ANSWERS TO QUESTIONS FROM IDPH NA INSTRUCTOR CONFERENCE

APRIL 21, 2017

BASIC SKILLS FAQ Session

Approved Evaluation Process: Evaluating the student

  • Can a manikin be used on a second or third attempt in the lab, such as the occupied bed? Or, do we always need to have another student stay after class? What if no students can stay over to help (be the person in bed) the student who is re-doing the skill?
  • Use of a manikin is NOT permitted when evaluating a student to determine competency on any of the 21 Performance Skills.It is the Instructor/Approved Evaluator’s responsibility to ensure that there is someone appropriate to role play as a resident for a skill being evaluated in the lab setting. The Approved Evaluator can NOT role play as the resident as full observation of the performance is impeded.
  • Reference: IDPH Performance Skills Manual, May 2009 page 4: “NOTE: The use of mannequins for the purpose of competency testing is not allowed.”
  • Is it acceptable to check-off 2 students performing nail care simultaneously if they are in the same room (you are able to see both at the same time)?
  • Skills evaluations are to be conducted on a one-to-one basis.
  • Reference: IDPH Performance Skills Manual, May 2009 page 4: “The test is administered on a one-to-one basis.”

Wash Hands. Performance Skill #1: STANDARD: HANDS ARE WASHED WITHOUT RECONTAMINATION.Reference: IDPH Performance Skills Manual, May 2009 page 13.

  • Can you turn off the faucet handles off with 1 clean paper towel instead of a paper towel for each handle?
  • Principle 9 of the Performance Skill #1: Used dry paper towel between hand and faucet to turn off water. The key word is “dry”. Also, the standard, “without recontamination” must be assessed. If this paper towel used to turn off the first faucettouches or is grasped by the student’s other hand, there is a high probability of recontamination. Therefore, it is recommended to use separate paper towels to turn off each faucet.
  • Why do we have to use another paper towel to turn off the faucet? The handle is already contaminated. Why can’t we use the last paper towel used to dry hands? This drove my students NUTS to have to waste another paper towel.
  • Because of their small size, pathogens (bacteria) will easily transfer from the faucet to the hands through the wet paper towel by capillary action (wicking action). Using the wet paper towel to turn off the faucet will re-contaminate the hands.
  • Do you feel it is misleading or deceptive to say one may use paper towel wiped hands with to get clean paper towel from hand pumped dispenser but you cannot use towel dried hands with to turn off faucet?
  • Use of the elbow to deploy additional paper towels is an acceptable method.
  • Did you mean that handwashing must be done for all 21 skills, then once checked off on all, may use sanitizer? Or, handwashing is only done on the hand washing skill, then the other 20 may use sanitizer?
  • Wash Hands is Performance Skill #1. The expectation is that this is the first skill to be evaluated. It is important that each of your students have been deemed competent to perform hand washing at the appropriate times based on the situation.
  • “Wash hands” is stated in the Beginning and Completion Tasks. Therefore, the expectation is that the student wash their hands instead of using the hand gelduring the evaluation of Performance Skills #2-21.
  • Hand hygiene may be either hand washing or use of alcohol-based hand gel. When providing direct resident care, the student can use the appropriate hand hygiene method.
  • Please go over handwashing! A) When I did renewal, I was corrected to use 3 paper towels for each hand & 1 for turning off water. B) I was taught the twisting method but switched this past year due to state eval. I would like to go back to twist/spiral up to wrist. Would you show us with paper towels? Thank you.
  • Principle 7 of Performance Skill #1: Dried hands thoroughly with paper towel(s) from fingertips to wrists. The number of paper towels to be used is dependent on factors such as the quality, size and absorption of the paper towel. Drying can be done in a spiral or a pat method. Direction of drying is important; we start at the fingertips and dry towards the wrist. Once the paper towel goes up towards the wrist, it is not to go back down in the direction of the fingertips.
  • Do you want the students to remove watch before hand washing or just push their watch above the wrist level?
  • Either removing a watch or pushing a watch above the wrist is acceptable.One factor is the type of watch band.

