Lansing area healthcare and community education courses.

CNA Clinical Skills Checklist


The checklist for each of the skills that may be on the Clinical Skills Test is provided on the following pages. These checklists are not procedures and are not necessarily provided in the order that you will perform the skill. The skills should not be learned from the checklists; however, the checklists can be helpful for you and your instructor to evaluate your performance in the classroom or clinical setting.

All candidates are scored on Handwashing and on a skill called Indirect Care, which is scored throughout the candidate’s entire test.

Indirect Care represents aspects of care related to resident rights, communication with the resident, resident safety and comfort, and infection control. When reviewing the checklist, you will notice that these checkpoints are a part of every skill.

Handwashing Note: Your handwashing technique is evaluated at the beginning of the test. This skill is not prompted, which means you will not be told to wash your hands. Nurse aides are expected to know to wash their hands before and after physical contact (touching) with the resident.

Handwashing

Does the candidate:
1. Greet resident, address by name and introduce self?
2. Wet hands and apply soap?
3. Work up lather cleansing front and back of hands and wrists, between fingers, around cuticles, under nails, and up wrists (halds-width)?
4. Provide cleansing friction for a minimum of 10 seconds?
5. Remove all soap, rinsing while holding fingers lower than wrists?
6. Dry hands with paper towel and limit contact of towel to cleansed skin surfaces?
7. Turn off water with paper towel and dispose of towel?
8. Complete task without contaminating hands, such as against sink?
9. Promote resident comfort throughout procedure?

Bedmaking - Unoccupied

Does the candidate:
1. Remove linen rolling away from uniform with dirty side in?
2. Secure bottom sheet to mattress at top and sides of mattress for flat sheet and on all sides if using fitted sheets?
3. Center drawsheet over bottom sheet and secure, leaving wrinkle free?
4. Align top sheet at/near head of mattress?
5. Leave sides of top sheet untucked?
6. Secure top sheet under foot of mattress?
7. Replace pillowcase?
8. Apply blank and/or bedspread over top sheet and secure at foot of mattress?
9. Utilize standard (universal) precautions throughout procedure to include handwashing at the beginning and end of task?
10. Promote resident safety throughout procedure?

Change an Occupied Bed

Does the candidate:
1. Greet resident, address by name and introduce self?
2. Provide explanations to resident before beginning and throughout procedure?
3. Lower head of bed before changing linen?
4. Position resident safely on side and on nonworking side of bed?
5. Roll dirty bottom linen and tuck under resident?
6. Place clean bottom linen on working side, securing under mattress at head of bed and along working side?
7. Extend clean bottom linen on working side, across bed and tuck under resident?
8. Ask or assist resident to turn to face opposite side of bed?
9. Complete placement of bottom linen, securing flat sheet under mattress at head of bed and on along working sides?
10. Leave bottom linen free of wrinkles?
11. Place clean top linen(s)?
12. Avoid exposure of resident throughout procedure?
13. Secure top linen(s) under foot of mattress allowing room for foot movement?
14. Leave top linen(s) untucked on sides?
15. Replace pillowcase?
16. Utilize standard (universal) precautions throughout procedure to include handwashing at the beginning and end of task?
17. Promote resident comfort throughout procedure?
18. Promote resident rights throughout procedure?
19. Promote resident safety throughout procedure?

Change of Position

Does the candidate:
1. Greet resident, address by name and introduce self?
2. Provide explanations to resident before beginning and throughout procedure?
3. Position and align resident to ensure safe turning?
4. Position device/padding/pillow behind resident’s back to maintain side-lying position?
5. Align legs with knees slightly bent to alleviate hip and back strain?
6. Position device/padding/pillow between legs to avoid contact between bony prominences of knees and ankles?
7. Position device/padding/pillow between legs to ensure (upper) hip and leg in proper alignment?
8. Adjust resident’s left arm and shoulder to avoid pressure?
9. Position pillow to provide support/alignment of neck and head?
10. Provide positioning device/padding/pillow to support right shoulder/arm?
11. Utilize standard (universal) precautions throughout procedure to include handwashing at the beginning and end of task?
12. Promote resident comfort throughout procedure?
13. Promote resident rights throughout procedure?
14. Promote resident safety throughout procedure?

