ROLE OF GENERAL DUTY ASSISTANT IN ELDERLY & CHILD CARE TEACHERS

Transcription

TEACHERS HANDBOOK
HSS402 - NQ2014
ROLE OF GENERAL DUTY
ASSISTANT IN ELDERLY &
CHILD CARE
i-lq-'k-dsUnzh; O;kolkf;d f'k{kk laLFkku]';keyk fgYl, Hkksiky
PSS Central Institute of Vocational Education, Shyamla Hills, Bhopal
© PSS Central Institute of Vocational Education, 2014
Copyright protects this publication. Except for purposes permitted by the Copyright Act, reproduction,
adaptation, electronic storage and communication to the public are prohibited without prior written
permission.
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PREFACE
The Teacher’s Handbook on “ROLE OF GDA IN ELDERLY & CHILD CARE” is a part of the qualification
package developed by the Healthcare Sector Skill Council (HSSC) for the National Skills Qualifications
Framework (NSQF) of “General Duty Assistant/Patient Care Assistant”. The National Vocational
Education Qualification Framework (NVEQF) now subsumed in NSQF is an initiative of the Ministry of
Human Resource Development (MHRD), Government of India to set common principles and guidelines for
a nationally recognized qualification system covering Schools, Vocational Education and Training
Institutions, Technical Education Institutions, Colleges and Universities. It is envisaged that the NVEQF
will promote transparency of qualifications, cross-sectoral learning, student-centered learning and
facilitate learner’s mobility between different qualifications, thus encouraging lifelong learning.
The National Curriculum Framework, 2005, recommends that children’s life at school must be linked to
their life outside the school. This principle makes a departure from the legacy of bookish learning which
continues to shape our system and causes a gap between the school, home, community and the
workplace. Experiential learning, which is a cyclical process involving observation, reflection and action,
should be an integral part of the teaching-learning process. Attempt by the students to solve problems,
guided by the teachers or instructors, would enable them to explore and discover new knowledge and
develop problem solving skills. A range of pedagogies, including interactive lecture, role plays, case
based studies, assignments, projects and on-the-job activities that provide students with generic,
technical and professional knowledge and skills should be adopted by the teachers and instructors to
foster student-centered learning.
The success of this effort of integrating knowledge and skills depends on the steps that the teachers will
take to encourage children to reflect their own learning and to pursue imaginative and on-the-job
activities and questions. Participation of learners in skill development exercises and inculcation of
values and creativity is possible if children are involved as participants in learning, and not as receiver
of information. These aims imply considerable change in school routines and mode of functioning.
Flexibility in the daily time-table would be a necessity to maintain the rigour in implementing the
activities and the required number of teaching days will have to be increased for teaching and training.
The suggestions by the teachers and other stakeholders in education and training will be of great value
to us in bringing about qualitative improvement in the teacher’s handbook.
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ACKNOWLEDGEMENTS
We place on record our sincerest gratitude to Shri Rajarshi Bhattacharya, I.A.S., Secretary (SE),
Ministry of Human Resource Development (MHRD), Government of India, Smt. Radha Chauhan, I.A.S.,
Joint Secretary (SE), Department of School Education and Literacy, MHRD and Smt. Ankita Mishra
Bundela, I.A.S., Deputy Secretary (VE), Department of School Education and Literacy, MHRD for the
support and guidance. We take this opportunity of expressing our gratitude to MHRD for financial
support to the project on development of curricula and courseware under National Skills Qualifications
Framework (NSQF).
We would like to thank Professor Parvin Sinclair, Director, National Council of Educational
Research and Training (NCERT) and Professor R. B. Shivagunde, Joint Director, PSS Central Institute of
Vocational Education (PSSCIVE) for their guidance.
The contribution of Shri M.K. Mishra and Shri Satish.C.Pandey of MPCON Ltd., Bhopal as
resource person and Dr. Sukhwant Singh, Dr. Jitendra Banweer, Dr. Richa Mishra, Dr. Ratan Lal
Patidar, Dr. Sandhya Singh, Dr. Ashish Acharya, Mr. Ashok Pal, Ms Priyanka Acharya, Ms. Manisha Gupta
and Ms Rashmi Mishra as experts in healthcare sector for developing the content of the courseware is
duly acknowledged.
We are grateful to Dr. Vinay Swarup Mehrotra, Professor and Head, Curriculum Development
and Evaluation Centre (CDEC) and National Skills Qualifications (NSQF) Cell, PSSCIVE, Bhopal for
coordinating the development of curricula, student workbooks and teachers‟ Handbooks
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GENERAL INSTRUCTIONS FOR TEACHERS
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Read the Teacher’s Handbook carefully before teaching or conducting the training.
Follow the session plan strictly
Familiarize yourself thoroughly with the relevant knowledge and skills to be transacted.
Ensure all materials/aids/equipment required for teaching and training is available.
Introduce the skill by explaining the purpose.
Demonstrate the skill to the participants, explaining each step in detail.
Invite the students to ask questions.
Ask the students to practice the skill themselves and make observation while they perform the
task.
Provide the students with constructive feedback.
Discuss in class, the problems faced by the students in performing the task.
Summarize the key learning.
Ensure key learning is captured and performance standards are met at the end of each session.
Regularly check student’s workbook to ensure all exercises are being completed on time.
Ensure that all participants complete the required assessments given in the student workbook.
Always encourage participants. Never discourage them from getting actively engaged in
discussions, question-answer sessions and task-oriented activities.
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TABLE OF CONTENTS
PREFACE
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ACKNOWLEDGEMENTS
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GENERAL INSTRUCTIONS FOR TEACHERS
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SESSION 1: INTRODUCTION TO OLD AGE
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SESSION 2: NORMAL CHANGES WITH OLDER PEOPLE
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SESSION 3: ACCOMPLISHING BASIC NEEDS OF ELDERLY
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SESSION 4: COMMON PROBLEMS & CARE OF ELDERLY
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SESSION 5: CARING FOR INFANTS & CHILDREN
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Session1: Introduction to Old Age
Relevant Knowledge
In this session, we will learn about the meaning of old age,
different age groups, basic terms and reason for longer life and
being old. We will also study the types of aging and some myths
and facts about aging.
There are more aging people in the India than ever before. We
have learned a lot about these people and their needs in the last
few years. Many old people are young in body and mind. Some are
not. All old people are not all the same. They are different. They
all have different needs.
Difference between each elderly
All of us know “old” people. It may be a parent. It may be a
grandparent. It may be a neighbour or a person from church. It
may also be the person that you take care of. Think for a minute
about these “old” people. Are they all the same? Or, are they
different? Think about how they all are in a physical way. Are they
all in poor health? Think about how they are in a mental way. Are
they all confused? Think about how they are in a social way. Do
they go out or do they all stay alone in their home? Think about
how they are in terms of money. Are they all poor? Do all “old”
people have the same spiritual needs? Are they different or, are
they all the same? Are all “old” people set in their ways? Or, are
some different? Think about all of the “old people that you know.
Make a list. How are they the same and how are they different? I
think that they are different in many ways and the same in only a
few ways. Not all “old” people are the same. Not all “old” people
have the same needs. Not all “old” people want to be treated the
same. We must care for them in different ways. We must also
communicate with them in different ways, as based on their own
special needs.
Meaning of Old
The meaning of the word “old” is always changing, as more and
more people get old and live longer than ever before. Some
people use these words for these ages:
The Age Groups
Age Group Age Span
Infant
Birth to 1 year
Toddler
1 to 3 years
Preschool child
3 to 5 years
School age child
5 to 12 years
Adolescent
12 to 18 years
Young Adult
18 to 45 years
Middle Age Adult
45 to 65 years
Old Adult
Over 65
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Even though people of these ages are referred to as old-old, aged,
etc., it still does not mean that all people of a certain age are the
same. They may have many differences.
Some Basic Terms
1. Geriatrics – special medical care and treatment for the
older adult
2. Gerontology – the study of the older adult
3. Gerontophobia – a fear of aging and that lack of
acceptance of older adults
4. Ageism – a dislike of older adults; age discrimination
Reason for Longer Life
There are several reasons for this increase of life span. Babies are
living even when they are very small or ill. Before, they died.
Deadly infections and diseases have been wiped out with vaccines
and drugs. People do not get smallpox anymore because they get
the vaccine. Many people in the past died from it. People can
fight off infections like strep and the flu with good medical care
and drugs. People with long term chronic illness, like diabetes and
heart disease, can live long with good care and drugs. All of these
things used to kill people at young ages. Now, people prevent
these things (smallpox) or they get good treatment and care
(diabetes and heart disease).
