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:

30 Combined Vital Signs 4.01J 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 sphygmomanometer, stethoscope, non-mercury glass thermometer, pen, paper, and alcohol pads. 1. Measure pulse for one full minute while waiting for thermometer indicator ribbon to rise if patient is cooperative and able to hold the thermometer in the mouth without assistance. Measure pulse per performance checklist. 2. Measure respiration next. Count for one full minute. Maintain the pulse taking position and count respirations. Measure respiration per the respiration performance checklist. 3. Measure temperature with a non-mercury glass thermometer performance checklist. 4. Record vital signs in the chart below. 5. State and record normal limits for temperature, pulse, respiration, and blood pressure. 6. Compare resident findings to normal limits. 7. State next action if vital signs are out of normal limits. Complete chart below. Vital Sign Temperature Resident s Measurement Axillary Oral Rectal Normal Range Pulse Respiration Blood Pressure Systolic Diastolic Normal Pre Hypertension Hypertension Stage 1 Hypertension Stage2 Next Action Instructor s Initials: Date:

31 Measuring Height & Weight 4.01K Measuring weight 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: Paper towel, upright scale, notepad, and pen/pencil. 1. Knock before entering room, address resident by name 2. State your name and title, Identify resident 3. Explain procedure and obtain permission maintaining face-to face contact whenever possible 4. Wash hands 5. Have resident void, assist as needed. 6. Transport or escort to scales, have patient wear proper footwear according to facility policy. Provide privacy 7. Place paper towel on scale platform if resident is being weighed without shoes. 8. If weight is to be taken with shoes, ensure resident has shoes on when walking to scale. 9. Assist to remove sweaters, extra clothing, or anything in the hands Place both weights of the upright scale on zero to see if the scale is in balance BEFORE resident stands on scale. Raise height rod if height is to taken. Instruct resident to step onto center of scale, standing next to resident to assist if needed. Move the bottom or large weight indicator one GROVE at the time until the balance bar goes down to the bottom. Then move the bottom or large weight indicator back ONE GROVE. Do not touch the bottom or large weight indicator again! Now work with the top or small weight indicator only, sliding it carefully away from zero until the balance bar becomes centered. Assure both scale weights are in the groves of the scale slide bar. Add the bottom and top numbers. NNAAP test tip: Candidate may turn the yellow measurement slip over and add the upper and lower weight.

32 13. Assist resident if needed in getting off the scale BEFORE recording weight. 14. After assisting resident off scale, wash hands prior to recording weight. Record resident s name and weight on notepad. Weight must be plus or minus lbs. of the NACES evaluator. 16. If height is to be measured, lower height bar until it gently rests on head. 17. Assist resident to step down from scale. 18. Wash hands and record the height on notepad. 19. Discard paper towel if used. 20. Return weights to extreme left on scale and lower height bar. 21. Assist resident to put on shoes/other clothing as needed return resident to room. 22. Provide for comfort with call signal in reach. Wash hands. Record weight and height per facility policy and procedure and report weight gains 23. or losses to supervisor. Instructor s Initials: Date:

33 Assisting to Ambulate with Cane or Walker 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 NATS Part II by the conclusion of the course. 1. Knock before entering room. Address resident by name. 2. State your name and title. Identify resident. 3. Explain procedure and obtain permission maintaining face to face contact whenever possible. 4. Wash hands. Assemble equipment. Provide privacy. 5. Assist the resident with putting on robe and non-skid footwear. 6. Place the gait belt around the resident s waist. 7. Assist resident to stand allowing time to gain balance. 8. Stand on the resident s weaker side, place one hand on the gait belt in front and one hand on the gait belt in the back. Walk in the same pattern as the resident. 9. When ambulating in the hallway with a hand rail, encourage the resident to hold on to the handrail with the stronger arm while you walk on the opposite (weaker) side. If using Cane: 10. Check cane assure the rubber tip is in place. Place the cane in the patient s stronger hand 11. Instruct the resident to move the cane forward 6-8 inches and to the outside of the stronger leg. 12. Assist the resident with stepping forward with the weaker leg. The toe of the weaker foot should be even with the tip of the cane. 13. Instruct the resident to put weight on the cane and the weaker leg as the same time while stepping forward with the stronger leg so that the stronger foot is now next to the weaker foot. 14. Walk in the same pattern as the patient. If using a Walker: 15. Check walker to assure rubber tips are in place. Assist the resident with positioning within the frame of the walker. 16. Instruct the resident to move the walker forward by lifting it and setting it down if it is a non-wheeled walker or rolling the walker forward if it has wheels. 17. Assist the resident with taking a step forward into the walker with the weaker leg. 18. Instruct the resident to move the strong leg forward. 19. Walk in the same pattern as the patient. 20. Encourage resident to keep chin up and eyes looking forward. 21. Ambulate the distance instructed by the charge nurse. 22. Return to bed or chair. Remove gait belt. 23. Provide for safety and comfort with call signal in reach. 24. Wash hands. Record actions and report any abnormal observations to supervisor. Instructor s Initials: Date:

34 Mechanical Lift B This skill MUST BE TAUGHT. However, individual skill competence check is NOT required for this skill. Equipment: Mechanical lift, sling, appropriate chair, footwear Note: Follow manufacturer s directions for transferring at all times. Most mechanical lifts require 2 staff members to safely operate. Check your facility policy before using lift. 1. Assemble equipment and request help from co-workers. 2. Knock before entering room. Greet and identify resident. 3. State your name and title and coworkers with you. Explain procedure and obtain permission. 4. Wash hands and provide privacy. 5. Follow manufacturer s directions for the specific lift you are using for transferring resident. ** 6. Elevate bed to a comfortable working height and lock wheels. 7. Positioned chair/wheelchair at foot of bed seat facing the head of bed, lock wheels. 8. Lower siderail. Place resident in center of sling, sling should extend from shoulders to buttock with resident in the center of the sling, resident aligned. Cover sling with bed/linen protector or follow facility procedure to avoid transmission of infection with the equipment or sling. 9. Attach suspension straps to sling with s hooks facing out. ASSURE HOOK IS IN THE METAL PIECE OF THE SLING NOT ATTACHED TO THE CANVAS PORTION!!! The shorter chains attach at shoulder grommet The longer chains attach at the knee grommet Resident s weight should be evenly supported 10. Bring resident to semi-sitting position by elevating the head of the bed. 11. Position lift over bed, attach sling to lift frame, place resident s arms across chest. 12. Reassure resident and slowly lift with turn crank or hydraulic control. 13. Pay close attention to the resident s head so the boom or other equipment parts does not strike the resident s head. 14. Check straps/ sling security and slowly turn lift and position over chair. 15. Slowly lower resident into chair, release straps and move lift away. 16. Provide for comfort with call signal in reach. Wash hands. 17. Record actions and report any abnormal observations to supervisor. 18. Reverse process to return to bed.

35 Range of Motion C 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: Bath blanket OR equivalent. 1. Knock before entering room. Address resident by name. 2. State your name and title. Identify resident. 3. Explain procedure and obtain permission maintaining face to face contact whenever possible. 4. Wash hands. Assemble equipment. 5. Provide privacy. 6. Provide for resident safety and raise bed to best level for body mechanics. 7. Cover with bath blanket or equivalent and fanfold top linens to bottom of bed. 8. Place in supine position in good body alignment. 9. Instruct client to inform nurse aide if pain is experienced during exercise. 10. Support the limb being exercised; move joint gently, slowly, and smoothly through the range of motion, discontinue exercise if resident verbalizes pain. 11. Exercise neck: Head flexion, extension and hyperextension Head right and left rotation Head right and left lateral flexion 12. Exercise shoulder: Support resident s arm by placing one hand at the elbow and the other hand at the wrist Shoulder flexion and extension: Raise resident s straightened arm from side position to the front toward head to at least the ear level and return arm to side of body at least three times Shoulder abduction and adduction: Move resident s straightened arm away from the side of the body at least to shoulder level and return to side of body three times unless pain is verbalized. Shoulder internal and external rotation Shoulder horizontal abduction and adduction 13. Exercise elbow Flexion and Extension Supported the resident s arm by placing one hand on the elbow and the other on the wrist Flexed the elbow by bending the forearm and hand up to the shoulder Extended the elbow by moving the forearm and hand down to the side, or straightening the arm 14. Forearm Pronation and Supination Supported the resident s arm by placing one hand on the elbow and the other on the wrist Pronated by turning the forearm and hand so that the palm of the hand is down Supinated by turning the forearm and hand so that the palm of the hand is up

36 15. Exercise the wrist Supported the resident s wrist by placing one hand above it and the other hand below it Flexed the wrist by bending the hand down toward the forearm Extended the wrist by straightening the hand Hyperextended the wrist by bending the top of the hand back toward the forearm Deviated the wrist in an ulnar direction by moving the hand toward the little finger Deviated the wrist in a radial direction by moving the hand toward the thumb 16. Exercised the fingers and thumb Supported the resident s hand by placing one hand at the wrist Flexed the thumb and fingers by bending them toward the palm Extended the thumb and fingers by straightening them Abducted the thumb and fingers by spreading them apart Adducted the thumb and fingers by moving them together Performed opposition by touching the thumb to the tip of each finger Circumducted the thumb by moving it in a circular motion. 17. Uncover the nearest leg. 18. Exercise hip: Supported the resident s leg by placing one hand under the knee and the other under the ankle Abducted the hip by moving the entire leg out to the side Adducted the hip by moving the entire leg back toward the body Flexed the hip by bending the knee and moving the thigh up toward the abdomen Extended the hip by straightening the knee and moving the leg away from the abdomen Medially rotated the hip by bending the knee and turning the leg in toward the midline Laterally rotated the hip by bending the knee and turning the leg out away from the midline 19. Exercised the knee: Supported the resident s leg by placing one hand under the knee and the other under the ankle Flexed the knee by bending the lower leg back toward the thigh Extended the knee by straightening the leg 20. Exercise ankle: Supported the resident s foot by placing one hand under the foot and the other behind the ankle Dorsiflexed the ankle by moving the toes and foot up toward the knee Plantar flexed the ankle by moving the toes and foot down away from the knee Inverted the foot by gently turning it inward Everted the foot by gently turning it outward 21. Exercise the toes: Rest the resident s leg and foot on the bed for support Abducted the toes by separating them, or moving them away from each other Adducted the toes by moving them together Flexed the toes by bending them down toward the bottom of the foot Extending the toes by straightening them 22. Repeat exercise on opposite side of body after providing for resident safety. 23. Replace top linens. 24. Return bath blanket or equivalent to appropriate place. 25. Provide for safety and comfort with call signal in reach. 26. Wash hands. 27. Record actions and report any abnormal observations to supervisor. Instructor s Initials: Date:

37 Assist to Dangle, Stand, Walk D 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: Proper size transfer belt, resident s footwear 1. Receive directions from supervisor. 2. Request assistance if needed, assemble equipment. 3. Knock before entering room, greet and identify resident. 4. State your name and title. 5. Explain procedure and obtain resident s permission. 6. Wash hands. Provide privacy. 7. Before assisting to stand, ensure resident is wearing shoes and assist with robe. 8. Before assisting to stand, bed is at safe level. 9. Before assisting to stand, check or lock bed wheels. 10. Before assisting to stand, assist resident to sitting position with feet flat on floor assist resident to scoot to the edge of the bed if needed to get the resident s feet flat on the floor! Dangle: Allow the patient to sit at the side of the bed for 1-2 minutes to adjust to the change in position. If the patient does not tolerated sitting at bedside, assist the resident to lie back down and notify the charge nurse. 11. Before assisting to stand, apply transfer belt over top of clothing, check for correct size and place buckle slightly off center. Tighten snugly: Insert two fingers under belt Ensure breast are above belt and that there are no tubes Check for comfort Ensure belt does not restrict breathing 12. Before assisting to stand, provide instructions to enable resident to assist in standing including a prearranged signal to alert client to begin standing. 13. Stand FACING resident to ensure safety of resident and health care worker. Count to three, or other per arranged signal, to alert resident to begin to stand.

38 Assist to Dangle, Stand, Walk D 14. On signal, gradually assist resident to stand Face resident, establish broad base of support Put resident s hands on bed or wheelchair and have them push on signal Grasp transfer belt on both sides with an upward (power) grasp Maintain stability of resident s legs Care provider should maintain the natural lumbar curve during the assist Bend at knees and straightened knees as resident stands 15. Walk resident with transfer belt Care provider should position slightly behind and to one side of resident while holding onto the transfer belt with upward (power) grasp. One hand on the back of the belt and one hand on the side of the belt Encourage resident to walk slowly and use handrails if available Watch resident closely and read for signs of fatigue or intolerance Assist if resident starts to fall anticipate a possible fall at all times 16. Return resident to bed and remove transfer belt, shoes, robe, etc. 17. Observe resident safety/comfort checks before leaving; bed in low position, call signal in reach, bed rails per facility policy. 18. Replace equipment and wash hands. 19. Record actions and report any abnormal observations to supervisor. Instructor s Initials: Date:

39 Transferring from Bed to Chair or Wheelchair Using Transfer Belt E (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: Armchair or wheelchair, transfer belt, resident s footwear 1. Knock before entering room, greet and identify resident. 2. State your name and title, explain procedure and obtain permission. 3. Wash hands, assemble equipment and provide for privacy. 4. Before assisting resident to stand, position chair/wheelchair along side of bed on the resident s strong side. Chair/WC may be positioned at head of bed or foot of bed. 5. Before assisting to stand, lock wheels on wheelchair or secure chair. 6. Before assisting to stand, fold up or remove footrests. 7. Before assisting to stand, check or lock bed wheels and lower bed. 8. Elevate head of bed and fanfold top linens to bottom of bed. 9. Put on footwear on dependent resident before sitting at bedside. May put a towel or bed protector on foot of bed to prevent soiling the bed linen 10. Place call bell in reach of the care provider so that help can be summoned during the transfer if needed. 11. Help resident to move to side of bed. 12. Assist resident to a sitting position with feet flat on the floor. There may be need to help the resident scoot to the edge of the bed. Allow dangling for several minutes if needed and observe for signs of distress. 13. Before assisting to stand, ensure resident is wearing shoes if resident can put their own shoes on. If not, assist the resident in putting on robe and shoes. 14. Before assisting to stand, apply transfer belt securely over clothing/gown at the waist. 15. Before assisting to stand, instruct resident how to assist in the transfer including a prearranged signal to alert when to begin standing.

40 Transferring from Bed to Chair or Wheelchair Using Transfer Belt E 16. Stand facing resident positioning self to ensure safety of resident and care provider during transfer. Count to three or other prearranged signal to begin standing. 17. On signal, gradually assist client to stand by grasping transfer belt on both side with an upward grasp (power lift position) and maintain stability of the residents legs. 18. Assist to turn or pivot slowly until back of resident s legs are against the chair and arms are on the armrests. 19. Lower slowly to sitting position. 20. Positions client with hips touching back of wheelchair. 21. Remove transfer belt and position feet on footrests. 22. Provide for comfort with call signal in reach. 23. Wash hands. 24. Record actions and report any abnormal observations to supervisor. Instructor s Initials: Date:

41 Transfer Bed to Stretcher F 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: Stretcher covered with a sheet, drawsheet, and pillow. 1. Assemble equipment and request help needed from coworkers. 2. Knock before entering 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. Assure wheels of bed are locked. Raise bed to highest level, while coworkers stand at sides of bed. 10. Cover resident with blanket. Fanfold linens to foot of bed. 11. Lower head of bed to flat position. Remove pillow. 12. Place drawsheet under resident, if not already present. With co-workers on both sides, roll sides of drawsheet close to resident. 13. Move resident to side of bed using drawsheet. 14. Position stretcher next to bed and lock wheels. 15. Assure bed and stretcher are the same height or the stretcher just a little lower. 16. Transfer using drawsheet on count of 3 and position in center of stretcher. 17. Provide for comfort and place pillow under head. 18. Fasten safety straps and raise side rails of stretcher. 19. Unlock wheels and transport as directed. Never leave on stretcher unattended. 20. Wash hands. 21. Report transfer to supervisor. 22. Reverse procedure to return resident to bed. Instructor s Initials: Date:

42 Assisting Resident to Cough and Deep Breathe G 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 Assist the resident into a sitting position. If patient cannot sit up, raise the head of bed to Fowler s position. If the patient had abdominal surgery, place a small pillow over the incision and ask the resident to hold it firmly against their body Instruct the resident to use the chest and abdominal muscles to: Breathe in slowly through the nose Hold each breath for 3-4 seconds Breathe out slowly through the mouth (pursed lips helps with this) Deep breathing exercises should be performed 5-10 times every 2 hours while the patient is awake Coughing exercises: Follow steps 1-3. As the patient breathes out, instruct resident to cough with mouth open Coughing exercises should be performed at least every 2 hours while the patient is awake If patient is able to cough up secretions, dispose of secretions in tissue(s). If the patient coughs up bloody, brown, yellow, or green secretions tell the charge nurse. 8. Wash hands. 9. Provide resident safety, bed locked in low position, call signal in reach. 10. Record actions and report any abnormal observations to supervisor. Instructor s Initials: Date:

43 Applying and Removing Elastic Stockings (TED or anti-embolic stockings) H 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: Anti embolic stocking (TEDs) Note: Stockings are to be removed at least twice a day. 1. Assemble equipment 2. Knock before entering room, address resident by name 3. State your name and title, identify resident 4. Explain procedure and obtain permission, maintaining face-to-face contact whenever possible. 5. Wash hands, Provide privacy 6. Provide for resident safety and raise bed to best position for body mechanics 7. Resident should be in supine (lying on back) position while stockings are applied. Legs must be elevated prior to applying stockings. Turn elastic stockings inside out at least to the heel. 8. This does NOT mean to wad the stocking. Below are pictures of what NOT to do.

44 Note: by wadding the stocking, many folds are created. The multiple folds are like having several rubber bands around your fingers. Both are very difficult to open wide. By having the stocking folded, not wadded, inside out to heel, the stocking is then like a single rubber band. Much easier to open wide. The wider the opening can be stretched the less resistance on the resident s toes and foot. Every fold in the wad represents a rubber band. TED stocking should not be put on like socks. They are not socks! Place foot of stocking over toes, foot, and heel Pull top of stocking over foot, heel and leg. 11. Move foot and leg gently and naturally. Avoid forcing and over-extension of limb and joints. 12. Finish procedure with no twists or wrinkles. Opening in toe area may be over or under toe area. This is determined by the manufacture of the stocking. Proper placement is heel box of stocking on the heel of the resident. 13. Provide for resident safety, lower bed and call signal within reach. 14. Provide for resident comfort and wash hands. 15. Record actions and report any abnormal observations to supervisor. 16. To remove, roll stocking from top down to ankle, ease over heel and pull over foot. Instructor s Initials: Date: Practice Hint: Practice putting on TEDs on a 16 oz. styrofoam cup. The indentations on the cup would be lesions on the resident s foot!

45 Providing Mouth Care A 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: Gloves, emesis basin, toothbrush, toothpaste, cups, hand towel and washcloth 1. Knock before entering room. Address resident by name. Identify resident. 2. State your name and title. 3. Explain procedure and obtain permission maintaining face-to-face contact whenever possible 4. Wash hands. Assemble equipment. 5. Provide privacy. 6. Assist resident to bathroom and ask him/her to brush teeth. 7. If unable to ambulate to bathroom, elevate head of bed to sitting position (75-90 degrees). 8. Place towel across chest to protect clothing and linen. 9. Put on gloves before cleaning resident s mouth 10. Moisten toothbrush and apply toothpaste on brush if resident unable to do so. 11. Give toothbrush to resident and encourage him/her to brush own teeth including tongue and all surfaces of the teeth using gentle motions 12. If resident is unable to brush, wear gloves and brush all surfaces of teeth and tongue with up and down motion. 13. Provide cool water in glass to rinse mouth. Use straw, tissues and emesis basin as needed. 14. For resident who needs more assistance, hold emesis basin/cup to chin while client rinses mouth 15. Maintain clean technique with placement of toothbrush throughout procedure 16. Offer diluted mouthwash if desired. Use emesis basin/cup and tissues as needed. 17. Empty, rinse, and dry basin then place basin in designated area 18. Dispose of clothing protector appropriately 19. Remove gloves and wash hands AFTER cleaning and storing equipment/supplies 20. Provide for comfort with call signal in reach and bed in low position. 21. Record actions and report any abnormal observations to supervisor. Instructor s Initials: Date: Tip: For NNAAP testing, resident is UNABLE to brush their teeth.

