Massachusetts Certified Nurse Aide (CNA) Curriculum Frameworks

Released April 2026

Note 1: This Curriculum Framework incorporates the federal training guidelines for both Nurse Aides and Home Health Aides. See the Nurse Aide Registry Laws and Regulations for all applicable state and federal guidelines.

Note 2: Competency areas with an asterisk (*) will be supported with instructional content on the state’s online CNA Training platform (LMS)

Please find the link to a downloadable framework exhibit at the bottom of the page.

Foundations of the Certified Nurse Aide (CNA) role in Massachusetts*

1. Describe the role of the CNA in the lives of individuals receiving services and the importance of taking a person-centered approach to care
2. Describe the primary responsibilities and scope of practice of the CAN
3. Describe the importance of understanding the job description and how scope of practice, roles, responsibilities, and setting guide safe, ethical and effective care of individuals receiving services

Understanding Healthcare Settings*

1. Describe the structure of the healthcare system, the role of long-term supports and services (LTSS) within it, and how the system continues to change over time
2. Compare and contrast the roles, expectations, and limitations of the CNA across settings
3. Identify how organizational structure and policies and procedures impact the CNA's role

The Care Team*

1. Describe the interdisciplinary healthcare team and the role of the CNA within it
2. Describe the Five Rights of Delegation and how they apply to care delivery
3. Identify effective collaboration and teamwork strategies to support continuity and quality of care
4. Differentiate between tasks the CNA can perform independently through the scope of practice and those requiring supervision
5. Describe the purpose and components of the medical treatment plan and nursing plan of care, why changes are made to the plan of care, and how each care team member contributes
6. Identify ways to show accountability for daily tasks by following care plans, observing and communicating changes, and reporting and documenting accurately

Professional Skills*

1. Describe the importance of professionalism in the workplace, codes of conduct, personal/professional boundaries
2. Describe how to balance various responsibilities, set priorities, manage time, and mitigate stress
3. Identify employment-related and personal resources for professional support and understand how and when to reach out to them to support self-care and prevent burnout.
4. Describe the importance of professional development and continuing education

Culture, Diversity and Person-Centered Care*

1. Identify aspects of culture and reflect upon how an aide's life has been influenced by culture
2. Describe how values, traditions and lifestyles shape care needs and integrate inclusive, culturally responsive practices into care delivery
3. Reflect on personal values, unconscious biases and assumptions and practice applying a mindset of cultural humility to build respectful, compassionate and person-centered relationships with individuals from diverse cultural backgrounds

Supporting LGBTQ Aging*

1. Describe how to care for lesbian, gay, bisexual and transgender older adults in line with Prevention & Elimination of Discrimination Based on Sexual Orientation (Chapter 19A, Section 43)

Communication and Documentation*

1. Demonstrate effective communication skills (verbal, non-verbal, written and listening) leading to strong relationships with individuals receiving services, their family members, colleagues, supervisors and other members of the care team
2. Demonstrate problem-solving and conflict-reduction methods, including adjusting behavior in response to the individual's behavior and applying de-escalation strategies.
3. Identify common cultural barriers to communication and apply respectful, culturally responsive strategies when interacting with individuals from diverse backgrounds
4. Compare and contrast objective and subjective information and identify ways to observe, document and report clearly and accurately
5. Identify barriers to communication (hearing loss, language, cognitive impairment) and strategies to address them

Rights, Ethics and Confidentiality*

1. Identify rights related to dignity, privacy and autonomy for the individual receiving services and their families and explain how those rights are protected
2. Identify the different types of potential abuse and neglect and identify how to report as required by law
3. Identify the roles of mandated reporter and ombudsman
4. Identify examples of ethical and legal decision-making and behavior in common care situations
5. Define the Health Insurance Portability and Accountability Act (HIPAA) and ways to protect the privacy of the individual receiving services, including guidelines for social media
6. Define the Patient Self-Determination Act (PSDA), Advanced Directives, and related medical orders
7. Describe how to give assistance to the individual receiving services and their family in resolving grievances and disputes
8. Identify how to maintain care and security of an individual's personal possessions

