Module 17: Patient/Resident Abuse

Statement of Purpose: The purpose of this unit is to introduce the Nurse Assistant to patient/resident abuse. The module will focus on the nurse assistant role in preventing, recognizing, and reporting instances of patient/resident abuse.

Module 17 Vocabulary Study Tool: https://claude.ai/public/artifacts/bb9afa88-7a4e-4f5a-8740-be9210019cda

Performance Standards (Objectives): Define key terminology:

1. Abuse

2. Advance Directive

3. Aiding and abetting

4. Assault

 5. Battery

6. Choice

7. Chronic

8. Coercion

9. Confidential

10. Defamation

11. Defamation of character

12. Do Not Resuscitate (DNR)/ No Code

13. Ethical standard

14. False imprisonment

15. Financial abuse

16. Grievances

17. HIPAA

18. Informed consent

19. Involuntary seclusion

20. Laws

21. Legal standard

22. Libel

23. Mandated reporter

24. Neglect

25. Negligence

26. Ombudsman

27. Physical abuse

28. Policy and Procedure

29. Privacy

30. Psychological abuse

31. Resident council

32. Restraints

33. Scope of practice

34. Sexual abuse

35. Slander

36. Social services

37. Theft

38. Verbal abuse

Patient, resident, and client are synonymous terms referring to the person receiving care

Module 17 Vocabulary Sentences for CNA California Exam

Patient/Resident Abuse Terms

1. Abuse includes any physical, emotional, or mental injury inflicted on a resident and must be reported immediately by nursing assistants.
2. An advance directive is a legal document where patients write their wishes for medical treatment in case they cannot speak for themselves later.
3. Aiding and abetting means helping someone do wrong things or not reporting bad behavior that you see happening to residents.
4. Assault occurs when someone threatens to hurt a resident or tries to harm them, even if no physical contact happens.
5. Battery is touching a resident’s body or belongings without getting permission first from the resident.
6. Residents have the right of choice to make their own decisions about activities, clothing, and daily routines.
7. A chronic condition lasts for a long time and may never completely go away, like diabetes or arthritis.
8. Coercion means forcing residents to do something they don’t want to do against their wishes.
9. All resident information must remain confidential and should only be shared with authorized healthcare team members.
10. Defamation happens when someone spreads false information that damages another person’s good reputation.
11. Defamation of character is the same as defamation – spreading untrue stories that hurt someone’s good name.
12. A Do Not Resuscitate (DNR) or No Code order means doctors should not use extraordinary measures to restart a patient’s heart or breathing.
13. An ethical standard means doing what is morally right and following the facility’s rules for proper behavior.
14. False imprisonment occurs when staff restrains or confines a resident without proper consent or legal authority.
15. Financial abuse involves stealing money or improperly using a resident’s money or financial resources.
16. Grievances are formal complaints that residents make about their care or living conditions at the facility.
17. HIPAA is a federal law that protects patients’ private health information and controls who can see medical records.
18. Informed consent means residents must fully understand and agree in writing before any medical procedure is performed.
19. Involuntary seclusion means separating a resident from others without the resident’s permission or agreement.
20. Laws are rules created by the government to protect people and help society function safely and fairly.
21. Legal standards are official rules and guidelines that healthcare workers must follow to provide lawful care.
22. Libel consists of false written statements or pictures that damage someone’s reputation.
23. A mandated reporter is someone who is legally required to report suspected or witnessed abuse to authorities.
24. Neglect means failing to provide the proper care and services that residents need to stay safe and healthy.
25. Negligence occurs when a healthcare worker fails to provide reasonable care and causes harm to a resident.
26. An ombudsman is a neutral person who advocates for residents and helps resolve complaints about their care.
27. Physical abuse involves hitting, pushing, or any other harmful physical contact with residents.
28. Policy and procedure are the written rules and step-by-step instructions that guide how facilities operate and provide care.
29. Privacy means protecting residents from unwanted exposure and keeping their personal information confidential.
30. Psychological abuse includes threatening, insulting, or emotionally hurting residents through words or actions.
31. A resident council is a group where facility residents meet to discuss problems and communicate with staff.
32. Restraints are devices that limit residents’ movement and can only be used with a doctor’s written order.
33. Scope of practice defines exactly what skills and tasks nursing assistants are legally allowed to perform.
34. Sexual abuse involves using force or threats to make residents participate in unwanted sexual acts.
35. Slander consists of false spoken statements that damage someone’s reputation.
36. Social services is the facility department that helps residents with non-medical needs like personal problems or family issues.
37. Theft means taking anything that belongs to a resident without their permission or consent.
38. Verbal abuse uses harmful language, yelling, or cruel words to hurt residents emotionally.

Module 17: 5 CNA Training Dialogues – Patient Care and Safety

Dialogue 1: Orientation Day – Understanding Your Role

Supervisor Maria: Welcome to your first day, Sarah. As a new CNA, it’s important you understand your scope of practice.

