4.2 Core Workflows and Decision Points

4.2 Core Workflows and Decision Points

The Ohio skills exam does not score order unless a step says BEFORE or AFTER, but skipping a bolded key step fails the task. Learning each workflow as an ordered checklist is still the easiest way not to skip a step.

Safe transfer workflow (bed to wheelchair)

Ohio's stand-and-pivot task sheet lists these steps:

1. Perform hand hygiene, explain the procedure to the resident, and obtain a gait belt.
2. Position the wheelchair close to the bed.
3. Lock the wheelchair brakes and lock the designated bed brake(s).
4. Help the resident put on non-skid footwear.
5. Help the resident to a sitting position and lower the bed so their feet are flat on the floor while sitting on the edge.
6. Place the gait belt around the waist, tighten it to fit, and check it by slipping your fingers between the belt and the resident.
7. Face the resident, grasp the gait belt with both hands, and bring the resident to a standing position using proper body mechanics.
8. Help the resident pivot and sit in the wheelchair in a controlled manner, then remove the gait belt.
9. Keep a respectful, courteous manner throughout, place the call light within easy reach, and perform hand hygiene.

Locking the wheelchair brakes and the designated bed brakes are bolded key steps, so missing either fails the task; the gait-belt steps are scored non-key steps. The sheet places the wheelchair close to the bed and does not name an angle or a side.

Fire response: RACE then PASS

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, complete every listed step, 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 (Ohio tasks 2 and 3) with its own safety steps: lock the bed and wheelchair brakes (bolded key steps), help the resident put on non-skid footwear, place the gait belt at the waist and check its fit, help the resident stand, then hold the belt with one hand, steady the resident (task 2) or the walker (task 3) with the other, and walk behind and slightly to the side of the resident. 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 falls are on the D&S knowledge-exam vocabulary list.

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.