Nail Care. Performance Skill #4: STANDARD: FINGERNAILS ARE CLEAN AND SMOOTH. Reference: IDPH Performance Skills Manual, May 2009 page 17.

  • Can CNAs trim/cut toenails? Textbooks say no, 21 Skills pack says no; but facility says, “Why not? They trim/cut finger nails.”
  • The 21 skills check-off sheet specifically states that CNAs are not allowed to clip toenails. When a local facility questioned this & we called SIU-C, we were told there were no guidelines for toenails. Please clarify.
  • CNAs are trained to provide nail care to the fingernails. Providing a warm soak to the feet and smoothing the toenails with an emery board have been deemed as safe procedures for a CNA to perform on residents without diabetes or circulatory diseases.
  • NOTE: CNAs are not to trim the toenails of residents. This is a statement directly from the Performance Skills Manual, page 17. It is based on F328 (CMS F-tag) relative to CFR §483.25(k)(7) Foot Care ( This identifies licensed persons as those qualified to provide treatment of foot disorders which includes preventive care to avoid foot problems (trimming of toe nails). CNAs are not licensed staff. As a person ages, many develop circulatory problems and changes in toe nail growth and contours. It becomes unsafe for the resident to have toenail care provided by an unlicensed staff member.

Perineal Care. Performance Skill #5: STANDARD: PERINEAL AREA IS CLEAN. Reference: IDPH Performance Skills Manual, May 2009 page 18.

  • Is using a quad fold wash cloth allowed for peri care instead of the mit?
  • The mit is preferred since it encloses the caregiver’s gloved hand decreasing the chance of the glove touching the perineal area which may cause discomfort to the resident.

Intake & Output – Performance Skill #14: STANDARD: TOTAL INTAKE AND OUTPUT QUANTITIES CALCULATED WITHOUT ERROR. Reference: IDPH Performance Skills Manual, May 2009 page 28.

  • Intake & Output – Nursing program advisory committees recommend teaching about ice chips. Example: 1 – 240 ml cup of ice chips = 120 ml of fluid.
  • Ice chips are liquid at room temperature; therefore, they are counted as intake and included in this content area of a BNATP. Requiring the student to calculate the equivalency of ice chips to water is the choice of the BNATP.
  • Intake & Output – If we don’t practice with “ambiguous’ foods, will the CNA exam reflect that teaching in its questions?
  • The development of test items for the state written examination includes review by the IDPH NA Advisory committee which includes several BNATP educators who are aware of which foods are considered ambiguous. Use of these foods in test items is avoided for this reason.
  • A BNATP instructor will present, discuss and explore a multitude of foods with their students. Informing students which of the food items may be counted as intake at one facility, but not another facility, is important content to share. Because of the ambiguous nature of that food item, it is recommended that an instructor not include it on a test.
  • Does “pudding thick” liquids count as liquids or food?
  • This is a question for the facility staff. Some facilities will count liquids thickened to pudding consistency, others do not.
  • Dehydration of the resident is a major issue with the use of thickened liquids.
  • If pudding does not count, then it should not be included during the instructor evaluation sessions.
  • Ambiguous food items are excluded from the Approved Evaluator Skills Refresher.
  • For counting intake fluids, the thickened liquids are categorized as nectar, honey & pudding consistencies. Why would pudding not count then?
  • Pudding is considered a soft food item; it is not a liquid at room temperature which is a determining factor. Therefore, it is not counted as fluid intake.
  • Where does the urinal get placed if there are no bed rails? Floor, head board, bedside stand, over bed table?
  • A chair on the side of the bed within easy reach of the resident is the best choice. Only clean items should be placed on the over bed table.

PPE. Performance Skill #17: STANDARD: APPLY AND REMOVE PERSONAL PROTECTIVE EQUIPMENT WITHOUT CONTAMINATION. Reference: IDPH Performance Skills Manual, May 2009 page 31.