Sarah (New CNA): Thank you, Maria. What exactly does that mean?

Maria: Your scope of practice defines what you can and cannot do legally as a nursing assistant. You’ll follow our policy and procedure manual for all patient care activities.

Sarah: I want to make sure I provide good care. What should I watch out for?

Maria: Great question. As a mandated reporter, you’re legally required to report any signs of abuse or neglect you observe. This includes physical abuse, psychological abuse, financial abuse, and sexual abuse.

Sarah: That sounds serious. How do I know what to look for?

Maria: We’ll train you to recognize signs like unexplained injuries, changes in behavior, or missing personal items that might indicate theft. Remember, patient confidentiality is crucial – we only discuss concerns with appropriate staff.

Sarah: I understand. Patient safety comes first.

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Dialogue 2: Incident Reporting

CNA Tom: Nurse Jackson, I need to report something concerning about Mrs. Chen in room 204.

Nurse Jackson: What did you observe, Tom?

Tom: During her bath, I noticed bruising on her arms that wasn’t there yesterday. She seemed scared and said her son visited last night.

Jackson: Thank you for reporting this immediately. This could be physical abuse. Did she give you informed consent for the examination?

Tom: Yes, she agreed to let me check. She also mentioned he took money from her purse. Could that be financial abuse?

Jackson: Absolutely. Taking someone’s money without permission is a form of abuse. We need to document everything and contact social services and the ombudsman.

Tom: Should I talk to her son when he visits?

Jackson: No, that’s outside your scope of practice. Our job is to ensure Mrs. Chen’s safety and follow proper reporting procedures. The investigation team will handle interviewing family members.

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Dialogue 3: Patient Rights and Restraints

CNA Lisa: Dr. Williams, Mr. Rodriguez keeps trying to get out of bed, but he’s a fall risk. Can we use restraints?

Dr. Williams: Restraints should be our last option, Lisa. Using them without proper authorization could be considered false imprisonment.

Lisa: I don’t want him to get hurt. What alternatives do we have?

Dr. Williams: First, let’s ensure he understands his condition and treatment plan – that’s part of informed consent. We could also try positioning his bed lower or using bed alarms.

Lisa: He mentioned wanting to go home. He seems frustrated.

Dr. Williams: That’s understandable. Patients have the right to express their feelings. However, we must never use coercion to force compliance. If we do need restraints, we need a doctor’s order and regular monitoring.

Lisa: What about his family? They’re asking lots of questions.

Dr. Williams: They have a right to information, but remember HIPAA rules. Only share information that Mr. Rodriguez has authorized us to share.

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Dialogue 4: Handling Difficult Situations

CNA Angela: I’m having trouble with Mr. Peterson. He’s been using inappropriate language and making me uncomfortable.

Supervisor Carol: That sounds like verbal abuse, Angela. Can you be more specific?

Angela: He makes sexual comments and calls me names. Yesterday he grabbed my arm when I was helping him.

Carol: The grabbing could be battery – unwanted physical contact. And the sexual comments create a hostile environment. You don’t have to tolerate this behavior.

Angela: What should I do? I want to provide good care, but I feel unsafe.

Carol: Your safety is important. We’ll address this with Mr. Peterson and possibly involve social services. For now, have another staff member present during care. Remember, providing choice to patients doesn’t mean accepting abusive behavior.

Angela: Should I document everything?

Carol: Yes, detailed documentation helps protect both you and the patient. Write down dates, times, and exact words or actions. This isn’t defamation – it’s professional reporting.

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Dialogue 5: End-of-Life Care Discussions

CNA David: Mrs. Thompson’s daughter is asking about her mother’s advance directive. She’s concerned about the Do Not Resuscitate order.

Nurse Patricia: That’s a serious topic, David. What specific questions does she have?

David: She wants to know if we’re still providing full care. She’s worried we’re neglecting her mother.

Patricia: I understand her concern. A DNR order doesn’t mean we provide less care – it just means we won’t perform CPR if her heart stops. We continue all comfort measures and medical treatment.

David: The daughter mentioned something about involuntary seclusion. She thinks her mother is being isolated.

Patricia: We need to explain that any isolation is for medical reasons, like infection control, not punishment. Patients have rights to visitors and social interaction within medical guidelines.

David: Mrs. Thompson seems to have some chronic conditions. Her daughter is asking if she’s suffering.

Patricia: We follow ethical standards in all our care decisions. If there are concerns about pain management or quality of life, we can arrange a family conference with the doctor and social worker.

David: Should I tell the daughter about the resident council meetings?

Patricia: That’s a great idea. The resident council gives patients and families a voice in care decisions and helps address grievances through proper channels.

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Key Learning Points:

• CNAs have specific legal and ethical responsibilities
• Patient safety and rights must always be protected
• Proper reporting channels exist for concerns
• Documentation is crucial for patient protection
• Professional boundaries must be maintained
• Confidentiality rules apply to all patient information