I was searching for CNA educational sites and found this.

The “WHAT HAS HAPPENED TO ME” Dementia Specific training program has been developed in order to expand training of the Certified Nursing Assistant (CNA), the front line care giver, in how to understand and care successfully for the resident with Dementia.

This sounds like an excellent program and I might purchase a copy for myself and for review here.

Highlights:

“A Plan Of Care For The Resident With Dementia”
Teaches the definitions of Dementia and Cognitive Loss and how it impacts the resident’s performance of their activities of daily living. The CNA will design a “Plan of Care” with the Best Practice interventions that will help them successfully care for the resident with Dementia.

“What Do They Want From Me”…….From the Resident’s Perspective.
This is a two part program that identifies 12 different behaviors that the CNA encounters with their residents. The Lesson Plan discusses the definitions of behavioral problems for the resident with Dementia and the Best Practice intervention. The CNA will understand the definitions of illusion and delusion, catastrophic reactions, Sundowners Syndrome, etc. A list of Best Practices discusses appropriate interventions with these types of behaviors. The CNA gains an understanding of the resident and will be able to demonstrate Best Practices for behavioral problems.

“How Well Do I Know My Resident”
The Lesson Plan discusses the definitions of Dementia, symptoms of Dementia and the importance of the CNA having the ability to positively impact the resident’s life. It gives the CNA a greater understanding of the importance of reporting behavioral changes to the nurse. By knowing the resident’s previous lifestyle and personality before and how they are now, the CNA will be able to care for the resident in an effective manner.

“I Want To Be Free”
Gives the CNA the concept that the resident has the right to be free from physical restraints. They gain understanding of the risks and benefits of restraint use, regulations for use of restraints, types of restraints and side rail use. Also included are alternatives to restraints and a restraint reduction program.

“Don’t Drug Me Up”
Teaches the CNA the concept that the resident has the right to be free from chemical restraints. They will be informed about the federal regulations regarding psychotropic drugs. The four categories of psychotropic drugs and their side effects will be discussed. They will gain an understanding of the importance of their role in reporting behaviors and side effects to the nurse.

The “What Has Happened To Me” Dementia Training Program contains the following

Handouts to be utilized with each Lesson Plan.

* Definition of Dementia
* Diseases that cause Dementia
* Symptoms of Dementia
* Behavioral Problems of the Resident with Dementia: Definitions for CNAs
* Best Practices for the care of the Resident with Dementia
* Course Content for CNAs
* What is a Physical Restraint?
* Risks of Restraint Use
* Restraint Reduction Program
* Federal Regulations regarding Psychotropic Drug Use
* Four Categories of Psychotropic Drugs, Their side effects and alternatives to drug use

The program also includes the following:

* Pre and Post Tests and Test Answers
* Certificate of Completion individualized for each Lesson Plan
* Certificate for the Orientation Training
* Activities for each Lesson Plan
* Tips for the Trainer
* Inservice Training Form
* Nurse Assistant Orientation Content form HS 278A
* Program Evaluation

The Training Sessions include:

* A Lesson Plan with stated Course Objectives
* Pre Test
* Course Content to be discussed
* Handouts for each Lesson Plan
* Activities for each Lesson Plan
* Post Test
* Certificate of Completion
* Test Answers

The entire program is $299.00

It sounds very comprehensive.

In the comments a reader left this question:

Could you give me some suggestions on what CNAs really want for education in a long term care?

Briefly, I can say without a doubt, those who have intentions of being educated CNA’s want to know these things:
1) The Basics- nursing skills we currently learn- with more emphasis on the hows, whys, whens, what happens…details are always better than scratching the surface which is what is taught now.

2) Expanded information about the Nursing Process and the role of the CNA and other members of the health care team.

3) Employment skills: Work ethics, resume preparation, interview skills, mentoring; HOW not to destroy our young, being professional, dealing with co workers and management; dealing with families and others.

4) Career opportunities for CNA’s; other roles and resources besides nursing homes and long term care.

5) History of nursing and particularly of CNA’s.

6) Expanded information about abuse, neglect and other legal issues CNA’s face everyday on the job.

Other thoughts?? Ideas?

When a resident or patient falls, and hits their head, nursing staff have serious responsibility to monitor the possible effects. Brain injuries are life altering events and sometimes we can prevent this from happening. By intervening at critical times, we have a big impact on people.