Reason of Being Old
There is no fountain of youth. People, all people, age. Some say
that people begin to age as soon as they are born. It is a long
process. No one knows for sure why people age, but some have
some thoughts about it.
Biological Aging
Some people say that people age because the cells of the body
change or “age” over time. The person may have their own
“biological clock”. This clock keeps ticking as the cells of the
body and the body itself changes. For example, a woman reaches
menopause; hair turns gray; and the skin changes. Others people
believe that the body just runs out of healthy genes. Harmful
genes then take over to produce the signs of aging. Still more
believe that DNA damage, radiation and a breakdown of our
immune system lead to aging. Recently, “free radicals” have been
found to perhaps lead to aging. Antioxidants (vitamins A, B, C, C,
folic acid) lower these “free radicals”.
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Psycho-Social Aging
Some believe that people age for a number of things NOT having
to do with the human body. These people believe that people age
because they:
 separate themselves from the people around them;
 no longer keep their body active (active people tend to be
happier with life); and
 separate themselves from the people around them AND they
no longer keep their body active;
Myths & Fact About Aging
There are many things said about older people that are just not
true. Some of these false myths are below:
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All old people are the same.
Old people cannot learn. You just cannot teach “old dog new
tricks”.
Old people are forgetful.
All old people will get confused and senile.
Old people are sick and frail. Old people become sicker and
sicker as they age.
Old people cannot exercise.
Old people depend on others.
Old people will lose their teeth.
Old people are usually lonely, alone and withdrawn.
Old people retire at the age of 65.
All old people are NOT the same. Often the age of the person is
not the best way to know about the person, their strengths and
weaknesses. Some 90-year-old people exercise daily; some take
college courses; some are very active in their area
(temple/religious, civic groups, politics, etc.). Aging does not
affect our personality. It remains about the same. Old people
keep these personality differences as they age. Happy old
people who liked to talk as a young person continue to be happy
and talkative as they age.
Old people can still learn and they are not always “forgetful”.
Aging does not mean that the person cannot learn. Their longterm memory stays good for most. Some have short-term
memory problems but they cope with this and can learn. They
may “think things out” more than when they were younger. The
mental functions of older people should stay the same.
Confusion is NOT a normal sign of aging.
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Many old people are NOT sick and frail. Some are very healthy
and with no disability. Older people can, and should, exercise on
a daily basis. Healthy aging involves many things, including a
good diet and exercise. Although some older people may need
some assistance because they have some disability, many more
are NOT dependent on others.
Old people do NOT have to lose their teeth. Good dental care is
needed. Socially, NOT all old people are lonely, alone and
withdrawn. They remain active.
Most old people are NOT alone. More than ½ of people who are
65 and older live with a spouse or with other family members.
Less than one out of five live alone. Also, many old people
remain active and involved with family, friends and other
friends. Some may enter a senior group home or an assisted
living place with lots of activities.
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Session Plan 1
T1: Interactive Lecture
1. SESSION TOPIC:
Introduction to Old Age
DURATION: 02 HOURS
2. OBJECTIVE: To develop
student’s
knowledge,
skill & abilities to
understand the facts
related to Old Age
1. Prepare the points for the lecture.
2. Introduce the topic.
3. Make an opening by telling students the purpose of the
lecture or presentation.
4. Introduce the topic in the class and provide relevant
knowledge to the students. Topics may include but not limited
to the following:
a) Describe different age groups
b) Explain Biological Aging
c) Explain the reasons for longer life and being old
5. Relate the topic to the situation and ask questions.
6. Provide specific examples.
7. Involve students by giving them the opportunity to ask
questions related to the topic.
8. Clarify any questions students may have.
9. Summarize the topic and emphasize on the key points.
3. MATERIALS/EQUIPMENT
REQUIRED:
Charts,
Sketch Pens, Computer,
Open Source Software
for Slide Presentation,
LCD Projector and lab
for demonstration
4.
PREPARATIONS
o Arrange all the
materials well in
advance
5. TEACHING/TRAINING
METHODOLOGY:
PROCESS
T2 : Practical Session
DURATION: 02 HOURS
Exercise
This practice session will enable the student to understand the
practical aspect of this topic. Ask them to observe the old people
in their surroundings and tabulate the myths and facts of aging
Myths observed
Facts Communicated
Checklist for Assessment Activity
Use the following checklist to check whether your students could
meet all the requirements for assessment.
Part A
Students could differentiate between the following:
1. Care needed by an adolescent and an Old adult
2. Biological and psychosocial cause of ageing
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Part B
Students could answer in class the following:
1. Care needed by an old adult
2. The importance of understanding myths and facts related to
ageing in providing care of elderly
3. Reasons for longer living
Part C
Performance Standards
The performance standard may include, but not limited to:
Performance standards
Yes
No
Demonstrate the knowledge of different age
groups
Differentiate the myths and facts of ageing
Describe the biological and psychosocial reasons
of ageing
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Session 2: Normal changes with Older People
Relevant Knowledge
In this session, we will learn about the normal changes occur in
old age in different systems and part of the body. We will also
study about the special needs, thinking, emotional changes, social
changes and legal needs required at the old age. Reasons for
caring elderly will also be covered in this session.
The following changes occur in the old age:
Skin, Hair and Nails: Some of the normal skin changes are:
 The skin becomes more fragile. Skin tears may happen.
 Rashes are more common. Contact with some soaps and
“make up” can lead to rashes.
 The skin may become paler.
 “Age spots” or “liver spots” may appear.
 Skin tags may appear, mostly on the neck.
 The skin may become thinner. Wrinkles appear.
 Dry skin may occur.
 The hair gets gray and faded.
 Hair thins on the head, under the arms and in the pubic
area.
 Nose and ear hair becomes thicker and more visible.
 Facial hair for women may appear.
 Finger nails and toe nails get thick.
 The sweat glands in the skin slow down. The person may
not tolerate hot rooms because this “cooling” (sweat)
slows down.
 Red, purple or brown spots may begin on the arms and
legs.
Muscles and Bones: Some of the normal bone and muscle changes
are:
 The bones lose calcium.
 Bones get weaker and thinner.
 The disks of the spine get smaller so some will have a
curve in the spine and lose a couple of inches in their
height.
 The joints get less flexible and less mobile.
 Muscle tone gets less.
 Muscle mass gets lower.
 As muscle mass gets lower, fat builds up.
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Respiratory System: Some of the normal respiratory systems
changes are:
 The nose gets drier.
 The vocal cords lose their elastic so the voice of the
person may change.
 Lung capacity may decrease.
 Breath sounds decrease.
 Lower air moving out as the person breathes out.
 An increase in the amount of air held in the lungs as the
person breathes.
Cardiovascular System: Some of the normal heart changes are:
 Loss of heart muscle tone.
 Increased size of the heart muscle.
 A larger left side of the heart.
 Less elasticity of the heart and blood vessels.
 Lower output from the heart.
 Greater deposits in the blood vessels.
 Lower pulse.
 The blood gets thicker.
 A small drop in the red blood cells and white blood cells.
 The T cells get less effective.
Gastrointestinal System: Some of the normal GI changes are:
 The gums pull back from the teeth so the teeth may get
loose.
 Increase in the number of cavities.
 Less feelings of thirst.
 Poor gag reflex.
 Less muscle tone at the end of the Oesophagus to the
stomach.
 Less saliva.
 Less stomach digestion.
 Slower movement of the GI tract.
 Smaller liver size.
 Lower stomach mucus production.
Urinary System: Some of the normal urinary changes are:
 The kidneys get smaller.
 The kidneys lose some of their function.
 Lower blood flow to the kidneys.
 The concentration of the urine decreases.
 The bladder gets smaller.
 Less holding power of the bladder.
 Loss of bladder muscle tone.
 Loss of bladder elasticity.
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Slower and/or lower feeling of the need to void.
More urine at night.
Prostate in men gets larger.
Nervous System: Some of the normal nervous system changes are
below.
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The brain gets smaller.
The brain weighs less.
Blood flow to the brain gets lower.
Reflexes get slower.
A decrease in the number of nerves in the brain and the
entire body.
Eyes: Some of the normal eye changes are:
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Less able to focus.
The eyelids sag.
Eyelashes get thin, short and less.
A gray area around the edges of the cornea.
People get far sighted. They cannot see things that are
close to them.
Lower eye muscle tone.
Less tears.
Decrease in eye muscle elasticity so things may be blurry
to the person.
Ear: Some of the normal ear changes are:
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Thinner ear membrane.
Less able to hear higher tones as well as they did in the
past.
Less ear wax in the outer ear.
The parts of the inner ear shrink.
Taste and Smell: Some of the normal taste and smell changes
