4.2 Core Workflows and Decision Points
Key Takeaways
- Every transfer follows a fixed order: explain, raise bed to safe height, lock wheels, apply gait belt, position the chair, then move on the count.
- Fire response is RACE in order; fire-extinguisher use is PASS; aides rescue and alarm before ever trying to extinguish.
- Choking with no air movement means immediate abdominal thrusts; do not leave to get the nurse first.
- Pressure-injury prevention means repositioning bed-bound residents at least every 2 hours with skin checks each time.
4.2 Core Workflows and Decision Points
The Ohio skills exam grades sequence. Doing the right steps in the wrong order can cost points, and skipping a critical step can fail the station. Learn these workflows as ordered checklists, not loose facts.
Safe transfer workflow (bed to wheelchair)
- Greet the resident, identify them, explain what you will do, and wash your hands.
- Raise the bed to a safe working height and lower the side rail on the working side.
- Lock the bed wheels. Bring the wheelchair to the resident's stronger side at a 45-degree angle and lock the wheelchair wheels; swing footrests out of the way.
- Apply non-skid footwear and place a gait belt around the waist over clothing, snug but with room for fingers.
- Help the resident sit and dangle to check for dizziness before standing.
- On a clear count ("1-2-3, stand"), assist them to stand, pivot toward the chair, and lower gently.
Missing the wheel lock or the gait belt are the most common skills-test failures in this station.
Fire response: RACE then PASS
| Step | Meaning | Aide action |
|---|---|---|
| R | Rescue / Remove | Move residents away from immediate danger first |
| A | Alarm / Activate | Pull the fire alarm and call for help |
| C | Confine / Contain | Close doors and windows to slow the fire |
| E | Extinguish / Evacuate | Use an extinguisher only if the fire is small and you are trained; otherwise evacuate |
To use an extinguisher, follow PASS: Pull the pin, Aim at the base of the fire, Squeeze the handle, Sweep side to side. Residents are removed and the alarm is pulled before any attempt to fight the fire.
Choking decision point
If a resident cannot speak, cough, or breathe, the airway is fully blocked. Begin abdominal thrusts (Heimlich) immediately while calling out for help. Do not offer water, do not pat the back of an adult with complete obstruction, and do not leave the resident to find the nurse first. If the resident can still cough forcefully, encourage coughing and stay with them.
Pressure-injury prevention
- Reposition bed-bound residents at least every 2 hours; chair-bound residents about every 1 hour.
- Inspect bony prominences (sacrum, heels, hips, elbows) at each turn.
- Keep skin clean and dry, smooth wrinkles from linens, and use pillows or wedges to offload heels and bony areas.
- Report any reddened area that does not fade to the nurse promptly.
Standard precautions and hand hygiene workflow
Infection control is a safety workflow the examiner watches closely. Hand hygiene is the single most important step and frames almost every skill: wash hands before and after resident contact, after removing gloves, and whenever hands are visibly soiled. Proper hand washing runs in order: turn on water and wet the hands with fingertips pointed down, apply soap, lather and rub all surfaces including between fingers and under nails for at least 20 seconds, rinse with fingertips down so water runs off the dirtiest area, dry with a paper towel, and use a fresh paper towel to turn off the faucet so you do not recontaminate clean hands.
Standard precautions mean treating every resident's blood and body fluids as potentially infectious, wearing gloves for contact with body fluids, and using gowns, masks, or eye protection when splashing is likely. Personal protective equipment is removed in an order that keeps the dirtiest items away from your skin, and hands are washed immediately after.
Oxygen and equipment safety
When oxygen is in use, the room becomes a fire hazard. Post "oxygen in use" signs, remove smoking materials and open flames, and avoid electrical equipment that could spark. Aides do not adjust the oxygen flow rate, which is a nurse's responsibility, but they do report a kinked tubing, an empty humidifier, or a resident who has removed the cannula. For beds and lifts, check that brakes are locked, that mechanical lift slings are the right size and properly attached, and that two staff assist with a lift when the procedure requires it.
The unifying rule
Across all of these workflows the logic is the same: protect the airway and prevent falls first, follow the fixed order of steps, keep yourself and the resident free from infection, and report or call for help rather than act beyond your scope. When a workflow question gives you a list of steps out of order, the answer is the option that puts the safety-critical step first.
Ambulation and assisting a fall
Walking a resident is a graded skill with its own safety order: check the order and the resident's footwear, apply a gait belt at the waist over clothing, help the resident to stand and steady before moving, then walk slightly behind and to the weaker side holding the belt from underneath. If the resident begins to fall, the workflow is not to hold them upright. You widen your stance, pull them in close, and slide them down your leg to the floor while protecting the head, then call for help and do not move them further until assessed.
This controlled lowering protects both the resident and your back, and it is a frequent skills-test scenario as well as a written-test item.
Positioning to prevent injury
Positioning is a quiet but constant safety task. Common positions you must distinguish are supine (flat on the back with spine aligned), Fowler's (head of bed raised 45 to 60 degrees, used for breathing and eating), semi-Fowler's (about 30 degrees), lateral or side-lying (used in the recovery position and for pressure relief), and prone (on the abdomen, used rarely). Every position uses pillows and supports to keep joints aligned and offload bony areas, and you reposition on the every-2-hour schedule.
The safety logic is the same throughout: maintain alignment, protect the skin, and never leave a repositioned resident without the call light in reach and the bed lowered.
A resident begins choking during a meal and cannot speak, cough, or breathe. What should the nurse aide do FIRST?
How often should a bed-bound resident be repositioned to help prevent pressure injuries?