[Music] [Music] never before have there been so many opportunities for nurse assistants as there are today in long-term care as you're probably aware people are living much longer in the United States by the year 2030 the number of older people in this country will double to over 70 million one of every five people will be elderly long-term care facilities have many staff but most care is given by nurse assistants therefore as a nurse assistant you will have the greatest impact on residents in long-term care facilities career opportunities in long-term care are constantly growing as you become involved today you will be helping to shape the future of long-term care in the role of a nurse assistant you will be providing about 80% of all residents care while other team members are involved you have more contact with residents than anyone else in the healthc care team you are closer to Residents than anyone else in the facility you have a very very privileged role because you're in a position to give excellent care to Residents you already know that a longterm care facility is a place where people live and receive care in your career as a nurse assistant you will learn to balance the science or skills of nursing which are the tasks you must perform with the art of caregiving which is your personal caregiving style these two are equally important and must work together if either is missing you cannot give quality care and meet your resident's needs for quality of life in this video you will learn how to perform a number of important skills you will use as a nurse assistant the skills are structured to balance the Art and Science of caregiving this is because these skills are based on themes of care that when followed will lead you to striking this critical balance at this point you may be asking yourself how you will do that what does it mean to provide care and balance the Art and Science of caregiving while everyone has their own style of caregiving the themes of care are embedded in each of the skills in this video there are eight themes four that are caregiving themes and three that are nursing themes the eighth theme is a general theme the caregiving themes are communication autonomy respect respect and maximizing capabilities the nursing themes include safety infection control and observation the eighth theme is a general theme of care time management managing your time will ensure that you conduct your work in an efficient manner by learning the skills the way they are demonstrated with attention to each of these eight themes you will be balancing the Art and Science of of caregiving each of the skills in this video is organized into four parts one you will consider your resident capabilities two you will prepare and get ready to do the task three you will do the task or procedure and four you will complete or finish the task for each skill or task you perform you should start by preparing yourself your resident and the environment M by obtaining and organizing your equipment and considering the care plan residents preferences and common preparation steps you will be seeing this icon appear at the beginning of each skill presentation it will be a reminder to always consider the preparation steps applicable to your resident the most common preparation steps you will use are checking your resident's care plan knocking on the door and waiting for permission to to enter introducing yourself by name and saying you are the nurse assistant caring for them checking your resident's identification according to your facility's policies telling your resident what you would like to do and asking if the timing is all right determining your resident abilities so you can maximize their capabilities and determine what equipment is needed explaining what you're about to do Gathering supplies located outside your resident's room Gathering supplies that belong to your resident preparing the equipment and environment providing privacy by closing the door or pulling the curtain washing your hands before preparing the environment if needed and always before touching your resident wearing gloves goggles mask and gown when needed offering help with the task but only as needed using the proper container to dispose of dirty items observing your resident and asking yourself about anything You observe talking to your resident while you're performing the task talk talking to your resident about anything they may need this video will demonstrate how to perform more than a dozen procedures you will use every day each procedure is shown step by step in each procedure you will see how the nurse assistant balances the Art and Science of caregiving after you have finished performing a skill there are suggested completion steps that will enable you to practice the eight themes of Care on a daily basis you will be seeing this icon appear at the close of each procedure it will be a reminder to always consider the completion steps applicable to your resident the most common completion steps designed around the eight themes are completing the skill without any distractions or interruptions and using good body mechanics providing for your residents Comfort making your resident comfortable with proper positioning and body alignment checking with your resident to be sure everything is satisfactory putting the call light or other call device close to your resident making sure the bed is lowered disposing of all used items in their proper containers removing your gloves and disposing of them in the proper container washing your hands recording the completed procedure in your resident facility records reporting any changes in your resident or the environment to the charge nurse remember the saying it's not what you do but how you do it or did you ever hear anything worth doing is worth doing right care for your resident considering both the quality of your caregiving and the quality of your resident's life the themes will be your guide for performing all skills beginning to end they will help you always give Quality Care imagine you are your resident with a chronic disease every day can be a challenge in some cases the only person they can count on is you and the hope that you will care in this segment you will learn the important skill of hand washing as you know