Del. Admin. Code tit. 16, Department of Health and Social Services, Division of Health Care Quality, 3220, app A
MODULE: The Nursing Assistant Role and Function
* Introduces the characteristics of an effective nursing assistant including but not limited to: personal attributes, on-the-job conduct, appearance, grooming, health and ethical behavior.
* Presents the responsibilities of the nursing assistant as a member of the resident/patient care team.
* Teaches legal aspects of resident/patient care and rights.
* Relevant Federal and State statutes are reviewed.
COMPETENCIES:
* Define the role and functions of the nursing assistant and provide awareness of the legal limitations of being a nursing assistant.
* Recognize the responsibilities of the nursing assistant as a member of the health care team. Understand the relevant State and Federal regulations for long term care and legalities of reporting and documenting incidents and accidents.
* Understand the role of long term care advocates, investigators and surveyors.
* Identify the "chain of command" in the organizational structure of the health care agency.
* Maintain personal hygiene and exhibit dress practices which meet professional standards.
* Recognize the importance of punctuality and commitment to the job.
* Differentiate between ethical and unethical behavior on the job.
* Understand the role, responsibility and functional limitations of the nursing assistant.
* Demonstrate behavior that maintains resident/patient rights.
* Provide privacy and maintenance of confidentiality.
* Promote the resident/patient right to make personal choices to accommodate individual needs.
* Give assistance in resolving grievances.
* Provide needed assistance in going to and participating in resident/patient and family groups and other activities.
* Maintain care and security of resident/patient personal possessions as per the resident/patient desires.
* Provide care which ensures that the residents/patients are free from abuse, mistreatment, neglect or financial exploitation and report any instances of same to the Department.
* Discuss the psychological impact of abuse, neglect, mistreatment, misappropriation of property and/or financial exploitation of residents/patients.
* Maintain the resident/patient environment and care through appropriate nursing assistant behavior so as to keep the resident/patient free from physical and chemical restraints.
* Discuss the potential negative outcomes of physical restraints, including side rails.
MODULE: Environmental Needs of the Resident/Patient
* Introduces the nursing assistant to the need to keep residents/patients safe from injury and infection in the long term care setting.
* The nursing assistant is taught why and how to use infection control and isolation techniques.
* Safety through prevention of fires and accidents, and emergency procedures for fire and other disasters are presented.
COMPETENCIES:
* Apply the basic principles of infection control.
* Identify how diseases are transmitted and understand concepts of infection prevention.
* Demonstrate proper hand washing technique.
* Demonstrate appropriate aseptic techniques in the performance of normal duties and understand the role of basic cleaning, disinfecting, and sterilization tasks.
* Demonstrate proper isolation and safety techniques in the care of the infectious resident/patient and proper handling and disposal of contaminated materials.
* Assist with basic emergency procedures.
* Follow safety and emergency procedures.
* Identify safety measures that prevent accidents to residents/patients.
* Recognize signs when a resident/patient is choking or may have an obstructed airway.
* Assist with clearing obstructed airway.
* Call for help when encountering convulsive disorders, loss of consciousness, shock, hemorrhage, and assist the resident/patient until professional help arrives.
* Follow disaster procedures.
* Report emergencies accurately and immediately.
* Identify potential fire hazards.
* Provide a safe, clean environment.
* Identify the resident's/patient's need for a clean and comfortable environment.
* Describe types of common accidents in the nursing home and their preventive measures.
* Be aware of the impact of environmental factors on the resident/patient in all areas including but not limited to light and noise levels.
* Report unsafe conditions to appropriate supervisor. Use the nurse call system effectively.
* Report evidence of pests to appropriate supervisory personnel.
* Report nonfunctioning equipment to appropriate supervisory/charge personnel.
* Prepare soiled linen for laundry.
* Make arrangement of furniture and equipment for the resident's/patient's convenience and to keep environment safe.
MODULE: Psychosocial Needs of the Resident/Patient
* Focus is placed on the diverse social, emotional, recreational and spiritual needs of residents/patients in a long term care setting.
* The curriculum shall describe some of the physical, mental, and emotional changes associated with aging and institutionalization, and present ways in which the nursing assistant may effectively communicate with residents/patients and their families.
COMPETENCIES:
* Demonstrate basic skills by identifying the psychosocial characteristics of the populations being served in the nursing facility including persons with intellectual/developmental disabilities, mental illness, dementia and other related disorders.
* Indicate the ways to meet the resident's/patient's essential needs for physical and psycho-social well-being.
* Modify his/her own behavior in response to resident's/patient's behavior.
* Respect the resident's/patient's beliefs recognizing cultural differences in holidays, spirituality, sexual orientation, gender identification, clothing, foods and medical treatments.
* Identify methods to ensure that the resident/patient may fulfill his/her maximum potential within the normal aging process.
* Provide training in, and the opportunity for, self-care according to the resident's/patient's capabilities.
* Demonstrate principles of behavior management by reinforcing appropriate behavior and reducing or eliminating inappropriate behavior.
