Nurse Aide Training Skills

Transcription

1 Nursing Fundamentals 7243 AHSII 7212 ( is the last year) Nurse Aide Training Skills Use for

2 NURSE AIDE TRAINING SUMMARY (NATS) NURSING FUNDAMENTALS 7243 & AHSII 7212 (last year ) Student School (Because this document will be handled frequently and be kept on file for three years, it is suggested (not required) that it be printed on card stock paper.) NATS - PART 1 PREREQUISITES SATISFIED Grade for AHSI or MSI or Health Science I Date of completion for AHSI or MSI or HSI (semester / school year) Grade for Health Science II-7242 (Nursing Fundamental students only) Date of completion for Health Science II-7242 (semester / school year) Date Healthcare Provider Basic Life Support completed (must be current) NATS - PART 2 SKILLS MASTERY IN TRAINING LAB All skills MUST be mastered and documented at 100% prior to direct patient contact. SKILLS marked with an asterisk must be taught. However, individual proficiency check is NOT required. Approved instructor does NOT have to date and sign initials for these skills. APPROVED instructor must initial and date, to document the student s mastery of the skill in the training laboratory. (Use black or blue ink, not pencil) APPROVED instructor must sign and date the bottom of form when the clinical experience is completed. This is a legal document and must be stored in the student s individual file for three* years. *Change effective school year UNIT A - NURSE AIDE WORKPLACE FUNDAMENTALS 1.03A SKILL Restraint Alternative - Apply Electric Alert Device 1.03B SKILL Apply Restraints 3.01A SKILL Wash Hands 3.01B SKILL Handrub (hand hygiene) 3.01C SKILL Don and remove complete PPE 3.01D SKILL Dispose of equipment from resident unit with transmission based precautions 3.01E SKILL Collect specimen from resident under disease transmission based precautions 3.02A SKILL Perform relief of choking (assure CURRENT competence) UNIT B - NURSE AIDE RESIDENT CARE SKILLS 4.01A SKILL Take oral temperature with non-mercury glass thermometer 4.01B SKILL Take axillary temperature with non-mercury glass thermometer 4.01C SKILL Take rectal temperature with non-mercury glass DATE OF SKILL PROFICIENCY APPROVED INSTRUCTOR S INITIALS thermometer 4.01D SKILL Take oral temperature with electronic thermometer 4.01E SKILL Take temperature with tympanic thermometer 4.01F SKILL Count and record radial pulse 4.01G SKILL Count and record apical pulse Retain all parts of the Nurse Aide Training Summary (NATS) in the student s individual file for a minimum of three years. This is a legal document and should be stored in a locked file cabinet ready for nurse aide training program review at any time. 1

3 4.01H SKILL Count and record respirations 4.01I SKILL Measure and record blood pressure - Manual BP cuff 4.01J SKILL Measure and record combined vital signs 4.01K SKILL Measure and record height and weight 4.02A SKILL Ambulation with cane or walker 4.02B SKILL Use mechanical resident lift 4.02C SKILL Range of Motion 4.02D SKILL Ambulation with transfer (gait) belt 4.02E SKILL Transfer from bed to chair / wheelchair 4.02F SKILL Transfer from bed to stretcher 4.02G SKILL Assist resident to cough and deep breath 4.02H SKILL Apply and remove anti-embolic stockings (TEDs) 5.01A SKILL Assist and provide when needed, resident mouth care 5.01B SKILL Denture care 5.01C SKILL Mouth care for unconscious resident 5.01D SKILL Fingernail care 5.01E SKILL Foot care 5.01F SKILL Shaving a resident 5.01G SKILL Provide hair care 5.01H SKILL Shampoo resident s hair in bed 5.01I SKILL Dressing and undressing the resident 5.01J SKILL Complete bed bath 5.01K SKILL Partial bed bath 5.01L SKILL Tub bath or shower 5.01M SKILL Perineal care 5.01N SKILL Giving a back rub 5.02A SKILL Move resident up in bed with and without turn sheet 5.02B SKILL Position resident on side 5.02C SKILL Apply non-sterile dressing 5.02D SKILL Apply warm and cold applications 5.03A SKILL Make a closed (unoccupied) bed 5.03B SKILL Opening a closed bed 5.03C SKILL Make an occupied bed 6.01A SKILL Provide fresh drinking water 6.01B SKILL Measure and record intake and output 6.01C SKILL Assist with dining 6.01D SKILL Serve supplemental nourishment 6.02A SKILL Assist to bathroom (BR) 6.02B SKILL Assist to bedside commode (BSC) 6.02C SKILL Assist resident with use of bedpan 6.02D SKILL Apply adult brief 6.02E SKILL Administer cleansing enema 6.02F SKILL Collect fecal (stool) specimen 6.02G SKILL Assist with urinal 6.02H SKILL Provide catheter care 6.02I SKILL Empty urinary drainage catheter bag 6.02J SKILL Collect routine urine specimen 6.02K SKILL Apply condom catheter I CERTIFY THAT ALL NURSE AIDE I CURRICULUM SKILLS REQUIRING PROFICIENCY CHECKS WERE MASTERED PRIOR TO DIRECT PATIENT CONTACT. Approved Instructor s Signature Date Retain all parts of the Nurse Aide Training Summary (NATS) in the student s individual file for a minimum of three years. This is a legal document and should be stored in a locked file cabinet ready for nurse aide training program review at any time. 2