no procedure is more important than washing your hands to prevent the transmission of disease and infection handwashing is one of the key preparation steps you will complete before beginning each skill almost any time is a good time to wash your hands at work but at certain times we must all wash our hands before and after each shift worked before and after every every resident contact between various care activities after helping the resident toilet and before you help with the bath after using the bathroom before and after handling food after handling anything you think is contaminated or dirty after contact with blood or body fluids before and after cleaning an area before and after handling body fluids collected for testing after smoking a cigarette after removing gloves after covering a cough or sneeze after blowing your nose every facility has readily accessible hand washing areas before washing your hands check the sink soap dispenser and towel dispenser ask yourself will I contaminate my hands touching these items after I wash my my hands if the answer is yes then prepare the environment to prevent later contamination of your hands when soap and water are not available for washing your hands or other body areas apply an antiseptic hand cleanser and rub your hands thoroughly until they are dry as soon as possible wash your hands with soap and water wash your hands with soap and lukewarm running water immediately before and after all care procedures proper proper hand washing is required to adequately cleanse the skin of contamination by potentially infectious microorganisms once you have determined the environment is ready remove your watch and roll up your sleeves you may not want to wear jewelry so you don't have to constantly remove it for hand washing if you do not remove your watch and Rings be sure to wash rinse and dry under them turn on the water to a comfortable temperature wet your your hands and wrists apply soap to your hands rub your hands together in a circular motion with friction for 10 to 15 seconds lace your fingers together to wash in between them clean under your nails use a nail brush or orange stick or rub your nails briskly in your palm to clean them because acrylic or silk nails are difficult to clean under and may Harbor back bacteria they should not be worn rinse your hands with warm water keeping them downward allowing the water to run from the wrist to the fingers get paper towels from the dispenser if you have to touch the dispenser to remove the towel you must have the towel ready before you start so you do not contaminate your hands dry your hands with paper towels start at the top of the fingers and work downward toward the rib wrists turn off the faucets with a paper towel discard paper towels and appropriate receptacles you may use a lotion on your hands if they are dry this will prevent them from cracking as you know handwashing is one way to break the chain of transmission practice the procedure carefully and consistently this skill will demonstrate how to make an occupied bed some residents cannot get out of bed for these residents changing their linen and making their bed will require that you do so while they are in the bed creating a homelike environment helps your resident feel safe and comfortable think about how important your home is to you so you can help your resident feel like their room space is their home to make an occupied bed you will need the following supplies a draw sheet two flat sheets or a fitted and a flat sheet if the facility uses fitted sheets a blanket and spread as needed a pillow case for each pillow on your resident's bed a disposable incontinence sheet if needed by the resident and a laundry bag for used linen Mrs Johnson yes it's Ellen and Carolyn here to make your bed may we come in sure place the clean linen on a clean surface never place clean linen on the floor or on other dirty surfaces this will result in contamination of the clean linen you will be putting on your resident's bed as always before you begin consider the common preparation steps referred to in this video introduction okay thank you you're welcome put the head of the bed flat keep in mind that you only want to lower the head of your resident bed if it is comfortable for your res resent in this flat position remove the spread in any blankets fold them and place them on your resident chair okay Mrs Johnson now we're going to loosen all the corners of your bed okay I'm going to need you to roll towards me can you lift your knees a little bit when making an occupied bed always roll your resident toward you which is safer than rolling your resident away from you two now that your resident is on her side your coworker can support your resident make sure she remains safe and assist with making the bed now check for any belongings in the bed Mrs Johnson I'm you're going to be feeling me rolling the dirty linen under your back okay okay I'm making your bed up for you okay thanks you're welcome roll lengthwise the bottom dirty sheets from the side of the mattress to the center of the bed close to your resident's body start with the bottom sheet unfold it lengthwise down the bed Center being careful not to shake the linen while you unfold it shaking linen raises dust and other organisms that could spread infection flat sheets are used at this facility if your facility uses fitted sheets those with elastic edging ask for instruction on how to put a fitted sheet on your resident's bed be sure you put the Hem seams toward the mattress which keeps the rough edges from touching your resident when they are sleeping this helps prevent skin breakdown and improves Comfort adjust the sheet so that the Hem is even with the foot of the mattress you will want the extra length of the sheet at the top to tuck it under the mattress open the bottom sheet as as you work be sure to keep the fold in the exact center of the bed from head to foot after opening the bottom sheet fanfold it lengthwise so that one half of the sheet is next to the rolled used sheet tuck the top hem in tightly under the mattress at the head of the bed next make a mitered corner which is also called a hospital Corner face the outside of the bed with one hand pick up the top of the sheet hanging down the side of the bed and lay it on