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?
10 ounces of fluid
100 mL
300 mL
1,000 mL
When making a bed, why is a toe pleat included at the foot?
It gives the bed a more professional appearance for the evaluator
It relieves pressure of tight top linens on the resident's toes and feet
It keeps the bottom sheet from coming untucked
It makes it easier for the resident to climb out of bed
When dressing a resident who has a weak (affected) right arm, which arm goes into the sleeve first?
The strong left arm, because it is more flexible
Whichever arm the resident reaches out first
The weak right arm, because the strong arm can follow more easily
Both arms at the same time to save time
Which action is a critical step when caring for an indwelling urinary catheter and drainage bag?
Raise the drainage bag above the bladder while emptying it
Let the drain spout rest in the measuring graduate for stability
Clean the catheter from the tubing toward the meatus
Keep the drainage bag below the level of the bladder at all times
Sections you finish are checked off in the contents.