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

 

 

 

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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

Texas CNA Skills (Part Two): the Initial Steps, a.k.a. “Opening Procedures,” That Must Be Performed Before Demonstrating Skills on the State Examination

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In most U.S. states, including Texas, a test-taker who wants to pass the state-approved CNA examination must demonstrate his or her ability to successfully complete several hands-on procedural tasks during the skills portion of the state test. This all takes place as an examiner carefully observes the steps associated with each skill performance from start to finish.

Out of 20+ possible testable skills on the CNA state test, five skills will be selected at random for the test-taker to perform in front of the examiner. In order to pass the skills portion of the CNA state test, four out of five of the randomly selected skills must be completed successfully and by the book. It is advisable to know how to perform all 20+ testable skills for maximal test preparation.

Each testable skill possesses an assigned value that shall correspond to each step associated with the complete, successful performance of the skill. For instance, a skill such as hand-washing that requires a number of steps from start to finish would be worth multiple points. If all steps of the hand-washing skill are performed properly and in the correct order by the test-taker, then all points will be awarded for the performance of that particular skill.

Keep in mind that the test-taker is allowed to miss a small number of steps that are considered not critical and still successfully pass the skills portion of the CNA state examination. The overriding point is that examiner wants to see that the test-taker knows how to execute the procedural skill from start to finish.

On the other hand, the nurse aide test-taker is absolutely not allowed to miss or forget to perform any critical steps of a procedural skill during the skills portion of the CNA state test. Generally, measures such as infection control, safety, privacy and provision of a signaling device or call light within reach are regarded as critical steps. In essence, these steps must always be performed. After all, they are considered critical steps.

Initial steps are known by various names, including pre-steps and opening procedures. Since the skills section of the CNA state exam is usually performed as one single scenario, these opening procedures need to be completed once, typically when the scenario starts. To reiterate, test-takers must carry out these opening procedures at the beginning of each test.

Opening procedures normally involve routinized steps such as knocking on the patient’s door, introducing oneself to the patient, identifying the correct patient, and ensuring privacy. According to Lewis-Clark State College (2013), the opening procedures should be carried out in the following order:

  1. The nursing assistant should get instructions from the nurse concerning the patient’s needs, functional limitations, and what the patient is able to do.
  2. The nursing assistant needs to knock before going inside the patient’s room. If applicable, await permission to enter the room if the patient is verbal in the scenario that has been assigned.
  3. The nursing assistant must refer to the patient by name. The nursing assistant must confirm the patient’s identity to ensure it is the right patient.
  4. The nursing assistant needs to identify himself or herself. The nursing assistant needs to identify his or her workplace title (e.g., “I am Joy. I am going to be your nurse aide for the day.”
  5. The nursing assistant should clearly explain the procedure in language the patient can understand. The nursing assistant should encourage the patient to complete as much as he or she possibly can.
  6. The nursing assistant should gather supplies and examine equipment prior to the start of the skill or procedure.
  7. The nursing assistant must properly wash his or her hands.
  8. The nursing assistant must ensure the patient’s privacy is upheld by keeping doors and/or privacy curtains in the closed position.
  9. The nursing assistant needs to keep the bed’s side rails in the ‘up’ position before elevating the bed to an appropriate height. The nursing assistant is to lower the side rails on the side of the bed where the care is being delivered.
  10. The nursing assistant should adhere to standard precautions by gloving up as needed.
  11. The nursing assistant should perform all skills while utilizing appropriate body mechanics. Maintain correct body alignment while working.

REFERENCES

4YourCNA. (2018). The Opening – a 4 YourCNA Lesson. Retrieved from https://www.youtube.com/watch?v=OOMXB_ahFyE

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

Los Angeles Mission College. (2016). General Information, Exam Requirements, and Skills Steps Review Packet. Retrieved from https://www.lamission.edu/alliedhealth/docs/SkillsReview%20Rev02-16.pdf

Texas CNA Skills (Part One): Hand-Washing, a.k.a. Hand Hygiene Instructions and Video

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Hand-washing is arguably one of the easiest and most effectual methods of infection control in healthcare facilities. Correctly-performed hand hygiene prevents the spread of harmful diseases. In fact, the overarching goal of hand-washing is to remove microbes, dirt, debris and particles from the hands by way of sufficient manual friction along with soap and warm water to prevent the spread of disease-causing germs to vulnerable patients and residents.

In addition, hand-washing happens to be a testable skill on the Texas state examination and skills evaluation test to attain certification as a certified nursing assistant (CNA). During the course of the CNA state test, the test-taker is expected to perform a full hand-washing skill sequence in front of the examiner to ensure that it is being done properly. Thus, a thorough working knowledge of correct hand-washing techniques is imperative in order for a candidate to pass the skills portion of the state exam.

Without satisfactory knowledge of hand-washing techniques, a test taker could quite possibly fail the skills portion of the state test, resulting in a disappointing loss of time, money, effort and confidence. Who wants to continually retake the CNA state exam? Not you! In other words, it would be an excellent idea to know how to perform the skill of hand-washing in the precise manner that the state test examiner wants it completed.

CNAs and other healthcare workers will need to wash their hands multiple times per work shift during the course of performing direct care. The nurse aide must perform proper hand hygiene before entering patients’ rooms, prior to exiting patients’ rooms, before and after feeding residents, after handling unclean bedding and linens, prior to performing procedures on patients, and after coming into contact with skin tears and open wounds.

Again, the rationale for hand-washing is to reduce the likelihood of transmitting infectious germs. The World Health Organization (2009) asserts that five instances are appropriate for hand hygiene: 1) prior to contact with patients and residents; 2) prior to performing clean and/or aseptic tasks; 3) after body fluid exposure risks; 4) after contact with patients and residents; 5) after making contact with patients’ surroundings.

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To successfully complete the hand-washing skill for the Texas CNA state exam, Pearson Vue (2018) asserts that this procedure should be performed utilizing the following steps in the order that has been listed below:

  1. The nursing assistant must refer to the patient by his or her name. The nursing assistant must also introduce himself or herself to the patient by name.
  2. The nursing assistant must proceed to turn on the water faucet at the sink.
  3. The nursing assistant needs to completely wet his or her hands and wrists.
  4. The nursing assistant adds a sufficient amount of soap to his or her hands.
  5. The nursing assistant must ensure all surfaces of his or her hands, wrists and fingers are lathered up for a minimum of 20 seconds while using sufficient friction. While lathering up, make sure the hands remain lower than the elbows. While lathering up, also make sure elbows and fingertips are kept down.
  6. The nursing assistant needs to clean his or her fingernails by rubbing the fingertips against the palms of the opposite hand.
  7. The nursing assistant must rinse off all surfaces of his or her hands, wrists and fingers while being sure to keep the hands lower than the elbows and the fingertips down.
  8. The nursing assistant must use dry paper towels to dry off all surfaces of his or her hands, wrists and fingers while starting at the fingertips. The nursing assistant then must proceed to dispose of the used paper towels into the wastebasket receptacle.
  9. The nursing assistant must use dry paper towels to turn the water faucet off before properly throwing the used paper towels into the wastebasket receptacle.
  10. The nursing assistant must not touch the inside of the sink during any point in time while performing the hand-washing skill in front of the examiner.

REFERENCES

All About Medical Training. (2015). Hand Hygiene (Hand Washing) CNA Skill Video AAMT. Retrieved from https://www.youtube.com/watch?v=6ae0eODZyNQ&t=2s

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

World Health Organization. (2009). Hand Hygiene: How, Why & When? Retrieved from http://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochure.pdf

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