Wis. Admin. Code Department of Health Services DHS 129.07 - Standards for nurse aide training programs
(1) CURRICULUM FOR
A NURSE AIDE TRAINING PROGRAM. The training program shall include theory and
practice in all of the following care areas:
(a)
Interpersonal communication and
social interaction.The program shall include the theory of and
practice in communicating and interacting on a one-to-one basis with a client;
serving as part of a team implementing client care objectives; demonstrating
sensitivity to a client's emotional; social and psychological needs through
directed interactions; and skills that enable expressions of age-appropriate
behavior by allowing a client to make personal choices and by reinforcing
behavior that supports a client's sense of dignity. After completion of this
portion of the training program, a nurse aide shall do all of the following:
1. Identify the components of a
caregiver-client relationship and be able to recognize and demonstrate
understanding of all of the following:
a. The
uniqueness of each client, in terms of that person's age, disability, family
status, financial status, gender, marital status, race, and sexual orientation,
and cultural, generational, social, ethnic, religious or other background,
values or characteristics.
b. The
needs of a client with Alzheimer's disease, dementia, mental illness,
intellectual disability, or other cognitive disabilities or
impairments.
c. Ways both nurse
aides and clients can cope with stress.
d. What constitutes caregiver
misconduct.
e. The messages
conveyed by body language, speech and facial expressions.
2. Demonstrate an ability to establish
effective relationships with clients and be able to do all of the following:
a. Communicate with clients in a respectful
manner that affords clients dignity.
b. Explain procedures and activities to
clients before carrying out those procedures or beginning those
activities.
c. Demonstrate concern
for clients who have long-term or disabling illnesses or who are
dying.
d. Identify developmental
tasks associated with the aging process.
3. Demonstrate an ability to use appropriate
verbal and nonverbal communication skills with clients and be able to do all of
the following:
a. Recognize effective
listening techniques.
b.
Distinguish assertive from aggressive responses.
c. Identify the difference between
non-acceptable and acceptable touching during job performance.
d. Identify therapeutic interventions and
specialized techniques for responding to client's wandering and
confusion.
4. Recognize
common barriers to communication, including language, vision changes, hearing
loss, speech problems, memory loss, disorientation and pain.
5. Demonstrate an ability to promote the
independence of clients within the limitations of their physical, mental and
intellectual impairments by fostering self-help skills through appropriate
responses to clients' attempts to provide self care, including recognizing
clients' level of ability in self care activities.
6. Identify the role of the family and other
persons of importance to the client in the client's care and as resources for
client emotional support.
(b)
Basic nursing skills.
The program shall include the theory of and practice in basic nursing skills,
including bed making, taking vital signs, measuring height and weight, caring
for the client's environment, measuring fluid and nutrient intake and output,
assisting in the provision of proper nutritional care, walking or transferring
the client using body mechanics and appropriately selected equipment with
regard to principles of client care ergonomics, and maintaining infection
control and safety standards. A nurse aide shall do all of the following:
1. Use acceptable personal hygiene.
2. Recognize the components of working
relationships.
3. Identify how and
when to seek guidance, using the supervisory channels of communication within
the facility or agency.
4. Use
proper body mechanics.
5.
Demonstrate an understanding of the meaning of common medical terms and
abbreviations.
6. Observe and
report changes in client behavior and physical status, including signs and
symptoms of common diseases and conditions.
7. Recognize when a client may be choking and
respond appropriately.
8. Recognize
the normal physical and psychological changes associated with aging.
9. Identify the basic principles of nutrition
and hydration.
10. Recognize and
report deviations from a client's normal food and fluid intake and
output.
11. Recognize the basic
requirements of commonly prescribed therapeutic diets.
12. Use common measures to promote a client's
skin integrity, considering the client's ethnicity, race and age.
13. Demonstrate appropriate techniques in
walking, transferring, positioning and transporting clients.
14. Recognize and respond appropriately to
unsafe environmental conditions, including damp floors, frayed electrical cords
and loose hand rails.
15. Recognize
and respond appropriately to emergency situations including following emergency
evacuation procedures.
16.
Demonstrate appropriate hand washing techniques.