4 NATS - PART 3 DEMONSTRATION OF ABILITY TO TRANSFER SKILL COMPETENCE IN A REAL LONG TERM CARE RESIDENT CARE SETTING AS REQUIRED BY DHSR/CARE. Effective July DHSR requires that the following (18) skills must be performed in a clinical setting, with instructor supervision following demonstration of proficiency in a classroom laboratory setting. Instructors should initial and date after competent skills performance. MUST BE PERFORMED IN THE CLINICAL SETTING Must perform six (6) of the following twelve (12) skills in the clinical setting. 1. Assist with oral hygiene 2. Provide mouth care 3. Assist with denture care 4. Clean and trim nails 5. Assist resident with shaving 6. Care for hair 7. Shampoo hair in bed 8. Dress and undress 9. Give complete bed bath 10. Give tub bath or shower 11. Give perineal care 12. Give back rub EACH of the following nine (9) skills must be performed in the clinical setting. 1. Assist with dining/feeding resident who cannot feed self 2. Measure oral temperature*** 3. Count respiration 4. Count radial pulse 5. Measure blood pressure 6. Measure height and weight 7. Provide catheter care*** 8. Perform ROM exercises 9. Transferring from bed to chair Must perform three (3) of the following six (6) skills in the clinical setting. 1. Assist to ambulate using cane or walker 2. Use mechanical lift (for nurse aide students 18 years of age*) 3. Assist to dangle, stand and walk 4. Move up in bed 5. Move up in bed using turn sheet 6. Position resident on side Demonstrated successfully during the clinical experience, the ability to apply skill competence to residents in long term care as evidenced by demonstrating the 18 skills required by DHSR/CARE as listed above with teacher documentation of the same. Approved instructor sign in the cell below. Approved instructor signature: Instructor Initials / Date Performed Student demonstrated clinical competence of (18) DHSR/CARE identified skills in clinical. Enter date in cell below. Date: *** If the experience of measuring oral temperature with a non-mercury glass thermometer or catheter care is not available in the clinical setting, student may perform the temperature and catheter care in the laboratory setting. Document why students were unable to perform these skills during clinical and where the skills were practiced. Memo from DHSR/CARE on * Fair Labor Standards Act / Hazardous Order No. 7 / July 2010 Retain all parts of the Nurse Aide Training Summary (NATS) in the student s individual file for a minimum of three years. This is a legal document and should be stored in a locked file cabinet ready for nurse aide training program review at any time. 3

5 NATS - PART 4 CLINICAL REQUIREMENTS MET Successfully completed 40 hours of supervised long term care or long term type care clinical experience, performing hands on personal care skills to residents. Approved instructor signature: # Clinical hours & date hours completed: Date: NATS - PART 5 NURSE AIDE TRAINING COURSE COMPLETION Grade for Nsg. Fund or AHSII (final grade must be75% or greater) Date of completion for Nursing Fundamentals 7243 or AHSII Approved instructor signature: Date: TRAINING IS COMPLETE AND CANDIDATE IS ELIGIBLE TO RECEIVE A CERTICATE OF NAI TRAINING COMPLETION, AND ELIGIBLE TO REGISTER FOR THE NNAAP EXAMINATION WHEN THE STUDENT HAS: NATS Satisfied course prerequisites Part 1 NATS Mastered all curriculum skills in the training lab prior to clinical Part 2 NATS Part 3 Demonstration of ability to transfer skill competence in a real long term care resident care setting as required by DHSR/CARE NATS Part 4 NATS Part 5 Met clinical experience time requirement Completed Nursing Fundamentals or AHSII (READ NOTES BELOW) 1. The teacher does NOT have to wait until EOC exams are administered to complete the certificate of completion and guide candidates to apply for registry by NNAAP competency evaluation. 2. When NATS Part 1,2,3,4 listed above are totally completed and the student is for sure on track to pass Nursing Fundamentals or AHSII with a 75 or better, the candidate may apply to take the NNAAP exam. 3. The date on the Training Completion Form is the date all requirements for nurse aide training are complete. It does not need to be the last day of school. NATS - PART 6 CERTIFICATE OF NAI TRAINING COMPLETION Issue only after completion of nurse aide training. Refer to NATS Part 5 notes above. Date original notarized certificate of completion was given to the student Copy of the notarized certificate of completion was placed in the student file Approved instructor signature: Notes/Comments: Date: <End of Nurse Aide Training Summary> Retain all parts of the Nurse Aide Training Summary (NATS) in the student s individual file for a minimum of three years. This is a legal document and should be stored in a locked file cabinet ready for nurse aide training program review at any time. 4

6 Restraint Alternative Procedure Apply Electronic Warning Device 1.03A This performance checklist must be used by the teacher and student during skill acquisition, guided practice, and independent practice. During skill check-off, the student must perform the skill unassisted with 100% competence. While the course is being taught, a skill performance summary document/chart may be used to verify skills that have been completed. However, verification that the student has demonstrated competency on this skill MUST be recorded on the NATS Part II by the conclusion of the course. Restraint Alternatives: (Electric Warning Device is one Restraint Alternative*) 1. Help keep residents safe and still upholds resident right to be restraint free 2. Types of restraint alternatives: A. Bed alarms Alert staff if a patient gets up without help* B. Floor cushion or pads next to the bed decrease injuries if a person does fall when getting out of bed C. Barriers such as STOP SIGNS posted on doors- discourages confused patients from wandering into the area D. Partial bed rails prevent patients from rolling out of bed while allowing them freedom to get up if they wish to E. Wedge cushions Place in wheelchairs to prevent forward sliding F. Wheelchair/chair alarms alerts staff if the person slides forward or tries to get up without help* G. Activities and diversions games, movies, music distract residents H. Positioning devices and wedges I. Furniture low beds, rocking chairs, or recliners J. Easy-release belts is a reminder of safety moves but person can release if desired.