are:
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Less taste buds.
Less nose scent cells.
Endocrine System: Some of these normal changes are:
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Less growth hormone (less muscle mass).
Lower thyroid function.
Less insulin.
Less parathyroid function.
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Reproductive System: Some of these normal changes for women
(vagina) are:
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Lower estrogen and lower moisture.
Low elasticity.
Less pubic hair.
Increase in alkaline fluid in the area.
Some of these normal changes for men are:
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Lower testosterone.
Lower circulation to the penis.
The Special Needs of the Older Person
As you learned, not all people are the same, but some, or many;
older people may have some of these health problems.
 A slowing down of the mind and thinking
 A slowing down of the body’s physical function
 A slowing down of the person’s coping
 Less social support
 Losses of loved ones (friends, husband, wife)
 Lower quality of life
Thinking and Emotional Changes & Needs
As stated before, not all old people have a mental problem or
confusion. These things are NOT a normal change. Most are fine in
terms of their thinking, learning and communication, but some
have a disease or problem that affects these things. Some of
these problems are things like Alzheimer’s and some drugs. It is
also known that the personality of the person does not change, as
the person gets old.
Lastly, most old people are happy with life for the most part. The
person copes well if they have done so during their earlier life.
Social Changes and Needs
There are many social changes and needs for old people. Many of
these are related to the fact that loved ones, both friends and
spouses, may have died. Others miss working after they retire.
Others may have a physical problem that does not let them to be
with others as they used to do. For example, some old people lose
their sight so they are not able to drive their car; some may have
muscle weakness so they cannot take long walks as they used to.
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Legal Needs
The elderly also have their own legal needs. Some of these special
needs are:
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Maintaining rights and dignity
Advanced directives
Health care proxy
Power of attorney/ other financial issues
Prevention from being abuse
Prevention from violence
Reason for caring Elderly
As the human body ages, it slows down and it does not work as
well as it did in the past. For example, digestion slows down.
Foods that are eaten take longer to digest. It also takes longer to
burn the calories that we eat.
Old adults do not have the same appetite that they had when they
were younger. Their need for large amounts of food and calories
is lowered. They may also not want to eat. If the sense of taste
and smell are gone, they may not enjoy food as much as they did
when they were younger.
Vision and hearing may also get poor as a person gets older. Many
old patients and residents use eyeglasses, hearing aids and
devices as they get older.
The old adult may also have weak muscles, unstable joints and
poor balance. These things can make an old person fall or slip.
Falls and slips can break bones and even lead to death.
Many elderly people also have long-term diseases that affect how
we care for them. Many older people have diabetes, arthritis,
Alzheimer’s disease, heart, lung and kidney disease. They are also
not able to fight off infections as well as they did when they were
young.
Old patients are at great risk of getting an infection, like
pneumonia or a urinary tract infection, because their immune
system has slowed down.
The aging process also affects their skin. The skin gets dry and
easily irritated; it breaks down and tears very easily for many
patients and residents.
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Also, the body temperature is not controlled as well as it was in
the past. Old patients feel extremes of hot and cold more than
younger people.
Mental ability also changes as one gets older. Mentally, many old
residents and patients are confused. They forget things quickly.
They are not able to remember recent events. They may not know
the time of day, the day of the week or even the current year.
Some do not know, or cannot remember, where they are and who
they are. They are disoriented. They are not oriented to person,
place and time. They may also be agitated and use poor
judgment. Others may have delirium, dementia and depression.
All of these normal aging changes affect the kind of care we must
provide to our aging patients.
Although an old adult is 65 years of age and older, it is not always
clear when one age group ends and the next one begins. Some
people in the old adult age group may be typical of the age group
and others may not. Some people have the needs of their age
group. Others do not. So, please remember that not all old adults
are same. All patients and residents should be cared for based on
their own needs. However, knowing about the aging process helps
us to guide care.
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Session Plan 2
1. SESSION TOPIC: Changes
with older people
DURATION: 02 HOURS
PROCESS
student’s
knowledge,
identify
the
normal
changes occur in old age
in different systems and
part of the body
REQUIRED:
Charts,
for demonstration
4.
PREPARATIONS
o Arrange all the
materials well in
advance
METHODOLOGY:
to the following:
a) Describe the legal needs of the elderly
b) State the changes that occurs in different systems of
body during old age
c) Explain the reasons for caring elderly
DURATION: 02 HOURS
Exercise
practical aspect of this topic. Ask them to understand the
following needs with different age groups and fill the table given
below:
Needs
Elderly
Young Adult
Legal needs
Social needs
Thinking needs
Emotional needs
Special needs
Part A
1. Changes occur in muscular system and nervous system
during old age
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2. Changes occur in urinary system and reproductive system
in elderly.
3. Changes occur in respiratory system and cardiovascular
system in elderly.
4. Thinking and emotional changes and needs
Part B
1. The social changes and role of elders in the society
2. Reasons for caring elderly
3. Special needs of Older peoples
Part C
Yes
Identify the normal changes occur in old age in different
systems and part of the body
Demonstrate the knowledge of special needs, thinking,
emotional changes, social changes and legal needs
required at the old age.
Describe the reasons for caring elderly
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No
Session 3: Accomplishing Basic Needs of Elderly
Relevant Knowledge
In this session, we will learn about some tasks for elderly and
their thinking and learning ability. We will also study safety,
security, food and fluid needs of the elder people. The way GDA
should communicate with older patient will also be covered in this
session.
GDA and other health care workers care for old patients and
residents all over the world. In the India today there are more old
adults than any other age group. There are more old adults now
than ever before. The elderly are also living longer and longer.
They are getting older and older.
GDA, nurses and many others get a lot of joy as they care for
older adults. They also have a lot of challenges and things that
they must know about the old adult age group. The old adult age
group has its own needs. We must provide care to the old adult
that meets each patient's needs. These needs are best met when
GDA, nurses and many other health care providers know about the
normal aging process.
Some Tasks for the Elderly
Erik Erikson, a psychologist, is the expert who listed the 8 major
developmental tasks that every person must accomplish during
their life.
GDA and other health care providers must know about these
major tasks for each age group that they are taking care of. For
example, GDA who take care of adolescents must know that
adolescents have to cope with identity formation- “Who am I?”. A
hospital stay can affect an adolescent's sense of self, it can also
keep them from their friends or peer group, a group that is much
more important to them than their own family. Their peer group
helps them to define who they are.
Older adults, according to Erikson, have to share their wisdom,
maintain their sense of self, have integrity and be happy with
their life and what they have done. Old adults who can NOT do
these tasks may be sad, depressed and unhappy. They may view
their life as worthless and without meaning. They may think that
they are useless. Some may feel that they are a burden to their
family, friends and health care workers.
Old adults also have to deal with losses. They may lose their
husband or wife, their friends and other people who they loved.
They may feel lonely and not loved. They can also be very sad and
depressed. As they get older and lose their own mental and
physical health, they may NOT be able to care for themselves any
more. This may make the patient or resident sad or angry.
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All of these losses tell the old person that they, too, will die.
Many old people plan for their own death. They write their will
and their advance directives. They give their own things and
prized possessions to their family and loved ones. Some older
adults may think silently about these losses and their own death.
They may also review their own life and what they have done in
silence. Other old adults may speak about their losses to nurses,
GDA, social workers, family and others.
As a health care provider, we should listen to the older patient
when they talk about their losses and their thoughts about death.
These thoughts should also be reported to the nurse on the unit.
Thinking and Learning Abilities
The thinking and learning abilities of the older adult affect how
we communicate instruct and teach them and their family
members. Older adults need special care during communication
and education. They often have a physical and mental problem
that can interfere with learning and thinking. Older adults may
have:





A short attention span. Old adults may not be able to
understand long and detailed information. They may do
better with short instructions.
Less learning ability. Old people may not be able to learn
new things as well as they did in the past.
Less ability to understand. Many older adults are confused
and not able to understand.
An inability to communicate. Older adults may not be able
to speak and ask questions. After a stroke, many patients
have aphasia, a lack of ability to speak.
Poor hearing and sight. Vision and hearing gets poor as
humans age. GDA and others must give a patient their
eyeglasses and/or their hearing aid so they can
communicate with you and others.
When GDA are communicating with an older patient, they should:







Give the person their eyeglasses and hearing aid, if they
have one
Speak slowly and clearly while facing the person
Keep information simple
Use words that the person can understand
Use pictures and large print material when you can
Provide enough light if the patient will be reading
Keep sessions short
22





Repeat your communication as often as needed so that
the patient can understand it and remember it
Allow enough time for the patient. Some patients need
more time than others.
Make sure that the area or room is quiet
Allow the person to talk and ask questions
Include the husband, wife, and other loved ones in the
communication and instruction process
Safety & Security Needs
The need for safety is one of our most basic of human needs.
Safety is very important for all age groups but safety needs are
the greatest for young children and the elderly. For example,
infants put small objects in their mouths. These small things can
be dangerous. They can eat pills, poisons and even choke on
something small.
The old adult who has a mental, sensory (eyes, ears) or a physical
loss, like poor balance and weak muscles, is a safety risk. These
losses and the aging process make older adults prone to accidents.
An old patient that has poor vision and hearing, is confused and
has poor judgment can:






Slip
Fall
leave the facility and get hit by a car
drink a gallon of a cleaning chemical
cut their hand off with an electric saw that was left on
the unit
chew all the pills in the medication cart
Physical problems, confusion, loss of hearing and vision, poor
judgment and the inability to see danger when it exists are some
of the reasons why healthcare providers must maintain a safe
environment for the elderly. Safety is everyone's responsibility.
Safety needs must ALWAYS be a priority even when you have a lot
of work to do and you feel rushed. ALL patients and patient care
areas must be safe and free of all dangers.
Food and Fluid Needs
Food and nutritional needs also change as a person gets older and
older. The need for a lot of calories decreases when a person gets
older. These needs were highest when the person was an infant, a
teen and when they were pregnant or breast feeding their baby.
23
Old patients and residents need the least calories of all age
groups. They do not burn calories and food as quickly as they did
when they were younger and more active. This doesn't mean,
however, that the elderly do not need a good diet. Older patients
do need a good diet just like the other age groups.
The appetite and the digestive process also slow down as the
human body ages. Old adults do not feel as hungry as they did
when they were young. Also, when they eat meals they feel full
and they may not want to eat another meal for a long time. They
may even skip a meal. Old adults often do better with small
snacks during the day rather than large meals three times a day.
In terms of fluid needs (hydration), a patient or resident may not
be able to swallow fluids. They may not even feel thirst when
they should under normal conditions. We must, therefore, offer
fluids very often to older people. GDA should ask their patients
and residents if they want a drink of water every time they speak
to them unless they are not allowed to drink.
Some other old people may not be able to safely drink liquids
unless they are thick. They may choke with water, juice and other
thin fluids like tea or coffee. GDA are often asked by nurses to
give the patient water and fluids that are made as thick as honey.
These thick fluids help provide fluids to patients who have trouble
swallowing.
Aging people may also not be able to use a spoon or a fork. They
may be too confused to know how to feed themselves. Their lack
of ability to eat or drink often makes it necessary to go to an
assisted living facility or a nursing home so that they can be
helped with eating, a basic ADL. It is the GDA that most often
provides the necessary food and fluids to these patients and
residents
Other things that can decrease the amount and kinds of food and
fluids that an elderly person will eat are:



Money: An old person will not get a good diet if they do
not have the money to pay for it.
Physical health: If a person is not able to drive or walk to
the store, if they are not able to make and cook good
meals, if they are not able to use a fork or a spoon, they
will need the help of others to get a good diet and enough
fluids.
Mental ability: If a person is confused they may not be
able to buy, cook and eat meals. Again, the help of others
is need so that they get a good diet.
24


Teeth: If a person has no teeth, poor dentures or is not
given their dentures before a meal, they will probably not
get a good diet.
The ability to swallow: It is dangerous when a person
chokes on food or fluids. It can cause death. Unless they
get a tube feeding or special care, like thick fluids, these
people will not get enough food and fluid.
Some of the other things that GDA can do to help the patient or
resident get a good diet and enough fluids include giving the aging
adult:










dentures, as needed
a pleasant and nice dining environment
nice looking, tasty and foods that the patient or resident
chooses
help with foods and fluids as needed
plates, forks and other special items that help the patient
or resident feed themselves
smaller meals and fluids more often
proper positioning for safe eating and drinking
close monitoring, reporting and documentation of how
much food or fluid is taken and sometimes how much
urine is put out (intake and output)
extra nutritional supplements, if ordered
offers of food and fluid as often as needed when the diet
and fluid intake is poor
25
Session Plan 3
1. SESSION TOPIC:
Accomplishing basic
needs of Elderly
DURATION: 02 HOURS
PROCESS
student’s
knowledge,
skills & abilities to
accomplish the basic
needs of Elderly
REQUIRED:
Charts,
for demonstration
4.
PREPARATIONS
o Arrange all the
materials well in
advance
METHODOLOGY:
to the following:
a) Explain the security and safety needs of an elderly
b) Describe the food and fluid needs of an elderly
DURATION: 02 HOURS
Exercise
practical aspect of this topic. Ask them to visit a nearby hospital
and observe the old age patients and write the safety related
requirement and care rendered by GDA in the table given
below:
Name of
patient
Safety related need
Care rendered
by GDA
26
Part A
1. Thinking and learning ability of elderly
2. Physical need and mental need of an elderly
Part B
1. Discuss the food and fluid need of the elderly
2. Physical and mental care of the elderly
3. Security and safety needs of old people
Part C
Yes
No
Demonstrate the knowledge of thinking and learning
abilities of old age people
Describe the special need of elderly related to food,
fluid, safety and security requirement
27
Session 4: Common Problems and Care of Elderly
Relevant Knowledge
In this session, we will learn about the problems introduced in
human body systems during old age.
There are many parts of care that must be changed to meet the
needs of the older patient. Some of these special care items
include how we:






