Test. A Guide To - Ed

Training Program Outline (continued)5.Help patient relearn household skills.6.Help patient with eating, prepare meals (including special diets.)7.Assist with oral medications that can be self administered.8.Perform those household services which will facilitate the patient'shealth care at home and are necessary to prevent or postpone institutionalization.The training staff will seek these experiences with physician's orders from:The Health Department case load, from the DPW, from voluntary health agencies, fromhospitals and from personal contacts of staff and aides.

26142483Nurse (R.N.)Vocational HomeEconomistVocational HomeEconomistNurse (R.N.)Nurse (R.N.)NUrse (R.N.) andVocational HomeEconomistIII. Management ofthe HomeTV. Food for thePatientTOTAL NO. OFVII. Planning forPatient CareVI. Special ProceduresV. Basic NursingSkillsII. Approach toPatients andFamiliesI. The Home HealthAide3InstructorNurse and Vocational Home EconomistUnitNo.Hrs.InstructionTPR, hot water bottleOrientation to community agencies;Department of Public Welfare; Red Cross;Salvation Army; Good Willthe R. N.Plan own schedule for patient selected byTake TPR and prepare hot water bottle;observe administering of medicines inObserve othernursing home or hospital.special procedures, if possible.Complete patient care in home, nursing homeor hospital under direct supervision of R.N.Make record on patients cared for.Demonstration andreturn of: Bedmaking,bath, oral hygiene,backrub, moving thepatient, care of skinand hair, shaving.27Experience in hospital or nursing homekitchen (ADA dietitian on staff if possible)prepare and serve measured, low sodium andFeed patients.soft diet.Clean and arrange bathroom, kitchen andbedroom.Film and/or demonstration onsanitation and safety by P.H. sanitarian.Field trip may be included. Written evaluation on own home for safety and sanitation.Field trip to rehabilitation center.Field trip - nursing home, extended carefacility and/or hospital210Tour of Health Department.Preliminary Field ExperienceSuggested Activity2No.ofHoursPlan general and conva10lescent diet; planmeasured diet; prepareend set up trays.SuggestedActivitiesSUGGESTED SCHEDULEHOME HEALTH AIDE TRAINING

Social worker, nursing home operator, minister, psychologist, psychiatric nurse.Extension home economist, public health sanitarian, fireman.Dietitian (A.D.A.), Extension home economist.Physicians, dentists, and other R. N.'s or L. P. N.'s.(2)(3)(44)(5)xiiCounty medical director, physician.(1)Suggested Resource People:

HOME HEALTH AIDE TRAINING RECORDS AND REPORTSA.The following records should be filed in individual folders for eachaide trainee.1.Application form or forms./2.References.3.Observations during interviews.4.Test scores.2a.5.B.C.Suggested tests.(1)Life Satisfaction Test3(2)CATB test(3)Other tests by instructors.Physical record.a.Physicians' letterb.Physical screening testc.ImmunizationClass records file should contain:1.A schedule of the entire course.2.List of instructors and resource people.3.Narrative progress report on each student.4.4EValuation check sheet completed on each student.5.Record of class attendance and field experiences.Evaluation of program include:1.Eathods of initiating the program.2.Method of recruiting trainees.3.Tests given and screening methods used.4.Distribution of time.a.36 hours classroom instruction.

Home Health Aide Training Records and Reports (continued)5.b.24 hours of activities, demonstrations and return demonstrations.c.60 hours - preliminary on-job training.d.80 hours - field experience (on-job training).Employment of Aides.Appendix:1.Application for Home Health Aide Training.2.Observation during interview.3.Life Satisfaction Test.4.Evaluation check sheet.xiv

