okay and here good morning if you want to find your ID bad there on the corner of my desk and then just have a seat anywhere where there's books and we are live all right just get my pen good morning you want to find your ID badge here and then just have a seat anywhere where there's books hey we're just waiting for everybody online to join good morning for all of you joining virtually okay good morning hi how is everybody today good anybody stressed a little bit I'm gonna make this super easy as long as you stay reasonably awake you'll get through it no problem okay the first class is the most important because we're going to be laying a foundation that we're going to build on in future classes so today it really is kind of important that you get pretty much everything that I say uh we are live streaming this will be available to you after class for review I'm going to send you an email um with the link and some other information as well a wrap up from today's lesson but you can click on that link and review today's live stream from this particular class okay so first things first this um is a listing has your name and your email address if you can verify that everything is correct if it is in this box right here just put okay okay if it's not use this box to change whatever it is I need to change sound good how many of you guys got my emails everybody okay if you have not been getting my emails that means that there's a problem with your email address and I do have one on here that there is a problem with so just make sure that um everything is correct so that you get all of my wrap-up emails and if you need a pen let me know anybody need a pen and there you go you're welcome all right couple housekeeping issues before we get started um I'm not sure why I have to point this out it's a small room but in case of fire flood or other emergency your exit is there I don't know why I have to point that out but the Fire Marshall says I do if that exit does not work you need to go through the back door that back door will let you out it won't let you back in unless you unlock it first so unlock it before you go out good morning you can find your ID badge here on the corner of my desk and then just have a seat wherever there's books temperature in this room there's only two hot and cold that's it there's no middle ground I do have the AC on it will take a few minutes to cool down because we do have a over full class so all this body heat is going to keep the room a little bit warm for a little while it will cool down when you start to get too cold somebody throws something at me because my perception of temperature is going to be different than yours I'm up and moving okay good make sense bathroom is just be on the archway on the right you can eat and drink in this room I don't have a problem with that just clean up after yourselves if you I got it yeah you can't reach that oh that's cute if you um have liquids in a cup make sure you dump the liquids out before you throw the cup away okay we will have a break about 15 minutes somewhere about halfway through it varies um no set time it just depends on when I get to a stopping point during break 15 minute break you're free to leave to go get something to eat or drink if you want that's fine no problem um if you're a little late coming back that's okay too just when you come back in I'll start teaching on time when you come back in just try to be quiet when you re-enter sounds good any questions everybody good with that cell phones need I got to do this cell phones need to be off or on vibrate I have a ton of information that I'm going to be sharing with you and I do it all from up here I've been doing this for 18 years kind of know what I need to say but if a whole bunch of cell phones go off it makes me lose my place so cell phone's off or on vibrate all right so is everybody ready get started okay so you got a whole bunch of books in front of you we're going to go over that in just a little bit we're going to jump right into the instruction first let me tell you a little bit about who I am my name is Patricia laramy I've been doing this class for about 18 years now I am full-time in education we are very small in Spring Hill but we are very big internationally we have over 130,000 subscribers on YouTube and over 35 million views we are the number one CNA preparation Channel on YouTube I wrote a book this book you have a copy of it this is your book you can write in it make notes in it this book is the third most used text textbook in the country for CNA training so you're getting the information from a reputable Source okay I am known as the subject matter expert on Prometric Testing I didn't set out to get that title but over time researching the testing standards to make the program a little bit better for you I amassed a lot of information about Prometric Testing and now INR c s come to me all the time with specific questions about testing evaluators come to me too with stories that I'll be sharing with you as well so um we're going to progress through this course in a very structured linear way I'm going to explain something I'm going to explain what it means how it's relevant and then later on we're going to build on that principle so if you fall behind it's G to affect your ability to stay caught up with the class so try really hard not to fall behind because we do build as we go sound good sound good got a ton of resources for you I'm going to make this super easy um normally I go around and get your names but there's just too many of you guys so we're not going to do that today it will take me about four weeks to learn all of you and then you're gone so I just just learned everybody's name from the last class and now they're all gone so it does take me a little bit of time I will ask you periodically what was your name what was your name because I'm trying to get it um stuck in the brain brain's a little older now it doesn't work quite the way it used to all right so this book is going to be yours we're going to use it in our training you do have another book we'll talk about that later but I want you to know as we jump into this that you can write in this book it is yours the other book will be returning to me on the last day of class so don't writeen that one okay so we're going to open up to page 17 in this book those of you online that are joining us um the book can be purchased here if you don't have a copy of it oh thank you very good Kira where's Kira k but I can give you another I was gonna say do you have another one can I get you to write it in because my system won't send it once it bounces it won't send it out because it's your um uh mailbox might be full yeah all right so if we go to page 17 you're going to see this page so every principle that we learn in here is going to have a page like this so I just kind of want to go through the basics of this so you can kind of get an overview of how this is laid out and what it all means um you don't have to memorize this it's okay but it will make it easier as we go through if you kind of understand the format this course is based on principles there's 11 principles that you need to learn and we're going to apply them to all kinds of skills so think of these as building blocks okay there's 11 of them they're taken from something called best nursing practices so this is universal everybody has to apply by these rules okay so think of them as rules there's 11 of them that we're going to to learn we're going to start out with the very first one called skill rules now you can see all 11 on the back um wall there we're going to learn all of that before the midpoint of the class so it looks like a lot but it's really not hard to learn as we go through that's probably the most challenging part for you guys is you're expecting it to be hard and I'm going to make it easy and then you're going to wonder do I I didn't have to work at it does it really count it does okay I'm just going to present it in a way that makes it make sense okay so the first thing you see here is the skill rules Banner it matches the one on the back wall there and it tells us four specific things about this Rule and we're going to learn this as we go I got a video I'm going to show you but this applies to every single skill that we're going to learn in class we are going to learn 20 skills to be able to perform three for the state exam so on the state exam these are the 20 skills that they have to choose from and the computer is going to pick three of those for you we'll talk a little bit more about the exam coming up in a little while um there's a formula that they use but understand that these are all the skills that we are going to learn that you could be assigned to perform for the state exam and the skill rule is how all of them start so this one's a really important one now at the bottom you'll see a video clapboard you know one of those things like from a movie this tells you that I have a video for this now in your wrap up emails that you're going to get after each class I'm going to give you the links to the these videos now I'm not going to show you this one in class um I'd rather talk so you can watch that video on your own I'm going to give you all the information from the video but this is a good review for you and again I'll be sending that link out after class this we're going to talk about in just a little while so we're going to learn all four of these and in order to learn it I'm going to uh show you a quick video that's how we're going to start um feel free to KN off at any point on anything else other than this video this video is the most important thing that we go over because this is what's going to tell us what to do with every single patient you ever encounter anywhere so super important I took notes for you you do not have to take notes in my class I've done it all for you notes are going to be on page 18 okay good good all right the video is going to talk about activities of daily living and I just want to point this out because it's not with that section I put it a little bit further back in the book so when it when the video talks about the activities of daily living that the notes for that are going to be on page 89 now on your syllabus here this the syllabus you will see where is it I'm not sure oh in um right here right down here it's going to have activities of daily living you might want to star that because um that'll just tell you where to go back and find that later if you if you want so let me show you this video it's going to take about 15 minutes but it's going to form the foundation of everything that we're going to talk about from this point the care plan and the CNA why it's always ways about the care plan a presentation brought to you by for your cna.com [Music] thank you for joining for your cna's online CNA test prep we will be preparing you for both the written and skills portion of the exam this course contains videos interactive lessons activities testing care plans test registration instructions practice questions and much more this program goes way beyond our skills videos available on YouTube but in order to pass the test there is one single principle that you must understand the importance of the care plan without this key learning the skills is meaningless you might be able to mimic what I do in the skills later but chances are you will fail the test because you didn't follow the care plan so this course will teach you the skills but you must first learn how those skills need to be done so come on inside and I'll explain to you how the care plan works and why it is so important to the test we are sure that you will become great CNAs and you will provide excellent care for our residents but before you get started let's review some Basics does anyone know what the initials CNA stand for certified nursing assistant that's exactly right April a nursing assistant is there to assist the nurse you will be receiving all of your instructions from the nurse and must follow their directions this will probably include taking Vital Signs and assisting with personal care tasks but you may also be asked to assist with other nursing procedures as well it is important to only do the things that you have been trained to do if you aren't sure how to do something ask someone for help it's okay to not know everything but please don't try to do something that you aren't familiar with it might harm the patient in this online CNA test prep program we're going to show you how to do all tested skills but that is only the beginning of your education you will learn way more on the job because every patient is different and will have a different way that those skills need to be done and that's where the care plan comes in as a CNA you will be expected to assist our patients with many routine tasks generally speaking CNAs help patients with things that they can no longer do for themselves things like sleeping toileting grooming bathing dressing eating socializing and activities together these are called the activities of daily living or ADLs these are things that everyone does every day for a healthy life but not all patients will be able to do these things for themselves because of illness or injury sometimes people are too weak to go to the bathroom on their own or feed themselves and that's where you come in if a patient needs help with any of these tasks you will be there to help them but not all patients will need help with all tasks this is Henry Henry had a stroke and has right-sided paralysis and this is Martha she had a left hip replacement this is Bob he has had a recent leg amputation and Annie has dementia and they will all require different care some patients will need help brushing their teeth but others will do that themselves as a CNA we will help the patients do the things that they cannot do alone but we will let them continue to do the things for themselves that they can do how will I know what I'm supposed to do with each patient I'm so glad you asked Cassie as the registered nurse caring for these patients that's my job when a patient gets admitted to our facility I will do a head totoe assessment I will review all body systems to evaluate the patient for real problems and potential problems this is a very long complicated process but here's a brief overview of a general assessment I'm going to look at his neurological status I'm going to look at his cardiac status and his respiratory system I will also look at his integumentary system which is Hair Skin and nails and his gastrointestinal system his urinary system is important as is his MUSC muscular skeletal system and then I will review his endocrine lymphatic and reproductive systems and finally I will review the doctor's orders for this patient I will use all of this information to determine the patient's real and potential problems here's an example to put it into perspective let's say that this patient has just had a right hip replacement now we know that she will need to continue her activities of daily living she still has to eat drink go to the bathroom bathe groom and dress and after my assessment I know that she did all of those things herself until today however she cannot get out of bed for any reason for the next 3 days so since we know that she must stay in bed I have to figure out how to meet all of her ADL needs the easiest way to evaluate basic needs is using the teams method toileting eating adl's Mobility and special as the RN I'll take all the information I gathered during the assessment to figure out the best way to help her she can't get out of bed so I have to figure out the best way to meet her elimination needs bed pan or catheter I also know she is at risk for constipation since she's not moving much and she's on pain medication this is a potential problem she can feed herself but the trace must be brought to her in bed she can't sit all the way up because of surgery but she can't eat lying flat either she has Dentures so they must be within reach at meal times and they must be clean daily she's able to clean herself as long as the supplies are brought to her but she can't reach her legs or feet so she'll need help she is on total bed rest for 3 days and she also needs her dressing changed every day you can see how the RN uses all the information available to create a plan of care specifically for this patient this is called a care plan and it's something that only an RN can do of course this was a simplified version of The Care planning process a real patient care plan is much more extensive every single aspect of her health condition and ability level will be evaluated in order to help her even the smallest decision can have long-term consequences the RN will write a detailed care plan for the entire healthc care team to follow and the care plan must be followed exactly so every patient will have a different care plan that's correct Ben every care plan will be different because every patient will be different even patients that seem alike because they have a similar diagnosis or have had the same surgery may have differences in care CNAs don't have enough education or experience to know all the differences so as a CNA your job is to read and follow the care plan for every indiv individual patient in fact you could say that your job is to follow the care plan the whole care plan and nothing but the care plan do you think you can do that can you follow directions exactly I can yes awesome then you're well on your way to being a great CNA but helping patients with ADLs isn't all that you will do you are also there to help the nurses by making observations the CNAs are the hands and the feet of the pat patient if the patient is cold and cannot reach their sweater you will get it for them if the patient can't brush their own teeth then you will do that for them if the patient can't get up to shower then you will help them stay clean you will become their hands and feet to help patients with things that they can't do themselves but you are also the eyes and the ears of the healthc Care team you will report everything you see hear smell or feel to the nurse this is the most important task that you have as a CNA if you see redness around a wound you must report it if you hear the patient wheezing after walking to the toilet you must report it if you feel that a patient's skin appears warmer than usual you must report it if you notice that a patient is coughing when eating you must report it as a CNA you will be spending much more time with a patient than the nurse does so you will be in a position to notice a lot more about the patient the nurse needs this information to make decisions about the patient's care reporting these observations gives the nurse another assessment opportunity that new assessment may even change the tasks you are assigned to perform this is called the nursing process and here's how it works the RN assesses the patient and develops the care plan this gives you specific tasks to do while doing those tasks you notice things you report those observations to the RN and the RN performs another assessment to review the changes in the patient that new assessment prompts changes in the care plan and this gives the CNA new tasks to do and the cycle continues around and around as the patient gets better or worse this is a continuous process until the patient is discharged I'm not sure I understand are you saying the care plan is going to change all the time yes it could depending on the needs of the patient let me give you an example the care plan told you to make an occupied bed in room 2011 as you Chang the sheets you notice that the skin on the patient's back side was red and irritated you notified the nurse who then reassessed the patient the nurse decided that the patient needed to be repositioned every 2 hours around the clock this was added to the care plan as another task for the CNA using this model we can respond to the needs of the patient quickly as their needs change but it also works for patients that are getting better too you've been assisting Mr Hopkins with transferring out of bed and into a chair after surgery but you notice he isn't leaning on you any longer you notify the nurse the nurse reassesses the patient and decides that the patient can transfer on his own now the care plan is changed and this task is removed from the care plan since the patient