top of the bed this makes it look like a triangle next tuck the remaining sheet under the mattress drop the section of sheet from on top of the bed over the side of the bed and tuck it in continue tucking the remaining sheet under the mattress neatly starting from the mitered corner down to the foot of the mattress next take the draw sheet a draw sheet is often used for residents who need help with moving and positioning or sometimes to keep bottom sheets clean and dry open up the draw sheet and place it in the center of the bed so it covers the middle part of the bed tuck in the draw sheet on your side fold the excess and tuck it in with the sheet you may also put any needed disposable incontinence pads over the draw sheet flatten the rolled sheets and let your resident know that she will be rolling over the Linens as she turns toward you you going to feel a pile of lining under your back I'm going ask you to roll over a little bit to me please once safely on the opposite side you can support your resident and make sure she remains safe while your colleague makes the other side of the bed your coworker can begin to make The Other Side by removing the linen you should never leave your resident unattended to take away used laundry put the used sheet in the laundry bag if it is in the room or at the bottom of the bed between the mattress and footboard pull the clean linen toward you until it is completely unfolded and Tuck the sheets in tightly the same way as you did on the other side tuck in the draw sheet if you us okay Mrs Johnson now that we've changed the linen you can roll back onto your back into the center of the bed one two three okay okay thank you place the top sheet on the bed over the sheet covering your resident as you do this be sure the wide hem is at the top with the seam on the outside so the smooth side will be next to your resident's skin open the sheet from the fold so that the sheet hangs evenly on each side of the bed the excess sheet will go over the foot of the bed ask your resident to hold on to the clean sheet then carefully remove the used top sheet by placing your hand under the CL clean top sheet and rolling the used sheet down toward the foot of the bed if the resident prefers a blanket place it over the top sheet place the spread on top in the same way you did the top sheet tuck in the Linens including the spread at the foot of the bed and make a mitered corner at the bottom ends smooth the Linens making sure they are not so tight that they are pressing on your resident's feet now that the bed linen has been changed you will need to replace the pillowcase hold the center of the closed end of the pillowcase with your hand and turn it inside out over your hand then grab the pillow with your hand inside the pillowcase and Slide the case over the pillow adjust the pillowcase as needed making sure the corners of the pillow fit into the corners of the case place the pillow under your resident's head return the bed to the lower position and finish the skill remembering to check your resident's environment and asking yourself and your resident whether you have met their needs and consider the applicable completion steps for closing the skill shown at the introduction keep in mind that the bed is only one part of your residence environment you also take care of the bedside table over bed table other furniture and your residence belongings think also about finishing touches you can add to make your res resident's room feel warm friendly and more comfortable moving up in bed when your resident is unable to help helping your resident move and be comfortably positioned is one of the most important things you will do as a nurse assistant remember that the centers for Medicare and Medicaid guidelines say that all long-term care facilities must ensure that residents abilities for the activ activities of daily living do not diminish unless their health deteriorates a primary activity of daily living is moving about freely statistics indicate that the leading cause of injury to nurse assistance involves incorrect body mechanics when moving and lifting these injuries often occur because of poor planning when moving or positioning your resident for your safety and your residents before you try to move or position any Resident decide whether you need help you may need help for many reasons if you are unsure how your resident will respond to your help if you do not know your resident well or if you're uncomfortable lifting your resident by yourself be safe and get help always get help if you are unsure at all hi Caroline hi Haren how are you doing today I'm doing pretty good that's good um do you have a few minutes yeah I have Mr Smith in 103 and I need to reposition him do you think you could give me a hand oh sure as always before you begin consider the common preparation steps referred to in this video introduction good morning Mr Smith it's Ellen and Carolin here to help you move up in bed can we come in yes you may if your resident is Supine and needs help moving up down or to the side of the bed for personal care or repositioning remember to First Position the bed for the the move put the head of the bed flat if your resident can tolerate it and move the pillows against the headboard that's great good communicating with residents and your coworker is important Serious injury can occur if someone does not understand how the move is to be done be sure to talk clearly with your resident about their role for residents who are able to have them bend their knees this will help with the move roll the draw sheet up from the side toward your resident until you and your helper both have a tight grip on it with both hands keep your palms up if that gives you more strength for moving you can put one knee on the bed to get as close to your resident as possible if needed place a barrier on the bed to protect your uniform if your resident is able ask him to lift his head off the bed during the move one two three use good body mechanics during the move then unroll the draw sheet and tuck it in on both sides be sure to eliminate wrinkles in the sheet and make sure your resident is in proper body alignment after completing the procedure consider the applicable completion steps and your call is right here and see if there is