Rehabilitation facility Post-mortem care Hospice care Pediatrics PD in a facility Parkinson’s patients Geriatrics (elderly) Comatose patients Alzheimer’s/Dementia patients Diabetic patients Seizure disorders Mental retardation Paraplegics (paralyzed waist down) Other: Specific Clinical/Non-Clinical Abilities Instructions: Check the box pertaining to your work experience/competency level using the following scale: Personal care ability areas 1 2 3 Personal care ability areas 1 2 3 1 = EXPERIENCED, 2 = CAPABLE WITH SUPERVISION/ASSISTANCE, 3 = INEXPERIENCED Ambulation assist patient with cane, walker Hair care shampoo in sink/tub – – or crutches Ambulation assist with walking Hand washing techniques – Ambulation assist with wheelchair Medxs remind and – – monitor only Apply Ace Bandage (CNA only task) Nail care clean/paint only (no – cutting) Apply hot/cold packs Oral hygiene care brushing and – flossing Back rubs/massages (never massage a patient’s calf) Oral hygiene care dentures – Bathing assist with shower/tub bath Oxygen assist in – – administration Bathing give sponge bath Positioning client in chair, bed or – car Bathing give complete bed bath (CNA only task) Pulse take, read and record – – Blood Pressure take and record (CNA only task) Range of Motion exercises – – active and passive Body Mechanics use proper techniques Record I & O (Input/Output) – Cardio Pulmonary Resuscitation Respiration take, read, and (CPR) record (CAN only task) Catheter Care bag only Sitz – Cosmetics assist with or apply in a pleasing manner Skin care – Personal care ability areas (cont.) 1 2 3 Personal care ability 1 2 3 Diapers change and reapply Temperature take, read and record – Dressing assist patient Toileting assist client with bedpan, – urinal Enemas (CNA only task) Toileting assist client to & from commode/toilet Feeding assist, cue, feed patient his/her meals Transfer techniques – intake measure/record Transfer use gait belt/transfer bench – – Gloves donning/removing Transferring use Hoyer lift – Hair care shampoo, dry, and style Turning a bed-bound patient – Hair care shampoo in bed Weight: Accurately and record – Housekeeping Ability Area Housekeeping Ability Area Care of house plants Meal preparation low fat diet – Care of pets Meal preparation low salt diet – Counters bathrooms / kitchens Meal preparation soft diet – –
Rehabilitation facility Post-mortem care Hospice care Pediatrics PD in a facility Parkinson’s patients Geriatrics (elderly) Comatose patients Alzheimer’s/Dementia patients Diabetic patients Seizure disorders Mental retardation Paraplegics (paralyzed waist down) Other: Specific Clinical/Non-Clinical Abilities Instructions: Check the box pertaining to your work experience/competency level using the following scale: 1 = EXPERIENCED, 2 = CAPABLE WITH SUPERVISION/ASSISTANCE, 3 = INEXPERIENCED Personal care ability areas 1 2 3 Personal care ability areas 1 2 3 Ambulation – assist patient with cane, walker or crutches Hair care – shampoo in sink/tub Ambulation – assist with walking Hand washing techniques Ambulation – assist with wheelchair Medxs – remind and monitor only Apply Ace Bandage (CNA only task) Nail care – clean/paint only (no cutting) Apply hot/cold packs Oral hygiene care – brushing and flossing Back rubs/massages (never massage a patient’s calf) Oral hygiene care – dentures Bathing – assist with shower/tub bath Oxygen – assist in administration Bathing – give sponge bath Positioning client in chair, bed or car Bathing – give complete bed bath (CNA only task) Pulse – take, read and record Blood Pressure – take and record (CNA only task) Range of Motion exercises – active and passive Body Mechanics – use proper techniques Record I & O (Input/Output) Cardio Pulmonary Resuscitation (CPR) Respiration take, read, and record (CAN only task) Catheter Care – bag only Sitz Cosmetics – assist with or apply in a pleasing manner Skin care Personal care ability areas (cont.) 1 2 3 Personal care ability 1 2 3 Diapers – change and reapply Temperature take, read and record Dressing – assist patient Toileting assist client with bedpan, urinal Enemas (CNA only task) Toileting assist client to & from commode/toilet Feeding – assist, cue, feed patient his/her meals Transfer techniques intake – measure/record Transfer – use gait belt/transfer bench Gloves – donning/removing Transferring use Hoyer lift Hair care – shampoo, dry, and style Turning a bed-bound patient Hair care – shampoo in bed Weight: Accurately and record Housekeeping Ability Area Housekeeping Ability Area Care of house plants Meal preparation – low fat diet Care of pets Meal preparation – low salt diet Counters – bathrooms / kitchens Meal preparation – soft diet