46 Assisting with Denture Care B 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: Denture cup, tissues, mouthwash, toothbrush, toothpaste or powder, emesis basin, cleaning tablet if used, swabs, disposable cups 1. Knock before entering room 2. Address resident by name, state your name and title 3. Identify resident 4. Explain procedure and obtain permission while maintaining face-to-face contact whenever possible 5. Wash hands, Assemble equipment 6. Assist resident to bathroom. Provide privacy while in bathroom and provide tissue for removal of dentures. Ask resident to remove dentures. 7. If resident unable to use bathroom, provide privacy and place resident in semi- Flower s position. 8. Put on clean gloves before handling dentures 9. Assist with removal of dentures by pushing gently to break suction if necessary 10. Carefully place dentures in denture cup and carry to bathroom sink 11. Line the bottom of sink with wash cloth or paper towel and/or partially fill sink with water before denture is held over sink (to avoid denture breakage if denture are dropped in the sink) 12. Apply toothpaste to toothbrush and place toothbrush on a clean paper towel 13. Remove dentures from denture cup and rinse in tepid/moderate running water before brushing them 14. Hold dentures in palm of hand and brush until all surfaces of dentures are clean 15. Rinse all surfaces of dentures under tepid/moderate temperature running water 16. Rinse denture cup and lid and fill with tepid/moderate temperature water 17. Place dentures in denture cup and place lid on denture cup 18. Maintain clean technique with placement of toothbrush and denture 19. Remove sink liner and dispose of properly and/or drain sink

47 Assisting with Denture Care B 20. After rinsing and replacing equipment, dispose of sink liner, remove and dispose of gloves (without contaminating self) into waste container and wash hands 21. Take denture cup containing dentures to bedside 22. Apply a clean pair of gloves 23. Assist resident to rinse mouth with diluted mouthwash. Use emesis basin or clean paper cups and tissues. Offer swabs or soft toothbrush to clean entire mouth. 24. Clean equipment and straighten area 25. Remove gloves and wash hands 26. Provide for comfort with call signal in reach and bed in low position 27. Record actions and report any abnormal observations to supervisor Instructor s Initials: Date: Tip: For NNAAP testing, dentures have already been removed from the resident s mouth and are in a denture cup. Once the denture is cleaned it is returned to the denture cup, not the NNAAP candidate volunteer resident.

48 Mouth Care for Unconscious Resident C 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: Emesis basin, towel, tongue depressor, swabs, water soluble lubricant, disposable cup filled with cool water 1. Knock before entering room. 2. Address resident by name. 3. State your name and title. 4. Identify resident. 5. Explain procedure, assuming permission. 6. Wash hands. 7. Assemble equipment. 8. Provide privacy. 9. Provide for resident safety and raise bed to best level for body mechanics. 10. Turn resident to side-lying position, facing you. 11. Place towel and emesis basin under cheek. 12. Put on gloves. 13. Hold mouth open with tongue blade. 14. Clean entire mouth with swabs: roof, floor, tongue, teeth, cheeks, and lips. DO NOT POUR WATER IN THE RESIDENT S MOUTH 15. Dry face with towel and apply lubricant to lips. 16. Position for comfort with call signal in reach, provide for safety and lower bed. 17. Clean and dispose of equipment. 18. Remove gloves and wash hands. 19. Record actions and report any abnormal observations to supervisor. Instructor s Initials: Date:

49 Fingernail Care D 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: Wash basis or emesis basin, orange stick, emery board, towel, gloves, soap, goggles, nail clippers 1. Knock before entering. Address resident by name. Identify resident. 2. State your name and title. Explain procedure maintaining face to face contact whenever possible. 3. Wash hands. 4. Provide privacy. 5. Raise the bed to a comfortable working height, and raise the side rail on the opposite side of the bed. 6. Assist the patient to a sitting position by raising the HOB 45 to 90 degrees, or assist the patient with sitting in a chair at the bedside. 7. Fill wash basin 1/3 full with water not warmer than o F. Emesis basin may be used. Before immersing fingernails, checks water temperature for safety and temperature and ASK CLIENT TO VERIFY COMFORT OF WATER. 8. Place wash basin on over bed table so client can comfortably place hands in water OR place wash basin beside the client if there is space so the client can comfortably immerse fingers in the basin. 9. Allow fingers to soak 5 to 10 minutes to soften the nails. 10. Put on clean gloves before cleaning fingernails. 11. Gently remove dirt from under and around each fingernail using an orange stick. 12. Wipe the orange stick on towel after cleaning each nail. 13. Rinse the hands with clean warm water and dry the hands with a towel. 14. Place a towel under the client s dry hands. 15. IF ALLOWED BY THE FACILITY AND INSTRUCTED BY NURSE, trim the fingernails in a gentle curve. Wear goggles when trimming nails.

50 Fingernail Care D 16. Shape and smooth the nails with an emery board as needed. Feel each nail to determine need. 17. Rub lotion onto the hands. 18. Dispose of orangewood stick and emery board per facility policy. 19. Empty, rinse, and dry basin then place basin in the bedside stand or other designated area. 20. Dispose of used linen into soiled linen container. 21. Remove gloves and wash hands AFTER cleaning, and storing equipment/supplies. 22. Provide for comfort and with bed in low locked position and call signal in reach. 23. Record actions and report any abnormal observations to supervisor. Instructor s Initials: Date:

51 Foot Care E 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: Nail clippers, emery board, orange stick, basin of warm water, lotion, goggles, towels, gloves 1. Knock before entering. Address resident by name. Identify resident. 2. State your name and title. Explain procedure maintaining face to face contact whenever possible. 3. Wash hands. 4. Provide privacy. 5. Raise the bed to a comfortable working height, and raise the side rail on the opposite side of the bed. 6. Fill wash basin 1/3 full with water not warmer than o F. Before immersing foot/feet, checks water temperature for safety and temperature ask client to verify comfort of water. 7. If the client remains in bed for foot care, raise HOB 45 if tolerated. Flex the knee thus bringing the client s foot toward the body. Place basin on a protective barrier and assist in putting bare foot in the basin. Turn the wash basin at a diagonal angle to accommodate larger feet. 8. Some clients may be able to sit at bedside or in a chair for foot care. Assist client to comfortable position with bare feet in basin that is on a protective barrier. 9. Put on clean gloves before cleaning toe nails. 10. Wet wash cloth, wring out excess water, and apply soap to washcloth. 11. Lift foot from water and wash foot/feet including between the toes. Soak 5-10 minutes if permissible. 12. Gently remove dirt from under and around each toenail using an orange stick. 13. Wipe the orange stick on towel after cleaning each toenail. 14. Rinse foot/feet, including between the toes. 15. Dry foot/feet, including between the toes. 16. Place a towel under the client s dry feet.

52 FOOT CARE E 17. IF ALLOWED BY THE FACILITY AND INSTRUCTED BY NURSE, trim the toenails straight across. Wear goggles when trimming nails. 18. Shape and smooth the toenails with an emery board as needed. Feel each nail to determine need. 19. Apply lotion to top and bottom of foot/feet. (NOT between toes.) Remove excess with towel if there is any. 20. Dispose of orangewood stick and emery board per facility policy. 21. Empty, rinse, and dry basin then place basin in bedside table or other designated area. 22. Dispose of used linen into soiled linen container. 23. Remove gloves and wash hands AFTER removing, cleaning, and storing equipment/supplies. 24. Provide patient comfort and safety with bed low and locked and call signal in reach. 25. Record actions and report any abnormal observations to supervisor. Instructor s Initials: Date: Tip: During NNAAP testing, trimming of nails is NOT required. For testing purposes, only one foot will receive care during the NNAAP evaluation.

53 Shaving a Resident F This skill MUST BE TAUGHT. However, individual skill competence check is NOT required for this skill. Equipment: Basin of warm water, shaving cream, safety razor or electric razor, towel, washcloth, mirror, aftershave lotion or powder, tissues, gloves NOTE: Get permission from nurse before shaving. Some patients may be diabetic or on blood thinners and should not be shaved with safety razor. Never trim a resident s beard or mustache without their consent. Safety Razor 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. Elevate head of bed to semi-fowlers position. Spread towel under chin. 7. Put on gloves. 8. Place dentures in mouth if worn. 9. Moisten face and apply shaving cream. 10. Hold skin taut and shave in direction that hair grows. 11. Use firm, short strokes and rinse razor frequently. 12. Start under sideburns, in front of ear, and work downward over cheek toward chin. 13. Shave chin and under nose carefully. Work upward on neck under chin. 14. If skin is nicked, apply pressure with tissue directly over area until bleeding stops. 15. Wash off remaining soap when finished. 16. Apply aftershave lotion or powder if desired. 17. Clean and return equipment to proper place. 18. Remove gloves and wash hands. 19. Provide for safety and comfort with bed in low locked position and call signal in reach.

54 Electric razor 20. Carry out steps 1-8 under safety razor. 21. Read instructions that came with electric razor. 22. Follow preference as to dry skin or use of pre-shave lotion. 23. Hold skin taut and shave all areas of face. Some electric razors require short circular strokes; while others require short strokes in direction hair grows. 24. Wash and dry face thoroughly when finished. 25. Carry out steps under safety razor. 26. Record actions and report any unusual observations or injury to supervisor. Instructor s Initials: Date:

55 Hair Care G This skill MUST BE TAUGHT. However, individual skill competence check is NOT required for this skill. Equipment: Towel, comb and brush, resident supplies and products, gloves (optional) 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. Provide privacy. 5. Assist to chair or elevate head of bed to semi-fowlers position. 6. Place towel around shoulders. 7. Place towel across pillow if remaining in bed. 8. Assist with removal of eyeglasses as needed. 9. Put on gloves. (Optional) 10. Part or section hair and comb with one hand placed between scalp and end of hair. 11. Brush gently from scalp to hair ends. 12. Style hair as requested using preferred supplies and products. 13. Remove towel and place in appropriate receptacle. 14. Replace eyeglasses as needed and return equipment. 15. Provide for safety and comfort with bed in low locked position and call signal in reach. 16. Remove gloves and wash hands. 17. Record actions and report any abnormal observations to supervisor.