Empowerment and Advocacy*

1. Describe how the CNA can partner with an individual receiving services to set goals, make informed choices, track and document progress, and follow-through
2. Describe how to work in partnership with an individual to advocate for themselves and speak for themselves, including seeking adjustment of services as needed and desired
3. Describe how to partner with an individual to access needed services, supports and resources and to address barriers to access
4. Describe how to support an individual receiving services to make personal choices, and provide and reinforce other behaviors consistent with the individual's dignity and preferences

Community Inclusion and Networking*

1. Describe how to encourage and partner with an individual receiving services to connect with others and develop valued social/emotional support, and/or work roles based on individual choices
2. Describe how to partner with an individual receiving services to connect with family and friends, and live and be included in the community of their choice
3. Describe how to partner with an individual receiving services to transition between services and adapt to life changes including moving to a new care setting
4. Describe how to respect the role of family members as a source of emotional support as well as their role in planning and providing services for the individual

Safety and Emergency*

1. Understand and practice observational skills and use them to support a safe living environment including how to identify risk factors across care settings, identify ways to reduce the risk of falls, and recognize and respond to emergency situations
2. Identify ways to protect oneself on the job including occupational health and safety measures
3. Develop techniques that support physical and psychological safety while on the job, including developing environmental awareness and applying strategies for violence prevention
4. Explain the importance of reporting unsafe living conditions
5. Describe health and safety practices following professional medical protocols, OSHA standards, and other regulations
6. Describe roles, responsibilities and procedures when caring for individuals with restraints and take steps to avoid an individual's need for restraints in accordance with professional standards

Medical Terminology, Body Systems and Common Diseases*

1. Define basic medical terminology and identify common medical and healthcare abbreviations
2. Identify the major body systems and explain the role of the CNA in promoting the health of each
3. Define common diseases and disorders pertaining to each major body system

Aging and Individual Needs*

1. Describe common physical disabilities, developmental disabilities, cognitive impairments, and brain injuries including traumatic brain injuries and identify appropriate care strategies to support individuals with these conditions
2. Identify and reflect upon personal beliefs and attitudes relating to age and disabilities
3. Identify the developmental tasks associated with the aging process and explain how they affect a consumer's needs and care
4. Describe how the aging process may differ for individuals with developmental disabilities

Alzheimer's Disease and Related Dementias*

1. Identify the characteristics of the healthy brain, normal aging, and all types of dementia, focusing on the five most common types
2. Describe the importance of meaningful connections between aides and persons living with dementia (PLWD)
3. Identify how to shift perspective and practice effective communication, care, and safety approaches for persons living with dementia
4. Identify strategies to supportively respond to behavioral expressions of persons living with dementia
5. Develop the ability to make meaningful connections and sustain engagement by embracing the reality of persons living with dementia
6. Identify strategies to support the family and friends of persons living with dementia, as well as the need to practice self-care

Mental Health and Substance Use (Behavioral Health) *

1. Describe the relationship between mental and physical health and identify common behavioral health conditions, including substance use disorders
2. Identify common signs and symptoms of behavioral health conditions, substance misuse, and possible medication interactions and describe how to report concerns accurately and in alignment with the care plan and relevant policies
3. Develop effective communication strategies that reduce stigma around behavioral health needs and promote trust with an individual receiving services by applying trauma-informed care principles, active listening, and motivational interviewing
4. Identify de-escalation strategies that prioritize dignity, safety and respect when an individual receiving services is experiencing behavioral health distress

Adaptive Care*

1. Identify different levels of support needs and explain how changes in the condition of an individual receiving services may require adjustments in care and updates to the care plan
2. Describe how to use observational skills to detect and report early signs of increased support needs, such as decreased mobility or new safety risks
3. Describe how to adapt communication and caregiving approaches to meet the physical, emotional and dignity needs of individuals whose level of independence has changed

