Nursing Skills Template

Part 1: Hand Hygiene (Hand Washing)

Addresses client by name and introduces self to client by name

Turns on water at sink

Wets hands and wrists thoroughly

Applies soap to hands

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

Cleans fingernails by rubbing fingertips against palms of the opposite hand

Rinse all surfaces of wrists, hands, and fingers, keeping hands lower than the elbows and the fingertips down

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

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

Does not touch inside of sink at any time

Demonstrated Competency?

Comments:

Part 2: Applies One Knee-High Elastic Stocking

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

Privacy is provided with a curtain, screen, or door

Client is in supine position (lying down in bed) while stocking is applied

Turns stocking inside-out, at least to the heel

Places foot of stocking over toes, foot, and heel

Pulls top of stocking over foot, heel, and leg

Moves foot and leg gently and naturally, avoiding force and over-extension of limb and joints

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; if using a mannequin, candidate may state stocking needs to be wrinkle-free

After completing skill, wash hands

Demonstrated Competency?

Comments:

Part 3: Assists to Ambulate Using Transfer Belt

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

Privacy is provided with a curtain, screen, or door

Before assisting to stand, client is wearing non-skid shoes/footwear

Before assisting to stand, bed is at a safe level

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

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

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

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

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

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

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

Assists client to bed and removes transfer belt

Signaling device is within reach and bed is in low position

After completing skill, wash hands

Demonstrated Competency?

Comments:

Part 4: Assists with Use of Bedpan

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

Privacy is provided with a curtain, screen, or door

Before placing bedpan, lowers head of bed

Puts on clean gloves before placing bedpan under client

Places bedpan correctly under client’s buttocks

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

After positioning client on bedpan and removing gloves, raises head of bed

Toilet tissue is within reach

Hand wipe is within reach and client is instructed to clean hands with hand wipe when finished

Signaling device within reach and client is asked to signal when finished

Puts on clean gloves before removing bedpan

Head of bed is lowered before bedpan is removed

Ensures client is covered except when placing and removing bedpan

Empties and rinses bedpan and pours rinse into toilet

Places bedpan in designated dirty supply area

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

Signaling device is within reach and bed is in low position

Demonstrated Competency?

Comments:

Part 5: Cleans Upper or Lower Denture

Puts on clean gloves before handling denture

Bottom of sink is lined and/or sink is partially filled with water before denture is held over sink

Rinses denture in moderate temperature running water before brushing them

Applies denture toothpaste to toothbrush

Brushes all surfaces of denture

Rinses all surfaces of denture under moderate temperature running water

Rinses denture cup and lid

Places denture in denture cup with moderate temperature water/solution and places lid on cup

Rinses toothbrush and places in designated toothbrush basin/container

Maintains clean technique with placement of toothbrush and denture

Sink liner is removed and disposed of appropriately and/or sink is drained

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

Demonstrated Competency?

Part 6: Counts and Records Radial Pulse

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

Places fingertips on thumb side of client’s wrist to locate radial pulse

Count beats for one full minute

Signaling device is within reach

Before recording, washes hands

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

Demonstrated Competency?

Part 7: Counts and Records Respirations

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

Count respirations for one full minute

Signaling device is within reach

Before recording, washes hands

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

Demonstrated Competency?

Comments:

Part 8: Donning and Removing PPE (Gown and Gloves)

Picks up gown and unfolds

Facing the back opening of the gown places arms through each sleeve

Fastens the neck opening

Secures gown at waist making sure that back of clothing is covered by gown (as much as possible)

Puts on gloves

Cuffs of gloves overlap cuffs of gown

Before removing gown, with one gloved hand, grasps the other glove at the palm, remove glove

Slips fingers from ungloved hand underneath cuff of remaining glove at wrist, and removes glove turning it inside out as it is removed

Disposes of gloves into designated waste container without contaminating self

After removing gloves, unfastens gown at waist and neck

After removing gloves, removes gown without touching outside of gown

While removing gown, holds gown away from body without touching the floor, turns gown inward and keeps it inside out

Disposes of gown in designated container without contaminating self

After completing skill, washes hands

Demonstrated Competency?

Comments:

Part 9: Dresses Client with Affected (Weak) Right Arm

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

Privacy is provided with a curtain, screen, or door

Asks which shirt he/she would like to wear and dresses him/her in shirt of choice

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

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

Before dressing client, disposes of gown into soiled linen container

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

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

Finishes with clothing in place

Signaling device is within reach and bed is in low position

After completing skill, washes hands

Demonstrated Competency?

Comments:

Part 10: Feeds Client Who Cannot Feed Self

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

Before feeding, looks at name card on tray and asks client to state name

Before feeding client, client is in an upright sitting position (75-90 degrees)

Places tray where the food can be easily seen by client

Candidate cleans client’s hands before beginning feeding

Candidate sits in a chair facing client during feeding

Tells client what foods and beverage are on tray

Asks client what he/she would like to eat first

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

Offers beverage at least once during meal

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

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

Removes food tray

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

After completing skill, washes hands

Demonstrated Competency?

Comments:

Part 11: Gives Modified Bed Bath (Face and one arm, hand, and underarm)

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

Privacy is provided with a curtain, screen, or door

Removes gown and places directly in soiled linen container while ensuring client’s chest and lower body is covered

Before washing, checks water temperature for safety and comfort and asks client to verify comfort of water

Puts on clean gloves before washing client

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

Dries face with dry cloth towel/washcloth

Exposes one arm and places cloth towel underneath arm

Applies soap to wet washcloth

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

Rinses and dries fingers, hand, arm, and underarm

Moves body gently and naturally, avoiding force and over-extension of limbs and joints

Puts clean gown on client

Empties, rinses, and dries basin

Places basin in designated dirty supply area

Disposes of linen into soiled linen container

Avoids contact between candidate clothing and used linens

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

Signaling device is within reach and bed is in low position

Demonstrated Competency?

Comments:

Part 12: Measures and Records Urinary Output

Puts on clean gloves before handling bedpan

Pours the contents of the bedpan into measuring container without spilling or splashing urine outside of container

Rinses bedpan and pours rinse into toilet

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

After measuring urine, empties contents of measuring container into toilet

Rinses measuring container and pours rinse into toilet

Before recording output, removes and disposes of gloves (without contaminating self) into waste container and washes hands

Records contents of container within plus or minus 25 ml/cc of evaluator’s reading

Comments:

Part 14: Measures and Records Weight of Ambulatory Client

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

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

Before client steps on scale, candidate sets scale to zero

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

Asks client to step off scale

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)

Demonstrated Competency?

Comments:

Part 15: Performs Modified Passive Range of Motion (PROM) for One Knee and One Ankle

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

Privacy is provided with a curtain, screen, or door

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

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.

Signaling device is within reach and bed is in low position

After completing skill, washes hands

Demonstrated Competency?

Comments:

Part 16: Performs Modified Passive Range of Motion (PROM) for One Shoulder

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

Privacy is provided with a curtain, screen, or door

Instructs client to inform candidate if pain experienced during exercise

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.

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

Signaling device is within reach and bed is in low position

After completing skill, washes hands

Demonstrated Competency?

Comments:

Part 17: Positions on Side

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

Privacy is provided with a curtain, screen, or door

Before turning, lowers head of bed

Raises side rail on side to which body will be turned

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

Places or adjusts pillow under head for support

Candidate repositions arm and shoulder so that client is not lying on arm

Supports top arm with supportive device

Places supportive device behind client’s back

Places supportive device between legs with top knee flexed; knee and ankle supported

Signaling device is within reach and bed is in low position

After completing skill, washes hands

Demonstrated Competency?

Comments:

Part 18: Provides Catheter Care for Female

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

Privacy is provided with a curtain, screen, or door

Before washing, checks water temperature for safety and comfort and asks client to verify comfort of water

Puts on clean gloves before washing

Places linen protector under perineal area including buttocks before washing

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

Applies soap to wet washcloth

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

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

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

Empties, rinses, and dries basin

Places basin in designated dirty supply area

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

Avoids contact between candidate clothing and used linen

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

Signaling device is within reach and bed is in low position

Demonstrated Competency?

Comments:

Part 19: Provides Foot Care on One Foot

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

Privacy is provided with a curtain, screen, or door

Before washing, checks water temperature for safety and comfort and asks client to verify comfort of water

Basin is in a comfortable position for client and on protective barrier

Puts on clean gloves before washing foot

Client’s bare foot is placed into the water

Applies soap to wet washcloth

Lifts foot from water and washes foot (including between the toes)

Foot is rinsed (including between the toes)

Dries foot (including between the toes) with dry cloth towel/washcloth

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

Supports foot and ankle during procedure

Empties, rinses, and dries basin

Places basin in designated dirty supply area

Disposes of used linen into soiled linen container

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

Signaling device is within reach

Demonstrated Competency?

Comments:

Part 20: Provides Mouth Care

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

Privacy is provided with a curtain, screen, or door

Before providing mouth care, client is in upright sitting position (75-90 degrees)

Puts on clean gloves before cleaning mouth

Places cloth towel across chest before providing mouth care

Secures cup of water and moistens toothbrush

Before cleaning mouth, applies toothpaste to moistened toothbrush

Cleans mouth (including tongue and all surfaces of teeth), using gentle motions

Maintains clean technique with placement of toothbrush

Candidate holds emesis basin to chin while client rinses mouth

Candidate wipes mouth and removes clothing protector

Disposes of used linen into soiled linen container

Rinses toothbrush and empties, rinses, and dries basin

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

Signaling device is within reach and bed is in low position

Demonstrated Competency?

Comments:

Part 21: Provides Perineal Care (Peri-Care) for Female

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

Privacy is provided with a curtain, screen, or door

Before washing, checks water temperature for safety and comfort and asks client to verify comfort of water

Puts on clean gloves before washing perineal area

Places pad/ linen protector under perineal area including buttocks before washing

Exposes perineal area (only exposing between hips and knees)

Applies soap to wet washcloth

Washes genital area, moving from front to back, while using a clean area of the washcloth for each stroke

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

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

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

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

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

Repositions client

Empties, rinses, and dries basin

Places basin in designated dirty supply area

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

Avoids contact between candidate clothing and used linen

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

Demonstrated Competency?

Comments:

Part 22: Transfers from Bed to Wheelchair Using Transfer Belt

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

Privacy is provided with a curtain, screen, or door

Before assisting to stand, wheelchair is positioned alongside of bed, at head of bed facing foot or foot of bed facing head

Before assisting to stand, footrests are folded up or removed

Before assisting to stand, locks wheels on wheelchair

Before assisting to stand, bed is at a safe level

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

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

Before assisting to stand, client is wearing shoes

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

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

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

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

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

Lowers client into wheelchair

Positions client with hips touching back of wheelchair and transfer belt is removed

Positions feet on footrests

Signaling device is within reach

After completing skill, washes hands

Demonstrated Competency?

Comments:

Part 23: Measures and Records Manual Blood Pressure

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

Before using stethoscope, wipes bell/diaphragm and earpieces of stethoscope with alcohol

Client’s arm is positioned with palm up and upper arm is exposed

Feels for brachial artery on inner aspect of arm, at bend of elbow

Places blood pressure cuff snugly on client’s upper arm, with sensor/arrow over brachial artery site

Earpieces of stethoscope are in ears and bell/diaphragm is over brachial artery site

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

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)

Removes cuff

Signaling device is within reach

Before recording, washes hands

Demonstrated Competency?

Comments:

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