DEPARTMENT OF HEALTH
COURSE STANDARDS TO TEACH THE OKLAHOMA LONG TERM CARE NURSE AIDE TRAINING AND
COMPETENCY EVALUATION PROGRAM
TOPIC 1: HEALTH CARE DELIVERY
TOPIC 2: ROLE OF THE NURSING ASSISTANT
TOPIC 3: OBSERVING AND REPORTING
TOPIC 4: COMMUNICATION AND INTERPERSONAL SKILLS *
TOPIC 5: INFECTION CONTROL *
TOPIC 6: BODY MECHANICS
TOPIC 7: SAFETY *
TOPIC 8: EMERGENCIES *
TOPIC 9: RESIDENT'S RIGHTS *
TOPIC 10: PROMOTING RESIDENTS’ INDEPENDENCE *
TOPIC 11: BASIC ANATOMY
TOPIC 12: AGING PROCESS
TOPIC 13: COGNITIVE IMPAIRMENT
TOPIC 14: RESIDENT'S FAMILY
TOPIC 15: RESIDENT'S ENVIRONMENT
TOPIC 16: POSITIONING
TOPIC 17: VITAL SIGNS AND MEASUREMENTS
TOPIC 18: BATHING
TOPIC 19: SKIN CARE
TOPIC 20: ORAL CARE
TOPIC 21: HAIR AND NAIL CARE
TOPIC 22: DRESSING
TOPIC 23: TRANSFERRING
TOPIC 24: MOBILITY
TOPIC 25: NUTRITION AND HYDRATION
TOPIC 26: ELIMINATION
TOPIC 27: CARE OF THE DYING RESIDENT
TOPIC 28: SURVEY PROCESS AND TYPES OF FACILITIES
TOPIC 29: ALZHEIMER’S DISEASE AND CARE OF THE RESIDENT WITH ALZHEIMERS
Per the Code of Federal Regulations at 483.152(b)(1)(i-v), At least a total of 16 hours of training in the
following topics are required prior to a nurse aide trainee having any direct contact with a resident:
(i) Communication and interpersonal skills;
(ii) Infection control;
(iii) Safety/emergency procedures, including the Heimlich maneuver;
(iv) Promoting residents’ independence;
(v) Respecting residents’ rights
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TOPIC 1: HEALTH CARE DELIVERY
1. The Health Care System is composed of different parts designed to work together to make health care accessible to everyone. The health care system includes:
a. Hospitals – provide acute care (treatment for illnesses which come on suddenly
and are usually of short duration) and either general or specialized care (children's,
cancer, psychiatric, AIDS).
b. Doctor's offices and Clinics – provide maintenance and preventative care.
c. Rehabilitation/Convalescent Care Facilities – provide sub acute care (treatment
for illnesses after acute phase).
d. Long Term Care Facilities – provide long term care (treatment for chronic
illnesses that may develop slowly and continue for long periods of time). Many
residents are elderly but an increasing number of residents are younger.
e. Home Health Agencies – provide care within the person's home.
f. Hospices – provide terminal care (treatment for the dying person to improve
comfort and quality of life).
2. Long Term Care is provided in nursing facilities, psychiatric facilities and facilities for persons with special needs. Long term care facilities:
a. Provide a home-like and safe living environment with daily routines designed to
meet the resident's specific needs.
b. Coordinate resident care through the efforts of the health care team.
c. Provide health care, restorative care, and maintenance care.
d. Provide activities and entertainment for the residents.
e. Are subject to inspections by the federal government, the state department of
health, and local health and fire departments.