is improving doesn't this mean that I'm going to be bothering the nurse all the time won't they be annoyed the nurse should never be annoyed with you for reporting changes in the patient they are legally liable for every aspect of that patient's care since the nurse requires that information to plan the patient's care they expect to receive updates from you on the changes that you see but how often you will have to report changes to the nurse will depend on the setting you are working in nursing home patients are pretty St T and don't really change all that often that's pretty common for long-term care facilities like nursing homes and alfs and even home care but in other settings like hospitals rehabilitation centers and hospice Patients health can change rapidly in those settings nurses and CNAs are going to work closely and constant communication is required since CNAs must follow the care plan and are not allowed to alter it they can't solve problems the RN is ultimately legally responsible for the care of that patient if you have information about the patient that you're not giving to the nurse the patient can suffer and the nurse is legally liable for that remember you are an assistant you are there to help but the nurse is always in charge of the patient so all changes regardless of how minor they seem to you must be reported Ed to the RN when the patient is stable you will not have much to report it may go days without talking to the RN but if you notice something then it must be reported even if you don't think it matters if you aren't reporting observations the nurse can't rely on you anymore and if the RN can't rely on you then you aren't a good assistant to that nurse you must report to the nurse everything you see hear smell or feel be a good assistant and report all changes and observations this is the most important job you have so the care plan is developed by the RN gives the team tasks CNAs follow the care plan and report changes let's recap what we learned today can you tell me how a CNA knows what each patient needs the plan as a CNA you follow the care plan the whole care plan and nothing but the care plan anything unusual that you notice about the patient you must report it to the nurse great job for the exam you will receive a care plan what should you do follow it exactly that's correct if you don't follow the care plan you will fail the exam it's that simple now that you understand the care plan I can show you how the skills will be done for the exam but remember you must always read and follow the care plan that's a big part of the skills exam take the brief quiz below to make sure you understand see you in the next lesson all right see here okay any question questions on that video any questions so let's review the care plan process this forms the basis of what we do and why we do it okay so the RN assesses the patient when they come in and this is a very big task it's not small so as the RN when a new patient comes in I have to look at them head to toe and I've got to figure out all of their real problems but part of my job is also to figure out all potential problems and figure out how to avoid those and all of that information is going to be put together and written out in the form of a care plan that care plan is going to tell not just you but everybody on the team what they're supposed to do with the patient so care plans are what we call interdisciplinary so there's going to be information on there for physical therapy for dietary for occupational therapy for activities for um everybody everybody on the team is going to have information on that care plan as CNAs we're going to just kind of focus on the part of the care plan that relates to us sound good but I am ultimately responsible for that patient as the nurse once I take responsibility for the patient it all falls on me it doesn't matter who's helping me the liability is still on me okay gestures all right so the liability is still on me so in a perfect world I would do everything with a patient since I'm the one liable for it I would go in and help them with brushing their teeth or help them with toileting or feed them or get them bathed and dressed I would do all of that myself because let's face it if I'm the one that's going to be liable for that care I want to make sure it's done right but the problem is that I've got another patient coming into that bed that's going to need a head to toe assessments and I've also got some nursing things that I have to do hang IVs do wound care give medications uh interpret lab results coordinate tests I got a lot of nursing stuff that has to be done so I can't ask somebody else to do all that nursing stuff so I've got to have somebody that can do some of these routine things for me somebody that I can trust because ultimately whatever they do I'm responsible for does that make sense so that is the role of the CNA is CNAs do routine tasks on stable patients according to the care plan now you've got to follow that care plan because let's say that I have a patient who has a huge ulcer at the top of their uh pallet okay huge ulcer at the top of their pallet that goes up into their sinus now if I tell you go do mouth Care on that patient and you go in there you put toothpaste on the toothbrush and you brush brush brush that toothpaste is going to go up into their sinuses what do you think that's going to feel like yeah it's going to burn like fire and it might actually abscess um so we probably don't want you doing mouth Care on that patient that really needs to be done by the nurse because it's not a routine task on a stable patient does that make sense so the care plan for that patient would not have you do mouth care now if I've got Jenny over here and Jenny's just Jenny and she brushes her teeth like you brush your teeth but today she has two broken arms and can't brush her teeth well that is a good delegatable task that's a routine task on a stable patient I can get somebody to help me with that does that make sense so when we're talking about things that CNAs do the best way to remember it is CNAs doe normal routine tests on stable patients according to the care plan so if the care plan doesn't tell us to do mouth Care on this person are we doing mouth care no so does that make sense now on top of that we're going to let patients do everything for themselves they can do so if Jenny can brush her own her own teeth I'm not doing it neither are you we're gonna let Jenny brush her can you imagine what's your name Tanya Tanya can you imagine Tanya you don't know me if I walked into your house tomorrow morning at six o'clock I'm here to brush your teeth right Tanya brushes her own teeth she's been doing it for years she's good how awkward would that be that'd be really weird yeah your first question is why I could do my own why are you here this doesn't make any sense your patients feel the same way we don't do tasks on patients when the patient can do that task themselves so we want to encourage Independence that make sense so does this um help you guys kind of understand what we're doing how we know what to do and why we're doing it all right let me talk to you about this part right here CNAs make observations and those observations get reported onto the RN this right here this part o sorry this part is the most important job we have yes we're going to learn how to brush teeth but I'm betting you guys probably have a pretty good idea how to do that we're going to learn to feed another patient I'm betting you probably have a pretty good idea of what's involved in feeding right none of the skills I'm going to show you are you know groundbreaking you guys know how to do most of what we're going to learn yeah we're going to throw some nursing stuff in there pul some respirations and blood pressure and stuff like that but most of what a CNA does is ADLs activities of daily living stuff you guys are very familiar with nothing really Earth shake shaking here make sense okay so a question I get asked a lot is what's the difference between CNA and PCA and HHA and nurse Tech and PCA I mean there's a it's called alphabet soup there's a million initials out there and what are the difference between between all of them and the difference is right here that's the difference CNAs are trained to observe changes and Report those changes that is the difference between you and everybody else that's why you have to take a test that is the difference between you and everybody else so this is the part that doesn't get talked about a lot right most uh programs are going to focus on what you do this is how you give a paral back this is how you ambulate a patient this is how you do hand care this is how you do foot care that most programs focus on the hat and that's probably what you were focused on before five minutes ago but that's not what makes you a CNA everybody else can do those tasks too home health aids can do those tasks patient care Texs can do those tasks so why do you have to take a test and they don't it's right here this is what the test is going to be focused on understanding the care plan and the role it plays and making observations and re reporting those observations to the nurse now I'm going to get up on a soap box here for a second so bear with me but this is kind of important how many of you guys have ever heard about travel CNAs and you probably heard that you can get paid a lot of money being a travel CNA right and that may even be your career plan but let me give you a different perspective here for a minute when you were are a travel CNA you are a substitute you go into a facility because they don't have enough regular staff you're a substitute so you go in they tell you what to do with the patients and you do that but you don't know these patients they're not your patients you have no idea if Mr McGill's confusion today is new or not because you don't work with these patients on a regular basis and it takes a while to get to know people right so when you're a travel CNA do you see what's not getting done we have a lot of medical errors that are occurring at the CNA level because of the travel CNA industry you guys see how that could happen because if you don't know the Pati Patti and the nurses are Travelers and they don't know the patients things can get missed do you guys see that and our patients aren't getting Optimal Care because of this most places are now trying to get away from travel CNA and I see this I'm plugged into a million CNA groups online and I see this all the time I can't find any travel positions can you let me know of any travel positions and they don't understand that the reason travel positions aren't being offered very much anymore is because of the negative impact they have on the patient now if you were just train on how to be a CNA how to do the tasks and you weren't trained on this it wouldn't make any sense to you does that make sense good so you may still find a few travel positions available but if you take those remember you're there to do but you're missing a big part of what makes a CNA a CNA and you're still responsible for that okay is that Mak sense good okay so care plan process very important let's see if we uh get this whole concept down go to page 20 in your book and on page 20 when I talk about the book I'm always talking about the spiral book that's the only book I will talk about in class so if you go to page 20 you'll see eight questions you'll see four care plan clipboards let's go ahead and take 10 minutes and um read the care plans and then answer these questions and we're going to go over them together in class in just a few minutes so go ahead and answer that when you're done answering those questions uh this is Page 20 in the skills book for those of you following Along online when you're done answering those questions put your pens down so I know who's still working for you're done way you guys are working on that I'm going to answer a question here um hi Chiefs I believe your name is Vanessa if I'm not mistaken let me know if I'm wrong but question is I forgot to ask you this question about hand washing can we use our elbows to turn off the water faucet to avoid contamination we're going to talk about that at the end of class today so stay tuned and shaima has test date for 7:30 good luck we're gonna keep you keep you in our thoughts you'll do great when you attend virtually when you type a comment in it actually shows up and I ble to display it and I answer it right away so if you're attending from home you can still ask questions and it shows up live and I answer that is just beyond the archway on the right for for for for give you just a few more minutes looks like most of you guys are done give you just a few more minutes looks like everybody's done okay all right so let me uh let me get my book I don't have the page up there all right so we're going to perform the skill as directed on the care plan we are going to follow the care plan the whole care plan and nothing but the care plan so what does that mean that means we can't add to it we can't take away from it we have to follow the care plan we're going to make observations while we're following that care plan and we're going to report those observations to the nurse so these are the four um components that make up skill rules so we follow the care plan it's the care plan the whole care plan and nothing but the care plan while we're performing care we'll observe for any changes or abnormalities or pain or anything so let me explain to you what I mean by that even little things that you think don't really matter should be reported so if you walk into a patient's room and it smells like great Kool-Aid and they don't have any great Kool-Aid laying around but it's got that great Kool-Aid smell that's something you should be reporting now it seems like such a small detail I mean why would I have to report that well because great Kool-Aid is the Hallmark sign of a pomonis infection cool right if you have a patient who um wants a privacy curtain closed all the time all the time that's something that should be reported to the nurse because maybe that patient is depressed and that will delay healing something I need to know if you are caring for a patient and um she's 92 years old and she keeps asking when is lunch when is lunch when is lunch don't just go get her a snack you need to let me know because confusion is the very first sign of a urinary tract infection in the elderly so even small details things that you may not think too much about or think to yourself oh that doesn't really matter can matter big when it comes to caring for a patient this is why in a perfect world oh I forgot my sorry guys this is why in a perfect world I would be doing all care for the patient because I'll pick up on these things as the nurse and I know what all of those things mean so I'll pay attention to them but as a CNA I've got to make sure that you are aware that Everything You observe everything that goes into that brain and makes you go huh if if you go hm that automatically has to be reported to the nurse you don't get to decide whether it's big enough to report or not good make sense okay so how do we know what to do with each patient the care plan and we don't just follow the care plan we follow the whole care plan and nothing but that care plan and while we're following the care plan what should we also be doing with the patient observing and then who do we tell those observations to the nurse okay all right so let's look at page 20 real quick we're not going to go through all of them but I am going to pull a couple out um so let's go to number two real quick you receive the displayed care plan what is required to assist this patient to stand what' you guys put gate belt can we decide that the patient needs a walker because they're a little weaker today what do you guys think no no if you decide to use a walker you have altered the care plan if you think the patient's a little too weak today and they're not safe to walk with a gate belt who should you be telling the nurse you don't get to make the decision you just relay the information does that make sense this is a very common question on the state exam they're going to ask you questions like this to make sure that you understand following the care plan good make sense all right so let's look at number three real quick you receive the displayed care plan which body part will you exercise let me stop you here real quick exercise is good for us isn't it we're supposed to be getting like 15 or 20 minutes of cardio exercise every single day and it it's good for your digestion it's good for your respiration it's good for your skin it's good for your part it's good for every single body part that you have right so exercise is good and we know this and we want to keep our patients as active as possible so with all of that information in mind that exercise is good which body part are we going to exercise how come we wouldn't do all joints that the patient can't move on their own not on the care plan easy answer not on the care plan are you starting to put it all together now these are the types of questions that you would get on the state exam they want to know that you know despite all the stuff going around in your head about exercise being good for you they want to know that you can get past that and get to the care plan good okay let's go down to number seven you receive the displayed care plan what vital signs are you required to obtain pulse everybody get pulse okay now it told us to take a pulse how many of you guys have family or friends working in healthcare most people yeah if you go to that family or friend and you ask them hey when you're taking a pulse how long do you count for nobody in nobody out there nobody is going to tell you to count for one minute just simply not done everybody counts for 15 seconds multiply that by four to get our minute reading you go on to YouTube type in how to take a polls 99 of the videos that show up will tell you 15 seconds multiply that by four get your full minute reading and that's what you report it's industry standard now for people that have the uh availability they'll tell you yeah we don't even count pulse anymore we use one of these things this is a pulse oximeter or pulse ox looks like a little close Pin goes on the finger you press a button give it a couple of seconds and the pulse will actually show up on the screen so we don't even have to count we just put a Clos pin on their finger and put whatever number it tells us good my pulse is probably oh 93 I'm up and moving okay 93 so that's my pulse okay so lots of uh ways to get a pulse but if we look at number eight it asks us how long do we need to count for for this patient one full minute now I point this out because this is one of the most failed skills on the exam because if you don't understand the importance of the care plan you think that the evaluators just want the number and they don't care how you get it actually the evaluators don't care about the number they care more about how you get it okay it's not about being accurate it's about understanding and following the care plan so you're starting to see how the test is structured okay the written test is going to have a whole bunch of questions make sure you understand normal abnormals what to report and following the care plan and all the skills are going to revolve around following the care plan good starting to demystify the test well wouldn't it be nice wouldn't it be nice if you had all the testing care plans if I told you hey right over there I've got all the care plans from the test wouldn't you want those right you know you got to follow them for the test so wouldn't it be nice to see them beforehand that's what you have here on page 20 these are the actual testing care plans for these four skills and if you want the rest of them go to page 25 these are the testing care plans the exact testing care PL with the same words and the same tasks that you're going to be asked to do that means that you can practice for the state exam before you ever get there using the same materials they're going to test you on now each one of these we're going to get into the test in a little while but each one of these follows a very specific specific pattern Prometric Testing which is who we use here um they only have 11 care plan sets that they assign for