Nursing Home Magazine’s October Issue has guild lines that are sound and should be followed. CNA’s often play an important role in helping the nurse perform neurological exams. It’s vitally important to be timely when you’re asked to help with these exams. The best scenario would be for the nurse and CNA to go together to do this.

Protecting Your Residents and Facility
A crisis of the neurological system can be the most challenging to monitor and evaluate for any healthcare professional. Whether it’s a brief check of neurological status or a comprehensive neuro exam, a nurse’s assessment may uncover nervous system dysfunction before it is too late. Therefore, it is essential that every nursing facility has policies and procedures, coordinated by the medical director, to guide and address when and how these exams should be done. Consider the following when developing your plans:

1. Have a licensed nurse perform neurological checks after all unwitnessed falls involving residents with a history of confusion or residents with a suspected head injury.

2. Check for signs and symptoms of head injury, which include one or more of the following:

* unusual drowsiness or can’t be awakened (easily or at all), mental confusion, slurred speech
* nausea and forceful or repeated vomiting, stiff neck and fever
* seizure activity
* unequal pupils, papillary response, or accommodation
* clumsy walking, stumbling, or other problems with use of extremities, areas of numbness, parasthesias
* headache (mild or severe), dizziness, double vision, or blind spots
* increased blood pressure or a marked drop in blood pressure
* decrease in pulse and/or increased and shallow respirations (these are associated with intracranial pressure)
* unequal grasp and/or nonexistent extremity movement (these are associated with cerebral damage)

Right here is where CNA’s are often called upon to assist with these exams. We’re the ones who will first encounter residents and patients who:
*Cannot be aroused as usual or who seem more tired than normal
*Have a fever
*Respirations that are different- slow and deep or fast and shallow
*Complain of a headache
*Vomit
*Experience dizzy spells or complain of double vision
*have a change in their normal B/P readings
*Cannot hold onto things they normally can- dropping a hairbrush or comb, for example
THESE observations should be reported the nurse immediately. Not in an hour. Not after care is given.

3. Conduct an initial thorough exam at the location where the resident was found, without moving him or her. Wear gloves when necessary and provide as much privacy as possible.

4. Evaluate the level of consciousness and mentation of the resident. A change is usually the first clue to a deteriorating condition. Since terms, such as lethargy, are frequently used imprecisely, it is wise to descriptively document how the resi-dent responds.

5. Check pupil reaction, blood pressure, temperature, pulse, respirations, grasp, and active range of motion of all extremities. If neck or spinal injury is suspected, keep the resident still and call for emergency help.

6. Obtain orthostatic blood pressures per facility protocol. Move the resident to his or her bed only after a full assessment of injuries or potential injuries is complete, and use a method that will protect the resident from any further injury.

7. Perform neurological checks according to the frequency indicated on the medical director’s or attending physician’s orders. In addition, subsequent assessments should be problem-focused, zeroing in on the parts of the nervous system affected by the resident’s condition. The resident’s diagnosis and the acuity of his or her condition will determine how extensive your problem-focused assessments will be and if you should conduct them more frequently.

8. Be sure to compare your findings with those of previous exams. Through comparison, you’ll be able to spot changes and trends and, when necessary, intervene quickly and appropriately.

9. Immediately notify the resident’s physician of any sign of deterioration in the resident’s status.

Initally after a fall, the resident/patient should not be moved by the CNA. Get the nurse. I have worked with nurses who will refuse to come right down to assess the situation- they’re in the middle of a med pass or something. This is not acceptable. If this happens go to the next person in the chain of command. If no such person is in house, inform the nurse that you will not move the resident/patient until an assessment is completed. And go stay with your resident/patient.

Learn what a full neuro exam is and what tools are needed, in case you’re asked to get them together. Every facility should have a kit with these items all ready for use and clearly labeled.

More about neuro checks:
Neurological assessment: A refresher
The Precise Neurological Exam (pictures included)

Here in New Hampshire a state nursing home has finally received a good report from the state.

LACONIA — The Belknap County Nursing Home is ending the year on a positive note after an inauspicious beginning.

The results of a recent state Department of Health and Human Services review of the home are overwhelmingly positive, County Commissioner Christopher Boothby said.

“The state has given us not just a clean bill of health, but a rousing well done,” he said.

