define the following term:

3 Understanding Your Residents

Define the following term:

Psychosocial needs

needs having to do with social interaction, emotions, intellect, and spirituality.


1. Identify basic human needs

A human being has six basic physical needs:• Food and water• Protection and shelter• Activity• Sleep and rest• Safety• Comfort, freedom from pain



Think about this question:What tasks do you perform as an NA to help residents meet their physical needs?



A human being has the following psychosocial needs:• Love and affection• Acceptance by others• Security• Self-reliance and independence in daily living• Interaction with other people• Success and self-esteem



Think about these questions:• How do people respond when their psychosocial needs are not

met?• How do you think these strong negative feelings might

interfere with a resident’s health?


Transparency 3-1: Maslow’s Hierarchy of Needs



Think about this question:What do self-esteem and self-actualization mean to you?



Masturbation to touch or rub sexual organs in order to give oneself or another person sexual pleasure.



Remember these important points about sexual needs and situations:• People continue to have sexual needs throughout their lives. • Humans express their sexuality through different behaviors.• Knock and wait for a response before entering residents’

rooms.• Provide privacy if you encounter a sexual situation.• Do not judge any sexual behavior you see. • Honor “Do Not Disturb” signs.


Handout 3-1: Myths About Older Adults and Sexuality

Myth #1: Older men are not capable of having sexual relations. There are some physical changes that may alter the way a

couple engages in sexual relations. The man may need more direct contact, may take longer, and may need longer between relations to perform again. However, many men continue to have satisfying relations well into old age.

Myth #2: After menopause older women are not interested in sexual relations.

Many women relax and enjoy sex more in later years. With no fear of pregnancy, and older children leaving home, many women feel much freer. There may be some physical changes, such as less lubrication, but there are remedies available. Communication with her physician is important. The reason many older women stop having sexual relations is because they lose their partners when their husbands die.


Handout 3-1: Myths About Older Adults and Sexuality (cont’d.)

Myth #3: Any expression of sexuality by older people is either disgusting or cute.

This attitude deprives older people of their right to dignity and respect. Older adults have the same needs and rights to express their sexuality as other age groups and they may do so in the same ways. In all age groups there is a wide variety of behavior. This is true of older people also.


Handout 3-1: Myths About Older Adults and Sexuality (cont’d.)

It is true, however, that our society discourages this expression by the messages we send through our jokes, advertisements, and the media. Older people see and hear these messages and may believe that there is something wrong with them if they feel or act on their desires.



As an NA you can help your residents with their spiritual needs:• Learn about their religion. • Assist with practices (never make judgments). • Encourage participation in religious services if they are

religious. • Respect all religious items. • Report requests to see clergy to nurse. • Get to know resident’s priest, rabbi, or minister. • Allow privacy for clergy visits. • If asked, read religious materials aloud. • Refer resident to spiritual resources if requested.


Transparency 3-2: Not Permitted

You should never: • Try to change someone’s religion • Tell a resident his/her belief or religion is wrong • Express judgments about a religious group • Insist that a resident join religious activities • Interfere with religious practices



Think about these questions:• Why should you not be judgmental about other people’s

beliefs?• Why shouldn’t you impose your beliefs on your residents?• Would your political ideas be appropriate conversation with

your resident or his family?• What are some appropriate topics of conversation with

residents and their families?



Holistic care a type of care that involves considering a whole system, such as a whole person, rather than dividing the system into parts.


2. Define “holistic care”

Think about this question:How does the term “holistic” apply to caregiving and what does it mean to care for the “whole person?”


3. Explain why promoting independence and self-care is importantThink about these questions:• What are some of the major adjustments and changes you’ve

experienced in your life?• How would you feel if you had to move into an LTC facility?


3. Explain why promoting independence and self-care is important

Imagine the losses residents may be experiencing:• Loss of spouse, family, or friends• Loss of workplace• Loss of ability to go places• Loss of home and personal possessions• Loss of ability to attend religious services and meetings• Loss of ability to care for themselves• Loss of ability to move freely• Loss of pets• Can you think of any others?



