feeling, warmth, and color

This is a brand, I am not sure if you would want to use it.

This is the wrong term. It should be "Inversion". Supination is the combined movement of inversion, adduction, and plantarflexion.

This is the wrong term, it should be "Eversion". Pronation is the combined movement of eversion, abduction, and dorsiflexion.

DHS requires the entire skill to be taught. I have outlined the steps below that are missing from the list.

___ 5 Shoulder Exercises: ___ Horizontal Abduction/Adduction: Start by placing the client’s straightened arm away from the body at shoulder level (palm up), move the arm upward so the fingers are pointing towards the ceiling, then bend the arm at the elbow to touch the client’s fingertips to the opposite shoulder. Then reverse the motions to return the arm to the original position at shoulder level AND ___ Rotation: With the arm still at shoulder level, bend the client’s arm at the elbow so the palm is facing the foot of the bed. Move the hand back toward the head of the bed and then downward towards the floor. This movement rotates the shoulder joint.

"any pain or discomfort" is required

and the palm facing the leg,

The wheelchair should never go towards the HOB because the night stand is there. It should always be moved to the foot of the bed with the breaks locked before they sit the resident on the side of the bed. It should be kept at the foot of the bed so that when you swing the residents feet around, they do not hit the wheelchair. Then once the resident is in a seated position on the side of the bed, the CNA pulls the wheelchair forward so that it is touching the residents thigh area and so that the wheel is touching the bed. This way the CNA never walks away from the residents side to obtain the wheelchair giving them the opportunity to fall either forward or backwards while sitting on the side of the bed. (Fall Prevention)

These are 2 different skills - pivot transfer and ambulation.

Before pivoting, they should be asking the resident again if they are feeling dizzy or light-headed because going from a seated position to a standing position frequently causes this. If they are feeling dizzy or light-headed, they are able to immediately sit them back down onto the bed instead of having them pass out mid-pivot.

feet FLAT on the floor

This should be moved up to bullet point 2. They should be done at the same time.

Pivot Transfer

to wheelchair

I typically try to stay away from using the term TED Hose as this is a brand vs a "Compression Sock". Many facilities no longer use TED Hoses.

Although we are not teaching the students to test, the set up for this skill should be the same. The patient should be lying in the bed, then sat on the side of the bed, they then apply the gait belt, assist the patient to a standing position, and ambulate to the wheelchair. Here is what my skills checklist says... * ASSIST TO AMBULATE USING A GAIT OR TRANSFER BELT NOTE: 3A is done for testing purposes. SET UP: The bed brakes and wheelchair bakes are unlocked. Place the wheelchair 10 steps away from the bed ___ 1 Preparation steps (SKWIPES) (Sanitize, Explain) PLUS… • Obtain a gait belt and gripper socks of the proper size. • Obtain a wheelchair and position it out of the way with the brakes LOCKED so that the client can sit in it after ambulating 10 steps. For state testing, the observer will position the wheelchair 10 steps away, but you are still responsible for locking the brakes. • Elevate the head of the bed to the high Fowler’s position to PREPARE to ASSIST the client to a seated position on the bedside.

___ 2 BEFORE assisting the client to a standing position: • Check and/or lock the bed brakes. • Ensure the client is wearing non-skid footwear. (It is easiest to do this while the client is still lying down in bed.) • ASSIST the client to a seated position on the bedside. Ensure the bed is at a safe level so the client's feet are flat on the floor. • Ensure the client is “steady” before applying gait belt. Ask them if they are feeling dizzy or light-headed. • PROPERLY apply the transfer belt securely at the waist over their clothing/gown AND CHECK THE BELT FOR TIGHTNESS (2 fingers). Use your feet to prevent the client from slipping by angling them in front of the client’s feet. • Grasp the transfer belt at the backside of the client’s waist and provide instructions to enable the client to assist in standing, including a prearranged signal to alert the client to begin standing (Ex. “Let’s stand on the count of 3 --- 1…2…3…”).

___ 3A Ambulatory – (No assistive devices needed) Position yourself in front of the client. Get close to the client, bend your knees, if able, instruct the client push off the bed with their hands. Grasp the gait belt on both sides of the waist with your palms and fingertips up. Using proper body mechanics, direct the client to stand on the count of 3, PAUSE before ambulating to ensure the client feels steady.

