Texas CNA Skills (Part Twelve): Understand the Patient Care Scenario!

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The CNA state test consists of  a written section as well as a hands-on clinical skills portion. The clinical skills section of the CNA state exam test is comprised of multiple procedural skills interwoven into a simulated patient care scenario that has been formulated to resemble situations nursing assistants aides normally encounter during the course of a shift at the workplace.

The clinical skills section of the CNA state test is administered in a simulated caregiving situation that will look almost exactly like the patient care environment in which most nursing assistants are expected to function. Unless specified otherwise, all the equipment and supplies a test taker needs during the clinical skills section of the CNA state test will be supplied by the testing site.

The skills section of the CNA state test will be designed to seem as realistic as possible. Also, the test taker will perform the hand-washing skill the on first instance it is needed in the test. However, after the first hand-washing demonstration, all other moments that require hand hygiene will only need to be verbalized. For instance, after performing foot care, the test taker would verbalize, “Now I would wash my hands.”

The patient care scenario will be typed on a sheet of paper or index card and handed to the test taker by the testing site evaluator. In most cases the testing site evaluator will read the scenario instructions to the test taker before the clinical skills section of the CNA state test is slated to begin.

The ‘patient’ who participates in the simulated patient care scenario is usually another test taker who has graciously volunteered to step into that role. In other words, test takers will perform hands-on skills on each other during the CNA state test. Test takers who volunteer to pose as a patient must adhere to a predetermined dress code.

However, instances do arise where performance of a procedural skill on a mannequin would be far more appropriate. For instance, if the scenario card involves an intimate skill such as perineal care or urinary catheter care, the test taker will demonstrate it on a mannequin rather than another person.

The following is an example of a simulated patient care scenario that is similar to what one would receive during the skills section of the CNA state test.

Sample Scenario 

Ms. Hernandez: Hand-washing / Manual Blood Pressure / Give Modified Bed Bath / Mouth Care / Position on Side

Ms. Hernandez is a 65-year-old long term resident of Curry Hills Nursing & Rehab Center who has hypertension and major depressive disorder. She has refused showers for the third day in a row due to her depressed mood. When you enter Ms. Hernandez’s room, you find her laying in bed. She is wearing a hospital gown, bra and underwear.

You will wash your hands and check Ms. Hernandez’s blood pressure manually before giving her a modified bed bath. You will perform oral care prior to positioning her on her side. You will leave Ms. Hernandez in a position of safety and comfort. You will document as needed while providing the care.

 

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Texas CNA Skills (Part Eleven): Pearls of Wisdom from Nurse Aides Who’ve Passed the CNA State Examination

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Due to legislation that had been enacted and implemented in the late 1980s, nurse aides must obtain state certification as certified nursing assistants (CNAs) if they want to secure employment in certain healthcare facilities that accept federal dollars. The Omnibus Budget Reconciliation Act of 1987, more simply known as OBRA, established the minimum acceptable standards for nurse aide training.

The overarching goal of nurse aide training programs is to sufficiently prepare students in nursing assistant programs with the practical knowledge, clinical skills, and procedures that must be adhered to by members of staff at all skilled nursing facilities that receive federal payments. In simpler wording, OBRA is the very reason that nurse aides must attain CNA certification if they want to work at these types of workplaces.

So, this is the burning question. How in the world does a nurse aide obtain certification as a CNA? The answer to this question is the following: a nurse aide becomes certified in a particular state by passing the national CNA state exam utilized by that state. A wonderful way to become more familiar and confident with the setup of the CNA state exam is to obtain feedback from nurse aides who have taken and passed the test.

The following responses are from multiple nurse aides who possess firsthand experience in regards to taking the CNA state exam. The responses provided by these nurse aides pertain mainly to the successful completion of the skills section of the CNA state exam. Keep in mind that a written (or oral) section of the CNA state exam exists as well.