anything else you can help with how's that that's great good this skill will demonstrate how to turn your resident from the Supine position to a sid lineing position for personal care good evening Mrs Sullivan I'm Ellen I've come to give you a backrub before bed oh great let me just wash my hands first thank and before you begin consider all the applicable common preparation steps referred to in the video introduction how are you feeling pretty good good okay I'm going to lower your head and just raise up the bed all right as with all moving and positioning skills you'll want to assess your resident your own capabilities and the environment you'll want to use good body mechanics and communicate so that your resident will know what to expect and will be able to participate as much as possible now this one great that feel okay okay now I'm going to reach across you and then on the count of three if you can help we'll turn towards me all right one two three now continue with personal care followed by the common completion [Music] steps this skill is the stand pivot transfer transferring means moving your resident from one surface to another such as from a bed to a chair a chair to a toilet a bed to a commode and so on when transferring your resident safety is a key factor the stand pivot transfer is one of the most commonly used transfer methods good afternoon Miss Mercedes how you doing may I come in okay I'm here to help you to go to lunch okay with your whe chair but before I do that I'm going to get myself set up first okay so so you just give me a minute and I'll be right back okay as always remember to prepare yourself your resident and the environment and consider the common prepar a steps before demonstrating this skill the nurse assisted Mrs Mercedes to a sitting position at the side of the bed because of Mrs Mercedes steadiness another nurse assistant is not necessary for this transfer for the safety of your resident and the nurse assistant a guard belt around your resident's waist will help with balance and prevent injury the belt prevents residents from straining or injuring their arms or legs residents also often feel more secure moving when a guard belt is used you will want to explain the use of the guard belt to your resident before you put it on never use a guard belt with a resident who has a broken rib abdominal wound an abdominal tube such as a g tube or an abdominal opening such as a colostomy lift your arm up good okay are you feeling okay place the belt around your resident do not make it so tight that you cannot get your fingers under it to hold it when transferring your resident are you okay yes okay now let's get the STA lift up your feet for me lift your feet up stand in front of your resident ready Place one of your legs between the resident's legs this will give you better control over the speed and the direction of the movement have her push down on the bed with her hands and lean forward to a standing position now turn around once your resident is standing keep your back neutral and body facing forward and pivot to turn her until the backs of her knees are against the wheelchair ask your resident to reach back for the arm of her wheelchair with one or both hands have her Bend her knees to sit okay are you feeling okay I'm all right once seated if your resident is not well positioned help her to push back into the chair so she is comfortable during a transfer problems may occur for example you may lose your grip on the guard belt or resident your resident's legs may get weak and give out if a problem should occur use your legs to help steady your resident helping them to sit down again you will need to reassess how to to perform the transfer and you may need to get additional help before you move the wheelchair make sure the resident's feet are on the footrests or ask her to raise her feet off the floor finish the skill remembering to meet your resident needs and ensure the common completion steps are [Music] accomplished this skill will demonstrate how to move your resident using a mechanical lift if your resident cannot help with a transfer she will need to be lifted from the bed to the chair and back you can do this with two or more staff or a mechanical lift good afternoon Mrs Sullivan it's Ellen and Victoria we've come to get you out of bed we're gonna use the same lift that we used yesterday okay great you need to know how the mechanical lift in your facility Works always follow the manufacturer's instructions and never use any piece of equipment you are not familiar with before you begin consider all the applicable common preparation steps referred to in the video introduction there are various types of mechanical lifts most lifts have a base and frame on wheels that can be locked and unlocked a sling in different sizes that you can place under your resident and an arm that attaches the sling to the lift can you lift your legs a little bit great and cross your arms wonderful okay I'm going to reach across you on the count of three turn towards me one two three you comfortable I'm fine okay Mrs salivan I'm going to put this thinging underneath you okay so you're going to feel some pting under under your back okay okay okay I'm putting it now I can now I want you to turn towards me okay for safety and comfort the sling should be placed from under your resident shoulders to the back of the knees have the same amount of Sling material on both sides of your resident now I'm going to pass it underneath your legs okay okay I'll put this together and you're all set ready to be lift up from the bed to the chair okay okay I'm just going to raise the head of your bed make sure the wheels on the lift are locked into place securely before beginning the lift if your resident cannot keep her hands in her lap or across her chest try having her hold on to an object on her lap repeatedly ask your resident if she is okay reassure your resident because this can be a frightening experience especially the first time raise your resident 6 to 12 in over the bed used properly all lifts keep resident safe during a transfer and reduce the stress on your body when you move a dependent resident and remember at least two people are always needed to transfer your resident with a mechanical lift now that your resident