Change of Position with Backrub

Does the candidate:
1. Greet resident, address by name and introduce self?
2. Provide explanations to resident before beginning and throughout procedure?
3. Position and align resident to ensure safe turning?
4. Warm lotion in hands before applying to resident’s back?
5. Provide backrub using strokes to cover from base of spine and working towards neck and shoulders using gentle strokes and circular motions?
6. Remove unabsorbed excess lotion on resident’s back?
7. Position device/padding/pillow behind resident’s back to maintain side-lying position?
8. Align legs with knees slightly bent to alleviate hip and back strain?
9. Position device/padding/pillow between legs to avoid contact between bony prominences of knees and ankles?
10. Position device/padding/pillow between legs to ensure (upper) hip and leg in proper alignment?
11. Adjust resident’s left arm and shoulder to avoid pressure?
12. Position pillow to provide support/alignment of neck and head?
13. Provide positioning device/padding/pillow to support right shoulder/arm?
14. Utilize standard (universal) precautions throughout procedure to include handwashing at the beginning and end of task?
15. Promote resident comfort throughout procedure?
16. Promote resident rights throughout procedure?
17. Promote resident safety throughout procedure?

Transfer

Does the candidate:
1. Greet resident, address by name and introduce self?
2. Provide explanations to resident before beginning and throughout procedure?
3. Place wheelchair near bed before assisting resident to sitting position at edge of bed?
4. Lock wheelchair before beginning transfer?
5. Remove or swing footrests out of way before transferring resident?
6. Place nonskid footwear on resident before transferring resident?
7. Provide support to assist resident to sitting position on side of bed?
8. Apply gait belt securely around waist and ensure gait belt is not restricting circulation or breathing, or injuring skin?
9. Ensure resident’s feet are flat on the floor before beginning transfer?
10. Position wheelchair before transfer with front interior wheel close to bed to facilitate pivot transfer?
11. Stand in front of resident, bracing resident’s legs, reaching around resident, under arms to hold gait belt at back?
12. Maintain own body mechanics in assisting resident to stand?
13. Complete transfer as a pivot?
14. Maintain own body mechanics in assisting resident to sit in wheelchair?
15. Provide support for controlled gentle lowering of resident into seat of wheelchair?
16. Position resident in proper body alignment in wheelchair with resident’s hips in back of seat?
17. Place resident’s feet on footrests?
18. Remove gait belt from resident’s waist without harming resident when transfer completed?
19. Utilize standard (universal) precautions throughout procedure to include handwashing at the beginning and end of task?
20. Promote resident comfort throughout procedure?
21. Promote resident rights throughout procedure?
22. Promote resident safety throughout procedure?

Dressing

Does the candidate:
1. Greet resident, address by name and introduce self?
2. Provide explanations to resident before beginning and throughout procedure?
3. Include resident in decision-making about clothing to wear?
4. Collect all garments (sockes, undergarments, pants, shirt or dress) before undressing from gown?
5. Support affected right arm while undressing and dressing?
6. Remove gown from affected right arm last?
7. Dress affected right arm first?
8. Gather up sleeve to ease pulling over affected arm?
9. Assist resident to put on underwear, T-shirt, slacks and top/or dress, and socks?
10. Move resident’s extremities gently and without over-extension or force when assisting with undressing and dressing?
11. Adjust all clothing for comfort, neatness and alignment and close all fasteners?
12. Place dirty gown in hamper?
13. Utilize standard (universal) precautions throughout procedure to include handwashing at the beginning and end of task?
14. Promote resident comfort throughout procedure?
15. Promote resident rights throughout procedure?
16. Promote resident safety throughout procedure?

Feeding

Does the candidate:
1. Greet resident, address by name and introduce self?
2. Provide explanations to resident before beginning and throughout procedure?
3. Raise head of bed with resident in sitting position (minimum 60°) and in proper alignment, before feeding?
4. Offer and assist resident to wash hands before feeding?
5. Sit to maintain eye level contact with resident while feeding?
6. Apply clothing protector before feeding?
7. Offer fluid to drink to moisten mouth before offering food?
8. Use spoon to feed?
9. Offer fluids to drink throughout feeding (after at least every 3-4 bites of food)?
10. Check to see if resident has swallowed before offering next bite?
11. Offer encouragement to resident toward maximizing food and fluid intake?
12. Converse with resident during meal?
13. Leave area around resident’s mouth clean and dry?
14. Remove protective clothing cover and tidy work area at completion of task?
15. Accurately record percent of food intake on Food Acceptance Record?
16. Utilize standard (universal) precautions throughout procedure to include handwashing at the beginning and end of task?
17. Promote resident comfort throughout procedure?
18. Promote resident rights throughout procedure?
19. Promote resident safety throughout procedure?

Blood Pressure

Does the candidate:
1. Greet resident, address by name and introduce self?
2. Provide explanations to resident before beginning and throughout procedure?
3. Expose the resident’s antecubital area?
4. Position the resident’s arm with palm up, and elbow at the level of the heart?
5. Wrap cuff evenly around arm (bladder over brachial artery), with bottom of cuff positioned within an inch above the antecubital?
6. Locate the brachial artery before placing the stethoscope?
7. Position diaphragm of stethoscope over brachial artery, and place stethoscope earpieces in his/her ears, before inflating cuff?
8. Inflate cuff safely (no more than 30mm past point pulse last felt or heard)?
9. Control slow deflation of cuff?
10. Record blood pressure within +/- 4mm of CSO’s systolic and diastolic readings?
11. Clean (earpieces and diaphragm of stethoscope with alcohol swab or other disinfectant) and store equipment at completion of procedure and leave work area tidy?
12. Utilize standard (universal) precautions throughout procedure to include handwashing at the beginning and end of task?
13. Promote resident comfort throughout procedure?
14. Promote resident rights throughout procedure?
15. Promote resident safety throughout procedure?

Pulse and Respirations

Instructions: Measure the resident’s pulse and respirations. Count each one for one full minute. Record your results on the Pulse and Respiration Form.

Does the candidate:
1. Greet resident, address by name and introduce self?
2. Provide explanations to resident before beginning and throughout procedure?
Pulse
3. Support resident’s forearm while taking pulse?
4. Place fingers over radial pulse?
5. Count pulse for at least one full minute?
6. Record pulse rate?
7. Report pulse rate within +/- 4 beats per minute of CSO’s measurement?
Respirations
8. Conceal counting of respirations by not telling resident?
9. Count respirations for at least one full minute?
10. Record rate of respirations?
11. Report respirations within +/- 2 breaths per minute of CSO’s measurement?
12. Utilize standard (universal) precautions throughout procedure to include handwashing at the beginning and end of task?
13. Promote resident comfort throughout procedure?
14. Promote resident rights throughout procedure?
15. Promote resident safety throughout procedure?

Bedpan

Does the candidate:
1. Greet resident, address by name and introduce self?
2. Provide explanations to resident before beginning and throughout procedure?
3. Place protective pad on bed over bottom sheet, under buttocks before placing bedpan?
4. Position bedpan under resident according to form/shape of the selected bedpan to allow for comfort and collection?
5. Raise the head of bed to level of resident’s comfort, after positioning the resident on the bedpan?
6. Provide resident with toilet paper before removing bedpan?
7. Lower head of bed before removing bedpan?
8. Empty contents of bedpan into toilet?
9. Rinse, dry and store bedpan in bottom shelf/drawer of bedside cabinet?
10. Utilize standard (universal) precautions throughout procedure to include handwashing at the beginning and end of task?
11. Promote resident comfort throughout procedure?
12. Promote resident rights throughout procedure?
13. Promote resident safety throughout procedure?

Measure and Record Contents of Urinary Drainage Bag

Does the candidate:
1. Greet resident, address by name and introduce self?
2. Provide explanations to resident before beginning and throughout procedure?
3. Empty urinary drainage bag into graduated container without touching tubing against the container?
4. Wipe drain with alcohol swab after emptying urine contents?
5. Clamp and tuck drain into protective pocket of urinary drainage bag after emptying?
6. Leave bag secured to nonmovable part of bed, ensuring drainage bag and tubing are not touching floor?
7. Set graduated container on flat surface in bathroom to read?
8. Position self to read urine amount in graduated container at eye level?
9. Empty urine in graduated container into toilet, rinse container and store?
10. Remove gloves and wash hands before recording output?
11. Record output within +/- 50cc’s of CSO’s reading?
12. Record output as urine and indicate the correct time on the I&O sheet?
13. Utilize standard (universal) precautions throughout procedure to include handwashing at the beginning and end of task?
14. Promote resident comfort throughout procedure?
15. Promote resident rights throughout procedure?
16. Promote resident safety throughout procedure?

Catheter Care

Does the candidate:
1. Greet resident, address by name and introduce self?
2. Provide explanations to resident before beginning and throughout procedure?
3. Apply gloves before beginning catheter care?
4. Place incontinent pad under buttocks before beginning procedure?
5. Ensure water is at safe and comfortable temperature?
6. Use soapy washcloth to clean around the catheter at insertion site?
7. Change spot on soapy washcloth for each washing stroke, from front to back?
8. Cleanse catheter, washing away from body and down the catheter about 3-4 inches?
9. Use clean wet washcloth for rinsing all washed areas?
10. Change spot on washcloth for each rinsing stroke, wiping from front to back?
11. Dry entire perineal area, from front to back, and catheter after completing cleaning and rinsing of each area?
12. Leave tubing coiled on bed, without kinks, obstructions, or loops of tubing hanging over the side of bed?
13. Remove incontinent pad at completion of procedure?
14. Clean and store equipment at completion of procedure and leave work area tidy?
15. Utilize standard (universal) precautions throughout procedure to include handwashing at the beginning and end of task?
16. Promote resident comfort throughout procedure?
17. Promote resident rights throughout procedure?
18. Promote resident safety throughout procedure?

Hair and Nail Care

Does the candidate:
1. Greet resident, address by name and introduce self?
2. Provide explanations to resident before beginning and throughout procedure?
3. Use comb or brush to groom hair, pulling gently through hair without breaking hair or causing discomfort to the resident?
4. Soak nails in water of safe, comfortable temperature before removing residue from under nails?
5. Remove residue from under nails with either nailbrush or orangewood stick?
6. Dry hands after soaking?
7. Leave nails smooth and free of jagged edges?
8. Apply lotion to hands after nails are cleaned and shaped?
9. Clean and store equipment at completion of procedure and leave work area tidy?
10. Utilize standard (universal) precautions throughout procedure to include handwashing at the beginning and end of task?
11. Promote resident comfort throughout procedure?
12. Promote resident rights throughout procedure?
13. Promote resident safety throughout procedure?

Height and Weight

Does the candidate:
1. Greet resident, address by name and introduce self?
2. Provide explanations to resident before beginning and throughout procedure?
3. Ensure scale balanced zero before measuring weight?
4. Provide assistance to help resident onto scale platform?
5. Provide assistance to help resident off scale platform?
6. Record resident’s height within +/-1 inch of CSO’s measurement?
7. Record resident’s weight within +/-2 lbs. of CSO’s measurement?
8. Utilize standard (universal) precautions throughout procedure to include handwashing at the beginning and end of task?
9. Promote resident comfort throughout procedure?
10. Promote resident rights throughout procedure?
11. Promote resident safety throughout procedure?

Mouth Care ~ Brush Teeth

Does the candidate:
1. Greet resident, address by name and introduce self?
2. Provide explanations to resident before beginning and throughout procedure?
3. Position resident in a sitting position (minimum of 45 degrees) before beginning mouth care?
4. Place protective covering over resident’s clothing before providing mouth care?
5. Moisten toothbrush with water and apply toothpaste before brushing teeth?
6. Brush all surfaces of teeth and gumline with a gentle motion?
7. Offer resident opportunity to rinse mouth and spit into emesis basin as needed?
8. Leave area around resident’s mouth clean and dry?
9. Clean and store equipment at completion of procedure, remove protective clothing cover and leave work are tidy?
10. Utilize standard (universal) precautions throughout procedure to include handwashing at the beginning and end of task?
11. Promote resident comfort throughout procedure?
12. Promote resident rights throughout procedure?
13. Promote resident safety throughout procedure?

Mouth Care ~ Dentures

Does the candidate:
1. Greet resident, address by name and introduce self?
2. Provide explanations to resident before beginning and throughout procedure?
3. Transport denture to sink in a denture cup or emesis basin?
4. Line sink with washcloth or paper towels, or fill sink with water to reduce risk of denture breakage?
5. Use cool or tepid running water to clean and rinse dentures?
6. Brush all surfaces of the dentures?
7. Brush dentures over sink?
8. Rinse dentures to remove toothpaste/denture cleaner?
9. Store clean dentures in denture cup filled with clean cool or tepid water?
10. Protect resident’s clothing before beginning mouth care?
11. Provide mouth care to resident using a toothbrush/ toothette/swab to massage gums, freshen mouth and remove food residue from gum pockets?
12. Offer resident the opportunity to rinse mouth and spit into emesis basin?
13. Leave area around resident’s mouth clean and dry?
14. Clean and store equipment after use and leave work are tidy?
15. Utilize standard (universal) precautions throughout procedure to include handwashing at the beginning and end of task?
16. Promote resident comfort throughout procedure?
17. Promote resident rights throughout procedure?
18. Promote resident safety throughout procedure?

Partial Bed Bath

Does the candidate:
1. Greet resident, address by name and introduce self?
2. Provide explanations to resident before beginning and throughout procedure?
3. Ensure water is at safe and comfortable temperature?
4. Drape/cover resident to expose only area being cleansed?
5. Use washcloth without soap to wash face?
6. Wipe eye from the inside to out, changing to clean area of washcloth before returning to inner eye and cleansing other eye?
7. Leave face clean and dry?
8. Contain corners of washcloth while washing and rinsing (e.g., forming mitt)?
9. Protect bedding by repositioning towel under resident throughout washing and rinsing?
10. Wash neck, hands, arms and chest using small amount of soap applied directly to washcloth (avoid soap poured directly into bath basin)?
11. Rinse neck, hands, arms and chest removing soap residue?
12. Dry neck, hands, arms and chest?
13. Ask or assist resident to turn safely on side to wash back?
14. Wash, rinse and dry back?
15. Warm lotion in hands before applying to resident’s back?
16. Provide backrub from base of spine and work toward neck and shoulders using gentle strokes and circular motions?
17. Remove unabsorbed excess lotion from resident’s back?
18. Replace hospital gown without exposing resident and secure gown in back?
19. Clean and store equipment after use and leave work area tidy?
20. Utilize standard (universal) precautions throughout procedure to include handwashing at the beginning and end of task?
21. Promote resident comfort throughout procedure?
22. Promote resident rights throughout procedure?
23. Promote resident safety throughout procedure?

Perineal Care ~ Female

Instructions: The female resident has been incontinent of urine and needs perienal care. The pad under the resident is wet, but the hospital gown is dry.