56 Shampoo Hair in Bed H This skill MUST BE TAUGHT. However, individual skill competence check is NOT required for this skill. Equipment: Washcloth, bath basin of warm water, clean graduate, shampoo, conditioner, towels, shampoo tray, bath thermometer, hair dryer if needed, comb or brush, gloves (optional) 1. Receive directions from supervisor. Assemble equipment. 2. Knock before entering room. Address resident by name. 3. State your name and title. Identify resident. 4. Explain procedure and obtain permission. Wash hands. 5. Provide for resident safety and raise bed to best level for body mechanics. 6. Lower head of bed. 7. Provide privacy. Put on gloves. (Depends on resident s skin and hair condition and facility policy.) 8. Place shampoo tray on a linen protector(s) and under the residents head. 9. Position shampoo tray drain tube to facilitate free running drainage into a bucket or empty plastic trash can. 10. Place a dry wash cloth over the resident s eye, towel under the neck, and towel across chest. 11. Fill basin with warm water 105 to 110 degrees. Check for temperature and safety of water and ask resident to verify comfort of the water temperature. 12. Use a small pitcher or cup to pour warm water over the hair to WET the hair. 13. After hair is thoroughly wet, apply appropriate shampoo. 14. Wash hair, using fingertips to massage all areas of the scalp. 15. Use a small pitcher or cup to pour warm water over the hair to RINSE the hair thoroughly. 16. Apply conditioner as desired. Rinse out conditioner. 17. Carefully remove shampoo tray, wrap hair with towel. 18. Raise head of bed if desired and tolerated by the resident and dry hair more thoroughly. 19. Comb or brush hair gently, blow dry with hair dryer if requested. Use extreme caution with dryer. 20. Use low setting, keep dryer moving, and move hand between dryer and hair to prevent burns. Ask resident if temperature is comfortable. 21. Style hair according to resident s wishes 22. Return equipment to proper place. 23. Remove gloves and wash hands. 24. Provide for safety and comfort with bed is low locked position with call signal in reach. 25. Record actions and report any abnormal observations to supervisor.

57 Dressing and Undressing I 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: Clothing selected by resident, bath blanket or equivalent 1. Knock before entering room 2. Address resident by name, identify resident 3. State your name and title, explain procedure, obtain permission 4. Provide privacy and wash hands 5. Assist resident to select clothing Open all zippers, buttons and fasteners and arrange clothing in order that they will be put on Provide for resident safety and elevate bed to best level for body mechanics 8. Position in semi-fowler s if appropriate While avoiding overexposure of resident, removes gown or other garment from unaffected side first, then removes gown or garment from the affected side. When putting on gown or garment, assist resident in putting affected/weak limb in garment first followed by putting the unaffected limb into garment last. Pullover garment (undershirt, pullover shirt, or pullover dress) Place arms in sleeves and adjust garment as high on arms as possible Gather garment to neck opening and slip over head Position sleeves comfortably at shoulders Assist to sit forward and adjust garment to cover upper body Smooth and ease garment over lower body by pulling garment down or assisting to roll from side to side while adjusting garment Secure fasteners on clothing

58 Dressing and Undressing I This skill may be required during NNAAP testing Garment that opens in front (shirt, blouse) Slide garment sleeve up on the resident s arm to shoulder on weak or affected side first Assist to sit forward while arranging garment around back Slide sleeve up onto the strong or unaffected arm and adjust garment at the shoulder Button or secure fasteners Underwear, slacks, or trousers Put on socks first. This prevents toes from getting caught in clothing Slide garment over feet and pull up legs as far as possible Have resident raise hips and pull garment to the waist If unable to lift hips, turn to strong side and pull up garment on weak side first Turn onto weak side and pull up garment on strong side Fasten slacks or trousers as indicated While putting on items, moves body gently and naturally, avoiding force and over-extension of limbs and joints Reverse procedure to undress, remove unaffected limb from garment first, remove affected limb from garment last 16. Dispose of soiled or removed garments into proper linen container 17. Provide for resident safety, signaling device is within reach and bed is in low position 18. Wash hands Instructor s Initials: Date:

59 Complete Bed Bath J A modification of 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: Bath basin, warm water, soap, 2-4 wash cloths, 3-4 bath towels, clean gown/garment, bath blanket or equivalent, linen bag, personal care items such as lotion, powder, or deodorant, gloves 1. Knock before entering resident s room 2. Address resident by name, identify resident 3. State your name and title, explain procedure 4. Wash hands, assemble equipment 5. Provide privacy and prevent drafts 6. Provide for resident safety and elevate bed to best level for proper body mechanics. Place bed in flat position if tolerated. Keep the side rail(s) up on the far side of the bed throughout the entire bath 7. Offer the resident the bedpan or urinal prior to bath 8. Perform oral hygiene or denture care following proper procedure, as needed. 9. Cover the top layers of linen with a bath blanket/equivalent. Ask the resident to hold the bath blanket/equivalent in place, and remove the top covers without disturbing the bath blanket/equivalent. If resident is unable to assist, hold the bath blanket/equivalent with one hand and pull the dirty top covers out from under the bath blanket/equivalent with the other hand. 10. Place dirty sheets in linen container if it is in the room. If no linen container is in the room, place dirty linen in a plastic bag. Do not place dirty linen directly on floor. 11. Remove resident s clothing and place in dirty linen container or plastic bag 12. Observe condition of skin throughout procedure 13. Place a towel across the patient s chest

60 Complete Bed Bath J 14. Place wash basin on over bed table. Check water temperature for safety and comfort, water not warmer than o F, ask resident to verify comfort of water. 15. Put on gloves 16. Wet washcloth, wring it out, and fold into a mitt or some other method so that the washcloth can be controlled and so that different parts of the washcloth can be used for a single wipe. 17. Wash eyes starting at the inner corner of the eyes and wiping out. No soap. USE A DIFFERENT CORNER OF THE WASHCLOTH/MIT FOR EACH EYE. 18. Wash and dry the face and ears DO NOT USE SOAP ON THE FACE UNLESS REQUESTED. 19. Wash, rinse, and dry the neck 20. When washing, wet washcloth, wring it out, and apply soap to washcloth. Do not put soap in the wash basin. This keeps water free of soap for later rinsing. 21. If using product that does not need rinsing, add to water as needed 22. Expose the arm on the far side of bed, and place a bath towel under the arm up to the shoulder 23. If the resident is able to participate, place the basin of water on the bed and place the resident s hand in the basin. 24. Wash and rinse the hand, arm, underarm, and shoulder on the far side of the bed. NOTE: If resident is large, do not attempt to reach and put undue strain on back. Provide for resident safety and go to opposite side of bed or get assistance as needed. This applies to washing legs also. 25. Dry the hand, arm, underarm, and shoulder on the far side of the bed 26. Wash, rinse, dry the arm nearest to you in the same manner 27. Place a towel across the chest and fold the bath blanket/equivalent down to the abdomen 28. Pick up bottom of towel and wash, rinse, and dry breasts/chest from under towel, without exposing resident. Use caution washing and drying under breasts. 29. Turn towel long ways and pull bath blanket down to expose abdomen. 30. Wash, rinse, and dry abdomen 31. Remove towel, and cover the patient with the bath blanket/equivalent 32. Expose the leg on the far side of the bed, bend the resident s knee, and place a towel under the leg form the foot to the hip. If possible, place the foot in the basin of water. 33. Wash, rinse, and dry the foot and leg

61 Complete Bed Bath J 34. Wash the foot and leg on your side in like manner. 35. Assist resident to turn away from you with his back toward you. 36. Arrange the bath blanket/equivalent over the resident s side to expose the back and buttocks. 37. Place a clean towel parallel to the resident s back from his shoulders to resident s hips. 38. Wash, rinse, and dry the back and buttocks 39. Give back rub using lotion. Lotion may be applied to other areas of dryness as needed. 40. Place a towel under the buttocks, turn the resident onto back. 41. If resident is able, give resident a clean washcloth, soap, and towel to wash the perineal area. If the resident is unable to assist, provide perineal care for the resident. 42. Assist to apply personal care products (lotion, deodorant, or powder as desired by the resident Sprinkle a small amount of power into the palm of your hand away from the patient Apply a thin layer of powder if used NEVER shake the power directly onto the resident s skin Breathing the powder can cause lung irritation 43. Put a clean gown or clothing on the resident without exposing the resident 44. During the bath, undressing, and dressing, move body gently and naturally, avoiding force and over-extension of limbs and joints 45. Empty, rinse, and dry wash basin 46. Place wash basin in the resident s unit or designated area 47. Dispose of used gown/clothing and soiled linen into the soiled linen container 48. Remove gloves and wash hands AFTER handling wash basin and soiled linen 49. Provide for resident safety and comfort: leave bed in lowest position and call signal within reach Instructor s Initials: Date:

62 Partial Bed Bath K This skill MUST BE TAUGHT. However, individual skill competence check is NOT required for this skill. Equipment: Bath basin, soap, 3-4 bath towels, 3-4 wash cloths, bath blanket or equivalent, linen bag, clean gown or clothes, personal care items such as lotion, powder, or deodorant, gloves NOTE A partial bath, also called a set-up bath, includes washing the face, underarms, hands, and the perineal area. The type of bath best suited for: resident who has drier, fragile, and more sensitive skin, residents who should not have daily full baths, or wants a resident who wants a quick bath before a meal and plans to take a full shower or tub bath later in the day. 1. Knock before entering. Address resident by name. Identify resident. 2. State your name and title. Explain procedure maintaining face to face contact whenever possible. 3. Wash hands. Provide privacy and prevent drafts. 4. Offer the client the bedpan or urinal or assist to rest room Raise the bed to a comfortable working height, and raise the side rail on the opposite side of the bed if you will be assisting. If the resident can perform the partial bath, set-up the supplies, leave bed in low position. Place client in the supine position on the side of the bed nearest you if you are assisting. 7. Remove clothing/gown while keeping patient covered if you or assist if needed. 8. Place a towel across the client s chest or assist if needed. 9. Fill wash basin 2/3 full with water not warmer than o F. Before washing, ASK CLIENT TO VERIFY COMFORT OF WATER. Place wash basin on over bed table. 10. Put on clean gloves before washing client Begin with the eyes. Wash one eye with wet washcloth (NO SOAP-unless requested) starting from inner corner next to nose, wipe out toward side of face. Use a different area of the washcloth and wash the other eye in the same manner or assist resident to do so. Wash rest of face, ears and neck with water (NO SOAP-unless requested) and pat dry with a towel or assist resident to do so.

