13.2 Detailed Skills Checklists: Critical Steps for Each Skill
Key Takeaways
- Each of the 21 skills has critical steps that must be completed correctly to pass
- Handwashing before and after every skill is the universal requirement
- Turn residents toward you for better control; position wheelchair on the strong side
- Bed making requires smooth linens (no wrinkles) and a toe pleat
- PROM: support above and below the joint, stop if pain, 3-5 reps
- Personal care follows consistent patterns: clean to dirty, weak first when dressing, front to back for peri care
Last updated: March 2026
Detailed Skills Checklists: Critical Steps for Each Skill
This section provides the critical steps for each of the 21 mandated performance skills. Critical steps are actions that, if omitted, will result in failing that skill. Focus your study on memorizing these critical elements.
Skill 1: Handwashing
Critical Steps:
- Wet hands and wrists under warm running water
- Apply soap and create a lather
- Rub all surfaces for at least 20 seconds: palms, between fingers, fingertips, thumbs, wrists
- Rinse with hands pointed downward (clean to dirty)
- Dry with a clean paper towel
- Turn off faucet with paper towel (not bare hands)
- Dispose of paper towel without touching the container
Skill 2: Indirect Care (Bed Making)
Critical Steps:
- Wash hands before and after
- Use proper body mechanics (bed at working height)
- Place bottom sheet with center fold in center of bed
- Tuck corners tightly (mitered corners or fitted sheet)
- Pull linens smooth and wrinkle-free (wrinkles cause skin breakdown)
- Apply draw sheet across the middle third of the bed
- Place top sheet, blanket, and bedspread evenly
- Make a toe pleat at the foot of the bed (prevents pressure on toes)
Skill 3: Positioning (Turning and Positioning)
Critical Steps:
- Lock bed wheels
- Explain procedure and provide privacy
- Use draw sheet for assistance if available
- Turn resident toward you (safer than pushing away)
- Support with pillows: behind the back, between the knees, under top arm
- Maintain proper body alignment
- Check for skin redness at pressure points
- Place call light within reach
Skill 4: Transfers (Bed to Wheelchair)
Critical Steps:
- Lock wheelchair brakes and move footrests
- Lock bed wheels; lower bed
- Apply gait belt (2 fingers between belt and resident)
- Wheelchair at 45-degree angle on strong side
- Resident wears non-slip footwear
- Stand the resident using proper body mechanics
- Pivot (do not twist); lower into wheelchair
- Remove gait belt; position footrests; ensure comfort
- Place call light within reach; lock wheelchair brakes
Skill 5: Ambulation with Assistive Device
Critical Steps:
- Apply gait belt
- Check assistive device (rubber tips intact, proper height)
- Clear pathway of obstacles
- Position yourself on the weak side or slightly behind
- Walk at the resident's pace
- Monitor for fatigue, dizziness, unsteadiness
- If the resident begins to fall: ease to the floor, protect head, call for help
Skill 6: Passive Range of Motion (PROM)
Critical Steps:
- Support the limb above and below the joint
- Move each joint through its full range of motion gently
- Stop immediately if the resident reports pain
- Perform 3-5 repetitions per joint
- Joints exercised per care plan order
- Do not force a joint past comfortable range
Skills 7-12: Measurements and Nutrition (Summary)
| Skill | Most Critical Steps |
|---|---|
| 7. Feeding/Hydration | Fowler's position; check diet card; 1/3 full spoon; 30 min upright after |
| 8. Oral Temperature | 15 min after eating/drinking; sublingual pocket; read and record |
| 9. Blood Pressure | Bare arm at heart level; cuff 1 inch above; 2-3 mmHg/sec deflation; first/last sound |
| 10. Radial Pulse/Resp | Fingertips (not thumb); full 60 seconds; count resp covertly; note rate, rhythm, quality |
| 11. Weight/Height | Same time, same scale; proper clothing; remove shoes; report 5 lb/wk change |
| 12. Intake/Output | Measure all fluids in mL; record on I&O sheet; 1 oz = 30 mL |
Skills 13-21: Personal Care (Summary)
| Skill | Most Critical Steps |
|---|---|
| 13. Bed Bath | 105-110°F water; clean to dirty order; cover exposed areas; change water before peri care |
| 14. Perineal Care (Female) | Front to back; clean area of washcloth each stroke; warm water; dry thoroughly |
| 15. Mouth Care (Conscious) | Fowler's position; brush all surfaces; rinse and spit; lip moisturizer |
| 16. Mouth Care (Unconscious) | Side-lying position; NO liquid poured in mouth; sponge swabs; suction if available |
| 17. Denture Care | Line sink with towel; denture brush and cleanser; cool/warm water (NOT hot); labeled cup |
| 18. Dressing/Undressing | Weak side on first; strong side off first; offer choices |
| 19. Hair Care | Start at ends, work to scalp; resident's preferred style; report hair loss |
| 20. Fingernail Care | Soak 5-10 min; clean under nails; trim straight across; file smooth; NO diabetic toenails |
| 21. Catheter Drainage Bag | Bag below bladder; don't touch spout to container; measure at eye level; record on I&O |
Test Your Knowledge
When making a bed, why is a "toe pleat" important?
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B
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D
Test Your Knowledge
When turning a resident in bed, you should turn them:
A
B
C
D
Test Your Knowledge
For the INACE clinical skills test, which of the following should you do with EVERY skill?
A
B
C
D