The individual and collective insights provided by these nurse aides that pertain to the CNA state test are rather enlightening. In addition, readers can learn quite a bit of new information from the varied perceptions and recollections of these nurse aides’ different experiences with the CNA state exam. Therefore, read and pay close attention to recurrent themes within the responses such as the importance of performing the procedural skills using the correct sequence of steps.

NURSE AIDE ONE: “If you mess up on a step or just forget to complete a step, you will simply lose points. If you forget to do a bold step (also known as a critical element step), or perform it wrongly, you fail the entire skill by default. You should be able to pass the CNA state test as long as you remember to perform the bold steps and always do them right.”

NURSE AIDE TWO: “You will need to do the skills in the exact order on the skills handbook or you will not pass. So, in your spare time, practice on other people or dolls until you have each step memorized. If you can memorize each and every move, you will pass your CNA state test with flying colors.”

NURSE AIDE THREE: “Where I live, the person who watches you do the skills on the CNA state test is looking for you to perform the tasks in the order listed on the handbook. If you perform the tasks out of order, but do them right, points get deducted from the total score.”

NURSE AIDE FOUR: “On the CNA state test I did the steps as I had learned them since I knew I would have forgotten to do something really important if I strayed from what I learned. All the steps are there for a reason. So I suggest you instill them into your memory bank as best as you can.”

NURSE AIDE FIVE: “Do all the steps in the exact order for the skills.”

NURSE AIDE SIX: “I took lessons for CNA and each time when I took the skills exam part of the CNA state test, we needed to complete every skill correctly step by step. It is because these steps were placed and organized the right way so as to cut down on the chances of cross contamination and to teach you the best way to do the skills for the best care of the residents.”

Texas CNA Skills (Part Ten): General Guidelines for the CNA State Exam

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The following list is a set of general guidelines to help future nurse aide test takers know what to expect when taking the CNA state test.

  1. Always remember to speak with the patient to whom you are providing care, even if it might be a manikin. Effective communication entails introducing oneself and clearly explaining the procedural skills, which is all part of the skills section of the CNA state test.
  2. Equipment for the procedural skills will be available at the testing center. The nurse aide evaluator will give the test taker a list of all the equipment needed for the procedural skills that will need to be performed. It is the responsibility of the test taker to gather all the equipment. Thus, the test taker should gather and organize all needed equipment in a manner that is easiest for him or her.
  3. At the moment the skills competency section of the CNA state test begins, the test taker is allotted approximately 30 minutes to work through all of the assigned procedural skills.
  4. The test taker is required to wash his or her hands at the beginning of the simulated patient care scenario for the CNA state test. Hand-washing is the first procedural skill to be performed. The test taker is expected to perform hand hygiene by using hand sanitizer at other moments during the CNA state test as needed.
  5. The patient’s privacy and safety must be upheld during the entirety of the simulated patient care scenario. In addition, strict compliance with infection control techniques must be sustained during the entire scenario for the CNA state test.
  6. The test taker will need to physically work through each step associated with every procedural skill he or she has been assigned for the CNA state test. Once the skill is started, if an error is made, the test taker must say so and correct himself or herself. The test taker will be expected to complete the step that was missed.
  7. For the CNA state test, side rails are utilized only for safety with certain procedural skills performances. At other times, the side rails should be in the low position.
  8. Always keep in mind that the CNA state test should be reflective of the test taker’s provision of basic nursing care duties to a real patient and performance of direct hands-on care for that person.
  9. For the skills competency section of the CNA state test, the test taker can be safe to assume that he or she will be performing the skills on one patient and/or manikin and will not be alternating from resident to resident as a typical nursing assistant would in a nursing facility setting. The test taker must become proficient at all of the testable skills in addition to the opening procedures and closing steps for each skill.

