A Message from Mark Baiada BAYADA Home Health Care has a special purpose—to help people have a safe home life with comfort, independence, and dignity. BAYADA will only succeed with your involvement and commitment as a member of our home health care team. I recognize your importance to the organization and appreciate your compassion, excellence, and reliability. I value the skills, expertise, and experience that you bring with you. And, as an organization, BAYADA is committed to providing you with opportunities to help broaden your expertise and experience. Acquiring new skills will allow you to participate in the care of a wider variety of clients. That makes you an increasingly valuable member of our home health care team. Most importantly, our clients benefit when you successfully master new skills that contribute to their safety and well-being. BAYADA University and the School of Nursing courses are designed to help you perfect your knowledge and skill to achieve clinical excellence in the care of clients. I applaud your willingness to continue the journey of life-long learning and wish you continued success in your professional development as an important member of the BAYADA team. Sincerely, Mark Baiada President Table of Contents Welcome ...........................................................................................................................iv Introduction to home care ................................................................................................. 1 Psychosocial ................................................................................................................... 13 Growth and development ................................................................................................ 28 Assessment..................................................................................................................... 69 Pathophysiology ............................................................................................................ 131 Nutrition and hydration .................................................................................................. 182 Medication administration ............................................................................................. 203 Safety ............................................................................................................................ 220 Rehabilitation ................................................................................................................ 255 Equipment ..................................................................................................................... 282 Pain, palliative care, and hospice ................................................................................. 200 Documentation .............................................................................................................. 318 Return demonstration checklists ................................................................................... 328 Welcome Welcome to BAYADA University. The goal of the BAYADA Home Health Care School of Nursing is the Achievement of Clinical Excellence (ACE). At BAYADA, we are committed to providing our clients and families with the best care possible. To accomplish this, we rely on our exceptional nurses who follow our core values of compassion, excellence, and reliability. For the pediatric client who has a life altering condition or illness, it is important to them and their families that they receive care from nurses who are compassionate, competent, and confident. It is also important to us that we provide a supportive learning environment for all of our team members. This means helping nurses gain knowledge and master the skills that will enable them to best meet the care requirements of our clients. Strategies for achieving our goals To ensure that you can meet our high standards of nursing care and that you have opportunities to grow in your professional practice, all nurses at BAYADA receive: • General orientation upon hire • Specific orientation for new case assignments • Continuing education and in-service opportunities The ACE Clinical Learning System is part of our ongoing commitment to professional staff development. The ACE Clinical Learning System is self-directed, which means that you, the learner, will take responsibility for your own learning. We believe that you can best determine when and where you want to learn. Self-directed learning also allows you to learn at your own pace. You can take the time you need to master both the learning and performance objectives before you are formally tested on them. Depending on your experience level, you could master the learning objectives by reading this self-directed learning course in three to four hours. It may take more time and it may take less. Also depending on your experience level, you may practice the performance objectives on a mannequin for one to two hours and feel competent to demonstrate your mastery. You may be very familiar with basic nursing procedures and require very little practice time. You may need more practice time. That’s the beauty of self- directed learning. You can control when, where, and how to pace your learning. iii Welcome Who must complete this clinical course? New nurses with no experience in the care of pediatric clients in the home are required to complete the appropriate self-directed learning course. New nurses with experience in pediatric home care are encouraged to complete the self- directed learning book and video but may forego the practice component. All nurses who will be caring for pediatric clients in the home must perform a return demonstration and pass the relevant exam with mastery to certify that they are competent to be oriented to a client, begin a preceptor program, or be permanently coded. Components of the system The ACE Clinical Learning System contains the following elements: • Self-directed learning package • Laboratory practice and guided practice • Return demonstration • Certification exam • Preceptorship and orientation Self-directed learning course The self-directed learning book and video present the information and procedures you will need to know in order to deliver safe care to a pediatric client in the home care setting. Your service office staff will give you the appropriate self-directed learning course relative to the type of clients for whom you will care. Each section of this book begins with a series of learning objectives. They identify the subjects you must be able to list or discuss before moving to the next section. Quizzes at the end of each section will test your mastery of the learning objectives. Do not continue to the next section until you have mastered the current section’s learning objectives by passing the section quizzes with 100 percent score. You will see the quiz symbol in the margin when there is a quiz to be completed. ii Welcome This icon refers to BAYADA Home Health Care policy. Laboratory practice and guided practice Once you have read the book and completed every quiz with 100 percent mastery you may practice the newly learned skills and procedures on mannequins in a laboratory setting. Practice means performing the new skills and tasks until you have mastered them. You may choose to practice on your own and then schedule time with the nurse educator or coach for additional guided practice. Or, you may want to schedule guided practice first, ask questions, and then practice on your own. Or you may not wish to practice at all. The choice is yours. Guided practice will give you the benefit of feedback from the nurse educator or coach. You will see a stethoscope symbol in the text margins to indicate when practice is needed. Return demonstration Once you feel completely confident in your abilities to successfully demonstrate the performance objectives of the pediatric home care course, you must schedule a return demonstration with the clinical instructor or clinical manager. At the end of this self- directed learning course is a sample Return Demonstration Checklist which lists all of the skills you will be expected to fully demonstrate. Certification exam Passing the certification exam signifies that you have successfully mastered the cognitive objectives of this course. The certification exam may be completed before, at the same time, or after you perform the return demonstration. The person who gave you this self-directed learning package will tell you how to schedule time to take the certification exam. Upon successful completion of the self-directed learning package, the return demonstration, and the certification exam, you will be ready to be oriented to a client or begin a preceptor program. iii Welcome Preceptorship and orientation After you have successfully completed the certification exam and the return demonstration, you will begin your precepting period in the home setting. You will work side by side with a preceptor to demonstrate your skills you performed in the lab setting. Initially, you will have a minimum of 16 to 24 hours or orientation for each age range; infant, 0 to 18 months and pediatric, 19 months to 18 years, depending of the client’s skill level and your experience. The orientation period will continue until you have successfully demonstrated all the required skills for that client. At that point, you will be able to work independently on that client. Ongoing, you will receive a minimum of two hours of orientation to new clients. Learning objectives Chapter