13.2 Detailed Skills Checklists: Critical Steps for Each Skill
Key Takeaways
- Critical steps fail the skill if omitted — memorize them per skill, not just the general flow
- Handwashing for 20 seconds with fingertips pointed down, and a paper towel to shut off the faucet, anchors infection control
- Transfers: gait belt with 2 fingers' room, wheelchair at 45 degrees on the strong side, pivot — never twist
- Personal care follows fixed directions: clean-to-dirty, weak arm dressed first, front-to-back peri care, bath water 105–110°F
- Measurements have exact targets: BP cuff 1 inch above the antecubital, count pulse and respirations a full 60 seconds, convert 1 oz = 30 mL
- Catheter bag stays below the bladder and never touches the graduate; PROM supports above and below the joint and stops at pain
How to Use These Checklists
Every skill below lists its critical steps — the actions that, if omitted, fail that skill outright. Remember that the indirect-care wrapper from Section 13.1 (wash hands, identify, explain, privacy, comfort, call light, lower bed, wash hands) is scored on top of these task-specific steps. Study the numbers: evaluators check exact targets, and a 'roughly right' demonstration still loses the critical point.
Skill 1 — Handwashing
- Turn on water; wet hands and wrists under warm running water
- Apply soap, work a lather 20 seconds — palms, backs, between fingers, fingertips, thumbs, wrists
- Keep hands lower than elbows; rinse with fingertips pointed down (clean to dirty)
- Dry with a clean paper towel from fingertips toward wrist
- Turn off faucet with a dry paper towel, never bare hands
- Discard towel without touching the bin
Skill 2 — Bed Making (Indirect Care)
- Raise bed to working height (body mechanics); wash hands
- Center fold of bottom sheet down the center of the mattress
- Tuck mitered corners tight; pull sheets wrinkle-free (wrinkles cause pressure injury)
- Place draw sheet across the middle third
- Apply top sheet, blanket, spread; make a toe pleat at the foot
- Lower bed; place call light within reach
Positioning, Transfers, and Mobility
Skill 3 — Positioning / Turning
- Lock bed wheels; raise bed; explain and provide privacy
- Use the draw sheet; turn the resident toward you (better control, no roll-off)
- Support with pillows: behind back, between knees, under the upper arm
- Maintain neutral body alignment; check pressure points for redness
Skill 4 — Bed-to-Wheelchair Transfer
- Lock wheelchair brakes and swing footrests away; lock bed wheels; lower bed
- Apply gait belt with two fingers of room under it
- Position wheelchair at a 45-degree angle on the resident's strong side
- Non-slip footwear on; stand on a count, pivot — do not twist the spine, lower into the chair
- Reposition footrests; remove gait belt; re-lock brakes; call light within reach
Skill 5 — Ambulation with a Device
- Apply gait belt; check the device (rubber tips intact, hip-height grip)
- Clear the path; stand slightly behind and to the weak side
- Walk at the resident's pace; watch for dizziness or fatigue
- If the resident starts to fall: ease to the floor, protect the head, call for help — never try to hold them upright
Skill 6 — Passive Range of Motion (PROM)
- Support the limb above and below the joint
- Move each joint slowly through its full range; stop at pain or resistance
- 3–5 repetitions per joint, per the care plan; never force a joint
Measurements and Nutrition (Skills 7–12)
These skills reward exact technique. The evaluator confirms you hit the numbers below.
| Skill | Critical targets |
|---|---|
| 7. Feeding / Hydration | Verify diet card; sit resident in Fowler's (≥75–90°); offer 1/3-full spoonfuls; alternate food and fluids; keep upright ~30 min after |
| 8. Oral temperature | Wait 15 min after eating/drinking/smoking; probe under tongue in the sublingual pocket; read and record |
| 9. Blood pressure | Bare upper arm at heart level; cuff 1 inch above the antecubital; stethoscope over the brachial artery; deflate 2–3 mmHg/sec; first sound = systolic, last = diastolic |
| 10. Radial pulse & respirations | Use fingertips, never the thumb; count pulse a full 60 seconds; count respirations covertly for 60 sec; note rate, rhythm, quality |
| 11. Weight & height | Same scale, same time of day, comparable clothing; remove shoes; report a change of ~5 lb/week |
| 12. Intake & output | Measure all fluids in mL; 1 oz = 30 mL; record on the I&O sheet; empty/measure output at eye level |
Worked example — converting intake. A resident drinks a 6-oz cup of juice and an 8-oz cup of coffee. Total fluid = 14 oz × 30 mL/oz = 420 mL. Record 420 mL on the intake column, not '14 ounces' — Illinois I&O is documented in milliliters, and reporting the wrong unit is a scored error.
Personal Care (Skills 13–21)
Personal-care skills share repeating directional rules: clean to dirty, front to back, weak side first when dressing, strong side first when undressing.
| Skill | Critical targets |
|---|---|
| 13. Bed bath | Water 105–110°F (test and verbalize); wash clean-to-dirty, eyes inner-to-outer corner, no soap on eyes; change water before perineal care; keep ungroomed areas covered |
| 14. Perineal care (female) | Front to back; a clean section of washcloth for each stroke; warm water; pat dry; never reuse a soiled area of cloth |
| 15. Mouth care (conscious) | Fowler's position; brush all surfaces plus tongue; let resident rinse and spit; apply lip moisturizer |
| 16. Mouth care (unconscious) | Side-lying position; never pour liquid into the mouth (aspiration); use moistened sponge swabs; suction if available |
| 17. Denture care | Line the sink with a towel/water to cushion drops; brush with denture brush; cool or warm water — never hot (warping); store in a labeled, water-filled cup |
| 18. Dressing / undressing | Weak (affected) arm into the sleeve first; strong arm out first when undressing; offer clothing choices |
| 19. Hair care | Comb from ends toward scalp to avoid pulling; honor preferred style; report excessive hair loss |
| 20. Fingernail care | Soak 5–10 min; clean under nails; trim straight across, file smooth; do not cut a diabetic resident's toenails (nurse-only) |
| 21. Indwelling catheter / drainage bag | Clean from meatus outward along the tubing; keep the bag below bladder level; never let the drain spout touch the graduate; measure at eye level; record on I&O |
Trap to remember: 'weak first, strong first' flips between dressing and undressing. When dressing, the weak/affected limb goes in first because the strong limb has the flexibility to follow; when undressing, the strong limb comes out first so the weak limb is moved least. Mixing these up is a frequent dressing-skill error.
A resident drinks a 4-oz cup of water and a 6-oz cup of tea. What do you record on the Illinois intake & output sheet?
When making a bed, why is a toe pleat included at the foot?
When dressing a resident who has a weak (affected) right arm, which arm goes into the sleeve first?
Which action is a critical step when caring for an indwelling urinary catheter and drainage bag?