3. The Health Care Team is a group of professionals and non-professionals with special skills who work together to meet a resident's needs. The team approach creates
the highest quality of care because information is shared, care is coordinated, and a comprehensive care plan is developed for each resident. Team members may include some or all of the following depending on each resident's needs:
a. Resident – efforts made to meet needs and maintain quality of life.
b. Resident's Family – provides information about resident to staff; may make
decisions if resident is unable with durable power of attorney.
c. Physician – responsible for treatment of disease and illness.
d. Nursing Staff – monitors and promotes health of the resident, identifies needs,
assists with activities of daily living (ADL's). Staff includes registered nurses,
licensed practical nurses, certified nurse aides (CNAs.)
e. Ombudsman – resident advocate who investigates complaints and helps achieve
agreement between parties.
f. Social Worker – counsels resident, family and staff and obtains needed services.
g. Activity Coordinator – plans and carries out appropriate activities for the resident.
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h. Physical Therapist – works with muscle groups to maintain and increase the
resident's physical abilities.
i. Occupational Therapist – works with fine motor skills to improve the resident's
use of hands for all activities and communication.
j. Speech Therapist – works with resident who has difficulty with speech,
communication and swallowing.
k. Dietician – plans menus, special diets, and monitors nutritional needs of the
l. Spiritual Counselor – provides guidance and coordinates religious services for the
m. Administrator – manages all departments within the facility and sets policies.
n. Building Maintenance – keeps buildings and grounds in good repair.
o. Laundry – cleans resident's clothing and maintains linens.
p. Dentist – provides routine and emergency dental care for the resident.
q. Podiatrist – provides foot care for the resident.
r. Optometrist – provides eye care for the resident.
s. Respiratory Therapist – provides breathing treatment and special equipment for
t. Housekeeping – keeps the facility clean and sanitary.
u. Qualified Mental Retardation Professional (QMRP) – person who is trained and
experienced in treating the mentally retarded.
v. Power of Attorney/Health Care Representative or Guardian – makes decisions
regarding care if resident is unable.
4. Observations made by all members of the health care team provide the nurse with the information necessary to complete the Minimum Data Set (MDS) which is a form used to identify the physical, mental, and psychological status of each resident. The MDS
provides the guidelines that help develop the comprehensive care plan.
5. The Comprehensive Care Plan (care plan) is a written plan of action developed by the Health Care Team to meet each resident's highest functional, medical, nursing, mental and psychosocial needs. The plan includes the identification of the cause and nature of a resident's needs, the short term and long term goals for the resident, the individualized approaches to reach those goals, and the disciplines responsible for monitoring those goals. The comprehensive care plan fosters Continuity of Care.
6. CNA's role:
a. Provide care according to the resident's comprehensive care plan.
b. Actively listen and communicate with the resident, the family and the health care
c. Observe and report any changes in the resident's appearance, behavior or mood to
d. Participate in care planning when asked.
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What is the difference between an acute care facility and a long-term care facility? What is the purpose of the Comprehensive Care Plan?
How does the CNA contribute to the Comprehensive Care Plan?
Maintenance Care – care that preserves function
Preventative Care – care that stops disease or injury from happening
Restorative Care – care aimed at regaining health and strength
Activities of Daily Living (ADL) – physical activities of everyday life (bathing, grooming, dressing, positioning, toileting, eating)
Advocate – one who defends the rights of another
Spiritual – the search for meaning in life usually through religion Psychosocial Needs – need for independence, a supportive environment, recognition as an individual, spiritual fulfillment, and social interaction
Continuity of Care – getting everyone from every department on all shifts working towards the same goals using compatible methods
Actively Listen – paying attention to what is said in a conversation
Communicate – exchange information
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TOPIC 2: ROLE OF THE NURSE AIDE
1. The role of the Certified Nurse Aide is to provide for the daily care, comfort, safety
and health needs of the residents. The CNA is an important member of the health
care team and the nursing team.
a. To provide for the resident's daily care, the CNA assists the resident with:
1. Bathing, dressing and grooming (Topics 17, 18, 19, 20, 21).
2. Eating (Topic 24).
3. Elimination (Topic 25).
4. Transferring and ambulating (Topics 6, 15, 22, 23).
5. Communication (Topic 4).
b. To provide for the resident's comfort, the CNA should:
1. Create a positive home-like environment (Topic 14).
2. Help the resident develop trust (Topic 9).
3. Offer emotional support and work with the family (Topic 13).
4. Communicate and actively listen.
c. To provide for the resident's safety, the CNA must:
1. Follow infection control practices (Topic 5).
2. Maintain a clean, safe environment and report safety problems
immediately (Topic 7).