REFERENCES

Lewis-Clark State College. (2013). Student Skills Packet. Retrieved from http://www.lcsc.edu/media/117278/2013-Student-Skills-Packet.pdf

CNA State Examination Practice Questions (Part One)

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As nursing assistant students enrolled in a nurse aide training program, a number of steps exist that can be taken to promote mastery of the knowledge and skills needed to pass the CNA state test. A few of these steps include cultivating top-notch study habits that are conducive to one’s personal learning style, reviewing some material on a daily basis, and staying abreast of various tips and tricks to help answer the trickiest of practice test questions.

A diligent student engages in self-discovery to pinpoint the manner in which he or she learns most optimally. Even though a wide array of different theories exist regarding adult learning styles, it is best to simplify things by asserting that a pupil can be a visual learner, auditory learner, tactile learner, kinesthetic learner, or perhaps a combination of two or more learning styles.

It has also been said that repetition is the mother of all learning. Learning by repetition is a valid way of becoming proficient at answering knowledge-based questions. Simply put, the more a nurse aide student answers practice questions, the more prepared he or she will be at the testing center when answering the real exam questions on the knowledge (or oral) section of the CNA state test.

One proven way of boosting a skill proficiency or becoming competent at a task is to ensure that it is a stored routine in the consciousness of the learner. To make sure this process takes place, the most imperative first step is to elevate the skill to a conscious level whereby the nurse aide student deliberately ruminates over the activity, but not necessarily the desired skill itself.

In other words, the nurse aide student has full knowledge about the particular skill that he or she lacks (read: answering knowledge-based test questions) and, therefore, focuses on accomplishing the types of activities that will help him or her build the skill (e.g., reading, creating flashcards, repeatedly answering practice questions). This type of learning is what educators commonly refer to as learning by repetition.

To prepare adequately for the written knowledge section of the CNA state test, a nurse aide student should answer multiple practice questions each and every day. Click on the video below to see a handful of examples of the types of questions that will appear on the written portion of the CNA state test.

Texas CNA Skills (Part Nine): Skills on the CNA State Test that Require Measurements

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The National Nurse Aide Assessment Program, or NNAAP for short, is a nationwide credentialing program for nurse aides who want to pursue certification as a certified nursing assistant (CNA). In other words, the NNAAP exam is better known as the CNA state test. Additionally, the National Council of State Boards of Nursing (NCSBN) is the entity that has been entrusted with the formulation, revision and administration of the CNA state test.

In most states in the US, the CNA state test is comprised of two distinct sections: a written (or oral) knowledge test made up of 70 multiple choice questions, and a procedural skills competency evaluation consisting of five different hands-on skills that must be demonstrated in front of a nurse aide evaluator.

The procedural hands-on skills evaluation section of the CNA state test takes place in a setting that has been arranged to simulate a patient care environment such as a room inside a long term care facility. Each test taker will have exactly 30 minutes to demonstrate competency in the five skills. The nurse aide candidate must attain a passing cut score on four out of the five procedural skills in order to pass the skills evaluation section of the CNA state test.

The first procedural skill that all test takers in Texas complete is hand-washing, and the remaining four skills will be selected totally at random. Moreover, the NNAAP skills evaluation mandates that all test takers complete at least one numerical measurement skill as part of the CNA state test (Pearson Vue, 2018). All of the hands-on procedural skills that require documentation of a numeric measurement have been listed below.

  1. Measurement and documentation of blood pressure
  2. Measurement and documentation of respiration rate
  3. Measurement and documentation of radial pulse
  4. Measurement and documentation of urinary output
  5. Measurement and documentation of an ambulatory patient’s body weight

On the scheduled day of the CNA state test, the test taker will need to bring three sharpened number two pencils with erasers to the testing center site to record the numerical measurements. The test taker will also need to bring a wristwatch with a second hand to the testing center to perform certain skills.

During the CNA state test, nurse aide test takers in Texas will be using the following standardized, approved form to document the numerical measurement(s) of the random procedural skill(s) they have been assigned.