the test so these are you you're going to not might you will get one of these 11 you will no doubt about it they just pick one skill set for the test one skill set and they don't pick it the computer does yeah the computer does but they will pick one of these 11 we'll get into the uh testing process in a little while but I do want you to know that you have all of the testing care plans on page 25 we'll refer back to them from time to time in the class all right so let's go to page 22 scope of practice is a term that defines what you are and are not allowed to do within your industry it's called your scope of practice nurses have a scope of practice doctors have a scope of practice CNAs have a scope of practice plumbers have a scope of practice it's not limited to just the medical industry these are things that within your industry you are allowed to do and things that you are not allowed to do this is for us as CNAs defined in part two of chapter 64 of our Florida Statutes so this is a legal principle we have to abide by it or there are legal consequences so it's important that you know what your scope of practice is in order to stay safely inside it so that you don't go off and get in legal trouble good make sense okay so our scope of practice really can I've got a whole lesson on this anytime you see in one of these lessons that video clapboard it's an animated lesson online that you guys can watch but the scope of practice really boils down to five things now I've got those five things right here in this Banner I'm going to put the banner up on the screen in a minute but this Banner defines our scope of practice so when you're looking at at the banner is it the next one yeah so right here on page 13 is our Banner when you're looking at this Banner there's five components or something called five key phrases that we need to know and we already know the first one the care plan the whole care plan and nothing but the care plan is the foundation of what a CNA does okay that means that we can't alter the care plan we can't disregard the care plan we either follow it or we tell the nurse why we can't that's it those are the only two doors that CNAs have to walk through you either follow that care plan exactly or you tell the nurse while you can't so if the patient if I come in what's your name David if I come in and I say David I need to feed you a snack and you say no well I can't follow the care plan so who would I have to tell the nurse hey nurse I went to give him a snack he said no now you know what the nurse is gonna ask me why why why did he say no so if I get that information before I go to the nurse I save myself a trip because if I have to go back to the the uh David's room and I have to say David why don't you want a snack and get the information and go back to the nurse that's valuable time so if I walk into David's room and I say hey David you want a snack and he says no I'm probably gonna ask him nicely why not is there a better time that I could come back or are you not feeling well is there a reason you don't want to snack I got to go let the nurse know and I'll let him tell me what's happening and then I'll relay that information to the nurse so if I go to the nurse and I say David doesn't want a snack because he says he's got a really bad headache well that's an observation isn't it and the nurse needs that information to do their job good make sense so CNAs only have two doors we follow the care plan exactly or we report it to the nurse so anytime your patient refuses is anything find out why and report it to the nurse we should never Force patients you say that again our job is not to force patience to do anything not our job make sense not our job now some of you are going hold up hold up what about dementia what if patient doesn't know what they're saying well dementia patients are a little bit different we don't ask them yes or no questions because with dementia what you're losing is your higher brain functions so anybody have a two-year-old anybody ever see a two-year-old I love two-year-olds I love that's probably my favorite age anybody that has a year old is going uhuh because when you're two you start to develop autonomy you start to realize that you are a separate person a distinct person separate from everybody else and you start to figure out that power is important okay two-year-olds are tyrants because they're learning about power make sense so a 2-year-old generally has a pretty decent vocabulary but when you ask him a question they will always respond with no do you want to put your shoes on no do you want to have lunch no do you want to take a nap no this is all because of power so you never ask a 2-year-old a yes no question you give them Limited choices still allows them to exercise power but within the framework that you decide is relevant I don't ask a 2-year-old do you want to put your shoes on I will ask them would you like to wear your pink shoes or your black shoes okay now we have to put them on so it still allows them choice they still get to flex that power muscle that they're developing but it limits their choice now with dementia because our higher brain functions have slowly eroded they are going to be all about power because they've lost power everywhere else so if you ask a dementia patient a yes no question do you know what answer you're always going to get no because it's a way to exercise power and autonomy so with dementia we don't use yes no questions we give them limited choice but we still don't Force trying to force somebody will always result in them fighting back always how many you guys have ever had a bad day like a really bad day I mean a real like everything went wrong and you're standing in the kitchen slamming cabinets and throwing stuff and you know life is not good and somebody walks in what do they normally tell you to do when you're in the middle of a hissy fit yeah relax calm down in the history of ever has anyone ever calmed down by being told to calm down no in fact most people it's like it's on go ahead come at me because I am in the mood let's go right being told to calm down never ever ever calms anybody down now I don't know why we think it works on other people when we know it doesn't work on us but yet we try to employ this you know this tactic it doesn't work guys don't ever tell a dementia patient calm down because they will bow up what you want to do is try to distract them get them involved in something else physical activity is an awesome stress reliever anybody a stress cleaner yeah make me mad my bathroom will Sparkle yeah stress cleaner some of you will go out and clean your car when you're really in a mood some of you will take a walk you generally employ activity when you're angry you have to burn off that mad so don't tell somebody go sit down over there yeah go sit down and calm down yeah okay that's not going to happen make sense so we have to be careful about the techniques that we use especially with our dementia patients so what I'm going to talk about in class is going to apply to non-dementia patients those of you that are going to work with dementia patient you'll get additional training on how best to work with that subset okay okay good if you want to get if you know you're going to be working with dementia patients look up TIA snow she's an awesome instructor specific to dementia her name is Tia snow and she is amazing so we know to follow the care plan we learned earlier that CNAs do normal remember normal is routine tasks on stable patients according to the care plan plan and how do we do those tasks well we're going to follow all of these principles the principles are going to tell us how to do that task so our care plan tells us what to do CNAs do normal tells us when it's appropriate to do it the principles tell us how to do it now above all we've got to be careful not to get so focused on the task that we forget that we're doing it on a person now this is the hardest thing that I have to teach you way harder than anything else that I have to teach you in here I have to teach you that it's not about you now I know some of you are like well I already know that I'm going into Healthcare of course it's not about me but when you go into test who are you going to be focused on you're going to be focused on yourself yeah because you know that you're you're being tested you know you're being watched you know you're being graded so your reaction to that usually is self I got to make sure I get all the right supplies I got to make sure I do all the right steps I've got to make sure that I remember the opening and remember the closing you focus on yourself and it's no different when you get out there and you start working because you got 12 patients to take care care of and that's on a good day you've got all these tasks to do on patient one and all these tasks to do on patient two and all these TKS to do on patient three and somewhere in there you gotta get somebody into the shower oh and there's meal times oh and this patient's got to go down to radiology and transporter is not available and I got to do that I got to work that in too you got all this stuff going on so who's your focus naturally going to turn to you but we have to remember that it's not about us it's never about us so in everything that we do we've got to revise our Focus back to the patient does that make sense so during the exam instead of focusing on you and your steps you should be focused on the patient you're going to ask me somewhere in this four weeks that we are here together oh by the way we do meet on Mondays and Wednesdays do not come tomorrow I will not be here I'm not here on Tuesdays it's Mondays and Wednesdays from 9:00 to one for four weeks so somewhere in this four weeks that we are together somebody in this room is going to ask me yeah but do I have to say everything that you say when I'm doing these skills and the answer is yeah you should because if you're not saying what you're doing you're not focused on them because they don't know what you're doing does that make sense right if you're staying quiet you're focused on you you're not making this good for them make sense so we have to keep in mind above everything else it's all about the patient all about the patient and then the very last principle is the most important it's what CNA sets CNAs away apart from everybody else and that's all observations have to be reported to the RN remember that's the one thing about being a CNA that's different from everything else so we have to keep that in mind remember observations are the reason we exist so if you're not making observations if you're just going through the motions and you're doing the tasks you're not being a CNA you're being a caregiver so observations are the reason we exist good I just went over to Jacksonville Beach last week and uh spoke to the health Educators for the state of Florida at the high school level all of them and I explained this the five key phrases and it was amazing the response that I got from this and I made it clear for the instructors so they can make it clear for the students and it was really amazing the response I got so remember that this is what's going to to comprise the test because this is your scope of practice it is so important if you look on the back of your ID badge you will see it in the bottom corner or I'm sorry in the middle of the back it is the only thing that I make sure is in front of you at all times is your scope of practice so if somebody asked me can you sum your program up into less than two minutes I could say yes it's right here we follow the care plan the whole care plan and nothing but the care plan CNAs do normal principles guide performance above all keep in mind that it's about the patient and the whole reason we're there is to make observations and report it that is the CNA program in two minutes or less okay good good so along the way we're going to end up with something like this a nurse somewhere is going to ask you hey I need you to do this and you're going to go uh wait am I allowed to do that because I didn't learn that in CNA school am I allowed to do that so for instance you might go to work at an outpatient surgery center what's your name Rebecca so you might go to work at an outpatient surgery center in there postop section which is patients have had surgery they're getting ready to go home because same day surgeries you go home that day okay so you are in the postop section now usually with surgeries once we P you out we put a catheter in because we don't want you peeing on our sterile field when we relax everything okay so these patients are going to have a catheter they can't go home with one most of the time so somebody's got to take get out now as a nurse I may say to you Rebecca right I may say Rebecca I want you to go take a catheter out of room two before they go home or getting ready to discharge them now you're going to think to yourself am I allowed to do that and if you go on to Google and ask Uncle Google am I allowed to do that you will get 180 conflicting answers so we have to kind of figure out what what are we allowed to do well first of all it has to be normal guys remember that so routine task on a stable patient patient's getting ready to go home he's pretty stable we don't let unstable people go home right it's a routine task taking a catheter out routine tasks and according to the care plan if it's on the care plan so it meets the normal component but can you do it is it still part of our scope of practice so the other question to this is have I been trained so in this class we're not going to learn how to take catheters out not a CNA task at the foundation level but if you go to work in a Same Day Surgery Center in their posttop unit you may be trained to remove catheters and that is still within your scope of practice now what's your name Alex Alex goes to work at the Same Same Day Surgery Center but she goes to work in preop preop now Alex isn't going to be trying to Cath take catheters out because there's no need for that in her job but she's also not going to be trained to put catheters in because that is an employer decision not to allow unlicensed individuals to perform sterile technique so we have state statutes that Define our scope of practice but we also have employer mandates that tell us what we can and cannot do the two together make up your job description make sense so when you're asked to do something that you're not familiar with it wasn't something that we learned here in class and you ask yourself am I allowed to do that your first thought is is it normal is it a routine task on a stable patient according to the care plan the second question is have I been trained if the answer is no to either one of those you cannot do it okay third question should be is this Allowed by my facility now that's something that the nurse is supposed to check out before they delegate okay so there's a um safety net there for you so do you guys know how to answer this now you come up with a am I allowed to do that question would you answer it to them so if I ask her Rebecca hey Rebecca I want you to take a catheter out in room two and Rebecca has never she just graduated she's never taken a catheter out hasn't been trained no idea how she's not not g pull it up on YouTube and do a quick primer to figure this out she's going to tell me I'm sorry I haven't been trained to do that but I'm willing willing to be trained and I could say oh cool you haven't been trained oh I didn't know that so come with me I'm going to show you how because training doesn't have to be done in a classroom training can be done at the bedside by the nurse so I can take you and show you what I need done watch you do it answer any questions that you have and then I have to be available in some capacity so that if you have a question or a problem comes up I am reachable for any delegated task Good makees Sense okay yes book or something where you note what you've been trained in and somebody validates been trained in that depends on the facility that you're working at now facilities generally have education coordinators that will keep all of that they try to keep their staff that are working in certain areas up to date on skills and training um so if you're working in that area they'll give you the tasks um the training for the tasks they need you to do that's usually done at the facility level there's no need for you to keep a log um just kind of a a mental note just know what you've been trained to do and what you haven't now let's say that you were trained to take catheters out 15 years ago and you haven't worked in healthc care in 15 years you got your certification you go to work at the Outpatient Clinic and they say hey go take a catheter out you go um here's the thing I haven't done that in like 15 years I'd really like a refresher I want to make sure my skills are up to date so no problem because it's all about this so let's let's go to page 15 and talk about this now I talked to you guys about this a few minutes ago remember I said that as the nurse I retain liability for the patients doesn't matter who is doing the task it actually falls on me for liability so as a nurse I don't know you guys I was hired by the facility you guys were hired by the facility you're put with me and I have to assume liability for what you do I don't know you Alex I'm hoping that you're going to do things the right way but if you don't it could come back on me make sense that's why the care plan is so important because I'm going to put on the care plan everything that I want done as long as you're following that care plan we are on the same page I'm okay assuming liability for what you're doing because you're going to do it according to the instructions I just laid out for you good now if you go wandering off into the forest by yourself and you start doing things that I did not ask you to do or do things differently than how I asked you to do it do you think I'm going to take liability for that absolutely not so as a CNA you are only covered by the care plan if you step outside of that care plan no nurse in the world is going to accept liability for your decisions that's on you so as long as you're following the care plan and you're letting the nurse know when you aren't comfortable doing a skill because remember it's all on them then you're covered there's no liability but if you step outside of that it's all on you so if you decide you know this patient isn't really bearing weight real well anymore and I'm afraid to get them up and to the bathroom I'm going to go get one of those mechanical lifts we call them hayers and I'm going to use a mechanical lift to get them over to the bathroom that way they don't fall all sounds like a good idea doesn't it I'm keeping the patient safe but it wasn't on the care plan so do you think the nurse is going to take responsibility for that if you decide to use a mechanical lift when it wasn't on the care plan that is all on you and that's not a decision that you are authorized to make so something happens to that patient who's on the chopping block you good makes sense it would be much better to go to the nurse and say hey care plan says to walk this patient with a gate belt but I don't think that's a good idea they're unsteady on their feet well now the nurse has an opportunity to go in and reassess and redo the plan and make sure this patient is safe we don't make decisions we relay observations good there's going to be five or six questions on the state exam that are going to try to trip you up CNAs only have two doors they follow the care plan exactly or what is it say it loud report report it to the nurse that's it that is it good do you guys understand the legal framework here okay all right so let's talk about the test it's on page 12 caran I have a two-year-old yeah yeah you probably are familiar with the word no all right so page 12 is going to explain to us what to expect on the CNA exam so when you go take the test there are two portions to the test there is a written test that 60 Questions multiple choice I have a whole resource for that everything that I've told you in here is going to help you answer those questions but overall the written test is pretty easy it's not difficult as long as you understand your scope of practice okay the skills is a little more challenging because you have