End of Life Care*

1. Identify the stages of grief and the grieving process, including how feelings and attitudes about death differ among individuals and groups
2. Describe ways to provide care for a dying individual that uphold dignity, respect individual rights, and offer emotional support to both the individual and their family
3. Compare and contract palliative and hospice care, explain the goals of each and describe how palliative and hospice care support individuals and their families during the end-of-life process
4. Identify common signs in the body of approaching death and changes that may occur in the human body after death
5. Explain postmortem care practices across care settings and apply culturally, religiously, and personally respectful approaches
6. Identify personal experiences and responses to loss and grief and identify self-care practices and resources

Housekeeping

1. Develop key housekeeping skills based on the preferences of the individual receiving services and understand special challenges that may be encountered when assisting a person with housekeeping and cleaning, such as compulsive hoarding and bed bugs
2. Demonstrate the effective use of Personal Protective Equipment (PPE) when laundering and cleaning

Assisting with Self-Administered Medications in the Home

1. Describe how a CNA's role and responsibilities related to medication administration may vary depending on their job title, associated scope of practice and care setting and describe what actions a CNA can and cannot take when assisting an individual with self-administered medication in the home
2. List “The Seven Rights” of medication administration and describe their role in assuring safety across care settings
3. Demonstrate how to assist an individual receiving services in the home with self-administered medication including: 1) Reminding the individual to take the medication 2) Checking the package to ensure the name on the package is that of the individual including right date and time, 3) Observing the individual, 4)Documenting the individual's actions regarding the medication
4. Identify observations about medications that should be reported right away
5. Identify what to do in an emergency involving medications
6. Demonstrate methods of proper medication storage
7. Identify signs of drug misuse and abuse and understand how to report them

Personal Care

1. Describe the importance of maintaining the dignity of the individual receiving services while assisting with personal care tasks
2. Demonstrate basic techniques for bathing, maintaining skin integrity, supporting a person to use the bathroom, providing peri care, providing mouth and nail care, grooming, and dressing individuals, including those with a weak side
3. Demonstrate how to assist an individual with basic activities of daily living (ADLs) and demonstrate proper use and application of appliances and assistive devices
4. Recognize and acknowledge different personal care preferences, approaches, and culture including in hair care

Infection Control

1. Identify major types of infection transmission (contact, droplet, airborne) and the precautions required for each
2. Demonstrate application of precautions (use of gloves, masks and other PPE, hand hygiene) and identify their importance across care settings to prevent the spread of infections
3. Demonstrate how to follow proper cleaning and disinfecting procedures for equipment and environmental surfaces, including those in the home
4. Demonstrate safe handling of linens, sharps and other potentially infectious materials
5. Identify early signs of infection in individuals receiving services and understand importance of reporting them promptly
6. Identify the difference between non-sterile and sterile dressings
7. Explain principles of infection control as they relate to sterile dressings and identify important observations to report

Basic Nursing Skills

1. Identify the components of vital signs, describe their importance, and demonstrate how to monitor, document and report temperature, respiration, radial pulse and pulse oximetry
2. Demonstrate how to obtain and record manual blood pressure
3. Describe guidelines for pain management and how to apply them to care of an individual receiving services
4. Describe the basic steps and precautions for observing and cleaning non-infected wounds and apply infection control techniques
5. Demonstrate the ability to safely apply warm and cold therapies to individuals receiving services
6. Demonstrate how to measure and record height and weight
7. Demonstrate how to care for the individual's environment; recognize abnormal changes in body functioning and report such changes to a supervisor, per nurse aide federal requirements
8. Identify signs and symptoms of respiratory distress and demonstrate appropriate action to take
9. Demonstrate how to assist an individual utilizing compression/anti-embolism stockings
10. Demonstrate how to assist an individual with an ace bandage for treatment or support uses