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REFERENCES

National Council of State Boards of Nursing. (2018). NNAAP & MACE. Retrieved from https://www.ncsbn.org/nnaap-and-mace.htm

Pearson Vue. (2018). Texas Nurse Aide Candidate Handbook. Retrieved from https://home.pearsonvue.com/getattachment/73a0c524-4cbe-401a-aa5c-fe1ebf4e2517/Texas

Texas CNA Skills (Part Eight): What to Wear and How to Dress for the CNA State Test

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The broad majority of states in the U.S. have enacted laws that require graduates of nurse aide training programs to pass the respective state-approved examination in order to secure occupational certification as a certified nursing assistant (CNA). Therefore, the CNA state test is extremely important to the future career prospects of countless nursing assistants.

Nonetheless, many nurse aide students remain blissfully unaware that a testing center dress code exists. Well, a dress code certainly does exist for the CNA state test, and more than one rationale for being dressed in a specific way at the testing center site has been presented. The rationales for the dress code have been listed below.

  1. Nurse aide test takers should anticipate the remote possibility of spending all day at the testing center. Therefore, all-day comfort is of the utmost importance.
  2. A nurse aide test taker might be asked to participate in a simulated patient care environment where he or she plays the role of a debilitated elderly patient for one or more other test takers who need to perform hands-on skills. Thus, nurse aide candidates will actually be performing their skills on each other during the skills evaluation section of the CNA state test.
  3. Nurse aide test takers should wear shoes with non-skid soles (bottoms) for safety reasons. The safety of all test-taking candidates needs to be upheld at the testing center.
  4. Any candidate who volunteers to play the role of the patient must wear flat slip-on non-skid closed toe shoes, loose pants or bottoms that are capable of being rolled up, and a loose tank top or loose-fitting shirt with sleeves that can be rolled up to the shoulders (Pearson Vue, 2018).

In general, test takers will never go wrong by dressing the part of an employed nursing assistant regardless of whether or not they opt to volunteer to pose as a patient. The following dress code is more of a basic set of guidelines for appropriate testing center clothing for the CNA state test. Keep in mind that Pearson Vue testing centers are the testing sites where all CNA state tests are conducted in the state of Texas. The following list contains generalities surrounding proper attire in regards to the Texas CNA state test, as well as testing sites in the majority of other states in the US.

  1. Wear closed-toe shoes with flat non-skid soles.
  2. Nurse aide test takers who do not volunteer to play the role of a patient should wear a medical uniform, scrub set, or casual attire. Clothing should be clean.
  3. Nurse aide test takers who choose to wear casual attire should wear jeans, pants, khakis or slacks to comply with the potential need for hands-on skills practice. Dresses and skirts are discouraged with the exception of religious reasons.
  4. Midriffs and abdominal areas should be covered.
  5. Nurse aide test takers should appear clean, groomed, and be free from strong body odor. Perfumes, body sprays and colognes are discouraged.
  6. Nurse aide test takers who wear white bottoms should wear proper underwear since patterned panties, briefs or boxer shorts might be seen through white material.
  7. Long hair should be worn back into a ponytail, bun, contained by a headband, or pinned.
  8. Fingernails should be kept short and trimmed.
  9. Nurse aide test takers must wear a wristwatch with a second hand.
  10. Limit / curtail the amount of jewelry worn to the testing center. The amount of jewelry the nurse aide test taker wears to the testing center site should be minimal.

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Be completely mindful that the CNA state test dress code is different in a handful of states in the US. For example, CNA state test sites in Arizona require all test-taking candidates to adhere to a very specific dress code, and those who do not comply will not be permitted to take the exam.

With regards to the CNA state test in Arizona, Headmaster LLP (2018) asserts that “SCRUBS (which consists of a scrubs top and scrub pants, scrub skirt (long, loose-fitting) or scrub dress (long, loose-fitting) and closed-toed, soft-soled shoes are the required dress code for testing. You will not be admitted for testing if you are not wearing scrub attire and the appropriate shoes. You will be considered a NO SHOW. You will have to pay for another exam date.”

