September 24, 2014 NNAAP® Skills

September 24, 2014 NNAAP® Skills Kathy Turner - Assistant Chief, Health Care Personnel Registry & Center for Aide Regulation and Education Margaret Roberton - Director, Continuing Education - Training & Standards North Carolina Community College System

Session Overview Review NNAAP® Results and Trends for Community College Students Review Score Analysis Methods Clarify Specific Skills Steps Identify Resources for Additional Information

Community Colleges vs State July 2013 – July 2014
Skill Community Colleges Pass % State Provides Perineal Care 80% 70% Provides Mouth Care 82% 75% Gives Modified Bed Bath 84% Positions on Side 87% 79% Provides Catheter Care 85% 78% Overall Pass Rate 71% 61%

North Carolina 2013 Skills Passing Percentage
State PS HS CC E4 E6 E7 Other Washes hands Applies knee-high stocking 94% 86% 96% 92% 97% 93% 90% 80% 82% 77% 98% Assists to ambulate using transfer belt Assists with the use of bedpan 87% 78% 91% 89% 85% 88% 81% 69% 83% 68% 67% Cleans upper or lower denture Counts and records radial pulse 79% 95% 72% 76% 75% Counts and records respirations Donning and removing PPE 84% 74% Dresses client with weak right arm Feeds client who cannot feed self Gives modified bed bath Measures and records blood pressure 65% 71% 62%

North Carolina 2013 Skills Passing Percentage (con’t)
State PS HS CC E4 E6 E7 Other Measures and records urinary output Measures and records weight 82% 83% 88% 84% 89% 75% 79% 78% 73% 74% Performs passive ROM shoulder Performs passive ROM knee & ankle 86% 81% 87% 90% 92% 76% 66% 85% Positions on side Provides catheter care 70% 64% 69% 59% Provides foot care Provides mouth care 94% 67% Provides perineal care for female Transfers from bed to wheelchair 80% 60% 77% 56% OVERALL Pass % 61% 71% 49% 54% 46% 72% % of Testing 100% 7% 9% 35% 27% 10% 3% RTS INF 57% overall state % RTS = 82% & INF = 18% of testing Proprietary % RTS testing = 45% INF testing = 55%

NC Community College Highest to Lowest Skills July 1, 2013- July 31, 2014
Pass % Cleans upper or lower denture Washes hands Counts and records respirations Provides foot care 98% 97% 94% Measures and records urinary output Performs passive ROM shoulder Assists with the use of bedpan Measures and records blood pressure 88% Assists to ambulate using transfer belt Performs passive ROM knee & ankle Applies knee-high stocking 92% Positions on side Dresses client with weak right arm 87% Donning and removing PPE Transfers from bed to wheelchair 91% Provides catheter care Gives modified bed bath Counts and records radial pulse 85% 84% Measures and records weight Feeds client who cannot feed self 89% Provides mouth care Provides perineal care for female 82% 80%

Pearson VUE Reports BI Portal Pass/Fail Report BI Portal Reports (P/F roster)– sent on the 15th of the month Contains data from previous month (if no one tested, a report will not be sent) Includes student names, dates, P/F, missed skills (not steps) Does not contain SSNs or ID information

Sample BI Portal Pass/Fail Roster

Pearson VUE Reports Training Program Quarterly Report Training Program Report (Quarterly Report) – sent on the 15th of the month following the quarter (next report due October 15) Training program summary of results for written and skills for students who testing using that program code Compares stats with state Numbers only

Sample Training Program (Quarterly) Report

REMINDERS! All reports sent zipped and password protected
Be sure and whitelist the Pearson VUE Communicate address changes to your consultant

NCNA Passing Rates & Information
Q1 & Q2 2014

Q1 & Q2 2014 NCNA Testing Data 11/13/2018 1st TIME FAIL 1st TIME PASS
Grand Total % PASS Community College TP 1 10 40 50 80% Community College TP 2 9 54 63 86% Community College TP 3 7 39 46 85% 26 133 159 84% NCNA Testing Data 11/13/2018

Pass Rates by Age 11/13/2018 Row Labels 1st TIME FAIL 1st TIME PASS
Grand Total % PASS Community College TP 1 10 40 50 80% 16 to 18 2 8 19 to 24 3 11 73% 24 to 34 16 18 89% 35 to 49 6 9 67% 50 plus 100% Community College TP 2 54 63 86% 1 20 90% 19 22 4 15 5 Community College TP 3 7 39 46 85% 12 75% 50% 26 133 159 84% 11/13/2018