17. Understand and use commonly used
alternatives to restraints in accordance with current professional
standards.
18. Maintain the safety
and cleanliness of client care areas.
19. Make use of proper isolation
technique.
20. Perform commonly
accepted infection control practices, including proper gloving technique and
proper disposal of blood and body fluids and secretions.
21. Make occupied and unoccupied
beds.
22. Measure temperature,
pulse and respiration.
23. Measure
a client's weight and height.
24.
Record objective information.
25.
Apply nonprescription ointments to unbroken skin areas.
26. Recognize the general effects of
prescribed routine medications.
27.
Recognize therapeutic interventions and specialized non-pharmacological pain
control interventions.
28. Assist
with care of clients when death is imminent.
29. Assist with post-mortem care.
30. Maintain the safety and cleanliness of
areas where food is stored.
(c)
Personal care skills.
The program shall include the theory of and practice in basic personal care
skills, including bathing, mouth care, grooming, dressing, toileting, and
assistance with eating, hydration and skin care. A nurse aide shall demonstrate
the ability to do all of the following:
1.
Give a complete or partial bed bath to a client and assist a client in taking a
bath or a shower.
2. Provide care
of the client's perineal area.
3.
Apply appropriate oral hygiene practices when assisting a client with oral
hygiene, including caring for the client's dentures.
4. Care for a client's nails, hair and
skin.
5. Shave and shampoo a
client, including applying nonprescription medicated shampoos.
6. Dress and undress a client.
7. Prepare a client for meals.
8. Assist in feeding a client, including
helping a client use adaptive devices and feeding utensils and encouraging a
client to eat nutritionally balanced meals.
9. Assist a client with bowel and bladder
elimination.
(d)
Basic restorative services. The program shall include the
theory of and practice in providing restorative services. Basic restorative
services include the application of assistive devices for ambulation; eating
and dressing; maintenance of range of motion through appropriate exercises;
proper turning and positioning both in bed and chair; proper transferring
techniques; bowel and bladder training; and care and use of prosthetic devices
such as hearing aids, artificial eyes and artificial limbs. A nurse aide shall
demonstrate the ability to do all of the following:
1. Recognize the importance of bowel and
bladder programs.
2. Recognize the
method for maintaining and improving musculoskeletal functioning by promoting
joint mobility, body alignment and movement, including being able to do all of
the following:
a. Position clients by use of
pillows, towel rolls, padding and footboards.
b. Perform simple range of motion
exercises.
c. Assist clients in the
use of crutches, walkers, wheelchairs, canes, prostheses and
appliances.
3. Transfer
clients safely and according to principles of patient care ergonomics and with
proficiency in use of available equipment that is used to transfer clients.
Note: Equipment used to transfer clients includes, but is not limited to, mechanical lifts, friction reducing devices; wheelchairs and gait belts.
4. Reinforce breathing exercises, including
coughing and deep breathing.
5.
Help clients use hearing aids and visual aids.
(e)
Rights of clients.
1. The program shall provide instruction on
the principles of and requirements relating to clients' rights. The nurse aide
shall demonstrate an understanding of all of the following obligations:
a. Providing privacy for clients in
treatment, living arrangements and personal care needs.
b. Maintaining the confidentiality of client
health and personal records.
c.
Allowing clients to make personal choices to accommodate the clients'
needs.
d. Providing help clients
need in getting to and participating in activities, including client and family
group meetings.
e. Maintaining the
personal possessions of clients in good and secure condition.
f. Interacting with clients without abusing
or neglecting the clients.
g.
Interacting with clients without misappropriating the clients'
property.
h. Immediately reporting
to appropriate facility or agency staff every instance of abuse or neglect of a
client or misappropriation of a client's property as defined in s.
DHS 13.03 (1), (12), and
(14).
2. The nurse aide shall demonstrate behavior
that recognizes that clients have rights and that the aide respects those
rights. The nurse aide shall do all of the following:
a. Demonstrate respect and concern for each
client's rights, preferences and awareness of age, color, disability, family
status, financial status, gender, marital status, race, sexual orientation, and
ethnic, cultural, social, generational and religious differences.
b. Show respect for cultural, ethnic and
religious food preferences.
c.
