Texas CNA Skills (Part Four): Ending Steps, a.k.a. “Closing Procedures” After Completion of Each Skill on the State Test

In the vast majority of U.S. states, Texas included, a nurse aide candidate who intends to be successful on the the CNA state-approved examination for certification as a certified nursing assistant will need to demonstrate his or her abilities to correctly perform a series of hands-on procedural tasks during the skills section of the state test.

Of course, the demonstration of skills competency is occurring at the testing center in the midst of a simulated scenario. Additionally, an examiner is carefully eyeballing the test-taking candidate for evaluation purposes while he or she is performing the myriad of steps required to complete each skill performance from beginning to conclusion.

A grand total of 22 testable skills exist on the skills portion of the CNA state test in Texas that a test taker might be called upon to perform. Furthermore, five of the 22 skills are chosen randomly for the test taker to perform from start to finish in the presence of the examiner to demonstrate competency.

The test taker will pass the skills section of the CNA state test if he or she correctly performs four out of five of the randomly selected skills that have been assigned. Hence, it is imperative for the test taker to be completely prepared prior to the testing date by possessing thorough knowledge on how to accurately perform all 22 testable skills.

As a reminder, the test taker is permitted to miss a small, predetermined number of steps that have been deemed not critical and still be able to pass the skills section of the CNA state examination for certification. The main idea is that examiner is observing to ensure that the test-taker knows how to complete all steps associated with each procedural skill.

Nonetheless, be advised that the nurse aide candidate is strictly not permitted to miss or fail to perform any critical steps of a procedural skill during the skills portion of the Texas CNA state test. Customarily, provisions related to infection control (read: hand hygiene), maintenance of a safe environment (read: bed in low position and side rails up), upholding patient privacy (read: keeping doors and privacy curtains closed) and ensuring a signaling device or call light remains within reasonable reach are considered critical steps.

To recap, critical steps are ones that need to always be performed when demonstrating skills competency at the testing center during the CNA state test. A test taker will fail the skills competency section of the CNA state examination if any critical steps associated with a particular skill are missed or forgotten. For instance, forgetting to wash one’s hands after removal of gloves would be a missed critical step since hand hygiene is an essential aspect of infection control.

Ending steps are known by a number of differing names, including post-steps, completion steps, ending procedures and closing procedures. Due to the fact that the skills section of the CNA state exam is normally completed as part of one simulated scenario, the closing procedures must be completed once, usually when the scenario is ending. To reemphasize, test takers need to carry out these closing procedures at the end of each CNA state test.

Closing procedures tend to entail routine nursing care steps such as making sure that the patient’s call light or signaling devise is within easy reach, ensuring comfort measures, lowering the bed to a safe position, raising or lowering the bed’s side rails in accordance with the patient’s plan of care, performing hand hygiene, and documenting. According to Professional Healthcare Development (2011), the closing procedures should be completed in the following sequence:

1. The nursing assistant should utilize proper body mechanics during the performance of all skills.
2. The nursing assistant should position the patient for comfort. The nursing assistant should position the patient in appropriate body alignment.
3. The nursing assistant must adjust the bed’s side rails per physicians’ orders and lower the bed.
4. The nursing assistant should ensure the patient has everything they will need. The nursing assistant should take the time to thank the patient.
5. The nursing assistant should maintain the cleanliness of the patient’s room per facility policies.
6. The nursing assistant must remove his or her gloves and wash the hands as the situation dictates.
7. The nursing assistant should offer to open privacy curtains and doors in accordance with the wishes of the patient.
8. The nursing assistant must observe the environment for safety, always ensuring that the call light remains within reasonable reach.
9. The nursing assistant must report any abnormal findings to the nurse.
10. The nursing assistant must document per facility policies and procedures.

RESOURCES

Lindsey, Carol. (2010). Ending Procedures (video). Retrieved from https://www.youtube.com/watch?v=TzgyjUcC080

Professional Healthcare Development, LLC. (2011). Performance Skill Procedures. Retrieved from http://www.profhd.com/Skills%20procedures.pdf