Training And Skills

HAND HYGIENE (HAND WASHING)

Here Are The Steps

  • 1. Address client by name and introduces self to client by name
  • 2. Turns on water at sink
  • 3. Wets hands and wrists thoroughly
  • 4. Applies soap to hands
  • 5. Lathers all surfaces of wrists, hands, and fingers producing friction, for at least 20 (twenty) seconds, keeping hands lower than the elbows and the fingertips down
  • 6. Cleans fingernails by rubbing fingertips against palms of the opposite hand
  • 7. Rinse all surfaces of wrists, hands, and fingers, keeping hands lower than the elbows and the fingertips down
  • 8. Uses clean, dry paper towel/towels to dry all surfaces of hands, wrists, and fingers then disposes of paper towel/towels into waste container
  • 9. Uses clean, dry paper towel/towels to turn off faucet then disposes of paper towel/towels into waste container or uses knee/foot control to turn off faucet
  • 10. Does not touch inside of sink at any time

APPLIES ONE KNEE-HIGH ELASTIC STOCKING

Here Are The Steps

  • 1.  Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact               whenever possible
  • 2.  Privacy is provided with a curtain, screen, or door
  • 3.  Client is in supine position (lying down in bed) while stocking is applied
  • 4.  Turns stocking inside-out, at least to the heel
  • 5.  Places foot of stocking over toes, foot, and heel
  • 6.  Pulls top of stocking over foot, heel, and leg
  • 7.  Moves foot and leg gently and naturally, avoiding force and over-extension of limb and joints
  • 8.  Finishes procedure with no twists or wrinkles and heel of stocking, if present, is over heel and           opening in toe area (if present) is either over or under toe area
  • 9.  Signaling device is within reach and bed is in low position
  • 10. After completing skill, wash hands

ASSISTS TO AMBULATE USING TRANSFER BELT

Here Are The Steps:

 1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Before assisting to stand, client is wearing shoes.
3. Before assisting to stand, bed is at a safe level.
4. Before assisting to stand, checks and/or locks bed wheels.
5. Before assisting to stand, client is assisted to sitting position with feet flat on the floor.
6. Before assisting to stand, applies transfer belt securely at the waist over clothing/gown.
7. Before assisting to stand, provides instructions to enable client to assist in standing including prearranged signal to alert client to begin standing.
8. Stands facing client positioning self to ensure safety of candidate and client during transfer. Counts to three (or says other prearranged signal) to alert client to begin standing.
9. On signal, gradually assists client to stand by grasping transfer belt on both sides with an upward grasp
(candidate’s hands are in upward position), and maintaining stability of client’s legs.
10. Walks slightly behind and to one side of client for a distance of ten (10) feet, while holding onto the belt.
11. After ambulation, assists client to bed and removes transfer belt.
12. Signaling device is within reach and bed is in low position.
13. After completing skill, wash hands.

ASSISTS WITH USE OF BEDPAN

Here Are The Steps:

1. Explains procedure speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2.  Privacy is provided with a curtain, screen, or door.
3. Before placing bedpan, lowers head of bed.
4.  Puts on clean gloves before handling bedpan.
5.  Places bedpan correctly under client’s buttocks.
6.  Removes and disposes of gloves (without contaminating self) into waste container and washes hands.
7.  After positioning client on bedpan and removing gloves, raises head of bed.
8. Toilet tissue is within reach.
9.  Hand wipe is within reach and client is instructed to clean hands with hand wipe when finished.
10. Signaling device within reach and client is asked to signal when finished.
11.  Puts on clean gloves before removing bedpan
12.  Head of bed is lowered before bedpan is removed
13.  Avoids overexposure of client
14.  Empties and rinses bedpan and pours rinse into toilet
15.  After rinsing bedpan, places bedpan in designated dirty supply area
16.  After placing bedpan in designated dirty supply area, removes and disposes of gloves (without contaminating self) into waste container and washes hands.
17.  Signaling device is within reach and bed is in low position.

CLEANS UPPER OR LOWER DENTURE

Here Are The Steps:

1.  Puts on clean gloves before handling denture.
2.  Bottom of sink is lined and/or sink is partially filled with water before denture is held over sink.
3.  Rinses denture in moderate temperature running water before brushing them.
4.  Applies toothpaste to toothbrush.
5.  Brushes surfaces of denture.
6.  Rinses surfaces of denture under moderate temperature running water.
7.  Before placing denture into cup, rinses denture cup and lid.
8.  Places denture in denture cup with moderate temperature water/solution and places lid on cup.
9.  Rinses toothbrush and places in designated toothbrush basin/container.
10.  Maintains clean technique with placement of toothbrush and denture.
11.  Sink liner is removed and disposed of appropriately and/or sink is drained.
12.  After rinsing equipment and disposing of sink liner, removes and disposes of gloves (without contaminating self) into waste container and washes hands .

 

 

COUNTS AND RECORDS RADIAL PULSE

Here Are The Steps:

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Places fingertips on thumb side of client’s wrist to locate radial pulse.
3. Count beats for one full minute.
4. Signaling device is within reach.
5. Before recording, washes hands.
6. After obtaining pulse by palpating in radial artery position, records pulse rate within plus or minus 4 beats of evaluator’s reading.

COUNTS AND RECORDS RESPIRATIONS

Here Are The Steps:

1. Explains procedure (for testing purposes), speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Counts respirations for one full minute.
3. Signaling device is within reach.
4. Washes hands.
5. Records respiration rate within plus or minus 2 breaths of evaluator’s reading.

DONNING AND REMOVING PPE (GOWN AND GLOVES)

Here Are The Steps:

1. Picks up gown and unfolds.
2. Facing the back opening of the gown places arms through each sleeve.
3. Fastens the neck opening.
4. Secures gown at waist making sure that back of clothing is covered by gown (as much as possible).
5. Puts on gloves.
6. Cuffs of gloves overlap cuffs of gown.
7. Before removing gown, with one gloved hand, grasps the other glove at the palm, remove glove.
8. Slips fingers from ungloved hand underneath cuff of remaining glove at wrist, and removes glove turning it inside out as it is removed.
9. Disposes of gloves into designated waste container without contaminating self.
10. After removing gloves, unfastens gown at neck and waist.
11. After removing gloves, removes gown without touching outside of gown.
12. While removing gown, holds gown away from body without touching the floor, turns gown inward and keeps it inside out.
13. Disposes of gown in designated container without contaminating self.
14. After completing skill, washes hands.

DRESSES CLIENT WITH AFFECTED (WEAK) RIGHT ARM

Here Are The Steps:

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Privacy is provided with a curtain, screen, or door.
3. Asks which shirt he/she would like to wear and dresses him/her in shirt of choice.
4. While avoiding overexposure of client, removes gown from the unaffected side first, then removes gown from the affected side and disposes of gown into soiled linen container.
5. Assists to put the right (affected/weak) arm through the right sleeve of the shirt before placing garment on left (unaffected) arm.
6. While putting on shirt, moves body gently and naturally, avoiding force and over-extension of limbs and joints.
7. Finishes with clothing in place
8.  Signaling device is within reach and bed is in low position.
9.  After completing skill, washes hands.

FEEDS CLIENT WHO CANNOT FEED SELF

Here Are The Steps:

1. Explains procedure to client, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Before feeding, looks at name card on tray and asks client to state name.
3. Before feeding client, client is in an upright sitting position (75-90 degrees).
4. Places tray where the food can be easily seen by client.
5. Candidate cleans client’s hands with hand wipe before beginning feeding.
6. Candidate sits facing client during feeding.
7. Tells client what foods are on tray and asks what client would like to eat first.
8. Using spoon, offers client one bite of each type of food on tray, telling client the content of each spoonful.
9. Offers beverage at least once during meal.
10. Candidate asks client if they are ready for next bite of food or sip of beverage.
11. At end of meal, candidate cleans client’s mouth and hands with wipes.
12. Removes food tray and places tray in designated dirty supply area.
13. Signaling device is within client’s reach.
14. After completing skill, washes hands.

GIVES MODIFIED BED BATH (FACE AND ONE ARM, HAND AND UNDERARM)

Here Are The Steps:

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Privacy is provided with a curtain, screen, or door.
3. Removes gown and places in soiled linen container, while avoiding overexposure of the client.
4. Before washing, checks water temperature for safety and comfort and asks client to verify comfort of water.
5. Puts on clean gloves before washing client.
6. Beginning with eyes, washes eyes with wet washcloth (no soap), using a different area of the washcloth for each stroke, washing inner aspect to outer aspect then proceeds to wash face.
7. Dries face with towel.
8. Exposes one arm and places towel underneath arm.
9. Applies soap to wet washcloth.
10. Washes arm, hand, and underarm keeping rest of body covered.
11. Rinses and dries arm, hand, and underarm.
12. Moves body gently and naturally, avoiding force and over-extension of limbs and joints.
13. Puts clean gown on client.
14. Empties, rinses, and dries basin.
15. After rinsing and drying basin, places basin in designated dirty supply area.
16. Disposes of linen into soiled linen container.
17. Avoids contact between candidate clothing and used linens.
18. After placing basin in designated dirty supply area, and disposing of used linen, removes and disposes of gloves (without contaminating self) into waste container and washes hands.
19. Signaling device is within reach and bed is in low position.

MEASURES AND RECORDS BLOOD PRESSURE

Here Are The Steps:

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Before using stethoscope, wipes bell/diaphragm and earpieces of stethoscope with alcohol.
3. Client’s arm is positioned with palm up and upper arm is exposed
4 Feels for brachial artery on inner aspect of arm, at bend of elbow
5 Places blood pressure cuff snugly on client’s upper arm, with sensor/arrow over brachial artery site
6 Earpieces of stethoscope are in ears and bell/ diaphragm is over brachial artery site
7. Candidate inflates cuff between 160 mm Hg to 180 mm Hg. If beat heard immediately upon cuff deflation, completely deflate cuff. Re-inflate cuff to no more than 200 mm Hg.
8. Deflates cuff slowly and notes the first sound (systolic reading), and last sound (diastolic reading) (If
rounding needed, measurements are rounded UP to the nearest 2 mm of mercury).
9. Removes cuff.
10. Signaling device is within reach
11. Before recording, washes hands
12. After obtaining reading using BP cuff and stethoscope, records both systolic and diastolic pressures each within plus or minus 8 mm of evaluator’s reading.

MEASURES AND RECORDS URINARY OUTPUT

Here Are The Steps:

1. Puts on clean gloves before handling bedpan.
2. Pours the contents of the bedpan into measuring container without spilling or splashing urine outside of container.
3. Measures the amount of urine at eye level with container on flat surface.
4. After measuring urine, empties contents of measuring container into toilet.
5. Rinses measuring container and pours rinse into toilet.
6. Rinses bedpan and pours rinse into toilet.
7. After rinsing equipment, and before recording output, removes and disposes of gloves (without contaminating self) into waste container and washes hands.
8. Records contents of container within plus or minus 25 ml/cc of evaluator’s reading.

MEASURES AND RECORDS WEIGHT OF AMBULATORY CLIENT

Here Are The Steps:

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Client has shoes on before walking to scale.
3. Before client steps on scale, candidate sets scale to zero.
4. While client steps onto scale, candidate stands next to scale and assists client, if needed, onto center of scale; then obtains client’s weight.
5. While client steps off scale, candidate stands next to scale and assists client, if needed, off scale before recording weight.
6. Before recording, washes hands.
7. Records weight based on indicator on scale. Weight is within plus or minus 2 lbs of evaluator’s reading (If weight recorded in kg weight is within plus or minus 0.9 kg of evaluator’s reading).

PERFORMS MODIFIED PASSIVE RANGE OF MOTION (PROM) FOR ONE KNEE AND ONE ANKLE

Here Are The Steps:

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Privacy is provided with a curtain, screen, or door
3. Instructs client to inform candidate if pain is experienced during exercise.
4. Supports leg at knee and ankle while performing range of motion for knee.
5. Bends the knee and then returns leg to client’s normal position (extension/flexion) (AT LEAST 3 TIMES unless pain is verbalized).
6. Supports foot and ankle close to the bed while performing range of motion for ankle.
7. Pushes/pulls foot toward head (dorsiflexion), and pushes/pulls foot down, toes point down (plantar flexion) (AT LEAST 3 TIMES unless pain is verbalized).
8. While supporting the limb, moves joints gently, slowly, and smoothly through the range of motion,
discontinuing exercise if client verbalizes pain.
9. Signaling device is within reach and bed is in low position.
10. After completing skill, washes hands.

PERFORMS MODIFIED PASSIVE RANGE OF MOTION (PROM) FOR ONE SHOULDER

Here Are The Steps:

1. Explains procedure, speaking clearly, slowly, and directly,maintaining face-to-face contact whenever possible.
2. Privacy is provided with a curtain, screen, or door.
3. Instructs client to inform candidate if pain experienced during exercise.
4. Supports client’s upper and lower arm while performing range of motion for shoulder.
5. Raises client’s straightened arm from side position upward toward head to ear level and returns arm down to side of body (flexion/extension) (AT LEAST 3 TIMES unless pain is verbalized). Supporting the limb, moves joint gently, slowly, and smoothly through the range of motion, discontinuing exercise if client verbalizes pain.
6. Moves client’s straightened arm away from the side of body to shoulder level and returns to side of body (abduction/adduction) (AT LEAST 3 TIMES unless pain is verbalized). Supporting the limb, moves joint gently, slowly, and smoothly through the range of motion, discontinuing exercise if client
verbalizes pain.
7. Signaling device is within reach and bed is in low position.
8. After completing skill, washes hands.

POSITIONS ON SIDE

Here Are The Steps:

1 Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Privacy is provided with a curtain, screen, or door.
3. Before turning, lowers head of bed.
4. Raises side rail on side to which body will be turned
5. Slowly rolls onto side as one unit toward raised side rail.
6. Places or adjusts pillow under head for support
7. Candidate positions client so that client is not lying on arm.
8. Supports top arm with supportive device.
9. Places supportive device behind client’s back.
10. Places supportive device between legs with top knee flexed; knee and ankle supported.
11. Signaling device is within reach and bed is in low position.
12. After completing skill, washes hands.

PROVIDES FOOT CARE ON ONE FOOT

Here Are The Steps:

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever
possible.
2. Privacy is provided with a curtain, screen, or door.
3. Before washing, checks water temperature for safety and comfort and asks client to verify comfort of water.
4. Basin is in a comfortable position for client and on protective barrier.
5. Puts on clean gloves before washing foot.
6. Client’s bare foot is placed into the water.
7. Applies soap to wet washcloth.
8. Lifts foot from water and washes foot (including between the toes).
9. Foot is rinsed (including between the toes).
10. Dries foot (including between the toes).
11. Applies lotion to top and bottom of foot, removing excess (if any) with a towel.
12. Supports foot and ankle during procedure.
13. Empties, rinses, and dries basin.
14. After rinsing and drying basin, places basin in designated dirty supply area.
15. Disposes of used linen into soiled linen container.
16. After cleaning foot and equipment, and disposing of used linen, removes and disposes of gloves (without contaminating self) into waste container and washes hands.
17. Signaling device is within reach.

PROVIDES MOUTH CARE

Here Are The Steps:

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever
possible.
2. Privacy is provided with a curtain, screen, or door.
3. Before providing mouth care, client is in upright sitting position (75-90 degrees).
4. Puts on clean gloves before cleaning mouth.
5. Places clothing protector across chest before providing mouth care.
6. Secures cup of water and moistens toothbrush.
7. Before cleaning mouth, applies toothpaste to moistened toothbrush.
8. Cleans mouth (including tongue and surfaces of teeth), using gentle motions.
9. Maintains clean technique with placement of toothbrush.
10. Candidate holds emesis basin to chin while client rinses mouth.
11. Candidate wipes mouth and removes clothing protector.
12. After rinsing toothbrush, empty, rinse and dry the basin and place used toothbrush in designated basin/ container.
13. Places basin and toothbrush in designated dirty supply area.
14. Disposes of used linen into soiled linen containe.
15. After placing basin and toothbrush in designated dirty supply area, and disposing of used linen, removes and disposes of gloves (without contaminating self) into waste container and washes hands.
16. Signaling device is within reach and bed is in low position.

PROVIDES PERINEAL CARE (PERI-CARE) FOR FEMALE

Here Are The Steps:

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Privacy is provided with a curtain, screen, or door.
3. Before washing, checks water temperature for safety and comfort and asks client to verify comfort of water.
4. Puts on clean gloves before washing perineal area.
5. Places pad/ linen protector under perineal area before washing.
6. Exposes perineal area while avoiding overexposure of client.
7. Applies soap to wet washcloth.
8. Washes genital area, moving from front to back, while using a clean area of the washcloth for each stroke.
9. Using clean washcloth, rinses soap from genital area, moving from front to back, while using a clean area of the washcloth for each stroke.
10. Dries genital area moving from front to back with towel.
11. After washing genital area, turns to side, then washes and rinses rectal area moving from front to back using a clean area of washcloth for each stroke. Dries with towel.
12. Repositions client.
13. Empties, rinses, and dries basin.
14. After rinsing and drying basin, places basin in designated dirty supply area.
15. Disposes of used linen into soiled linen container and disposes of linen protector appropriately.
16. Avoids contact between candidate clothing and used linen.
17. After disposing of used linen, and placing used equipment in designated dirty supply area, removes
and disposes of gloves(without contaminating self) into waste container and washes hands.
18. Signaling device is within reach and bed is in low position.

TRANSFERS FROM BED TO WHEELCHAIR USING TRANSFER BELT

Here Are The Steps:

1.Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Privacy is provided with a curtain, screen, or door.
3. Before assisting to stand, wheelchair is positioned along side of bed, at head of bed facing foot or foot of bed facing head.
4. Before assisting to stand, footrests are folded up or removed.
5. Before assisting to stand, bed is at a safe level.
6. Before assisting to stand, locks wheels on wheelchair.
7. Before assisting to stand, checks and/or locks bed wheels.
8. Before assisting to stand, client is assisted to a sitting position with feet flat on the floor.
9. Before assisting to stand, client is wearing shoes.
10. Before assisting to stand, applies transfer belt securely at the waist over clothing/gown.
11. Before assisting to stand, provides instructions to enable client to assist in transfer including prearranged signal to alert when to begin standing.
12. Stands facing client positioning self to ensure safety of candidate and client during transfer. Counts to three (or says other prearranged signal) to alert client to begin standing.
13. On signal, gradually assists client to stand by grasping transfer belt on both sides with an upward grasp (candidates hands are in upward position) and maintaining stability of client’s legs.
14. Assists client to turn to stand in front of wheelchair with back of client’s legs against wheelchair.
15. Lowers client into wheelchair.
16. Positions client with hips touching back of wheelchair and transfer belt is removed.
17. Positions feet on footrests.
18. Signaling device is within reach.
19. After completing skill, washes hands.