Skills

The 23 skills that follow are arranged in alphabetical order, except for the Hand Hygiene (Hand Washing) skill. Hand Hygiene is listed first as a reminder of the importance of performing this skill before all other skills. The numbered lines below each skill are the steps needed to perform that skill.

Note: Critical Element Steps are in bold type.

Skill 1 — Hand Hygiene (Hand Washing)

1. Address client by name and introduces self to client by name.
2. Turns on water at sink.
3. Wets hands and wrists thoroughly. 
4. Applies soap to hands.
5. 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. 
6. Cleans fingernails by rubbing fingertips against palms of the opposite hand.
7. Rinse all surfaces of wrists, hands, and fingers, keeping hands lower than the elbows and the fingertips down.
8. 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. 
9. 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.
10. Does not touch inside of sink at any time.

Skill 2 — Applies One Knee-High Elastic Stocking

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Provides Privacy with a curtain, screen, or door. 
3. Client is in supine position (lying down in bed) while stocking is applied.
4. Turns stocking inside-out, at least to the heel.
5. Places foot of stocking over toes, foot, and heel. 
6. Pulls top of stocking over foot, heel, and leg.
7. Moves foot and leg gently and naturally, avoiding force and over-extension of limb and joints.
8. 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.
9. Signalling device is within reach and bed is in low position. 
10. After completing skill, wash hands.

Skill 3 — Assists to Ambulate Using Transfer Belt

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Provides Privacy with a curtain, screen, or door. 
3. Before assisting to stand, client is wearing non-skid shoes/footwear. 
4. Before assisting to stand, bed is at a safe level.
5. Before assisting to stand, checks and/or locks bed wheels. 
6. Before assisting to stand, client is assisted to sitting position with feet flat on the floor.
7. Before assisting to stand, applies transfer belt securely at the waist over clothing/gown. 
8. Before assisting to stand, provides instructions to enable client to assist in standing including prearranged signal to alert client to begin standing. 
9. 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.
10. 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.
11. Walks slightly behind and to one side of client for a distance of ten (10) feet, while holding onto the belt. 
12. Assists client to bed and removes transfer belt 
13. Signaling device is within reach and bed is in low position. 
14. After completing skill, wash hands.

Skill 4 — Assists With Use of Bedpan

1. Explains procedure speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Provides Privacy with a curtain, screen, or door.
3. Before placing bedpan, lowers head of bed.
4. Puts on clean gloves before placing bedpan under client.
5. Places bedpan correctly under client’s buttocks.
6. Removes and disposes of gloves (without contaminating self) into waste container and washes hands.
7. After positioning client on bedpan and removing gloves, raises head of bed.
8. Toilet tissue is within reach.
9. Hand wipe is within reach and client is instructed to clean hands with hand wipe when finished.
10. Signaling device within reach and client is asked to signal when finished.
11. Puts on clean gloves before removing bedpan.
12. Lowers head of bed before bedpan is removed.
13. Ensures client is covered except when placing and removing bedpan.
14. Empties and rinses bedpan and pours rinse into toilet.
15. Places bedpan in designated dirty supply area.
16. Removes and disposes of gloves (without contaminating self) into waste container and washes hands.
17. Signaling device is within reach and bed is in low position.

Skill 5 — Cleans Upper or Lower Denture

1. Puts on clean gloves before handling denture.
2. Lines bottom of sink and/or partially fills sink with water before denture is held over sink.
3. Rinses denture in moderate temperature running water before brushing them.
4. Applies denture toothpaste to toothbrush.
5. Brushes all surfaces of denture.
6. Rinses all surfaces of denture under moderate temperature running water.
7. Rinses denture cup and lid.
8. Places denture in denture cup with moderate temperature water/solution and places lid on cup.
9. Rinses toothbrush and places in designated toothbrush basin/container.
10. Maintains clean technique with placement of toothbrush and denture.
11. Appropriately removes and disposes of sink liner and/or drains sink.
12. Removes and disposes of gloves (without contaminating self) into waste container and washes hands.

Skill 6 — Counts and Records Radial Pulse

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Places fingertips on thumb side of client’s wrist to locate radial pulse.
3. Count beats for one full minute.
4. Signaling device is within reach.
5. Before recording, washes hands.
6. Records pulse rate within plus or minus 4 beats of evaluator’s reading.

Skill 7 — Counts and Records Respirations

1. Explains procedure (for testing purposes), speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible. 
2. Counts respirations for one full minute.
3. Signaling device is within reach.
4. Before recording, washes hands.
5. Records respiration rate within plus or minus 2 breaths of evaluator’s reading.

Skill 8 — Donning And Removing PPE (Gown and Gloves)

1. Picks up gown and unfolds.
2. Facing the back opening of the gown places arms through each sleeve.
3. Fastens the neck opening.
4. Secures gown at waist making sure that back of clothing is covered by gown (as much as possible).
5. Puts on gloves.
6. Cuffs of gloves overlap cuffs of gown.
7. Before removing gown, with one gloved hand, grasps the other glove at the palm, remove glove.
8. Slips fingers from ungloved hand underneath cuff of remaining glove at wrist, and removes glove turning it inside out as it is removed.
9. Disposes of gloves into designated waste container without contaminating self.
10. After removing gloves, unfastens gown at waist and neck.
11. After removing gloves, removes gown without touching outside of gown.
12. While removing gown, holds gown away from body without touching the floor, turns gown inward and keeps it inside out.
13. Disposes of gown in designated container without contaminating self.
14. After completing skill, washes hands.

Skill 9 — Dresses Client with Affected (Weak) Right Arm

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Provides Privacy with a curtain, screen, or door.
3. Asks which shirt he/she would like to wear and dresses him/ her in shirt of choice.
4. Avoids overexposure of client by ensuring client’s chest is covered.
5. Removes gown from the left (unaffected) side first, then removes gown from the right (affected/weak) side.
6. Before dressing client, disposes of gown into soiled linen container.
7. Assists to put the right (affected/weak) arm through the right sleeve of the shirt before placing garment on left (unaffected) arm.
8. While putting on shirt, moves body gently and naturally, avoiding force and over-extension of limbs and joints.
9. Finishes with clothing in place.
10. Signaling device is within reach and bed is in low position.
11. After completing skill, washes hands.

Skill 10 — Feeds Client Who Cannot Feed Self

1. Explains procedure to client, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Before feeding, looks at name card on tray and asks client to state name.
3. Before feeding client, client is in an upright sitting position (75-90 degrees).
4. Places tray where the food can be easily seen by client.
5. Cleans client’s hands before beginning feeding.
6. Sits in a chair facing client during feeding.
7. Tells client what foods and beverage are on tray 
8. Asks client what he/she would like to eat first.
9. Using spoon, offers client one bite of each type of food on tray, telling client the content of each spoonful.
10. Offers beverage at least once during meal.
11. Candidate asks client if they are ready for next bite of food or sip of beverage.
12. At end of meal, candidate cleans client’s mouth and hands.
13. Removes food tray.
14. Leaves client in upright sitting position (75-90 degrees) with Signaling device within client’s reach.
15. After completing skill, washes hands.

Skill 11 — Gives Modified Bed Bath (Face and One Arm, Hand and Underarm)

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Provides Privacy with a curtain, screen, or door.
3. Removes gown and places directly in soiled linen container while ensuring client’s chest and lower body is covered.
4. Before washing, checks water temperature for safety and comfort and asks client to verify comfort of water.
5. Puts on clean gloves before washing client.
6. 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.
7. Dries face with dry cloth towel/washcloth.
8. Exposes one arm and places cloth towel underneath arm.
9. Applies soap to wet washcloth.
10. Washes fingers (including fingernails), hand, arm, and underarm keeping rest of body covered.
11. Rinses and dries fingers, hand, arm, and underarm.
12. Moves body gently and naturally, avoiding force and overextension of limbs and joints.
13. Puts clean gown on client.
14. Empties, rinses, and dries basin.
15. Places basin in designated dirty supply area.
16. Disposes of linen into soiled linen container.
17. Avoids contact between candidate clothing and used linens.
18. Removes and disposes of gloves (without contaminating self) into waste container and washes hands.
19. Signaling device is within reach and bed is in low position.

Skill 12* — Measures and Records Electronic Blood Pressure (This skill is not tested in California)

Note: State specific (evaluator: do not substitute this skill for skill 23 ‘manual blood pressure’)

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Provides Privacy with a curtain, screen, or door.
3. Verifies client assumed a comfortable lying or sitting position.
4. Client’s arm is positioned at level of heart with palm up and upper arm is exposed.
5. Selects appropriate cuff size.
6. Feels for brachial artery on inner aspect of arm, at bend of elbow.
7. Places blood pressure cuff snugly on client’s upper arm and sensor/arrow is over the brachial artery site.
8. Turns on the machine and ensures device is functioning. If the machine has different settings for infants, children, and adults, selects the appropriate setting.
9. Pushes start button. If cuff inflates to more than 200 mm Hg then stops machine and uses cuff on client’s other arm.
10. Waits until the blood pressure reading appears on the screen and for the cuff to deflate, then removes the cuff.
11. Signaling device is within reach.
12. Before recording, washes hands.
13. After obtaining reading using Blood Pressure cuff, records both systolic and diastolic pressures exactly as displayed on the digital screen.

Skill 13 — Measures and Records Urinary Output

1. Puts on clean gloves before handling bedpan.
2. Pours the contents of the bedpan into measuring container without spilling or splashing urine outside of container.
3. Rinses bedpan and pours rinse into toilet.
4. Measures the amount of urine at eye level with container on flat surface (if between measurement lines, round up to nearest 25 ml/cc).
5. After measuring urine, empties contents of measuring container into toilet.
6. Rinses measuring container and pours rinse into toilet.
7. Before recording output, removes and disposes of gloves (without contaminating self) into waste container and washes hands.
8. Records contents of container within plus or minus 25 ml/cc of evaluator’s reading.

Skill 14 — Measures and Records Weight of Ambulatory Client

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Client has non-skid shoes/footwear on before walking to scale.
3. Before client steps on scale, candidate sets scale to zero.
4. Asks client to step on center of scale and obtains client’s weight.
5. Asks client to step off scale. 
6. Before recording, washes hands.
7. 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).

Skill 15 — Performs Modified Passive Range of Motion (Prom) for One Knee and One Ankle

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Provides Privacy with a curtain, screen, or door.
3. Ensures that client is supine in bed and instructs client to inform candidate if pain is experienced during exercise.
4. 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.
5. While supporting the foot and ankle close to the bed, pushes/pulls foot toward head (dorsiflexion), and pushes/ pulls foot down, toes point down (plantar flexion) (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.
6. Signaling device is within reach and bed is in low position.
7. After completing skill, washes hands.

Skill 16 — Performs Modified Passive Range of Motion (Prom for One Shoulder)

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible. 
2. Provides Privacy with a curtain, screen, or door.
3. Instructs client to inform candidate if pain experienced during exercise.
4. 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.
5. 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.
6. Signaling device is within reach and bed is in low position.
7. After completing skill, washes hands.

Skill 17 — Positions On Side

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Provides Privacy with a curtain, screen, or door.
3. Before turning, lowers head of bed.
4. Raises side rail on side to which body will be turned.
5. Candidate assists client to slowly roll onto side toward raised side rail.
6. Places or adjusts pillow under head for support.
7. Candidate repositions arm and shoulder so that client is not lying on arm.
8. Supports top arm with supportive device.
9. Places supportive device behind client’s back.
10. Places supportive device between legs with top knee flexed; knee and ankle supported.
11. Signaling device is within reach and bed is in low position.
12. After completing skill, washes hands

Skill 18 — Provides Catheter Care for Female

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Provides Privacy with a curtain, screen, or door.
3. Before washing, checks water temperature for safety and comfort and asks client to verify comfort of water.
4. Puts on clean gloves before washing.
5. Places linen protector under perineal area including buttocks before washing.
6. Exposes area surrounding catheter (only exposing client between hip and knee).
7. Applies soap to wet washcloth.
8.  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.
9. While holding catheter at meatus without tugging, using a clean washcloth, rinses at least four (4) inches of catheter from meatus, moving only in one direction, away from meatus, using a clean area of the washcloth for each stroke.
10. While holding catheter at meatus without tugging, dries at least four (4) inches of catheter moving away from meatus using a dry cloth towel/washcloth.
11. Empties, rinses, and dries basin.
12. Places basin in designated dirty supply area.
13. Disposes of used linen into soiled linen container and disposes of linen protector appropriately.
14. Avoids contact between candidate clothing and used linen.
15. Removes and disposes of gloves (without contaminating self) into waste container and washes hands.
16. Signaling device is within reach and bed is in low position.

Skill 19 — Provides Foot Care on One Foot

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Provides Privacy with a curtain, screen, or door.
3. Before washing, checks water temperature for safety and comfort and asks client to verify comfort of water.
4. Basin is in a comfortable position for client and on protective barrier.
5. Puts on clean gloves before washing foot.
6. Client’s bare foot is placed into the water.
7. Applies soap to wet washcloth.
8. Lifts foot from water and washes foot (including between the toes).
9. Foot is rinsed (including between the toes).
10. Dries foot (including between the toes) with dry cloth towel/washcloth.
11. Applies lotion to top and bottom of foot (excluding between the toes) removing excess with a towel/washcloth.
12. Supports foot and ankle during procedure.
13. Empties, rinses, and dries basin.
14. Places basin in designated dirty supply area.
15. Disposes of used linen into soiled linen container.
16. Removes and disposes of gloves (without contaminating self) into waste container and washes hands.
17. Signaling device is within reach.

Skill 20 — Provides Mouth Care

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Provides Privacy with a curtain, screen, or door.
3. Before providing mouth care, client is in upright sitting position (75-90 degrees).
4. Puts on clean gloves before cleaning mouth.
5. Places cloth towel across chest before providing mouth care.
6. Secures cup of water and moistens toothbrush.
7. Before cleaning mouth, applies toothpaste to moistened toothbrush.
8. Cleans mouth (including tongue and all surfaces of teeth), using gentle motions.
9. Maintains clean technique with placement of toothbrush.
10. Candidate holds emesis basin to chin while client rinses mouth.
11. Candidate wipes mouth and removes clothing protector.
12. Disposes of used linen into soiled linen container.
13. Rinses toothbrush and empties, rinses, and dries basin.
14. Removes and disposes of gloves (without contaminating self) into waste container and washes hands. 
15. Signaling device is within reach and bed is in low position.

Skill 21 — Provides Perineal Care (Peri-Care) for Female

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Provides Privacy with a curtain, screen, or door.
3. Before washing, checks water temperature for safety and comfort and asks client to verify comfort of water.
4. Puts on clean gloves before washing perineal area.
5. Places pad/ linen protector under perineal area including buttocks before washing.
6. Exposes perineal area (only exposing between hips and knees).
7. Applies soap to wet washcloth.
8. Washes genital area, moving from front to back, while using a clean area of the washcloth for each stroke.
9. Using clean washcloth, rinses soap from genital area, moving from front to back, while using a clean area of the washcloth for each stroke.
10. Dries genital area moving from front to back with dry cloth towel/washcloth.
11. 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.
12. Using clean washcloth, rinses soap from rectal area, moving from front to back, while using a clean area of the washcloth for each stroke.
13. Dries rectal area moving from front to back with dry cloth towel/washcloth.
14. Repositions client.
15. Empties, rinses, and dries basin.
16. Places basin in designated dirty supply area.
17. Disposes of used linen into soiled linen container and disposes of linen protector appropriately.
18. Avoids contact between candidate clothing and used linen.
19. Removes and disposes of gloves (without contaminating self) into waste container and washes hands.
20. Signaling device is within reach and bed is in low position

Skill 22 — Transfers from Bed to Wheelchair Using Transfer Belt

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Provides Privacy with a curtain, screen, or door.
3. Before assisting to stand, wheelchair is positioned alongside of bed, at head of bed facing foot or foot of bed facing head.
4. Before assisting to stand, footrests are folded up or removed.
5. Before assisting to stand, locks wheels on wheelchair.
6. Before assisting to stand, bed is at a safe level.
7. Before assisting to stand, checks and/or locks bed wheels.
8. Before assisting to stand, client is assisted to a sitting position with feet flat on the floor.
9. Before assisting to stand, client is wearing shoes.
10. Before assisting to stand, applies transfer belt securely at the waist over clothing/gown.
11. Before assisting to stand, provides instructions to enable client to assist in transfer including prearranged signal to alert when to begin standing.
12. 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.
13. 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 the client.
14. Assists client to turn to stand in front of wheelchair with back of client’s legs against wheelchair.
15. Lowers client into wheelchair.
16. Positions client with hips touching back of wheelchair and transfer belt is removed.
17. Positions feet on footrests.
18. Signaling device is within reach.
19. After completing skill, washes hands

Skill 23* — Measures and Records Manual Blood Pressure

Note: *State Specific (Evaluator: Do not Substitute this Skill for Skill 12 ‘Electronic Blood Pressure’)

1. Explains procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Before using stethoscope, wipes bell/diaphragm and earpieces of stethoscope with alcohol.
3. Client’s arm is positioned with palm up and upper arm is exposed.
4. Feels for brachial artery on inner aspect of arm, at bend of elbow.
5. Places blood pressure cuff snugly on client’s upper arm, with sensor/arrow over brachial artery site.
6. Earpieces of stethoscope are in ears and bell/diaphragm is over brachial artery site.
7. 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.
8. 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).
9. Removes cuff.
10. Signaling device is within reach.
11. Before recording, washes hands.
12. After obtaining reading using BP cuff and stethoscope, records both systolic and diastolic pressures each within plus or minus 8 mm of evaluator’s reading.