has been lifted off the bed you will want to unlock the swivel or use the steering handle depending on the mechanical lift to move your resident directly over the chair as you do this your coworker may need to guide your resident's legs once the resident is over the chair lower her slowly while your coworker adjusts her position if the sling is designed to remain comfortably under the resident you may leave it under her for a period of time make sure your resident is positioned with proper body alignment after completing the procedure consider the applicable completion steps see to her Comfort place the call light where it can be easily reached finally ask if there is anything else you can do for your resident this skill will demonstrate how to provide denture care Dentures or false teeth are worn by people who have lost some or all of their natural teeth your resident may have full dentures meaning Dentures for both upper and lower teeth or partial plates that replace some teeth encourage your residents to wear their Dentures as often as possible to avoid gum shrinkage to improve their speech to help them chew food and to improve their appearance when Dentures are removed for a time always store them in a denture Cup in cool water or a commercial denture cleansing solution if your resident prefers Dentures should be cleaned at least twice daily before you begin consider all the applicable common preparation steps referred to in the video introduction my name is Victoria and it's almost time for breakfast and I was wondering if I can clean your dentures please thank you okay layout out and organize all the materials you will need for the Denture cleaning have everything easily accessible before you begin I'll be right back okay I'm going to get some things from the bathroom okay okay wash your hands carefully and thoroughly as demonstrated in the handwashing segment next fill the drinking cup and the Denture cup with cool water after you have cleaned the Dentures ask the resident if he wants to wear the Dentures or if you should return the Dentures to the container use a paper towel to turn off the running water and dispose of it properly close the door or Draw the curtain for privacy it is important that you put on gloves when providing denture care okay Mr Joe I'm going to put this towel on you so that we can place a towel over your resident's chest to avoid soiling His Garment pour some mouth rinse in an empty cup and have your resident begin with S pushing it in his mouth follow with some water okay okay make sure you wipe the resident's face if any water spills your resident might prefer to remove his own dentures if he would like you to remove them use a paper towel or tissue to grasp them a gentle rocking motion may be needed to loosen them as the Dentures are removed and the upper one to during the procedure always ask your resident if he has any discomfort or other needs remove the upper and lower dentures in the same manner Place both in the Denture cup for safety now I'm going to clean your mouth with this okay moisten the tip with water and gently swab all around the inside of your resident's mouth as well as his gums and tongue be sensitive to whether or not this isus cusing your resident any discomfort okay I'm going to go to the bathroom and clean your dentures okay gather all the supplies you will need to clean the dentures in the bathroom dentures and plates are expensive and must must be handled carefully to prevent breaking them for instance always use cool water on dentures since hot water can damage them place a towel on the bottom of the sink when you're cleaning the Dentures this helps prevent breaking if they slip from your hands hold the dentur over the sink and brush all their surfaces thoroughly clean both then rinse the Dentures with cool water and return them to the Denture Cup in this case your resident will be wearing the Dentures so he will not need to put them back in for breakfast but if your resident does not want to wear the Dentures put them back at this time store them safely by putting them into the Denture cup labeled with your resident's name and half filled with cool water can you please open your mouth while the Dentures are removed inspect your resident's mouth for any bleeding sores dry or coated tongue and odor if you notice anything be sure to report it to the charge nurse your resident may or may not choose to use denture cream okay I'm going to try to put your denture in again okay ask your resident if he would prefer to put them in himself or have you do it for him gently place the dentures in and ask the resident if he is uncomfortable or feels anything unusual are you feeling okay as with any skill finish up with the common completion steps and one infection control reminder be sure to replace your gloves anytime they are contaminated this skill will demonstrate how to shave a male resident how someone looks and the manner in which they take care of their appearance is very personal being a nurse assistant requires that you must really learn what it means to your resident to have someone else do or help with very personal things shaving is a daily activity for many male res resents when you are shaving your resident keep the following considerations in mind male residents can use an electric razor or a safety razor never share the same razor among different residents or recap disposable razors and discard disposable razors in a Sharps container always check with the charge nurse before shaving your resident to learn if there are any special considerations good morning Mr Jordan before you begin remember to perform the common preparation steps that apply to this skill see you this morning I'm going to shave you just give me a few minutes okay thank you lay out all the supplies you will need before you begin a basin shaving cream after shave a mirror the razor as well as a towel and washcloth a plastic bag and gloves then fill the Basin halfway with warm water next observe your resident's face for any moles rashes or Cuts be sure not to shave those areas or use extra care as to not cause a cut place a towel over your resident to protect his clothing next put on a pair of gloves because of infection control precautions gloves will be needed just in case you accidentally cut