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Visiting DAWN ANN BEATTIE's Shares (account name: heartnhandstraining)
 
 MONTANA DEPARTMENT OF PUBLIC HEALTH & HUMAN SERVICES NURSE AIDE SKILLS COMPETENCY CHECKLIST
  
   CLICK on LINKS in the LEFT COLUMN for SKILL HELP                  ---                RNCIs: VERIFY the MT-NASCC (RN-CI Fillable/Printable MT-NASCC PDF)
Name:    Date of Birth:  
Applicant Address:   Facility /School: www.HeartAndHandsTraining.com 
PERSONAL CARE DATE PASSED BY DATE PASSED BY COMMENTS OBSERVER
EXAMINATION DEMONSTRATION Initials
Tub bath
     
Shower
     
Bed bath
     
Partial bath
     
Oral care
     
Denture care
     
Female pericare
     
Male Pericare
     
Nail care
     
Hair care
     
Shaving
     
Use of commode and bedpan
     
Dressing/undressing
     
Prevention/observation Pressure sore  
   DAB
Skin care  
   DAB
Catheter care: Proper handling, emptying, changing catheter bags
     
Obtain specimens:

 
Urine  
   DAB
Stool  
   DAB
Sputum  
  DAB 
Application of heat:

 
Aqua pad  
   DAB
Compresses  
   DAB
Application of cold:

 
Ice bag
     
Compresses
     
Application ted hose
     
Documentation in residents records  
   DAB
Assessment & care planning process  
   DAB
INFECTION CONTROL DATE PASSED BY DATE PASSED BY COMMENTS OBSERVER
EXAMINATION DEMONSTRATION SIGNATURE
Blood and body fluid precautions  
   DAB
Handwashing
     
Use of protective gown, gloves and mask
     
Disposal of contaminated supplies
     
Proper linen handling, storage and disposal
     
COMMUNICATION/RIGHTS DATE PASSED BY DATE PASSED BY COMMENTS OBSERVER
EXAMINATION DEMONSTRATION Initials
Respectful in interactions/communication
     
Knocks before entering room        
Asks permission/explains procedures in advance
     
Addresses resident by preferred name
     
Demonstrates techniques of responding to:

  DAB
Combative resident
     
Depressed resident
     
Anxious resident
     
Cognitively impaired
     
Ensures privacy during personal care
     
ENVIRONMENT DATE PASSED BY DATE PASSED BY COMMENTS OBSERVER
EXAMINATION DEMONSTRATION Initials
Makes an unoccupied bed
      
Makes an occupied bed
     
Cleaning a resident unit  
   DAB
Marks & cares for personal possessions  
   DAB
Completes clothing & possessions list  
   DAB
Cleans resident care equipment
     
Care of glasses  
   DAB
Care of hearing aid  
  DAB
Care of prostheses  
  DAB
SAFETY AND REHABILITATION DATE PASSED BY DATE PASSED BY COMMENTS OBSERVER
EXAMINATION DEMONSTRATION Initials
Uses correct body mechanics
     
Turn/position resident
     
Range of motion
     
Use of mechanical lifts
     
Ambulation techniques: Use of gait belt
     
Ambulation techniques: Use of mobility equipment
     
Transfers:   Bed to chair
     
Transfers:   Chair to bed
     
Transfers:   One person
     
Transfers:   Two person
     
ADL Re-training  
  DAB
Bowel/bladder retraining  
  DAB
Use of restraints eg. Lap buddy, Geri chair, Wedge, etc  
   DAB
Use of side rails        
Use of call lights
     

Use of protective devices:



   
Padding, heel/elbow protectors, etc.        
Alarms (bed, chair, door)
     
Participates in fire drill  
   
SPECIAL PROCEDURES DATE PASSED BY DATE PASSED BY COMMENTS OBSERVER
EXAMINATION DEMONSTRATION Initials
Resident admission procedure  
   DAB
Resident discharge procedure        DAB
Resident transfer procedures        DAB
Take and record:

 
Temperature-(Electronic/Temp Dots)
     
Oral
     
Tympanic
     
Axillary
     
Pulse
     
Respiration
     
Blood pressure
     
Height
     
Weight
     
CPR (optional)

   
Heimlich
     
Post mortem care  
   DAB
Ostomy care  
   DAB
Respiratory care:(oxygen set-up; safety)
     
NUTRITION DATE PASSED BY DATE PASSED BY COMMENTS OBSERVER
EXAMINATION DEMONSTRATION Initials
Positioning (at table; in bed; during tube feedings)
     
Assists residents who self feed (supervision/cueing)

     
Feeds dependent residents
     
Partial physical assist to eat
     
Serves supplements
     
Preparing & serving thickened liquids
     
Passes drinking water
     
Records meal/supplement intake
     
Records fluid intake / output
     
CERTIFICATION OF COMPETENCY
 
Program Coordinator or Clinical Instructor: HEART&HANDS/ Facility I,
 
 DAWN ANN BEATTIE, BSN, RN, PC Certify that:  
(Name of PC or RN CI - type or print)   (Name of student - type or print)
 
has satisfactorily performed all of the above listed skills.
 
Signature of PC                         BSN, RN,PC DATE:  
 
Signature of Student: DATE:    
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   

 

 
Certificate of Completion
awarded to
 
 
 
 
SSN
DOB
 
 for completing the prescribed course of studies for
NURSE AIDE
on
 
 
55
7/22/2014
32
Classroom Hours
Most recent MT-DPHHS program approval date
Lab+Clinical Hours

 

Program Instructor Signature:BSN, RN

Date:     

 

 

 ONLINE THEORY & LAB WORK COMPLETED (X):                                                                   
  X     X     X     X  

  X  

  X     X       X    X     X     X     X     X  

  X 

 X  X 

     

  X 

  X 

Bckgrnd

01 02 03

04a

 04b  

05

ALZ

  MID  06 07 08 09 10

PRACTICE

FINAL 

FINAL

EXAM 

 

RETAKE or SITE

FINAL EXAM

if applicable

 

LAB-Activities

X30 skills

LAB Comments

 X30 skills

DIS  DIS DIS DIS DIS   DIS DIS DIS DIS DIS 
*Total Clinical Days & Hours (25 HRS MIN):         
  TESTS: Pre/Adm Mid.  C Practice.  C Final Exam
OL Lab+Clinical Skills Completion Date  Clinical Performance:       X   Pass            Fail
Eligibility for State Exam:       X   Yes            No Exam Entry Completed:       X   Yes            No
Date of State Exam  CNA Certificate Received:       X   Yes            No

Written:            Pass            Fail


 Manual:            Pass            Fail

*Discussion Participation is waived for students already working a clinical facility.Lab/Clinical begins anytime after Chapter 5 successful completion.               

Program Coordinator/Theory Instructor:

 

 

 *Original Clinical Documentation

 

 


Creation date: Jun 25, 2015 9:49 pm     Last modified date: Sep 22, 2016 10:20 pm   Last visit date: Oct 22, 2016 10:58 am     link & embed ?...
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