Certified Nursing Assistant Examination (CNA) Role of the Nurse Aide and Legal/Ethical Foundations Syllabus

Under OBRA, what is the minimum required nurse aide training, and what must aides pass?

A minimum of 75 hours of training (including supervised clinical/practical hours) and a state competency evaluation (written/oral test plus a skills exam); passing places the aide on the state Nurse Aide Registry.

What are Residents' Rights?

Legal rights guaranteed to residents of long-term care facilities under OBRA, ensuring quality of life, dignity, autonomy, and protection; facilities must inform residents of these rights.

Define dignity in the context of resident care.

Treating residents with respect, honoring their worth as individuals, and supporting their self-esteem and preferences.

How can a nurse aide protect a resident's privacy during personal care?

Close doors and privacy curtains, drape/cover the resident, expose only the body part being cared for, knock before entering, and not expose the resident unnecessarily.

What is confidentiality, and what U.S. law protects health information?

Keeping a resident's personal and medical information private, sharing it only with the care team who need it. HIPAA (Health Insurance Portability and Accountability Act) legally protects this information.

Define abuse.

The intentional infliction of injury, unreasonable confinement, intimidation, or punishment that results in physical harm, pain, or mental anguish.

Define neglect.

The failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness; failing to meet a resident's basic needs.

List the major types of abuse a nurse aide must recognize.

Physical abuse, sexual abuse, psychological/emotional/verbal abuse, financial abuse (misappropriation), and neglect (including self-neglect).

What is verbal/psychological abuse? Give examples.

Using oral, written, or gestured words/actions that cause fear, humiliation, or distress — e.g., threatening, yelling, name-calling, ridiculing, or ignoring a resident.

Define a physical restraint.

Any manual method, physical/mechanical device, material, or equipment attached to or near the body that the resident cannot easily remove and that restricts freedom of movement or normal access to one's body (e.g., vests, lap belts, side rails used to confine).

Define a chemical restraint.

Any drug (e.g., sedative or psychoactive medication) used to control behavior or restrict movement that is not required to treat a medical condition.

Under OBRA, when may restraints be used?

Only when ordered by a physician, to treat a medical symptom, when less restrictive measures have failed, and never for staff convenience or as discipline/punishment.

List two physical and two psychological hazards of restraint use.

Physical: pressure injuries, muscle weakness/atrophy, incontinence, poor circulation, strangulation/injury. Psychological: depression, anxiety, agitation, loss of dignity and independence.

What is a 'restraint-free' or 'restraint alternative' approach?

Using measures other than restraints to keep residents safe — e.g., bed/chair alarms, frequent toileting, increased supervision, activities, adequate lighting, and lowering the bed.

What rights do residents have regarding personal possessions?

The right to keep and use personal belongings and to have them treated with care and respect; possessions should be protected from loss or theft and not taken or borrowed by staff.

What financial rights do residents have under OBRA?

The right to manage their own money/financial affairs, to be informed about their finances, and to have an accurate accounting of any funds the facility manages on their behalf.

What is self-determination (autonomy) as a resident right?

The right to make one's own choices and decisions about care, daily routine, schedule, and treatment, including the right to refuse care.

What does 'quality of life' mean as protected by OBRA?

A resident's overall well-being and ability to enjoy life, including dignity, independence, choice, social interaction, comfort, and participation in activities of their choosing.

What is the resident's right regarding their care plan?

The right to participate in planning their own care and treatment and to be informed about their medical condition.

What is the right to refuse treatment, and what must the aide do if a resident refuses care?

Residents have the legal right to refuse any treatment or care; the aide must respect the refusal, not force care, and report the refusal to the nurse and document it.

What should a nurse aide do if they suspect a resident is being abused or neglected?

Report it immediately to the nurse/supervisor (and as required by law); aides are mandated reporters. Do not ignore it, and protect the resident's safety.

List common physical signs that may indicate abuse.

Unexplained bruises, burns, fractures, cuts, or pressure injuries; injuries in various stages of healing; bruises in unusual locations; and signs of restraint on wrists/ankles.

List behavioral signs that may indicate a resident is being abused.

Fearfulness, withdrawal, agitation, depression, changes in behavior around certain staff, reluctance to speak, mood changes, and poor self-esteem.

What is involuntary seclusion?

Separating a resident from others or confining them to an area against their will without medical or safety reason; it is a form of abuse.

What is misappropriation of resident property?

The illegal or unauthorized use of a resident's belongings or money for one's own benefit (theft of property/funds) — a form of financial abuse.

Define mistreatment in long-term care.

Any inappropriate treatment or exploitation of a resident — including abuse, neglect, involuntary seclusion, and misappropriation of property.

What is an ombudsman?

A trained advocate (required by federal law) who investigates and resolves complaints made by or on behalf of residents and works to protect residents' rights and quality of care.

What is the main function of the ombudsman program?

To act as an advocate for residents — receiving, investigating, and resolving complaints, and ensuring residents' rights are upheld in long-term care facilities.

Define liability.

Legal responsibility for one's own actions; a nurse aide can be held legally accountable for harm caused by their conduct.

Differentiate negligence from malpractice.

Negligence is failing to provide the care a reasonable person would provide, causing harm. Malpractice is negligence by a licensed professional. Aides are most often charged with negligence.

Define assault and battery.

Assault is threatening or attempting to touch a person without consent, causing fear of harm. Battery is the actual unauthorized touching of a person's body without consent.

What is false imprisonment in health care?

Unlawfully restraining or restricting a person's freedom of movement, including improper use of restraints or confining a resident against their will.

Define informed consent.

Permission given by a resident for care/treatment after being fully informed of the procedure, its risks, benefits, and alternatives.

What is defamation, and how do libel and slander differ?

Defamation is harming someone's reputation with false statements. Libel is written defamation; slander is spoken defamation.

What is the difference between ethics and law?

Ethics are moral principles/standards of right and wrong that guide behavior; laws are rules enforced by government with legal penalties. Ethics guide conduct beyond what law requires.

Name the core ethical principles in health care.

Autonomy (self-determination), beneficence (do good), nonmaleficence (do no harm), justice (fairness), and fidelity (faithfulness/keeping promises); plus veracity (truthfulness).

What are professional boundaries for a nurse aide?

Limits that keep the caregiver-resident relationship professional — e.g., not accepting gifts/tips or money, not borrowing/lending, not becoming over-involved personally, and not discussing personal problems with residents.

Why should a nurse aide not accept tips or gifts from residents?

It violates professional boundaries and ethics, can be seen as accepting payment for care that should be given equally to all, and may lead to favoritism or exploitation.

What are the two main types of communication?

Verbal communication (spoken or written words) and nonverbal communication (body language, gestures, facial expressions, tone, eye contact, and touch).

List the basic parts of the communication process.

A sender, a message, a receiver, and feedback (a response confirming the message was understood).

What is active listening?

Focusing fully on the speaker, giving full attention, providing feedback, not interrupting, and clarifying to ensure the message is understood.

Give three examples of positive nonverbal communication.

Maintaining eye contact, smiling, leaning in/facing the resident, nodding, relaxed posture, and appropriate, gentle touch.

What is the difference between an open-ended and a closed-ended question?

Open-ended questions invite a detailed response (cannot be answered with yes/no), encouraging conversation; closed-ended questions can be answered with a single word like 'yes' or 'no.'

How should a nurse aide communicate with a hearing-impaired resident?

Face the resident, speak clearly at a normal pace, reduce background noise, get their attention first, ensure hearing aids are in/working, use gestures/writing, and don't shout.

How should a nurse aide communicate with a visually impaired resident?

Identify yourself when entering and announce when leaving, explain what you're doing, face the resident and speak normally, describe surroundings, and don't move belongings without telling them.

How should a nurse aide communicate with a resident who has aphasia or difficulty speaking?

Be patient, allow plenty of time to respond, ask simple yes/no questions, use gestures and communication boards/pictures, and don't rush or finish their sentences.

How should a nurse aide communicate with a resident who has dementia/confusion?

Use a calm, reassuring tone; speak slowly with short simple sentences; approach from the front; use the resident's name; give one direction at a time; and avoid arguing or correcting.

What is the difference between objective and subjective observations (reporting)?

Objective (signs) are observable, measurable facts you see/hear/feel/smell (e.g., temperature, a rash). Subjective (symptoms) are what the resident reports/feels and cannot be observed (e.g., 'I have a headache').

What does it mean to report 'objectively'?

Reporting only the facts you observe, without adding opinions, conclusions, or interpretations.

What is the difference between reporting and recording (documenting)?

Reporting is communicating information orally to the nurse/team; recording (charting) is writing the information in the resident's medical record.

What are key rules for accurate documentation/charting?

Be timely, accurate, objective, and legible; document only what you did/observed (never in advance); never erase or use white-out — correct errors per policy; sign with your name and title.

What should a nurse aide report to the nurse immediately?

Any sudden change in a resident's condition, signs/symptoms of illness or injury, falls, refusal of care, complaints of pain, abnormal vital signs, or anything unusual.

What is the purpose of the medical record (chart)?

To provide a permanent, legal record of the resident's condition and care, ensure continuity of care among the team, and serve as a communication and legal document.

What is the 'chain of command' and why is it important?

The line of authority/order in which staff report (e.g., aide → nurse → charge nurse → DON); it ensures proper communication, accountability, and that issues reach the right person.

How should a nurse aide handle communication with a resident's family?

Be courteous, respectful, and supportive; maintain confidentiality (do not share medical information beyond your role); refer medical questions to the nurse; and report family concerns to the nurse.