yourself or your resident while you're shaving him Mr Jordan can I ask your permission to take your glasses off make a mitt with the washcloth and wet your resident's face then apply the shaving cream when the beard is well lathered and softened start shaving shave in the direction the beard grows hold the skin tight and smooth by pulling the skin upward with one hand and shaving with a downward stroke with your other hand rinse the razor after each stroke or when the razor gets covered with shaving cream and hair be particularly careful with the neck chin and upper lip use upward Strokes for the neck downward and in slightly diagonal Strokes for the chin and very short downward Strokes above the lip use short even Strokes after you have completed shaving your resident use the mid again to wipe off any remaining shave cream after his face is completely clean ask if he would like to have aftershave applied give your resident a mirror so he can look at his face finally remove the towel from your resident's chest as with any skill close with the common completion steps this skill demonstrates care of your resident fingernails fingernail care includes daily cleaning and regular nail trimming although the visible part of the nail is not living tissue the skin around and under it is and you must protect this area from injury and infection trimmed smooth Nails also prevent your resident from accidentally scratching and injuring their skin your resident or your resident's family member may want you to use certain products for personal care like a fragranced lotion or special soap honor their requests and become familiar with these products after checking the care plan and confirming with resident that she would like you to provide Nail Care for her gather the supplies you will need bath Basin half filled with warm water towel washcloth soap lotion Orange Wood stick nail clippers nail file or Emory board hi Mrs petti it's Ellen I've come to do your fingernails I think that's very nice of you great okay and before you begin consider all the applicable common preparation steps referred to in the video introduction there we go now I'm going to put the tray front of you start out by laying out all the materials you will need for the Nail Care treatment okay I just need to get some warm water fill the Basin to comfortable height with lukewarm water put some soap in here in this Basin for you and then put both your hands into to soak okay allow your resident's hands to soak for three to five minutes how's that let me wash this one for you may you take the wrinkles out will we aim to please leaving one hand in the water wash and rinse your resident's other hand dry the hand and place it on a dry towel feels okay great I'm going to take this orange stick use the orange wood stick to clean under each of your resident nails after completing the first hand continue cleaning your residence Nails on the other hand great okay now let me just look at your hands after you have cleaned your resident's Nails inspect their hands for cracks in the skin unusual spots or discolor a and rough areas great okay now you have a few nails that look long so I'm just going to trim them for you thank you is that okay you too great trim your resident's fingernails using the nail clipper clip Nails straight across keep in mind that while you will also provide toenail care a podiatrist nurse or physician use usually trims toenails be sure to follow your facility's policy after completing both hands shape and remove any rough edges using an Emory board or nail file okay I'm going to give you a little lotion massage now make your hands nice and soft great okay let's see yeah beautiful yeah that is really nice they feel much better good and finally close with the common completion steps demonstrate how to assist residents with meals food and nutrition are an important part of life nutrition and hydration affect residents quality of life and quality of care in many ways good nutrition and hydration help maintain Skin Integrity help the body fight infections and disease maintain resident overall strength and functional abilities and maintain normal bowel and bladder functions and normal weight and energy stores when people age or become ill however their appetite often changes this can create a challenge for their care one of your most important duties as a nurse assistant is to help your residents with meals although you might think this is a simple matter of Common Sense it actually requires a lot of attention your ability to do it well directly affects residents nutritional status hello Miss Berry can I come in sure thank you Miss very it's lunchtime are you ready to go and eat yes can you give me a minute to wash my hands and before you begin consider all the applicable common preparation steps referred to in the video introduction residents more fully enjoy their meals when they are properly prepared before the meal help your resident as needed with grooming handwashing Oral Care and toileting and look good okay good have let help you encourage your residents to use their Dentures glasses and hearing aids these devices improve residents functional abilities and help them be more independent help your residents to the dining room or make them comfortable in their room if possible transfer them them from their wheelchair to a dining room chair residents should sit upright at a 90° angle with their feet touching the floor Miss Barry are you okay I'm fine Seth thank you you're welcome I'm going to wash my hand I'll be back in a minute okay thank before assisting with a meal wash your hands thoroughly this is an important part of infection control make your residence as comfor comtable as possible use clothes protectors or napkins to protect their clothing pass trays as quickly as possible to be sure cold foods are still cold and hot foods hot put yourself in your resident Place how would you feel if you were hungry and your tray was ready but no one came to serve it for 20 or 30 minutes when you remove the tray from the cart first check the diet card this tells you which tray goes to Which Resident make sure the tray is meant for your resident and make sure the diet appears correct remove the food from the tray put the plate directly on the table for a more homelike