Nurse Assisting
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Chapter 10 Expanded Skills

Click on the skills to review expanded skills discussed in this chapter.

Starting-Up Steps

  1. Knock before entering, identify the client, and introduce yourself.
  2. Complete hand hygiene.
  3. Provide for privacy.
  4. Explain to the client what you will be doing before you start doing it.
  5. Assemble your supplies.
  6. Ensure that the bed is at a good working height and is locked; or, if the bed is not in use, you are in an ergonomically correct position to assist the client.

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Applying Soft Wrist/Ankle Restraints

When: Apply a restraint only when ordered by a physician. Check the client every 15 minutes while a restraint is in use. Remove the restraint every 2 hours. Remove the restraint at meal times.

Why: Use a restraint only when required to keep the client safe from harm.

What: Supplies needed for this skill include

  • A restraint

How:

  1. Complete your starting-up steps.
  2. Apply the restraint as per manufacturer directives to the wrist or ankle. The fit should be snug. Attach with a quick release knot to a nonmoveable part of the bed.
  3. Check on the client every 15 minutes. During this check, look at the area below where the restraint is applied. If, for example, the client has wrist restraints, their hand and fingers must be checked. Look for warmth, color, pain, function, and circulation. Touch the hand to see if it is cold or warm. Look at the color to see if it is rosy or dusky. The same would apply to the foot if ankle restraints are used. Ask these questions:
    1. Can you move your hand/foot?
    2. Can you feel me touching your hand?
    3. Do you have any pain in your hand?
    4. Do you have any numbness or tingling in your hand?
  4. Report any of these signs to the nurse immediately: pain, dusky color, cold extremity when compared to the rest of the body, loss of function in the extremity, and loss of sensation (that is, the client cannot feel your touch or they feels “pins and needles”).
  5. Remove the restraint every 2 hours. During this check, the nursing assistant is responsible for several things. Offer to help the client to the bathroom or change their incontinence product. Reposition the client. Take them for a walk. If the client is bed-bound, perform range-of-motion (ROM) exercises. Offer food and fluids, and encourage the client to eat and drink. Socialize with the client, or allow the client to socialize with others, if this is safe. Meet both the physical and emotional needs of the client.
  6. Complete your finishing-up steps.

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Finishing-Up Steps

  1. Ensure that all of the client’s needs have been met and that the client is positioned as desired.
  2. See to safety. Replace any alarms or positioning devices, as indicated on the care plan or individual service plan. The bed is in the low position and is locked.
  3. Place the call light within easy reach.
  4. Clean and replace equipment, and return supplies to the designated place in the client’s room or facility storage area.
  5. Leave the room clean and in order. Ensure that the bed is made. Remove trash and dirty linens from the room.
  6. Complete hand hygiene.
  7. Report and document, as required by your facility.

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