3. Perform procedures correctly (as taught and mandated by OSDH). d. To provide for the resident's health needs, the CNA should:
1. Observe and report any changes in the resident's appearance, behavior, or
mood to the nurse (Topics 3, 10, 11, 12, 26).
2. Determine measurements accurately (temperature, pulse, respirations,
blood pressure, weight, intake, output and food consumption) (Topic 16).
3. Assist the nurse during treatments, medical procedures and emergencies
4. Respond to any call light immediately.
2. A person who chooses to become a CNA must:
a. Understand that, by law, a criminal history check will be done. b. Have Mantoux/PPD testing or chest X-ray and a physical examination. c. Complete an Oklahoma State Department of Health (OSDH) approved training
program that includes at least 75 hours of training, and successfully pass both a
written and skills competency evaluation.
3. The CNA must exhibit ethical behavior. All health care employees are expected to
a. Perform to the best of your ability.
b. Be loyal to your employer, co-workers, residents, and their families. c. Be accountable for your actions.
d. Carry out your supervisor's instructions.
e. Perform only duties legally permitted.
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f. Respect the people and environment around you.
g. Maintain confidentiality.
h. Safeguard the resident's right to privacy.
i. Keep residents free from abuse or neglect. Report suspected abuse or neglect to
the nurse immediately.
j. Safeguard the resident's property.
k. Report incidents or errors to the nurse immediately.
4. The CNA must be aware of and abide by the legal considerations or rules of conduct
enacted by a governmental body. All facilities have standards of care based on federal,
state and local laws and rules, facility policies, and current nursing practices.
5. CNA's must understand their job description. The job description should list the tasks
that a CNA is expected to perform.
6. The CNA is expected to present a positive personal image. Take care of yourself before
you care for others. Because of the physical and emotional demands of the job, the CNA
a. Personal Health – eat a balanced diet, get adequate rest, and use good body
b. Personal Hygiene – bathe daily, use deodorant, practice good oral hygiene.
c. Personal Appearance – dress professionally including clean uniform and shoes,
limited jewelry, ID tag, moderate makeup, simple hair style, little or no perfume,
nails that are smooth, clean and trimmed.
d. Personal State of Mind - since the job is stressful, talk about feelings and
emotions identify what is stressful, feel sad when appropriate, set priorities.
Personal behavior on personal time is still a reflection on the employer.
7. To maintain certification, the CNA must:
a. Receive two (2) hours of in-service training specific to the job assignment each
b. Work for a health care provider at least one eight hour shift every twenty-four
c. Never have a verified complaint/allegation against them on the registry. If a
complaint of abuse or misappropriation of resident's property or funds is
found to be valid, the CNA will loose their certification in all 50 states
d. Have a performance review at least once every twelve (12) months by the
employing facility and be offered in-service education on their identified
How does a CNA provide for a resident's comfort?
What must a person do to become a CNA and maintain certification?
Explain ethical behavior.
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What is confidentiality?
What must a CNA do to present a "positive personal image"?
List the reasons why a CNA would have a complaint on the Nurse Aide Registry.
Environment – surroundings
Trust – to have confidence and faith in, to rely on
Call Light – a means of communicating with staff to get help
Ethical Behavior – doing what is right according to the rules of conduct of a particular group Accountable – being responsible for your own choices (words and actions) Respect – to treat with courtesy and consideration
Confidentiality – keeping information secret
Privacy – freedom from outsiders entering and watching without your consent Abuse – an act that causes harm
Neglect – failure to act in a reasonable and caring manner.