7 Equipment: Fall Alarms also known as Exit Devices, Fall Detection Alarms, or Electronic Warning Devices Pull Cord Fall Alarm Consists of an adjustable length cord and garment clip that is attached to the patient's/resident's clothing. The end of the cord is attached to the control unit via a small magnetic pin or metal pin. The alarm is activated and sounds when the patient/resident exits the bed, chair/wheelchair and the cord detaches from the control unit. Combination Pressure Pad & Pull Cord Fall Alarms These fall alarms can be used as a pull-cord alarm or attached to a pressure pad. When used as a pull-cord, the alarm is activated when the patient/resident exits the bed, chair/wheelchair and the cord detaches from the control unit. For pressure-pad use, the alarm is activated when the weight of the patient/resident is no longer on the pad. Note: Follow manufacturer s directions and the instructions given by the supervising nurse. Fall alarms do not prevent falls unless staff members respond to the sound of the alarm! 1. Knock before entering room. 2. Greet and identify resident. 3. State your name and title. 4. Explain procedure that will be done and obtain permission. 5. Wash hands and provide privacy if procedure requires privacy. 6. Do not remove fall detection alarms unless you are with the resident. 7. Reattach alarm device if you detach it during resident care. Attach the garment clip to the resident s clothing out of the resident s reach if pull cord fall alarm is used Assure the pull cord is not tangled Assure the alarm unit is on and the pull cord is attached to the alarm unit. (A magnet affixes the pull cord to the alarm unit.) 8. Respond to the sounding of alarms STAT. Assure resident is safe and redirect resident if necessary. 9. Report malfunctioning fall alarm device (restraint alternative) to supervisor immediately. 10. Record actions and report any abnormal observations to supervisor. Instructor s Initials: Date:

8 Name: Applying Restraints B This performance checklist must be used by the teacher and student during skill acquisition, guided practice, and independent practice. During skill check-off, the student must perform the skill unassisted with 100% competence. While the course is being taught, a skill performance summary document/chart may be used to verify skills that have been completed. However, verification that the student has demonstrated competency on this skill MUST be recorded on the NATS Part II by the conclusion of the course. WARNING: Restraint use may increase risk of injuries such as strangulation or entrapment! About restraints: 1. Restraint is defined as any manual or chemical item or device that is attached to or next to the person s body that limits the person s freedom of movement or body access that the person cannot easily remove. 2. Use of restraints topic of debate for 20 years. 3. Warning: OBRA permits a person to be restrained if: A. It is a part of the plan of care to treat the person s physical, emotional, or behavioral problems. B. Needed to protect other patients or persons from harm. C. Ordered for medical reason, the order includes the body part to be restrained, the device to use, and the amount of time the restraint is to be used. D. Least restrictive method is used. E. Person agrees to the use of the restraint. F. Person s dignity and quality of life are protected.

9 Applying Restraints B Basic Guidelines: 1. Never apply a restraint without a doctor s order. 2. Never apply a restraint if the person refuses it. 3. Never apply a restraint without fully understanding how the device should be used. 4. If a resident is restrained, the restraint and skin under the restraint must be checked at least every 15 minutes. 5. The resident s restraint must be released every 2 hours, skin care given, resident repositioned, and restraint reapplied as ordered. Basic Restraint Procedure(s) 1. Receive directions from supervisor. Knock before entering room. 2. Address resident by name. State your name and title. 3. Identify resident. Explain procedure and obtain permission. 4. Wash hands. Provide privacy. 6. Select the type of restraint ordered and select the correct size for the resident. 7. Position resident in good bodily alignment for the type of restraint being used. 8. Apply restraint according to the type of restraint and manufacturer s instructions. 9. Apply straps appropriately. Wheelchair Use: Straps to prevent sliding should always be over the thighs NOT around waist or chest when the safety belt if used in a wheelchair. Straps should be at a 45 degree angle and secured to the chair under the seat, not behind the back when the safety belt is used in a wheelchair. Bed Use: Secure straps to moveable part of the bed frame using a slipknot. Never tie to bedrails. Leave 1-2 inches of slack in the straps Tie straps out of the resident s reach 10. Monitor resident s circulation and resident s tolerance to restraint. 11. Record actions and report any abnormal observations to supervisor.

10 Mitten Restraint Hands must be clean, dry and padded when applying mitt restraints. Check pulse, color and temperature of hand every 5 minutes because resident cannot press call bell Offer help with toileting, offer fluids, reposition Wrist Restraint (Limb Restraint) Place soft edge against skin wrapping smoothly around wrist Pull secure and check fit by inserting two fingers between skin and restraint Position limb in comfortable position but limit movement as necessary Check pulse, color and temperature of hand every 15 minutes Offer help with toileting, offer fluids, reposition Tie to moveable part of bed frame or wheelchair using slipknot NEVER TIE TO BED RAILS.be sure call light is in reach Jacket or Vest Restraint Vest restraints are worn over clothing and must not restrict breathing. Slip sleeves over arms and positions V-area in the front Cross strap in back and pull through hole in jacket Secure straps to frame and check for tightness, comfort and movement limits Check pulse, color and temperature and breathing of resident in vest restraint every 15 minutes Offer help with toileting, offer fluids, reposition. Call light in reach Safety Belt Restraint Place belt over top of clothing in front, passing ties across back Check restraint to be sure there are no wrinkles and that restraint does not restrict breathing. Put ties through belt slots, Check position of restraint and breathing every 15 minutes Offer help with toileting, offer fluids, reposition. Be sure call light in reach Instructor s Initials: Date:

11 Washing Hands A (This skill must be performed during NNAAP testing) This performance checklist must be used by the teacher and student during skill acquisition, guided practice, and independent practice. During skill check-off, the student must perform the skill unassisted with 100% competence. While the course is being taught, a skill performance summary document/chart may be used to verify skills that have been completed. However, verification that the student has demonstrated competency on this skill MUST be recorded on the NATS Part II by the conclusion of the course. Equipment: Liquid soap, soap dispenser, sink, running hot and cold water, paper towels, waste receptacle 1. Address resident by name and introduce yourself to resident by name 2. Push sleeves up 4-5 inches on arms, push watch up 4-5 inches on wrist or remove watch 3. Turn on water at sink and adjust water to a warm temperature 4. Wet hands, fingers, and wrists thoroughly without splashing and with fingertips pointed downward 5. Apply soap to hands after wetting hands 6. Form LATHER on all surfaces of hands, wrist, and fingers. Create friction by rubbing in a circular motion for at least 20 seconds, keeping hands lower than the elbows and the fingertips down. Rub palms together Rub palm of one hand to the back of the other Interlace fingers and rub back and forth, be sure to include thumbs Clean fingernails by rubbing fingertips against palms of the opposite hand Wash two inches above the wrist If grossly contaminated, wash hands the length of time stated in facility policy 7. After lathering for at least 20 seconds, rinse all surfaces of wrists, hands, and fingers keeping hands lower thank elbows and the fingertips down 8. Uses clean, dry paper towel to dry all surfaces from tips of fingers to wrist then dispose of paper towel into waste container 9. Use clean, dry paper towel to turn off faucet then disposes of paper towel into waste container or use knee/foot control to turn off water 10. Do not touch inside of sink at any time Instructor s Initials: Date:

12 Handrub B This performance checklist must be used by the teacher and student during skill acquisition, guided practice, and independent practice. During skill check-off, the student must perform the skill unassisted with 100% competence. While the course is being taught, a skill performance summary document/chart may be used to verify skills that have been completed. However, verification that the student has demonstrated competency on this skill MUST be recorded on the NATS Part II by the conclusion of the course. Equipment: Handrub product 1. Duration of the entire procedure: seconds 2. Apply a palmful of the product in a cupped hand 3. Rub hands palm to palm in a circular motion 4. Rub right palm over left dorsum with interlaced fingers and vice versa 5. Rub palm to palm with finger interlaced 6. Rub backs of fingers to opposing palms with fingers interlocked 7. Perform rotational rubbing of left thumb clasped in right palm and vice versa 8. Perform rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa 9. Once dry, your hands are safe 10. When the hands are visibly soiled, hands must be washed. Handrub is not effective for visibly soiled hands. Instructor s Initials: Date:

13 Donning and Removing Complete PPE C (A modification of this skill may be required during NNAAP testing. NNAAP skill is to don and doff gown and gloves only.) This performance checklist must be used by the teacher and student during skill acquisition, guided practice, and independent practice. During skill check-off, the student must perform the skill unassisted with 100% competence. While the course is being taught, a skill performance summary document/chart may be used to verify skills that have been completed. However, verification that the student has demonstrated competency on this skill MUST be recorded on the NATS Part II by the conclusion of the course. Equipment: Non-Sterile Gown, Non-Sterile Gloves, Mask, Goggles, and Face shields Gloves protect the hands Gowns protect the skin and/or clothing Masks protect the mouth and nose Goggles protect the eyes Face shields protect the entire face - mouth, nose, and eyes Note: OSHA states that it is the employer s responsibility to instruct the staff on how to properly wear (don) and how to remove (doff) the PPE. Facility procedures may vary slightly. Donning (putting on) Gown 1. Wash your hands. 2. Pick up and unfold gown with opening at the back and do not let gown touch the floor. 3. Facing the back opening of the gown slip arms into sleeves and adjusting the gown over your shoulders. 4. Tie neck tie, or fasten Velcro or sticky strips at back of neck. 5. Reach behind and overlap the edges of the gown. Make sure the back of clothing is covered as much as possible by the gown. 6. Bring waist ties to the back and tie. If they are long enough to come around to the front, they may be tied in the front. Donning (putting on) Mask and Goggles 7. Pick up the mask by the top strings or elastic strap. Be careful not to touch the mask where it touches your face. 8. Adjust the mask over your nose and mouth. Tie the top strings, and then tie the bottom strings. 9. Masks must always be dry. Replace mask if it becomes wet.

14 10. Never wear a mask hanging from only the bottom ties. 11. Put on the goggles. FACE SHIELDS: Can be a substitute for mask and goggles. Face shields should 12. cover your forehead and go below the chin. It wraps around the sides of your face. Donning (putting on) Gloves Wash your hands. If you have already washed hands for donning down; omit 13. washing hands now. 14. Remove gloves from box one at a time. Be sure hands are dry! Place one hand through the opening of the first glove, and 15. pull the glove up and over the wrist. Place other hand through the opening of the second glove, and pull the glove up 16. and over the wrist. Adjust gloves to cover the wrist or cuffs of the gown if wearing a gown. Do 17. not touch any part of your body with your gloved hand(s). COMPLETE RESIDENT CARE Removing Gloves 1. Grasp one glove at the inside of the wrist, palm side, ½ inch below the band of the dirty side of the glove without touching your skin. 2. Pull glove down, turning it inside out, and pull it off your hand. Hold the glove in the still-gloved hand. 3. Insert fingers of ungloved hand inside the cuff of the glove on the other hand. 4. Pull glove down until it is inside out, drawing it over the first glove. 5. Place both gloves in the waste container according to your facility policy. 6. Wash your hands. Removing Goggles or Face Shield Remove goggles in such a way as to avoid contaminating your face or hair in the 7. process. Handle only the strings or straps. 8. Discard in appropriate waste container according to facility policy. 9. Wash your hands. Removing Gown Grasp one glove at the inside of the wrist, palm side, ½ inch below the band of the 10. dirty side of the glove without touching your skin. Pull glove down, turning it inside out, and pull it off your hand. Hold the glove in 11. the still-gloved hand. 12. Insert fingers of ungloved hand inside the cuff of the glove on the other hand.

