Wisconsin Legislature: DHS 129.07(1)(c)8.

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.