How do my skill steps look?

[zooz]

So...my skills test is coming up quick. I wrote out the general steps that I think can be used in almost every skill. I made these steps by combining what was in my textbook and what was in my candidate handbook.

1. Wash my hands.
   
2. Knock.
   
3. Identify the person.
   
4. Introduce myself.
   
5. Explain the procedure before beginning. (Also, during the procedure.)
   
6. Provide for privacy.
   
7. Collect any needed supplies/equipment. Place clean supplies/equipment on a clean surface.
   
8. Adjust the bed. (bed wheels locked, side rails up, bed raised to good working height, head/foot of bed raised/lowered as needed for procedure and in agreement with care plan)
   
9. Move the call light if it will be in the way.
   
10. Wash my hands. Apply gloves, if needed.
    
11. Do the skill.
    
12. Place call light within reach of person.
    
13. Adjust the bed. (bed wheels locked, side rails up, bed lowered to lowest horizontal position, head/foot of bed raised/lowered as person prefers and in agreement with care plan, side rails raised/lowered according to care plan)
    
14. Put needed item within reach. Ask if person is comfortable or needs anything else.
    
15. Clean any equipment used according to center policy. (Washed hands. Wore gloves.) Store cleaned equipment.
    
16. Tidy and clean up area. (Wore gloves, if needed)
    
17. Unscreen the person.
    
18. Follow center policy for trash/dirty linen.
    
19. Remove gloves, if wearing. Wash my hands.
    
20. Report and record.

Question 1:

Do you think I should add "Remove gloves, if wearing. Wash my hands." or just "Remove gloves, if wearing." After step #11? If yes, which one?

In the candidate test manual it does not say anything about washing hands (when finished with the skill) before you touch the person's call light or buttons on the bed. I was thinking you would. But then, you are moving and raising/lowering side rails with gloves on or before washing hands while you're doing the skill itself.

Question 2:

Before starting the actual skill, is it acceptable to wash your hands, adjust the bed, and then apply gloves and do your procedure?

I know, I know. I'm going about this like it's a sterile procedure. I'm anal, I can't help it!

It seems like the closer it gets to this test, the more I'm second guessing myself and my common sense.

If anyone has read this far (bless you!) and wants to take a stab at answering any one of my numerous questions, please feel free. Also, if you have any steps that you think are missing, let me know.

[lvnsandiego]

Hi! I am a CNA instructor and I am impressed at your dedication and hard work in creating this skills study list. In my opinion, for whatever that's worth, I think you have everything you need. Your question #1 is debatable, I think it is a judgement call. If the skill required contact with body fluids I would remove gloves, wash hands after step #11 then step back to the bed and complete steps #12 and so on. If gloves were relatively clean and no body fluids on them , I think its fine to just go from step #11 to #12. In some cases you may have to remove gloves, then adjust bed then wash hands for pts who are such a fall risk that they must have SR up at all times and bed in lowest position, you would have to remove gloves before touching siderails and bed controls if say your gloves were covered in feces or blood.

whew!! Sorry such a long response! A shorter one to your second question: Yes! Again, you must always use your judgement and in cases were body fluids were flying or pt highly contagious, put gloves on first before adjusting bed.

You are going to do fine on the test, don't overanalyze things. If you blank out, just ask yourself, how can I provide safety, comfort, privacy and infection control ? That should help you to get through any procedure along with some common sense!

Good luck.

[zooz]

Your question #1 is debatable, I think it is a judgement call. If the skill required contact with body fluids I would remove gloves, wash hands after step #11 then step back to the bed and complete steps #12 and so on. If gloves were relatively clean and no body fluids on them , I think its fine to just go from step #11 to #12. In some cases you may have to remove gloves, then adjust bed then wash hands for pts who are such a fall risk that they must have SR up at all times and bed in lowest position, you would have to remove gloves before touching siderails and bed controls if say your gloves were covered in feces or blood.

whew!! Sorry such a long response! A shorter one to your second question: Yes! Again, you must always use your judgement and in cases were body fluids were flying or pt highly contagious, put gloves on first before adjusting bed.

This is exactly what I was thinking! I guess I need to trust my reasoning a little more. Thanks, lvnsandiego! I appreciate the time you took to reply.