Recognize what constitutes abuse of clients and demonstrate an understanding of
how to interact with clients without abusing them or without appearing to abuse
them.
d. Demonstrate prevention and
intervention skills with combative clients that balance appropriate client care
with a need to minimize the potential for injury to the aide and
others.
e. Recognize the role of
state and federal regulatory agencies in licensing or otherwise approving
providers and in investigating complaints of abuse of client
property.
f. Demonstrate an
understanding of the process by which a client or staff member may file a
complaint on behalf of a client and seek redress for a perceived violation of
client rights.
g. Recognize the
role of client advocacy groups as client resources.
h. Demonstrate awareness of how to file a
complaint with the department regarding operations within the provider
setting.
(f)
Dementias. The program shall include instruction about
dementia and specific techniques for meeting the basic needs of clients with
dementia. The nurse aide shall demonstrate an understanding of all of the
following:
1. The nature of dementia,
including the cause, course and symptoms of the impairment. The effects that
brain changes have on the person's moods, abilities and functioning.
2. The effects on the client of staff verbal
and nonverbal communication with the client and means of modifying these
communications and approaches to facilitate effective interaction between
clients and staff.
3. The feeding
and fluid intake problems associated with dementia and the specialized
techniques for addressing those problems.
4. The effect of the environment on clients
with dementia and the appropriate environmental stimuli to use with those
clients to reduce stress and maximize normal functioning and how to incorporate
strategies that preserve function and prevent excess disability.
5. Possible causes of dementia related
symptomatic behavior changes, specifically focusing on understanding behavior
as an attempt to communicate unmet needs and then how to address the unmet need
including an understanding of how pain impacts behavior.
6. Ways to help the person with dementia
continue meaningful involvement in his or her day, the importance of structure
and routine and the incorporation of the person's life story and past
interests, routines, tastes, values and background.
7. The stress involved for the client, family
and nurse aide in caring for a client with dementia and techniques for coping
with this stress and ways to address the person with dementia's core needs of
having self-esteem boosted, being useful, giving and receiving love, and caring
for self and others.
(2) PROGRAM OPERATION.
(a)
Class setting.
1. Programs shall ensure that classrooms and
lab facilities are adequate to meet the needs of the program, based on the
number of students enrolled and how the classroom space is used. Programs shall
ensure that classroom and skills labs have adequate temperature controls, clean
and safe conditions, adequate space to accommodate students, adequate lighting,
and all training equipment needed, including audiovisual equipment and any
equipment needed for simulating resident care. Lab equipment shall be in the
skill lab at all times necessary for demonstration, practice, and student
demonstration. Any area designated as a classroom or lab in a facility-based
program shall be an area that is not designated for resident care.
2. The program shall have qualified faculty
members for both the classroom and the skills portion of the program.
3. The program shall have reasonable
accommodations for students and prospective students with
disabilities.
(b)
Program standards for training programs.
1. A training program shall include at least
75 training hours as required under
42 CFR
483.152 (a). At least 16 of
those 75 training hours must be in a clinical experience in a clinical setting
as required under 42 CFR
483.152 (a) and approved by
the department. The first 16 hours of training shall be provided in a classroom
setting before a student has direct contact with clients. Tours of a facility,
including observations of clients and day-to-day facility activities, may be
incorporated into the classroom hours. Competency evaluation under s.
DHS 129.08 and provider orientation may not be counted
toward meeting the 75-hour minimum requirement.
2. The program shall cover all of the
following during the first 16 hours of classroom training:
a. Communication and interpersonal
skills.
b. Infection
control.
c. Safety and emergency
procedures.
d. Promoting residents'
independence.
e. Residents'
rights.
3. A health care
provider may employ a student as a nurse aide after the student has completed
16 hours of classroom training in the topics in subd. 2., and if the student is
a full-time permanent employee, and is enrolled in an approved training
program. The training program shall provide the health care provider with
verification that the program has provided the instruction specified in subd.
2.
4. The program shall provide
notification to students sponsored by Medicaid-certified nursing facilities
that the students are not responsible for any costs associated with training,
including deposits for textbooks or supplies used.
