Certified Nurse Aide

Annual In-service Education

Module 2: Resident Rights

Before beginning this course, ensure that your computer meets the following system requirements.

Certified Nurse Aides are not required to take the Health and Human Services Commission computer-based training if they are fulfilling the requirement through a nursing facility or another approved Nurse Aide Training and Competency Evaluation Program (NATCEP).

Click here to access available trainings in your region.

More details on Texas nurse aide rules and requirements are outlined in the Texas Administrative Code: TAC, Title 26, Chapter 556: Nurse Aide

1. Texas Long-term Care Overview - 2 hours

2. Resident Rights- 2 hours

3. Quality of Resident Care- 2 hours

4. Infection and Infection Control - 2 hours

5. Dementia and Dementia-related Disorders - 2 hours

6. Resident Care for Dementia-related Conditions (including Alzheimer's Disease) - 2 hours

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The Texas Nurse Aide Registry (NAR) renewal process requires all CNAs to complete 24 hours of approved in-service education over a two-year period.

There is no way to create a lost certificate of completion without taking or retaking the course. If you do not keep a copy for your records, you will need to repeat this course.

• Identify residents' rights that are protected by federal and state laws

• Determine ways to care for a resident's environment that provides privacy, respect and safety

• Identify procedures for end of life and post mortem care

According to the Texas Administrative Code (TAC), Title 26, Chapter 556 a resident is any individual residing in a nursing facility.

Under Texas law, any person who is authorized to act on a resident's behalf when they are incapacitated (known as the resident's surrogate or representative) is covered under the term "resident".

Residents living in a nursing facility can expect the same rights, benefits, responsibilities and privileges granted by our laws.

During surveys of nursing facilities, one of the most frequently cited tags is F550: Resident Rights/Exercise of Rights.

The regulation states that "the resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility."

Resident rights included under F550 include:

• The right to be treated with respect and dignity;
• The right to be provided care in a manner and in an environment that promotes maintenance or enhancement of quality of life, recognizing each resident as an individual;
• The right to equal access to quality care regardless of payment source, severity of condition or diagnoses, including for provision of discharges and transfer/discharge; and
• The right to exercise rights as a resident of the facility as well as a citizen/resident of the United States and the right to exercise these rights without interference, coercion, discrimination or reprisal from the facility

Each resident has the right to be treated with dignity and respect.

The resident has the right to:

• Live in safe, decent and clean conditions;
• Be free from abuse, neglect and exploitation;
• Be free from discrimination based on age, race, religion, sex, nationality, disability, marital status, or source of payment;
• Practice individual religious beliefs;
• Keep and use personal property, secure from theft or loss;
• Choose and wear preferred clothes;
• Be free from any medical restraints (physical or chemical) used for discipline or convenience; and
• Receive visitors.

Each resident has the right to freedom of choice.

Residents can:

• Make individual choices regarding personal affairs, care, benefits and services;
• Choose a physician at the individual's own expense or through a health care plan;
• Manage individual financial affairs in the least restrictive method, as allowed by law;
• Access money and property deposited with the facility and have an accounting of individual money/property deposited and spent;
• Participate in activities inside and outside of the facility;
• Use electronic monitoring device owned and operated individually or provided by a legal guardian;
• Refuse to perform services for the service provider;
• Use advance directives as legally defined; and
• Designate a legal guardian if, necessary.

Every morning, you assist Mrs. Meyer with range of motion (ROM) exercises. Today, she decided she did not want to participate and tells you to leave the room.

What do you do?

Check your answer here!

Each resident has the right to privacy and confidentiality. Residents can expect:

• Complete privacy during a visit, phone call or while using a computer;
• Privacy during the care of personal needs;
• Information in records maintained by the facility; and
• The sending/receiving of unopened mail.

HIPAA protects the privacy of individually identifiable health information and includes:

• HIPAA Security Rule
  • National standards for protecting electronic health records
• Patient Safety Rule
  • Protections in place to de-identify a patient when info/data is used for improving patient safety

As a CNA, it's important to understand HIPAA privacy regulations and what is meant by Protected Health Information (PHI).

PHI is individually identifiable health information maintained or transmitted by the facility for all residents and employees.

PHI involves any information about the resident, including his/her medical record/chart and information on his/her demographics, finances and lifestyle.

PHI comes in many forms at the facility, including paper, electronic and spoken information.

Facility employees are responsible for protecting IIHI while caring for residents. This term defines any information that might identify a resident such as his/her:

• Name
• Address
• Date of birth
• Social security number
• Medical record number
• Family member names
• Photos.

The "Need to Know" rule states that protected health information should only be used, or disclosed, as necessary to perform your job duties. Accessing resident information that you do not need to perform your job duties at the facility is a violation of HIPAA policies.

An example would be searching for information about co-workers, family members, or friends while working at the facility and using the facility's computer system or medical records system. Violations of HIPAA policies may have severe penalties.

Please refer to your facility's policies and procedures for details.

Click here for a more in-depth discussion of HIPPA.

Twitter, Facebook, blogs, Instagram, TikTok, online forums - the options are endless when we talk about platforms involving social media.

The long list of choices and methods for using social media make it necessary to review the guidelines for social media use as a CNA.

Additional policies and procedures may exist that are not outlined here. Check with a supervisor at the facility for the complete list.

