Integrated Skills Demonstration Lab

What This Lab Is and Why It Matters

The Integrated Skills Demonstration Lab is your capstone performance checkpoint before clinical practicum. In a single lab session you will show that you can perform CPR correctly, assist a resident with two real-world activities of daily living (ADLs), and explain—out loud—why every step is done the way it is. This mirrors what state CNA evaluators and future employers expect: technical skill and professional reasoning, not just going through the motions.

Passing this lab is a required gateway. If you do not pass, you will complete a focused remediation session and one re-attempt before the next lesson. Use this reading to prepare, not just to review afterward.

CPR and AED: AHA Heartsaver Protocol Review

Cardiac emergencies can happen to any resident at any time. Your AHA Heartsaver certification means you are trained to respond immediately, before EMS arrives.

Critical performance standards (these are the AHA pass criteria you must meet):

• Compression rate: 100–120 compressions per minute.
• Compression depth: At least 2 inches (5 cm) for an adult; do not exceed 2.4 inches (6 cm).
• Full chest recoil: Release all pressure between compressions so the heart refills; do not lean on the chest.
• Ventilation ratio: 30 compressions to 2 breaths (30:2) when working without an advanced airway.
• Minimize interruptions: Pauses in compressions should be less than 10 seconds.
• AED: Power on the AED as soon as it is available, attach pads correctly (upper right chest, lower left side/ribs), follow voice prompts, ensure no one is touching the patient during shock delivery, and resume CPR immediately after the shock.

A critical error on the AHA skills check—such as failing to open the airway, skipping AED shock delivery when prompted, or compressing at the wrong depth consistently—results in an automatic failure requiring remediation. Your peer evaluator will use the AHA skills-check sheet to time and record every element.

Scope-of-Practice Reminder for CPR

As an HHA or CNA you are authorized and expected to initiate CPR when you witness or discover a pulseless, non-breathing adult. You must also activate the emergency response system (call 911 or the facility emergency number) simultaneously or direct a bystander to do so. You do not wait for a nurse or physician before starting compressions—every minute without compressions reduces survival. Document the event and notify the supervising nurse as soon as CPR is underway or turned over.

ADL-Assist Skills: Safety and Dignity First

ADL-assist skills appear on every state CNA skills-check checklist because they are the core of daily care. Four skill areas appear in this lab's card deck:

Safe Transfer: Bed to Wheelchair Using a Gait Belt

1. Explain the procedure to the resident; obtain consent and cooperation.

2. Apply the gait belt snugly over clothing at the waist—you should be able to slide your flat fingers underneath.

3. Lower the bed to the lowest position; lock the wheelchair and position it at a 45-degree angle to the bed.

4. Assist the resident to a sitting position (dangle at the edge); assess for dizziness before standing.

5. Grasp the gait belt with an underhand grip on each side; do not grab clothing or place your hands under the axilla (armpits).

6. Use a wide stance and bend your knees—protect your own back.

7. Pivot and lower the resident into the wheelchair; check positioning and comfort.

Safety rationale: The gait belt distributes force safely. Axilla lifts risk brachial plexus injury. Locking wheels prevents the chair from rolling.

Partial-Bath Assist with Privacy and Dignity

• Gather all supplies before exposing the resident to prevent chilling and unnecessary exposure.
• Maintain privacy with bath blankets; expose only the area being washed.
• Test water temperature with the inside of your wrist (or a thermometer if available) before any skin contact—older adults are more susceptible to scalds.
• Wash from clean areas to dirty (face first, perineum last); use a different part of the washcloth for each wipe.
• Pat dry; inspect skin for redness, breakdown, or pressure-injury signs; document findings.

Oral Hygiene for a Cognitively Impaired Resident

• Position the resident upright or at least 30–45 degrees to reduce aspiration risk.
• Use a soft-bristled toothbrush; use only a small amount of toothpaste to minimize swallowing risk.
• Offer simple, one-step verbal cues and allow extra time; never force mouth opening.
• Suction equipment should be available if the resident has a known swallowing problem (alert the nurse).
• Document completion and any concerns (bleeding gums, refusal, pain).

Repositioning and Skin-Check Documentation

• Reposition at minimum every two hours for bed-bound residents to prevent pressure injuries.
• Use a turn sheet and ask for a second aide if needed; do not drag skin across the sheet.
• Inspect bony prominences (sacrum, heels, hips, shoulders, ears) each time you reposition.
• Use pillows or foam wedges to maintain alignment and offload pressure points.
• Document position, time, skin condition, and any new findings in the resident's record.

Narrating Your Rationale: Why You Must Talk Through Each Step

During both ADL demonstrations the instructor will score not only what you do but why you say you are doing it. This habit is not just for the lab—it protects residents, demonstrates professionalism, and reinforces your own memory under stress. For every step, briefly state the safety or dignity reason. Example: "I am locking the wheelchair wheels now to prevent any movement during the transfer, which could cause a fall."

Self-Evaluation: Building a Reflective Practice Habit

After your demonstrations, you will write a one-page self-evaluation for your portfolio. Compare your actual performance to the checklist criteria honestly—not to what you wish you had done. Identify one specific skill area for improvement and write one concrete practice strategy (for example, practicing compression rate with a metronome app, or rehearsing the gait-belt transfer sequence with a family member). Evaluators and future supervisors value professionals who can assess themselves accurately.

Lab Safety Rules

• PPE (gloves at minimum) must be worn during all hands-on skill practice.
• Report any equipment malfunction or injury to the instructor immediately.
• Treat every peer or manikin as if they were a real, vulnerable resident—dignity applies even in simulation.