to demonstrate three skills in front of two RNs in Florida and they're going to grade you now most people have never taken a skills based exam before so most of the tests you took in high school were all paper and Pen right very few people have taken a skills-based exam so there's a lot of uncertainty Unknowing what do I expect and your anxiety goes up a little bit because somebody is watching you and I hear it all the time from students I don't I'm not comfortable with two RNs watching me do the skills I mean it's it's a little unnerving and what I want to point out to you is that this is the first time that somebody will be watching your skills not the last time because when you get out there and work your patient is going to watch everything you do you're doing it on their body your family members are going to be watching everything that you do because you're doing it on their loved ones and the nurses are going to be watching everything you do because you're doing it under their license the test is not the last time that you're going to be watched It's merely the first so you need to get comfortable with doing your skills and having other people judge you now that's hard it's hard but after a while it will become second nature okay but I need you to understand that this is just the first time so let's talk about testing day our closest test testing center to us is Tampa most testing centers are in large metropolitan areas Tampa has two one on the West Side closest to us one on the east side closer to Bush Gardens area 275 area so we have two to choose from we'll go over all of this next week when we go through the test application process I'm just giving you a brief overview here so on testing day you're going to go to the testing center and you're going to be there with seven strangers you will not be testing with the people in this room testing centers are open seven days a week there is not a specific testing day that you're waiting for they test seven days a week there are roughly about 30 testing centers in Florida each one tests roughly eight people a day seven days a week so if you do that math you'll realize that a couple hundred people every day are being tested okay good you're not alone but when you go to the testing center you're not going to be seeing the people in this room because each one of you are going to te to register independently and your application has to go through a very long process which we'll be talking about when we go through the application itself but to um summarize really quickly when you send in your application to Prometric Prometric looks in a filing cabinet for your background check it's called the clearing house and they take the information you put on the the application or the registration and they look in the filing cabinet and they find you what's your name Owen Owen so they find Owen and they pull his background check and they put it with the application and then they send that to the board of nursing now this is an actual human eyes on event the Board of Nursing has a human that looks at your registration and your background check and clears you for testing they say yes this person is good to go approved and they send that back to Prometric so that process can take a little bit of time and when they send it back to Prometric they say Owen is good to go Prometric gets that information determines the next test date opening in the testing center that you chose puts you in in that slot you don't get to choose your testing date or you you get to choose your location but that's it and then sends that to Owen and says Owen you are approved for testing the next email you get will have your test date attached so Owen you are scheduled for testing August 17th now all testing starts at 900 a.m. you have to be there a half hour early so you need to be at the testing center no later than 8:30 on testing day okay good do you guys understand the process there and it can take you know 7 to 10 days usually for that whole process to happen that's if you have no hiccups now if you didn't do your background check that's a hiccup it's going to time if your payment didn't go through that's a hiccup it's going to add time if you have a criminal history that's a hiccup and it's G to add time if you have the same name as someone else with an extensive criminal history that's a hiccup and it could add time because I have to make sure that you are not them okay so when you go into your testing uh Center there's only three things you're allowed to take in with you your test admission letter says you're supposed to be there you don't have to print this off but it's nice if you have it your keys and two forms of ID one of them has to have a a picture State uh issued with a picture can also be a passport so governmen issued so if you have a non-expired passport or a non-expired uh military ID you can use that otherwise it's going to need to be a driver's license or state ID you need a second form of ID with the same name make sure the name matches so if you have a credit card that let's say um has your maiden middle initial you know instead of your actual middle name initial and it doesn't match your ID you can't use it so make sure you're looking through through your um IDs and make sure you have a secondary ID with the same name good make sense okay that secondary ID just has to have a signature so a credit or debit card a a library card Works social security card works as long as the names match that's all you can take in you can't take any study material you can't take any electronic devices like cell phones SmartWatches anything like that just you your keys and your IDs you're going to go into the waiting room with the seven o other individuals and there's going to be two additional rooms off of that one room is for the clinical skills the other room is for the computer uh written test so when you're in the waiting room they're going to come in and check you in and when they come in they're going to ask you do you have any conditions that would keep you from being a patient during the exam so what's your name Jessica so when they um go they're going to pull you aside they're going to look at your IDs make sure you are you and they're going to say do you have any thing that would keep you from being a patient now you really want to answer no unless you have a really good reason to answer yes so if you just had some dental work done and you got some stitches you need to let them know because if she's got mouth care I don't want to pair her up with you undo those stitches accidentally and now you're bleeding everywhere and now the test isn't fair for her because we just threw our curveball okay if you've got um a prosthetic leg probably needs to come up okay so things like that if you have anything that would keep you from being a patient for any of the skills you need to let them know and then after they check everybody in those two evaluators are going to go away for about 20 or 30 minutes and what they're doing is pairing you up with another individual this is not random so let's say that you have transfer out of bed and into a wheelchair I've got to find somebody to pair you up with that's about your body size or smaller okay so I'm going to look around and try to find who I can pair you up with but let's say that um well I'm not going to use him because he's significantly taller than you okay so let's say I pick on you what's your name Stephanie so Stephanie would be a good candidate she's about your body size okay but Stephanie has um dental work that was just done and your second skill is mouth care so I can't use her so now I got to go find somebody else do you see how this process can take a little bit of time so for that 20 or 30 minutes you're sitting in the waiting room staring at seven strangers and it's very awkward because remember you don't have your phone and that's what we normally go to in awkward situations we'll flip through our phones you don't have that phones should be in your car or in a locker so what ends up happening on test day is you start to make friends and people will go around the room where'd you go to school where'd you go to school where'd you go to school and you'll tell them I went to miss Patty and you'll get instant Celebrity Status eight out of 10 people that take the test in Florida prepare with our videos so you will get instant celebrity you want like Miss Patty from you actually went there wow that's cool um and then the next thing that's going to happen is people are going to start asking questions about skills so it'll go something like this oh my gosh I hope I don't I don't forget my supplies oh I don't want to forget my steps oh there's so many steps I don't know if I'm going to remember them all and somebody else is going to say something like oh my gosh uh handwashing I know everybody fails on handwashing and I can't remember how many paper towels to use I think it's seven and you're going to go what there's no count for paper towels and they're going to go yes my instructor said it was seven and somebody else is gonna say oh no it's 10 you have to have one for every finger and you're gonna go what I wasn't told that and then it'll go into other skills and by the time you go into test your brain is just spinning because now you can't figure out who to listen to so yeah there here's your first clue make sure you listen to me me I know the test okay but the real problem is that it's going to erode your self confidence so the best advice I can give you is on testing day do not make friends do not make friends sit in the corner la la la la la la do not make friends after testing go Teach the World how to do these skills everybody should have these skills everybody teach the world but not on testing day because if you try to explain to somebody why paper towels don't matter and they go in and take the test and fail do you know who they're going to blame the last person that gave them information you don't want to be in that situation okay don't make friends on testing day now if you want to talk about the weather you want to talk about your kids you want to talk about summer plans employers you can talk about all that don't talk about the test don't do it you will regret it good okay so after you get checked in they're going to pair you up into groups of two and remember this is not random when when they have you paired up into groups they're going to give you specific information and for our purposes here I'm going to make it random you guys are group one don't go anywhere you two are group two um you can go get a cup of coffee wait in your car wait in the waiting room but you need to be back in here in about 45 minutes you two are group three you've got about an hour and a half to kill so go Target clearance shopping get your mind off of this you guys are group four you've got about two and a half hours before you need to be back here so Chili's two for one Margaritas we'll see you guys in a while so group one is going to be brought into the testing center now remember if we go back to slides here remember the testing room is a separate room with a door that means that all these people sitting out here cannot see or hear what is happening inside that room you are not performing you are not performing in front of on a stage in front of a lot of people that's not what this is this is very small it is a small room there's only four people in there you you and the two evaluators that's it now you should not be focused on the evaluators who should your focus be on the patient that's right the evaluators are going to show you around because you've never been there you don't know where the washcloths are you don't know anything so imagine for a minute we had a wall going across here with a door in it this would be our testing room okay so you would have a couple of beds you'll have a three drawer bedside unit you'll have an overbed table you'll have a privacy curtain now let me talk to you about the Privacy curtain real quick I've got to get the follow me thing for my camera here so give me a second let me talk to you about the Privacy curtain real quick so in testing they have to be able to see what you're doing in order to grade it if I have a curtain that goes all the way around the bed they would have to be inside that curtain with you and that's a little too close they're going to get in your way you're going to get all nervous it's not an ideal situation so for the test privacy curtains are not going to go all the way around the bed they're only going to go a short distance okay and that's how they're going to indicate privacy now you and I know that this isn't doing anything for privacy we get it but remember it is a testing scenario does that make sense so they're going to show show you this is how you indicate privacy and at the end of the scale this is how you open the curtain okay they're also going to show you around this is our supply shelf over there is our patient bathroom um they're going to show you how to work the equipment this is how we raise the bed this is how we lower the bed so all of that we call it an orientation will take two to three minutes to show you around okay good good okay so once they show you around once they show you around they are going to pick one of you two to go first okay so one of you two and we'll just ladies first okay so you'll go first and the evaluator is going to read the care plan to you so what's your name uh beranda okay so um give me a number one to 11 five okay so the computer randomly picked skill set five for you and the evaluator can't even trust that you know how to read so they're going to read it to you so your skill set is measure and record respirations make an occupied bed and change position to supported side lying and they're going to read each care plan for each one of those tasks to you and then they're going to give you that care plan set and that is yours throughout the entire test so if you get halfway through and you can't remember something remember we're graded on following the you can start in the middle of your skill and go over and read that care plan at any time okay this is not memorization this is following the care plan so if you're not sure what the care plan says stop and go look good make sense so you're going to do your three skills on him when you're taking the skill when you're performing the skills the evaluators are going to have a checklist this is the checklist that the test uses this is the exact checklist that the test uses for all of the skills here we go this is not a secret these are published by Prometric anybody has access to this but the problem is that these are written for r ends so it's not going to going to help you as a student very much because it's written for an RN what I did is I took this put it through an RN brain and wrote out stepbystep instructions and that's what you're going to find in that spiral book for every skill that we learn I've got stepbystep instructions that check off every single one of these checkpoints good make sense so when you do a step and you do it correctly you're going to get a checkpoint I'm a little ahead of my slid so let's catch up so the skill set is read to the testing candidate by the evaluator the uh care plan is given to the testing individual and the second person is going to become the patient for those three skills now when you're the patient you're going to get a script they don't want you ad living this you're also gonna act like yourself so if one of her skills is ambulate with a gate belt and you have to walk you're going to walk like you walk you're not going to walk like a 90-year-old man you're going to walk like you walk you're going to be you you're also going to follow the script you're going to be pleasant cooperative and follow instructions okay good make sense now how many of you guys have family at home that may help you with the skills that may be a patient for you when you're practicing the skills anybody have somebody at home a live Human lying around that you might be practicing on okay you have to go home today and you have to tell them all right my instructor said that when I'm practicing skills you're not allowed to make it hard you do exactly what I tell you to do because if somebody at home is trying to make this hard for you and they always do this well you have to get used to it this is the way it is in the real world right we're not there you're trying to make a kindergarten or do trigonometry we're not there yet so they need to make sure that they adjust their performance to your skill level good otherwise it's not practice it's throwing you into the deep end and watching you drown that doesn't do anybody any good okay so you go home tonight and you tell them that so these are the 11 skill sets you've got a copy right there these are are the 11 skill sets they're always in here hanging up on the hook over here you have access to them remember they're on page 25 of your skills book as well now the ones that we use in class on the back side of it has the checklists so as we go through the program and you start to practice that will be good for you for a checklist just a dry run getting ready for the exam Okay so each one of those testing care plans has a specified formula that it has to follow we're going to provide mouth care to a resonant with teeth on this one we're going to measure and record respirations and we're going to change position to supported side lineing so this follows a formula every single testing care plan has one addl skill One Mobility skill and one documentation skill so if you look at this graphic it'll break it down for you ADL skills are things like mouth care denture care hand and Nail Care Foot Care partial bed bath hairy care catheter care bed pan making an occupied bed and dressing a resident with a weak arm so the majority of skills that we learn to do in this class fall under ADL okay activities of daily living things we do for ourselves every day you get yourselves up and dressed and bathed and groomed you feed yourself right none of that's new to us makes up the bulk of the skills that we learned to do Mobility skills are things like range of motion transfering ambulate and change position so there's not a whole lot of uh Mobility skills you will get one of those and then documentation skills there's only four there's pulse respirations feeding a patient and emptying the drainage bag those are documentation skills you will get one everybody gets a documentation skill for the exam you will get one of these guaranteed good questions so you get one out of each category they make up a skill set that's what we have there it's what you have on page 25 so there's nothing random about this so on the back of that uh packet that we have there has the testing check lists for each one of the skills that we're going to do and as long as you do the step properly you're going to get a check mark yay anything that you don't do at all no check mark if you do it but do it it wrong no check mark anything without a check mark is called a deficiency and this is how you're graded it's called grading by exceptions so basically you get credit for everything unless you don't do it so if you're taking the test and you don't support the present's arm to avoid dangling when you're taking the pulse so basically you have their arm uh okay okay so basically you have the arm hanging over the bed like this this is a dangling arm so we wouldn't get a uh checkpoint for that what you need to do is have the elbows supported on the bed when you're taking or have it like this you see the difference okay somebody broke my mannequin um so if we have a deficiency something without a check mark that at the end of the skill is what's going to go into the computer and that's how you're going to be graded anything without a check mark is a deficiency now these are not all graded equally so in order to understand this um this is going to be on page 65 in order to understand this I'm going to give you an example so let's say that we have to do mouth Care on this individual here is she in a safe position for mouth care what do you guys think why okay so what could happen to her she a choke the medical term for that is called aspiration or breathing food or fluid into the lungs aspiration so we know that this isn't safe so if we were to um perform mouth Care