Credentia North Carolina NURSE AIDE I SKILLS

Opening Procedure

• Knock

• verbalize “wash hands”

• hello miss __ my name is Layla and I will be your aide today. I will be assisting you with (say the skill).

• Before I get started, I will make sure your bed is low and locked. Here is your call bell in case you need anything.

• Provide privacy → pul curtain 360 degrees or halfway

• note: once you introduce during the opening procedure, do not have to do it again

Closing Procedure

• Remove gloves and wash hands (if applicable)

• Place call bell within reach

• Make sure bed is low and locked

• ask “Would you like your privacy curtain open or closed?”

• verbalize “wash hands then skill complete”

SKILL 1 — HAND HYGIENE (HAND WASHING)

Supplies: Soap and Paper Towels

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 fingers, hands, and wrists starting at fingertips 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

SKILL 2 — APPLIES ONE KNEE-HIGH ELASTIC STOCKING

Supplies: One Knee-High Elastic Stocking

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 Place's 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 the toe area (if present) is either over or under toe area; if using a mannequin, candidate may state stocking needs to be wrinkle-free

9 Signaling device is within reach and bed is in low position

10 After completing skill, wash hands

SKILL 3 — ASSISTS TO AMBULATE USING TRANSFER BELT

Supplies: Transfer Belt/Gait Belt (Non-Skid Shoes/Footwear)

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, client is wearing nonskid shoes/footwear

4 Before assisting to stand, bed is at a safe level

5 Before assisting to stand, checks and/or locks bed wheels

6 Before assisting to stand, client is assisted to sitting position with feet flat on the floor

7 Before assisting to stand, applies transfer belt securely at the waist over clothing/gown

8 Before assisting to stand, provides instructions to enable client to assist in standing including prearranged signal to alert client to begin standing

9 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

10 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 by standing knee to knee, or toe to toe with client

11 Walks slightly behind and to one side of client for a distance of ten (10) feet, while holding onto the belt

12 Assists client to bed and removes transfer belt → ask client if they want to lay down or stay seated, place belt on table

13 Signaling device is within reach and bed is in low position

14 After completing skill, wash hands

SKILL 4 — ASSISTS WITH USE OF BEDPAN

Supplies: 2 Pairs of Gloves, Toilet Paper, Hand Wipes, and a Standard Bedpan, and (Chux Pad) for a barrier

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

→ put on gloves

3 Before placing bedpan, lowers head of bed → verbalize that the head of the bed is lowered

4 Puts on clean gloves before placing bedpan under client

5 Place's bedpan correctly under client's buttocks

6 Removes and disposes of gloves (without contaminating self) into waste container and washes hands → verbalize wash 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 Ensures client is covered except when placing and removing bedpan

14 Empties and rinses bedpan and pours rinse into toilet

15 Places bedpan in designated dirty supply area

16 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

note:

• place the toilet tissue on the table and verbalize that is in reach for the client

• place the hand wipes on table with the toilet paper

SKILL 5 — CLEANS UPPER OR LOWER DENTURE

Supplies: Denture Cup with Lid, Dentures, 1 Pair of Gloves, Denture Toothpaste, Toothbrush, Paper Towel for lining the bottom of the sink, and Kidney Basin

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 Rinse's denture in moderate temperature running water before brushing them

4 Applies denture toothpaste to toothbrush

5 Brushes all surfaces of denture

6 Rinse's all surfaces of denture under moderate temperature running water

7 Rinse's denture cup and lid

8 Place's denture in denture cup with moderate temperature water/solution and places lid on cup

9 Rinse's 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 Removes and disposes of gloves (without contaminating self) into waste container and washes hands

SKILL 6 — COUNTS AND RECORDS RADIAL PULSE

Supplies: A Watch with a Second Hand (Analog or Clock)

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 Records pulse rate within plus or minus 4 beats of evaluator's reading

SKILL 7 — COUNTS AND RECORDS RESPIRATIONS

Supplies: A Watch with a Second Hand (Analog or Clock)

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 Before recording, washes hands

5 Records respiration rate within plus or minus 2 breaths of evaluator's reading

SKILL 8 — DONNING AND REMOVING PPE (GOWN AND GLOVES)

Supplies: Gown and Gloves

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 waist and neck

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

SKILL 9 — DRESSES CLIENT WITH AFFECTED (WEAK) RIGHT ARM

Supplies: Two Clean Shirts with Buttons

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 Avoids overexposure of client by ensuring client's chest is covered

5 Removes gown from the left (unaffected) side first, then removes gown from the right (affected/weak) side

6 Before dressing client, disposes of gown into soiled linen container

7 Assists to put the right (affected/weak) arm through the right sleeve of the shirt before placing garment on left (unaffected) arm

8 While putting on shirt, moves body gently and naturally, avoiding force and over-extension of limbs and joints

9 Finishes with clothing in place

10 Signaling device is within reach and bed is in low position

11 After completing skill, washes hands

SKILL 10 — FEEDS CLIENT WHO CANNOT FEED SELF

Supplies: Spoon (2), Wet Wipes, Cup with Water, Meal Tray, Towel and Shirt Protector

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 before beginning feeding

6 Candidate sits in a chair facing client during feeding

7 Tells client what foods and beverage are on tray

8 Asks client what he/she would like to eat first

9 Using spoon, offers client one bite of each type of food on tray, telling client the content of each spoonful

10 Offers beverage at least once during meal

11 Candidate asks client if they are ready for next bite of food or sip of beverage

12 At end of meal, candidate cleans client's mouth and hands

13 Removes food tray

14 Leaves client in upright sitting position (75-90 degrees) with signaling device within client's reach

15 After completing skill, washes hands

SKILL 11 — GIVES MODIFIED BED BATH (FACE AND ONE ARM, HAND AND UNDERARM)

Supplies: Bath Basin, Gown, Towel (1 or 2), Washcloths ( 3 or 4), Soap, and Gloves

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 directly in soiled linen container while ensuring client's chest and lower body is covered

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 dry cloth towel/washcloth

8 Exposes one arm and places cloth towel underneath arm

9 Applies soap to wet washcloth

10 Washes fingers (including fingernails), hand, arm, and underarm keeping rest of body covered

11 Rinses and dries fingers, hand, arm, 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 Place's basin in designated dirty supply area

16 Disposes of linen into soiled linen container

17 Avoids contact between candidate clothing and used linens

18 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

SKILL 13 — MEASURES AND RECORDS URINARY OUTPUT

Supplies: 1 Pair of Gloves, Measuring Container, a Bedpan with Urine and Paper Towel

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 Rinses bedpan and pours rinse into toilet

4 Measures the amount of urine at eye level with container on flat surface (if between measurement lines, round up to nearest 25 ml/cc)

5 After measuring urine, empties contents of measuring container into toilet

6 Rinses measuring container and pours rinse into toilet

7 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

SKILL 14 — MEASURES AND RECORDS WEIGHT OF AMBULATORY CLIENT

Supplies: Non-Skid Shoes/Footwear

1 Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible

2 Client has non-skid shoes/footwear on before walking to scale

3 Before client steps on scale, candidate sets scale to zero

4 Asks client to step on center of scale and obtains client's weight

5 Asks client to step off scale

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)

SKILL 15 — PERFORMS MODIFIED PASSIVE RANGE OF MOTION (PROM) FOR ONE KNEE AND ONE ANKLE

Supplies: (Gloves Optional)

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 Ensures that client is supine in bed and instructs client to inform candidate if pain is experienced during exercise

4 While supporting the leg at knee and ankle, bends the knee and then returns leg to client's normal position (flexion/extension) (AT LEAST 3 TIMES unless pain is verbalized). Moves joints gently, slowly, and smoothly through the range of motion, discontinuing exercise if client verbalizes pain.

5 While supporting the foot and ankle close to the bed, pushes/pulls foot toward head (dorsiflexion), and pushes/pulls foot down, toes point down (plantar flexion) (AT LEAST 3 TIMES unless pain is verbalized). Moves joints gently, slowly, and smoothly through the range of motion, discontinuing exercise if client verbalizes pain.

6 Signaling device is within reach and bed is in low position

7 After completing skill, washes hands

SKILL 16 PERFORMS MODIFIED PASSIVE RANGE OF MOTION (PROM) FOR ONE SHOULDER

Supplies: (Gloves Optional)

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 While supporting arm at the elbow and at the wrist, 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). Moves joint gently, slowly, and smoothly through the range of motion, discontinuing exercise if client verbalizes pain.

5 While supporting arm at the elbow and at the wrist, 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). Moves joint gently, slowly, and smoothly through the range of motion, discontinuing exercise if client verbalizes pain.

6 Signaling device is within reach and bed is in low position

7 After completing skill, washes hands

SKILL 17 — POSITIONS ON SIDE

Supplies: 3 Pillows (Chux Pad Optional)

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 Candidate assists client to slowly roll onto side toward raised side rail

6 Places or adjusts pillow under head for support

7 Candidate repositions arm and shoulder 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

SKILL 18 — PROVIDES CATHETER CARE FOR FEMALE

Supplies: Bath Basin, Soap, 1 Pair of Gloves, Chux Pad, and Washcloths (3)

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

5 Places linen protector under perineal area including buttocks before washing

6 Exposes area surrounding catheter (only exposing client between hip and knee)

7 Applies soap to wet washcloth

8 While holding catheter at meatus without tugging, cleans at least four inches of catheter from meatus, moving in only one direction, away from meatus, using a clean area of the washcloth for each stroke

9 While holding catheter at meatus without tugging, using a clean washcloth, rinses at least four inches of catheter from meatus, moving only in one direction, away from meatus, using a clean area of the washcloth for each stroke

10 While holding catheter at meatus without tugging, dries at least four inches of catheter moving away from meatus using a dry cloth towel/washcloth

11 Empties, rinses, and dries basin

12 Place's basin in designated dirty supply area

13 Disposes of used linen into soiled linen container and disposes of linen protector appropriately

14 Avoids contact between candidate clothing and used linen

15 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

SKILL 19 — PROVIDES FOOT CARE ON ONE FOOT

Supplies: Bath Basin, Soap, Lotion, Towel (1), Washcloths (2), and 1 Pair of Gloves

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) with dry cloth towel/washcloth

11 Applies lotion to top and bottom of foot (excluding between the toes) removing excess with a towel/ washcloth

12 Supports foot and ankle during procedure

13 Empties, rinses, and dries basin

14 Place's basin in designated dirty supply area

15 Disposes of used linen into soiled linen container

16 Removes and disposes of gloves (without contaminating self) into waste container and washes hands

17 Signaling device is within reach

SKILL 20 — PROVIDES MOUTH CARE

Supplies: Gloves, Kidney Basin, Toothbrush, Toothpaste, Towel, Washcloth, Cup with Water, and Barrier

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 Place's cloth towel 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 all 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 Disposes of used linen into soiled linen container

13 Rinse's toothbrush and empties, rinses, and dries basin

14 Removes and disposes of gloves (without contaminating self) into waste container and washes hands

15 Signaling device is within reach and bed is in low position

Skill 21 PROVIDES PERINEAL CARE (PERI-CARE) FOR FEMALE

Supplies: Bath Basin, Soap, Washcloths (4), Towel (1), Linen Protector/Chux Pad, and 1 Pair of Gloves

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 Place's pad/ linen protector under perineal area including buttocks before washing

6 Exposes perineal area (only exposing between hips and knees)

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 dry cloth towel/washcloth.

11 After washing genital area, turns to side, then washes rectal area moving from front to back using a clean area of washcloth for each stroke.

12 Using clean washcloth, rinses soap from rectal area, moving from front to back, while using a clean area of the washcloth for each stroke

13 Dries rectal area moving from front to back with dry cloth towel/washcloth

14 Repositions client

15 Empties, rinses, and dries basin

16 Place's basin in designated dirty supply area

17 Disposes of used linen into soiled linen container and disposes of linen protector appropriately

18 Avoids contact between candidate clothing and used linen

19 Removes and disposes of gloves (without contaminating self) into waste container and washes hands

20 Signaling device is within reach and bed is in low position

SKILL 22 TRANSFERS FROM BED TO WHEELCHAIR USING TRANSFER BELT

Supplies: Gait Belt and Wheelchair (Don't forget the shoes)

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

→ get the transfer belt and place on table/within reach

3 Before assisting to stand, the wheelchair is positioned alongside 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, locks wheels on wheelchair

6 Before assisting to stand, bed is at a safe level

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 → say “I am going to help you sit up in bed now”

Note: When assisting the client to a seated position, loop arm through theirs and have them sit up. Then, place one hand under the back and the other hand under the knee, and swing them over the side. Keep hand on back and tell them to scoot forward to make sure feet are flat on floor (verbalize that their feet are flat on the floor), make sure client’s gown is completely closed

9 Before assisting to stand, client is wearing shoes

→ say “here are your shoes will you please put them on”

10 Before assisting to stand, apply the transfer belt securely at the waist over clothing/gown (loop excess belt in the back)

→ say “please raise your hands so I can put on the transfer belt on” feed the belt through the teeth first, and then the other latch

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 another prearranged signal) to alert client to begin standing

→ stand with knee in between the clients feet (make sure knee is touching theirs!)

→ say “on 3 I am gonna have you use your hands to push off the bed and stand up, 1, 2, 3” (adjust gown if needed)

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 by standing knee to knee, or toe to toe with the client

14 Assists client to turn to stand in front of wheelchair with back of client's legs against wheelchair

→ say “Please turn to the right/left and step back until the back of you legs hit the wheel chair. Do you feel it? Okay, on 3, I will have you sit down, 1, 2, 3”. If their back is not hitting the back of the wheelchair, ask them to scoot back

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 → give them the call bell

19 After completing skill, washes hands

SKILL 23 MEASURES AND RECORDS MANUAL BLOOD PRESSURE

Supplies: Blood Pressure Cuff, Stethoscope (Dual Heal), and Alcohol Pads

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 160mm 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

9 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