Residents may encounter these problems due to lack of independence:• Poor self-image• Anger• Feelings of helplessness, sadness, and hopelessness• Feelings of uselessness• Increased dependence• Depression



As an NA you can promote independence in these ways:• Encourage residents to do as much as possible for themselves

no matter how long it takes.• Be patient.• Allow residents to make choices.



REMEMBER:Never treat residents like children. Respect the fact that they can make their own choices and always encourage self-care.



Cultural diversity the variety of people with varied backgrounds and experiences who live and work together in the world.


4. Identify ways to accommodate cultural differences

Culture plays a part in determining all of these things:• Language• Religion• Food preferences• Degree of comfort with touch


Handout 3-2: Religions and Dietary Practices

Understanding a little bit about common religious groups in America may be useful. Common types of religions, listed alphabetically, follow:

Buddhism: Buddhism started in Asia but has many followers in other parts of the world. Buddhism is based on the teachings of Siddhartha Gautama, called “Buddha.” Buddhists believe that life is filled with suffering that is caused by desire, and that suffering ends when desire ends. Buddhism emphasizes meditation. Proper conduct and wisdom release a person from desire, suffering, and a repeating sequence of births and deaths (reincarnation). Nirvana is the highest spiritual plane a person can reach. It is the state of peace and freedom from worry and pain. The Dalai Lama is considered to be the highest spiritual leader.


Handout 3-2: Religions and Dietary Practices (cont’d.)

Christianity: Christians believe Jesus Christ was the son of God and that he died so their sins would be forgiven. Christians may be Catholic or Protestant. There are many subgroups or denominations (such as Baptists, Episcopalians, Evangelicals, Lutherans, Methodists, Mormons, and Presbyterians). Christians may go to church on Saturdays or Sundays. They may read the Bible, including the Old and New Testaments, take communion as a symbol of Christ’s sacrifice, and be baptized. Some Christians may try to share their beliefs and convert others to their faith. Religious leaders may be called priests, ministers, pastors, or deacons.



Hinduism: Hinduism is the dominant faith of India; it is also practiced elsewhere. Hindus follow the teachings of ancient scriptures like the Vedas and Upanishads, as well as other major scriptures. Hindu beliefs vary widely; there may be a belief in only one God or in multiple gods. Worship can occur at a temple or at home. Hindus believe in reincarnation, which is a belief that some part of a living being survives death to be reborn in a new body. Hindus also believe in karma, which is the belief that all past and present deeds affect one’s future and future lives. Hindus advocate respect for all life, and some Hindus are vegetarians. Vegetarians do not eat any meat. Hindus who do eat meat almost always refrain from eating beef.



Islam: Muslims, or followers of Mohammed, believe that Allah (God) wants people to follow the teachings of the prophet Mohammed as recorded in the Koran. Many Muslims pray five times a day facing Mecca, the holy city for their religion. Muslims worship at mosques and generally do not drink alcohol or eat pork. There are other dietary restrictions, too. There is a variety of Islamic religious leaders.



Judaism: Judaism is divided into Reform, Conservative, and Orthodox movements. Jews believe that God gave them laws through Moses and in the Bible, and that these laws should order their lives. Jewish services are held on Friday evenings and sometimes on Saturdays, in synagogues or temples. Some Jewish men wear a yarmulke, or small skullcap, as a sign of their faith. Some Jews follow special dietary restrictions. Jewish people may not do certain things, such as work or drive, on the Sabbath. This lasts from Friday sundown to Saturday sundown. Religious leaders are called rabbis.

Confucianism, which is practiced in China and Japan, is another major world religion. Native Americans follow many spiritual traditions.



Some people may not believe in God or a higher power and identify themselves as “agnostic.” Agnostics claim that they do not know or cannot know if God exists. They do not deny that God might exist, but they feel there is no true knowledge of God’s existence. Atheists are people who claim that there is no God. This is different from what agnostics believe. Atheists actively deny the existence of God. For many atheists, this belief is as strongly held as any religious belief.