Does the candidate:
1. Greet resident, address by name and introduce self?
2. Provide explanations to resident before beginning and throughout procedure?
3. Apply gloves before touching soiled pad?
4. Replace soiled pad under resident’s buttocks before beginning perineal care?
5. Ensure water in basin is at safe and comfortable temperature?
6. Use soapy washcloth to cleanse genital area?
7. Pass over urinary meatus with first stroke of washcloth?
8. Change spot on washcloth for each washing stroke?
9. Wipe from front to back with all washing and rinsing strokes?
10. Remove all soap from perineal area using a fresh wet washcloth for rinsing?
11. Change spot on washcloth for each rinsing stroke?
12. Cleanse all skin folds of perineal area, front and back?
13. Dry entire perineal area, from front to back, after completing cleansing and rinsing of each area?
14. Replace basin of water during task if it becomes cold or soapy?
15. Position resident on side for cleansing of buttocks and rectal area?
16. Cleanse, rinse and dry rectal and buttocks area?
17. Leave resident on dry underpad at completion of procedure?
18. Clean and store equipment at completion of procedure and leave work area tidy?
19. Utilize standard (universal) precautions throughout procedure to include handwashing at the beginning and end of task?
20. Promote resident comfort throughout procedure?
21. Promote resident rights throughout procedure?
22. Promote resident safety throughout procedure?

Range of Motion ~ Lower Extremity

Does the candidate:
1. Greet resident, address by name and introduce self?
2. Provide explanations to resident before beginning and throughout procedure?
3. Support extremity above and below joints throughout ROM exercises?
4. Take resident’s hip and knee through ROM, flexing knee and hip, raising toward torso, returning back to mattress?
5. Take resident’s hip through abduction/adduction ROM exercises (moving leg away from midline and returning to midline, with leg lifted slightly off the bed)?
6. Take resident’s hip through rotation ROM exercises (e.g., rolling leg toward midline and out toward bed, or by turning foot toward midline and out toward edge of bed)?
7. Flex and extend ankle through ROM exercises?
8. Rotate ankle through ROM exercises?
9. Provide three repetitions of each ROM exercise?
10. Determine resident’s comfort with movement either verbally or by observing resident’s face throughout ROM exercises?
11. Control extremity throughout ROM exercises providing smooth, slow, nonforceful movement?
12. Utilize standard (universal) precautions throughout procedure to include handwashing at the beginning and end of task?
13. Promote resident comfort throughout procedure?
14. Promote resident rights throughout procedure?
15. Promote resident safety throughout procedure?

Range of Motion ~ Upper Extremity

Does the candidate:
1. Greet resident, address by name and introduce self?
2. Provide explanations to resident before beginning and throughout procedure?
3. Support extremity above and below joints throughout ROM exercises?
4. Take resident’s shoulder through ROM, raising and lowering straightened arm along side, toward head of bed and back to mattress?
5. Take resident’s shoulder through abduction/ adduction ROM exercises (moving straightened arm away from side, up toward head, and returning along resident’s side)?
6. Take resident’s shoulder through rotation ROM exercises (positioning shoulder extended straight to the side with elbow flexed, rotating shoulder by moving forearm forward toward mattress and backward toward mattress)?
7. Flex and extend elbow through ROM exercises?
8. Rotate wrist through ROM exercises (e.g., gently moving wrist in circular motion to include flexion and extension, abduction, and adduction of wrist)?
9. Flex and extend finger and thumb joints through ROM exercises?
10. Provide three repetitions of each ROM exercise?
11. Determine resident’s comfort with movement either verbally or by observing resident’s face throughout ROM exercises?
12. Control extremity throughout ROM exercises providing smooth, slow, nonforceful movement?
13. Utilize standard (universal) precautions throughout procedure to include handwashing at the beginning and end of task?
14. Promote resident comfort throughout procedure?
15. Promote resident rights throughout procedure?
16. Promote resident safety throughout procedure?



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