UNIT ITHE HONE HEALTH AIDE1

B.A.EthicsIntroduction2.1.Al AIMS,Introduction:STEPS4.2Agency policies regarding punctuality, meals,reCeiving gifts.Interpersonal relationships.3.Introductions,Confidentiality of personal and medical information.Common courtesies of daily living:conversation and conduct.Each trainee tell about2.1.self."Get acquainted" session:Preview of the entire course content, including classschedule.4.5.The place of the home health aide on the health team,functions of the home health aide.Place of home health care in the aver-all programof the agency. Brief explanation of relationshipof local agency to the pavent state and Federalagencies.Home health care is the care in his awn home of thesick and injured.3.2.1.KEY POINTSAide handbookDistribute aide handbooks, American Red Crosstexts and notebooks.Vocational Home Economist& Nurse Instructor.Public Health NurseMedical DirectorTRAINING AIDS AND TOOLStest and the physical screening test andThe application, interview, life satisfactioncompleted before the first classphysician's endorsement of trainee's health will have beenprofessional nurse.session, under the stipervision of the registeredshould be studied during each class period.A list of unfamiliar terms pertinent to the lessonTHE HOME HEALTH AIDEUNIT I

SummaryAssignmentsF.Personal appearance isrelated to health.Personal HealthE.D.C.STEPS3.A pleasant attitude is reflected in the generalappearance.Smoking and gum chewing are to be avoided when on duty.Grooming: Good posture, neat hair arrangement;reasonable use of cosmetics; regular use ofdeodorant; avoid use of strong perfume, no jewelryexcept watch and wedding band.Clothing: Uniform, shoes, hose, underclothing.comfortable, clean, practical.Care of the body: Bathing, care of hands and nails,oral hygiene, cleanliness of hair.Avoid illness by: (a) Having regular medical anddental examinations (b) having immunizations, and(c) practicing good personal hygiene and carryingout sanitation measures.3Give hour, date and place of next session; subject(s)to be covered; textbook or practice assignments;materials needed for following class session.Brief review of: Purpose of program; course plan;expectation of trainees; ethics, personal healthand appearance.5.4.3.2.1.5.Through nose, mouth,Rest and recreation essential to health.2.How infection is spread:skin, and intercourse.A well balanced diet.1.4.KEY POINTSPersonal health and sanitation defined.Demonstration of correctposture with traineesparticipating.Classroom charts onposture, personal healthand/or grooming.Aide HandbookDemonstrations: Handwashing, newspaper waste bag,covering sneeze or cough.ARC Text pp 182-183 and323-324Immunizations to begiven to trainees afterclass sessions.Metropolitan Life Ins.booklets. Hea-HealthDept. literature. ARCText: pp 54-57List of new terms.TRAINING AIMS & TOOLS

HOHE HEALTH AIDE PRE-EXAMComplete the following statements. Three of the answers are correct and one isincorrect in each statement. Circle the incorrect answer.1.2.3.4.5.In preparing the menu or meal pattern for a patient, thefacts that must be considered are:(a)Meal patterns must be based on the food habits ofthe patient.(b)The economic status of the patient should be considered.(c)The nutritional content of food should be considered.(d)The aide should not prepare any food that she, the aide,does not like.The following foods are high in protein:(a)Chocolate cake(b)Meat(c)Eggs(d)CheeseLack of Vitamin C may result in:(a)Bleeding gums(b)Easy bruising(c)Result in a predisposition to pressure sores(d)Nervous reactionVitamin A, which is called the anti-infection Vitamin, isfound in:(a)Breads and cereals(b)Dark green vegetables(c)Dark yellow fruits and vegetables(d)LiverMeasured diets are used for:(a)Diabetes(b)Overweight4

Home Health Aide Pre-Exam - Continued (2)6.7.(c)Underweight(d)Where a low sodium diet is requiredThe following foods are high in sodium:(a)Bologna(b)Baking Soda(c)Cheese(d)Fresh BeefWhen a home health aide goes into a home she must:(a) Perform the duties as outlined by the R. N. in charge(b)Consider the family in performing her duties(c)Do the things which she (the home health aide) can dothe best(d)8.9.10.Perform the duties which would add most to the comfortand well being of the patientWhen caring for a patient the aide should:(a)Under R. N.'s and patient's physician's directions decidewhat patients can do for themselves(b)Do everything possible for patients(c)Motivate patients to want to do things for themselves(d)Plan to make self care easy for the patientA home health aide should:(a)Plan her work so the most can be accomplished with theleast effort(b)Be sure she takes enough time doing her work to fill upher eight hours a day(c)Make every move count in her work(d)Use labor-saving equipment, food, and ideas wheneverpossibleSome ways to avoid food poisoning are:5

. 4,Home Health Aide Pre-Exam - Continued (3)(a)Do not give patient foods in which egg which have notbeen thoroughly cooked(b)Place all perishable foods in the refrigerator forpreservation(c)Avoid handling food when one has an open sore or wound(d)Depend completely on family members for safe sanitaryproceduresComplete the following statements by checking the answer which will make thestatement true.11.In giving mouth care to an unconscious patient, all of thefollowing are articles commonly used except -(a) applicators12.13.14.(b)glycerine and lemon juice(c)toothpasteIn combing a woman's hair, it is especially important tograsp the hair above where the comb is being used if thehair is (a)short(b)coarse(c)tangled(d)curlyIf a bedpan is to be put under a heavy patient whose skintends to stick to the pan, a practical first step is to (a)moisten the seat of the bedpan with alcohol(b)sprinkle talcum on the seat of the bedpan(c)oil the buttocksFor which, if any, of these body areas is 99.6 F a normaltemperature?(a)axilla(b)mouth6

Home Health Aide Pre-Exam - Continued (4)15.16.17.18.19.(c)rectum(d)none of the aboveThe home health aide gets a (Fahrenheit) rectal thermometerfrom the container and finds that it reads 92.80. Beforeusing the thermometer to take a rectal temperature one must (a)re-read it(b)sterilize it(c)shake it down more(d)lubricate itIf the pulse beats occur at the rate of two per second for afew beats, then one per second again, the pulse is called en the patient's respirations are being counted, it is bestthat the patient (a)try to breathe evenly(b)sit up straight(c)breathe as deeply as he can(d)not be aware of the countingWhen a person breathes in and then breathes out, then breathesin and out again, this is counted as (a)one respiration(b)two respirations(c)three respirations(d)four respirationsThe words in each of these pairs can be used to mean thesame thing, except (a)feces and stool7

Home Health Aide Pre-Exam - Continued (5)20.(b)void and urine(c)comatose and unconscious(d)clammy and warmAll of these points may be true of a well made bed.one is the most important?Which(a)The cuff made by turning the top sheet back aver thespread is eight inches wide.(b)The drawsheet is smooth and tight.(c)The heavy seam of the pillow case is toward the top ofthe bed.(d)The open end of the pillow case is away from the door.ReferencesTest Reservoir forAideanstructors in Nursing, National League in Nursing.

INSTRUCTOR'S KEY FOR PRE-KKAM QUESTIONSGive the twenty questions at the beginning of the course to determine thebasic knowledge of the group. The questions should be given again at the end of theI.course.II.III.Keep a record, mainly for evaluation to see if they retain new knowledge.Do not discuss the questions with the student at this 17.D8.B18.B9.B19.D10.D20.B9

UNIT IITHE APPROACH TO PATIENTS AND FAMILY10

UNIT IITHE APPROACH TO PATIENTS AND FAMILIESBackgroundLong-term illness has many side effects; some are discouragement, fear,anxiety, loneliness, economic stress and disruption of the family's patternof living.These effects, together with fatigue and irritability may mar thenormal or customary family harmony.It is important that the home healthaide understand that these stresses will often be present in the family thatis coping with illness of one or more family members.Illness affects the way the patient feels about himself.His emotionalresponse may be disproportionate to the degree of illness or other realityfactors.Each family will differ in its response to illness and what ishelpful with one family or patient may not be effective with another, eventhough the situations may appear similar.Sick people of all ages react emotionally to illness.Everyone,whether sick or well, strives for certain basic needs; love, security, asense of belonging and self realization.Some of the fears of illness,especially of the older person, are that he will become helpless and unableto care for himself, lose his independence or be abandoned.Long-term illnesssometimes destroys the individual's ability to handle problems and decreaseshis sense of personal worth.Self-esteem may be maintained or increased byencouraging self help to the maximum extent of the person's ability.Situations of patients of different age levels will have differingemotional impact on the home health aide, depending on her life experiencesand family relationships.Equally true is the fact that patients and familieswill react in various ways to the home health aide, often casting her in arole that meets their needs.In some instances she may be regarded by the11