15 13. Pull glove down until it is inside out, drawing it over the first glove. 14. Place both gloves in the waste container according to your facility policy. 15. Wash your hands. 16. With gown-covered hand, pull gown down over the other hand. Fold gown away from your body with the contaminated side inward, keep gown 17. turned inside out and DO NOT LET GOWN TOUCH THE FLOOR. Roll the gown into a ball and dispose of according to your facility policy without 18. contaminating self. 19. Wash your hands. Remove Mask Remove mask in such a way as to avoid contaminating your face or hair in the 20. process. Handle only the strings or straps. 21. Discard according to facility policy. 22. Wash your hands. Instructor s Initials: Date:

16 Disposing of Equipment with Transmission Based Precautions D This skill MUST BE TAUGHT. However, individual skill competence check is NOT required for this skill. Equipment: PPE plastic bags in the isolation cart, ties, labels 1. Receive directions from supervisor. Wash hands. 2. Assemble equipment. Fill out label on container. 3. Put on appropriate personal protective equipment per skill 3.01C. Combination of PPE will affect sequence, be practical. 4. Knock before entering room. 5. Address resident by name. State your name and title. 6. Identify resident. Explain procedure and obtain permission. 7. Prepare Articles for Removal from isolation room: Clean/disinfect all articles in the unit Place in plastic bag and label ISOLATION Fold the plastic bag down twice and tape shut A second person outside holds a second plastic bag bag should be cuffed to prevent self contamination The person in the unit places the already sealed and labeled bag into the second bag without touching the outside of the clean/outside/second bag. The person in isolation should have no contact with the clean outside (second) bag. Outside person turns the bags down twice and tapes. Labels Isolation AND the CONTENTS of the bag Bag is then sent to proper destination for processing 8. Provide patient safety: Bed locked in low position Call bell in reach Check patient comfort 9. Where to Remove PPE: In a two-room isolation unit, go to the outer room. In a room one-room unit, remove garments while you are standing close to the inside of the door. Take care not to touch the inside patient s door. Take care not to touch the room s contaminated articles. 10. Wash Hands: Open the door using a paper towel and discard it as you leave. 11. Record actions and report any abnormal observations to supervisor.

17 Collect Specimen under Transmission Based Precautions E This skill MUST BE TAUGHT. However, individual skill competence check is NOT required for this skill. Equipment: Specimen container, paper towels, personal protective equipment, leak-proof transport bag, gloves Receive directions from supervisor. Wash hands. Assemble equipment. Fill out label on container. Put on appropriate personal protective equipment Put on gown: (combination of PPE will affect sequence be practical / CDC 2004) Slip arms into sleeves of gown. Slip fingers under inside neckband and grasp ties in back. Tie in bow or fasten Velcro strip. Grasp edges of gown and pull to back. Overlap edges, closing opening so that uniform is completely covered. Tie waist strings in bow or fasten Velcro strip. Put on mask: Pick up mask by upper ties. Place mask over nose and mouth. Place upper strings over ears and tie in bow at back of head. Tie lower strings in bow at back of neck. Put protective eyewear over eyes. Put on gloves: Remove two gloves from clean container. Pull on gloves over hands and wrists, using medical asepsis. Medical asepsis includes not letting gloves touch contaminated surfaces or objects while being put on and replacing gloves with obvious holes or tears. Prepare specimen container: If possible write resident s name, date, and other required information on the specimen container label prior to going into the resident s room. Affix label to container. Knock before entering room. Address resident by name. State your name and title. Identify resident. Explain procedure and obtain permission. Collect Specimen: Place specimen container and leak-proof transport bag on clean paper towel on appropriate surface with container lid off. Inside of lid should be facing up. Collect specimen following procedures in appropriate skills. Apply lid without touching the inside of the lid

18 Place specimen in container without touching outside of container Remove gross contamination of the outside of the specimen container if needed Assure specimen container is labeled Place specimen container in a biohazard bag for transport Provide patient safety: Bed locked in low position Call bell in reach Check patient comfort Where to Remove PPE: In a two-room isolation unit, go to the outer room. In a room one-room unit, remove garments while you are standing close to the inside of the door. Take care not to touch the inside patient s door. Take care not to touch the room s contaminated articles. Remove Gloves: With dominant hand, remove other glove by grasping it just below wrist. Pull glove down over non-dominant hand so that it is inside out. Hold removed glove in gloved hand. With first two fingers of ungloved hand, reach inside glove without touching outside of glove. Pull glove down (inside out) over hand and remaining glove. Discard gloves into waste receptacle. Wash hands. Remove Eyewear: (face shield or goggles) Remove Gown: Untie waist strings and loosen gown. Wash hands. Untie neck strings. Slip fingers of right hand inside left cuff without touching outside of gown. Pull gown down over left hand. Pull gown down over right hand with gown-covered left hand. Remove gown by rolling it in ball, contaminated side inward, not touching the floor with gown. Dispose of gown in appropriate container. Remove and Discard Mask or Respirator: Wash Hands: Open the door using a paper towel and discard it as you leave. Have another person outside the resident s room assist in double bagging the specimen Take specimen to appropriate area. Record actions and report any abnormal observations to supervisor.