Basic Restorative Care

1. Demonstrate the proper body mechanics needed to prevent self-injury while providing gentle, competent, and respectful physical assistance to individuals receiving services
2. Demonstrate how to safely assist a consumer with activities of daily living (ADL) such as repositioning, transfers, walking, using the bathroom, bathing, nail care, hair care and mouth/denture care
3. Demonstrate the ability to support bowel and bladder training for the individual receiving care
4. Identify how to support self-care according to the abilities of the individual receiving care
5. Demonstrate basic post-op care, such as turning, and positions for comfort, coughing and deep breathing
6. Demonstrate proper dressing reinforcement

Preventative Measures for a Bedbound Person

1. Define pressure areas/decubitus ulcers, identify the causes of skin breakdown, and identify high-risk areas on the body
2. Describe the importance of observing and reporting skin changes
3. Describe guidelines for providing skin care and apply preventative measures for skin breakdown
4. Identify special devices and equipment used for immobilized individuals
5. Define and identify the causes of contracture and demonstrate how to apply preventative measures
6. Describe risk factors and preventative measures related to proper nutrition and hydration and apply them to the care setting
7. Demonstrate proper use of bedpan and how to measure and record urine output
8. Demonstrate proper body positioning, body alignment and safety for both the CNA and the individual receiving services
9. Demonstrate how to provide safe and respectful care for bed-bound individuals, including positioning, turning, and skin care, to prevent complications such as pressure injuries

Rehabilitation

1. Define rehabilitation and its principles and guidelines including proper safety procedures and the importance of promoting independence for the individual receiving services
2. Demonstrate proper technique and protocol for mechanical/Hoyer lift transfers, including two person Hoyer lift transfers
3. Demonstrate range of motion exercises, passive range of motion, and how to properly assist the individual receiving services
4. Demonstrate proper care, cleaning, application, and removal of prosthetic devices
5. Demonstrate how to assist an individual to ambulate using a gait belt and principles of proper gait training
6. Demonstrate how to assist with mobility assistance devices such as canes, walkers and crutches and practice proper wheelchair safety
7. Identify safety considerations for an individual receiving medical ventilation

Nutrition

1. Describe approaches to meal planning assistance, food preparation and serving, as well as food shopping, storage, and handling
2. Describe the importance of respecting the nutritional preferences of the individual receiving services whenever possible
3. Demonstrate approaches to assisting with eating and hydration; and proper feeding techniques, including with individuals who are bedbound
4. Demonstrate how to recognize and record adequate nutrition and fluid intake
5. Identify emergency actions to take when an individual experiences difficulty swallowing or begins chocking

Catheter and Ostomy Care

1. Describe the principles and guidelines of catheter care, including proper cleaning
2. Describe the importance of fluid balance and explain intake and output measurements including reporting decrease in urine output
3. Identify the principles and guidelines of urine testing including the collection of routine urine specimen and clean-catch specimen
4. Demonstrate principles and guidelines for emptying a catheter drainage bag
5. Demonstrate principles and guidelines for applying a leg bag and Texas catheter
6. Demonstrate the principles and procedures for ostomy care and recognize important observation of an ostomy to report to a supervisor

Recommended Supplemental Content

Note: The following content areas are recommended as supplemental to the core curriculum frameworks to 1) highlight career pathway and career progression opportunities for CNAs and 2) to assure that trainees are properly prepared to pursue and attain certification through credential exam preparation

Career Pathways

1. Compare and contrast various career advancement opportunities in direct care and other healthcare and human service areas and identify employment and career pathway resources

Preparing for the CNA Credentialing Exam

1. Identify the structure, format and requirements of the Massachusetts CNA credentialing exam, including both the written/oral knowledge test and the skills demonstration portion
2. Develop effective test-taking and self-preparation strategies to build confidence and reduce test anxiety
3. Apply selected skills to simulated testing conditions, ensuring accuracy, professionalism, and compliance with exam checklists

Download the CNA Curriculum Frameworks