* For persons with dementia, recognize that cognitive functions are impaired, determine what the resident/patient is trying to communicate and respond appropriately.
* Demonstrate skills which allow the resident/patient to make personal choices and promote the resident's/patient's dignity.
* Utilize resident's/patient's family as a source of emotional support and recognize the family's need for emotional support.
* Recognize how age, illness and disability affect memory, sexuality, mood and behavior, including wandering.
* Recognize aggressive behavior and learn management techniques.
* Recognize that certain behaviors, such as wandering, are a form of communication.
* Learn to apply strategies to promote safe behaviors.
* Discuss how appropriate activities are beneficial to residents/patients with cognitive impairments.
* Recognize and utilize augmentative communication devices and methods of nonverbal communication.
* Demonstrate appropriate and effective communication skills.
* Demonstrate effective verbal and nonverbal communications in keeping with the nursing assistant's role with residents/patients, their families and staff.
* Observe by using the senses of sight, hearing, touch and smell to report resident/patient behavior to the nurse.
* Document observations using appropriate terms and participate in the care planning process.
* Recognize the importance of maintaining the resident's/patient's record accurately and completely.
* Communicate with residents/patients according to their state of development.
* Identify barriers to effective communication.
* Recognize the importance of listening to residents/patients.
* Participate in sensitivity training in order to understand needs of residents/patients with physical or cognitive impairments.
* The CNAs dementia specific training shall include:
* Communicating with persons diagnosed as having Alzheimer's disease or other forms of dementia; the psychological, social, and physical needs of those persons;
* Safety measures which need to be taken with those persons; and
* Prevention of patient abuse that shall include: definitions and signs and symptoms of abuse and neglect, reporting requirements and prevention strategies.
MODULE: Physical Needs of the Resident/Patient
* Presents the basic skills which nursing assistants use in the physical care of residents/patients.
* The nursing assistant will learn basic facts about body systems and what is needed to promote good functioning.
* The nursing assistant will learn to provide physical care to residents/patients safely and to keep the residents/patients nourished, hydrated, clean, dry and comfortable.
* The nursing assistant will also learn to make observations regarding residents/patients and to record and/or report observations.
* The nursing assistant will be introduced to the basics of range of motion and learn to integrate range of motion into routine personal care activities.
COMPETENCIES:
* Apply the principles of basic nutrition in the preparation and serving of meals.
* Incorporate principles of nutrition and hydration in assisting residents/patients at meals.
* Understand basic physiology of nutrition and hydration.
* Understand basic physiology of malnutrition and dehydration.
* Identify risk factors for poor nutritional status in the elderly:
* Compromised skin integrity
* Underweight or overweight
* Therapeutic or mechanically altered diet
* Poor dental status
* Drug-nutrient interactions
* Acute/chronic disease
* Depression or confusion
* Decreased appetite
* Recognize how the aging process affects digestion.
* Accurately calculate and document meal intake and report inadequate intake or changes in normal intake.
* Accurately calculate and document fluid intake and report inadequate intake or changes in normal intake.
* Recognize and report signs and symptoms of malnutrition and dehydration.
* Understand concepts of therapeutic diets including dysphagia diets and the related risks associated with dysphagia including aspiration and aspiration pneumonia.
* Incorporate food service principles into meal delivery including:
* Distributing meals as quickly as possible when they arrive from the kitchen to maintain food temperature.
* Assisting residents/patients with meal set-up if needed (i.e. opening packets or cartons, buttering bread if desired).
* Serving meals to all residents/patients seated together at the same time.
* Offering appropriate substitutions if the residents/patients don't like what they have received.
* Utilize tray card or other mechanism to ensure the resident/patient is served his/her prescribed diet and identify who to notify if a resident/patient receives the wrong diet.
* Demonstrate understanding of how to read menus.
* Assist residents/patients who are unable to feed themselves.
* Demonstrate techniques for feeding someone who:
* Bites down on utensils
* Can't or won't chew
* Holds food in mouth
* Pockets food in cheek
* Has poor lip closure
* Has missing or no teeth
* Has ill-fitting dentures
* Has a protruding tongue or tongue thrust
* Will not open mouth
* Demonstrate proper positioning of residents/patients at mealtime.
* Demonstrate skills for feeding residents/patients who:
* Are cognitively impaired
* Have swallowing difficulty
* Have sensory problems
* Have physical deformities
* Demonstrate positioning techniques for residents who:
* Have poor sitting balance
* Must take meals in bed
* Fall forward when seated
* Lean to one side
* Have poor neck control
* Have physical deformities
* Demonstrate use of assistive devices.
* Identify signs and symptoms that require alerting a nurse, including:
* Difficulty swallowing or chewing
* Coughing when swallowing liquids
* Refusal of meal
* Choking on food or fluids
* Excessive drooling
* Vomiting while eating
* Incorporate principles of a pleasant dining environment when assisting residents/patients at mealtime including, but not limited to:
* Ensuring adequate lighting
* Eliminating background noise
* Sitting at the resident/patient level
* Being engaged with the resident/patient
* Demonstrate positive interaction with residents/patients recognizing individual resident/patient needs.