19 Performing Relief of Choking A This performance checklist must be used by the teacher and student during skill acquisition, guided practice, and independent practice. During skill check-off, the student must perform the skill unassisted with 100% competence. While the course is being taught, a skill performance summary document/chart may be used to verify skills that have been completed. However, verification that the student has demonstrated competency on this skill MUST be recorded on the NAT Part II by the conclusion of the course. Student should learn and perform with 100% competence, the most current AHA or ARC procedure for relief of choking (FBAO) in the conscious and unconscious resident in conjunction with other emergency care skills. Instructor s Initials: Date:

20 Measure/record temperature using non-mercury glass thermometer: 4.01A Oral This performance checklist must be used by the teacher and student during skill acquisition, guided practice, and independent practice. During skill check-off, the student must perform the skill unassisted with 100% competence. While the course is being taught, a skill performance summary document/chart may be used to verify skills that have been completed. However, verification that the student has demonstrated competency on this skill MUST be recorded on the NAT Part II by the conclusion of the course. Equipment: Paper, pen, non-mercury glass thermometer, sheaths, tissues, gloves 1. Knock before entering room. Address resident by name. 2. State your name and title. Identify resident. 3. Explain procedure and obtain permission. 4. Wash hands. Assemble equipment. 5. Provide privacy. 6. Ask if resident has recently had hot or cold liquids or has been smoking. Wait minutes if response is positive. 7. Put on gloves. 8. If soaking in disinfectant, rinse thermometer with cold water and dry with tissue. 9. Check thermometer for chips and cracks. 10. Shake indicator ribbon down and place thermometer in sheath, if available. 11. Place bulb end of thermometer under tongue and ask that resident keep mouth and lips closed. 12. Leave in mouth for 3 minutes or as directed. 13. Remove thermometer, holding stem end. Remove sheath and discard or wipe thermometer with tissue from stem toward bulb. 14. Read thermometer accurately. 15. Record resident s name and temperature on notepad. 16. Shake indicator ribbon down. 17. Replace thermometer in container. 18. Remove gloves and wash hands. 19. Provide for comfort with call signal in reach. 20. Record temperature on appropriate form and report any abnormal reading to supervisor. Instructor s Initials: Date:

21 Measure/record temperature using non-mercury glass thermometer: 4.01B Axillary This skill MUST BE TAUGHT. However, individual skill competence check is NOT required for this skill. Equipment: Paper, pen, non-mercury glass thermometer, sheaths, tissues, gloves 1. Knock before entering room. Address resident by name. 2. State your name and title. Identify resident. 3. Explain procedure and obtain permission. 4. Wash hands. Assemble equipment. 5. Provide privacy. 6. If soaking in disinfectant, rinse thermometer with cold water and dry with tissue. 7. Check thermometer for chips and cracks. 8. Shake indicator ribbon down and place thermometer in sheath, if available. 9. Help resident remove arm from sleeve. 10. Place bulb end of thermometer in center of axilla. Ask resident to hold thermometer in place by closing arm. Assist in doing so if resident unable. 11. Leave thermometer in place for 5-10 minutes or as directed. 12. Remove thermometer, holding stem end. Remove sheath and discard or wipe thermometer with tissue from stem toward bulb. 13. Read thermometer accurately. 14. Record resident s name and temperature with A for axillary on notepad. 15. Shake indicator ribbon down and place in container. 16. Help resident replace sleeve. 17. Wash hands. 18. Provide for comfort with call signal in reach. 19. Record temperature on appropriate form and report abnormal reading to supervisor.

22 Measure/record temperature using non-mercury glass thermometer: 4.01C Rectal This skill MUST BE TAUGHT. However, individual skill competence check is NOT required for this skill. Equipment: Paper, pen, non-mercury glass thermometer, sheaths, tissues, gloves 1. Knock before entering. Address resident by name. 2. State your name and title. Identify resident. 3. Explain procedure and obtain permission. 4. Wash hands. Assemble equipment. Provide privacy. 5. Provide for resident safety. Place bed in flat position at best working level for body mechanics. 6. Put on gloves. Have resident turn on side. 7. If soaking in disinfectant, rinse thermometer in cold water and dry with tissue. 8. Check thermometer for chips or cracks. 9. Shake indicator ribbon down and place thermometer in sheath, if available. 10. Lubricate bulb of thermometer with KY jelly and insert one inch into rectum or as directed. 11. Hold thermometer in place for 3-5 minutes or as directed. Never let go of thermometer. 12. Remove thermometer, holding stem end. Remove sheath and discard or wipe thermometer with tissue from stem toward bulb. 13. Read thermometer accurately. 14. Shake down indicator ribbon thermometer and lie down or replace in container without touching container. 15. Remove gloves and wash hands. 16. Record resident s name and temperature on notepad with R for rectal. 17. Provide for resident safety and lower bed. 18. Provide for comfort with call signal in reach. 19. Record temperature on appropriate form and report any abnormal reading to supervisor.