Pass Rates by Testing Site
Row Labels 1st TIME FAIL 1st TIME PASS Grand Total % PASS Care One Nurse Aide Training Inc. 6 19 25 76% Chosen Healthcare Services Inc. 2 0% HealthCore Resources Inc 100% Nash Community College 1 Optimal Health Providence Training Institute 30 31 97% Community College TS 1 16 68 84 81% Community College TS 2 11 12 92% 26 133 159 84% In-facility Testing 11/13/2018

Pass Rates by Age & Test Site
Row Labels 1st TIME FAIL 1st TIME PASS Grand Total % PASS Care One Nurse Aide Training Inc. 6 19 25 76% 35 to 49 4 2 33% 16 to 18 1 3 67% 19 to 24 9 10 90% 24 to 34 5 100% 50 plus Chosen Healthcare Services Inc. 0% HealthCore Resources Inc Nash Community College Optimal Health Providence Training Institute 30 31 97% 50% 12 Community College TS 1 16 68 84 81% 8 75% 13 77% 7 24 83% 23 26 88% Community College TS 2 11 92% 133 159 84% 11/13/2018

Pass Rate of Skills Less than State Rate Less than 75% 11/13/2018
Statewide College TP 1 College TP 2 College Total Skill Description Tested Pass Pass % Cleans upper or lower dentures 1,183 1,117 94% 32 30 2 100% 34 Hand Hygiene (Hand Washing) 8,277 7,757 276 259 10 286 269 Dresses client with affected (weak) right arm 1,546 1,259 81% 47 43 91% 1 48 44 92% Positions client on side 1,723 1,413 82% 55 49 89% 3 58 52 90% Measures and records urinary output 1,713 1,428 83% 50 88% 46 Measures and records weight of ambulatory client 1,695 1,417 84% 54 87% 57 Performs modified passive range of motion (ROM) for one knee and one ankle 1,424 1,226 86% 45 39 41 Assists client to ambulate using transfer belt 1,746 1,525 85% 4 Assists client with use of bedpan 1,462 1,179 40 42 Counts and records respirations 1,429 1,289 Gives modified bed bath (face and one arm, hand and underarm) 1,643 1,247 76% Performs modified passive range of motion (ROM) for one shoulder 1,427 1,161 78% 53 79% Provides foot care on one foot 1,200 1,020 35 37 Measures and records blood pressure 1,734 1,433 67 69 Donning and removing PPE (gown and gloves) 1,745 1,510 65 77% 66 51 Feeds client who cannot feed self 1,721 1,397 68 Transfers client from bed to wheelchair using transfer belt 1,229 74% Counts and records radial pulse 1,706 1,382 72% 59 73% Provides catheter care for female 1,911 1,472 71% Applies one knee-high elastic stocking 1,454 1,278 33 70% Provides mouth care 1,568 1,166 69% 36 Provides perineal care (Peri-Care) for female 1,650 1,191 50% Less than State Rate Less than 75% 11/13/2018

Average Scheduled Hours
Pass Rates to Hours No strong correlation between average hours of instruction and pass rates. (-0.17) College Fail Pass Total % Pass Average Scheduled Hours Western Piedmont CC 16 100% 164 Davidson County CC 7 74 81 91% 159 Tri-County CC 3 28 31 90% 189 Nash CC 6 53 59 144 Surry CC 9 83 89% 192 Blue Ridge CC 8 62 70 187 Mayland CC 49 57 86% 160 Wake TCC 26 133 84% Asheville-Buncombe TCC 29 138 167 83% 150 Forsyth TCC 24 99 123 80% 174 Wilson CC 15 72 79% 172 Haywood CC 10 38 48 162 Roanoke Chowan CC 11 78% 190 Piedmont CC 18 60 78 77% 140 Coastal Carolina CC 30 39 154 11/13/2018

Instructional Distribution
mean median mode minimum maximum 174 172 192 132 220 Average hours of instruction Mid-point of instructional hours Most frequent instructional schedule 154 – 192 is the mid-range of hours provided *all other hours 1 StDev from this set (tails) 11/13/2018

How to get there… Excel Demo 11/13/2018

NCSBN Skills Clarifications
Most Frequently Missed Skills Provides Mouth Care Provides Perineal Care for Female Client Gives Modified Bed Bath (face & one arm, hand & underarm) – none from NCSBN Positions on Side Provides Catheter Care for Female

Skills Clarification PROVIDES MOUTH CARE
Step #13: Places basin and toothbrush in designated dirty supply area. Previously: If candidate starts to store toothbrush in area other than basin or designated dirty supply area, direct candidate to place in basin or dispose of into wastebasket and mark “YES” for this step. NCSBN clarification (10/5/2013): The toothbrush is to be placed in the basin and disposed of in the designated dirty supply area not the waste basket. If candidate starts to place/store equipment in area other than designated dirty supply area, direct candidate to place in dirty supply area and mark “NO” for this step. Step 13 is missed by 9% of candidates in NC Copyright©2014 NACES All rights reserved