* Ensure residents/patients are dressed appropriately.
* Allow residents/patients to eat at their own pace.
* Encourage independence and assist as needed.
* Recognize and report, as appropriate, the risk factors and signs and symptoms of malnutrition, dehydration and fluid overload.
* Accurately calculate and document intake and output including meal percentages and fluids.
* Demonstrate understanding of basic anatomy and physiology in the following areas:
* Respiratory system
* Circulatory system
* Digestive system
* Urinary system
* Musculoskeletal system
* Endocrine system
* Nervous system
* Integumentary system
* Sensory system
* Reproductive system
* Recognize abnormal signs and symptoms of common illness and conditions. Examples are:
* Respiratory infection - Report coughing, sneezing, elevated temperatures.
* Diabetes - Report excessive thirst, frequent urination, change in urine output, drowsiness, excessive perspiration and headache. Understand the healing process as it relates to diabetes.
* Urinary tract infection - Report frequent urination, burning or pain on urination, elevated temperature, change in amount and color of urine, blood or sediment in urine and strong odors.
* Cardiovascular conditions - Report shortness of breath, chest pain, blue color to lips, indigestion, sweating, change in pulse, edema of the feet or legs.
* Cerebral vascular conditions - Report dizziness, changes in vision such as seeing double, change in blood pressure, numbness in any part of the body, or inability to move arm or leg.
* Skin conditions - Report break in skin, discoloration such as redness, bruising, rash, itching.
* Gastrointestinal conditions - Report nausea, vomiting, pain, inability to swallow, bowel movement changes such as color, diarrhea, and constipation.
* Infectious diseases.
* Provide personal care and basic nursing skills as directed by the nurse in the appropriate licensed entity.
* Provide for resident/patient privacy and dignity when providing personal care.
* Assist the resident/patient to dress and undress.
* Assist the resident/patient with bathing and personal grooming.
* Observe and report condition of the skin.
* Assist the resident/patient with oral hygiene, including prosthetic devices.
* Administer oral hygiene for the unconscious resident/patient.
* Demonstrate measures to prevent decubitus ulcers, including, but not limited to positioning, turning and applying heel and elbow protectors.
* Assist the resident/patient in using the bathroom. Understand consequences of not assisting resident/patient to the bathroom.
* Assist the resident/patient in using a bedside commode, urinal and bedpan.
* Demonstrate proper bed making procedures for occupied and unoccupied beds.
* Feed resident/patient oral table foods in an appropriate manner. Demonstrate proper positioning of resident/patient who receives tube feeding.
* Distribute nourishment and water.
* Accurately measure and record with a variety of commonly used devices:
* Blood pressure
* Height and weight
* Temperature, pulse, respiration
* Report significant change in vital signs.
* Assist the resident/patient with shaving.
* Shampoo and groom hair.
* Provide basic care of toenails unless medically contraindicated.
* Provide basic care of fingernails unless medically contraindicated.
* Demonstrate proper catheter care.
* Demonstrate proper perineal care.
* Assist the nurse with a physical examination.
* Apply a non-sterile dressing properly.
* Apply non-sterile compresses and soaks properly and safely.
* Apply cold and/or heat applications properly and safely.
* Demonstrate how to properly apply compression stockings.
* Demonstrate proper application of physical restraints including side rails.
* Demonstrate skills which incorporate principles of restorative care under the direction of a nurse.
* Assist the resident/patient in bowel and bladder training.
* Assist the resident/patient in activities of daily living and encourage self-help activities.
* Assist the resident/patient with ambulation aids, including, but not limited to cane, quad-cane, walker, crutches, wheelchair and transfer aids, such as a mechanical lift.
* Perform range of motion exercise as instructed by the physical therapist or the nurse.
* Assist in care and use of prosthetic devices.
* Assist the resident/patient while using proper body mechanics.
* Assist the resident/patient with sitting on the side of the bed, standing and walking.
* Demonstrate proper turning and/or positioning both in bed and in a chair.
* Demonstrate proper technique of transferring resident/patient from low and high bed to chair.
* Demonstrate safety and emergency procedures including proficiency in the Heimlich maneuver and certification in cardiopulmonary resuscitation (CPR).
* Provide care to resident/patient when death is imminent.
* Discuss own feelings and attitude about death.
* Explain how culture and religion influence a person's attitude toward death.
* Discuss the role of the CNA, the resident's/patient's family and significant others involved in the dying process.
* Discuss the stages of death and dying and the role of the nurse assistant.
* Provide care, if appropriate, to the resident's/patient's body after death.
Del. Admin. Code tit. 16, Department of Health and Social Services, Division of Health Care Quality, 3220, app A
6 DE Reg. 1505 (05/01/03)
8 DE Reg. 1014 (01/01/05)
14 DE Reg. 169 (09/01/10)
15 DE Reg. 192 (08/01/11)
15 DE Reg. 1010 (01/01/12)
16 DE Reg. 632 (12/01/12)
20 DE Reg. 901(5/1/2017)
26 DE Reg. 107( 8/1/2022) (Final)