23 Measure and record temperature: Electronic Thermometer 4.01D This performance checklist must be used by the teacher and student during skill acquisition, guided practice, and independent practice. During skill check-off, the student must perform the skill unassisted with 100% competence. While the course is being taught, a skill performance summary document/chart may be used to verify skills that have been completed. However, verification that the student has demonstrated competency on this skill MUST be recorded on the NATS Part II by the conclusion of the course. Equipment: Paper, pen, electronic thermometer, probe covers, tissues, and gloves 1. Assemble equipment. Knock before entering room. 2. Address resident by name. State your name and title. 3. Identify resident. Explain procedure and obtain permission. 4. Wash hands. Provide privacy. 5. Provide for resident safety. Position bed at best level for body mechanics. 6. Put on gloves if contamination possible Remove appropriate colored probe from stored position and insert into disposable probe cover. Insert covered probe into mouth, axilla, or rectum as required. Probe should be lubricated for rectal temperature. Red probe is for rectal temperatures Blue probe is for oral temperatures or axillary temperatures 9. Hold probe in place. 10. Wait for signal indicating temperature reading is complete. 11. Remove probe, eject, and discard probe cover. Do not touch probe cover. 12. Return probe to its stored position 13. Record resident s name and temperature on notepad using R or A as appropriate. 14. Remove gloves, if worn, and wash hands. 15. Lower bed. Provide for comfort with call signal in reach. 16. Return thermometer to appropriate place. 17. Record temperature and report any abnormal reading to supervisor. Instructor s Initials: Date:

24 Measure and record temperature: Tympanic Thermometer 4.01E This skill MUST BE TAUGHT. However, individual skill competence check is NOT required for this skill. Equipment: Paper, pen, electronic thermometer, probe covers, tissues, gloves 1. Assemble equipment. Knock before entering room. 2. Address resident by name. State your name and title. 3. Identify resident. Explain procedure and obtain permission. 4. Wash hands. Provide privacy. 5. Provide for resident safety. Position bed at best level for body mechanics. 6. Put on gloves if contamination possible. 7. Place cover on tympanic thermometer. 8. Do not use until ready is displayed. 9. To gently insert the probe into the ear canal: Gently pull back and up slightly on the edge of the ear to straighten out the ear canal. In children under the age of 2, pull the earlobe down and back to straighten the ear canal. The probe should totally occlude the ear canal. Hold thermometer in right hand if right ear is to be used for measurement. Hold thermometer in left hand if left ear is to be used for measurement. 10. Press the start button on the thermometer. 11. Leave the thermometer in place until you hear a tone or see a flashing light on the readout display. Read the thermometer reading on the display. 12. Remove the probe from the ear and let go of the ear. 13. Until the skill is perfected, take three temperatures and record the highest. 14. Remove probe and eject and discard probe cover. Do not touch the cover. 15. Return probe to its stored position or put tympanic thermometer down. 16. Record resident s name and temperature on notepad using T as appropriate. 17. Remove gloves, if worn, and wash hands. 18. Lower bed. Provide for comfort with call signal in reach. 19. Return thermometer to appropriate place. 20. Record temperature and report any abnormal reading to supervisor.

25 Count / Record Radial Pulse 4.01F This skill may be required during NNAAP testing This performance checklist must be used by the teacher and student during skill acquisition, guided practice, and independent practice. During skill check-off, the student must perform the skill unassisted with 100% competence. While the course is being taught, a skill performance summary document/chart may be used to verify skills that have been completed. However, verification that the student has demonstrated competency on this skill MUST be recorded on the NATS Part II by the conclusion of the course. Equipment: Watch with second hand, notepad and pen 1. Knock before entering, address resident by name, state your name and title. Identify resident, explain procedure and obtain permission. 2. Wash hands, provide privacy. 3. Position resident so that hand and arm are resting comfortably. 4. Locate pulse by placing tips of first three fingers on the thumb side of the resident s wrist (palm side of wrist) at base of thumb over radial artery. 5. Press lightly until you feel pulse; note rhythm and if beat is steady or irregular, strong or weak. Pressing too hard will occlude the pulse. 6. Note position of second hand on watch; count pulse rate for 30 seconds and multiply by 2. If pulse is irregular, take for one full minute. When taking the NNAAP skills exam count for ONE FULL MINUTE! 7. Wash hands BEFORE recording the pulse rate. 8. Record resident s name and pulse rate on notepad. For NNAAP skill testing, pulse must be within plus or minus 4 beats. 9. Provide for comfort, place call signal in reach. 10. Record pulse and report any abnormal findings: irregular rhythm, weak or pounding force, changes from previous measurements, pulse rate under 60 or over 90 beats per minute, to supervisor. Practice Tip: If there is difficulty in palpating the radial pulse, and the caregiver s position for taking the radial pulse is correct, try extending the resident s hand back very gently. This may cause the artery to become tight thus keeping the radial artery from moving and bringing the artery up closer to the surface of the skin. To demonstrate the effect that the amount of pressure exerted on the resident s pulse, use a drinking straw. Pinch the end of a drinking straw between the thumb and the forefinger. Demo that a little pressure does not close the end of the straw very much, moderate pressure closes the opening of the straw some, and heavy pressure between the forefinger and the thumb will totally close the straw/artery. This illustrates a candidate obliterating a pulse! Instructor s Initials: Date:

26 Measuring Apical Pulse 4.01G This skill MUST BE TAUGHT. However, individual skill competence check is NOT required for this skill. Equipment: Stethoscope, watch with second hand, antiseptic swabs, notepad and pen 1. Assemble equipment 2. Knock before entering resident s room 3. Address resident by name 4. State your name and title 5. Identify resident 6. Explain procedure and obtain permission 7. Wash hands 8. Provide privacy 9. Clean earpieces and diaphragm on stethoscope with antiseptic swabs 10. Put earpieces in both ears 11. Warm the diaphragm of stethoscope by holding in palm of hand for several seconds 12. Uncover left side of chest or place stethoscope under clothing. Avoid over exposure 13. Locate apex of heart by placing bell of stethoscope under left breast, just below and to inside of nipple and listen for heart sounds 14. Count heart rate one full minute noting abnormal sounds, and/or rhythm 15. Record name of resident and number of beats on notepad 16. Cover resident and make comfortable 17. Clean earpieces and diaphragm of stethoscope with antiseptic swabs 18. Wash hands 19. Provide for comfort with call signal in reach 20. Record apical pulse and report abnormal reading to supervisor