Be sure to dress for success on the day of the CNA state test and beyond. The nurse aide testing site evaluator is the individual who will be observing for competency as the test taker performs the skills evaluation section of the state test. Dressing the part for the CNA state test can go a long way in presenting the image of a candidate who is fully competent, prepared, professional, and serious about his or her future career as a nursing assistant.

Readers have probably heard the olden adage that one never gets a second chance to make a first impression. The point is to present oneself to the testing site evaluator as a nurse aide who deserves to pass the CNA state test. A cleanly nurse aide candidate looks the part, whereas a test taker with 10 gold chains, a tight-fitting cropped top that exposes the torso and dirty blue jeans does not look professional.

REFERENCES

Headmaster, LLP. (2018). Arizona Nursing Assistant Candidate Handbook. Retrieved from http://hdmaster.com/testing/cnatesting/arizona/azformpages/azforms/AZCandidateHandbook%202.1.18.pdf

Pearson Vue. (2018). Texas Nurse Aide Candidate Handbook. Retrieved from https://home.pearsonvue.com/getattachment/73a0c524-4cbe-401a-aa5c-fe1ebf4e2517/Texas

 

 

 

Texas CNA Skills (Part Seven): Critical Element Steps in the Skills Competency Section of the CNA State Test

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Nursing assistants who want to obtain certification as a certified nursing assistant (CNA) will need to pass the CNA state examination for the state where they plan to work. In the state of Texas, the CNA state test consists of two sections: a written (or oral) examination with a series of 70 multiple choice questions, as well as a hands-on skills competency evaluation consisting of five procedural skills that are to be performed in the presence of a testing site nurse aide evaluator.

During the skills section of the CNA state test, all test takers will need to successfully perform hand washing as the first procedural skill. Thereafter, the test taker will be required to perform an additional four out of five testable procedural skills. The remaining four testable skills will be selected completely at random.

Before the skills evaluation section of the CNA state test starts, the testing site nurse aide evaluator hands the test taker an instruction card that lists the randomly selected procedural skills that must be completed. Hand washing is the only CNA state test procedural skill that is not selected randomly. In other words, all nurse aide candidates who take the Texas CNA state test will be assigned the skill of hand washing during the skills evaluation portion.

Critical element steps are also referred to as critical steps, key steps, critical items, and critical elements. According to Pearson Vue (2018), critical element steps are the important actions associated with each procedural skill that the test taker must complete with accuracy in order to pass that particular skill. In other words, critical element steps are actions that must always be performed when completing a skill in front of the testing center nurse aide evaluator during the CNA state test.

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A nursing assistant candidate will most certainly fail the hands-on skills evaluation section of the CNA state test if he or she forgets to perform, misses, or incorrectly performs any critical element steps associated with a particular procedural skill. Also, be advised that most, but not all, skills have critical element steps that need to be correctly done in order to successfully complete the entire procedure with a passing cut score.

As an example, the procedural skill of cleaning an upper or lower denture has no critical element steps associated with it. However, the skill of measuring and recording a patient’s respirations has at least one critical element step attributed to it. Missing, forgetting, or incorrectly completing the critical element step associated with measuring and recording respirations means that the test taker fails the entire skill.

The skill of measuring and recording a patient’s respiratory rate is listed below in a step by step sequence, along with the single critical element step associated with this procedure. The critical element step is emboldened and underlined.

  1. The nursing assistant explains the procedure using clear and slow speech that is understandable. The nursing assistant maintains face to face contact with the client as much as possible.
  2. The nursing assistant measures the client’s respiration rate for one whole minute.
  3. The nursing assistant makes sure that the client’s call bell or signaling device is within reasonable reach.
  4. The nursing assistant washes his or her hands before documenting the client’s respiration rate.
  5. The nursing assistant is to document a respiration rate number that falls approximately within plus or minus two breaths of the testing site nurse aide evaluator’s documented number.