___ 3B If using a walker, position and stabilize the walker in front of the client. Grasp the gait belt from the backside of the waist with your palm up and use the other hand to stabilize the walker. Direct the client to stand on the count of 3. Assist the client to a standing position, while stabilizing the walker. Ensure the client feels steady.

___ 3C If using a cane, bring it close to the bedside so that it is within reach. Assist the client to a standing position as if they were ambulatory. Once standing, provide the cane to the client. The cane should be held in the hand that is on the client's strong side.

___ 4 Position yourself slightly behind and on the client’s weaker side. Prepare to start off walking on the same foot as the client.

___ 5 Hold the gait belt by the backside of the waist with one hand, palm up. Offer the client your other hand as a stabilizer (if the client falls, this prevents you from having to hold them dangling with one hand by the belt) and safely ambulate the client at least 10 steps.

___ 6 After ambulating, assist the client to pivot turn in front of the wheelchair. Assist the client into their wheelchair in a safe, controlled manner (have the client back up until their legs touch the seat of the wheelchair and have them feel for the armrests before assisting them to sit). Remove the transfer belt. NEVER pull a client down into a chair.

___ 7 Completion steps (CLOWDS). (Be Respectful, Provide Call Light, Sanitize your Hands)

and ask the resident to bed their knees. (No one urinates with their legs straight out. It will make a mess and urine will be everywhere.)

This step should be above discarding the soiled linen in the designated laundry hamper.

if they wiped themselves or assist the client to clean their perineal area.

Because bedpan is a general term, this should say a standard or fracture pan. This verbiage will change statewide as of 11/1/26. The word would need to be updated throughout this skill.

and that it is placed as close to the underarm as possible to prevent the skin from rubbing.

This works wonderful if the client is able to assist but not for an unresponsive resident who still needs to be repositioned every 2 hours.

This is good if there are 2 staff but not if they are working alone. The 3 step method should also be discussed because when they are testing, they are testing without a partner.

As of 11/1/26, this terminology is changing to "Raise the side rail on the side of the bed to which the client will be facing to ensure safety."

They should have a sock on between the skin and device.

This skill requires a stand, pivot, sit method... not a stand, pivot, side step a couple times, and then sit like it is done in the video. If the resident could walk we would have them walking forward vs sideways or backwards. This is how it was explained to me by DHS which is why they require that the front of the wheelchair be pulled all the way up so that it is touching the residents thigh area and that the wheel of wheelchair is touching the bed.

In the video she talks about how the belt needs to go through the teeth first and then the larger opening. We explain to our students that you have to "Chew your food first BEFORE you swallow". It helps them remember the process. Not sure if you want to use this

If you wish to add it... Here is the skills checklist that I use with my students. I teach this to all of my students but it is in addition to the 75 hour program. Our program is 77 hrs just so we are able to teach it.

MEASURES AND RECORDS BLOOD PRESSURE (This is taught in addition to the 75-hour training program)

___ 1 Preparation steps (SKWIPES) Supplies Needed: sphygmomanometer, stethoscope, alcohol wipe to clean ear pieces ___ 2 Position client. Blood pressure is typically taken with the client in a seated or upright position, the arm should be placed palm up and resting comfortably on the bed, their lap, tabletop, etc. and both feet should be flat on the floor, if sitting. <br /> 3 Clean the diaphragm and earpieces of the stethoscope with an alcohol wipe and discard the wipe. ___ 4 Loosen the screw on the bulb by turning it to the left. Squeeze any excess air out of the cuff. Expose the person’s upper arm and locate the brachial pulse. This is found slightly above the crease of the elbow in the upper arm to the medial side of the bicep muscle. ___ 5 Place the cuff snugly on person’s arm about one inch above the elbow and adjust the cuff so that the arrow/artery marker is directly over the brachial artery.<br /> 6 Place the earpieces in your ears with the tips facing forward toward your nose. Place the stethoscope diaphragm over the brachial pulse. ___ 7 Inflate the cuff by first tightening the screw (turning it to the right) and pumping the bulb to fill the cuff with air. The cuff should be inflated to 30-40 mm Hg above the person’s normal systolic blood pressure. Once inflated, let air the out slowly (2 – 4 mm Hg per <br /> second) while listening for the first pulse sound (the first beat you can hear) – remember that number – and then listen for when the pulse sounds stop - remember that number. The number for the first beat that you hear was the systolic pressure and the number where you stopped hearing beats was the diastolic pressure. Deflate the cuff all the way and remove it from the person’s arm. ___ 8 Record your reading as a fraction with the systolic pressure on top and the diastolic pressure on the bottom. ___ 9 Clean up and put away your supplies. Completion steps (CLOWDS). Normal AVERAGE blood pressure is 120/80. Notes: • No caffeine or nicotine should be used 30 minutes prior to taking a blood pressure • Tight clothing or bulky clothing may need to be removed before taking a blood pressure • Taking a blood pressure immediately after a previous measurement will elevate the second reading – You should wait one full minute before retaking or switch to another arm • Affected arms/limbs should not be used to measure blood pressure – Ex. Affected side of a client with a stroke, side of a mastectomy, arm used for dialysis, injured/paralyzed side, etc. • If person was physically active, allow them to rest for at least 5 minutes prior to obtaining their blood pressure • The person should avoid talking while their blood pressure is taken • A cuff that is placed to tightly can artificially elevate blood pressure while a cuff that is too loose can artificially lower blood pressure

We emphasize not using your thumb when taking a pulse on a resident. The person in the video is using her thumb.

Should this be listed with 6.3 Pain?

Here is the checklist we use with our students... PROVIDING POSTMORTEM CARE - This is a general guideline, please ensure that you are following your facilities policies and procedures. ___ 1 Ensure with the nurse that cares are ready to be completed. ___ 2 If family is present, greet them sympathetically, ask if they have any requests for the preparation or viewing of the body (such as position of the body, special clothing, jewelry, etc.) If they express any religious or cultural preferences, accommodate them as much as possible. ___ 3 If the family wishes to be present or assist with care, explain/talk them through each step of the procedure/process. ___ 4 Perform preparation steps (SKWIPES), including gathering extra PPE for family members if needed. ___ 5 Cover the over-bed table with a towel and fill the wash basin with warm water. Place the basin and supplies on the table. ___ 6 Put on gloves and/or gown per facility policy. Lower the bed and place the client into the supine position. ___ 7 Place a bath blanket over the body and remove client’s soiled clothing. ___ 8 If needed, change the fitted sheet. Place an absorbent pad under the client’s buttocks. Urine/feces is often expelled as the client is moved. ___ 9 IF APPROPRIATE per facility policy, remove indwelling devices (e.g., urinary catheter, endotracheal tube), If an autopsy is to be performed, DO NOT remove any indwelling devices. ___ 10 If needed, gently close the client’s eyes by pulling the eyelids down over the eyes. Also gently close the mouth if open. A rolled towel can be placed under the chin to stabilize the jaw. ___ 11 If the client has dentures that are not in his or her mouth, place them there. If the dentures do not stay securely in the mouth, place them in a labeled denture cup and ensure that they are transported with the client’s body to the mortuary. ___ 12 Remove or place jewelry ensuring that you are following facility policy (wedding and engagement rings are typically left on) and per family wishes. Place remaining jewelry in an envelope or small plastic bag. Record each item on an inventory sheet as it’s removed. ___ 13 Provide client with a COMPLETE bed bath. Dress the client in a clean gown or the preferred clothing. Urine/feces is also often expelled when the client is moved for transport, so a clean incontinence brief should be placed after the bath is completed. ___ 14 Place a clean sheet over the client’s body up to the chin area. Position the client’s hands on top of the abdomen so one hand is placed on top of the other hand. ___ 15 Brush or comb the client’s hair. Remove any hair clips, hairpins, or rubber bands. ___ 16 Check facility policy for applying an identification bracelet. ___ 17 If the client’s family requests a viewing, prepare the client’s body and room in a culturally sensitive manner per facility policy. a) Remove unneeded medical equipment from the room. b) Provide soft lighting and chairs for the family. c) Put a chair at the bedside for a family member who may collapse. d) Provide tissues, a pitcher of water, and cups for the family. ___ 18 Discard your supplies, remove personal protective equipment (PPE), and perform hand hygiene. ___ 19 Identify which of the client’s belongings are to stay with his or her body and which are to be given to the family. ___ 20 Completion Steps (CLOWDS). ___ 21 Ensure the work area is clean before inviting the family back into the room. Provide privacy and leave the room. ___ 22 Allow the family time alone with the client’s body. a) Encourage the family to say good-bye with religious rituals and in their culturally accepted manner. b) Do not rush the grieving process. Allow the family as much time as they need to say goodbye. c) Do not force family members to view the client. d) Remain accessible to address needs and answer questions. ___ 23 Check frequently with the family to see if there is any further care is needed.

You are leaving your client exposed during this entire process.

You could remove all of these and just put "Perform SKWIPES or Perform CLOWDS"

I am not sure what you are trying to say. You have already applied the shirt and are putting on the persons pants then discussing tucking the shirt under the unaffected side. Are you talking about tucking the shirt into the pants? Bullet points 8 and 12 seem out of place. Then in bullet point 9 - 11 you are discussing pulling up the pants again, 12 discusses the shirt, 13 & 14 discuss the pants.<br /> After watching the video I now understand the steps above but if you set the HOB up while putting on the shirt, you can just have the resident lean forward to put the shirt on. Because the resident is laying down when the student arrives, i have them put on the pants and socks first because the person is already in a hospital gown instead of removing the gown first and leaving the person lying completely naked. Once the pants and socks are on, I have them elevate the HOB to put on the shirt and then leaving them sitting up in bed after they are dressed so they can watch TV or read or eat...

Because Enhanced Barrier precautions requires a gown and gloves do we want to emphasize that the caregiver should be wearing a gown.

The woman in this video never washes around the catheter tube where it exits the meatus she only washes the 4 inches down the tubing.

meatus vs urethra throughout this entire skill

This word seems out of place or unnecessary

I would recommend replacing this word with perineal area. The urethra is an internal tube.

The caregiver in the video is standing. they are required to sit.

using a napkin.... the clothing protector can not be used to wipe their mouth.

Should mention after this step to turn off the water using a clean paper towel.

this should also mention the underside of the denture needing to be cleaned.

should say "multiple paper towels", 1 paper towel is not acceptable.

After this step it should emphasize that if the client wants their teeth flossed they should break off 18" of dental floss and ........ DHS has mentioned this to me specifically in the past. DHS also required that I have the students apply "lip balm". They suggested getting the squeeze type and applying it to a Q-tip to put on the lips but I chose to purchase lip balm with my logo on it and just give each student one along with their toothbrush and toothpaste.

A video for Unconscious would be nice also.

After this step it should emphasize that the students need to maintain a clean technique with the placement of the toothbrush at all times.

Using this terminology confuses the students because they think they are leaving out the teeth in the front. We typically just use "brush the upper outer surfaces, the upper inner surfaces, and the upper chewing surfaces" and then repeat using the lower... but I am fine with the way you have worded it also. We can't please everyone.

putting on gloves should be done AFTER all of the supplies are set up including putting on the clothing protector and elevating the HOB. It is bolded on the state materials. The idea behind putting on the gloves right before putting the toothbrush up to the clients mouth so that only a "clean" gloves is going towards the mouth.

This should say meatus. The urethra is the tube that transports the urine from the bladder out of the body.

You have the skill steps listed for someone "uncircumcised" but not for someone who is circumcised.

Should this word be replaced with rectum in this sentence?

This should be listed with the 6th bullet point vs after the care is completed.

we use the 3-3-3 method for men also but the second 3 is for washing the tip of the penis, the shaft of the penis, and the scrotum.

"with a clean area of the washcloth" should be added.

I will stop mentioning it but all materials need to be emptied, rinsed, and dried with the exception of bedpans and graduate containers.

Because the vagina is in the front, i think this could be confusing to the students. Thoughts on using the word rectum? or start at the bottom and wipe towards the tailbone.

Because DHS doesn't want us to teach the students to test, this skill should list that the pubic hair and groin areas also need to be cleaned. We use a 3-3-3 method. First set of 3 is pubic hair, left groin, right groin, second 3 is the vaginal area (left labia, right labia, center), and the last set of 3 is the left butt cheek, right butt cheek, and end with the crack. No one soils just the vaginal area and butt crack.

I will stop mentioning it but this really needs to be a prep step for all skills.

Empty, Rinse, AND Dry is required.

DHS has said that ONLY Peri-care and Cath-care REQUIRE multiple washcloths. However, we do still teach the skill using 2. I wasn't sure if this mattered to you.

This should never be done while in bed. The resident should be sitting in a chair.

Should be a prep step

DHS requires that it is dried with a papertowel.

Using the verbiage "including between each toe", might be more clear for students.

Per DHS, gloves are not needed for this skill.

Healthcare facilities do not have enough washcloths for the students to use 4 - 6 of them per resident. DHS only requires 2.

This should be a prep step.

DHS requires that the students DRY the basin. Only items that hold urine are emptied and rinsed. Everything else is emptied, rinsed, and dried.

This should have more detail: ex: Wash BOTH of the clients’ eyes with a wet washcloth (NO SOAP), using a different area of the washcloth for each stroke. Wash from the inner aspect of the eye to the outer aspect and then proceed to wash the entire face using a clean area of the washcloth.

DHS requires a bath blanket to be used.

Should say "Partial Bed Bath" because it is performed while the resident is still in the bed

DHS requires that we review the IDDSI charts as all healthcare facilities are suppose to switch to it instead of using the traditional Nectar, honey, and pudding thickness.

I like the word Low to stay here but emphasize lowering the bed AND the siderails.

This should be part of the "preparation steps" or pre-procedural steps along with the wheelchair brakes.

We have added an S at the end of CLOWDS as well for "Signaling Device: This has always been one of the last things I want the student to check before leaving the room.

Could we add an S for Safety? Ensure bed and wheelchair brakes are locked /unlocked, ensure client safety AT ALL TIMES. Adjust the bed height between mid-thigh and waist level when needed to protect yourself.

This terminology could also be confusing. The term "Completion Steps" has always been used.

I think this terminology is going to be confusing for the students. The term "preparation steps" has always been used.

We emphasize here also that the seam side of the sheet should be facing the ceiling so that it is not against the skin.

I checked with DHS regarding the need to remove and put on, remove, and put on gloves. The only time gloves need to be removed and changed is if the gloves become visibly soiled. Otherwise you can use the same gloves to put on the clean that you used to remove the soiled because it is that residents "dirt". I do always mention to the students that if you accidently stick your glove into something that if you wish you didn't, then change it.

I have always emphasized that the seam side should be facing the ceiling so that when they fold back the top of the top sheet over the bed spread, the smooth side will be against the skin.

Should they remove the gloves after cleaning the dirty mattress?

If you look at the second picture, I typically will slap hand sanitizer across the wrist of the student while they have the gown and glove on. I then ask them to try and remove the glove in this fashion without contaminating the back of their two fingers. It is impossible using this technique. I explain that the sleeves of the gown are the dirtiest because you are reaching over the resident to help them roll, under the resident to help them move to the side of the bed, around the back of the resident to help them sit up or move to the side of the bed. I explain that you can't see what has landed on your sleeve.

For abdominal thrusts, they would stand behind the victim but for back blows, they should be positioned on the victims side and slightly behind them. Then place one arm diagonally across the persons chest. Have the victim bend at the waist leaning forward.

Should say something like "Position yourself behind the victim. Place one foot (not leg) forward between the victims feet (not legs) with your knees slightly bent to provide balance and stability.

This is a 3rd term: Heimlich, Abdominal Thrusts, Choking Maneuver. Is it possible to use Abdominal Thrusts for Choking

I confirmed with DHS that it doesn't matter which direction the hands are dried, they just need to be dried.

I recommend removing the 15 from this section.

For at least 20 seconds is required by WI DHS. I think listing the 15 seconds is going to be confusing.

Can we add a list of "don'ts" ex: Don't recontaminate your hands at any time by touching the inside of the sink, by using a paper towel to dry off the countertop around the sink, touching your face or clothing, etc.

I would recommend removing the 15 seconds from this section. DHS requires a minimum of 20 seconds.

Is it possible to move this skills checklist within this chapter instead of covering it a second time in Chapter 5

This describes what to do with 1 of your feet but not the other.

This term is no longer used through American Heart or the American Red Cross. This term is intentionally avoided. The video you have posted below this section also leaves this term out of it. I think using 2 terms to describe the same thing can be confusing to students. I would recommend changing the words "Heimlich maneuver" with Abdominal Thrusts throughout the entire section.

Is this term used on the state exam? It doesn't align with the video you have posted below it.