on somebody who's laying down there's a high likelihood that she could die because we're putting food or fluid into her lungs so putting the head of the bed up is a pretty important step don't you think now think about when you brush your teeth you're probably standing over a sink and you're not just standing like this you're usually like this because where do we want all that foam and stuff from mouth care to go in the sink we don't want it all over our clothing make sense so think about yourself brushing your teeth you're usually in a bent forward position well if we put the head of the bed up she is not in a bent forward position so that means that whatever's dripping out of her mouth is probably going to fall onto her clothing what could we put there that might prevent her clothes from getting all gunked up tell sure absolutely towel washcloth I don't care what you use put something there to keep her clothes clean make sense okay both of those are checkpoints head of the bed up towel on the chest both of them are checkpoints point do you think that they're graded equally if you forget to put the head of the bed up your patient could die if you forget to put a towel on their chest ah they're going to get messy clothes but nobody dies from that does that make sense this is what we call weighted scoring that means that some steps are going to count way more than other steps so if you forget to put the Hat of the bed up you will fail one step fail if you forget to put the towel on their chest you get a deficiency but you didn't fail you guys understand that so a question I get asked a lot is well how many steps can you miss and still pass and the answer is it depends what steps are you missing because some steps just one will fail you good questions all right so once you've taken the clinical skills exam you would do your three skills on him he'll get a different care plan usually you'll do your three skills on her you'll both go out to the waiting room and wait you guys will be brought in you'll do your skills on her she'll do her skills on you you'll both go back out to the waiting room and wait you guys come in you'll do your skills on her she'll do her skills on you you go back out to the waiting room and wait you guys stumble in from chili yay you'll do your skills on her she'll do her skills on you and then you go back out to the wning room when everybody has tested then they usually do the written test now there are some instances where the written test would come first but not usually usually skills is first the evaluators can make the rec or the decision which test to do first now usually if the test is failed skills is what's failed but some people do fail the written now let's say Rebecca Rebecca okay so let's say that Rebecca failed the written not really but let's just say that you failed the written if you come back to retake it you only have to retake the written so everybody else is here for both parts Rebecca has already done both parts so we're going to do the written first to get her out before I do the skills and everybody make sense so if you've got somebody there retesting for written sometimes they'll do the written first to keep that person from sitting around all day waiting for the written test so it depends on who's there to test as to which one comes first so is it all day test it is an all day test yeah you'll usually get out somewhere between 2 and 3 sometimes it's a little earlier but generally speaking between two and three no you have to be there at 8:30 in the morning and you're there until ever until you're done so yeah I know if you're waiting on a ride it can be a little problematic yep so let's say that um just for illustration purposes is remember you have to do three skills and in general you're given somewhere around 30 minutes to do those three skills usually somewhere between 31 and 37 38 something like that but let's just break it down to 30 now you may not take all 30 minutes to do your skills you might you won't you might so it's hard to gauge right but if we just go by that assumption 30 minutes 30 minutes for skills 30 minutes 30 minutes for skills 30 minutes 30 minutes for skills 30 minutes 30 minutes for skills that's four hours and we don't start skills until 9 so that means that we're not even taking the written test until around one and then everybody takes the written test when you're done with the written test that's when you get to leave and you'll find out that day whether you pass both portions okay so does that make sense good okay all right so you'll have 60 question multiple choice written exam you have 90 minutes to do that test and I have a resource for you to make this easy so this is a free ebook it's on our website you're going to get a link to it in a little bit uh or at after class A thank you Anna so Anna says thank you so much Miss Patty for everything I pass my CNA exam you are the best teacher congratulations great job great job okay oh I'm sorry yeah I've got yeah when I went over there they couldn't see the sorry about that guys um I got to get the follow me camera but they're so expensive okay so let's go so I put the link for the ebook in the chat for you guys if you go back and watch you'll you'll see the link in the chat it's also you get a wrap-up email today it'll be in there as well it's also on the paper that you have in front of you um not the syllabus not the long one the other one but um it's workbook style it's free it'll help you understand what's going to be on the written exam but I'm going to break it down into five topics so we're going to go over these as we go through the program I'm going to make sure you're well prepared for the written test this is not the hard one but what they're going to be grading you on is number one Know Your Role well we just spent two hours talking about our role You Should Know Your Role by now you should know what a CNA does what they don't do how they do it and why they do it that's what our role is you also need to know your normals so normals goes beyond Vital sign sure we need to know that a normal respiration is 12 to 20 a normal pulse is 60 to 100 we'll go over this a normal blood pressure is 100 to 119 on the top 60 to 79 on the bottom we we're going to learn all of this stuff don't memorize it yet but we have to know normals but this goes beyond Vital Signs knowing your normals actually involves understanding what's normal for the patient what's normal for aging what's normal for certain conditions because if we don't know what normal is how in the world are we going to know what to report so knowing your normals is going to be tested on the written test we also need to understand safety now safety is a really big topic I'm going to um integrate it into every single lesson that we learn moving forward every principle is going to teach us about safety so the principles are going to cover safety as we go through infection control boy do I have a lot to teach you about infection control and in fact the first two hours of Wednesday I'm going to talk Non-Stop about infection control and I'm going to challenge some of your beliefs I'm going to make you think about things a little bit differently so stay tuned um but infection control is going to be covered as we go through the program and then we have patient rights now patient rights is a big one think about all of the rights that you have you have the right to wear what you want you get up in the morning you get to look in in your closet and figure out what you're going to wear yes your employer might dictate a certain color or style but you still get to pick whether you want to wear that or you want to suffer the consequences it's still your decision right at what age are you willing to give up that right you get to decide what you want to eat and when you want to eat it if you want to get up at 2:00 in the morning and have an entire sleeve of chips aoy cookie you are free to do so there is no food police standing in your kitchen telling you you can't do that you are free to make that decision at what age are you willing to give that up you are free to decide when you want to go to bed you want to stay up late and finish that movie that's your decision you want to go to bed because you're tired that's on you at what age are you willing to give up that right never do you not make the mistake of thinking that patients have no rights patients have every single right that you have and then a few more so we have to be careful not to make our patients into prisoners okay we're going to talk about that as we go too but those are the five topics that are covered in the workbook it'll give you sample questions how to figure out what they're asking why they're asking it and how to disqualify certain answers it's interactive um so that means it's going to ask you to do something it's a workbook to work through those questions so we have um I have 4800 downloads of this something like that and the reviews I get from this is amazing this will help you it's quick to read too you can get it on for your cna.com ebook all right so when you're done with the test you've done the skills you've done the written you're ready to go when you walk out the evaluators are going to give you some printouts they're going to look like this this is for the written test you're going to get another one for the skills test I'll show you in a minute and then you're going to get a page that lists your deficiencies remember those deficiencies from the skills everything you did not get a check mark on we'll go into that in just a minute but this is for the written so here you've got the five categories of questions how many questions were in the categories and how many you got correct now very common question how many can I miss and still pass right because we're FOC focusing on us again how many can I miss and still pass and the answer to that is it's a little more complicated than that because you have to pass every one of these categories so safety has nine questions if you miss all nine questions should you be a CNA would you want a CNA taking care of your mom that failed safety on the test so there's only nine questions here that means if you miss four out of this category you're not going to pass so four questions could potentially fail you now if we go down to the bottom here providing Specialized Care for residents with changes there's only seven questions in that category if you miss three you will fail so it's not as easy as oh you can miss 17 questions and still be okay it doesn't work like that it's all graded by category does that make sense now it gets worse it gets worse so not only can missing three questions fail you there are some questions on the exam that if you answer it the wrong way it will fail the entire exam these are what we call critical concept questions and what it means is you've got a question and four answers answer a is right B is wrong C is wrong and D put your patient's life in Mortal Jeopardy if you choose D you will fail the exam because you picked an action that would put your patient IM mortal Jeopardy and these are all emergency questions so what to do in a fire what to do um when your patient is having a heart attack if you pick the wrong wrong answer it could fail the entire exam now every exam has at least one critical concept question on it and they're just trying to make sure that in an emergency you're going to not take an action that puts your patient in Jeopardy good does that make sense okay so in some cases one question can fail you so once you uh are done with the test and you get your written test results you'll also get your skills test results as long as they both up at the top say candidate has passed this the written test or the clinical skills test if both of them are pasted you're a CNA right then and there you are a CNA congratulations now down here it'll tell you the skills that you got that'll go over onto the next page and then you've got your feedback and that's what they call it but these are the deficiencies now in the State of Florida we are graded by two RN if you see the same checkpoint here twice that means it counted against you both of those evaluators said you failed to do this step but if you only see it once that means one of the evaluators was daydreaming somebody saw it so that means you did it but the other one didn't give you credit for it so it's not going to count against you so Florida is the only state that requires two RN evaluators and it's specifically because um we want to make sure that the evaluators aren't grading you unfairly so if you're graded by two there's less of a chance of bias okay good all right let's go ahead and take a break and um we're going to take a 15minute break so I come back at 25 after oops and I'm put this 35 um and then when you come back from break we're going to get into the skills Jessica okay for for for for for for for for for for for for for for for for for for e for for for for for for e for s for [Music] [Music] all right any questions on what we've gone over so far no am I going too fast for anybody all right so when I was developing this program when I first started teaching it I didn't do a very good job and the reason is when I started teaching CNA I kind of figured I'm an RN I can teach CNA can't be that hard so what I started doing was what we did for RN I was trying to create many nurses so I focused on body systems Anatomy physiology medical terminology all that kind of stuff that's not up here is it so my students uh they did okay but they didn't do great and the problem is they really weren't prepared for out there so I took their feedback and I started diving into what was required for the test and as I started going through this I started to realize these things so by studying this I developed this good but I also developed the principles and let me explain to you how these came about so as I was going through these the clinical checklists I noticed that number one was the same for every single one of them every skill number one was exactly the same number one says does the candidate that's you greet the resident address by name and introduce self so if you don't do that you don't get that check mark That's A deficiency so if you didn't GRE the resident you don't get the check mark so just walking in and saying hey I'm here to do Parry care is that okay that's no check mark because you didn't greet the resident you didn't introduce yourself by name does that make sense so this was on every single one so huh okay I might be able to do something with that I looked a little further and I realized that number two was exactly the same on every single skill number two is provide explanations to the resident about care before beginning and during care so there's the answer to your question do I have to say everything you say number two says we have to tell them before and during so the answer to that is probably yes you probably do need to say everything that I'm doing because otherwise they don't know what you're doing and it's a checkpoint okay now moving on I started to also notice that at the end of every skill these checkpoints kept coming up like ask resident about Comfort needs during care and before care completed oh that's on every single checklist so okay we got a GRE the resonant we've got to address them by name we've got to introduce oursel we've got to provide explanations and we got to ask them about Comfort during care and before care is complete so I use this information as I was going through the checklist and I started to notice common themes so those checkpoints are the same on every single skill we're going to learn we have to do those they're always there but there's also a few that were always on washing skills and there were a few that were always on skills when a patient was uncovered or undressed and there were some that um showed up when there were towels and washcloths and linens involved so I grouped all of these together these checkpoints it kept showing up on multiple skills and I created the principles with them and that's what we're going to learn these are principles so you see them on the back wall we're going to learn them as we go through of course we already know skill rules we follow the care plan so this is called the opening or opening procedures this is how we start every skill so every skill that we're going to learn how to do is going to start like this doesn't matter what the skill is all 20 skills we're going to learn they all start like this hi Miss Jones my name is Patty I'm your CNA today I always throw a how are you I want to know how my patient is legitimately I want to know it's not just something to say because if I got to get this patient out of bed and into a wheelchair I kind of have to know that they're okay to do that before I get them sitting up on the side of the bed so I always ask how are you if they say oh I feel awful I'm hurting I've got a headache I'm nauseous oh I don't have to go any further let me go report that to the nurse saves me a ton of time okay so knock knock knock hi Miss Jones my name is Patty I'm your CNA today how are you then I let him know why I'm here I am here to insert name of skill here now you can say it in your own words I'm here to take you for a walk or you can read it right off the care plan if you're nervous I am here to measure and record respirations so if you're nervous and you can't put it in your own words you can you can read it off the care plan I like to put it in my own words I want to use words my patient is going to understand I'm here to take you for a walk feel like going for a walk and then we're going to ask the most important question in healthcare is that okay you do not have the right to do anything to another human that they don't allow you to do good make sense now you don't know me if I come over there and I put my hands on you without permission and you tell me no and I still touch you you can file charges anybody know what those charges are battery that's right now what is that mean what what what does that mean if you're charged with battery I mean what does it mean you did touch somebody without their permission that's right do you think it matters whether you're outside at the bus stop or in the movie theater or on a date no touching somebody without their permission is battery period no means no so it does not matter if it's an nursing home or a hospital or an assisted living facility either no means no so if you touch somebody without their permission you can and will be charged with battery so it's important to understand that patients have rights they have the right to say No in fact they can say no at any time for any reason so if you're halfway through a skill and they say no you need to be hands off because no means no so let me tell you a little bit about help I have a saying Help isn't help if it doesn't help it's pretty easy saying right help isn't help if it doesn't help so a couple years ago I was very busy so everything that you see I actually create so all the graphics like I actually make this I make her I make make this I do all of my Graphics I also record all of the videos and edit them the animated video you saw to today I created that myself I do all the websites I'm a pretty busy individual about 18-hour days seven days a week but I got a busy mind so I'm okay with that and I love what I do I if you love what you do you'll never work a day in your life I love what I do which is a good thing now the problem with that is that I am a team of one so I don't have anybody that I can you know say hey will you go do this so Jacob helps he's my manager he runs a store he's my son he runs a store and he does the shipping for me but as far as all of this goes it's me make sense good all right so when when we're talking about this right the opening we have to understand I just lost my train of thought hold on a minute we have to understand that this every part of it means something okay it means something so each one of these is going to represent a checkpoint so if you don't do this in the order I show you and do it the way that I teach you you're risking not getting all of your checkpoints but it goes beyond that and I create a lot of resources to reinforce this and because I create a lot you're not going to see everything that I do because I create a lot I'm going to give you links