talk to the patient
instruct the patient
help them with the activities of daily living (ADLs),
including eating, bathing and personal care
keep the patient or resident room safe and free of
dangers
respond to nurse call bells right away
make sure the patient gets enough food and fluids
When caring for the older patient, the GDA must show respect
and call the patient by their name and not "mom", "honey" or
"grandma". We must respect their rights and maintain their
dignity. We must let them make their own choices, help them to
be as independent as they can be, and keep them safe.
The system wise common problem of elderly are described
below:
Skin and Nails
The skin becomes thinner, dry, pale, fragile, rough, less elastic,
with less sweat glands and fat as the person gets older. The older
person may get these problems as a result of these changes.






Skin tears (thin and fragile skin)
Skin breakdown and pressure ulcers: The skin is thin, dry,
fragile and has less cushion as the person ages.
Skin cancer and sun burns. The pale and fragile skin makes the
person prone to sunburns and skin cancer.
Rashes and infections like contact allergies with some soaps
and shingles.
Less able to cope with heat and cold: The person may get too
cold because they have less fat tissue. The person may also get
too hot because they have less “cooling off” sweat glands.
Pressure Ulcer: Pressure ulcers occur when people are not up
and walking. Patients and residents with a poor diet are at risk
for pressure ulcers. Residents and patients who are wet are at
risk for pressure ulcers.
28
People that do not have a normal sense of pain and the
physical ability to turn will remain in one position for a
very long time unless someone else turns them. If a
patient stays in one position for a long time, they will get
a pressure ulcer. Friction occurs when a patient or
resident is pulled up in bed or in the chair. These forces
can make the skin irritated. They can cause the skin to
break and develop a pressure ulcer. Uneven pressure is
created when sheets are wrinkled. This leads to pressure
ulcers.
Skin Care: GDA can render following care as needed to the
patient:

Dry skin care: Dry skin is one of the most common skin
problems with old people. Dry skin can lead to burning,
itches and cracked skin. Scratching the skin can lead to a
bad infection. Skin lotions and mild soaps should be used.
Also, the person does not always need a daily bath or
shower.

Skin tears and other skin breakdown: Skin breakdown and
pressure ulcers are a very serious problem. The older
person must not be gripped during a transfer. This can
lead to a skin tear. Pressure ulcers are very painful and
costly. People on bed rest are most at risk.

Provide good skin care: Use mild soap and gentle strokes
with a soft washcloth when giving a bath to a resident or
patient. Rinse the skin well and then pat it dry with a soft
towel. Use a bland lotion to help dry skin. Lotion helps to
keep the skin healthy and soft. No NOT use alcohol or
alcohol base lotions on skin. Alcohol dries the skin. Look
at areas where skin touches skin, such as under the
breasts. If these areas are moist, place a light dusting of
corn starch to help keep this area dry.

Keep the skin clean and dry: Immediately remove all wet
or dirty linens, briefs and clothing. Do not let the patient
remain wet or dirty with urine, feces or other fluids,
including water or tea. Wash, rinse and dry all wet and
dirty skin as your read above.

Patients and residents who stay in bed, the chair or
wheelchair must be moved and re-positioned at least
every 2 hours.
29

Encourage patients to walk about and move if it okay with
their MD. Walking and moving about increases blood flow.

Anticipate the patient's need to use the commode or
bathroom. Follow the patient's bowel and bladder training
program if it is ordered.

Encourage the person to eat good foods and lots of fluids.

Use pressure reducing cushions, mattresses, beds,
booties, elbow pads, etc. These items lower pressure
when patients stay in the bed or chair for long periods of
time.

Do NOT elevate the head of the bed more than 30
degrees, unless ordered.

Do NOT allow a patient to remain on a bedpan for a long
period of time.

Do NOT drag a person's body along bed sheets. Lifting
devices and lifting sheets lower friction and shear. They
also prevent patient and staff injury.

The feet and toes should be washed and dried during
every bath and kept clean. Leaving the area between the
toes wet can lead to soft skin that could break down. It is
also important use a good skin lotion on the feet but NOT
between the toes. This will soften the area and make it
more prone to sores.

Nails should be clean, short and smooth. Dirty fingernails
spread infection. Jagged fingernails can cause injury. Nail
care is done best when the person is sitting in a chair. If
the person is not able to sit in a chair, it can be done in
the bed.
Bones
As the body ages, the bones lose calcium, get weak, thin, brittle
and weak. Spine get smaller. Joints become less flexible and less
mobile. Many people get broken bones and fractures because of
these changes. People can lose about 2 inches of their height
when the discs of the spine become smaller. The can also lead to
a curve in the spine. Falls can lead to great injury and even
death.
30
The most common problems of the bones are:
 Osteoporosis
 Osteoarthritis
 Rheumatoid arthritis
 Gout
 Bursitis
The GDA should do these things to combat these problems:








Provide the person with a good healthy diet.
Make sure the person gets enough calcium and vitamin D.
Provide the person with regular, daily, exercise.
Encourage the person to walk and get out of bed, if they
can.
Prevent falls because a fall can lead to serious breaks and
injuries.
Preventing falls is a team/GDA effort. Nurses and other
people that work in homes, hospitals and nursing homes,
like the doctor and the physical therapist, must assess a
resident or patient for falls. They have to find out if the
patient or resident is at risk for falls. Move the patient's
bed and/or room closer to the nursing station.
Regular rest and sleep, good diet, Active exercise
and range of motion, Passive range of motion
helps in osteoarthritis patient.
Good diet, NO purine foods, NO alcohol in case of
gout.
Muscles
As a person gets old, the muscles have less tone, less mass and
less strong.
The most common problems of the muscles are:
 Muscle weakness and loss of tone as well as mass; and
 Increased fat as muscle mass gets lower.