The 94-bed nursing facility was cited by the state last March after a resident was admitted to a local hospital and questions arose about the care she had received at the home. A review showed a lack of staff was affecting the amount of direct care the home’s residents were getting.

The home was fined nearly $100,000 and placed in immediate jeopardy of losing its license. The home was assessed a per-day fine by the state work was ongoing to correct the most serious problems and set a plan to deal with all the issues.

The home since has hired 21 new clinical workers, including nurses and nurse’s aides, and added staff in areas such as quality assurance and an activity director.

Bud Daigneault, Belknap County Commission chairman, said he’s pleased with the latest results, which revealed zero health care deficiencies.

“We’ve come a long way in several months’ time, and it is directly attributable to the administration and staff at the home,” Daigneault said.

The improvements also included better documentation of care, he said.

Bernard Gray, the home’s administrator, said the New Hampshire Association of Counties helped by forming a consultation team. The group included a nursing home administrator and a nursing director from other facilities who worked with the Belknap home.

“The most critical area was the lack of staff,” Gray said. “We were so low, some staff that were hired to provide direct care were taken from their direct care positions … The vacated direct care positions were never replaced.”
[…]
Key improvements included better direct care, timeliness of care, record keeping and medical documentation, he said. Other improvements include a better quality and level of service in dietary areas and better communication between administration and staff.

I’m surprised to see this is happening without civil rights advocacy groups questioning the privacy of patients.

“It’s everywhere,” explained Dr. Rick Hartman, the medical center’s physician champion for the MRSA-prevention initiative. “It lives on your skin, in your mouth, in your nose. It even lives on tabletops.”

Hartman said that about 10 percent of the patients who visit the medical center have MRSA colonies in their bodies, usually inside their noses. But, in most cases, there are no symptoms.

“People have it, and don’t even appear to be sick,” he said. “Most people’s body can keep it in check. When it becomes a problem is with at-risk patients — elderly patients, infants or people who are already sick and weak.”

Depending on where the bacteria decides to settle, MRSA can cause a variety of infections, some more serious than others. That’s why the national VA hospital system has made it a goal to completely eradicate the spread of the bacteria in its hospitals.

To stop the spread of MRSA and the infections it causes, Hartman said, the medical center is taking a number of steps. First, the staff has begun testing anyone who is admitted to the hospital. If someone tests positive for MRSA, they are placed in a hospital room by themselves, and doctors and staff members treating them are required to wear gloves and masks and wash their hands after coming into contact with the patient.

This is a good initiative. Let’s hope it stands up to those who might see this as a violation of privacy rights.

A CT hospital and union are in the midst of battle over activities the hospital management is accused of…they were trying to educate staff about the cons of union membership. This is considered illegal.

The divide between Yale-New Haven Hospital and the union seeking to organize 1,800 of its employees continues to grow, as union and hospital officials show no signs of reaching an agreement within the upcoming weeks.

The hospital’s union election had been postponed from last week by the National Labor Relations Board following a report that showed the hospital had acted illegally in campaigning against the union. The election will likely not be rescheduled until two investigations into the hospital’s recent alleged misconduct are complete, which will probably not happen within the next month.
[…]
In a report released last week, Kern stated that managerial staff at Yale-New Haven had convened mandatory meetings to discuss hospital business, but would follow those meetings with voluntary meetings to discuss unionization. Kern found that those voluntary meeting were compromised because any employee who left would be automatically labeled “pro-union.”

Yale-New Haven has offered to sit down with the Service Employees International Union to help resolve the tensions, hospital spokesman Vin Petrini said, but SEIU has declined.

SEIU communications director Bill Meyerson said the union will not discuss a settlement until it better understands who in the hospital administration knew about or ordered allegedly mandatory meetings held during work hours that were anti-union and possibly violated federal law.

So, if management discussed union issues before the mandatory part of this meeting, would it be illegal?

The response we have received from Patti’s Tips and Timesavers article has been unexpected! I thought we should re-cycle some of the other articles here that are similar, and readers can email us for an easy to read/print version of these.

Everything You Want To Know About Being a CNA

Workplace Culture and CNA’s

Being Professional

Horizontal Violence

A Call For Action

Shift Wars

The Nursing Process and CNA’s

Legal Issues for CNA’s

Observation

There are many other articles too- see the CNA Education Section to the left. These are free to use.

