Based (Minimum 600 Hours)
On-The-Job Learning: The following competency areas have been identified to lend focus and direction to the professional development of nursing assistants. The apprentice will attain a basic level of mastery across all competency areas before receiving certification. Basic mastery will be represented by the apprentices being able to articulate their learning with each competency area and demonstrate that they have successfully integrated all the competencies in their work. The order in which the apprentices learn will be determined by the flow of work on-the-job and will not necessarily be in the order listed. Times allotted to these various processes are estimated for the average apprentice to learn each phase of the occupation and demonstrate competency. They are intended only as a guide to indicate the quality of training being provided and the ability of an apprentice to absorb this training in an average amount of time.
Approximate Hours
Competencies (Min/Max)
A. Functions as member of health care team and as a role model/leader ... 150-200 • Demonstrates professionalism in appearance (clean, neat) and in respectful interactions
with residents and co-workers.
• Incorporates principles of adult learning in apprentice program. • Collaborates with apprentice to identify learning needs.
• Demonstrates knowledge of the apprentice's role.
• Utilizes positive reinforcement & coaching skills to assist apprentice.
• Documents apprentice progress and assists in developing action plans for areas needing improvement.
• Develops timelines and learning plan to meet program goals & individual apprentice's learning needs.
• Demonstrates respect for resident dignity, confidentiality and resident rights. • Demonstrates ability to objectively record observations & provide direction and
correction (when applicable) to apprentice.
• Understands principles of policy/procedures and follows correct procedures in demonstrating skills to apprentice.
• Adapts learning techniques according to apprentice's learning style preferences and needs.
• Follows apprentice development plan and documents progress timely and completely • Demonstrates teamwork in cooperating with other staff.
• Demonstrates ability to assist apprentice in dealing with reality
shock/stress of confronting new situation(s) and the ability to assist the apprentice to become integrated into their new role.
• Recognizes unique needs of new employees when serving as a mentor • Utilize age and culturally appropriate teaching and learning principles
• Demonstrates understanding of the role of the mentor as distinct from the role of the supervisor
• Demonstrates positive attitude and serves as advocate for organization’s mission & values.
B. Demonstrates clear, concise, respectful communication & interpersonal skills ... 100-200 • Provides concise verbal report to charge nurse re: resident status and concerns.
• Clarifies expectations with apprentice in clear, concise communication.
• Incorporates assertive communication in interactions with peers and apprentice. • Demonstrates ability to develop trusting relationship with apprentice, peers, &
residents/families.
• Demonstrates ability to utilize creative problem-solving when confronted with resident/family and/or co-worker concerns.
• Demonstrates respect of cultural differences and develops plans to meet these individual needs for residents, families, peers.
• Provides specific & accurate feedback to apprentice & verifies apprentice concerns via active listening & paraphrasing skills.
• Demonstrates effective written communication
• Refers customers to appropriate individual if can't answer questions.
• Recognizes anxiety and stress levels & allows for venting of concerns from residents, families, peers.
• Develops trust and rapport with all customers.
• Demonstrates responsibility and accountability for actions and avoids defensiveness, reflecting on different perspectives and perceptions.
• Utilizes communication skills to defuse anger and redirect negative comments. Maintains calm tone of voice.
C. Organizational & Time Management Skills ... 100-150 • Demonstrates ability to manage time effectively while maintaining individualized
approach to resident care.
• Recognizes conditions that require prompt report and demonstrates ability to reprioritize daily routines in response.
• Follows apprentice development plan and documents progress timely and completely. • Arrives at work timely, keeps breaks and mealtimes as scheduled OR adapts to meet
resident needs.
• Recognizes time constraints, but demonstrates ability to not "rush" residents during cares or portray a sense of urgency.
• Assists apprentice to prioritize tasks and seek out assistance when indicated. • Takes needed time to listen to resident, family and apprentice concerns.
• Demonstrates ability to plan "learning opportunities" for apprentice & acts as resource & sounding board during these.
• Assigns increasing level of complexity of tasks to apprentice & monitors timeliness and accuracy of task completion.
• Demonstrates willingness to assist others, respond to any call lights or resident requests, and adapt own tasks accordingly.
• Shares organizational skills and tips for apprentice’s success.
D. Demonstrates advanced knowledge in implementing care strategies & taking
appropriate actions ... 100-150 E. Demonstrates advanced skills in implementing process improvements with
grasp of quality improvement approaches to problem solving and improving the workplace. Encourages input, feedback and takes appropriate actions to
improve apprentice experiences and high self-esteem ... 100-150 F. Understands the hiring and staff evaluation process ... 50-75
RELATED INSTRUCTION OUTLINE
CERTIFIED NURSING ASSISTANT, MENTOR SPECIALTY O*NET-SOC CODE: 31-1012.00
RAPIDS CODE: 0824M
Description: The related instruction outlines the courses that provide the technical knowledge that supplements the on-the-job learning. It is through the combination of both the on-the-job learning and the related technical instruction that the mentor can reach the skilled level of the occupation. The following is the suggested course curriculum during the term of mentorship:
Approx. Hours A. Initial training: role of mentor; communication, teamwork, interpersonal skills,
adult learning, time management, etc. ... 12
B. Regulatory Issues (include hiring/evaluation) and incorporating expected standards of care ... 8
C. Meeting the challenges of directed adult students ... 16
D. Dealing with confrontation and anger – advanced ... 4
E. Cultural diversity and chronic/misunderstood conditions ... 4
F. Quality Improvement in healthcare, understanding data and approaches to improvements ... 8
G. Techniques to improve positive reinforcement for successful mentoring ... 8
H. Case studies: The Mentor in Action ... 8
TOTAL HOURS of RELATED INSTRUCTIONS ... 68
Individuals who complete the CNA, Mentor Specialty on-the-job learning and related instruction components shall receive a “Certificate of Proficiency” credential. Some courses and/or work experience can be credited toward a LPN program or other viable work experience depending on state and educational institution requirements.