to a lot of this I'm going to give you links to a video on the opening whether you use them or not is completely up to you I'm giving you enough information to pass but if you want to go above and beyond watch the videos that I send you after class today but the whole point here is that I can't overstate how important the checkpoints are because they're going to show up on every single skill you do and it's not just for the test it's for a clinical setting too so I don't work in clinical setting anymore this takes up all of my time guys all of it so I'm not out in a clinical setting any longer but when I was this is how I did it all the time all the time you never ever ever ever saw me lay hands on a person without their permission so help isn't help if it doesn't help okay so because I'm so busy I hired a house cleaner once now when the house cleaner came in I explained roughly what I wanted them to do but I wasn't overly detailed because they're house cleaners this is what they do they should know what to do I tell them the rooms I want done and they should do it right well when they vacuumed and mopped they didn't move any of the Little rugs like in front of the sink in the bathroom they just vacuumed around them and mopped around them so they did the sliding glass doors but they only did up as high as they could reach they um wiped my counters off you know I got Granite counters they wiped the counters off but didn't move a thing so like the toaster is sitting there and there's crumbs under the toaster but the rest of it got wiped now it was my fault because I wasn't specific I didn't tell them exactly what I wanted done I also never hired a house cleaner before so I didn't know what was expected and I haven't hired a house cleaner since because help isn't help if it doesn't help now that house cleaning Adventure cost me a couple hundred bucks and I still had to go back and do it all myself so we have to understand when we are helping patients we are there to do just that we are there to help our patients but it's not helping if it doesn't really help and that means that we kind of have to do things the way they want it done now we're going to use some guidelines to help us keep us in our scope of practice but we also want to take our patients um preferences into account as as well does that make sense okay so we want to humanize this not just these are skills I have to do there's a body over there I have to do them on these are humans and they have preferences and they have ways that they've been taking care of their own body forever and we want to make sure that we're incorporating those as well getting to know our patients because help isn't help if it doesn't help does that make sense so we're going to learn all of these principles but please remember as we're doing this um oh okay hold on as we're doing this we definitely want to keep our patience in mind okay so uh miss Patricia laramy what is your email address this is very easy we are branded everywhere so it's for your CNA gmail.com that's how you find us we're branded everywhere now for those of you guys in my classroom on your syllabus up in the upper corner right here upper right hand corner you will see um this is my personal email address you can um get in touch with me personally now I only give that to my classroom students Not To The World At Large because I already get like 500 emails a day so um if you want to reach me for those of you virtual if you want to reach me it's for your CNA gmail.com so we're going to use these principles to learn how to care for our patients effectively but keeping in mind that we may have to tweak it a little bit based on their specific needs so opening sounds like hi Miss Jones my name is Patty I'm your CNA today I'm here to whatever name of skill is that okay now if you want to throw a how are you today in there that's great it's not graded it's not on the checkpoint you don't have to I like to when I'm working with real patients okay good good okay there we go so so as I was creating all this this is actually pretty new I just developed these as I created this uh I started to realize I I color Cod it all I like color I like bright colors I think it's fun I don't think that education should be boring right so I colorcoded everything and then I went in I took the checklist these are the actual checklist right I and I colorcoded which checklists which checkpoints went with one of my principles to see and I was doing this before taping to make sure that I got every single principle and every single checklist right so if you look at this okay notice how much green and red is on here do you guys see see that do you see how much green and red is on there it's like half the skill half the skill green is the opening right the opening knock knock knock hi Miss Jones knock knock knock hi Miss Jones my name is Patty and I will be doing whatever skill on you is that okay make sense good now at the end of every scale we're going to learn how to do the closing in a few minutes and those you can see all in red so when you start looking at all of these and I've got them all up here when you start looking at all these look how much green and red look how much green and red look how much green and red guys about half of every single skill that we're going to learn how to do half of the checkpoints for every single skill we're going to learn how to do is the opening and the closing you guys see that so if you skip the opening when you're doing your test look how many checkpoints you're missing now that's going to be important because when you guys are St starting to practice in here week three is really when we have some practice time built into the program when you start to practice in here invariably every single class session I have somebody that's practicing that totally skips the opening they just go over to the supply shelf they get their supplies and they start doing their skill and I remind them hey you got to do your opening and they'll usually tell me yeah yeah I know I got to do that but I'm just focusing on the steps of the skill right now the the these are the steps of the skill the opening is the step it's not the opening and the skill it's the opening of the skill because if you practice without doing the opening you know what's going to happen on the test you'll forget y because it's not part of your routine now the best place to practice the opening we'll get to this in a little bit and I'll say it again but the best place to practice the opening is in your bathroom at home you got a door to knock on you got somebody to talk to the one in the mirror you've got a privacy curtain to pull and you got a sink right there to wash your hands everything you need to practice the opening is in your bathroom at home write the steps on your mirror and every time you go in the bathroom practice it Okay it should roll off your tongue by Wednesday I should be able to point to you and say Owen oh I got one right I should be able to point to you and say tell me the opening and you should be able to go hi Miss Jones my name is Owen and I'm your CNA today and I'm here to whatever is that okay close curtain wash hands you should be able to Rattle it off that quickly that smoothly and if you can't it's going to be really hard for you when you start practicing okay so practice this in your bathroom at home send everybody else out for ice cream because you sound weird talking to yourself but write the steps on your mirror every time you walk in there practice your opening good it counts it counts big on the state exam and remember when you get your three skills you're going to be graded on checkpoints for each one of these skills you can see these checkpoints here in the classroom and they're going to be in your book as well so each one of these is going to count a little bit differently depending on how important that particular checkpoint is but I am going to tell you that these checkpoints in the opening are all weighted heavily because it doesn't do your your patient any good if they don't know what you're about to do on them it doesn't do your patient any good if they don't know who is about to do this skill on them and it certainly doesn't do your patient any good if they aren't sure that you're supposed to do this on them doeses that make sense okay remember that each one of these is going to correspond to a checkpoint on that checklist and you can see here how many checkpoints this addresses so they're important so we call this the big four we have skill rules that we learned they apply to every skill it tells us what to do the opening applies to every skill knock knock knock hi Miss Jones my name is Patty I'm your CNA today I'm here to whatever is that okay close curtain wash hands get supplies glove rules which we're going to learn on Wednesday is evaluated for every skill we don't wear gloves for every skill and I'll explain to you on Wednesday why that's not a good practice and then at the end of every skill we have the closing which we're going to be learning in just a few minutes but we call this the big four because these four principles apply to every single skill it doesn't matter what else we're doing with the patient every skill is going to have a care plan to follow the opening that has to be done gloves to evaluate and closing to end the skill and we're going to learn the closing in a few minutes we're actually going to learn the um opening a little bit more as well so if you look at page 27 I have all of these principles laid out for you and as we go through the program we're going to mix and match these principles remember the big four is on every single skill but washing rules isn't privacy blanket is on a few linen rules is on on a few shoe rules are on a few so we're going to mix and match them to create skills but we can't do that until we learn the principles so as we go through this program if a principal is involved in a skill we're either going to review it if you've already learned it or learn it and apply it to the skill good questions so resident rights is going to play into this a little bit and some of the rights that residents have is to be treated with dignity and respect now I want to stop there for a second I used to tell people I want you to imagine your very favorite family member in bed when you're doing a skill but I'm changing that I want you to imagine you're doing this skill on you you how would you want to be treated would you want all of your most private areas exposed to total strangers would you want to be fed so fast that you begin to choke would you want to be grabbed out of bed and thrown into a wheelchair so when we talk about treating residents with dignity and respect what I mean is how would you want to be treated I don't care what you see out there I don't care what other CNAs do and I definitely don't subscribe to the theory well this is the way you learn it in school and this is the way we do it in the real world don't get me started on that one because out in the real world there are real people and these principles should apply to those real people a whole lot more than they apply to a plastic one don't ever forget that patients deserve to be treated with dignity and respect if these patients could take take care of themselves where would they be at home taking care of themselves that's where they want to be when you get sick let's say for some reason you develop a stomach bug right now and you're sick where do you want to go home right it's your safe space it's where you feel most comfortable and when you're ill you want to be at home way more than you want to be anywhere else so if we have patients that want to be home and they're not home that's probably going to make them a little grumpy correct all right anybody ever been a patient at a hospital yeah when you are sick the one thing you need more than anything else is rest the one place you can't get it is in the hospital in a hospital an average of 17 different individuals come in and out of that room every 24 hours 17 times yeah you've got doctors and nurses different shifts you got CNAs you got FLOTUS you got EKG teex you got Transporters you have social services you've got billing clerks you've got volunteers You' got Specialists all of those people come in and out of that room it's a whole lot of people which means that your p is probably not getting a whole lot of rest what does that do to our mood oh man so we're grumpy because we're not home we're cranky because we're being interrupted at all times and then we get some smart Alex CNA that comes in and assists that we do things their way you think that we're going to take that laying down probably not and this is how we set up conflict between staff members and patients so instead of conflicting with a patient I want you to put yourself in their shoes they're very very self-absorbed right now they're trying to figure out what's going on with them they're scared to death every patient in a hospital is dying just ask them they'll tell you absolutely not just the hospital every setting when something goes wrong with you your first instinct is is this GNA kill me how serious is this and that's closely followed by how is it going to impact my life am I going to be able to work who's feeding my cat who's picking up my kids who's cooking dinner for my significant other how am I going to pay this bill because healthc care is not free it costs a lot of money and that is generally paid for by the patient in some way either through insurance payments or through pays and we have to be aware of all of that because if I'm paying $6,000 a month to be in this nursing home and you aren't answering my call light where is my $6,000 a month going and if you don't think that will make your patients grumpy let me tell you again I know you've got way too much to do but remember the patients are paying for your service and we have to keep that in mind dignity and respect good other rights they have is to be able to freely communicate I actually got into it with the CNA one time over this the patient family was coming in from out of state they had a very small window that they could meet with the patient and the the CNA decided that that is when giving the patient a bath would fit into her schedule so she tried to chase the family out of the room so she could do her skills I sto that because the patient has a right to freely communicate doesn't matter whether your patient schedule fits into yours who should it all be about the patient the patient patient has a right to use their own possessions they have a right to join religious and social activities I'm GNA stop here for a second because religion is a big issue big issue you do not have to believe the way your patient believes to listen to what they believe you don't have to convert but if your patient wants to talk about religion you have an obligation to listen to them because it's part of their care emotional care as well as physical care so if you have a patient who wants to talk about Buddhism let him talk you don't have to respond you don't have to convert you don't have to explain why your religion is way better than theirs all you have to do is listen Okay but you also don't want to force them to do things that they don't want to do if there's a religious service in the activity room and you know that this patient is that religion you can't force them to go be like me dragging you to church it may not be what you want to do today but let me tell you the worst story I ever saw about this this was absolutely horrible there was a patient who um he didn't speak much English at all he and his wife had been in a horrible car accident she had died he um went to live with his son and girlfriend I think it was might have been wife but went to live with his son and it got to be too much so he went into a nursing home now he spoke very very little English but he had a little Shrine built like on his table bedside table and one day the statue on that Shrine went missing and he searched high and low I mean he moved the bed he moved the table he searched high and low could not find it he quit eating he quit communicating he laid down and essentially died when they packed up his clothes after he passed away they found that statue wrapped up in a pair of boxer shorts in the back of the closet intentionally hidden and of course they questioned all the staff what happened and one CNA finally came clean and said yeah I didn't like the way the eyes were following me around the room so I hid the statue so this is not just just a very bad lapse in judgment this is desecration moving a religious statue and specifically wrapping it up in dirty boxer shorts before hiding it is desecration that CNA was reported to the Board of Nursing and is no longer a CNA now what was particularly troubling is the CNA knew the patient was going downhill and still didn't step up and admit what happened I'm okay with that person not being a CNA anymore patients have the right we can't interfere with that good make sense I don't care if those eyes are following you around the room make friends with it they also have a right to be free from abuse and restraints and we'll get into restraints a lot later all right so all of these principles I do have flash cards I just like to mention this to you guys um just so that you know I have flash cards it has all of the principles it has all the skill steps and it has all of the supplies that we're going to use for each skill these are available for you guys on my website I think they're $29.99 um for you guys or $24.99 for you guys they're $49 9 while you're enrolled so after graduation they'll go back up to the regular price so if you wish to purchase them just go next door and let Jake know and he'll get you set um it's not mandatory you can make your own but these are available to you so we talked a little bit about this the patient experience we know they're sick we know that they're focused on themselves we know know that they're sleep deprived we know that they're grumpy and that they're worried about their own health we know all that but what we don't often think about is the setting that they're in um okay yeah I'm not going to get into that um so let's think for a second about this patient right here okay this patient is um let's say she's got a hip fracture she had hip surgery she's in our hospital and she brought her own pathogens with her she didn't leave them at home she brought her own pathogens with her and the problem with hospitals specifically is oh let me put this in terms you can understand I am tired I worked long hours last last week and I'm tired and if I want a break I can't just call up my local hospital and say hey I'd like to reserve a room for three days I need a little break right you can't do that that's what hotels are for it's what cruise ships are for right they're not the local hospital in fact when you go into the ER of the hospital their whole job is to get you out not up in order to get a bed in the hospital you've got to prove that you are sick enough to need that bed and it's really hard to do how many you guys have ever been to the ER and got discharged yeah that's their job that is their job if they admit you they have to justify that admission so it's a hard job that means this woman earned this spot she is sick enough to be here congratul ations but so is everybody else and they all brought their own pathogens so we brought the sickest people of our community all Under One Roof it is a pathogen Paradise now these patients aren't going room to room they pretty much stay where we put them in most cases with the occasional exception of wandering down to Subway I've seen that too so they pretty much stay where they put them which means that all of her pathogens are going to stay with her but I go in and out of her room and then I go in and out of somebody else's room and then I go in and out of another patient's room and I'm the one that's going to track pathogens from place to place that is what infection control is all about recognizing the danger that the pathogens present in a clinical setting and taking action to prevent not Contracting it ourselves but passing it from Patient to Patient because remember she's already got a problem she has a hip fracture that had surgery her immune system currently at full capacity now if we give her another