27 Counting Respirations 4.01H This skill may be required during NNAAP testing This performance checklist must be used by the teacher and student during skill acquisition, guided practice, and independent practice. During skill check-off, the student must perform the skill unassisted with 100% competence. While the course is being taught, a skill performance summary document/chart may be used to verify skills that have been completed. However, verification that the student has demonstrated competency on this skill MUST be recorded on the NATS Part II by the conclusion of the course. Equipment: Watch with second hand, notepad, and pen. 1. Knock before entering room 2. Address resident by name 3. State your name and title 4. Identify resident 5. Explain procedure and obtain permission 6. Provide privacy 7. Wash hands 8. After taking the apical or radial pulse rate, leave stethoscope or fingers in place and count number of times chest rises and falls. One rise and one fall of chest counts as one respiration. 9. Count respirations for 30 seconds and multiply by 2. If irregular count for one full minute. For NNAAP skill testing count for ONE FULL MINUTE. 10. Wash hands 11. Record resident s name, pulse and respirations on notepad. For NNAAP testing the rate counted must be within plus or minus 2 breaths of evaluator s reading. 12. Provide for comfort and safety with call signal in reach 13. Record respirations and report any abnormal reading to supervisor Practice Tip: When the resident is lying down, it may be easier to count the respirations by looking at the abdomen rather than putting a hand on the shoulder. Instructor s Initials: Date:

28 Measuring Blood Pressure 4.01I This skill may be required during NNAAP testing This performance checklist must be used by the teacher and student during skill acquisition, guided practice, and independent practice. During skill check-off, the student must perform the skill unassisted with 100% competence. While the course is being taught, a skill performance summary document/chart may be used to verify skills that have been completed. However, verification that the student has demonstrated competency on this skill MUST be recorded on the NATS Part II by the conclusion of the course. Equipment: Manual and electronic sphygmomanometers with correct size cuff, stethoscope, antiseptic pads, notepad and pen. 1. Assemble equipment, knock before entering room. 2. Address resident by name, state your name and title. Identify resident. 3. Explain procedure and obtain permission maintain face-to-face contact whenever possible. 4. Wash hands. Provide privacy. 5. Position resident in sitting or lying position. Expose upper arm. 6. Extend resident s arm and rest level with heart, palm upward on bed or table. Manual Blood Pressure 7. Before using stethoscope, wipes bell/diaphragm and earpieces of stethoscope with alcohol pad. 8. Loosen valve on bulb and expel any remaining air from cuff by squeezing cuff. 9. Locate brachial artery. 10. Wrap cuff snugly around upper arm, one inch above elbow, with arrow on cuff over brachial artery. 11. Position manometer so numbers can be read easily, with one hand close bulb valve by turning it clockwise Place earpieces in ears with the tips of the earpieces pointing away from the face. Place the bell/diaphragm of stethoscope directly over brachial artery. Palpate radial artery and inflate cuff 30 mm Hg beyond point where pulse was last felt OR inflate cuff between 160 mm Hg to 180 mm Hg. If beat heard immediately upon deflation, completely deflate cuff. Re-inflate to no more than 200 mm Hg. NNAAP Tip: Inflate cuff between 160 mm Hg to 180 mm Hg. If beat heard immediately upon deflation, completely deflate cuff. Re-inflate to no more than 200 mm Hg. 14. Deflate cuff at even rate of 2-4 mm per second by turning valve counterclockwise. 15. Note point on scale where first sound heard (systolic reading). 16. Note point where sound disappears or changes (diastolic reading).

29 17. Deflate cuff completely and remove from arm. 18. Clean earplugs and diaphragm of stethoscope with antiseptic pad. 19. Wash hands. Provide for comfort with call signal in reach. 20. Record blood pressure reading and report any abnormal reading or observations to supervisor. NOTE: For NNAAP testing, the reading must be correct within plus or minus 8 mm of the evaluator s reading. Electronic Blood Pressure 1. Assemble equipment, knock before entering room. 2. Address resident by name, state your name and title. Identify resident. 3. Explain procedure and obtain permission maintain face-to-face contact whenever possible. 4. Wash hands. Provide privacy. 5. Position resident in sitting or lying position. Expose upper arm. 6. Extend resident s arm and rest level with heart, palm upward on bed or table. 7. Before using stethoscope, wipe bell/diaphragm and earpieces of stethoscope with alcohol pad. 8. Loosen valve on bulb and expel any remaining air from cuff by squeezing cuff. 9. Locate brachial artery. 10. Wrap cuff snugly around upper arm, one inch above elbow, with arrow on cuff over brachial artery. 11. Position manometer so numbers can be read easily, with one hand close bulb valve by turning it clockwise. 12. Place the earpieces in ears. Place the bell/diaphragm of stethoscope directly over brachial artery 13. Wrap cuff snugly around upper arm, one inch above elbow, with arrow on cuff over brachial artery. 14. Follow manufacturer s directions for cuff inflation and reading results. 15. Remove cuff from arm. 16. Clean earplugs and diaphragm of stethoscope with antiseptic pad. 17. Wash hands. Provide for comfort with call signal in reach. 18. Record blood pressure reading and report any abnormal reading or observations to supervisor. Instructor s Initials: Date: