June 13, 2012
Lisa Johnson R.N.
Testing Procedure:
Need to be on time, wear scrubs, have hair pulled back, have a wrist watch and have I.D. and voucher.
What are students tested on?
· Vital Signs:
Temp: How to correctly obtain a tympanic temperature: many forget to pull back on the ear gently.
Pulse: How to locate a radial pulse. Please teach them how to obtain an apical pulse.
Respirations:
B/P: Don't re-inflate cuff. Do NOT tighten B/P valve too tight, just turn until it stops.
Make sure students know how to time for 30 seconds or 1 minute and do any math involved. Students are allowed to use a calculator for the skill and written tests.
· Beginning/Ending Procedure:
Many are forgetting to verbalize/demonstrate-WEARING GLOVES, providing privacy, raising bed to working height, return bed to lowest position & report and document.
· Critical Criteria:
Critical criteria include behaviors that are part of EVERY skill tested.
1. Infection control and universal precautions: (Following all rules of medical asepsis)
2. Safety: (Protecting resident and self from physical harm)
3. Residents’ rights: (Taking action to prevent or minimize emotional stress to resident)
4. Communication: (Explaining procedure to resident prior to initiating it)
5. Recognizing and reporting changes: (Observing and reporting abnormalities)
· Hand Washing: Demonstrating hand washing is necessary and is evaluated as part of the critical criteria. Approximately 40% of students are doing this WRONG!!!
Hand washing Procedure
1. Don’t touch the sink with your uniform
2. Turn water to warm
3. Wet and soap hands
4. Wash hands with fingers down for 15-30 seconds, including wrist, nails and between fingers
5. Rinse with fingertips down
6. Use dry paper towel to dry hands
7. Use same paper towel to turn off faucets
8. Discard paper towels appropriately (Do not use it to finish drying your hands)
Prompts: Each student will be given 2 prompts (helpful hints during the test, if needed). What is a prompt?
What skills do I think most people struggle on?
Right vs. Left: (Right vs. left side of resident, this will count as a prompt. I give at least one prompt a day for this), hand washing, placing Nasal Cannula, obtaining accurate height, log roll with hip fracture precautions, dressing/undressing, PROM and ambulating (placing cane and wheelchair on strong side).
Overview of Skills:
Each student will be given a scenario with 5 skills from the list below.
Students are expected to demonstrate skills.
Students need to physically practice each skill, not just watch.
SKILL 1: PRESSURE ULCER PREVENTION
Most students do this skill very good!!!
SKILL 2: POSITION FOLEY CATHETER/BAG/TUBING
Some students forget to place tubing over leg and attach to bed frame (not over or on side rail) always-below level of bladder.
SKILL 3: OXYGEN
MANY students have never placed a nasal cannula before.
SKILL 4: OCCUPIED DRAW SHEET CHANGE
Many students forget to raise the side rail when turning patient. Some students do not know what the draw sheet is.
SKILL 5: APPLY COLD PACK OR WARM COMPRESS
Most students do fine with this skill, they will need to verbalize how often to check/remove compress.
SKILL 6: MEASURE AND RECORD FLUID INTAKE
They need to calculate intake by subtracting what is remaining in container from the amount they are told was originally in the container.
SKILL 7: CONVERTING OUNCES TO ML’S
Some students forget the conversion rate.
SKILL 8: EMPTY DOWN DRAINAGE BAG AND MEASURE/RECORD URINE OUTPUT
Many students do fine with this skill.
SKILL 9: ISOLATION PRECAUTIONS
Some students forget what order to put on/remove PPE.
SKILL 10: POSTMORTEM CARE:
Due to the length of time it would take to perform all of the steps we have students verbalize the bathing and oral care.
SKILL 11: ABDOMINAL THRUST (Conscious Patient only)
They need to remember to ask “Are you choking”. Many students do not know correct placement.
SKILL 12: OBTAIN AND RECORD WEIGHT AND HEIGHT
Most students do fine measuring the weight. Many students do not know how to measure height.
SKILL 13: APPLICATION OF ANTI-EMBOLISM STOCKINGS (TED hose)
Some students do not know how to place the heel in the correct location.
SKILL 14: PASSIVE RANGE OF MOTION 2 JOINTS
Most students do not do this properly. They need to know the terms flexion, extension, adduction, abduction or rotation- how to take the joint through all ranges of motion.
SKILL 15: MOVING AND POSITIONING RESIDENTS
Most students do well at positioning. Many students forget to raise side rail while turning patient.
SKILL 16: ASSISTING TO AMBULATE
Many students forget cane should be placed on residents’ strong side.
SKILL 17: TRANSFERRING FROM A BED TO A WHEELCHAIR
Many students are forgetting to lock the wheelchair brakes. MANY DO NOT KNOW WHERE TO PLACE THE WHEELCHAIR WHEN THEY TRANSFER. They do not know what a “Pivot Transfer” is.
SKILL 18: RESTRAINTS
Some students forget how to tie a quick-release knot.
SKILL 19: DENTURE CARE
Some students forget to line the sink.
SKILL 20: LOG ROLLING RESIDENT WITH HIP FRACTURE PRECAUTIONS
This is a very difficult skill for MOST students. They are forgetting to use at least 2 persons and the draw sheet. Resident should not be rolled onto injured side and they also forget to place abduction splint or pillows between legs to support hip.
SKILL 21: ORAL CARE FOR AN UNCONSCIOUS RESIDENT/ASPIRATION PRECAUTIONS
Most students do fine with skill. A few students do not know they should not use toothpaste and a toothbrush for this skill.
SKILL 22: BACK RUB/MASSAGE
Most students do fine with this skill.
SKILL 23: FOOT/TOENAIL CARE
Most students do fine with this skill.
SKILL 24: DRESSING/UNDRESSING RESIDENT
Many students forget to dress weak side first and undress weak side last.
SKILL 25: SHAVING
Most students do fine with this skill.
SKILL 26: PROVIDE PERI-CARE
Most students are doing fine with this.
SKILL 27: ASSISTING WITH A BEDPAN/FRACTURE PAN
Some students do not know how to properly place fracture pan.
SKILL 28: COLLECTING A STOOL SPECIMEN
Most students do not know to place the label on the specimen container and not just in the bag.