63 Partial Bed Bath K Wash or assist resident in washing the underarms, perineal area. Provide clean water and wash or assist resident to wash hands. Empty, rinse and dry basin. Remove, clean, and store other equipment according to facility policy. AFTER removing, cleaning and storing equipment per facility policy, remove gloves and wash hands Assure resident safety and comfort with signal device in reach and bed in low locked position. 17. Record actions and report any unusual observations or injury to supervisor.

64 Tub Bath or Shower L This skill MUST BE TAUGHT. However, individual skill competence check is NOT required for this skill. Equipment: Note: Soap dish, soap or non-rinsing product, washcloth, towels, bath mat, chair or stool, clean clothing, personal care products, disinfectant. Temperature of bath/shower room should be warm enough for comfort. 1. Assemble equipment in bath or shower room; clean and disinfect tub or shower, if needed. 2. Knock before entering room. Greet and identify resident by name. 3. State your name and title. Explain procedure and obtain permission. 4. Wash hands. Gloves optional unless contamination possible or required by facility. 5. Select clothing and personal items needed. 6. Assure privacy throughout procedure. *If resident is undressed in the resident s room, assure resident is totally covered before pushing wheelchair or stretcher out in the hall. 7. Assist to put on robe and slippers and escort/transport to bath/shower room. 8. Fill tub half full of water or turn on shower. Test to ensure water temperature is not more than 105 degrees F for tub or shower and that bottom of tub or floor of shower not slippery. ASK RESIDENT TO VERIFY COMFORT OF WATER TEMPERATURE. 9. Place bath mat or towel in front of tub or shower. 10. Assist to undress and get into tub or shower. Use shower chair as needed. 11. Stay with resident and/or assist with washing as needed. 12. Assist out of tub or shower and help dry by patting gently with towel. 13. Have resident stand on bath mat or sit on towel-covered chair as needed. 14. Assist with deodorant or antiperspirant and personal care products. 15. Help dress and return to room. Provide for safety and comfort with call signal in reach. 16. Put on gloves, return to bathing area, clean and disinfect tub or shower. 17. Place used towels in dirty linen container. Remove gloves and wash hands. 18. Record actions and report any unusual observations to supervisor.

65 Perineal Care M 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: Basin of warm water, washcloths, bed protector, towel, bath blanket/equivalent, soap or pericare product, gloves 1. Knock before entering room. Address resident by name. 2. State your name and title. Identify resident. 3. Explain procedure and obtain permission maintaining face-to-face contact whenever possible. 4. Wash hands. Provide privacy. Assemble equipment. 5. Provide for resident safety and raise bed to best level for body mechanics. 6. Fill wash basin 2/3 full with water not warmer than degrees F. Before washing check water temperature for safety and comfort and ASK CLIENT TO VERIFY COMFORT OF WATER. 7. Put on gloves before washing perineal area. 8. Cover resident with bath blanket/equivalent and fanfold top linen to foot of bed exposing perineal area while avoiding overexposure of client. 9. Remove soiled clothing and linen protector(s) if necessary. Change gloves and wash hands as needed, providing for resident safety. 10. Place linen protector under client s perineal area.

66 Perineal Care M 11. Female Resident This skill may be required during NNAAP testing Assist resident to flex knees and spread legs as much as possible. Gently open all skin folds and wash inner area front to back with soap or periwash. If soap is used, wet wash cloth, wring out excess water, apply soap to wash cloth. Wash inner area, outer skin folds, inner legs, and outer area along and then the outside of the labia. Wash all those areas using front to back strokes. Using CLEAN washcloth, RINSE soap from genital area, moving front to back, while using a clean area of the washcloth for each stroke. DRY genital area moving from to back with towel. TURN client to the side after washing genital area. Wash and rinse the rectal area moving front to back using a clean area of washcloth for each stroke. Dry rectal area with towel. 12. Male Resident Gently push back foreskin of penis, if resident uncircumcised. Using a circular motion, gently wash the penis by lifting it and cleaning from the tip downward. Rinse in the same manner and return foreskin to natural position. Wash scrotum and rinse. Wash, rinse, and pat dry the skin area between the legs. TURN client to the side after washing genital area. Wash and rinse the rectal area moving front to back using a clean area of washcloth for each stroke. Dry rectal area with towel. Provide for resident safety. 13. Remove the bed protector and the bath blanket/equivalent. 14. Reposition the client in a comfortable position. 15. Empty, rinse, and dry basin and place in bedside table or designated area. 16. Dispose of used linen into soiled linen container and dispose of bed protector appropriately. 17. Avoid contact between care provider clothing and used linen. 18. AFTER Removing, cleaning, and storing other equipment according to facility policy remove gloves without contaminating self, dispose gloves into waste container, and WASH HANDS. 19. Provide for resident safety and comfort, leave bed locked in low position. 20. Record actions and report any abnormal observations to supervisor. Instructor s Initials: Date:

67 Giving a Back Rub N Equipment: This skill MUST BE TAUGHT. However, individual skill competence check is NOT required for this skill. Bath towel, washcloth, basin of warm water, soap, lotion, bath blanket or equivalent, gloves (optional) 1. Knock before entering room. Address resident by name. State your name and title. 2. Identify resident. Explain procedure and obtain permission. 3. Wash hands. 4. Assemble equipment and place lotion in warm water. 5. Provide privacy. 6. Provide for resident safety and elevate bed to comfortable working level. 7. Cover resident with bath blanket or equivalent and fanfold linen to bottom of bed. 8. Put on gloves. (Optional) 9. Position resident in prone or side-lying position so back is toward you, providing for safety of resident. 10. Position towel on bed next to back. 11. Expose, wash, and dry back, if necessary, and examine for pressure areas. Do not massage reddened areas. 12. Put small amount of lotion in your hands and apply to back. 13. Stroke upward from base of spine to neck, around shoulders and down sides of back and upper area of buttocks for 3 to 5 minutes using circular motions and long, smooth, firm strokes. 14. Straighten and tighten bottom sheet, pull up top linen and remove bath blanket without exposing resident. 15. Lower bed. 16. Clean and return equipment to proper place. 17. Remove gloves and wash hands. 18. Provide for resident safety and comfort with bed locked and low with call signal in reach. 19. Record actions and report any abnormal observations to supervisor.

68 Moving Resident Up in Bed - With and Without Turn Sheet A This skill MUST BE TAUGHT. However, individual skill competence check is NOT required for this skill. Equipment: Turning sheet (drawsheet or full flat sheet folded in half or large fabric underpad) 1. Request help from co-worker. 2. Knock before entering. 3. Greet and identify resident. 4. State your name and title. 5. Explain procedure and obtain permission. 6. Wash hands and provide privacy. 7. With co-worker at one side of bed, provide for resident safety and then raise bed to best level for body mechanics. Check that wheels are locked. 8. Lower bed to flat position. 9. Place pillow against headboard. 10. Without Turning Sheet Person on either side of bed places one arm under shoulder and one arm under thigh. Ask resident to help if able by flexing both knees, placing feet on bed and grasping headboard with hands. Explain that on count of 3, resident should pull up with hands and push against bed with feet, as you and co-worker move resident up. This may take more than one attempt. 11. With Turning sheet Position turning sheet under resident, if not already in place. Roll sides of turning sheet up close to resident and grasps sheet firmly at shoulder and buttocks. Move up in bed on count of 3. Buttocks must clear mattress to avoid shearing. Place pillow under head. Provide for resident safety and lower bed. Provide for comfort with call signal in reach. Wash hands. Record actions and report any abnormal observations to supervisor.

69 Position Resident on Side B 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: Pillows or positioning devices, folded blankets, folded towels with pillow case covering them. Items used to position may vary. 1. Assemble equipment. Knock before entering room. 2. Greet and identify resident. State your name and title. 3. Explain procedure and obtain permission maintaining face-to-face contact whenever possible. 4. Wash hands. 5. Provide privacy. 6. Assure bed wheels are locked. 7. Provide for resident safety and then raise bed to best level for body mechanics. 8. Lower head of bed to flat position. 9. Stand on opposite side of bed to which you will turn resident. 10. Move resident to side of bed nearest you. (This step is very important. Moving the client to the side makes room for the torso when the client is turned and prevents patient s face from hitting the side rail. Especially for larger residents.) 11. Cross resident s arms over chest. 12. Cross leg nearest you over opposite leg. 13. Elevate the side rail, and then go to opposite side of bed. 14. With the side rail up on the working side, gently roll client onto their side as one unit, toward you and the raised side rail. Use open hands with gently curved fingers. 15. Position in good body alignment. 16. Place or adjust pillow under head and shoulder. 17. Assure client is not lying on arm and flex lower arm at elbow. 18. Support top arm, flexed at elbow, with supportive device or pillow.

70 Position Resident on Side B 19. Place supportive device behind client s back. 20. Place supportive device or pillow between legs with top knee flexed; top knee and ankle supported. Be sure both the knee AND the ankle are supported. 21. Provide for resident safety. Call signal in reach and bed in low position. 22. Wash hands. 23. Record actions and report any abnormal observations to supervisor. Instructor s Initials: Date:

71 Apply Non-Sterile Dressing 5.02C This skill MUST BE TAUGHT. However, individual skill competence check is NOT required for this skill. Equipment: Dressing supplies, tape, gloves, biohazard bag as needed. 1. Receive directions from supervisor. 2. Assemble equipment. 3. Knock before entering room. 4. Address resident by name. 5. State your name and title. 6. Identify resident. 7. Explain procedure and obtain permission. 8. Wash hands. 9. Provide privacy. 10. Adjust bed to safe working height, assure bed is locked 11. Expose the affected body part, being careful to keep the patient covered as much as possible. 12. Prepare clean dressing materials: Select correct size and type of dressing Dressing should extend approximately one inch beyond wound edge or cover area of skin to be protected. Cut pieces of tape long enough to secure the dressing Hang tape on the edge of a table within reach Open gauze package without touching gauze Place the open package on a clean flat surface Open biohazard bag or other bag into which dressing will be discarded 13. Put on gloves. 14. Removing old dressing: Slowly peel tape toward the wound Lift the dressing off the wound. Do not drag it over the wound. Observe dressing for any odor/drainage, notice color and size of wound. Discard in proper container Remove and dispose of gloves