Many religious beliefs include dietary restrictions. These are rules about what and when followers can eat. Some examples are listed below.

• Many Buddhists are vegetarians, though some include fish in their diet.

• Some Catholics do not eat meat on Fridays during Lent.• Many Jewish people eat kosher foods, do not eat pork, and

do not eat lobster, shrimp, and clams (shellfish). Kosher food is food prepared in accordance with Jewish dietary laws. Kosher and non-kosher foods cannot come into contact with the same plates. Jews may not eat meat products at the same meal with dairy products.

• Mormons may not drink alcohol, coffee, or tea or eat chocolate. Mormons often abstain from smoking tobacco.



Religious dietary practices (cont’d.):• Many Muslims do not eat pork or shellfish. Certain birds

may need to be avoided, too. They may not drink alcohol. Muslims may have regular periods of fasting. Fasting means not eating food or eating very little food.

• Some people are vegetarians and do not eat any meat for religious, moral, or health reasons.

• Some people are vegans. Vegans do not eat any animals or animal products, such as eggs or dairy products. Vegans may also not use or wear any animal products, including wool and leather.


5. Describe the need for activity

Physical activity has the following benefits:• Lessens risk of illness• Relieves symptoms of depression• Improves mood and concentration• Improves body function• Lowers risk of falls• Improves sleep• Improves ability to cope with stress• Increases energy• Increases appetite



Inactivity and mobility can cause many problems for residents:• Loss of self-esteem• Depression• Boredom• Pneumonia• Urinary tract infection• Constipation• Blood clots• Dulling of the senses



Think about this question:What activities do you think might be fun and appropriate for residents?


6. Discuss family roles and their significance in health care

There are many types of families:• Single-parent families• Nuclear families• Blended families• Multigenerational families• Extended families• Unmarried couples• Same-sex couples



Families play an important role in the care of residents. They are vital in these and other ways:• Making care decisions• Communicating with the care team• Providing support and encouragement• Connecting to the outside world• Giving assurance



NAs must treat residents’ families and friends in a professional manner:• Be respectful and nice• Allow privacy for visits• Observe and report effects of visits on residents.



REMEMBER:• Take the time to ask families questions.• Communicate with the families and show them that you have

time for them.


7. Describe the stages of human development

Stages of development include:Infancy (birth to 12 months)• Grow and develop quickly• Development is from head down

Childhood: The Toddler Period (1 to 3 years)• Formerly dependent, now gain independence and body control• Learn to speak, gain coordination and bladder and bowel

control• May have tantrums or whine to get their way



Stages of development (cont’d.):Childhood: The Preschool Years (3 to 6 years) • More social relationships• Play cooperatively and learn language• Know right from wrong

Childhood: School-Age Children (6 to 12 years)• Cognitive development (thinking and learning)• Get along with others in peer group• Develop a conscience and self-esteem



Stages of development (cont’d.):Puberty and Adolescence (12 to 18 years)• Secondary sex characteristics appear• Reproductive organs begin to function• Concern for body and peer acceptance• Changing moods• Interact with opposite sex

Young Adulthood (18 to 40 years)• Select a career• Select and live with a mate • Raise children• Develop satisfying sex life



Stages of development (cont’d.):Middle Adulthood (40 to 65 years)• More comfortable and stable• May have “mid-life crisis”

Late Adulthood (65 years and older)• Many physical and psychosocial changes• Loss of physical health• Loss of friends and jobs



Ageism prejudice toward, stereotyping of, and/or discrimination against older persons or the elderly.


Transparency 3-3: True or False?

People over 80 years old cannot live by themselves.

Most older adults are lonely and depressed.

Older adults are not able to adjust to changes.

Most older adults are ill or disabled in some way.

Older adults can stay active by pursuing favorite hobbies.

Good health can help older adults live independently.