Regular exercise is very important in order to maintain
and improve muscle function. The GDA should help the
person to do range of motion exercise so the person can
move their muscles and joints completely. GDA and other
members of the team often help and/or remind the
patient or resident to perform these exercises.
31


When a person is not able to do these transfers they must
depend on others for help and GDA can do it in better
way.
Teach the patient to practice how to walk up and down
stairs using a handrail. When a person walks up the stairs
they should put their good leg up on the stair and then
bring up the weak one.
Respiratory System
Some of the common problems are:





COPD
Lung cancer
Flu
Pneumonia
TB





COPD is treated with a number of medicines, including
those that dilate the lungs and keep the respiratory
secretions thin so that they can be coughed up. Also
advice good diet, plenty of fluids, oxygen, and
deep breathing exercises.
Lung cancer is treated with surgery, radiation and drugs.
Pain, a poor appetite, nausea and vomiting may be issues
with this people. The GDA can provide the person with a
good diet and fluids; make the person as comfortable as
possible; and observe the person’s coughing, chest pain
and blood in the sputum. Report anything that is NOT
normal.
When the person has the flu, the GDA should observe the
person’s coughing, chest pain and blood in the sputum.
Report anything that is NOT normal; and give the person
as much comfort as they can.
The treatment of pneumonia includes drugs to kill the
germs supportively by rest, fluids, a good diet, pulmonary
hygiene and oxygen.
GDA must observe all of their patients about their
breathing, especially older people. They must
immediately report anything that is not normal.
Heart and Blood & Blood Vessels
 High blood pressure
 Coronary artery disease (angina)
32





Heart attack
Heart valve problems
Heart failure
Peripheral vessel problems
Anemia







Most people with high blood pressure have both numbers
high. A person can lower their high blood pressure by NOT
using alcohol or cigarettes, by eating foods low in salt and
cholesterol and by managing their stress.
Exercise and a healthy weight are also important in
keeping the blood pressure at a good level. A patient's
doctor may order medications.
When a person has angina pain with activity, they should
rest. Some people have more pain when the weather is
cold, when they are under stress or after they have just
finished a meal. The treatment of angina often involves
the use of several drugs, including nitro, which the person
places under their tongue during an attack. Some people
will also get bypass surgery to repair it.
Heart attacks are treated with rest, oxygen, a number of
different medications, including aspirin, which thins the
blood, and pain medications to help the pain and to ease
the amount of work that the heart has to do as a result of
the pain. The GDA can help the person to prevent a heart
attack by giving them a healthy diet, encouraging them to
exercise and reminding them to take their heart pills.
Heart disorder is treated by treating the cause of it, and
by taking away some of the things that make the disorder
worse, like losing weight, stopping smoking and lowering
the amount of salt, or sodium, in the diet.
The GDA can care for the person Peripheral Vessel
Problems by encouraging the person to walk and then to
rest if pain begins, checking the feet and toes regularly
for any signs of a sore, giving the person good foot care,
encouraging the person to stop smoking if they do so,
giving the person a good diet with a lot of fruit,
vegetables and whole grains rather than fats and salt.
The GDA should encourage the person to eat a good diet
with iron and vitamin B12 in case of anemia.
33
Digestion
Some of the common digestive problems among older people are:





Hiatal hernia
Gastritis and ulcers
Hemorrhoids
Incontinence
Constipation





Advice smaller meals spread out during the day, sit up
after a meal, rather than lying down, provide a good diet
with low fat and caffeine in case of hernia.
Gastritis and ulcer can be managed by providing a good
diet with no foots that tend to irritate the person
(caffeine, for example), encouraging NOT drink or smoke
and helping the person to cope with their stress.
Many older people get these when they are constipated or
very obese. The person may have pain and bright red
blood. The person should be encouraged to use stool
softeners or bulk fiber additives. The GDA should report
any pain or bleeding as it may be caused by Hemorrhoids.
When the GDA cares for a person with incontinence, the
area must be washed with a no rinse skin cleanser,
alcohol free wipes, or a bath or shower. Alcohol wipes and
rubbing will damage the skin. The area should be air dried
or with gentle patting. A special cream should also be
used on clean dry skin to prevent skin breakdown and to
keep all stool away from the skin. Cornstarch can also be
used. Remember, pads, briefs and other items are NOT a
way to cleanse the person promptly.
The GDA should advice at least 20 to 40 grams of fiber
every day, fruit, vegetables, beans, bran and whole
grains, plenty of fluids such as water and juice, exercise
on a daily as well as regular basis. The physician may
prescribe laxatives, a stool softener pill, or an enema.
Urine System



Urine infections
Incontinence
Kidney failure
34
 Good hygiene, hand washing and encouraging the person
to have water in their diet helps in preventing urine
infections.
 Bladder training along with medicine and surgery is done,
in some cases of Incontinence.
 Smaller meals, control of the diabetes, heart disease and
high blood pressure, treatment of urine infections, low
salt & protein in the diet advised to the patient with
kidney failure.
Nervous System
Some of these common problems are:




Parkinson’s disease
Dementia
Alzheimer’s disease
Stroke (CVA)
The GDA should advice the following to help the patient with
above problems:
 The GDA must maintain safety, insure good nutrition,
enable as much independence as possible and support the
person because they may get depressed about this
problem and their lack of ability to do simple things like
eating and getting dressed.
 GDA and others in healthcare provide care to Alzheimer’s
and other dementia patients according to their own
needs. For example, if a patient in the early stage of the
disease is able to dress and bath without help, we should
help them to remain as active and as independent as
possible. If the patient is at risk for falls, we must make
sure that their room and the nursing unit is safe, secure,
neat and uncluttered. Keep the patient care area bright.
Keep stimulation and noise to a minimum. Use large
clocks, calendars and other things to orient the patient.
Take away all clutter and dangerous chemicals, like
medicines and cleaning liquids in order to ensure safety.
 A patient may have oxygen and an intravenous line (IV)
right after their stroke. They may also get medicine to
lower brain swelling. Soon after the stroke, basic care
restores function and prevents complications. For
example, rehabilitation, bladder and bowel function and
the prevention of pressure sores become nursing care
priorities shortly after a stroke. Rehabilitation usually
begins right after a stroke. Some people may need special
assistive devices after a stroke.
35
They use special forks, plates and devices to pick items up from
the floor. These things help with the activities of daily living.
Eyes
Some of these common vision problems are:





Diabetic retinopathy
Cataracts
Glaucoma
Age-related macular degeneration (AMD)
Low Vision
above problems:



The older person, who have vision problems, need
assistance with many activities of daily living (ADL),
including dressing, walking and eating. The need for
safety, freedom from falls, and other injuries (cooking
fires) are of highly important.
Encourage their older patients to have regular, annual eye
exams and to take all of their ordered eye drugs. They
should also observe and report any changes in the
person’s vision.
Special low vision programs help these people by giving
them and teaching them how to use special things that
help the person to read, write and do other things. For
example, they may get special lighting, magnifiers, large
print reading materials, computers that talk, clocks and
watches that talk and/or have larger numbers, etc.
Ear
Some hearing problems that are often seen in older people are:


Hearing loss
Tinnitus (ringing in the ear which results from hearing
losses)
above problems:
 Hearing loss: Advice to use all the time hearing aid in
case of hearing loss. Speak slowly and clearly while facing
the person, keep information simple, use words that the
person can understand, use pictures and large print
material when you can, provide enough light if the patient
will be reading, repeat your communication as often as
36
needed so that the patient can understand it and
remember it
Taste and Smell
Some of the normal taste and smell changes are:


Less taste buds
Less nose scent cells
Loss of smell also places a person at risk because they may not
smell a meal burning on the stove or a fire in their bedroom. Fire
alarms and smoke alarms are needed.
Endocrine Glands
Some gland problems that are often seen in older people are:
 Diabetes
 Slow thyroid
GDA and others who take care of people with diabetes should:

In case of diabetes health care workers/GDA should help
these patients to control their disease. Advice to eat a
proper diet, to exercise and to follow their doctor's order
for medicine, blood sugar testing and other care,
including foot care, skin care and personal hygiene.

Help patients exercise on a regular basis, especially if
they weigh too much, have high blood pressure or high
cholesterol.

Assist their patients and residents to eat a good diet.
Some may have a diet that is low in salt when they have
high blood pressure.

Help their patients to use stress management tools such
as sitting quietly and relaxing, deep breathing, prayer and
meditation. Stress increases blood sugar levels. If you
would like to learn more about stress and stress
management, take the NursingAssistantEducation.com
course entitled “Stress Management”. This course will
help you and your patients to learn more about stress and
how we can cope with it and live a better life.
37
Slow Thyroid (hypothyroid)
The physician will find it with blood tests. The person will get
drugs to treat this problem. GDA and other people who care for
these people should:
 Inspect the skin for any breakdown
 Report any skin problems
 Provide good skin care
 Allow periods of rest
 Clothe the person to keep them from feeling cold
 Observe bowel patterns
 Report any constipation
Reproductive System
Some of these problems that are often seen in older people are:


Breast cancer (women and men)
Prostate cancer (men)
Breast cancer: The treatment depends on the type and the stage
of the cancer. Some of the treatments may include
Surgery, Radiation and Drugs (hormones and chemo). Some people
get swelling of the area and arm after surgery. A caring for a
person that has had breast cancer surgery should:



Observe the area and the arm (swelling)
Keep the affected arm out of the sun or use sun screen
NOT take blood pressures on the arm
Prostate cancer: Men can be screened for it with an annual exam
and PSA level in the blood. The treatment depends on the type
and the stage of the cancer. Some of the treatments may include
Surgery, Radiation and Drugs (hormones and chemo). GDA,
especially those who care for older men, should observe the
person’s urine patterns and report anything that is not normal
(blood, frequency, etc.). They should also encourage the person
to have their screening (exam and PSA) every year.
38
Session Plan 4
1. SESSION TOPIC: Common
Problems and Care of
Elderly
student’s
knowledge,
identify
common
problems and care of
elderly
REQUIRED:
Charts,
for demonstration
4.
PREPARATIONS
o Arrange all the
materials well in
advance
METHODOLOGY:
DURATION: 02 HOURS
PROCESS
to the following:
a) Describe the common eye problems that may occur in old
age
b) Describe the common problems occur in endocrine glands
during old age
T2 : PRACTICAL SESSION
DURATION: 02 HOURS
Exercise
practical aspect of this topic. Ask them to visit a nearby hospital
and identify the problems occurred in human body system during
old age. Ask them to fill the table given below with the problem
identified:
Name of patient
Human Body
Problem identified
System/Part
Part A
1. Problems of respiratory system and cardiovascular system
2. Care required for problems of muscular system and
nervous system
39
3. Care of incontinence and constipation
4. Heart vessels and blood vessels
Part B
1. Care of Diabetic elderly
2. Common hearing and vision problems
Part C
Yes
No
Describe common problems in human body systems
during old age
Demonstrate the knowledge of the role of GDA in
providing the care according to patient need
40
Session 5: Caring for Infants and Children
Relevant Knowledge
In this session, we will learn about the classification of infants and
children age group, growth and development of children, stages
of learning and thinking ability of child and their safety aspects.
We will also study about nutrition and hydration for infants and
children’s and special care needed for them.
GDA and other health care workers must know how to care for
babies and children. This care must meet the special needs of
these age groups. GDA, nurses and many others get a lot of joy as
they care for children but there are also a lot of challenges.
Infants, toddlers, pre-school children, school age children and
teenagers all have their own age related needs. These needs are
best met when GDA, nurses and many other health care providers
know about the normal growth and development process that
children go through. We must know how the needs of these age
groups affect the care we give.
The Age Groups
Infants and children have many age related needs. These patients
belong to one of these are groups:
 INFANTS- Birth to 1 year
 TODDLER- 1 to 3 years
 PRE-SCHOOL CHILD- 3 to 5 years
 SCHOOL CHILD- 5 to 12 years
 ADOLESCENT (TEENAGER)- 12 to 18 years
A new baby is an infant from the minute they are born until they
have their 1st birthday. They are a toddler after their 1st birthday
and until they are 3 years of age. These young children begin to
walk and toddle around the house.
From the age of 3 until 5, a child is in the pre-school age group.
The young child has not yet started the first grade of school. From
5 to 12 years of age, the child is considered a school age child.
The last stage of childhood is adolescence. A boy or girl is a
teenager, or adolescent, from 12 to 18 years of age. After the age
of 18, the child is considered a young adult and able to make legal
decisions of their own.
41
Growth & development of children
Erik Erikson, a psychologist, taught us about the 8 major
developmental stages that human beings go through during their
life. Each one of these stages has some tasks, or things, that
every person must do when they are in each age group.
GDA and other health care providers must know about the major
tasks for each of the age groups. For example, GDA who take care
of adolescents must know that teenagers have to form their own
identity. They have to form their own sense of self and who they
are.
A teenager's sense of self must be encouraged when they are in
the hospital or home ill for a long period of time. When this age
group is in the hospital they are not with their friends. Their
group of friends helps them define who they are. Friends have
become much more important to the teenager than their own
family.
Things that each age group must do are listed below for the
infant, toddler, pre-school child, school age child and adolescent.

Infants- learn how to trust others. They are not yet able
to do anything for themselves. They depend on others to
feed them and to keep them safe. They need to be loved.
They need others to keep them clean and dry. They must
feel that their needs will be met as soon as they begin to
cry.

Toddlers- begin to take care of themselves and do things
on their own. They learn to control themselves and what
they do. They learn how to walk around, feed themselves,
use the toilet and control their own behavior. This age
group does not like to be frustrated. They also want to be
with their parents. They do not like people that they do
not know.

Pre-School Children- start to act with a purpose and a
goal. They begin to feel happy about what they can do.
This age group is afraid of being punished and rejected.

School Age Children- want to be confident. They want to
do well in school. They try very hard to please their
teachers and their parents. School age children want to
feel that they are competent and able to do things on
their own.
42

Adolescents, or Teenagers- want to be a part of a group.
They need to have a sense of self and know who they are.
They form their own identity when they belong to a
group. Also, they often rebel against their parents.
Learn and Understand Among Infants & Children
Jean Piaget, another psychologist, is a well-known expert on how
human beings learn from birth until the age of about 15. Usually,
children by the age of 15 have fully developed their ability to
learn in a complete adult way.
Teenagers at 15 years of age no longer have to see a picture of a
beach ball in a book in order to read and understand the word
"ball" in the book. They can read the word "ball" and have a
picture of a ball in their mind without seeing an actual ball on
their desk or in a book. Children that are 12 to 15 years of age are
also able to subtract numbers on paper without having to use
concrete objects like pennies to add, subtract, multiply and
divide.
Below are the stages of learning and thinking ability that begin
immediately after birth and continue to grow until the child
reaches the age of about 15.
Pre-Operations. During the pre-operational stage, the young child
is not yet able to do concrete operations like adding and
subtracting even if they are using marbles or other concrete
objects.
Concrete Operations. The child in this stage is not able to think or
learn in an abstract way. They can, however, add simple numbers
when they have concrete objects, such as marbles or pennies, to
use. For example, they are able to learn that 2 pennies and 3
pennies adds up to be 5 pennies with they move and count the
pennies. These young children also begin to understand the
meaning of written numbers and words.
Formal Operations. During this stage the child is able to see the
numbers 3 and 2 on paper and understand that adding these two
numbers together will be 5. They can now add, subtract, multiply
and divide in an abstract way, that is, they no longer need
concrete objects to do it. They also understand the meaning of
words as they read. They no longer need picture books or
concrete objects to understand the meaning of a word.
43
GDA should know about how children learn. Knowing about the
learning stage of the child helps us to speak with them and to
instruct them in a way that they understand.
From birth until about the age of 2, young children learn how to
separate themselves from the things and people around them.
They begin to touch and control some objects.
During the Preoperational Stage, toddlers and pre-school children
begin to speak and communicate with others using words. They
learn how to count. They begin to understand the meaning of
each number and word. They test things and they try new things.
They are very curious. They like to discover new things.
Children at this age ask a lot of "why" questions. They ask, "Why is
the sky blue?" "How do trains run down the track?"
At about 7, the child begins to reason and think things out
logically. Between the ages of 12 and 15, the child finally thinks
and learns in an adult way. Their thinking growth is complete.
They are ready for the life that is ahead of them.
Keeping Children Safe
Safety is one of the most basic human needs. Children and old
adults have the GREATEST safety needs. For example, infants will
put almost anything in their mouth, including poison and small
things that they can choke on. We must, therefore, prevent
poisoning and choking by keeping dangerous things away from
infants and small children. Old adults may also put harmful things
in their mouth. Sometimes older adults may over dose on their
own medications or drink dangerous home cleaners when they are
confused. They also have to be kept safe.
In addition to putting strange things in their mouth, infants and
young children also do NOT know the difference between things
that are safe and those that are not. They are very curious and
they will try just about anything. They have little or no fear about
getting hurt. It is our job to watch them very closely so they do
not injure themselves while we are taking care of them in the
home or in the hospital.
Nutrition & Hydration for Infants and Children
Nutritional and hydration needs also change as a person ages.
Infants, teenagers, pregnant women and women who are
breastfeeding their child need more calories than the other age
groups.
44
Infants need extra iron and the fats from whole milk, formula or
breast milk. Infants get baby foods at about 4 to 6 months of age
starting with cereal. New foods should be added slowly and ONE
at a time so that new foods that cause problems can be identified
right away.
Toddlers like to eat foods that they can pick up with their hands
and eat. They start to use cups instead of bottles. They may even
begin to use a spoon to feed themselves. Pre-school children start
to decide what foods they like and dislike. They use a fork, knife
and spoon to eat.
School age children like "fast food" and eating with friends.
Teenagers need extra calories, protein, calcium, iron, iodine and
B complex vitamins for their growth. They often do not get a good
diet. They eat a lot of snacks and "fast food". They also do not
stick to regular meal times. Many teenagers develop eating
disorders that can lead to poor health and even death.
Special Care for Infants and Children
GDA and other healthcare providers must change the way they
provide care, as based on the age group of the patient. For
example, an infant is not able to learn about the care they are
getting. We must, therefore, tell the family or care giver about
the care the patient is getting.
The Special Needs of Infants
Infants need frequent small feedings. They have to be kept warm
with a blanket and proper clothing because their body is not yet
able to control its own temperature. Infants can also become
dehydrated very quickly, especially if they have diarrhea or
vomiting. They have to be kept safe and away from infections
because their body is not able to fight off infections as older
children and adults can.
The vital signs of the infant are also different from those of the
adult. The usual vital signs are as follows:



Pulse- 100 to 160 per minute
Respirations- 30 to 60 per minute
Blood Pressure- 50 to 100/25 to 70
Infants must be held, cuddled and touched. It is important to let
the parents have close contact with the infant so that the baby
bonds and gets attached to the parents.
45
The mother, father, sisters and brothers are the most important
people to them. They do NOT want to be separated from them.
They often cry when the parents are not seen. We should
encourage the family members to stay with the infant and young
child whenever this is possible. We should also help the family to
care for the sick infant or child.
Infants have to learn how to trust others. We must meet their
needs immediately so that this trust can be developed.
Infants must NEVER be left alone unless they are in a safe crib
with the side rails up. They should be placed on their back and
WITHOUT any pillows when they sleep. Medications, small objects
and other items that are not safe MUST be kept out of their
reach. When the infant or young child leaves the hospital, a safe
and approved car seat must be used.
The Special Needs of Toddlers
Toddlers learn how to walk, run and climb. They have a lot of
energy. They must be protected from injuries. They begin to play
with blocks and color with large crayons. They like to sit side by
side with another child as they play. This age group starts to
communicate their needs to others using words instead of crying.
Toddlers begin to ask the GDA questions about their care and
their illness. We must answer these questions in a way that the
toddler, or young child, can understand. Since the toddler and the
young child have a very short attention span, we should explain
things to these patients in a very simple and short way. It is good
to use dolls, puppets and story books as you talk to the young
child.
This age group will also cry when they are separated from their
parents. Parents are the most important people to them. They
want the love and approval of the parents.
They do not like people that they do not know, including GDA. We
should, therefore, let the parents stay with the child as much as
possible.
The Special Needs of Pre-School Children
During this stage of life, the child can better deal with being away
from their parents. They are able to speak to others and tell them
what they want or need.
46
These young children ask a lot of "Why" questions. They like to
learn new things. GDA should answer their questions in an honest
way and in a way that the child can understand.
The preschool child learns their name, address and phone
number. They, too, have a lot of energy and must be watched
closely. They often get hurt and injured. They need a safe place
to live, play and sleep.
At times, these young children are afraid of the dark. Some have
nightmares. The care giver should comfort them when they are
afraid. Preschool children have food likes and dislikes. They can
feed themselves. They also start to take care of some of their
basic needs. For example, they are able to get dressed on their
own.
The Special Needs of School Age Children
This age group likes to do well in school. They also like to please
others. They can help around the house and take care of
themselves. Friends are important to them.
This age group has a little knowledge about the human body and
how it works. They are able to understand their illness if we
explain the illness and their care in clear words that they can
understand. They can also do some of their own personal care.
The Special Needs of Teens
Teens (adolescents) like to be their own person. They often rebel
against their parents and other people in their life, like their
school teachers. They often show anger. Sometimes, they break
rules and laws.
Their friends are the most important group to them. They are not
happy when they are not with their friends. This age group wants
to look and dress nicely. They want to be liked by their group of
friends. This gives them a sense of self. They also like the
opposite sex. Healthcare providers must give them privacy and
time with their friends. We also have to watch them so that they
do not use alcohol, cigarettes and illegal drugs.
Some teens become sad and depressed. Suicide rates are high in
this age group.
Teenagers like to eat "fast foods" with loud music and friends
rather than good meals at home with their family. Their diet is
very often NOT good.
47
Session Plan 5
1. SESSION TOPIC: Caring
for Infants and Children
student’s
knowledge,
skill & abilities of caring
the infants and children
REQUIRED:
Charts,
for demonstration
4.
PREPARATIONS
o Arrange all the
materials well in
advance
METHODOLOGY:
DURATION: 02 HOURS
PROCESS
to the following:
a) Explain the stages of learning and thinking abilities
amongst infants and children’s
b) Explain the importance of nutrition and hydration
required for infants and children
c) Describe the safety needs of children
DURATION: 02 HOURS
Exercise
1. This practice session will enable the student to understand
the practical aspect of this topic. Ask them to observe any
five toddlers nearby their house and fill the growth and
developmental changes in male and female occur during
this age :
Name of
Growth and
Growth and
toddler
developmental
developmental
change in male
change in
female
2. Ask their students to identify the special needs of child in
following age groups:
Age Group
Special Needs
Infant
Toddlers
Pre-school children
School age children
Teen
48
Part A
1. Developmental changes occur in preschool and school age
children
2. Special needs of infant and toddler
3. Nutrition and hydration
4. Toddler and adolescent age group
Part B
1.
2.
3.
4.
Development and growth of children
Classification of age group below 18 years
Stages of learning and thinking ability amongst children
Special care for infants and children
Part C
Yes
No
classify the age groups of children below 18 years
Demonstrate the knowledge of growth and
development of children, stages of learning and
thinking ability of child and their safety aspects
Demonstrate the knowledge of nutrition and
hydration for infants and children’s and special
care needed for them
49

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ROLE OF GENERAL DUTY ASSISTANT IN ELDERLY &amp; CHILD CARE TEACHERS

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ROLE OF GENERAL DUTY ASSISTANT IN ELDERLY & CHILD CARE TEACHERS