WORK PROCESSES SCHEDULE
CERTIFIED NURSING ASSISTANT, RESTORATIVE SPECIALTY O*NET-SOC CODE: 31-1012.00 RAPIDS CODE: 0824R (CB)
Description: Performs any combination of following duties: Assists with residents activities of daily living (ADL’s) and mobility by incorporating advanced knowledge of musculature, and conditions by using adaptive equipment and task segmentation to maximize function. Provide restoration principles in dining, incorporating skills for communication and swallowing techniques, along with adaptive devices. Work with nursing and rehab specialists on reviewing interventions and monitoring resident/client response.
Term: Competency Based (Minimum 1,000 Hours)
On-The-Job Learning: The following competency areas have been identified to lend focus and direction to the professional development of nursing assistants. The apprentice will attain a basic level of mastery across all competency areas before receiving certification. Basic mastery will be represented by the apprentices being able to articulate their learning with each competency area and demonstrate that they have successfully integrated all the competencies in their work. The order in which the apprentices learn will be determined by the flow of work on-the-job and will not necessarily be in the order listed. Times allotted to these various processes are estimated for the average apprentice to learn each phase of the occupation and demonstrate competency. They are intended only as a guide to indicate the quality of training being provided and the ability of an apprentice to absorb this training in an average amount of time.
Approximate Hours
Competencies (Min/Max)
A. Mobility: Demonstrate use of appropriate mobility, balance and strengthening
exercises as well as incorporating these into therapeutic activities ... 200-300 • Demonstrate appropriate usage of adaptive equipment: large motor & small
motor muscles- walkers, canes, wheelchairs, prosthesis.
• Incorporate fall prevention strategies in care delivery and verbalize factors contributing to falls and strategies to minimize their effects.
• Demonstrate appropriate turning and repositioning and use of devices to prevent skin breakdown.
• Demonstrate appropriate positioning, transfer techniques, and monitoring of resident.
• Reinforce basic range of motion and demonstrate use of related equipment. • Discuss complications that arise from improper positioning.
• Demonstrate use of various assistive devices in ambulation. • Reinforce good body mechanics during all transfers.
B. Activities of Daily Living (ADL’S): Demonstrate and use task segmentation in assisting a resident to complete ADL’s and appropriate use of adaptive
equipment ... 150-150 • Demonstrate and assist resident with reaching devices and other adaptive
equipment.
in daily living activities.
• Demonstrate understanding of how to monitor fatigue.
• Assists with training/implementation of dressing/undressing programs, grooming, bathing, toileting, exercise/movement programs and eating/ swallowing programs according to plan of care.
• Provides or assists in providing all assigned residents' ordered tasks within appropriate time frame, using appropriate infection control procedures. • Maintains residents' self esteem, privacy and confidentiality of personal
information.
• Assists residents to attain/maintain their individual highest functional level of independence.
Restorative dining, swallowing deficits ... 200-250 • Demonstrate understanding of resident specific goals related to a restorative
dining program.
• Demonstrate proper positioning for meal consumption - table height, distance from table, position of resident's elbows and shoulders.
• Provide alternate food choices as per their plan of care. • Provide a positive experience for eating.
• Document intake and observations per facility policy.
• Demonstrate use of built-up utensils, plate guards, and non-skid material and other accommodations that may be individual to each resident.
• Demonstrate safe feeding techniques.
• Demonstrate understanding of hazards and/or complications related to swallowing.
• Demonstrate understanding of the different types of diet textures and liquid consistencies.
Restoring continence: Document response to individualized toileting plans
and compile elimination data to determine appropriate toileting plans ... 125-125 • Demonstrate understanding of the different types of incontinence.
• Demonstrate understanding of the role in retraining. • Documents response to individualized toileting plans.
• Compiles elimination data to determine appropriate toileting plans. • Monitor hydration and its importance related to continence. C. Demonstrates appropriate use of special treatments (heat and
cold therapy modalities) according to state-specific regulations. ... 50-75 Demonstrates prosthetic care and assistance ... 50-75
RELATED INSTRUCTION OUTLINE
CERTIFIED NURSING ASSISTANT, RESTORATIVE SPECIALTY O*NET-SOC CODE: 31-1012.00
RAPIDS CODE: 0824R
Description: Related instruction supplements on-the-job learning and lists the courses that provide technical ability. It is through a combination of both on-the-job learning and the related instruction that an apprentice can reach a skilled level in the occupation. The following are suggested courses to be completed during the term of apprenticeship:
CORE SKILLS APPROXIMATE HOURS
A. Role of restorative as part of the healthcare team ... 8
B. Muscles, joints, common disorders, conditions & changes in geriatric populations ... 16
C. Restorative dining, swallowing problems & therapeutic Interventions ... 8
D. Adaptive devices and therapeutic interventions in Activities of Daily Living skills ... 4
E. Communicating challenges and interventions for aphasia and other disorders ... 4
F. Bowel & bladder changes, conditions, & interventions ... 4
G. Pain management and use of the pain scale ... 4
TOTAL HOURS OF RELATED INSTRUCTION ... 48
Individuals who complete the CNA, Restorative Specialty on-the-job learning and related instruction components shall receive a “Certificate of Specialization” credential. Some courses and/or work
experience may be credited toward the LPN Apprenticeship Program and or training depending on state regulations or other viable work experience.