(c)
Clinical setting. Before
a student performs any client-related services, the RN primary instructor shall
determine that the student has been trained and found proficient in providing
those services. The training program shall ensure all of the following:
1. Access to a clinical setting approved by
the department that is adequate to meet the needs of the program.
a. Clinical settings shall be in compliance
with state and federal law. The program designee or primary instructor and the
health care provider with whom the program has contracted are responsible for
verifying that the clinical facility is in compliance with state and federal
law. This verification shall be documented in the program's files and shall be
available during the evaluation process.
b. The agreement between the program and the
clinical setting shall be reviewed and renewed annually by the department and
upon any change of facility or school administration. A copy of the agreement
shall be submitted to the department.
c. During classroom and lab instructions,
students shall be oriented to the various forms used to document resident
information. Instructors shall supervise documentation on the appropriate flow
sheets and forms during the clinical rotation.
d. Before a student begins a clinical
rotation, the primary instructor shall evaluate and document that the student
successfully demonstrated the ability to perform a skill.
e. Students may not give hands-on care to a
resident who is not assigned to the student unless the student is under the
direct supervision of the primary instructor.
f. Students who are under the general
supervision of the primary instructor may be paired, during the student's
clinical rotation, with nurse aides who are employed by the health care
provider.
g. Students shall
maintain safe practices, infection control and respect resident rights at all
times.
h. Students shall
demonstrate knowledge regarding their assigned residents' diagnoses and
identified needs.
i. Students and
instructors shall wear clothing that is in compliance with program policy and
that is appropriate for performing resident care. The clothing shall include a
nametag that designates the name of the nurse aide training program and the
person's status as a student or instructor.
j. The scheduled clinical hours shall provide
experiences that meet expected outcomes outlined in the program
curriculum.
k. The length of the
clinical day may not exceed 8 hours.
l. A health care facility may serve as the
site of clinical instruction for up to 2 nurse aide training programs at the
same time, except that the department may decide to allow more than 2 programs
at a single health care facility on a case-by-case basis in conjunction with
the facility's administrative staff.
m. The program shall not be used as a
substitute for staff orientation or staff education
programs.
2. An adequate
number of primary instructors in the clinical setting to provide safe and
effective supervision and assistance of students.
a. Primary instructors shall not function in
another role while supervising students in the clinical setting.
b. A ratio of 6 to 8 students per instructor
is considered to be adequate in most circumstances.
c. The primary instructor shall evaluate and
document that a student demonstrated successfully the ability to perform a
skill before the student begins a clinical rotation.
d. The primary instructor shall make all
student clinical assignments with the approval of the health care provider. The
instructor shall complete a review of each resident's chart to retrieve
pertinent information needed by the students to provide the required cares.
Care plan information shall be reviewed at the beginning of each clinical
experience and shall include new orders or changes in each resident's
status.
e. A student's assignment
shall be shared with the clinical setting to which the student is assigned
before the student arrives at the clinical setting.
f. Each student shall be given an individual
assignment. More than 2 students shall not be assigned to the same resident at
the same time.
g. Clinical
assignments shall include all of the following:
i. Care of clients with varied levels of care
needs.
ii. The opportunity to be
evaluated on organizational skills and time management.
h. The RN primary instructor is responsible
for supervising the clinical performance of each LPN program
trainer.
(d)
Nursing home-based program. Training of nurse aides may be
performed under the general supervision of the director of nursing for a
facility; however, the director of nursing may not act as the primary
instructor or as a program trainer. Primary instructors shall not be involved
in more than one role while supervising students in the clinical
area.
(e)
Expectations and
records.
1. The training program
shall maintain a list of the required skills and competencies that a student
will complete by the end of the training program.
2. On the list of skills, the primary
instructor shall verify, by initialing and dating each individual skill, that
the student has satisfactorily performed that skill. When a student has
satisfactorily completed all required skills and competencies and attained the
necessary knowledge, as well as achieved the stated course completion criteria,
the trainee qualifies to enter a competency evaluation program.
3. The primary instructor shall provide a
copy of the student's performance record to the student at the conclusion of
the student's training.
(f)
Record retention. The
training program shall retain all records required by this section for a period
of at least 3 years after a student completes the training
program.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.