Sample Nurse Aide Theory, Laboratory and Clinical Skills Checklist with Terminal Competency Evaluation INSTRUCTION: Student and Instructor to initial & date the practical skill that the student has been trained & found proficient by the instructor to perform during the lab preparation or as indicated when covered in the theory class. Once proficient in the lab: Student and Instructor to initial and date the successful performance of skill at clinical. REMINDER: No student shall perform any skill at Clinical unless the instructor has first trained and found that student to be proficient in performing the skill in the laboratory/simulation setting. Student Name:______________________________________________ Class (date/section):________________
Basic Nursing Skills
Lab Date Instructor Student Clinical Instructor Student Initials Initials Date Initials Initials
Measure & record vital signs -Temperature • Oral (digital/manual) • Axillary (digital/manual) • Tympanic • Other :_______________ -Pulse • Radial* • Apical • Brachial -Respirations* -Blood Pressure (manual)* Measure & record height & weight -Height -Weight (Ambulatory Client)* Caring for Client’s environment -Make unoccupied bed -Make occupied bed* Measure & record Intake & Output - Intake (liquids) - Intake (food) - Output* Infection Control -Handwashing* -Don/Doff Gown & Gloves* -Biohazardous Waste Disposal
Personal Care Skills
Lab Date Instructor Student Clinical Instructor Student Initials Initials Date Initials Initials
Bathing -Bed Bath (full/partial)* -Tub Bath -Shower -Shampoos Client Hair (as needed) Skin Care -Provide Foot Care* -Observe & Report Skin Changes -1-
Student Name:______________________________________________ Class (date/section):_________________
Personal Care Skills (continued) Grooming -Mouth Care • Clean/Store Dentures* • Brush Client’s teeth* • Unconscious/NPO Client -Fingernail Care* -Shave Client with safety razor -Combs/Brushes Client hair -Assists Client with toiletries Dressing -Total assistance to dress/undress -Assist Client to dress (affected R or L side)* -Dressing Client with I.V. -Place Antiembolitic Stocking* Toileting -Bedpan* -Bedside commode or toilet -Urinal -Perineal Care • Male • Female* -Catheter Care • Male • Female* • Empty Catheter Bag -Empty Ostomy Bag Assisting with eating & hydration -Serves Meal Tray -Provides meal set-up as needed -Performs Heimlich Maneuver Proper Feeding Techniques -Feed/hydrate dependent Client* -Cue confused Client to eat/drink Transferring, Positioning & Turning -Transfers • Bed to wheelchair* • Two person transfer -Positioning in Bed • Positions Client on Side* • Reposition with lift sheet -Logrolling Client
Lab Date Instructor Student Clinical Instructor Student Initials Initials Date Initials Initials
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Student Name:______________________________________________ Class (date/section):_________________
Basic Restorative Skills
Lab Date Instructor Student Clinical Instructor Initials Initials Date Initials
Assistive Devices for Transfers, Mobility, Eating and Dressing -Transfers • Mechanic Lift (hoyer type) • Mechanic Lift (sara type) • Transfer Board • Other:________________ -Mobility/Ambulation • Gait Belt* • Walker • Cane • Other:________________ -Eating • Plate Guards • Adaptive Utensils -Dressing • Sock Donner • Other:_________________ Maintaining Range of Motion -Passive Range of Motion • Ankle/Wrist* • Knee/Elbow* • Shoulder* • Hip Proper positioning in bed and chair -Positioning in Bed • Fowler’s/ Semi-Fowler’s • Sim’s • Lateral • Supine • Prone -Reposition Client in wheelchair Care and Use of prosthetic & orthotic devices -Assist Client with glasses -Assist Client with hearing aide -Assists Client with Splint or Brace -Assists Client with prosthetic • Arm • Leg • Eye
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Student Initials
Student Name:______________________________________________ Class (date/section):_________________
Skills to Promote Client’s Rights
Lab Date
Instructor Student Clinical Instructor Initials Initials Date Initials
Student Initials
Theory or Instructor Student Clinical Instructor Lab Date Initials Initials Date Initials
Student Initials
Theory or Instructor Student Clinical Instructor Lab Date Initials Initials Date Initials
Student Initials
Using appropriate interventions to minimize the need for physical and chemical restraints in accordance with the current professional standards -Restraint Alternative Use • Tab Alarm/Pressure Alarm • High/Low Bed • Fall Mat • Saddle Cushion
Basic Nursing Skills Caring for dying patient -Provides care to dying Client -Provides post-mortem care Recognizing & reporting abnormal signs & symptoms of common conditions related to all systems of the body - Observe Client for abnormal signs and symptoms during cares - Documents any abnormal sign or symptom as instructed - Reports any abnormal sign or symptom to the supervisor
Skills that Meet the Psychosocial and Mental Needs of Clients
Modifying own behavior in response to Client behavior -Use appropriate approach with • Hearing Impaired Client • Vision Impaired Client • Tearful Client • Angry Client Recognizing developmental tasks associated with aging process - Assists Client to meet Client’s own need for: • Purpose/Meaningful Activity • Reflection/Reminiscence Student Name:______________________________________________ Class (date/section):_________________ -4-
Skills that Meet the Psychosocial and Mental Needs of Clients
Theory or Instructor Student Lab Date Initials Initials
Clinical Instructor Date Initials
Student Initials
Theory or Instructor Student Lab Date Initials Initials
Clinical Instructor Date Initials
Student Initials
(Continued)
Allowing Client to make personal choices, providing and reinforcing other behavior consistent with the Client’s dignity -Provides Client with appropriate choices of: • Clothing/Attire • Other:_______________ Responding appropriately to Client behavior -Employs appropriate response to: • Aggressive Client • Sexually inappropriate/ aggressive Client • Client refusing care Recognizing available resources, including family, for Client support -Reports changes in Client affect or Client requests for specialized assistance to supervisor or charge nurse
Care of Cognitively Impaired Clients
Techniques to address the unique needs & behaviors of patients with dementia - Employs Validation Method when working with confused Client - Redirects Wandering Client Communicating with cognitively impaired - Speaks slowly in simple sentences - Employs lower tone of voice Understanding the behavior of cognitively impaired - Reduces Client exposure to stimuli that produce behaviors - Attempts to identify cause of Client behavior (pain, hunger, need for toileting) Student Name:______________________________________________ Class (date/section):_________________ -5-
Care of Cognitively Impaired Clients (continued)
Theory or Instructor Student Lab Date Initials Initials
Clinical Instructor Date Initials
Student Initials
Basic Restorative Services Theory or Instructor Student Lab Date Initials Initials
Clinical Instructor Date Initials
Student Initials
Clinical Instructor Date Initials
Student Initials
Appropriate response to behavior of cognitively impaired - Responds appropriately when Client: • Is ‘Sundowning’ • Has repetitive verbalizations • Has a catastrophic reaction Methods to reduce the effects of cognitive impairment -Plays calm quiet music for Client -Ensures Client’s daily routine is followed -Offers Client meaningful activity
Training the Client in selfcare according to the Client’s abilities -Follows restorative care plan -Assists Client with self-care techniques as needed Bowel & Bladder training -Follows Client’s toileting schedule/care plan Promoting Clients’ physical ability to function independently -Encourages Client to complete tasks for which the Client is able
Skills to Promote Client’s Rights
Theory or Instructor Student Lab Initials Initials Date
Providing privacy & maintaining confidentiality -Knocks and awaits response before entering Client’s room -Provides privacy during all cares -Maintains all Client records and information in a confidential manner Student Name:______________________________________________ Class (date/section):_______________ -6-
Skills to Promote Client’s Rights
Theory or Instructor Student Lab Initials Initials Date
Promoting the Client’s right to make personal choices to accommodate their needs -Encourages Client to make choices regarding attire, activity, meals etc. Giving assistance in resolving grievances and disputes -Reports Client’s grievance or concern to charge nurse or other appropriate staff Providing needed assistance in getting to and participating in Client and family groups and other activities -Reminds Client of scheduled activities and offers assistance to or from activity -Offers an unoccupied Client assistance in pursuing an activity of the Client’s interest Caring for & maintaining security of clients’ possessions -Handles Client possessions with care -Returns Client possessions to designated location when Client is finished using the item Promoting and maintaining the Client’s right to be free from abuse, mistreatment, and neglect -Answers call lights timely -Interacts with Client in professional manner Reporting any suspicion of abuse, mistreatment, and neglect immediately -Observes Client for signs of abuse/neglect during cares -Documents and reports signs of abuse/neglect to supervisor or charge nurse * Denotes practical skill that is part of the State Competency Evaluation
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Clinical Instructor Student Date Initials Initials
Student Name:______________________________________________ Class (date/section):_________________
Terminal Competency Evaluation All students completing the nurse aide training program are expected to demonstrate, at minimum, the six Terminal Competencies listed below. Please evaluate the student’s success affecting the Terminal Competencies when interacting with actual Clients. 1= Needs Improvement – The student seldom or never meets the objective. 2= Meets the Standard – The student frequently or often meets the objective. 3= Exceeds the Standard – The student consistently or always meets the objective.
# Terminal Competency 1
1
The student demonstrates the ability to form relationships, communicate and interact competently on a one-to-one basis with Clients. Introduces self to Client; Explains procedure; Maintains professional communication;
2
The student demonstrates sensitivity to Clients' emotional, social, and mental health needs through skillful, directed interactions. Responds appropriately to Client behavior; Allows Client time to express feelings or concerns
3
The student demonstrates the ability to assist Clients in attaining and maintaining independence. Encourages and offers Client choices; Encourages Client to perform self-care
4
The student exhibits behavior in support and promotion of Clients' rights. Knocks and waits for permission to enter Client room; Answers call lights and provides care promptly; Maintains confidentiality and provides privacy
5
The student demonstrates observational and documentation skills needed in the assessment of Clients' health, physical condition and well-being. Observes Client for abnormalities or changes; Reports abnormalities or changes to Nurse; Documents vital signs, intake and output, height and weight correctly
6
The student demonstrates an awareness of the Colorado Nurse Aide Practice Act Provides cares/services according to care plan; Provides the cares/services for which he/she has been trained and found proficient
Comments
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