The following words and terms, when used in this chapter, shall
have the following meanings, unless the context clearly indicates
otherwise.
(1) Activities of daily living (ADLs)--limited to the
following activities: bathing, dressing, grooming, routine hair and
skin care, meal preparation, feeding, exercising, toileting, transfer/ambulation,
positioning, range of motion, and assistance with self administered
medications. The term does not include more specific tasks defined
as health maintenance activities under paragraph (8) of this section
(relating to Health Maintenance Activities).
(2) Administration of Medications--removal of an individual/unit
dose from a previously dispensed, properly labeled container; verifying
it with the medication order; giving the correct medication and the
correct dose to the proper client at the proper time by the proper
route; and accurately recording the time and dose given.
(3) Assistance with self-administered medication--any
needed ancillary aid provided to a client in the client's self-administered
medication or treatment regimen, such as reminding a client to take
a medication at the prescribed time, opening and closing a medication
container, pouring a predetermined quantity of liquid to be ingested,
returning a medication to the proper storage area, and assisting in
reordering medications from a pharmacy.
(4) Client--the individual receiving care.
(5) Client's Responsible Adult--an individual, 18 or
older, normally chosen by the client, who is willing and able to participate
in decisions about the overall management of the client's health care
and to fulfill any other responsibilities required under this chapter
for care of the client. The term includes but is not limited to parent,
foster parent, family member, significant other, or legal guardian.
(6) Delegation--means that a registered nurse authorizes
an unlicensed person to perform tasks of nursing care in selected
situations and indicates that authorization in writing. The delegation
process includes nursing assessment of a client in a specific situation,
evaluation of the ability of the unlicensed persons, teaching the
task, ensuring supervision of the unlicensed persons and re-evaluating
the task at regular intervals. It does not include situations in which
an unlicensed person is directly assisting a RN by carrying out nursing
tasks in the presence of a RN.
(7) Functional Disability--a mental, cognitive, or
physical disability that precludes the physical performance of self-care
tasks, including health maintenance activities and ADLs.
(8) Health Maintenance Activities (HMAs)--tasks that
may be exempt from delegation based on RN assessment that enable the
client to remain in an independent living environment and go beyond
ADLs because of the higher skill level required to perform. HMAs include
the following:
(A) administering oral medications that are normally
self-administered, including administration through a permanently
placed feeding tube with irrigation;
(B) topically applied medications;
(C) insulin or other injectable medications prescribed
in the treatment of diabetes mellitus administered subcutaneously,
nasally, or via an insulin pump;
(D) unit dose medication administration by way of inhalation
(MDIs) including medications administered as nebulizer treatments
for prophylaxis and/or maintenance;
(E) routine administration of a prescribed dose of
oxygen;
(F) noninvasive ventilation (NIV) such as continuous
positive airway pressure (CPAP) and bi-level positive airway pressure
(BiPAP) therapy;
(G) the administering of a bowel and bladder program,
including suppositories, enemas, manual evacuation, intermittent catheterization,
digital stimulation associated with a bowel program, tasks related
to external stoma care including but not limited to pouch changes,
measuring intake and output, and skin care surrounding the stoma area;
(H) routine preventive skin care and care of Stage
1 pressure ulcers;
(I) feeding and irrigation through a permanently placed
feeding tube inserted in a surgically created orifice or stoma;
(J) those tasks that an RN may reasonably conclude
as safe to exempt from delegation based on an assessment consistent
with §225.6 of this title (relating to RN Assessment of the Client);
and
(K) such other tasks as the Board may designate.
(9) Independent living environment--A client's individual
residence which may include a home or homelike setting such as the
client's home, an entity licensed or regulated by a state or federal
agency or exempt from such licensure or regulation, (such as a group
home, foster home, or assisted living facility), and includes where
the client works, attends school, or engages in other community activities.
The term does not include settings in which nursing services are continuously
provided.
(10) Not Requiring Delegation--a determination by a
RN that the performance of an ADL or HMA may be exempt from delegation
for a particular client and does not constitute the practice of professional
nursing based on criteria established by the Board/this chapter.
(11) Stable and predictable--a situation where the
client's clinical and behavioral status is determined to be non-fluctuating
and consistent. A stable/predictable condition involves long term
health care needs which are not recuperative in nature and do not
require the regularly scheduled presence of a registered nurse or
licensed vocational nurse. Excluded by this definition are situations
where the client's clinical and behavioral status is expected to change
rapidly or in need of the continuous/continual assessment and evaluation
of a registered nurse or licensed vocational nurse. The condition
of clients receiving hospice care in an independent living environment
where deterioration is predictable shall be deemed to be stable and
predictable.
(12) Unlicensed person--an individual, not licensed
as a health care provider:
(A) who is monetarily compensated to provide certain
health related tasks and functions in a complementary or assistive
role to the RN in providing direct client care or carrying out common
nursing functions;
(B) who provides those tasks and functions as a volunteer
but does not qualify as a friend providing gratuitous care for the
sick under §301.004(1) of the Nursing Practice Act;
(C) including, but not limited to, nurse aides, orderlies,
assistants, attendants, technicians, home health aides, medication
aides permitted by a state agency, and other individuals providing
personal care/assistance of health related services; or
(D) who is a professional nursing student, not licensed
as a RN or LVN, providing care for monetary compensation and not as
part of their formal educational program shall be considered to be
unlicensed persons and must provide that care in conformity with this
chapter.
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