72 Apply Non-Sterile Dressing 5.02C 15. Applying new clean dressing: Put on clean gloves Remove the new dressing from the package by touching the outer edges Apply it to the wound carefully. Do not drag the new dressing across the wound. 16. Tape in place: Tape so that it runs opposite from body action or movement Long enough to support dressing Not too long to irritate skin 17. Remove and dispose of gloves and wash hands. 18. Provide for resident safety and comfort with call signal in reach, bed low and locked. 19. Dispose of biohazard bag. 20. Record/record actions and report any abnormal observations to supervisor. Instructor s Initials: Date:

73 Apply Warm or Cold Applications D 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: Note: Water basin, arm or foot bath, bath thermometer, bath blanket, waterproof pads, towels Follow manufacturer s directions that accompany each type and brand of sitz bath, heating device or cold pack to ensure correct usage. 1. Receive directions from supervisor. Wash hands and assemble equipment. 2. Knock before entering room. Address resident by name. 3. State your name and title. Identify resident. 4. Explain procedure and obtain permission. Provide privacy. 5. Position the patient for the procedure. Expose only the body part to be treated. Place the signal light within reach 6. Place waterproof pad under the part of the body to which hot/cold pack will be applied 7. To fill ice bag, ice collar, or glove: Fill the device ½ to 2/3 full with crushed ice Remove the air by gently squeezing the device burp the bag Secure the device with the stopper or cap. Check for leaks, and dry the device with paper towels COVER THE DEVICE WITH A FLANNEL COVER, TOWEL, OR PILLOWCASE 8. Apply the pack to the area. Make note of the time. 9. Cover the patient with a bath blanket for warmth Check the area for redness, cyanosis or complaints of discomfort every 5 minutes. Stop the soak if any of these occur. Wrap the body part in a towel, and tell the charge nurse right away. At the end of the time ordered by the doctor, remove the compress from the area and pat skin dry. 12. Provide for resident safety and comfort. Bed in low, locked position with call signal in reach. 13. Record actions and report any abnormal observations to supervisor. Instructor s Initials: Date:

74 Making Unoccupied (Closed) Bed A This skill MUST BE TAUGHT. However, individual skill competence check is NOT required for this skill. Equipment : Mattress pad, 2 flat sheets or 1 flat and 1 fitted sheet, drawsheet, blanket and/or bedspread, pillowcase, or linen as needed 1. Wash hands. Assemble linens. 2. Place clean linens on chair in order of use. Raise bed to best level for body mechanics. 3. Using Flat Bottom Sheet Place flat sheet on top of mattress pad, hem down, with bottom edge of sheet even with bottom edge of mattress and centerfold in middle of bed. 4. Tuck bottom sheet under head of mattress. Miter corner. 5. Keep sheet straight and tuck in side. 6. Place drawsheet, if used, across bed and tuck in side. 7. Top Sheet Unfold and center, hem fold side up, hem even with upper edge of mattress. 8. Unfold and center blanket and/or bedspread lengthwise to center of bed. 9. Miter top sheet and spread or blanket together at bottom of bed. 10. Go to other side of bed and fold top linens to center of bed. 11. Tuck bottom sheet under head of mattress. 12. Pull sheet tight and tuck under side of mattress, working from top to bottom of bed. 13. Straighten top sheet, blanket and/or bedspread, tuck in at foot of bed, and miter corner. 14. Fold top sheet back over blanket and/or bedspread at top of bed. 15. Insert pillow into pillowcase. Place pillow on bed with open end away from door. 16. Adjust bed to lowest horizontal position. 17. Place call signal under pillow and attach. Leave room in neat and orderly condition. 18. Wash hands.

75 Opening a Closed Bed B This skill MUST BE TAUGHT. However, individual skill competence check is NOT required for this skill. Equipment: None 1. Wash hands. 2. Locate bed to be opened. 3. Raise bed to best level for body mechanics. Face head of bed and grasp top sheet, blanket and/or spread and fanfold top 4. linens to foot of bed. 5. Lower bed to lowest horizontal position. 6. Place over-bed table over foot of bed. 7. Place call signal under pillow and attach. 8. Leave room in neat and orderly condition. 9. Wash hands. 10. Report any malfunctioning resident unit equipment.

76 Making Occupied Bed C 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: Clean linens, dirty linen hamper or linen bag, gloves or other PPE as needed 1. Assemble equipment, knock before entering. 2. Address resident by name, state your name and title. 3. Identify resident, explain procedure and obtain permission maintaining face-to-face contact whenever possible 4. Wash hands. 5. Place clean linens on chair close to bedside, stacked in order of use. 6. Put on gloves per facility policy. Always put on gloves if linens are soiled with blood or body fluids. 7. Provide for privacy. Remove call signal from bed. 8. Provide for resident safety and raise bed to best level for body mechanics. Adjust bed as flat as can be tolerated by the resident. Lock wheels on bed. Raise and lower side rails for safety. 9. Loosen top linens at foot of bed. 10. Place bath blanket/equivalent over top linens. 11. Ask resident to hold top edge of bath blanket/equivalent. If patient unable to assist, tuck bath blanket under the resident s shoulders. 12. Slide top linens out from under the bath blanket/equivalent, leaving resident covered. 13. Discard soiled top linens in dirty laundry container or bag. 14. Assure the bedrail on the far side of bed is raised. 15. Ask patient to grab the rail on the far side of bed and turn toward the rail and away from you. Assist the resident with turning as needed. 16. Adjust pillow for comfort. 17. Loosen bottom linens along side of bed from head to bottom and roll to the center of bed as far as possible.

77 Making Occupied Bed C 22. Using Flat Bottom Sheet Place the centerfold of a clean flat sheet next to resident; hem down. Bottom edge of sheet should be even with bottom edge of mattress. (Bottom sheet is not tucked at the bottom.) 23. Push/fanfold/roll top portion of the sheet close to the patient s back. 24. Tuck the head end of the bottom sheet and miter corner. 25. Keep sheet straight and tuck in along the beside. 26. Place draw sheet, if used, across bed and tuck in side. Draw sheet should extend from the shoulders to beyond the hips. 27. Raise the side rail where you are working and go to opposite side of bed. 28. Lower the rail on that side, ask the resident to roll over and reach for the opposite side rail and pull to the opposite side, assist as needed. 29. Before the resident rolls toward the clean side, advise them it will feel like a large lump as they roll over. Keep patient covered with the bath blanket while they are being turned. 30. Move the pillow so it remains under the patients head. 31. Remove soiled bottom linen. Place in dirty laundry container or bag. If bottom sheet grossly contaminated, remove gloves. Avoid contact between clothing and used linen. 32. Pull clean bottom linen tight, tuck under head of mattress, miter corner and tuck in along the bedside. 33. Position resident in supine position in center of bed, with pillow adjusted for comfort. 34. Put on top linen over the bath blanket and remove the blanket by the same procedure as the soiled top sheets. 35. Make a toe pleat by grasping both sides of the top covers at the mitered corner and gently pulling the top covers at toward the foot of the bed to make a 3-4 inch fold across the foot of the bed then complete the corner. 36. Change the pillow case and adjust pillow under resident s head. Place dirty pillow case in hamper or linen bag. 37. Provide for resident safety and adjust bed to lowest position. 38. Provide for comfort with call signal in reach. 39. Reposition chair and over bed table. 40. Wash hands. 41. Return dirty laundry container to proper location. Instructor s Initials: Date:

78 Provide Fresh Drinking Water 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 NATS Part II by the conclusion of the course. Equipment: Cart with ice cooler/chest, pitchers, cups, trays, ice, scoop for ice, straws 1. Receive direction from supervisor regarding residents with special needs (NPO, fluid restrictions, no ice). 2. Wash hands Assemble supplies. (Cart with ice cooler/chest, pitchers, cups, trays, ice, scoop for ice, straws, list with special instructions) Fill ice cooler on cart with ice. Use scoop to move ice into ice cooler. Do not allow ice to touch your hand and fall back into the container. Place the scoop in proper receptacle after each use. Do not allow handle of scoop to touch ice. Close the lid. Move, then park cart outside resident s door, near wall, to avoid obstructing the hallway. 6. Check your list for special needs before entering the resident s room Knock; announce your identity and intent. Enter the resident s room, empty and rinse resident s water pitcher. Bring the resident s water pitcher to the cart parked in the hall and use scoop to fill the pitcher with ice. Close lid to ice cooler/chest. 9. Add fresh water to the pitcher of ice once in the resident s room. 10. Place pitcher with fresh drinking water within reach. 11. Offer to fill a cup with fresh water! Do not drop off water pitcher and run. 12. Repeat steps 5-11 for each resident. 13. Record on Intake/Output Record if required. 14. Return cart. Leave ice cooler clean and dry. 15. Wash hands. Instructor s Initials: Date:

79 Measure and Record Intake & Output B Includes: Measure and Record Urinary Output (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: Various containers, graduate, toilet, pen, notepad, intake and output sheet 1. Knock before entering room. Address resident by name. 2. State your name and title. Identify resident. 3. Explain procedure and obtain permission maintaining face-to-face contact as much as possible. 4. Have resident help record fluids, if he or she is able. 5. Record intake on bedside intake/output record. Intake includes: amount of fluid resident takes with meals, amount of water and fluids taken between meals. (Other fluids such as IV s and tube feedings are recorded by the administering nurse.) 6. Use listing of standard facility amounts for measuring. 7. Record fluids in milliliters (ml). Do not record in CCs. CCs are no longer used in charting! 8. Wear gloves and wash hands when handling body fluids. 9. Record all liquid output on bedside intake/output record. Output includes: urine, vomitus (emesis), drainage from wound or stomach, liquid stool, blood loss, perspiration. 10. Observe output for abnormal appearance, amount, or odor When measuring urine, pour contents of bedpan into measuring container (graduate) without spilling or splashing urine outside of container. Measure the amount of urine at eye level with container on flat surface where a paper towel has been placed as a barrier. Record fluids in milliliters (ml). Do not record in CCs. CCs are no longer used in charting!