In general, most provisions related to safety, privacy, numerical measurements and infection control are usually regarded as critical element steps for testing purposes while taking the skills competency section of the CNA state test. The test taker cannot miss any critical element steps while performing a hands-on procedural skill at the testing center, or else he or she will automatically fail that particular skill.

In fact, most failures on the skills evaluation portion of the CNA state test can be attributed to the test taker’s omission or forgetfulness of the critical element steps on procedural skills regarding client safety, rights, numerical measurement documentation, or privacy maintenance. In summary, do one’s best to avoid missing any critical element steps at the testing center.

REFERENCES

Pearson Vue. (2018). Texas Nurse Aide Candidate Handbook. Retrieved from https://home.pearsonvue.com/getattachment/73a0c524-4cbe-401a-aa5c-fe1ebf4e2517/Texas

 

 

 

Texas CNA Skills (Part Six): the Art of Nurse Aide Communication on the CNA State Test

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Communication can be defined as the ongoing exchange of data, information, thoughts, opinions and feelings among persons by way of utilizing speech, gestures and/or other means (Kourkouta and Papathanasaiou, 2014). Since nursing assistants are on the front lines of direct care in healthcare facilities, the communication skills of CNAs are truly fundamental to smooth interpersonal interactions and enhanced patient satisfaction.

Communication between nursing assistants and their patients is firmly grounded in a trifecta of three essential elements. These three elements include competent social skills, proven communicative techniques, and the Golden Rule of always treating other individuals in the same manner that one would want to be treated.

The communication of each nursing assistant is also guided by several ethical principles. First of all, veracity is defined as truth-telling. Nursing assistants possess the ethical obligation to be truthful (read: veracious) in all communications with their patients. Secondly, the ethical principle of integrity imposes a duty upon all nursing assistants to behave in a straightforward manner while adhering to high standards in all communications and encounters with patients. Finally, the ethical principle of fidelity is defined as being faithful, and nursing assistants have the ethical obligation to exercise faithfulness when communicating with patients.

Communication is also an element that is heavily tied into the skills portion of the CNA state test. The test taker will need to communicate with a patient in a simulated patient care scenario as a testing site evaluator observes. The vast majority of the hands-on procedural skills involve some type of verbal and nonverbal communication in order to pass the CNA state test. For instance, most of the skills on the CNA state test call upon the nurse aide test taker to engage in multiple communicative tasks.

The communicative tasks that are incorporated into the skills portion of the CNA state test often include verbal and nonverbal responsibilities such as introducing oneself as the nursing assistant, vocally identifying the patient, referring to the patient by his or her preferred name, explaining the procedure, maintaining face to face contact whenever possible, and asking if anything else is needed.

The following list is a set of general guidelines on communicating clearly and effectively with patients during the skills competency evaluation section of the CNA state test.

  1. The nursing assistant should greet the patient by his or her preferred name.
  2. The nursing assistant should introduce himself or herself to the patient by announcing one’s name and title (e.g., “My name is Rob and I will be your nursing assistant today.”).
  3. The nursing assistant should maintain face to face contact with the patient whenever possible.
  4. The nursing assistant should avoid staring into space or talking aimlessly. The nursing assistant should focus on the topic to be discussed.
  5. The nursing assistant should occasionally talk to the patient while providing the care.
  6. The nursing assistant should listen to the patient as he or she speaks and respond as needed.
  7. The nursing assistant should utilize appropriate social reinforcements such as praise, smiling, and rephrasing of the patient’s words as needed.
  8. The nursing assistant should encourage the patient to utilize the call light as needed and make sure it remains within easy reach.
  9. The nursing assistant should be cordial, even-tempered and honest in all verbal and nonverbal interactions with the patient.
  10. The nursing assistant should let the patient know verbally when he or she is preparing to exit the room.

REFERENCES

Kourkouta, L., and Papathanasaiou, I. (2014). Communication in Nursing Practice. Materia Sociomedica, 26(1), 65-67.