PROVIDES PERINEAL CARE FOR FEMALE CLIENT
Skills Clarification PROVIDES PERINEAL CARE FOR FEMALE CLIENT Step #14: After rinsing and drying basin, places basin in designated dirty supply area. Previously: If candidate starts to place/store equipment in area other than designated dirty supply area, direct candidate to place in dirty supply area and mark “YES” for this step. NCSBN clarification (10/5/2013): If candidate starts to place/store equipment in area other than designated dirty supply area, direct candidate to place in dirty supply area and mark “NO” for this step. Copyright©2014 NACES All rights reserved

Skills Clarification POSITIONS ON SIDE
Step #5: Slowly rolls onto side as one unit toward raised side rail. Question: Is it acceptable to cross ankle and/or reposition client’s knee prior to turning/performing log roll for this step? NCSBN clarification (06/02/14): Lateral positioning (this skill) is not the same as logrolling. The reference specifies that “the upper leg is in front of the lower leg,” which may make it wrong to cross the client’s ankles. Step #7:Candidate positions client so that client is not lying on arm Previously: Candidate had to touch the client’s arm. NCSBN clarification (11/13/13): The candidate may observe that the client is not lying on his or her arm without having to actually touch it. As long as proper placement of the client lying on arm has been met, this step has been met. Copyright©2014 NACES All rights reserved

Skills Clarifications
PROVIDES CATHETER CARE FOR FEMALE Step #12: After rinsing and drying basin, places basin in designated dirty supply area. Previously: If candidate starts to place/store equipment in area other than designated dirty supply area, direct candidate to place in dirty supply area and mark “YES” for this step. NCSBN clarification (10/5/2013): If candidate starts to place/store equipment in area other than designated dirty supply area, direct candidate to place in dirty supply area and mark “NO” for this step. Copyright©2014 NACES All rights reserved

REMAINING SKILLS CLARIFICATIONS
Copyright©2014 NACES All rights reserved

Hand Hygiene (Handwashing)
Step #9 – Uses clean, dry paper towel/towels to dry all surfaces of hands, wrists, and fingers then disposes of paper towel/towels into waste container. Use of automatic sensor-activated faucet control. NCSBN clarification (5/23/2014): If the faucet the candidate is using has to be turned off by hand, a dry paper towel or foot/knee control should be used. If the faucet the candidate is using is sensor-activated, the candidate should not be scored wrong for not using a paper towel. Step 5 -  time to 20 seconds and added “keeping hands lower than the elbows and the fingertips down” based on current CDC Guidelines Copyright©2014 NACES All rights reserved

Assists With Use of Bedpan (Standard Bedpan Only)
Step #4 – Puts on clean gloves before handling bedpan Previously: If candidate went to supply table to pick up bedpan, some NAEs were marking step #4 as ‘no’. NCSBN clarification (10/15/2013): The candidate is allowed to gather their supplies (as they do with every other skill) including the bedpan, without gloves on. Step #4 is referring to the candidate having gloves on before they pick the bedpan up to place it under the client. Copyright©2014 NACES All rights reserved

Assists With Use of Bedpan
Step #15: After rinsing bedpan, places bedpan in designated dirty supply area Previously: If candidate starts to place/store equipment in area other than designated dirty supply area, direct candidate to place in dirty supply area and mark “YES” for this step. NCSBN clarification (10/5/2013): If candidate starts to place/store equipment in area other than designated dirty supply area, direct candidate to place in dirty supply area and mark “NO” for this step. Copyright©2014 NACES All rights reserved

Cleans Upper or Lower Denture (Decontaminate Hands)
Step # 3, 6 & 8 – moderate temperature running water/solution NCSBN clarification: Cleaning dentures – the literature varies from textbook to textbook from specifying “cool” to “lukewarm” to “warm.” “Moderate” is acceptable as there is no specific temperature range given. Copyright©2014 NACES All rights reserved

Donning and Removing PPE
Step #4 - Secures gown at waist making sure that back of clothing is covered by gown. NCSBN clarification (11/06/13): Gown is to be secured at waist. May be secured at back, side, or front. Copyright©2014 NACES All rights reserved

Dresses Client with Affected (Weak) Right Arm
Step #4 - While avoiding overexposure of client, removes gown from the unaffected side first, then removes gown from the affected side, and disposes of gown into soiled linen container Previously: Gown may be placed in soiled linen container anytime within the skill. NCSBN clarification (11/13/13): “The candidate should place the client’s dirty gown in the hamper as soon as it’s removed.” If the candidate does not remove the client’s gown or removes it but does not place in soiled linen as soon as removed, step 4 should be marked ‘no’. Remember, as the candidate is facing the client, their right/left sides are opposite. Copyright©2014 NACES All rights reserved