80 14. After measuring urine, empty contents of graduate container into the toilet. NOTE!! For NNAAP testing, a bedside commode is used as a toilet. Measure and Record Intake & Output B 15. Rinse measuring container and pour into toilet. 16. Rinse bedpan and pour rinse into the toilet AFTER rinsing equipment, and before recording output, remove and dispose of gloves (without contaminating self) and wash hands. Records contents of container (within plus or minus 25 ml of NACES evaluator s reading). Must wash hands BEFORE recording. 19. Record totals of intake and output at end of each shift and at end of 24 hours. 20. Report abnormal observations to supervisor. Instructor s Initials: Date:

81 Assist with Dining-Feeding Resident C 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: Washcloth or hand wipes, and clothing protector if requested by resident. 1. Knock before entering room, address resident by name, and state your name and title. 2. Identify resident, explain procedure and obtain permission. 3. Wash hands. 4. Before feeding, look at name card from tray and ASK RESIDENT TO STATE NAME. 5. Before feeding resident, elevate HOB to upright position (75-90 degrees) 6. Position towel/napkin/clothing protector under chin if requested by resident. 7. Place tray where food can be easily seen by client. 8. Clean resident s hands with hand wipe before beginning to feed. 9. Prepare food by opening cartons, removing covers, cutting meat and/or buttering bread. 10. SIT facing client during feeding. 11. Assist as needed, while encouraging resident to do as much as possible for his or her self. 12. Tell resident what foods are on the tray and ask resident what they would like to eat first. 13. Allow hot foods to cool before offering. 14. Use tip of half-filled spoon to offer one bite, telling the contents of each spoonful before it enters the mouth. 15. Alternate solids and offering beverage, encourage eating as much as possible.

82 Assist with Dining-Feeding Resident C 16. Provide time to chew making sure resident s mouth is empty, not pocketed in the cheek, before offering next bite of food or sip of beverage. 17. Wipe mouth as needed during the meal. 18. At the end of the meal, wipe resident s mouth and clean resident s hands. 19. Provide for resident safety and comfort, with bed low locked and call signal in reach. 20. Remove tray from room and return tray to cart. 21. Wash hands when finished. 22. *Provide or assist with oral hygiene as needed. Wash hands. 21. Record amount of food consumed and record liquids if resident is on Intake and Output. 22. Report any abnormal observations to supervisor. Instructor s Initials: Date:

83 Serving Supplemental Nourishment D 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: Nourishments, napkins, utensils 1. Receive directions from supervisor regarding individuals with special dietary needs. 2. Wash hands. 3. Assemble supplies. 4. Allow each resident to choose from allowable and available nourishments. 5. Place nourishment, napkin and utensils within reach. 6. Provide assistance as needed. 7. Remove glasses and dishes after use. Do not touch rim of glass. 8. Repeat steps 4-7 for each resident. 9. Record on intake/output record if required. 10. Return used equipment to kitchen to be washed. 11. Wash hands. Instructor s Initials: Date:

84 Assisting to Bathroom 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 NATS Part II by the conclusion of the course. Equipment: Robe, slippers, gloves Check to see if resident needs a specimen collected! 1. Knock before entering room. Address resident by name. State your name and title. 2. Identify resident. Explain procedure and obtain permission. 3. Wash hands. Provide privacy. 4. Assure bathroom is ready for the resident. 5. Help to put on robe and footwear if not already dressed. 6. Assist to stand and ambulate to bathroom. 7. Adjust clothing so able to sit comfortably on toilet. 8. Place toilet tissue and call signal within reach and ask to signal when finished. 9. If resident can be safely left alone, leave room or wait outside bathroom door; if unable to be left safely alone, remain with resident. 10. Watch for call signal and respond promptly. 11. If left room, wash hands, put on gloves and assist to clean genital area if necessary. 12. Remove gloves and wash hands. Assist resident to wash hands. 13. Ask if voided or defecated without difficulty and approximate amounts. 14. Help to return to bed or chair. Remove robe and footwear as needed. 15. Wash hands. 16. Provide for comfort with call signal in reach. 17. Record actions and report any abnormal observations to supervisor. Instructor s Initials: Date:

85 Assisting to Bedside Commode 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: Portable commode and container, container cover, toilet tissue, basin of warm water, soap dish, soap, wash cloth, towel, gloves 1. Knock before entering room. Greet and identify resident. 2. State your name and title, explain procedure and obtain permission. 3. Wash hands and provide privacy. 4. Place commode next to bed. Open cover and adjust container under toilet seat as necessary. 5. Assist resident to sit on side of bed, put on footwear and transfer to bedside commode. 6. Place tissue and call signal within reach and ask resident to signal when finished. 7. Leave room if resident can be safely left alone or stay as necessary. 8. Watch for call signal and respond promptly. 9. When returning to room wash hands, put on gloves and assist to clean genital area as needed. 10. Remove gloves and wash hands. 11. Assist resident with hand washing if resident cleaned genital area. 12. Return to bed and make comfortable with call signal in reach. 13. Close cover on commode as soon as possible. 14. Put on gloves. 15. Remove container from commode, cover, and take to bathroom. 16. Observe appearance of feces or urine and measure output if on Intake and Output.

86 Assisting to Bedside Commode B 17. Empty container into toilet and flush. 18. Clean container and following facility procedure. Pour rinse water into toilet. 19. Remove gloves and wash hands. 20. Provide for comfort with call signal in reach. 21. Record actions and report any abnormal observations to supervisor. Instructor s Initials: Date:

87 Assisting with Use of Bedpan C 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: Bedpan, bedpan cover, toilet tissue, basin of warm water, liquid soap, washcloth, 2 pairs of gloves, incontinence pad Knock before entering room, greet and identify resident, state your name and title. Explain procedure and obtain permission, wash hands and assemble equipment. 3. Provide privacy. 4. Before placing bedpan, lower head of bed and elevate bed to best level for body mechanics. 5. Put on clean pair of gloves before handling bedpan. 6. Place bedpan on chair or other appropriate place Fold top linen to foot of bed and lower underclothing. Avoid unnecessary exposure. Ask resident to bend knees and place feet flat on mattress while lifting hips. Assist, as needed, by slipping hand under lower back and lifting. Use incontinence pad as needed. OR If resident unable to assist, turn resident away from you, and place bedpan against buttocks. Push bedpan downward into mattress and roll resident back onto bedpan. Place bedpan correctly under resident s buttocks. (NNAAP critical step) Remove and dispose of gloves immediately after taking gloved hands off of bedpan. Wash hands.

88 Assisting with Use of Bedpan C AFTER POSITIONING RESIDENT ON BEDPAN AND REMOVING GLOVES, raise head of bed to comfort position and replace top linen. Place toilet tissue and hand wipe within reach and ask resident ask to clean their private area then hands when finished. Place signal device within reach and instruct resident to signal when finished. 15. If resident cannot be safely left alone, wait in room on other side of curtain If leaving room, provide for safety, and lower bed. Watch for call signal and respond promptly. WASH HANDS AND PUT ON NEW GLOVES UPON RETURNING TO BEDSIDE TO REMOVE BEDPAN. Bring warm water and supplies to bedside if cleaning with toilet paper is not sufficient or if resident needs additional help washing hands 19. Lower head of bed and remove bedpan. 20. Assist with peri-care if resident is unable to do so. Place HOB as needed. 21. Provide for resident safety, cover bedpan and take to bathroom Observe amount and appearance of feces or urine and measure output if ordered. Empty bedpan into toilet, rinse bedpan and pour rinse water into toilet, flush toilet, and replace bedpan in bedside stand or designated area. 24. Remove gloves and wash hands. 25. Provide for resident safety and comfort, lower bed, lock bed wheels and place call signal in reach. 26. Record actions and report any abnormal observations to supervisor. Instructor s Initials: Date:

89 Apply Adult Brief D 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: Toilet tissue, basin of warm water, liquid soap, 2-3 washcloths, 3 pairs of gloves, 1-2 incontinence pads, 1 appropriately sized adult brief, and 1 small plastic bag Knock before entering room, greet and identify resident, state your name and title. Explain procedure and obtain permission, wash hands and assemble equipment. 3. Provide privacy Lower head of bed and adjust bed high for body mechanics. Apply gloves. Fold top linen to foot of bed and lower underclothing. Use a cover (towel, sheet, bath blanket, etc.) as needed to avoid unnecessary exposure. Place clean protective pad under resident s hips/buttocks and place an open plastic bag at the foot of the bed for later use. With resident in supine position, release the tabs on both sides of the adult brief and open the brief. Fold each tab onto itself to avoid tearing the resident s skin. Fold/roll the front of the adult brief into itself and toward the crotch containing body excretions as much as possible. Clean the skin of visible excretions as much as possible as you fold/roll the adult brief into itself. Reposition the resident on one side. Starting with the corner of the brief at the exposed hip, fold/roll the adult brief into itself and toward the bed. Contain as much excretion as possible. Reposition resident on the opposite side. Roll the remaining section of the brief into itself. Remove brief and place in a plastic bag that has been previously opened and placed at the foot of the bed. Remove gloves and drop into the plastic bag.

90 Apply Adult Brief D Close and tie the top of the plastic bag. Handling carefully as it is dropped into the resident s trash. (The bagged brief must not stay in the room after the care encounter). (See # 21) Wash hands. Apply a second pair of gloves and provide perineal care as needed. Wash hands and apply a clean pair of gloves. Reposition resident on the side. Place a clean adult brief behind the resident s hips/buttocks with the tabs toward the head of the bed, the waist of the brief aligned with the waist of the resident, and with absorbent side up. Log roll resident to the opposite side to complete placing the brief smoothly under the resident s hips/buttocks. Pull the front of the brief up through the crotch toward the abdomen, smooth the front of the brief, and attach the sticky tabs to secure the brief. 17. Redress bottom clothing if necessary and replace top covers Clean and return equipment to the designated area. Remove gloves and wash hands. Provide for resident safety and comfort, lower bed and place call signal in reach. 20. Record actions and report any abnormal observations to supervisor. 21. Remove the trash contained in a liner from the trash can. Note: The bagged brief will be removed from the room along with the other contents of the trashcan in the resident s room. Instructor s Initials: Date:

91 Administer Cleansing Enema E 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: Note: Enema container with tubing and clamp, bedpan and cover, bed/linen protector, lubricant, toilet tissue, disposable gloves, graduate containing prepared enema solution at 105F, paper towel, bath thermometer, bath blanket or equivalent, appropriate waste receptacle Gloves may need to be removed and hands washed more times than listed in skill if contamination occurs. 1. Receive directions from supervisor. Assemble equipment. 2. Knock before entering room. Greet and identify resident. 3. State your name and title. Provide privacy. 4. Explain procedure and obtain permission. 5. If able to expel enema in bathroom, make sure bathroom will be unoccupied and that footwear is readily available. 6. Wash hands. 7. Place IV pole beside bed as needed. 8. Close clamp on tubing and fill enema container with correct amount of water no warmer than 105 degrees. Open clamp, expel air in tubing by filling with solution and close clamp. If soap suds enema is used add castile soap AFTER the water is already in the enema bag. 9. Hang bag on IV pole. 10. Provide for resident safety and raise bed to best level for body mechanics. 11. Put on gloves. 12. Cover resident with bath blanket or equivalent and fanfold top linen to bottom of bed. 13. Place bed/linen protector under buttocks, place bedpan within reach. 14. Place resident in Sim s position. Provide for resident safety if unable to turn alone. 15. Lower underwear as needed to expose anus. 16. Put lubricant on paper towel and lubricate 6 inches of tubing.