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

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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

Texas CNA Skills (Part Three): Measuring and Recording Respirations

Screenshot 2018-12-01 at 12.22.36 PMRespiration, also known as breathing, is one of the four main vital signs that nursing assistants, nurses, respiratory therapists, paramedics, emergency medical technicians and other healthcare workers must know how to accurately obtain and record. Of course, the other three vital signs include temperature, pulse and blood pressure.

Alternately worded, a patient’s respiratory rate is his or her breathing rate. It is the number of breaths that he or she takes over the course of one full minute (60 seconds). Generally, a respiration rate that falls between 12 and 20 breaths over the course of one whole minute is considered a normal and expected finding in an adult who is resting.

Remember the concept in this manner for enhanced ease of recollection and lack of confusion: the process of respiration is more commonly known as the process of breathing. Respiration is a very high-priority basic need because a patient who stops breathing will be dead in a matter of minutes without timely outside intervention. Fortunately, taking and recording a patient’s respiratory rate is one of the technically easier procedural skills for a healthcare worker to carry out.

Respiration is an enormously complex activity that is comprised of two differing processes called inspiration and expiration. Through inspiration and expiration, the cells of the body continually exchange two gases called oxygen and carbon dioxide. The body simultaneously breathes in oxygen and expels carbon dioxide. Inspiration is the process of inhaling air into the lungs; likewise, it occurs when a patient breathes in. Expiration is the process of exhaling; therefore, it takes place when a patient breathes out.

Inspiration and expiration are massively important processes to the continual functioning of all human bodies since they are responsible for keeping the blood, organs and tissues rich with oxygen (read: inspiration) while ensuring that excess carbon dioxide leaves the body (read: expiration).

Furthermore, the procedure of measuring and recording a patient’s respiration rate is a testable skill on the Texas CNA state test. It is also a testable procedural skill in most other states. Therefore, a nurses aide who wants to pass the CNA state test to obtain certification as a certified nursing assistant will need to know how to accurately take and record a patient’s respiratory rate in the presence of an examiner at the testing site.

According to Pearson Vue (2018), a patient’s respirations should be counted and recorded using the following listed sequence of steps during the skills portion of the state CNA examination:

  1. The nursing assistant should explain the procedure to the patient in a slow and clearly understandable manner while maintaining regular face to face contact as needed.
  2. The nursing assistant must measure the patient’s respiratory rate for one entire minute (60 seconds).
  3. The nursing assistant should ensure that the patient’s call light or signaling device is within easy reach prior to ending the skill.
  4. The nursing assistant must wash his or her hands prior to recording the patient’s one-minute respiratory rate.
  5. The nursing assistant must document a respiratory rate number that is within two breaths of the examiner’s recorded reading. For instance, the nursing assistant will pass this skill if he or she records a respiratory rate of 16, even if the examiner had  documented a respiration rate of 14.

To pass the procedural skill of measuring and recording respirations on the CNA state exam, the test taker’s documented one-minute respiration rate must fall within a predetermined range of plus or minus two breaths of the test site examiner’s recorded reading. Here are a handful of additional tips that can potentially help with obtaining a respiration rate from patients in clinical settings:

  1. Perform the opening procedures before starting the skill.
  2. Count it as one respiration each time the patient’s chest rises.
  3. Count the respirations for one entire minute (60 seconds) to obtain the one-minute respiratory rate.
  4. Record the respiratory rate as indicated.
  5. Perform the closing procedures after ending the skill.

REFERENCES

All About Medical Training. (2015). Count and Record Respirations – CNA Skill Video AAMT. Retrieved from https://www.youtube.com/watch?v=VS0adbHFneA

BioSpine Institute. (2018). Breathing (picture). Retrieved from https://biospine.com/diaphragm-back-pain/

Pearson Vue. (2018). Texas Nurse Aide Candidate Handbook. Retrieved from https://home.pearsonvue.com/getattachment/73a0c524-4cbe-401a-aa5c-fe1ebf4e2517/Texas