appearance remove any covers and underliners from the plate unless the person is not ready to eat and put them back on the tray in the cart remove any plastic wrap Lids or foil open cond and cartons ask your resident if they want assistance in cutting and seasoning their food encourage your residents to express their choices while serving the meal describe the menu enthusiastically like you your residents prefer familiar Foods their preferences may be based on personal religious Regional or ethnic factors make sure your resident is close enough to the table to reach her food and utensils and give her any help she needs such as cutting her meat or other food encourage her to be as independent as possible but watch for residents who need help if you cut the meat for her cut it in small pieces to prevent choking after you have served the first resident at the table move on to other residents at the same table serve all residents at a table before moving on to the next it is frustrating to watch others eat and maybe even finish their meal while you're still waiting such a delay detracts from the social pleasure of eating together after you've served residents check with them often to offer further help as needed or to encourage them to eat some residents respond to prompting some residents eat much more slowly than others how's it going is it okay mhm oh okay okay if your resident does not eat well or rejects a particular food offer to get a substitute every resident has the right to expect a substitute for something they do not want to eat residents should never leave the dining room hungry or be given food they cannot eat that's fine thank you you're welcome do you like dressing so I can put on your salad it's okay like it do okay be sure your resident has enough time to finish their meal remove the tray and make sure each resident's hands and face are clean and that they're comfortable thank you as with any skill finish up with the common completion steps keep in mind that the resident should not take food from the D din room to eat later unrefrigerated food increases the risk of foodborn illness meal time is much more than eating meal time should be pleasurable and enhance your resident well-being attractive surroundings Pleasant company and courteous service all increase residents enjoyment of their meals as a nurse assistant you will have a key role in ensuring this for your residents this skill will demonstrate how to feed your resident if they cannot feed themselves food and nutrition help people stay healthy and happy most people associate food with Pleasant activities and their social life at special occasions and holidays we often enjoy certain types of foods we all have our own food preferences and Customs think about why you eat what you eat our feelings about food and our appetite are affected by many factors and these factors can help you understand how residents eating may be affected as a nurse assistant you have a direct role in assisting with the maintenance and Improvement of your residents's nutritional status you can help prepare them for Meal Time support them when they need help offer them supplements throughout the day and interact with them while dining to make eating a more pleasant experience you can also report any change in their appetite so that they will receive appropri Medical Care hi Ty I'm coming to feed your lunch as always begin with the common preparation steps cover your resident with a clothing protector or a large napkin remember to preserve your resident's dignity at all times by asking their permission and protecting their clothing you are being sensitive to your resident and their needs T you have when serving the meal take Foods off the tray and put them on the table remove any plastic wraps Lids or foil open condiments and cartons ask your resident if they want any seasoning added to their food would you like black pepper no you like the dressing no okay describe the food items placed in front of your residence residents may not see well or may need to be oriented to the items on the plate describe the menu enthusiastically so that your resident looks forward to eating you want to drink the water yes encourage residents to help in any way possible such as by holding their cup if they are able some residents may need total assistance okay can't let me know what you want to eat first as you assist your resident be aware of food temperatures if the food seems too hot give it time to cool do not mix Foods together unless your resident prefers it use a spoon from which your resident can easily remove the food usually a teaspoon rather than a soup spoon fill the spoon no more than one half full filling it too much could lead to a portion that is too large for your resident and could cause choking too much food on the spoon could also result in spilling onto the resident or the floor encourage residents to eat more nutritious Foods first offer small bites making sure your resident swallows each bite before offering another feed your residents in a manner as close to normal as possible to preserve their dignity sit down next to your resident while feeding them speak softly to your resident and maintain eye contact while feeding do not rush your resident offer liquids between bites to keep their mouth moist allow your resident to decide what to eat and in what order encourage your residents to eat all of their meal as with all residents offer to get a substitute if they're not eating or refuse some food yummy yum yummy save dessert until last if possible be sure to have and show a caring attitude meal time is important to Residents and a wonderful time to socialize and get to know residents better when you're your resident is finished eating remove the remaining food and the tray and assist with Oral Care all right thank you're welcome Ty I'm giving as with any skill finish up with the common completion steps is it okay is there anything else I can get for you oh yeah well you get um got to have a laptop please oh sure I'll get it for you thank you you're welcome report your observations to the nurse report any changes with feeding such as nausea stomach aches choking or decreased appetite to the charge nurse reporting even the slightest change in your resident eating habits is important no