pathogen Mera sedi pneumonia whatever we give her something else her immune system probably isn't going to be able to fight that new thing off because it's already busy now you might think that this is a very low risk and it's not one out of every 25 people in the hospital contract something they did not come in with guys that's like riding a roller coaster and saying hey one of you guys on this roller coaster is going to out not sure which one choose your seats wisely one out of 25 and one out of 12 of those is going to die this is a big deal this is not a little deal this is a big deal and that's why we have to talk so much about infection control to make sure that we're not the ones contributing to this medical errors kill more people than heart disease that's you guys you're the ones with the patience think about that medical errors kill more people than heart disease and heart disease is the number one killer so people rely on us to help them to take care of them and we're not doing such a great job of that we might help them with this problem but we're really good at giving them new problems so that's why a lot of this program is going to focus on steps to prevent that from happening good that's why we have to do things a certain way and that's what I'm going to teach you with these principles okay good good every patient is going to be different we'll talk about this as we go through but just remember that your patients are all different and what worked for one diabetic patient isn't going to work for another diabetic patient so let me I usually give this illustration when I talk about the care plan I forgot to do it earlier but let me give you an example of why this is so important guys and that we don't just treat everybody the same so and why we have to follow the care plan so there was a um nursing home and they put all of their diabetics on One Wing and the CNA was trying to do blood sugar sticks and you know monitor for signs and symptoms of diabetic um issues low blood sugar high blood sugar that type of thing and the sna had been working there for a long time and they had one patient that was a very brittle diabet itic now brittle means that blood sugars go up and down no real warning no real Association to food or activity it's just like their blood sugars have a mind of their own okay so it's not really tied to anything so at any time that could be high or low no clue so anytime the patient had symptoms the CNA had to report that to the nurse and the patient would get pale and sweaty and woozy and nauseous so the CNA reports it to the nurse the nurse goes and puts sugar and orange juice gives it to the patient the patient perks up life is great and this happened for months patient would have symptoms the CNA would report it to the nurse the nurse would put sugar in orange juice patient got better over and over and over again well on this particular day the nurse that normally cared for that patient was out and there was a substitute nurse who was busy with an emergency that was happening so the CNA couldn't there was nobody really to help right so the CNA patient gets symptoms CNA decides well I know what what works so put sugar and orange juice gave it to the patient within three days patient was dead so what happened why did it work for the nurse and not the CNA well what the CNA didn't know was that the patient wore a continuous blood glucose monitor and this is back when they were still pretty knew and anytime the CNA reported to the the nurse hey the patient's got symptoms the nurse looked at their actual blood sugar level on this monitor CNA never saw that step and every time that the blood sugar was low they gave them orange juice with sugar and it brought it back up well the symptoms of high blood sugar and low blood sugar are often very very similar and what the CNA did was she treated high blood sugar with more sugar patient went into a coma was transferred to the hospital and within three days died Happ to CNA so again they're outside of the scope of practice nobody told them to do that so what do you think happened to the CNA yeah they had to accept liability for that action okay does that make sense so you never want to be in that situation where you have to defend your actions you should always be able to say hey I was just doing what the care plan told me to do good make sense okay so be really really careful don't treat all diabetics alike if somebody gets woozy don't just automatically throw some sugar and orange juice and give it to them because not all patients are alike they're all going to be a little different so when we are taking the exam chances are you're probably going to make a mistake you're new to this and that's okay you'll probably mess a few things up during the test the good news is you can make Corrections so let's say that you are assigned to do range of motion on the left shoulder and you go in and you do all the exercises and then you stop and look and you realize you did it on the wrong side oops and we know we have to follow the care plan care plan said left shoulder I did it on the right oops maybe they won't notice yeah they did they did these evaluators are very very good at their jobs very good at their jobs so they noticed but if you say correction I did the exercises on the wrong side I would have done them on the left shoulder now that deficiency remember anything without a check mark is a deficiency because you acknowledged it it will get a check mark so you can make Corrections on the state exam you can also start any skill over if you're just like really out there and flubbing everything up and it's just a mess you can stop reset and start over over now they don't like that because those RNs that are grading you they're getting paid by the day they want to go home they want to be in their pools drinking their margaritas and not watching you start pulse for the third time and at some point they're going to say you've either got it or you don't so you want to use this very sparingly okay and remember the longer it takes you the longer everybody is going to be there for the day so they want you to kind of move along you want to show that you are able to take care of those patients safely with dignity and competently and if you can prove that you'll be a CNA okay if you're in there just messing up all over the place restarting six times and just like a total mess you're probably not going to do all that well and this is where practice is going to come in okay so you can make corrections I have a whole lesson on this page 33 and there is a video on it if you want to learn more about making making corrections but it's best to make them right away as soon as you realize you made a mistake now at the end of the scale I want you to at the end of the skill I want you to go back and read that care plan just to make sure you got everything because remember the care plan is key right and if you figure out you made a correction or you made a mistake you can correct it then but it's best to make those Corrections when you realize that you've made a mistake don't wait until the end to make your Corrections good good so you have to tell the evaluator my skill is done or you can say I'm finished or my task is complete however you want to say it nobody really cares but you have to end the skill and that's because when you say that it's kind of like that red button on a game show locking in your final answer you can't go back and change anything after you tell the evaluator your skill is done so don't say this until you're sure you don't have to make any corrections okay um yeah I always recommend that you reread that care plan one more time before you end your skill most of the time you actually have to perform the steps that you're correcting but not always so like if you did range of motion on the wrong side you can correct that verbally but if you um let's say you're doing mouth care and you can't say I would have brushed the teeth they need to see you do that okay so some things can be um corrected verbally most of them you'll have to go back and actually do it they'll tell you when they need to see it so let me show you how we're going to get through this course we have a syllabus which is this and we have two books in front of you and then you also have an online course that you're going to be enrolled in today after class so that online course we're going to talk about as we go it has a lot of interactive activities in it to make sure that you can put into practice what you're learning so like there's a supply Gathering activity it shows you all the supplies and says what do you need for this skill and you've got to choose the right ones there's a sequencing activity it shows you all the steps for the skill you got to put them in the right order there's practice questions there's documentation there's flashcards there's all kinds of stuff in the online program and you guys all have access to that for free as being part of this but let's talk about the two um talk about the two of the books so this oh cool Brock so Brock says I remember watching you during my CNA class I'm in nursing school now congratulations awesome thanks for tuning in all right so this is your homework book you're not going to write in this highlight it make notes you're going to return this to me on the very last day of class you're going to take it home today and leave it there don't bring it back and forth to class we don't use this book in class it's not my favorite book but it does work for homework reading because there's some stuff in here that I'm just not going to talk about that you're going to have to get through your reading okay so it's good for homework reading but we don't work out of that book in my book The spiral book I've got tests based on what you read so you're going to go home tonight and read chapter one in the yellow book and then you're going to go to page 181 in the spiral book and take the test now this is all on your syllabus right here in the homework column let me go back here I forgot to go through this hold on all right so when you're looking at your syllabus you'll see that there are four columns and that there's a whole bunch of rows the rows are the classes so this section is for today and then we have one for Wednesday Monday Wednesday Monday Wednesday Monday and Wednesday for graduation The Columns tell you what we're going to do in each class so here you'll see inclass uh skills so we learned skill rules you guys remember that we learned the opening we're going to get into that a little bit more in a minute uh we're going to learn the closing in a minute handwashing and indirect care so we still have a ways to go and I know I've only got 40 minutes minutes this is going to be the lectures that I give and that the pages corresponding to those lectures so we talked about what to expect on the CNA exam we talked about delegation and liability we talked about patient considerations I showed you the testing care plans here and we also talked about the principles or let's puzzle this out all of the principles that we're going to learn the third column is your homework you'll see that we're going to read chapter 1 Pages 1 to 20 and we're going to take the test in the white book or spiral book on page 181 now this last column are things that I hope we get to but we may not so today we actually went through the five key phrases we did the care plan activity we learned about corrections and we learned about skills grading so we still have to do warm dark moist okay so do you guys see how to use a syllabus okay so the yellow book goes home with you it is only used for homework reading don't bring it back to class and let me tell you why I don't like a yellow book in the back I'm just gonna borrow yours for a second it's a it's a good general knowledge book but if you go to the index you know the very back go to the index and look up care plan for me now ideally the care plan should be talked about on every single page in this book shouldn't it what do you guys think how important is care plan how many pages is it talked about it's actually two paragraphs out of this entire book you see why I don't like the book so I want you to keep in mind as you're reading this book that everything is dictated by that care plan okay thank you Brock all right so when you take that test on page 181 the very back of your book has the answer key this is how you're going to determine whether you got the answers right and then down here is your grading scale so if you missed one you got a 95 two is a 90 three is an 85 so when you come back to class on Wednesday I'm going to go right down my syllabus here I'm going to read your names and you're going to tell me how many you missed or what your grade was this is how I keep track of how you're doing in class now I want you to take that test as often as you need to to get a 100 because if you're reporting hundreds to me that way I know you've got the concepts if you come into class on Monday and you tell me you made a 70 I'm going to ask you which ones you missed so we can discuss them so I can make sure you got the information to me it's not about grades I could care less about grades I'm the only teacher on the planet that doesn't care about grades and that's because if I'm the body in the bed I'm not going to look up and say what's your name Carise I'm not going to say what' you get on chapter four you think I care as a patient what you what score you got on chapter 4 no I'm going to care that you know enough that when I start coughing like crazy that you put the head of the bed up to make it easier for me to breathe right that you got the concepts does that make sense good all right on the front of your yellow book is a letter and number the letter is y when I call your name tell me what your book number is y1 Y6 y10 um and that's how I know who has what if I call you a name and you want to be called something else let me know please Alexa [Music] stop Tanya Kira Carise naray did I get that right Christopher Christopher do you still have your books okay good Jada thank you and my condolences by the way Payton alisandra Jessica Alex Rebecca Amy beranda did I say that right yes good Stephanie chayla David Ariana and Owen thank you all right good job it's the hardest thing you'll have to do today so let's get through how to use this study guide I'm going to go through this very very quickly we'll get into it in more detail as we go but I'm running short of time again I talk way too much all right so if we go to page 52 this is how each skill is going to start every skill is going to follow the same format you'll see the name of the skill at the top down here it'll show you what principles cover the skill the skill specific one will be um spelled out for you these are the principles that govern this skill if you follow each one of these steps you're guaranteed to get 100% okay I have a video on it and then down here is test specific information so if you look down here it'll tell you for the test somebody with your level of experience should be able to complete this skill in five minutes or less it'll tell you if a skill is going to be done on a live patient like one of you or on the mannequin there are a few mannequin skills so if you see a mannequin there that means that you're going to do this on the mannequin in the test now I'm going to tell you something when you're practicing in this room if it shows live student there you need to be practicing it on a real person if it shows mannequin there you need to be practicing it on the mannequin if you try to practice something on a mannequin that you're really going to do on a live student when you get to the test it's going to be like you didn't practice at all okay so I put that there for you to know who you should be practicing it on beside that it tells you where that person is going to be either in bed or in a chair so you can set this up for the uh skill for the test the evaluator will set that up for you and then it'll tell you whether charting is required if you go to page 53 I'll show you how the skills pages are laid out now this skill uh page is going to tell you step by step how to do this skill I used to do a activity with you guys I don't have time to do today but just know that I am extremely detailed if you think about a peanut butter and jelly sandwich how many steps do you think are involved in a PB&J four 10 okay you're detail oriented it's actually 42 yeah it's actually 42 too cuz you got to open the cabinet to get the peanut butter you got to take the lid off the peanut butter you got to open the drawer to get the knife you got to open the twist tie on the bread wrapper a lot of steps so if I can make a peanut butter and jelly sandwich into 42 steps that means that I don't expect you to know anything that's how I wrote These so there is no question about when to put toothpaste on a toothbrush there's no question about when to recap the toothpaste there's no question about anything it is literally in these steps I handed this to a nine-year-old one time and said just follow this and they were able to duplicate the skill flawlessly so if I can get a nine-year-old to do this I'm certain I can get you to do it okay now when you're at home practicing best way to do this is to find a live Human laying around dead ones won't help you real well you got to find a live one hand them this book and at first tell them to read the step to you they read it you do it they read it you do it they read it you do it that way you make sure that you're doing it the right way but after a while when you've done the skill once or twice you don't need somebody to read it to you now you need them to check to make sure you're doing it right you can create your own evaluator at home long before you get to the test using these pages every single um skills page we'll start with care plan what do we need to know about the care plan follow it step-by-step instructions and then here I have uh um comprehension questions for every skill down below is your supplies for every skill um and then we have the online course now all of you will be enrolled in the online course after class today um you will the username and password that you created when you signed up for the class will get you into the online course so you'll actually get an email that says you've been enrolled okay so let's get into the opening I'm going to erace here let's get into the opening we've already talked a little bit about the opening this is on page 30 remember it's part of every single skill we do I have a video on it as well that you can watch watch and Page 31 actually in bold here in bold on page 31 gives you what to say hi Miss Jones my name is Patty I'm your CNA today how are you I am here to whatever is that okay close curtain wash hands get supplies so that is our opening we're going to do it at the beginning of every single skill and that's what's going to check off about a quarter of all of our checkpoints for each skill so it's pretty important that we learn to do this properly so knocking is actually an important step and it's one that CNAs miss a lot but I want you to think about patients that are not home they're in a strange Place surrounded by strangers they don't know you they don't know their roommates they didn't get to pick any of this and every time they close their eyes some new stranger walks in their room so imagine for a second you're laying there as a patient you close your eyes you finally manage to drift off to sleep you hear a noise you open your eyes and there's some stranger Rando standing over you with a sharp object what are you gonna do yeah I'm hitting first and asking questions later I can guarantee you that absolutely so this is what knocking is important because we need to keep that space safe for our patients they need a safe space to be in if we just invade their space with no warning it actually sets up for a negative patient encounter they will react whether they mean to or not they will react hostile to that because they don't they feel like absolutely everything is out of their control so we want to make sure that this is a psychological thing guys we want to make sure that they feel like they have control over their en they don't have control over anything else but they have to feel like they have control over their environment good make sense