2.2 Role, Rights, and Psychosocial Care

Know the CNA Lane

The Virginia CNA role is direct resident care under the supervision of a licensed nurse. A CNA may assist with activities of daily living (ADLs), take and record measurements, observe condition changes, follow the care plan, and report concerns. A CNA does not diagnose, assess independently, change the care plan, give medications (except very limited tasks if certified and delegated), perform sterile procedures, or decide on their own that a symptom is harmless. When a delegated task is unclear or feels unsafe, the safe answer is to stop and ask the nurse — never to guess or to refuse without reporting.

Scope and Rights Checkpoints

Resident Rights in Everyday Care

Resident rights are protected by federal OBRA regulations and show up in ordinary tasks. Knock before entering, identify yourself, explain the task, close the curtain or door, drape the resident, offer reasonable choices, and speak to adults as adults — never with a baby-talk "elderspeak" tone. Privacy covers the body, the medical record, belongings, and conversations. Confidentiality means sharing only what the care team needs; discussing a resident in the hallway or with another resident's family is a violation.

Residents also have the right to be free from restraints used for staff convenience and the right to refuse any treatment, even one the staff believes is best.

Key distinctions the exam tests:

• Abuse = intentional harm (hitting, threatening, humiliating).
• Neglect = failure to provide needed care (skipped repositioning, ignored call light).
• Misappropriation / exploitation = misuse of a resident's money or property.
• Mandated reporting = report the moment you suspect any of these; you do not need proof, and you do not interrogate the resident.

Psychosocial Care and Communication

Psychosocial care is not separate from physical care. A resident with dementia may be frightened by rushing, correction, or too many choices. Approach from the front so you are seen, use the resident's name, give one step at a time, validate feelings rather than arguing about false beliefs, and redirect to a safe activity. Worked scenario: a resident insists she must "go pick up the children from school." Arguing increases agitation; instead acknowledge the feeling ("You're a caring mother") and redirect to folding towels or a walk.

For a resident who is suddenly withdrawn, tearful, eating less, or giving away belongings, report it — these can signal depression or pain, which the nurse assesses.

Communication and documentation must stay objective. Write or report what you saw, heard, measured, and did: "Resident states pain in right hip 7/10, pulse 112, refused bath, nurse notified at 0815." Do not chart opinions, blame, guesses, or diagnoses. For urgent changes — chest pain, trouble breathing, a fall, suspected abuse, or sudden confusion — report immediately and stay with the resident as directed.

Therapeutic Communication Techniques

The exam separates therapeutic from non-therapeutic communication. Therapeutic techniques keep the resident talking and feeling heard; non-therapeutic ones shut them down. Memorize the contrast:

For a resident with a hearing impairment, reduce background noise, face the resident so they can read your lips, speak in a normal lower-pitched voice (shouting distorts speech), and confirm the hearing aid is on. For a visually impaired resident, announce yourself when entering and leaving, describe the food on the plate by clock position ("meat at 6 o'clock"), and keep belongings in their usual place. For a resident who is aphasic after a stroke, give time, use simple yes/no questions or a picture board, and never finish their sentences impatiently.

Cultural, Spiritual, and End-of-Life Respect

Residents have the right to practice their culture and religion. Honor dietary restrictions, allow personal religious items, and never assume your own preferences apply. Near the end of life, comfort, dignity, presence, and respect for advance directives (including a Do Not Resuscitate / DNR order) guide care; the CNA keeps the resident clean, repositioned, and comfortable, and provides emotional support to family. After death, follow the facility's postmortem care procedure and treat the body with dignity.

The recurring trap answer is the one that delays reporting, falsifies a chart entry, argues with a confused resident, ignores a cultural request, or forces care over a valid refusal; none of those ever score. When in doubt, the highest-scoring choice protects safety and dignity and routes the clinical decision to the nurse.

Delegation and the Five Rights

The nurse delegates tasks to the CNA, and a safe CNA knows when to accept a task. A delegated task should be within your training, appropriate for the resident's current condition, and something you can perform safely; if any of those is missing, you decline and explain, then ask the nurse, rather than silently refusing or attempting it unsafely. The CNA never performs tasks reserved for licensed staff: assessment, sterile procedures, tube insertion or removal, IV care, and independent medication administration.

This delegation boundary is the engine behind most scope questions — the right answer keeps the CNA assisting, observing, recording, and reporting while the nurse retains clinical judgment and accountability for the delegated outcome.