  • Which is it gown-mask-gloves or mask-gown-gloves on our skills?
  • The PPE skill in the manual does not match the CDC chart, please explain.
  • What order for PPE? Handout states gown, mask gloves; skill manual says mask, gown, gloves.
  • Do we follow CDC or the IDPH manual for donning PPE for clinical performance skill evaluation?
  • The poster of the Performance Skill #17 in the packet today show a different sequence of putting on PPE. Which is correct?
  • Performance Skill #17 Apply & Remove PPE and the CDC Guidelines basically follow the same steps to accomplish the same standard. The donning of the PPE varies with the donning of the gown prior to the mask. Since these are bulleted items, the order may be altered to comply with CDC guidelines. The removal of the PPE order is the same in both sources. Therefore, the CDC guidelines can be used when evaluating the students.
  • Skill #17 says washed hands between every piece removed. CDC says if visibly soiled. Which do we teach?
  • If hands are visibility soiled or if there was possible contamination of the hands, wash hands is appropriate after the removal of the item. This complies with the CDC guidelines; it slightly alters the Performance Skill to indicate to wash hands if needed.
  • Why can you not add a clause to the manual to update skill automatically with CDC guidelines?
  • Revision and updating of the IDPH Performance Skills Manual, May 2009 is progressing.
  • Removal of PPE – removal of gown is not specific enough.
  • A description with diagrams for the removal of the isolation gown can be found in the nursing assistant textbooks as well as the CDC poster.
  • Isolation – need clarification of removal of food trays. Every LTC facility seems to have different rules.
  • We instruct in theory, practice in lab and adapt in clinical. Therefore, teaching the general principles in theory will prepare the student to function in different facilities. In the clinical setting, the instructor will guide the student through that particular facility’s policy and procedure which is dependent upon equipment/supplies used. Once employed, the student, a.k.a. new hire, will be oriented to the new facility’s procedure.
  • General principles in the handling of food trays from an isolation room:
  • Uneaten food is disposed of in a special garbage container in the resident’s room.
  • Disposable isolation food trays are discarded in the garbage container in the room.
  • Reusable food trays that are to be returned to the kitchen should be double-bagged and labeled as coming from the isolation room.
  • We use masks & eye protection attached; for removal where would you suggest as #2 or #4?
  • After removing gloves and the gown, the mask with attached eye protection can be removed. This fits the current CDC Guidelines for alternate removal of PPE (
  • Can the CDC alternate method for removing PPE be used?
  • When combining procedural steps in the teaching of a skill, it is important to assess the student’s capability to perform the steps which are part of the skill (if not combined). If the standard is met, use of the alternate method for removing PPE can be used.

BP. Performance Skill #19: STANDARD: MEASURE AND RECORD BLOOD PRESSURE TO WITHIN + OR – 4MM OF THE EVALUATOR’S READING USING DUAL STETHOSCOPE. Reference: IDPH Performance Skills Manual, May 2009 page 34.

  • Normal BP range for state exam?
  • Systolic range – 90-140 mmHg
  • Diastolic range – 60-90 mmHg

Other

  • Can the student go to clinical before completing theory?
  • BNATPs can be offered in a variety of ways.
  • A BNATP may choose to have students complete theory before beginning the clinical component.
  • Other BNATPs may have students begin clinical once they have completed the required 16 hours of training (IL Administrative Code 77, Section 395.150(a)(6)). However, this may prove to be an inefficient use of clinical time since the students are ONLY able to perform the tasks identified in the required 16 hours of training; these skills are communicating with a resident, wash hands and apply PPE. To allow students to perform other tasks such as transport a resident in a W/C or assist with dining is a violation of Federal Code(CFR 42 §483.152(a)(4)). This code states that the “students do not to perform any services for which they have not trained and been found proficient by the instructor”.
  • Many BNATPs provide the required 16 hours AND additional theory/lab hours before beginning the clinical experience to ensure that the students are competent to perform nursing assistant tasks as stated in CFR 42 §483.152(a)(4), thereby, complying with Federal Code.

Respectfully submitted,

Barbara Meinke, MA, MS, RN-BC

Joyce Steber, BSN, RN

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