patient or family as a substitute daughter, or a mother figure; the aide mayalso be seenim displacing the wife or mother, or as a punishing or withholding person.Knowledge and supervisory support can help the home health aide handleherself in the home situation, and achieve the necessary balance between overprotectiveness and insensitivity to suffering.Teaching Suggestions1) Persons who choose home health aide work are often moved by thedesire to help people who are ill, helpless and in need of personal care.Theinstructor should encourage the discussion of the aides' interest in choosingtheir work and find opportunities for reinforcing positive and humanitarianattitudes that are expressed by the trainees.2) Natural ways of talking and getting along with patients are to beencouraged, since the aide's warmth, common sense and good intentions willcarry her through many difficult situations with beneficial results to thepatient.3) Knowledge of some of the common emotional states of ill or agingpeople can enable the aide to be more effective in the ways she works withsuch persons.The instructor can discuss with examples, the emotional stateswhich can be anticipated:depression, low self esteem, helplessness andhopelessness, futility; or on the other hand, demanding, childish, angry,fault-finding behavior.Discussion of the reasons for these emotional re-sponses can be placed in a framework of:a) Realistic responses to severe and devastating illness or otherevents in patient's situation.b) Childish, emotional response to illness.c) Responses associated with brain damage or other organic changes.12

This framework may be a learning tool for understanding the patient'semotional state more objectively so that these reactions are not felt asnecessarily directed at the aide or caused by her.4)Realistic goals:The aide's expectations of the changes she willbe able to effect should be optimistic but within the limits set by thepatient's physical and emotional condition and the situation.Many of thepatients can make only a little progress or will be doing well to slow up theeffects of the illness.The aides should not expect to accomplish miracles.The aide needs to understand the overall goal and her specific assignment as it relates to the medical and nursing plan for the individual and thefamily.Such understanding will help prevent the aide from setting impossiblegoals for herself with attendant frustration and sense of failure.5)Attention should be called to the wide variation in patients" desireto be helped or to be independent.Awareness of this desire will help theaide to understand that some patients will want to do for themselves, andothers receive satisfaction from being served.6)The range of choices for some sick and disabled persons is limited.The value of allowing the patient to make choices when feasible and with discretion, can be emphasized. (i.e., on which side, left or right?, do you wantto start your bed bath?)7)There is security for some people in holding on to customary pat-terns of doing things - i.e., washing dishes, making coffee, etc.8)Point out the contributions which might be made by the aide, whooften is the person on the Health Team having the longest periods of timewith the patient and the family.Her observation and reporting of such mattersas moods, changes in appetite, energy, personal hygiene and nature of complaints will help document the patient's progress.13

9)The aide should be taught that the person caring for the aged anddependent patients, often becomes emotionally involved.Specific Approaches1)Introduction of aide to family; decide who will do it; give oppor-tunity to observe manner of approach used by nurse; use role playing to re-hearse initiation of contact; talk about words and phrases aide can use inintroducing self.2)Interviewing Techniques:can be guided by what patient and familymembers say, and following their lead; match their mood (if appropriate); turnquestions back, i.e., Iiihat do you think?""How do you feel about that?" avoidtaking sides or engaging in a debate; (i.e., about sex, religion and politics);ways of giving encouragement and reassurance.Use of proper address andlast names except for children.3)Discuss confidentiality or the safeguarding of personal information:avoid use of names of families in conversations, or discussing situations andinteresting developments in cases, within or outside the agency, except insupervisory sessions.4)Discuss ways of handling personal questions as briefly and non-committally as possible.Avoid sharing personal experiences or comparingthe present situation with some previously known situation.5)Timing and Frequency of Contact:the patient often perceives thetime spent with him as evidence of concern and respect for him.Assuringpatient and family of the frequency and length of the home health ai

To train the home health aide to plan her work. 4. To teach the home health. aide to record information. needed by the. doctor and/or public health nurse. PRINCIPLES: 1. The home health aide works. under the supervision of. the supervising. nurse and other therapists as needed. 2. Follows a nursing care