Boundry areas to consider when using social media

Listed are several areas where the use of social media by a CNA may cross a line with legal penalties, possibly even risking the loss of employment at the nursing facility.

According to the National Council of State Boards of Nursing (NCSBN):

" Confidential information should be shared only with the patient's informed consent, when legally required or where failure to disclose the information could result in significant harm. Beyond these very limited exceptions, a nurse or nurse aide is obligated to safeguard confidential information."

Federal law reinforces and further defines privacy through the Health Insurance Portability and Accountability Act (HIPAA).

Let's review an example involving Angie, a CNA working in a nursing home.

Last week, Angie took a photo of Sylvia, a 95-year-old resident with Alzheimer's disease, on her personal cell phone while working. Angie asked a visiting family member, who agreed to take the photo of Angie and Sylvia together.

Angie posted Sylvia's photo on her Facebook page with this caption: "This is my 95-year-old Alzheimer's patient who is courageous and joyful every day! She is the reason I am so proud to be a CNA!"

In the photo, Sylvia's room number was also visible, and the photo was geotagged by the phone device. Other staff members saw the Facebook photo and reported it to the facility. Days later, the nursing home administrator called Angie into her office for a meeting.

What boundaries were crossed?

Each resident has the right to the freedom of information. This right includes, but is not limited to:

• Receiving a detailed written statement upon admission of rights, rules and regulations while in the facility;
• Receiving an agreement describing the services provided by the facility and the related charges;
• Receiving information on Medicare or Medicaid benefits;
• Receiving a copy of the Statement of Resident Rights and to be informed of revisions;
• Being informed in a language each resident understands about total medical condition, recommended treatment and expected results (including reasonably expected effects, side effects and associated risks); and
• Being notified whenever there is a significant change in his/her condition.

Each resident has the right to participate in his/her individualized care process. This can include:

• Receiving all care necessary to attain and maintain the highest possible level of health;
• Developing a plan of care;
• Refusing any treatment, care or service;
• Refusing participation in experimental research;
• Receiving information about prescribed psychoactive medications from the medical professional who either prescribes the medication or their designee;
• Refusing to consent to the prescription of psychoactive medications;
• Accessing personal and clinical records, which will be maintained as confidential and may not be released without resident consent; and
• Communicating in the resident's native language to acquire or to receive treatment, care or service.

When considering a facility transfer, or a discharge, each resident may:

• Refuse a transfer from a specific area within the facility;
• Discharge himself/herself from the facility, unless the resident is deemed not mentally competent;
• Receive a 30-day written notice of transfer/discharge;
• Appeal the discharge within 10 days of receiving notice in a Medicaid facility; and/or
• Be readmitted if the nursing facility can meet his or her needs.

Any resident has the right to:

• Complain about care or treatment, and receive a prompt response to resolve the complaint;
• Make a complaint or grievance without fear of retaliation or discrimination; and
• Organize or participate in any group that presents residents' concerns to the administrator of the facility (for example, a resident Council at the facility).

A CNA may be reported for an act, or acts, in violation of a resident's rights. An act may involve abuse, neglect and/or misappropriation of the resident's property. CNAs must have a clear understanding of these terms and their definitions. A CNA must also understand the severity of penalties involved if a violation is reported, investigated and proven.

Five ways to ensure a resident's right to privacy is not violated:

• Ask permission first to do anything for the resident in all situations.
• Allow the resident to be as independent as possible (but safe!).
• Maintain a respectful attitude.
• Provide safety, protection and care with residents in all situations.
• Provide privacy in care settings (use covers, draping, privacy curtains and knock before entering a room).

There will be times in your career as a CNA that you will encounter a resident death. It is important to provide the resident, family and staff with as much support as possible

Coping with Death

Residents and staff may go through many emotions as they experience feelings about a resident's impending or recent death.

Emotions related to grief or loss may occur simultaneously, or in different phases, and may include feelings of sadness, anger and depression.

Signs of Impending Death

Warning signs of impending death include:

• Drowsiness, increased sleep and/or unresponsiveness
• Confusion of time, place or people
• Withdrawal
• Loss of appetite
• Loss of bladder and/or bowel control
• Decrease in urine output
• Skin is cool to the touch, especially the hands and feet
• Rattling or gurgling sounds while breathing
• Increased difficulty controlling pain levels

Honoring Choice

CNAs may already be familiar with the resident, his or her beliefs and preferences. CNAs may also be familiar the resident's family and circle of friends.

Talk with a supervisor for professional/emotional support at work if the end of life process with a resident is personally uncomfortable.

For example, a CNA may be experiencing death from a closer perspective for the first time.

Understand that religious or spiritual professionals may visit the resident during the resident's end of life process. Residents may also ask a CNA to read a spiritual text or prayer during this time.

Sensitivity

Privacy and dignity considerations:

• Follow privacy rules according to the facility's policies.
• Be aware of family concerns and needs during this sensitive time. Emotions may run high.
• Maintain a respectful attitude.

The following slide will include a short knowledge check to help you demonstrate your understanding of the content provided.

Remember to keep your own record of all six in-service certificates.

To verify two credit hours for Module 2:

• Please review your score. You must receive a 70 or above to pass the course.

• Be sure to screen shot your score before printing! Save this to your desktop for easy access.

• Print or save electronic copies of your learning certificate for your records.