you actually see that I love the way Children's Hospitals do this I wish they would do this in other settings Children's Hospitals have got this down they don't do scary procedures on kids in the kids room they take them to a procedure room that's where scary procedures are done so we have to think about adults here adults are supposed to have better reasoning ability and that's why they do scary procedures in the room we shouldn't we should keep that room as a secure environment for our patients we can help with that by at least knocking before we enter so knocking actually counts a whole lot more than you think it does good questions all right so we're going to knock we're going to greet the resident and address them by name now now for the test everybody is Mr or Mrs Jones doesn't matter what your name is you're automatically going to be Mr or Mrs Jones we only use one name for the test makes it super easy for everybody but we're not going to check ID bands ID bands are never on a patient where they live think about your house when you go home do you have to put an ID band on so the people know who you are no it's where you live so if you're working in nursing homes assisted living facilities long-term care um Home Care your patients are not going to have ID bands the only place we have ID bands is short-term settings and that is less than 10% of our patients so they don't test with ID bands they test with having you address the patient by name same thing it happens in doctor's offices when you go to the doctor some Tech Medical Assistant somebody takes your height weight whatever puts you into a room puts chart outside the room and then when the medical provider comes in they call you by name was your name again Tanya I W so this is Tanya say hi Tanya okay so we all know she's Tanya if I walk in the room and I say hi Kira how are you today what are you GNA say that's not me because you don't want what I've got planned for Kira okay so you are able to self-identify and if our patient cannot self-identify that would have come up during the assessment and it would be reflected on the care plan we've already got a process for this got it so for the test we just identify our patient by name so one more time hi Miss Jones my name is Patty I'm your CNA today I'm here to whatever is that okay close curtain wash hands get supplies so let me explain to you why let's come back over here okay all right so let's say this is my patient and I've got to do my opening hi Miss Jones my name is Patty I'm your CNA today how are you I need to whatever is that okay now once I get permission from the patient then I'm going to close the curtain if I just walk in and close the curtain it kind of presupposes that my patient is going to say yes it really sends a nonverbal cue to my patient that I don't care whether they consent or not so we don't close the Privacy curtain until we get consent the order here matters guys but once I get consent and I close this curtain let's think about this curtain for a second who touches this curtain everyone so visitors are in the uh elevator scratching their butt and picking their nose and they're touching the curtain patients in bed cough and sneeze and scratch what itches and touch the curtain nurses come in empty the drainage bag with their gloves on and touch the curtain these things are not clean now housekeeping does spray them with a disinfectant spray in between patients but they're only taken down and physically washed about once a year [Music] so can we consider this thing clean no so when you touch the curtain what's the next thing you would like to do those two things need to be tied in your head forever if you touch the curtain you have to wash your hands do you guys remember me saying that the biggest risk of these patients is us because we touch curtains we touch all kinds of stuff and then we touch our patient and that's just germs good make sense everybody got it okay so the order of that is important knock knock knock hi Miss Jones my name is Patty I'm your CNA today I'm here to whatever is that okay close curtain now there is a checkpoint remember I said some checkpoints will fail you if you just missed this one checkpoint here it is if you touch the patient before you wash your hands hands it is an automatic fail you guys got that and that's because we know of the pathogens so you cannot touch this patient until your hands are clean so I'm going to close the curtain and then go wash my hands so let me show you hand washing well before we do that let's go here so remember I told you that um you have access to the online course so this is a lesson from the online course it has a video that you can watch on the opening explaining each step and then it has the steps so we're going to do this together really quickly and uh see if we've got the order down here so here are our steps we've got gather supplies close privacy curtain read the care plan identify the patient by name knock on door wash your hands explain the task and ask for permission and say your name and title those are our steps of the the opening which one comes first what do we do how do we know what to do read the care plan remember that step one for everything yep how do we know what to do with each patient we're going to read the care plan now what's our next step knock on the door okay what's our next step identify our patient okay and then yeah I always want to sing that song say your name I can't sing say your name and now what do we want to dok explain the task and then close curtain okay so we don't want to gather our supplies yet because we don't have clean hands so what do we want to do wash our hands and then gather supplies and then we're going to hit that check button and it's going to tell us yes you got all of those steps right now this is a drag and drop okay so you just drag each one of these tiles and you guys all have access to this you will have this for every single skill that we learn all of the steps laid out and you've got to put them in the right order okay um if you get wrong it'll reset all of it you got to start from scratch all right so let me um all right okay let's get into the closing and then I'll do handwashing all right just like the opening starts every single skill that we do the closing is going to end every single skill that we do it's in every single skill the specifics are going to be located on page 35 and there's eight C's to the Clos our main principle here is always leave your patient looking better than you found them and the very last thing that we do is wash our hands we have to end skill with clean hands as a testing checkpoint end skill with clean hands so it doesn't matter what else you do end skill with Clean Hands good now the opening the order mattered the closing the order does not matter doesn't matter how you do this other than the last two steps the last two have to be the last two the rest of it we don't care and there's eight C's here so our um the way that we remember this is we need to make sure our patient is in a clean and safe environment so we have to look around make sure the environment is clean guys how housekeeping is there to help us but it is not their responsibility to make sure your patient's in a clean environment it's yours they're just there to help um bed height needs to be in the low position for safety we want to make sure the patient is comfortable and we have to say the word are you comfortable they have to hear the word comfortable but it's not just about physical Comfort it's also about emotional comfort so think about about the patient here if they don't have anything to do they're going to be bored out of their minds which means they're going to be on the call light nonstop so you need to give them something to do a TV remote their phone crossover puzzle B something otherwise you're not going to get anything done remember it's like you know children you got to have them occupied so for the test we're going to address this by offering a magazine okay um you want to open the curtain make sure they have their call light and then clean your hands now if we have to chart if I'm going to pick up this pen and write with it my hands have to be clean to touch it this pin goes in and out of every single room nurses station goes home with me at the end of the day I only want to touch this with Clean Hands and then I have to end skill with clean hands so if I've charted I have to wash my hands again good so my closing should sound like this thank you very much Miss Jones is there anything else I can do for you are you comfortable your environment's clean bed is in low position you can adjust the head of the bed if the patient wants to um can I get you a magazine before I go I'm going to open the Privacy curtain here's your call light if you need anything please let me know I'm going to go wash my hands chart if necessary and wash my hands again so the open or the the opening is shorter the closing is really long but the closing takes up a lot of checkpoints as well this is not optional you have to learn this okay good again I have a lesson in the online program on the closing there's a video for you to watch and then there's a what we call Hot Spot activity it just asks you to address each part of the closing so make sure the environment's clean the bed's in low position chart give them their call light wash your hands open the curtain and ask if they're comfortable so now let's get into hand washing so this is going to be on page 44 you'll see the closing a million times now handwashing they're not going to tell you go wash your hands and let me grade you it doesn't work like that handwashing they're not going to say anything about you have to know that you are required to wash your hands after you do the opening before you get your supplies and after you do the closing they're not going to tell you to do it because they're grading that you know when to wash your hands as well as know how Okay so again this is going to be um a part of every single skill that we do you're going to be graded at the beginning and end of your first skill these are the checkpoints that we're going to be graded On and Here are our stepbystep instructions on how to wash our hands so let me show you handwashing can you guys see the the sink there okay so when we're washing our hands when we approach the sink the faucet is dirty my hands are dirty I can touch the faucet no problem dirty hands can touch a dirty faucet that's okay I want to get water that's comfortable for me if I like cold water I'll use cold water if I like warm I can use warm whatever's comfortable you're never going to get water hot enough to kill germs it would have to be boiling you can't wash your hands in boiling water so comfortable you're going to turn the water on and you're going to wet your hands now when you wet your hands you want to keep them in the sink area don't bring them out here so you're going to wet your hands and you're going to get a lot of soap and when I say a lot of soap I mean a lot of soap because you're grated on bubbles not kidding we're going to start rubbing our hands together and when we start rubbing our hands together we're going to look at the clock right above the sink there will be a clock above the sink in the testing center so when I bring my hands together I'm going to look at that clock and I'm going to rub the tops of my wrists all the way around the backs of my hands and in between my fingers down by my pinky the bottom of my hand in between my thumb and index finger keeping my hands lower than my elbows and over the sink and the palm of my hands interlacing the fingers and we have to rub all areas for at least 20 seconds minimum and then we're going to go down each one of our nails to clean our cuticles Circle our nails on the palm of our hand and then we can rinse and when we rinse you want to keep your hands from touching the sink or the faucet your hands are clean those items are not hardest part of hand washing don't shake tap when I tap the water goes in the sink when I shake the water goes everywhere so want to tap to keep the water in the sink we're going to get some paper towels it does not not matter how many we're going to dry what's clean now this up here is not clean if I take my paper towel and go up here and then back down to my hands I will have contaminated so only dry what's clean we're going to throw those away and get a clean dry paper towel to turn our faucet off don't use those wet paper towels wet paper towels rip easily that faucet is the dirtiest thing in the bathroom bring this over here that faucet is the dirtiest thing in the bathroom so we have to have a dry paper towel so that it doesn't rip when we're turning the faucet off good talk about this why do I tap pathogens need three things in an environment to thrive warm dark and moist bathrooms are usually 2 or 3 degrees warmer than other environments because we don't like to be chilled when we get out of the shower bathrooms are usually dark mom trained you turn light off when you're leaving the bathroom and they're often moist because of showers and toilets and sinks and things like that when you shake and you create pockets of moisture bacteria live in the bathroom we take them there every day to drop them off guys E coli they live in the bathroom when you create pockets of moisture you're creating little pools for that ecoli to multiply and then you walk through it and you walk through your clinical setting you have the same shoes you get in your car with and at home so you're transferring pathogens all over by just creating moisture in that area doing this keeps your moisture confined to the sink good questions okay yeah we just did that all right so these are our checkpoints let's see if I did this right let's look at the checkpoints did I begin handwashing by wetting hands and applying soap did I wet my hands first yes guys that's a checkpoint don't just walk up to the sink and get soap on your hands you have to wet them first order matters did I use friction to distribute soap and create a lather pling the front and back of hands between fingers around cuticles under nails and wrists did I provide cleansing friction for a minimum of 20 seconds did I rinse my hands and wrists did I use clean paper towels to dry my hands and wrists and dispose of those in the trash can and did I end handwashing skill with Clean Hands avoiding recontamination of hands um by direct contact with a faucet okay so I'm happy I did my skill correctly so what you saw was according to the actual checklist that you're going to be graded on so each one of those points matters good these are the areas that are most frequently missed on our hands the back of the thumb this part of the thumb is missed a lot the fingertips we're really good about doing this part but we're not real good about the fingertips and this area the webbing here gets missed quite a bit as well so pay attention to that because the evaluators are going to um faucet handles are the dirtiest thing in the bathroom but you can touch them with dirty hands we're going to wet our hands we're going to apply soap after we wet our hands we're going to rub together for at least 20 seconds using a clock keep your hands lower than your elbows and inside the sink Circle your wrists scrub the backs of your hands and in between your fingers the palm of your hands the thumb and the webbing and the bottom of your hands by your pinky remember it has to be at least 20 seconds those of you who like to sing ABCs happy birthday all the single ladies whatever you want to sing don't because when you're nervous for the test do you know what happens to your singing Speed yeah it's no longer an effective use of time gauge of time so for the test use the clock that's right above the sink remember I said there's two evaluators guys remember that the first one's over there at the sink watching you the second one the second evaluator you think is not doing anything when you put your hands together they actually write down where the second hand was when you put when you get soap and put your hands together you've got a rub when you move to your nails they write down where the second hand is when you moved your nails and if it's not at least 20 seconds in between you failed so that second evaluator is doing something with handwashing okay so no we're not on break sorry all right so we're going to tap to keep the water in the sink get some paper towels dry throw those away and then turn the faucet off with a clean dry paper tow all right I do have a um activity in the online program so if you go to the online program at the top you'll see the care plan it'll actually if you click on the button it actually brings up the care plan from the test along with the checklist there's a video and then we have a sequencing activity as well so let's do this really really quickly what is the first thing that we need to do for handwashing turn the water on yeah what second thing we do wet hands ply soap I know it's hard okay lather all surfaces rub for at least 20 seconds rent oops hold on rinse all right dry hands dry hands and then turn the water off with a barrier if we check it we get our gold star good job I have a whole lesson on CNA uh handwashing simulations we'll talk about this next class and indirect care you're going to need to read this doggy or this put a bookmark whatever you need to read this because I'm not going to get to it I got two minutes left so page 28 you'll want to read but indirect care really means treating your patient the way you would want to be treated so if you had to trade places with that patient how would you want to be treated right and you're being tested on it but indirect care really is going to um be comprised of these things eye contact tone of voice rate of speech facial expression body language explanations posture and attitude all of this goes into how the patient perceives us we've all seen that CNA that we wouldn't want taking care of a dead cat on the side of the road right we don't want to be one so pay attention to how you are presenting yourself to the patient so quick um recap of your homework in this book you're going to read chapter one on page 181 you're going to take the test and grade it I do have a CPR class this Saturday um you'll get some information on this as we go through the program as well I'll remind you again on Wednesday I have two CPR classes while you guys are in session week one Saturday week four Monday you don't need see PR for the class you don't need it for the test you will need it to work so while you're enrolled I give it to you for $45 after graduation it goes up to $55 so you'll probably want a schedule to come to one of these two you only need to come to one but sometime while I'm teaching to get it at a cheaper rate okay so Saturday it'll be 9 to one that's this Saturday or or week four Monday afternoon 2: to 6 so you'll come to class Monday 9:00 to1 you'll get an hour for lunch and then come back at two for CPR okay so let me get you your review sheets every class I give you a review sheet um these review sheets will help sum up what we went over in class and if you fill these out as as we go um it makes a great study packet for when you're uh sitting in your car waiting to test okay you're welcome so they're double-sided oh my gosh I couldn't have done that again if I tried wow so every class you'll get a review sheet if you don't happen to uh be able to come to class and you're joining us virtually the review sheets are on flcn training.com so if you look at your syllabus right up here at the very top says flcn training.com this is where the live stream is so you can see it on YouTube too but if you go to flcn training.com it's right there in the middle of the page you can join in without having to do anything um but the review sheets are actually below it you can click and print out the review sheets so those of you joining virtually you have access to these review sheets as well um they're always on the wall there so if you're missing any you can pick one up as well okay did I go too fast for anyone is everybody planning on coming back yes okay all right I will see you on Wednesday at 9ine remember I don't get here too early so if you're an early bird go get a cup of coffee coffee um I will be here at 9: I'll see you then till next time guys happy caregiving