Those who don’t want to be represented by a Union are finding it difficult to have their voice heard.

A group of employees at Cedarbrook nursing homes told Lehigh County commissioners Wednesday that they want a secret ballot to determine unionization and raised concerns about the bargaining committee now in contract negotiations with the county.

Gone are the days when a group of employees had to VOTE for union representation. Now, it’s a simple matter of getting enough union card signatures. Many people do not know this; they will sign these cards under the guise of having an interest in learning more about a union. The cards are being used as “signatures” now, replacing the voting option.

In October, County Executive Don Cunningham asked the state labor relations board to certify Local 1776, based on a count of pro-union cards from 56 percent of the employees in the prospective bargaining unit.

But a group of employees, concerned the cards were solicited under pressure, filed a petition with the state board to call for an election, as had been done seven times before. The board set an election date but last week rescinded it after the union appealed. It concluded that based on labor statutes, Local 1776 legally represents the workers, and that a previous decision in a 1984 case to grant an election to petitioners was incorrect.

Still, anti-union workers circulated a petition asking for a secret ballot that had 163 signatures and was given to Dougherty Tuesday.

I think ballot votes should prevail in all union based activity. Using the cards is deceptive practice. A vote is the voice of so many. I also believe many unions know they cannot get the votes they need so they’re resorting to abusing these cards. 163 people are forced to work with union representation they do not want. This is fair isn’t it?

On September 16 2003 a nursing home in Tennessee burned down, and 16 residents died. Recently some records have been released regarding the investigations. Fire safety isn’t something to joke about. It’s not something to be taken lightly. CNA’s have an important role in all of this: When we see frayed wires, report it IMMEDIATELY. When we hear the alarms for a drill, ACT immediately.
Take it seriously.

Long shielded from public view, thousands of pages of court documents filed in connection with a deadly Nashville nursing home fire were released Wednesday by a judge’s order.
[…]
Documents filed by the plaintiffs describe what they say was an array of fire-safety hazards and deficiencies at the NHC facility that raise questions about government oversight of nursing homes statewide.

Attorneys for NHC have blamed the Nashville Fire Department for the high death toll, and filed an expert analysis of what they say were the fire department’s mistakes.

From what I read, it’s not just the fire departments who hold some responsibility here. The nursing home management has a lot of explaining to do. When they know of problems, it is their responsibility to fix it. Allowing things to remain in poor condition just because a life safety code inspection was passed is criminal.

From falsified fire-drill records to electric beds so poorly maintained they were fire hazards, many of the plaintiffs’ claims involve NHC’s maintenance man at the facility, Scott Hansen.

Those suing NHC claimed that by putting an untrained person such as Hansen in charge of fire training, the nursing home company set the stage for disaster.

Hansen also routinely repaired electrical beds and other medical equipment at the nursing home, although he stated in a deposition that he had no formal training in electrical repair.

In sworn statements released yesterday, Hansen and other NHC employees said the bed suspected of causing the blaze had been malfunctioning and was scheduled to be repaired.

Many nursing homes have these Jack-of-all-trades people working in maintenance positions…those who have a little experience in the trades- plumbers, electricians, woodworkers, ect. Experts in nothing, yet they are expected to fix broken electric beds and other equipment. Often this means simply placing electric tape over the frayed wires; often it means geri-rigging fire alarm systems that aren’t working correctly. It’s the cheap way out of things.

NHC attorneys have said that maintenance problems with the beds, if there were any, had no bearing on the deaths and injuries resulting from the blaze.

They also insisted that fire-drill records were not falsified, but were simply inaccurately dated, and that the facility’s fire plan was made simple so all employees could easily understand and remember it without formal training.

Much of this has been countered with staff testimony. Fire drills were not conducted. Staff were not exposed to the safety plans; no one knew what to do.

Lessons: Have a comprehensive fire safety program in place. Educate and train staff in what MUST happen when an alarm occurs.
Test their knowledge with regular, unannounced drills on all shifts. Cooperate with local fire departments and listen to their concerns; call the Fire Marshall in for consultation if needed.

When staff report wiring problems, remove the equipment. Stop using it. Utilize the services of a professional- not a handy man.

Links to Nursing Home Fire Safety Web Sites:

NFPA: Nursing home safety

Employee Emergency & Fire Prevention Plans

Fire safety: is your facility legal?