Normal changes of aging do not include diseases, disabilities, or dependence on others.



Remember these facts about aging:• People have many different capabilities.• Stereotypes are false.• Older persons are usually active.• Aging is a normal process, not a disease.• Aging persons need to adjust to change.• They do not need to be dependent.



Aging brings many normal changes:• Thinner, drier, more fragile, and less elastic skin • Weaker muscles • Bones more brittle• Sensitivity of nerve endings in skin decreases• Responses and reflexes slow• Short-term memory loss• Changes in senses



Normal changes of aging (cont’d.):• Less efficient heart • Oxygen in blood decreases• Decreased appetite • More frequent elimination • Changes in hormone production • Weakened immunity • Change in lifestyle



Aging also may bring changes not considered normal:• Depression• Loss of ability to think logically• Poor nutrition• Shortness of breath• Incontinence



REMEMBER:It is important that you report ALL changes in residents.



Developmental disabilities

disabilities that are present at birth or emerge during childhood that restrict physical or mental ability.


8. Discuss the needs of people with developmental disabilities

Remember the following information on mental retardation:• Most common developmental disorder• Not a disease or psychiatric illness• Below-average mental functioning• May have limited ability to live independently• Have the same emotional and physical needs of others


8. Discuss the needs of people with developmental disabilities

There are special care guidelines for residents with developmental disabilities:• Treat adult residents as adults. • Praise and encourage often.• Help teach ADLs by dividing a task into smaller units.• Promote independence. • Encourage social interaction.• Repeat words you use to make sure they understand.• Be patient.



Apathya lack of interest.

Major Depression a type of mental illness that may cause a person to lose interest in everything he once cared about.

Bipolar disorder type of mental illness that causes a person to swing from deep depression to extreme activity.

Anxietyuneasiness or fear, often about a situation or condition.

Phobiasintense form of anxiety.



Claustrophobiathe fear of being in a confined space.

Obsessive compulsive disorder disorder in which a person uses obsessive behavior to cope with anxiety.

Post-traumatic stress disorderanxiety-related disorder caused by a traumatic experience.


9. Describe mental illness, depression and related care

Remember these guidelines for caring for mentally ill residents:• Observe for changes in condition or ability. Document and

report observations.• Support resident and family and friends. • Encourage resident to do as much for himself as possible.• Remember that mental illness can be treated.



Terminal illness a disease or condition that will eventually cause death.


10. Explain how to care for dying residents

In a book called On Death and Dying Dr. Elisabeth Kubler-Ross identified five stages of dying:

Denial: refusal to believe one is dying Anger: “Why me?”Bargaining: “Yes me, but . . .”Depression: need to mourn and review one’s life Acceptance: preparing for death



REMEMBER:Not every resident goes through all stages of dying or goes through them in this order.



Advance directives legal documents that allow people to choose what kind of medical care they wish to have if they are unable to make those decisions themselves.

Durable power of attorney for health care a signed, dated, and witnessed paper that appoints someone else to make the medical decisions for a person in the event he or she becomes unable to do so.



Living will a document that states the medical care a person wants, or does not want, in case he or she becomes unable to make those decisions for him- or herself.

Do-not-resuscitate (DNR) an order that tells medical professionals not to perform CPR.



REMEMBER:By law, advance directives and DNR orders must be honored. Respect each resident’s decisions about advance directives.



All of these factors influence feelings and attitudes about death: • Experience with death • Personality type • Religious beliefs • Cultural background



Think about these questions:• What are some of your own experiences and backgrounds? • How have they influenced your feelings and attitudes about

death?



Cheyne-Stokes respirations slow, irregular respirations or rapid, shallow respirations.



