62 9 Admission, Transfer, Discharge, and Physical Exams 1. Define important words in this chapter 2. List factors for families in choosing a facility 3. Explain the nursing assistant s role in the emotional adjustment of a new 4. Describe the nursing assistant s role in the admission process 5. Explain the nursing assistant s role during an in-house transfer of a 6. Explain the nursing assistant s role in the discharge of a 7. Describe the nursing assistant s role during physical exams Supplemental Tools transparency 9-1 body positions for exams handout 9-1 quiz: you are moving! Chapter 9: exam Assignments textbook reading, pp. 136-150 workbook exercises, pp. 55-58 Overview of Teaching Strategies This chapter focuses on the nursing assistant s role in the admission, transfer, and discharge of s, as well as assistance that will be provided during physical exams. Emphasis should be placed on empathizing with the and providing a helpful, comforting presence during these potentially difficult times. Students will learn what families look for when choosing a facility for a loved one and how to make a good first impression. During the admission process, the should feel welcome and wanted. It is important to mention that s have the right to be informed of any in-house transfer and the reasons for it, as early as possible. During discharge, the nursing assistant should have a positive attitude and be reassuring. Physical exams can be frightening, embarrassing, or uncomfortable, and the nursing assistant can be of great help in comforting the, providing privacy, and explaining why certain positions are necessary. Throughout this chapter, the critical role of the nursing assistant in helping s deal with stressful changes should be emphasized. 1. Define important words in this chapter textbook p. 136 workbook p. 55 Pronounce and define each of the key terms listed in the Learning Objective on page 136. 2. List factors for families in choosing a facility textbook p. 136-137 workbook p. 55 Discuss some of the questions families might consider when choosing a facility for a loved one: Do the staff seem courteous and friendly? Do most of the staff speak the s native language? Is an interpreter available? Are there enough staff members on duty at the facility? What is the ratio of nurses and nursing assistants to s? How is the facility staffed on evenings and weekends? Are foul odors present? What is the food like at the facility? Is attention paid to individual food preferences? Is a dietician available for meetings? Are s up and dressed in the morning? Do staff interact positively with the s?
63 Do staff speak courteously to other staff members? Do s look groomed, taken care of, and happy? How are s complaints resolved? Is the facility licensed? Have the state survey and other inspection results been satisfactory? Does the facility explain Residents Rights? Does the facility provide assistance with activities of daily living (ADLs)? If so, how is it provided, and what are the associated fees? Are physical, occupational, and speech therapists available? How often do falls, infections, and pressure ulcers occur? Do volunteers work with s? If so, are their interactions positive? How involved can the family be in creating the s care plan? Does the facility provide the level of care the needs? What about future needs? Is the environment safe, functional, and homelike? Is there an activities department? What kinds of activities are offered? What are the steps to take if a wants to move out of the facility? What policies does the facility have on advance directives and end-of-life decisions? Discussion Ask the students which of these factors are the most important, and ask them to think of more examples. If training in a facility, the instructor should answer the above questions about the facility. 3. Explain the nursing assistant s role in the emotional adjustment of a new textbook pp. 137-139 workbook pp. 55-56 Distribute Handout 9-1 quiz: you are moving! Hand out the quiz and give the students five minutes to complete it. Ask the following questions: How did you feel when deciding what to take and what to leave behind? What did you decide to take, and what are some things that you would be upset about leaving behind? How did you feel about the loss of your mail and your sister s response? Discuss the following reasons that adjusting to life in a facility may be difficult for s: Move may have been sudden, due to health reasons. Resident may have had to leave home and give up personal belongings and beloved pets. Resident may have had loved ones who have died. Residents may be experiencing a decline in health and independence. Stress that nursing assistants must empathize with s to help make the adjustment to facility life easier. Review the guidelines for helping new s adjust: Have a positive attitude. Be tactful. Communicate clearly. Show respect for s belongings. Be responsible. Be honest. Listen to s. Pay attention to s wishes. Respect s privacy. Be patient and kind. 4. Describe the nursing assistant s role in the admission process textbook pp. 139-145 workbook p. 56 Admission pack Baseline
64 Review the guidelines for admission: Wash hands and gather necessary equipment to bring to s room. Prepare the s room before he arrives. Prepare the bed and open curtains or blinds. Notify roommate of new s arrival. Introduce yourself to and call him by his formal name. Do not rush the process. Introduce the new to other s. Explain day-to-day life in the facility. Show how to work bed controls. Make sure call light is close to bed and explain how to use it. Explain how to work television and phone. Handle personal items with care and respect. Demonstrate the procedure: Admitting a. Have the students return the Pound Kilogram Metric Bedridden Contracture Abdominal girth Emphasize that any change in a s weight must be reported right away, as this can be a sign of illness. Demonstrate each of the following procedures, including all of the numbered steps in your Measuring and recording weight of an ambulatory Measuring and recording weight of a bedridden Measuring and recording height of an ambulatory Measuring and recording height of a bedridden Measuring abdominal girth Have the students return each 5. Explain the nursing assistant s role during an in-house transfer of a textbook pp. 146 workbook pp. 56-57 Review the following important points about transfers: Notify the as soon as possible of the transfer. Explain all the details you know about the transfer. Pack the s personal items carefully. Find out the method of transfer and plan the move. Introduce the to everyone at the new unit. When leaving the room, report to the nurse in charge of the. Demonstrate the procedure: Transferring a. Have the students return the 6. Explain the nursing assistant s role in the discharge of a textbook pp. 146-148 workbook p. 57