okay well very good thank you Caroline you're quite welcome this skill will demonstrate range of motion restorative activities are activities that help residents regain or maintain their ability to care for themselves the most common restorative programs are range of motion exercises and walking range of motion should be performed on joints daily range of motion exercises move each body part this is called range of motion because each joint in the body is moved through its full range in active range of motion the resident moves the body part using her own muscle power in active assisted range of motion exercises you help the person to move the body part in passive range of motion you move the body part of the resident your resident doctor along with the physical therapist and nurse design your resident range of motion exercise program depending on their capabilities and motivation ask your super visor or the therapist if your resident has any restricted joints as with all skills follow the common preparation steps I'm here to help you do your range of motion exercise okay for your safety and your residence here are a few tips when you're assisting with range of motion maintain a broad base of support by keeping your feet 10 to 12 in apart always bend at your knees and not at your back use counting as a way to move in sync with other helpers and your resident the most common joints that are exercised through range of motion are the shoulder elbow wrist hand hip knee ankle and foot each joint is to be exercised on both the right and left sides now for some examples of range of motion motion exercises okay now I'm going to flex your elbow okay okay if you feel any pain let me know okay you feel anything you ready the first elbow exercises are called flexion and extension when you are moving a joint always have one hand above and the other hand below the joint generally the hand above the joint stabilizes the extremity holding it in place the hand below the joint brings the part through the range of motion now turn her Palm over keeping her elbow straight then turn her Palm back up this movement is called pronation and supination do each exercise five to 10 times depending on the resident's Comfort level with each extremity for wrist flexion and extension Bend her wrist down and then up watch the person's facial expressions because they may not always be able to tell you when they are uncomfortable now move her hand toward her little finger and then back toward her thumb this exercise is called oler deviation and Radial deviation encourage residents also to use their arms and legs throughout the day if your resident has an exercise program from the therapist motivate them to do these throughout the day okay after each joint is completed on both sides finish with the common completion steps this skill will demonstrate how to assist your resident with walking exercise is a restorative activity and should be part of your resident routine all residents benefit from exercise exercise improves muscle function and increases mobility and Independence encourage your residents to par participate in the exercise activities offered by their facility walking is important for Independence and is an excellent way for residents to exercise and maintain optimal function walking is also called ambulation the term gate refers to how someone walks if your resident needs help or supervision when walking you will need to know about their abilities as well as your own capabilities if your resident needs help or supervision when walking you will need to know about their abilities as well as your own capabilities do they use an assistant device how much help do they need to walk if any how much queuing do they need to stay safe do they need a brace prosthesis or other equipment how far can they walk safely how much weight can they place on their legs while walking do you need need another staff person to help and before you begin consider all the applicable common preparation steps referred to in the video introduction once you have determined your resident situation and abilities you can help them walk combine short walks with other activities such as getting out of bed coming back from the bathroom going to meals and going to activities encourage your residents who can walk on their own to do so throughout the day to begin put the guard belt on your resident never use a guard belt with your resident if they have a broken rib abdominal wound an abdominal tube such as a g tube or an abdominal opening such as a colostomy for the safety of your resident and you a guard belt around the resident's waist will help with balance and prevent injury the belt prevents residents from straining or injuring their arms or legs residents also often feel more secure moving when a guard belt is used you will want to explain the use of the guard belt to your resident before you put it on stand close to you to help you stand up all right okay can you lean forward a little bit great now on the count of three use your strength and we'll stand one two three wonderful how are you feeling you're okay okay okay going to come here and let's take a few small steps just starting out okay great if your resident walks without an assisted device stand at their side so that you can watch their face as you hold on to the belt from behind when walking in hallways with residents who do not use assistive devices encourage them to use the safety bars for added support if your resident uses a walker stand to one side with one hand on the back of the belt outer garments can hang over the belt some residents tend to act unpredictably when they are walking their legs may get tired and give out easily or they may become confused and sit without telling you in such cases have another person follow you with a wheelchair as you walk with them have theair ready for them if they suddenly need to sit after walking finish up with the common completion steps as a nurse assistant you are a teacher helping your residents learn or relearn information and skills that will help them maintain their level of independent functioning with your mindful attention to Residents physical and emotional needs and your knowledge you can promote their independent functioning and thus improve their quality of of life