The following are signs of approaching death:• Blurred vision that gradually fails• Unfocused eyes• Impaired speech• Diminished sense of touch• Loss of movement, muscle tone, and feeling• Rising body temperature or below normal temperature• Decreasing blood pressure• Weak pulse that is abnormally slow or rapid



Signs of approaching death (cont’d.):• Slow irregular respirations or rapid, shallow respirations

(Cheyne-Stokes)• Rattling or gurgling sound as person breathes• Cold, pale skin• Mottling, spotting, or blotching of skin• Perspiration• Incontinence• Disorientation or confusion



Keep these guidelines in mind as you care for dying residents:• Diminished senses• Care of mouth and nose• Skin care• Comfort• Environment• Emotional and spiritual support



Think about these questions:• How can you treat residents with dignity when they are

approaching death? • Which of the Residents’ Rights may apply when a resident is

close to death?


Transparency 3-4: Some Residents’ Rights to Remember When Caring for the Terminally Ill

• The right to refuse treatment• The right to have visitors • The right to privacy


Handout 3-3: The Dying Person’s Bill of Rights

I have the right to:• be treated as a living human being until I die.• maintain a sense of hopefulness, however changing its

focus may be.• be cared for by those who can maintain a sense of

hopefulness, however changing this may be.• express my feelings and emotions about my approaching

death in my own way.• participate in decisions concerning my care.• expect continuing medical and nursing attentions even

though “cure” goals must be changed to “comfort” goals.• not die alone.• be free from pain.• have my questions answered honestly.• not be deceived.


Handout 3-3: The Dying Person’s Bill of Rights (cont’d.)

I have the right to:• have help from and for my family in accepting my death.• die in peace and dignity.• retain my individuality and not be judged for my decisions

which may be contrary to beliefs of others.• discuss and enlarge my religious and/or spiritual

experiences, whatever these may mean to others.• expect that the sanctity of the human body will be

respected after death.• be cared for by caring, sensitive, knowledgeable people

who will attempt to understand my needs and will be able to gain some satisfaction in helping me face my death.

(This was created at a workshop on “The Terminally Ill Patient and the Helping Person,” sponsored by Southwestern Michigan In-service Education Council, and appeared in the American Journal of Nursing, Vol. 75, January, 1975, p. 911.)


Transparency 3-5: Ways to Treat Dying People and their Families with Dignity

• Respect their wishes in all ways possible.• Do not isolate or avoid a resident who is dying• Do not make promises that cannot or should not be kept.• Listen if they want to talk.• Do not babble or be especially cheerful or sad.• Keep the resident comfortable.• Assure privacy when they want it.• Respect the privacy of the family and other visitors.• Help with the family’s physical comfort.



Postmortem carecare of the body after death.



Remember these guidelines for postmortem care:• Rigor mortis may make the body difficult to move. Talk to the

nurse if you need assistance.• Bathe the body gently.• Place drainage pads where needed.• Do not remove tubes or other equipment.• Put in dentures if instructed by the nurse.• Close eyes.



Guidelines for postmortem care (cont’d.):• Position body. Put a small pillow under head.• Follow facility policy on personal items.• Strip the bed after body is gone.• Open windows to air the room. Straighten room.• Respect wishes of family and friends.• Document procedure.



REMEMBER:Many facilities have special policies regarding postmortem care. Be familiar with your facility’s policies.



Think about these questions:• What are your feelings about providing postmortem care?• How can you show emotional support to the dying resident?• How can you help support family members after the death?


Define the following terms:

Palliative carecare that focuses on the comfort and dignity of the person, rather than on curing him or her.


11. Define the goals of a hospice program

These are the goals of hospice care:• Promote the comfort of resident• Preserve the dignity of resident



These are the goals of hospice care:• Promote the comfort of resident• Preserve the dignity of resident

Hospice works to meet the resident’s physical, emotional, social, and spiritual needs



The following skills and attitudes are helpful in hospice work:• Be a good listener• Respect privacy and independence• Be sensitive to individual needs.• Be aware of your own feelings.• Recognize the stress.• Take good care of yourself.• Take a break when you need to.



Think about this question:Are the skills and attitudes needed for hospice work any different than those required when caring for other residents?



Think about these questions:• Why is the focus of hospice care not on wellness or recovery?• How can you deal with your own feelings when doing hospice

work?• Would a hospice NA support group be a good idea?

3Understanding Your Residents

Chapter Exam:

Multiple Choice. 1. Holistic care focuses on

(A)The whole person, including physical, mental, and social well-being

(B)Disease and disability(C)How sick a person is (D)The absence of disease and illness

2. Psychosocial needs include the following: (A)Bathing (B)Activity(C)Sleep and rest(D)Love and affection


Chapter Exam (cont’d.):

3. What is one way a nursing assistant can promote a resident’s independence? (A) Finishing a resident’s task if he takes longer than ten minutes to

complete it (B) Allowing a resident to do a task by himself no matter how long it

takes him (C) Deciding where a resident should sit in the dining room (D)Deciding what a resident should wear for the day

4. ADLs include: (A)Reading (B)Taking part in facility activities (C) Taking part in worship services (D)Brushing teeth



5. Which of the following is an example of a physical need?(A) Need for self-esteem (B) Food and water (C) Social interaction with others (D)Need for love

6. Mrs. Goldman, a resident, begins to tell her nursing assistant, Gene, about the last religious service she attended. Gene does not believe in God. Gene’s best response is to: (A) Listen quietly to Mrs. Goldman (B) Tell Mrs. Goldman that he does not believe in God and would

prefer not to discuss it (C) Tell Mrs. Goldman that her beliefs are wrong (D)Ask Mrs. Goldman what makes her think that there is a God



7. If a nursing assistant encounters a resident in a sexual situation, she should: (A) Provide privacy and leave (B) Tell him that what he is doing is wrong (C) Ask him to stop what he is doing (D)Report the incident to the resident’s clergy

8. How can regular activity promote good health? (A) It decreases the appetite. (B) It increases energy. (C) It increases the risk of heart disease. (D)It raises the risk of falls.



9. Families help residents by: (A)Creating the care plan for them (B)Telling them what to do (C)Making decisions for them(D)Supporting and encouraging them

10. Which of the following statements is true of the aging process? (A)Aging means disease and illness. (B)Older people are not able to exercise. (C)Most older people live independent lives. (D)Most older people cannot live alone.



11. Normal changes of aging include: (A) Depression (B) Thinner, drier skin (C) Significant weight loss (D)Incontinence

12. A ______ is an intense form of anxiety. (A) Phobia (B) Coping mechanism (C) Fallacy (D)Situation response



13. Which of the following is a good way to for a nursing assistant to care for a mentally ill resident? (A)Do everything for the resident. (B)Give the resident his or her medication. (C)Support the resident and his or her family and friends. (D)Encourage the resident to stop being mentally ill and just get better.

14. If a nursing assistant notices abusive behavior from a family member towards a resident, she should(A)Report it to the nurse immediately. (B)Ask the family member why he did that.(C)Tell the resident that he doesn’t have to take it.(D)Walk away.



15. When caring for a dying resident’s diminished senses a nursing assistant should

(A)Turn the lights up (B)Try not to speak to the resident (C)Turn up the radio or television (D)Observe body language

16. To treat dying residents and their families with dignity a nursing assistant should

(A)Make promises (B)Listen if they want to talk (C)Babble (D)Isolate the dying resident



17. Postmortem care includes (A)Placing drainage pads where needed (B)Removing tubes (C)Removing equipment (D)Taking the body to the morgue

18. _______ is the special care that focuses on the dignity and comfort of a dying person. (A)Postmortem (B)Cheyne-Stokes (C)Hospice (D)Terminal



19. What does palliative care involve? (A)The resident’s recovery (B)Pain relief and comfort (C)Teaching the resident to care for himself (D)Curing the resident’s illness

20. Which sense is usually the last sense to leave the body?(A)Hearing(B)Sight(C)Touch(D)Taste



21. Which of the following is a sign of approaching death? (A)Decreasing blood pressure (B)Sharper vision (C)Warm, dry skin (D)Heightened sense of touch

define the following term:

Documents