65 Review the responsibilities of a nursing assistant during the discharge of a : Collect s belongings and pack them carefully. Be positive and reassuring. Know if the will need a wheelchair or stretcher. Remind students that the nursing assistant is responsible for the until she is safely in the vehicle, with the vehicle s doors closed. Demonstrate the procedure: Discharging a. Have the students return the 7. Describe the nursing assistant s role during physical exams textbook pp. 148-149 workbook pp. 57-58 Remind students that physical exams can be embarrassing and uncomfortable, and that part of their role during an exam will be to help s by listening to them, talking to them, or holding their hand. Review some of the equipment that nursing assistants may be responsible for gathering for the nurse or doctor: Sphygmomanometer Stethoscope Alcohol wipes Flashlight Thermometer Tongue depressor Eye chart Tuning fork Reflex hammer Otoscope Ophthalmoscope Specimen containers Lubricant Hemoccult card Vaginal speculum Gloves Drape Display Transparency 9-1 body positions for exams Dorsal recumbent Lithotomy Knee-chest Stress that students should expose only the parts of the body being examined and that s should be told why the position is needed and how long the can expect to stay in the position. Review additional guidelines for assisting during an exam: Wash hands before and after exam. Provide privacy measures. Provide light for doctor or nurse. Collect and label specimens as needed. Listen to and help him remain calm. Follow doctor s or nurse s instructions. Make sure does not fall. Put instruments in proper place and hand them to doctor or nurse. Follow Standard Precautions. Chapter Review Exam distribute chapter 9: exam (appendix c, pp. 307-308) Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Answers to Chapter Review in Textbook 1. Answers include: Do the staff seem courteous and friendly? Do most of the staff speak the
66 s native language? Is an interpreter available? Are there enough staff members on duty at the facility? What is the ratio of nurses and nursing assistants to s? How is the facility staffed on evenings and weekends? Are foul odors present? What is the food like at the facility? Is attention paid to individual food preferences? Is a dietician available for meetings? Are s up and dressed in the morning? Do staff interact positively with the s? Do staff speak courteously to other staff members? Do s look groomed, taken care of, and happy? How are s complaints resolved? Is the facility licensed? Have the state survey and other inspection results been satisfactory? Does the facility explain Residents Rights? Does the facility provide assistance with activities of daily living (ADLs)? If so, how is it provided, and what are the associated fees? Are physical, occupational, and speech therapists available? How often do falls, infections, and pressure ulcers occur? Do volunteers work with s? If so, are their interactions positive? How involved can the family be in creating the s care plan? Does the facility provide the level of care the needs? What about future needs? Is the environment safe, functional, and homelike? Is there an activities department? What kinds of activities are offered? What are the steps to take if a wants to move out of the facility? What policies does the facility have on advance directives and end-of-life decisions? 2. Answers include: The move into a facility may have been sudden, due to health reasons. They may have had to leave their home and get rid of their personal belongings. They may have had to give away beloved pets. Loved ones may have died. New s may be experiencing fear, loss, anger, and uncertainty, along with a decline in health and independence. 3. Answers include: Have a positive attitude. Be tactful. Communicate clearly. Show respect for s belongings. Be responsible; if you make a mistake with care, report it to the nurse immediately. Be honest; do not make promises you cannot keep. Listen to s if they want to talk. Pay attention to s wishes; if they choose to be alone, honor this decision. Respect s privacy. Be patient and kind. Allow s to adapt at their own pace. 4. To get information on the s personal preferences, history, rituals, and routines 5. Answers may differ, but could include: It helps the feel more comfortable. It may also make the family feel better. 6. Zero 7. Answers include: Change is always hard. The may have an illness or his condition may have worsened. 8. When the and his belongings are in the vehicle and the vehicle s doors are closed. 9. Dorsal recumbent position: A person in this position is flat on her back. The knees are flexed and feet flat on the bed. The drape is put over the, covering her body. Her head remains uncovered. Lithotomy position: The lies on her back and her hips are brought to the edge of the exam table. Her legs are flexed and her feet are in padded stirrups. The drape is put over the, covering her body. Her head remains uncovered. The drape is also brought down to cover the perineal area. Knee-chest position: A in this position is lying on his or her abdomen. The knees are pulled towards the abdomen and legs are separated. Arms are pulled up and flexed. The head is turned to one side. The will be wearing a gown, and possibly, socks. The drape should be applied in a diamond shape to cover the back, buttocks, and thighs. 10. Answers include: by draping the ; by closing the privacy screen or curtain; and by closing the door 11. Answers include: sphygmomanometer; stethoscope; alcohol wipes; flashlight; thermometer; tongue depressor; eye chart; tuning fork; reflex hammer; otoscope; specimen containers; lubricant; Hemoccult card; vaginal speculum; gloves; drape.