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Admitting, Transferring, and Discharging
1. Describe how residents may feel when entering a facility
Residents may have to make many emotional adjustments before
entering a facility and may be experiencing any or all of the
following:
• Fear
• Uncertainty
• Anger
• Loss of health, mobility, independence, family, friends, pets,
plants
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Admitting, Transferring, and Discharging
1. Describe how residents may feel when entering a facility
REMEMBER:
Lesbian, gay, bisexual and transgender (LGBT) residents may
experience additional challenges when moving into a facility.
They may fear they will not be accepted or understood by staff or
other residents.
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Admitting, Transferring, and Discharging
1. Describe how residents may feel when entering a facility
Think about these questions:
What can an NA do to make LGBT residents feel welcomed and
accepted?
How should an NA behave if she believes homosexuality is
wrong?
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Admitting, Transferring, and Discharging
1. Describe how residents may feel when entering a facility
REMEMBER:
A LTCF is a resident’s home. It is essential for an NA to make
every resident feel as comfortable as possible, even if the
resident’s culture or lifestyle is very different from his own.
11 Admitting, Transferring, and Discharging
Handout 11-1: Quiz: You Are Moving!
Your house has been sold, and you need to move in with your
sister and her family for about six months or more. You need to
work out some problems; perhaps you will even be staying with
them permanently. You don’t know for sure. You will share a
room with your niece. Your space is six feet wide by 12 feet long.
There is a single bed, a chest of drawers, and a soft chair that
you can use. There is also a screen available for your privacy.
Decide what you will take with you. You can store anything you
do not take, but you will not have access to any stored items
until you move again.
11 Admitting, Transferring, and Discharging
Handout 11-1: Quiz: You Are Moving! (cont’d.)
Think of space. All six items must fit into your small room, or in
your half of the closet, which is a five foot by three foot space.
Name six things you will take with you. (Seven outfits of clothing
count as one item.)
1. _________________________________________________
_________________________________________________
2. _________________________________________________
_________________________________________________
3. _________________________________________________
_________________________________________________
4. _________________________________________________
_________________________________________________
5. _________________________________________________
_________________________________________________
6. _________________________________________________
_________________________________________________
11 Admitting, Transferring, and Discharging
Handout 11-1: Quiz: You Are Moving! (cont’d.)
During the first week, your niece, who is 5 years old, is looking at
one of your treasured things and accidentally drops and breaks it.
How do you feel?
It is now the second week. You have still not received any of your
mail, which you had notified the post office to forward. You
mention this to your sister, and she says offhandedly, “Oh, I did
see some here yesterday. I don’t know where it is.” Then she
walks out of the room. What is your response?
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Admitting, Transferring, and Discharging
1. Describe how residents may feel when entering a facility
Think about these questions:
• What did you decide to take with you to your sister’s?
• How did you feel as you tried to decide what to take?
• Did you get angry? Sad? Frustrated?
• How did you feel about your mail and your sister’s response to
you?
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Admitting, Transferring, and Discharging
1. Describe how residents may feel when entering a facility
REMEMBER:
• In many ways, our homes are our personal museums. They
house the souvenirs of our lives, the pictures of our families,
the decorative items we like, the furnishings we have chosen.
It can be very difficult to part with these things, even for a
short time.
• Residents’ Rights recognizes how important personal property
is by assuring that residents can bring belongings into the
facility as space permits, unless doing so would infringe on
the rights, health, or safety of other residents.
• You can probably understand why Residents’ Rights state that
the resident has the right to privacy in written
communications, including the right to send and promptly
receive mail that is unopened.
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Admitting, Transferring, and Discharging
1. Describe how residents may feel when entering a facility
Think about this question:
What might this exercise teach us about residents’ experiences
when they are admitted to a facility?
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Admitting, Transferring, and Discharging
2. Explain the nursing assistant’s role in the admission process
Define the following term:
baseline
initial values that can be compared to future measurements.
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Admitting, Transferring, and Discharging
2. Explain the nursing assistant’s role in the admission process
NAs should remember these guidelines for admission:
• Prepare the room before the resident arrives.
• When resident arrives, note the time and resident’s condition.
• Introduce yourself, giving your position. Address the resident
by his formal name.
• Do not rush the admission process.
• Make sure the new resident feels welcome.
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Admitting, Transferring, and Discharging
2. Explain the nursing assistant’s role in the admission process
Guidelines for admission (cont’d):
• Explain daily operations in facility. Offer a tour. Introduce
resident to everyone.
• Handle personal items with care.
• Honor resident preferences when setting up the room.
• Observe the resident for any problems that are missed during
admission.
Admitting a resident
Equipment: may include
admission paperwork
(checklist and inventory
form), gloves, and vital signs
equipment
1.
Identify yourself by
name. Identify the
resident by name.
2.
Wash your hands.
3.
Explain procedure to the
resident. Speak clearly,
slowly, and directly.
Maintain face-to-face
contact whenever
possible.
Admitting a resident
4.
Provide for the resident’s
privacy with curtain,
screen, or door. If the
family is present, ask
them to step outside
until the admission
process is over. Show
them where they can
wait and let them know
approximately how long
the process will take.
Admitting a resident
4.
•
•
•
•
•
•
If part of facility policy,
do these things:
Measures the resident’s
height and weight (see
procedures below).
Measures the resident’s
baseline vital signs (see
Chapter 14). Baseline
signs are initial values
that can then be
compared to future
measurements.
Obtain a urine specimen
if required (see Chapter
16).
Complete the
paperwork. Take an
inventory of all the
personal items.
Help the resident put
personal items away.
Provide fresh water.
Admitting a resident
6.
Show the resident the
room and bathroom.
Explain how to work the
bed controls and the call
light. Show the resident
the telephone, lights,
and the television
controls.
7.
Introduce the resident to
his roommate, if there is
one. Introduce other
residents and staff.
8.
Make sure resident is
comfortable. Remove
privacy measures. Bring
the family back inside if
they were outside.
Admitting a resident
9.
Place call light within
resident’s reach.
10. Wash your hands.
11. Document procedure
using facility guidelines.
Measuring and recording weight of an ambulatory resident
Equipment: standing/upright
scale or bathroom scale, pen
and paper
1.
Identify yourself by
name. Identify the
resident by name.
2.
Wash your hands.
3.
Explain procedure to the
resident. Speak clearly,
slowly, and directly.
Maintain face-to-face
contact whenever
possible.
4.
Provide for resident’s
privacy with curtain,
screen, or door.
Measuring and recording weight of an ambulatory resident
5.
5. If using a bathroom
scale, set the scale on a
hard surface in a place
the resident can get to
easily.
6.
6. Make sure resident is
wearing non-skid shoes
that are securely
fastened before walking
to scale.
7.
7. Start with scale
balanced at zero before
weighing the resident.
Measuring and recording weight of an ambulatory resident
8.
Help resident to step
onto the center of the
scale as needed. Be sure
she is not holding,
touching, or leaning
against anything. This
interferes with weight
measurement. Do not
force someone to let go.
If you are unable to
obtain a weight, notify
the nurse.
Measuring and recording weight of an ambulatory resident
9.
Determine the resident’s
weight.
Using a standing
scale: Balance the scale
by making the balance
bar level. Move the small
and large weight
indicators until the bar
balances. Read the two
numbers shown (on the
small and large weight
indicators) when the bar
is balanced. Add these
two numbers together.
This is the resident’s
weight.
Measuring and recording weight of an ambulatory resident
10. Help resident to safely
step off scale before
recording weight.
11. Record the resident’s
weight.
12. Remove privacy
measures.
13. Place call light within
resident’s reach.
14. Wash your hands.
15. Report any changes in
resident’s weight (when
weighing resident after
admission) to the nurse.
16. Document procedure
using facility guidelines.
Measuring and recording height of an ambulatory resident
For residents who can get
out of bed, you will
measure height using a
standing scale.
Equipment: standing scale,
pen and paper
1.
Identify yourself by
name. Identify the
resident by name.
2.
Wash your hands.
3.
Explain procedure to the
resident. Speak clearly,
slowly, and directly.
Maintain face-to-face
contact whenever
possible.
Measuring and recording height of an ambulatory resident
4.
Provide for resident’s
privacy with curtain,
screen, or door.
5.
Make sure resident is
wearing non-skid shoes
that are securely fastened
before walking to scale.
6.
Help resident to step onto
scale, facing away from
the scale.
7.
Ask resident to stand
straight if possible. Help
as needed.
8.
Pull up measuring rod
from back of the scale
and gently lower the rod
until it rests flat on the
resident’s head
Measuring and recording height of an ambulatory resident
9.
Determine the resident’s
height.
10. Assist the resident in
stepping off scale before
recording height. Make
sure that the measuring
rod does not hit the
resident in the head while
trying to help the resident
off of the scale.
11. Record height.
12. Remove privacy measures.
13. Place call light within
resident’s reach.
14. Wash your hands.
15. Document procedure using
facility guidelines.
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Admitting, Transferring, and Discharging
2. Explain the nursing assistant’s role in the admission process
REMEMBER:
NAs will weigh residents repeatedly during their stay, and any
change in weight should be reported immediately.
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Admitting, Transferring, and Discharging
3. Explain the nursing assistant’s role during an in-house transfer
of a resident
REMEMBER:
It is a resident’s legal right to be informed of transfers. The nurse
should explain the details of the transfer, and the NA will pack
the resident’s personal items carefully. Residents must always be
informed of any room or roommate change, as well.
Transferring a resident
Equipment: may include a
wheelchair, cart for
belongings, the medical
record, all of the resident’s
personal care items and
packed personal items
1.
Identify yourself by
name. Identify the
resident by name.
2.
Wash your hands.
3.
Explain procedure to the
resident. Speak clearly,
slowly, and directly.
Maintain face-to-face
contact whenever
possible.
Transferring a resident
4.
Collect the items to be
moved onto the cart.
Take them to the new
location. If the resident
is going into the
hospital, they may be
placed in temporary
storage.
5.
Help the resident into
the wheelchair (stretcher
may be used). Take him
or her to proper area.
6.
Introduce new residents
and staff.
7.
Help the resident to put
personal items away.
Transferring a resident
8.
Make sure that the
resident is comfortable.
9.
Place call light within
resident’s reach.
10. Wash your hands.
11. Report any changes in
resident to the nurse.
12. Document procedure
using facility guidelines.
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Admitting, Transferring, and Discharging
4. Explain the nursing assistant’s role in the discharge of a
resident
The nurse may discuss the following with a resident who is being
discharged:
• Doctor or physical therapy appointments
• Home care or skilled nursing care
• Medications
• Ambulation instructions
• Medical equipment needed
• Medical transportation
• Restrictions on activities
• Special exercises
• Special dietary requirements
• Community resources
Discharging a resident
Equipment: may include a
wheelchair, cart for
belongings, discharge
paperwork, including the
inventory list from admission,
resident’s care items
1.
Identify yourself by
name. Identify the
resident by name.
2.
Wash your hands.
3.
Explain procedure to the
resident. Speak clearly,
slowly, and directly.
Maintain face-to-face
contact whenever
possible.
4.
Provide for resident’s
privacy with curtain,
screen, or door.
Discharging a resident
5.
Compare the inventory
checklist to the items
there. If all items are
there, ask the resident
to sign.
6.
Put the personal items to
be taken onto the cart
and take them to pickup area.
7.
Help the resident dress
and then into the
wheelchair or onto
stretcher if used.
8.
Help the resident to say
his goodbyes to the staff
and residents.
Discharging a resident
9.
Take resident to the
pick-up area. Help him
into vehicle. You are
responsible for the
resident until he is safely
in the car and the door is
closed.
10. Wash your hands.
Discharging a resident
11. Document procedure
using facility guidelines.
Include the following:
•
Time of discharge
•
Method of transport
•
Who was with the
resident
•
The vital signs at
discharge
•
What items the resident
took with him (inventory
checklist)
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Admitting, Transferring, and Discharging
5. Describe the nursing assistant’s role in physical exams
REMEMBER:
NAs can help lessen residents’ fear and discomfort during exams.
Listening, talking, and light touching may all help.
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Admitting, Transferring, and Discharging
5. Describe the nursing assistant’s role in physical exams
NAs may have to gather the following equipment for the nurse or
doctor:
• Sphygmomanometer
• Stethoscope
• Alcohol wipes
• Flashlight
• Thermometer
• Tongue depressor
• Eye chart
• Tuning fork
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Admitting, Transferring, and Discharging
5. Describe the nursing assistant’s role in physical exams
Equipment an NA may gather for the nurse or doctor (cont’d):
• Reflex hammer
• Otoscope
• Ophthalmoscope
• Specimen containers
• Lubricant
• Special card to test for blood in stool
• Vaginal speculum
• Gloves
• Drape
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Admitting, Transferring, and Discharging
5. Describe the nursing assistant’s role in physical exams
Define the following terms:
dorsal recumbent position
body position in which a person is flat on her back with her
knees flexed and her feet flat on the bed.
lithotomy position
body position in which a person lies on her back with her hips
at the edge of an exam table; legs are flexed, and feet are in
padded stirrups.
knee-chest position
body position in which the person is lying on her abdomen
with her knees pulled towards the abdomen and her legs
separated; arms are pulled up and flexed, and the head is
turned to one side.
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Admitting, Transferring, and Discharging
5. Describe the nursing assistant’s role in physical exams
REMEMBER:
NAs should communicate to residents why exam positions are
needed and how long the resident can expect to stay in the
position.
11 Admitting, Transferring, and Discharging
Transparency 11-1: Body Positions for Exams
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Admitting, Transferring, and Discharging
5. Describe the nursing assistant’s role in physical exams
NAs should remember these guidelines for physical exams:
• Wash hands before and after.
• Ask resident to urinate and collect urine if needed.
• Provide privacy throughout.
• Listen to and reassure the resident.
• Follow directions.
• Help resident into proper position.
• Protect the resident from falling.
• Provide light to examiner.
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Admitting, Transferring, and Discharging
5. Describe the nursing assistant’s role in physical exams
Guidelines for physical exams (cont’d):
• Put instruments in proper places.
• Take and label specimens.
• Follow Standard Precautions.
• Assist with vision screenings as ordered.
• Help resident clean up, get dressed, and return to room.
• Dispose of trash and equipment.
• Clean and store equipment.
• Take labeled specimens to proper place.
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Admitting, Transferring, and Discharging
Exam
Multiple Choice. Choose the correct answer.
1. Which of the following is a reason that new residents may have trouble
adjusting to life in a care facility?
(A) They will have more independence in a facility.
(B) Their health is improving.
(C) They have had to leave their home.
(D) The other residents and staff are people they already know well.
2.
Which of the following should a nursing assistant do during a resident’s
admission?
(A) The NA should get the admission process completed as quickly as
possible.
(B) The NA should allow the resident to introduce himself to everyone in
the facility.
(C) The NA should explain how to work the call light and bed controls.
(D) The NA should place the resident’s personal items where the NA thinks
is best.
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Admitting, Transferring, and Discharging
Exam
3.
What is a nursing assistant’s responsibility during an in-house transfer of a
resident?
(A) The NA decides that the resident must be transferred.
(B) The NA must keep the fact that a transfer will occur a secret.
(C) The NA should pack all of the resident’s belongings.
(D) The NA should tell the resident’s roommate about the transfer.
4.
When a resident is going to be discharged, a nursing assistant should
(A) Give the resident ambulation instructions from the doctor
(B) Be positive and assure the resident that he is ready for this change
(C) Give the resident his last medication
(D) Decide which dietary requirements the resident will need
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Admitting, Transferring, and Discharging
Exam
5.
Before weighing a resident, the scale should be balanced at
(A) Zero
(B) Five pounds
(C) The resident’s last known weight
(D) Negative two pounds to account for clothing
6.
During a physical exam, a nursing assistant can help a resident by
(A) Avoiding a resident’s question if he asks why a position is needed
(B) Chatting with the doctor to pass the time
(C) Telling the resident funny stories
(D) Covering the resident and not exposing him more than is necessary
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Admitting, Transferring, and Discharging
Exam
7.
Baseline vital signs are
(A) Initial values that can be compared to future measurements
(B) Normal ranges for vital signs
(C) Vital signs that are out of normal range
(D) Changes in vital signs from one measurement to another
8.
How will a nursing assistant measure the height of a resident who cannot
get out of bed?
(A) The NA will use a scale.
(B) The NA will use a tape measure.
(C) The NA will estimate height by looking at the resident.
(D) The NA will not be able to measure height.
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Admitting, Transferring, and Discharging
Exam
9.
In which position is the resident placed for examination of the breasts,
chest, and abdomen?
(A) Knee-chest position
(B) Lithotomy position
(C) Dorsal recumbent position
(D) Trendelenburg position
10. Why might a resident need emotional support during a physical exam?
(A) Residents are always frightened of exams.
(B) Doctors are not very sensitive to their patients’ emotions.
(C) The resident has probably never had a physical exam before.
(D) The resident may fear what the examiner will find.
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Admitting, Transferring, and Discharging
CHAPTER 11 PRACTICE
1. Which of the following is a reason that new residents may have trouble adjusting to life in a care facility?
(A) They will have more independence in a facility.
(B) Their health is improving.
(C) They have had to leave their home.
(D) The other residents and staff are people they already know well.
2. Baseline vital signs are
(A) Initial values that can be compared to future measurements
(B) Normal ranges for vital signs
(C) Vital signs that are out of normal range
(D) Changes in vital signs from one measurement to another
3. In which position is the resident placed for examination of the breasts, chest, and abdomen?
(A) Knee-chest position
(B) Lithotomy position
(C) Dorsal recumbent position
(D) Trendelenburg position
4. Why might a resident need emotional support during a physical exam?
(A) Residents are always frightened of exams.
(B) Doctors are not very sensitive to their patients’ emotions.
(C) The resident has probably never had a physical exam before.
(D) The resident may fear what the examiner will find.
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Admitting, Transferring, and Discharging
CHAPTER 11 PRACTICE ANSWERS
1.
2.
3.
4.
CACD-
THEY HAVE HAD TO LEAVE THEIR HOME
INITIAL VALUES THAT CAN BE COMPARED TO FUTURE MEASUREMENTS
DORSAL RECUMBENT POSITION
THE RESIDENT MAY FEAR WHAT THE EXAMINER WILL FIND