Feeds Client who Cannot Feed Self
Can candidate have client sit up on side of bed when performing this skill? – Yes Step #3 – Before feeding client, client is in an upright sitting position (75-90 degrees) Previously: If client’s head not up high enough, it was a safety stop. NCSBN clarification (11/13/13): No longer a safety stop if the client’s head is not at degrees. Allow the candidate to raise the spoon to the mouth, then say “stop, please raise the client’s head to degrees and then continue” and mark ‘no’ for this step. Copyright©2014 NACES All rights reserved

Measures and Records Blood Pressure
Can the skill be performed with client sitting up in a chair? The skill does not specify so for testing purposes either is acceptable. However, in order to get credit for step #10, the signaling device must be within reach. If candidate does not take the BP correctly -and the NAE cannot determine what the correct result is, the NAE waits until the candidate says “skill complete”, then stops the timer and retakes the BP on same arm to get the accurate reading Step #8 –Deflates cuff slowly and notes the first sound (systolic reading), and last sound (diastolic reading) (If rounding needed, measurements are rounded UP to the nearest 2mm of mercury) NCSBN clarification (6/02/14 )–After the cuff is inflated, the student is instructed to “deflate cuff slowly”. Copyright©2014 NACES All rights reserved

Measures and Records Weight of Ambulatory Client
Step #3 -Before client steps on scale, candidate sets scale to zero, then obtains client’s weight UPDATED Step 3: Before client steps on scale, candidate sets scale to zero Step #4 - While client steps onto scale, candidate stands next to scale and assists client, if needed, onto center of scale UPDATED Step 4: While client steps onto scale, candidate stands next to scale and assists client, if needed, onto center of scale then obtains client’s weight Previously: If candidate does not set the scale to zero, mark “NO” for this step. NOTE – this change is reflected in the October handbook or July handbook with erata sheet Copyright©2014 NACES All rights reserved

Measures and Records Weight of Ambulatory Client
NCSBN clarification (8/19/2013, 8/28/2014, 9/4/2014): If candidate does not set the scale to zero, mark “NO” for steps 3 & 4. The following is clarification regarding the steps in the skill Measures and Records Weight of Ambulatory Client. An accurate client weight drives numerous important healthcare decisions such as medication orders and management, dietary recommendations, disease management, and treatment orders etc. In the skill, the accuracy of step 4 is contingent upon the correct completion of step 3. Incorrectly completing step 3 has a direct impact on step 4 and ultimately a potential negative impact on client outcomes. With this in mind, steps 3 and 4 remain inextricably linked. During the skills examination, the candidate has the ability to self-correct a mistake or an omission prior to the end of the skill. The candidate must inform the evaluator of the mistake/omitted step and then prepare to complete the step correctly. In other words, during the exam, if the candidate realizes they have omitted/incorrectly completed step 3, they have the opportunity to correct the error and have a different impact on step 4 and ultimately client outcomes. The skill Measures and Records Weight of Ambulatory Client contains ordered-dependent steps and therefore must be completed in the appropriate order. Incorrectly completing step 3 and/or completing it in the incorrect order has a direct impact on step 4 and client outcomes. Copyright©2014 NACES All rights reserved

Weight Skill Errata Sheet

Performs Modified Passive Range of Motion (PROM) for One Shoulder
Step #5: Raises client’s straightened arm from side position upward toward head to ear level and returns arm down to side of body (flexion/extension) (AT LEAST 3 TIMES unless pain is verbalized). Supporting the limb, moves joint gently, slowly, and smoothly through the range of motion, discontinuing exercise if client verbalizes pain NCSBN clarification (07/30/2014): Within the context of the skill, the step notes the ear as a point of reference the lifted, straightened arm should not be lifted past when performing the shoulder flexion portion of the skill. The skill does not reference the use of the hand in identifying the landmark not to exceed. Full shoulder flexion ROM is degrees. This may be achieved in either a supine, sitting or standing position. Starting at the side of the body, the straightened arm is lifted in front of the body until arm is directly over the head. The ear is used as a landmark to indicate the 180 degree flexion not to exceed. The skill uses the terminology of “upward toward head” as some clients may not have the ability to reach the full ROM of the arm directly over the head. Copyright©2014 NACES All rights reserved

Resources Take advantage of workshops around the state offered by consultants and NCDPI Review and track test results (must be receiving and working with reports) Document successes Duplicate appropriate successful strategies from peers Stay plugged in: Read and share s, workshop notes, etc Ask for assistance BEFORE in a timely manner Practice, practice, practice – It’s important for you, as an instructor, to understand skills, clarifications, steps

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September 24, 2014 NNAAP® Skills

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