Incident – any unusual event (falls, theft, errors) that occurs in the health care facility Current Nursing Practices – up-to-date, proven and accepted ways of providing nursing care Stress - pressure or strain that disturbs a person's mental or physical well being In-service Education – opportunities for learning offered by an employer
Verified Complaint/Allegation – wrong doing that has been proven
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TOPIC 3: OBSERVING AND REPORTING
1. Observing and reporting is the most important way the CNA assists the nurse and
other members of the health care team to identify the needs of the residents.
a. Observing is the gathering of bits of information about a resident through
the use of the senses and feelings. The information provides knowledge about
the resident's condition and response to care. Methods of observation include:
1. Objective observation includes data available through the senses.
Sight - rash, swelling, diarrhea, skin color change, unconsciousness.
Sound - cough, irregular heartbeat, moans of pain.
Smell - foul odor from a wound, bad breath, unusual odors from urination
Touch - fever, change in pulse, swelling or lump under the skin.
2. Subjective observation includes information reported by a resident about
how he or she is feeling. Statements such as "I'm tired," "I'm dizzy," "I
can't see," "My ears are ringing".
3. Accurate observations include detailed information and improve the
quality of care.
4. Observations that indicate an acute condition requiring immediate
attention from the nurse include but are not limited to:
severe pain anxiety mood swings any sudden change in condition
fall or accident confusion depression skin tears or bruises
signs of shock odor loss of control loss of consciousness
seizures swelling hemorrhage difficulty breathing
b. Reporting means verbally informing the person in authority (the nurse)
about resident care and what has been observed. Telling another CNA or a
CMA about an observation is not reporting.
5. Report should include the resident's name, room and bed number and
detailed descriptions of the observation. Reporting may be:
a. Objective-stating what is seen, smelled, heard or felt including
exactly what the resident says.
b. Subjective – stating what cannot be observed by the senses but
rather a feeling about something that doesn't seem right ("Mrs.
Jones seems uncomfortable.")?
6. Routine reporting is usually done at the end of the shift. Routine
information is not of immediate importance. Include information about the
resident and the care given. Before reporting, ask:
a. Did I meet each resident's needs?
b. Was there anything new or changed?
c. What did I see, hear, smell, or touch?
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7. Immediate reporting must be done at the time the observation is made
a. Dangerous situations (i. e., frayed cord, loose handrails, broken
b. Unusual observations (i. e., high temperature, skin changes
especially any red or open areas).
c. Unusual incidents (i. e., falls, signs or suspicions of abuse).
d. Resident complaints of ill health (i. e., dizziness pain).
2. Documentation is the written account of a resident's condition. Documentation can
include charts, worksheets and facility records. Documentation is considered a permanent
legal record of the resident's condition and the care given. The CNA is legally
responsible for recording complete and accurate details of the care given. If it isn't
documented, legally it wasn't done.
a. Guidelines for Documentation:
1. Resident's name must be on each page before anything else is written.
2. Write all entries in ink - not pencil or felt tip - neatly and legibly.
3. Make sure all entries are accurate. Use quotation marks when reporting
what the resident said. Document only what you observe and perform.
4. Documentation must be in chronological order.
5. Never document before a procedure is completed.
6. Do not leave spaces or skip lines between entries to prevent altering of
7. Use standard medical terminology and standard abbreviations - no ditto
8. Time and date all entries, and sign with your name and title.
9. Never document for someone else.
b. Guidelines for Correcting Documentation.
1. Draw a single line through error. What was written should remain readable.
Never use correction fluid.
2. Print word "error". Initial and date the correction.
3. CNA's Role:
a. Use your senses to observe physical changes.
b. Use your active listening skills to observe any changes the resident may say they
c. Report any unusual findings to the nurse immediately.
d. Always document according to current nursing practices.
How does a CNA assist the health care team to identify the needs of the resident?
What is the difference between an objective and subjective observation?
To whom does the CNA report?
Give examples of observations that should be reported immediately.
What is the procedure for correcting an error in documentation?
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Accurate – correct, exact
Legally Responsible – accountable by law for one's actions Chronological Order – the sequence in which events occur Medical Terminology – the specific language of medicine Abbreviation – a shortened form of a word
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