92 Administer Cleansing Enema E Ask to take deep breath and gently insert lubricated tube into rectum 2-4 inches. Stop if pain or resistance. Hold enema container approximately 12 inches above anus or at height which allows solution to flow in very slowly and open clamp. Ask to take slow, deep breaths and to report any cramping, nausea, sweating or feeling of faintness. Encourage to take all of solution ordered, but clamp tube immediately if any symptoms other than feeling of fullness or urge to defecate, occurs. Put on call signal for help if nausea, sweating and feeling of faintness occur. 20. Slowly and gently remove tube from rectum and wrap in paper towel. 21. Assist resident onto bedpan or into bathroom, helping to put on robe and slippers. Remove gloves and wash hands as needed. 22. Place toilet tissue and call light within reach if on bedpan. Provide for resident safety. 23. If in bathroom, ask not to flush toilet when finished. 24. Stay in room if cannot safely be left alone. Dispose of enema bag in appropriate waste receptacle. 25. Put on gloves and assist to clean genital area, if indicated. Remove gloves and wash hands. 26. If resident is on bedpan, put on gloves, assist to clean genital area, remove bedpan, cover, provide for resident safety, take bedpan to bathroom and clean. Remove gloves and wash hands. 27. Note amount, color, odor and consistency of stool and how enema was tolerated. 28. Assist to wash hands as needed. 29. Put on gloves, remove incontinence pads, and put in waste receptacle. 30. Lower bed and provide for resident safety. 31. Clean area and equipment as needed. 32. Remove gloves and wash hands. 33. Provide for safety and comfort with call signal in reach. Bed locked and in lock position. 34. Record actions and report abnormal observations to supervisor. Instructor s Initials: Date:

93 Collect Stool Specimen F 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: Bedpan and cover/bedside commode/toilet hat, container and cover for specimen or specimen card if checking for occult blood, label, tongue blade, toilet tissue, laboratory requisition slip, gloves, and leak-proof transport bag. 1. Receive directions from supervisor. Assemble equipment. 2. Knock before entering room. Greet and identify resident. 3. State your name and title. Explain procedure and obtain permission. 4. Wash hands and put on gloves if assisting onto bedpan. Provide privacy. 5. Fill out label, put on label on specimen container and put container in bathroom with lid off and facing up. Use paper towel for clean surface as needed. 6. While wearing gloves, take covered bedpan/commode with sample to bathroom. 7. Use tongue blade to put approximately two tablespoons of stool into specimen container, discard excess stool and flush toilet. Discard tongue blade. 8. Note: For stool for occult blood apply only a SMEAR to the boxes as indicated. 9. Remove gloves and wash hands. 10. Apply a clean pair of gloves and cover specimen container. 11. Place container in leak-proof transport bag. Remove gloves and wash hands. 12. Provide for comfort and place call signal in reach. 13. Wash hands again if needed. 14. Transport specimen to proper area. 15. Record actions and report any abnormal observations to supervisor. Instructor s Initials: Date:

94 Assist with Urinal G 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: Urinal with cover, basin of warm water, soap dish, soap, washcloth, towel, gloves, incontinence pad 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 and put on gloves. Provide privacy. 5. Offer urinal or place between legs, positioned downward to prevent spills, with penis inside opening. Use bed protectors as needed. Cover with top linen. 6. Place toilet tissue and call signal in reach. Ask to signal when finished. 7. If cannot be safely left alone, wait in room on other side of curtain. 8. If leaving room, remove gloves and wash hands. Watch for call signal and respond promptly. Wash hands and put on gloves upon return. 9. Bring warm water and supplies for perineal care to bedside if needed. 10. Remove urinal, cover and take to bathroom. 11. Observe amount and appearance of urine. Measure output if ordered. 12. Empty urine into toilet and flush. 13. Rinse urinal and pour rinse water in toilet. Return to bedside stand. 14. Return equipment to bedside stand, discard wash cloth and towel. 15. Remove gloves and wash hands. Assist with hand washing. 16. Provide for comfort with call signal in reach. 17. Wash hands and record actions and report any abnormal observations to supervisor. Instructor s Initials: Date:

95 Catheter Care for Female/Male H 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: Wash basin of warm water, soap, wash cloths, towel, bath blanket/equivalent 1. Knock before entering, address resident by name, state your name and title. 2. Identify resident, explain procedure and obtain permission. 3. Wash hands and assemble equipment. 4. Provide privacy. 5. Provide for resident safety and elevate bed to best level for body mechanics. 6. Fill wash basin 2/3 full of warm water, degrees. Check water temperature for safety and comfort and ASK RESIDENT TO VERIFY COMFORT OF WATER. 7. Cover with bath blanket OR equivalent. 8. Put on clean gloves before washing. 9. Fold back bath blanket without over exposure of resident, place linen protector under perineal area before washing. 10. Expose area surrounding catheter while avoiding overexposure of client Separate labia on female Pull back foreskin on male Observe area around catheter for sores, crusts, redness, swelling, discoloration, and abnormal drainage 11. Wet wash cloth, wring out excess water and apply soap to wash cloth. 12. Hold catheter near meatus without tugging, clean at least four inches of catheter tubing beginning at the meatus, moving in only one direction, away from meatus, using a clean area of the cloth for each stroke. 13. Hold catheter near meatus without tugging, rinse at least four inches of catheter tubing beginning at the meatus, moving in only one direction, away from meatus, using a clean area of the cloth for each stroke. 14. Hold catheter near meatus without tugging, dry four inches of catheter tubing beginning at the meatus, moving away from meatus. 15. Empty, rinse, and dry basin. 16. After rinsing and drying the basin, place basin in bedside stand or designated area. 17. Dispose used linen into soiled linen container and dispose of linen protector appropriately.

96 Catheter Care for Female/Male H 18. Avoid contact between care provider clothing and used linen 19. Dispose used linen, clean equipment, THEN remove gloves without contaminating self, dispose of gloves into waste container and wash hands. 20. Position catheter so that urine flows freely into drainage bag attached to bed frame. Tape to leg as directed. Wash hands. 21. Provide for safety and comfort, bed locked and in low position with call signal in reach. 22. Record actions and report any abnormal observations to supervisor. Instructor s Initials: Date:

97 Empty Urinary Drainage Bag I 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: Graduate, disposable gloves, paper towel, drainage bag 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. Put on gloves. Assemble equipment. 5. Provide privacy. 6. Put paper towel on floor and place graduate on towel under drain. 7. To drain out urine: Remove drain from holder Open clamp and allow urine to run into graduate To prevent contamination do not allow spout to touch the side of graduate Prevent the splashing of urine 8. Clean tip of drain with antiseptic as directed. 9. Close clamp and replace drain in holder. 10. Measure urine, empty into toilet and flush. 11. Rinse graduate pouring rinse water into the toilet, store in appropriate area. 12. Remove gloves and wash hands. 13. Record output on Intake & Output record and report any abnormal observations to supervisor. Instructor s Initials: Date:

98 Obtain Routine Urine Specimen J 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: Clean bedpan and cover/urinal/toilet hat, basin of warm water, soap, wash cloth, towel, container and cover for specimen, clean graduate, label, laboratory requisition slip, gloves, leak-proof transport bag Note: There must be no feces in sample. 1. Receive directions from supervisor. 2. Assemble equipment. (Bedpan/urinal/toilet hat/graduate must be clean). 3. Knock before entering. Greet and identity resident. 4. State your name and title. Explain procedure and obtain permission. 5. Wash hands, put on gloves and provide privacy. 6. Fill out label, put on specimen container and put container in bathroom with lid off. Inside of lid should be facing up. Use paper towel for clean surface as needed. 7. Perform pericare or instruct resident to perform if perineal area dirty. 8. Instruct not to put toilet tissue into bedpan/toilet hat or urinal. 9. Instruct to urinate only into clean urinal/bedpan/toilet hat. 10. Take covered bedpan or urinal to bathroom or use urine in toilet hat. 11. Pour urine into clean graduate and measure if resident on intake and output. 12. Fill pre labeled specimen container about 3/4 full of urine. Do not touch inside of container or inside surface of lid. Avoid touching outside of container with contaminated gloves. If gloves contaminated, change gloves. 13. Discard excess urine and flush toilet. Clean equipment and return to proper place. 14. Remove gloves, wash hands, and put lid on specimen container. 15. Place specimen container in leak-proof transport bag. 16. Provide for comfort with call signal in reach. Transport specimen to proper location. 17. Record actions and report any abnormal observations to supervisor. Instructor s Initials: Date:

99 Apply/Care for Condom Catheter K 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: Incontinence pads, gloves, drainage bag, washcloth, towel, basin of warm water, soap, condom catheter, and skin barrier (optional). 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 and raise bed to best level for body mechanics. 6. Put on gloves and place bed protector under resident. 7. Secure drainage bag to bed frame. 8. Remove old condom catheter by rolling condom sheath off penis, disconnect from tubing and discard. Cap drainage tube. 9. Provide perineal care, observe penis for sores, blisters, or abrasions. 10. Hold penis firmly and roll on condom, leaving one inch space between penis and end of condom. 11. Use elastic tape provided by the manufacturer, wrap strip of tape over the catheter in a spiral fashion to secure it. 12. If using a self-adhesive catheter, follow the manufacturer s directions. 13. Connect condom catheter to drainage bag. Attach drainage bag to bed frame. 14. Remove gloves and wash hands. Lower bed and provide for resident safety. 15. Provide for comfort with call signal in reach. 16. Record actions and report any abnormal observations to supervisor. Instructor s Initials: Date: