AMANUEL MENTAL SPECIALIZED HOSPITAL NURSING DIRECTOR

HOSPITAL NURSING SKILL LAB PROTOCOL

PREPARED BY NURSING DIRECTOR IN COLLABRATION WITH NURSING AUDIT

TEAM

ADDIS ABABA, ETHIOPIA

December 21, 2023

Contents

Contents
CHAPTER ONE-INTRODUCTION..............................................................................................1

CHAPTER TWO- OBJECTIVES...................................................................................................2

2.1 Target Audience.....................................................................................................................3

CHAPTER THREE- EQUIPMENT AND RESOURCES..............................................................4

3.1 Anatomical Models and Charts:............................................................................................5

3.2 Reference Books and Guidelines:..........................................................................................5

CHAPTER FOUR- METHODOLOGY..........................................................................................7

CHAPTER FIVE- SAFETY GUIDELINES...................................................................................9

CHAPTER SIX- SKILL LAB PROCEDURES............................................................................11

6.1 Measuring Vital Signs.........................................................................................................11

6.1.2Measuring BP................................................................................................................11

6.1.2 Measuring Pulse Rate...................................................................................................13

6.1.3 Measuring Respiratory Rate.........................................................................................13

6.1.4 Measuring Temperature................................................................................................14

6.2 Bed Making.........................................................................................................................15

6.2.1 Making closed bed........................................................................................................15

 6.2.2 Making Open Bed.........................................................................................................16

6.3 NG tube insertion.................................................................................................................17

6.4 Urinary Catheterization.......................................................................................................20

6.4.1 Female Catheterization.................................................................................................21

6.4.2. Male Catheterization....................................................................................................22

6.4.3 Insertion of Foley Catheter...........................................................................................23

6.5 Administration of Medication and IV therapy.....................................................................24

6.5.1 Administration of Intramuscular Injections..................................................................24

6.5.2 IV Cannula Securement................................................................................................28

6.5.3 Maintaining and regulating an IV infusion...................................................................30

6.6 Oxygen Administration...................................................................................................33

6.7 Wound Care.........................................................................................................................36

6.7.1 Wound Dressing...........................................................................................................37

6.8 CPR (Cardiopulmonary Resuscitation)...............................................................................38

CHAPTER SEVEN- CONCLUSION...........................................................................................41

CHAPTER ONE-INTRODUCTION

Skill labs are simulated clinical environments where nurses and other healthcare professionals
can practice and enhance their clinical and patient care skills. Some key things to know about
nursing skill labs: Purpose is to provide a safe space for hands-on training. Skills can be
practiced without risk to actual patients. Commonly set up to mimic real-world patient
rooms/settings with equipment and supplies. May include hospital beds, mannequins, models,
etc. Nurses work through competency checklists to demonstrate techniques like medication
administration, wound care, assessments, and procedures.

St. Amanuel Mental Specialized Hospital is committed to providing the highest quality nursing
care to our patients. Developing and enhancing the clinical skills of our nursing staff is crucial to
achieving this goal. The purpose of this Nurses Skill Lab Protocol is to standardized best
practices for skills training and competency assessment at St. Amanuel Mental Specialized
Hospital. Following these protocols will help ensure our nurses are equipped with current
knowledge and demonstrate proficiency in key nursing techniques.

Skills labs provide a safe learning environment for nurses to practice techniques, receive
feedback, and improve their abilities. These simulated settings allow repetition without risks to
actual patients. Competency-based assessments help verify that nurses can perform skills
correctly and according to evidence-based standards.

Following this protocol will help advance our commitment to high-quality, safe and therapeutic
nursing care. Together, through skills training and practice, we can continue to meet the complex
needs of our patients with excellence

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CHAPTER TWO- OBJECTIVES

 Update Knowledge and Skills: The clinical skill laboratory aims to provide healthcare
professionals with opportunities to update their knowledge and skills in specific clinical
areas. The objective is to ensure that professionals stay abreast of the latest
advancements, evidence-based practices, and guidelines relevant to their specialty.
 Enhance Proficiency in New Procedures or Technologies: The skill lab focuses on
introducing and training healthcare professionals in new procedures, techniques, or
technologies relevant to their practice. The objective is to improve their proficiency and
confidence in adopting and utilizing innovative approaches that can enhance patient care
outcomes.
 Reinforce Core Clinical Competencies: The skill lab provides a platform for practicing
and reinforcing core clinical competencies linked to the healthcare professionals' scope of
practice. The objective is to maintain and enhance their foundational skills, ensuring a
high standard of care delivery.
 Address Identified Learning Needs: The clinical skill laboratory can be used to address
specific learning needs identified through self-assessment, performance evaluations, or
feedback processes. The objective is to provide targeted training and practice
opportunities to overcome identified gaps in knowledge or skill proficiency.
 Promote Evidence-Based Practice: The skill lab aims to promote the application of
evidence-based practice principles by offering training and hands-on practice in
implementing best practices and clinical guidelines. The objective is to equip healthcare
professionals with the necessary skills to integrate research evidence into their decision-
making and patient care processes.
 Improve Patient Safety: The clinical skill laboratory focuses on training healthcare
professionals in high-risk procedures or situations to enhance patient safety. The
objective is to simulate and address potential risks, errors, or adverse events, allowing
professionals to develop strategies for prevention, mitigation, and effective response.
 Foster Interprofessional Collaboration: The skill lab can facilitate Interprofessional
training and collaboration, bringing together healthcare professionals from different

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 disciplines to enhance teamwork and communication. The objective is to promote a
collaborative approach to patient care, improving coordination, and patient outcomes.
 Enhance Communication and Patient-Centered Care Skills: The clinical skill laboratory
aims to improve healthcare professionals' communication skills and their ability to
provide patient-centered care. The objective is to train professionals in effective
communication techniques, empathy, shared decision-making, and cultural sensitivity,
ultimately enhancing patient satisfaction and engagement.
 Promote Reflective Practice and Self-Assessment: The skill lab encourages healthcare
professionals to engage in reflective practice and self-assessment of their performance.
The objective is to develop self-awareness, identify areas for improvement, and engage in
lifelong learning and professional development.
 Facilitate Peer Learning and Collaboration: The clinical skill laboratory creates an
environment that fosters peer learning and collaboration. The objective is to encourage
professionals to share knowledge, experiences, and best practices, promoting a culture of
continuous learning and improvement within the healthcare team.

2.1 Target Audience

It's important to note that the target audience for clinical skill laboratories may vary depending
on the specific goals and focus of the program. Clinical skill laboratories for nurses typically
target practicing nurses who are looking to enhance their clinical skills and stay updated with the
latest advancements in nursing practice. This can include nurses from various settings such as
hospitals, clinics, long-term care facilities, and community health centers. In this case this skill
lab protocol is devised for those Registered Nurses working at St. Amanuel Mental Specialized
Hospital.

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CHAPTER THREE- EQUIPMENT AND RESOURCES

The necessary medical equipment for a skill lab in a hospital may vary depending on the specific
skills and procedures being taught. However, here is a list of commonly used medical equipment
that you might consider including in your skill lab:

Basic Equipment: Diagnostic Equipment: Surgical Instruments: Intravenous (IV) and

Injection Equipment:
 Examination  Stethoscope  Scalpels
table or bed  Blood pressure cuff  Forceps  IV Cannula
 Patient chairs and  Scissors  IV infusion sets
 Step stools sphygmomanometer (e.g., and tubing
 Thermometer surgical  Syringes of
 Otoscope and scissors, various sizes
ophthalmoscope bandage  Needles (e.g.,
 Reflex hammer scissors) hypodermic
 Tuning forks  Retractors needles,
 Tape measure  Needle butterfly
holders needles)
 Suturing  IV fluid bags
materials and solutions
(e.g.,  Intramuscular
sutures, (IM) and
needles) subcutaneous
 Airway (SC) injection
Management supplies
Equipment:

Monitoring Equipment: Simulation and Training Aids: Personal Protective

Equipment (PPE):
 Pulse oximeter Manikins (adult, pediatric, or
 Non-invasive infant) for various procedures  Gloves
blood pressure (e.g., CPR, intubation, central (latex,
(NIBP) monitor line placement) nitrile, or
 Glucometer for vinyl)
blood glucose  Masks
measurement (surgical
masks, N95
respirators)
 Gowns or
aprons

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  Protective
eyewear

3.1 Anatomical Models and Charts:

Anatomical models: These three-dimensional models help learners understand human anatomy
and practice various techniques on realistic representations of body parts or systems. Anatomical
charts and posters: These visual aids display detailed anatomical diagrams, allowing learners to
study and reference specific structures or systems

3.2 Reference Books and Guidelines:

Medical textbooks: Include a collection of relevant textbooks covering various medical

specialties, procedures, and clinical guidelines.

Clinical practice guidelines: Provide copies of evidence-based guidelines published by reputable

medical organizations to guide learners in delivering optimal patient care.

I. Introduction to Skill Lab Training (1 session)

 Overview of the skill lab and its purpose

 Introduction to key skills and competencies to be developed
 Explanation of the training methodology and evaluation process

II. Basic Patient Care Skills (Multiple sessions)

A. Hand Hygiene and Infection Control

 Importance of hand hygiene in healthcare settings
 Proper handwashing and hand sanitization techniques
 Infection control protocols and practices

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 B. Vital Signs Measurement

 Measurement of blood pressure, pulse rate, respiratory rate, and temperature

 Use of relevant equipment such as blood pressure cuffs, stethoscopes, and thermometers
 Interpretation and documentation of vital signs

C. Patient Positioning and Transfers

 Principles of proper patient positioning for comfort and safety

 Techniques for transferring patients from one surface to another
 Considerations for different patient populations and specific conditions

D. Wound Care and Dressing Changes

 Basic wound assessment and classification

 Techniques for wound cleaning, dressing application, and removal
 Infection control measures and prevention of cross-contamination

E. Administration of Medications

 Safe administration routes (e.g., oral, subcutaneous, intramuscular)

 Preparation, dosage calculation, and accurate medication administration
 Monitoring and documentation of medication effects and adverse reactions

III. Specialized Procedures (Multiple sessions)

A. Urinary Catheterization

 Indications and contraindications for urinary catheterization

 Procedure for inserting and managing urinary catheters
 Catheter care and troubleshooting common issues

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B. Intravenous (IV) Cannulation and Fluid Administration

 Anatomy and physiology of veins for cannulation

 Techniques for IV site selection, insertion, and securement
 Administration of fluids and monitoring for potential complications

C. Basic Life Support (BLS) and Cardiopulmonary Resuscitation (CPR)

 Recognition and response to cardiac arrest and respiratory emergencies

 Chest compressions, rescue breaths, and proper use of automated external defibrillators
(AEDs)
 Team dynamics and communication during resuscitation efforts

IV. Advanced Procedures (Optional, depending on the skill level and specialization of
participants. Examples may include advanced airway management; wound suturing, intravenous
medication administration, etc.

These sessions can be tailored to the specific needs and goals of the participants' roles or
departments.

V. Ongoing Practice and Skill Maintenance

 Encouragement and guidance for regular practice and skill review

 Opportunities for continued learning and professional development
 Periodic evaluation and re-assessment of skills to ensure competence

CHAPTER FOUR- METHODOLOGY

 Demonstration: Begin by demonstrating the skill or procedure to the participants. Show each
step clearly and explain the rationale behind it. Use visual aids, such as diagrams, models, or
videos, to enhance understanding.
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 Explanation: Provide a detailed explanation of the skill, including its purpose, indications,
contraindications, potential complications, and relevant anatomy and physiology. Encourage
participants to ask questions and clarify any doubts they may have.
 Hands-on Practice: Allow participants to practice the skill under supervision. Provide
guidance and constructive feedback as they perform the procedure. Start with simpler tasks
and gradually progress to more complex ones as participants gain proficiency.
 Simulations and Case Studies: Incorporate simulated scenarios or case studies to enhance
learning. Present participants with realistic patient scenarios and guide them through the
decision-making process, emphasizing the appropriate application of skills and critical
thinking.
 Peer Learning: Encourage participants to learn from each other by fostering a collaborative
environment. Pair participants up for practice sessions, allowing them to observe and learn
from their peers. Peer feedback and discussion can enhance understanding and retention of
the skills.
 Reflection and Debriefing: After each practice session, allocate time for reflection and
debriefing. Encourage participants to share their experiences, challenges, and lessons learned.
Facilitate discussions to reinforce key concepts and address any misconceptions.
 Repeated Practice: Emphasize the importance of repeated practice to develop and maintain
proficiency. Provide opportunities for participants to revisit skills through regular skill lab
sessions or self-directed practice. Offer resources, such as skill checklists or online modules,
to support ongoing skill development.
 Integration with Clinical Context: Connect the skills learned in the lab to their practical
application in the clinical setting. Discuss real-life scenarios, patient populations, and clinical
considerations that require the use of the skills taught. Encourage participants to reflect on
how the skills can positively impact patient care.
 Multimodal Learning: Utilize a variety of teaching methods to accommodate different
learning styles. Incorporate visual aids, hands-on practice, discussions, videos, interactive
modules, and case-based learning to engage participants and cater to diverse learning
preferences.

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 Assessment and Feedback: Regularly assess participants' progress and provide constructive
feedback. Use formative assessments, such as quizzes, skill checklists, or simulated
scenarios, to evaluate knowledge and skill acquisition. Offer individualized feedback to
identify areas for improvement and guide further learning.

CHAPTER FIVE- SAFETY GUIDELINES

Safety guidelines are crucial in hospital skill laboratories to ensure the well-being of participants,
prevent accidents, and maintain a safe learning environment. Here are some key safety
guidelines for a hospital skill laboratory:

1. Personal Protective Equipment (PPE): Require all participants and instructors to wear
appropriate PPE, such as gloves, lab coats, masks, goggles, or face shields, depending on
the nature of the activities and procedures being performed. Emphasize the importance of
PPE compliance to minimize the risk of exposure to hazardous materials or bodily fluids.
2. Hazardous Material Management: Safely handle and dispose of hazardous materials, such
as chemicals, sharps, or biohazardous waste, in accordance with hospital protocols and
regulatory guidelines. Provide clear instructions on the proper storage, handling, and
disposal of hazardous materials within the skill laboratory.
3. Emergency Preparedness: Establish emergency protocols and procedures in case of
accidents, injuries, or other emergencies. Clearly communicate the emergency exits,
evacuation routes, and location of emergency equipment, including fire extinguishers,
first aid kits, and emergency showers/eyewash stations. Conduct regular drills to
familiarize participants with emergency procedures.
4. Equipment Safety: Regularly inspect and maintain all equipment used in the skill
laboratory to ensure they are in good working condition. Provide training on the proper
use and handling of equipment, including electrical devices, simulation mannequins, or
surgical instruments. Clearly label equipment and machinery with safety instructions and
precautions

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5. Fire Safety: Implement fire safety measures within the skill laboratory. Ensure that fire
extinguishers are easily accessible, regularly inspected, and properly maintained. Enforce
a strict "no smoking" policy and prohibit open flames or flammable materials in the
laboratory. Educate participants on fire prevention and evacuation procedures.

6. Electrical Safety: Ensure that electrical outlets, cords, and equipment are in good
condition and comply with electrical safety standards. Avoid overloading electrical
circuits and use surge protectors when necessary. Instruct participants on safe practices
for plugging and unplugging equipment and using electrical devices.

7. Ergonomics: Promote proper ergonomics to minimize the risk of musculoskeletal

injuries. Provide ergonomic guidelines for participants to follow when performing
procedures or handling patients. Encourage the use of adjustable workstations, supportive
chairs, and proper body mechanics during skill practice.

8. Infection Control: Emphasize the importance of infection control practices within the
skill laboratory. Encourage frequent hand hygiene, proper glove usage, and adherence to
standard precautions. Provide access to hand hygiene stations, hand sanitizers, and
appropriate waste disposal containers.

9. Adequate Ventilation: Ensure proper ventilation within the skill laboratory to maintain air
quality and prevent the accumulation of hazardous fumes or substances. Regularly
inspect and maintain ventilation systems, such as exhaust fans or air filters, to ensure
their proper functioning.

10. Safety Training and Orientation: Prior to participating in skill lab activities, provide
participants with comprehensive safety training and orientation. Cover safety protocols,
emergency procedures, PPE usage, and any specific risks or hazards associated with the
skill lab activities. Regularly update participants on safety guidelines and protocols.

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 11. Documentation and Reporting: Establish a system for documenting incidents, near
misses, or safety concerns that occur within the skill laboratory. Encourage participants
and instructors to report any safety issues promptly. Use these reports to identify areas for
improvement and implement corrective actions.

It's essential to regularly review and update safety guidelines based on emerging best practices,
regulatory requirements, and feedback from participants and staff. Foster a culture of safety and
encourage active participation from all individuals involved in the skill laboratory to maintain a
safe learning environment.

CHAPTER SIX- SKILL LAB PROCEDURES

6.1 Measuring Vital Signs

Objective:

By the end of this lesson, learners will be able to accurately measure and document vital signs,
including temperature, pulse, respiratory rate, and blood pressure, using proper technique and
equipment.

Duration: 60 minutes

Procedure:

Introduction (5 minutes)

 Greet the learners and provide an overview of the lesson.

 Explain the importance of measuring vital signs in assessing a patient's health status and
detecting changes.
 Discuss the significance of accurate measurement and the role of vital signs in clinical
decision-making.

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6.1.2Measuring BP

Equipment

- Blood pressure apparatus (sphygmomanometer)

- Stethoscope
- Vital sign sheet
- Pen or pencil

Steps 5 4 3 2 1 0
1. Gather equipment. Be sure the cuff is an appropriate size for the patient.
2. Wash your hand
3. Explain procedure to patient
4. Place patient in a relaxed reclining or sitting position with arm at heart level.
Expose upper part of patient’s arm
5. Wrap cuff snugly and smoothly around the upper part of the arm (above 1
inch above antecubital space) with the center of the bladder over the brachial
artery.

6. Palpate brachial artery with fingertips.

7. Place bell of stethoscope on the medial antecubital fossa when brachial artery
is felt.
8. Place stethoscope earpieces in car.
9. Close valve on manometer pump.
10. Inflate cuff 30mm Hg above level at which positions are no longer heard.
11. To avoid distortion, read pressure with mercury at eye level with
mercury.
12. Gradually deflate cuff by opening valve on pump (2 mm Hg per second)
until the first korot koff’s [lubb] sound is heard. This is the systolic pressure or
phase..

13. Continue to deflate cuff (sounds will change in quality), continue to

release pressure gradually, 2-3 mm Hg per second. Do not re pump with out
letting cuff totally deflate.

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 14. Note when korot koff’s sound begins to get muffled and when it
disappears completely [dub sound is heard].
15. Do not leave the cuff inflated for a prolonged period since this produces
patient discomfort.
16. Completely deflate cuff before rechecking the blood pressure.
17. Remove cuff from patient’s arm.
18. Check to see that patient is comfortable.
19. Compare blood pressure reading with previous recordings.
20. Wash your hands.
21. Record the blood pressure

6.1.2 Measuring Pulse Rate

Equipment

 Wrist watch , Vital sign flow sheet and pen, Stethoscope, Tray

Steps 5 4 3 2 1 0
 For radial
1. Place the patient in a comfortable position lying or sated with the arm
resting across the chest.
2. Place two or three fingers over the radial artery and count the pulse for
one minute (may be counted for half a minute multiply by two except for
cardiac patient).
3. If the pulse is irregular, it should be count for the full minute
4. Observe the rate, rhythm and volume of the pulse while counting the pulse
and report any unusual findings.
5. Chart the rate, time and character of pulse.
 Apical – Radial pulse
Apical radial pulse- is the counting of the pulse at the radial artery and apex of the
heart simultaneously.
- The apical pulse is counted by placing the stethoscope over the chest on the
apex of the heart and listening for the heart sounds
- The different in the apical and radial pulse is termed as Pulse Deficit.
- Counting the apical – radial pulse gives the correct pulse rate.
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6.1.3 Measuring Respiratory Rate

Equipment
Wrist watch, Vital sign chart, Pen/ Pencil

Steps 5 4 3 2 1 0
1.Respirations are counted while taking the pulse
2.After counting the pulse have fingers on the wrist and count the respiration by
watching the rise and fall of the chest of abdomen. The patient should not be
aware that you are counting his respiration as he might control his breathings.
3. Count respirations for half a minute and multiply by two

4. Observe rate and depth of respiration and report any abnormal symptom.

5. Chart the rate, time, and observations.

6.1.4 Measuring Temperature

Equipment
 Thermometer: glass (client’s bedside); electronic and disposable protective sheath;
disposable (chemical); tympanic
 Lubricant (rectal, glass thermometer)
 Two pairs of no sterile gloves
 Tissues
Method 1: Oral Temperature Measurement

 Explain the indications and proper technique for oral temperature measurement.
 Instruct the nurses to wash their hands or use hand sanitizer and put on gloves.
 Demonstrate the correct placement of the thermometer under the tongue, ensuring it is in
contact with the sublingual pocket.
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  Explain the necessity of instructing the patient to keep their mouth closed during

Method 2Axillary Temperature Measurement

 Explain the indications and proper technique for axillary temperature measurement.
 Instruct the nurses to wash their hands or use hand sanitizer and put on gloves.
 Demonstrate the correct placement of the thermometer in the axilla, ensuring good skin
contact.

Method 3: Tympanic Temperature Measurement

 Explain the indications and proper technique for tympanic temperature measurement.
 Instruct the student to wash their hands or use hand sanitizer and put on gloves.
 Demonstrate the correct placement of the thermometer in the ear canal, ensuring a proper
seal.

6.2 Bed Making

6.2.1 Making closed bed

Equipment

 Linens, Bed spread, blanket, Trolley

 Bed, pillow
 Draw sheet, pillow case
 Rubber sheet

Steps 5 4 3 2 1 0
1. Wash your hands

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2. Assemble the necessary equipment and carry to bedside

3. Place chair at the foot of the bed

4. Arrange the linen on chair in the order that it will be used

5. Turn mattress and arrange on the bed.

6. Put on mattress cover if available

7. Place bottom sheet with right side up, center of sheet on center of bed and
wide hem at the head of the bed.
8. Tuck sheet under mattress at head of bed and miter the corner.
9. Remain on one side of bed until you have completed making the bed on that
side.
10. Tuck sheet on the sides and foot of bed mitering the corners.

11. Tuck sheets smoothly under the mattress. There should be no wrinkles.

12. Place rubber draw sheet in the center of the bed and tuck tightly.

13. Place cotton draw sheet on top of rubber draw sheet and tuck, Rubber draw sheet
should be covered completely.

14. Place top sheet with wrong side up, centerfold sheet at center of bed and wide hem
at foot of bed. Top edge of sheet should be even with top edge of mattress

15. Tuck sheet at foot of bed and mitering the corner.

16. Place blanket 2.5 cm below the edge of top sheet with center of blanket on center of
bed and tuck at the foot of bed and miter corner. Fold top sheet over blanket.

17.Put pillow cases on pillows and place at head of bed.

18. Place bed spread with right side up with top edge even with head of mattress. Tuck
at the foot of bed, miter corners and cover top bedding.

19. Go to other side of bed fanfold the top covers at the center of bed and tuck in
bottom sheet and draw sheet mitering corners, smoothing out all wrinkles, continue
with blanket and spread the same with the opposite side.

20. See that bed is neat and smooth

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 21.Leave bed in place and furniture in order

22. Place call light with in clients reach

23 Wash your hands

6.2.2 Making Open Bed

EQUIPMENT: Linens, Chair, Blanket Bed Spread, Bed, Trolley, Draw Sheet, Pillow, Rubber
Sheet, Pillowcase

Steps 5 4 3 2 1 0
1. Wash your hands

2. Assemble the necessary equipment and carry to bedside

3. Place chair at the foot of the bed

4. Arrange the linen on chair in the order that it will be used

5. Turn mattress and arrange on the bed.

6. Put on mattress cover if available

7. Place bottom sheet with right side up, center of sheet on center of bed and
wide hem at the head of the bed.
8. Tuck sheet under mattress at head of bed and miter the corner.

9. Remain on one side of bed until you have completed making the bed on that
side.

10. Tuck sheet on the sides and foot of bed mitering the corners.

11. Tuck sheets smoothly under the mattress. There should be no wrinkles.

12. Place rubber draw sheet in the center of the bed and tuck tightly.

13. Place cotton draw sheet on top of rubber draw sheet and tuck Rubber draw
sheet should be covered completely.

14. Place top sheet with wrong side up, center fold sheet at center of bed and wide
hem at foot of bed. Top edge of sheet should be even with top edge of mattress.

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 15. Tuck sheet at foot of bed mitering the corner.

16. Place blankets 2.5 cm below the edge of top sheet, with center of blanket on
center of bed and tuck at the foot of bed and miter corner. Fold top sheet over
blanket.

17. Place pillow at head of bed

18. Go to other side of bed fanfold the top covers at the center of bed and tuck in
bottom sheet and draw sheet mitering corners, smoothing out all wrinkles, continue
with blanket and spread the same with the opposite side.

19 Fanfold top bedding (top sheet, blanket, and bed spread down to the middle or
foot of the bed).

6.3 NG tube insertion

 Nasogastric Tube Insertion Procedure

 Objective: By the end of this lesson, learners will be able to demonstrate proficiency in
inserting a nasogastric tube using proper technique and infection control measures

Materials

Nasogastric tube Gloves

Water-soluble lubricating jelly Personal protective equipment (PPE)

Syringe (to inflate the balloon, if applicable) Hand hygiene supplies

Tape or securement device Cup of water or saline solution for irrigation

Towel or disposable pad

Duration: 60 minutes

Procedure:

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1. Introduction (5 minutes)
 Greet the learners and provide an overview of the lesson.
 Explain the purpose of nasogastric tube insertion and its role in patient care.
 Discuss the importance of proper technique and infection control measures during the
procedure.
2. Preparing for Nasogastric Tube Insertion (10 minutes)
 Explain the indications and contraindications for nasogastric tube insertion.
 Discuss the necessary steps for preparing the patient and the environment before the
procedure.
 Demonstrate proper hand hygiene techniques and the use of personal protective
equipment (PPE).
 Ensure that all necessary materials and equipment are readily available.
3. Nasogastric Tube Insertion Technique (30 minutes)
 Explain the anatomy and physiology of the nose, pharynx, and esophagus.
 Demonstrate the step-by-step procedure for nasogastric tube insertion, including:

a. Explaining the procedure to the patient and obtaining informed consent.

b. Preparing the nasogastric tube by measuring the appropriate length (typically from the nose to
the earlobe to the xiphoid process).

c. Lubricating the distal end of the nasogastric tube with water-soluble lubricating jelly.

d. Having the patient assume a semi-Fowler's position and tilt their head slightly backward.

e. Inserting the tube gently through the selected nostril, directing it posteriorly and slightly
downward.

f. Instructing the patient to swallow as the tube reaches the oropharynx.

g. Advancing the tube steadily while the patient continues to swallow, aiming for the desired
length.

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h. Confirming the proper placement of the nasogastric tube by:

i. Aspirating gastric contents using a syringe.

ii. Checking the pH and visual characteristics of the aspirate (pH <5 and visual characteristics of
stomach contents).

iii. Confirming placement by an X-ray (if necessary and as per institutional policy).

i. Securing the tube in place using tape or a securement device.

j. Verifying the patient's comfort and providing appropriate care and instructions.

 Emphasize the importance of maintaining aseptic technique throughout the procedure.

 Address potential complications and strategies for their prevention.
4. Hands-On Practice (10 minutes)
 Divide the learners into pairs or small groups.
 Provide each group with a nasogastric tube, lubricating jelly, and a simulation model or
mannequin.
 Allow learners to practice the nasogastric tube insertion technique under supervision.
 Provide feedback and guidance as needed.
 Encourage learners to ask questions and address any concerns they may have.
5. Debriefing and Discussion (5 minutes)
 Facilitate a group discussion to address any questions, concerns, or challenges
encountered during the practice session.
 Review key points and emphasize the importance of patient comfort, privacy, and dignity
during the procedure.
 Discuss potential complications and strategies for their prevention.
6. Summary and Conclusion (5 minutes)

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Summarize the main points covered in the lesson. Reinforce the importance of following proper
technique and infection control measures during nasogastric tube insertion. Encourage learners to
continue practicing and seeking opportunities for further skill development.

6.4 Urinary Catheterization

Objective:

 By the end of this lesson, learners will be able to demonstrate proficiency in performing
urinary catheterization under supervision, following proper technique and infection

Equipments

 Sterile gloves:  Sterile collection bag

 Sterile drape:  Sterile cotton balls or gauze
 Sterile urinary catheter:  Sterile specimen container:
 Lubricating jelly Sterile syringe:
 Antiseptic solution:

Procedure:

1. Introduction (5 minutes)
 Greet the learners and provide an overview of the lesson.
 Explain the importance of urinary catheterization in patient care and the need for proper
technique and infection control measures.
 Discuss the potential risks and complications associated with urinary catheterization.
2. Preparing for Urinary Catheterization (10 minutes)
 Explain the necessary steps for preparing the patient and the environment before the
procedure.
 Demonstrate proper hand hygiene techniques and the use of personal protective
equipment (PPE).
 Discuss the importance of obtaining informed consent from the patient.
3. Demonstrating Catheterization Technique (15 minutes)
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6.4.1 Female Catheterization

List of Steps 5 4 3 2 1 0
1. Prepare the trolley and take to patient‘s bedside. Explain the procedure to the patient
for her cooperation and reassurance.

2. The bed is screened.

3. Turn top bed linen upwards from the bottom to the patient‘s chest to protect her from
complete exposure.

4. Place patient in dorsal position with knees flexed and thighs apart, then put mackintosh
is covered.

5. Wash your hands thoroughly under running water.

6. Place the sterile towel in between her thighs under the buttocks and make sure the
Mackintosh under her buttocks.

7. Put receiver for urine near the vulva.

8. Put on gloves and clean the vulva by swabbing with the anti- septic lotion using your
forceps. Discard the forceps in the receiver for dirty instruments. When cleaning the
vulva, always clean using up to down motion and discard swab after one use.

9. Separate the vulva with two pieces of gauze.

10. Carefully pick up your catheter and introduce it right into the urethral orifice.
11. A little pressure on the bladder above the symphysis pubis could be useful to ensure
complete emptiness of the bladder.

12. If laboratory test is prescribed, collect some amount of urine in the sterile specimen
bottle straight from the catheter.

13. Discard the catheter under the trolley, measure the amount of urine by pouring the
urine in the measure jug. Swab the vulva and perineum dry with cotton wool. Remove
mackintosh and towel under the patient‘s buttocks.

14. Make patient comfortable by covering her up properly.

15. Take trolley away from the bedside and finally remove the screen.
16. Take care of the equipment and send the specimen to the laboratory.

6.4.2. Male Catheterization

The procedure is same as in a female patient

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 List of Steps 5 4 3 2 1 0
1. Clean the genital organ with antiseptic lotion
2. Hold the penis at an angle of 90% or in upright position, then insert the
catheter bringing the penis to angle of 60% or slightly bent until urine flows and
the foreskin retracted (16-18cm).

6.4.3 Insertion of Foley Catheter

List of Steps 5 4 3 2 1 0

1. Same as in catheterization, using folly catheter

2. Test the balloon of the catheter by filling it with sterile water using syringe and
needle before insertion.

3. When the catheter is inserted. Fill the syringe with proper amount of sterile
water and inflate the balloon slowly

4. Tie the opening of the catheter leading to the balloon tightly so that there is no
leakage. remove the syringe

5. Pull gently on the end of the catheter to be sure it will not leave the bladder.
6. Attach the drainage tube to the end of the catheter and place the other end in
the drainage bottle.

7. Tip the drainage tube loosely to the side of the using plaster to position it.
N.B.

 Make sure the catheter is in the bladder before inflating the balloon. If
there is pain when inflating the balloon, then push the catheter further
into the bladder.
 Use a long drainage tube, so that patient can move freely without
pulling the bottle.
 Inspect the opening of the tube-leading balloon so that there is no
leakage as this might pull the catheter out of place of position.

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  4. The end of the drainage tube should not be submerged in the urine
in the drainage bottle.

Emphasize the importance of maintaining aseptic technique throughout the procedure.

Hands-On Practice (25 minutes)

 Divide the learners into pairs or small groups.

 Provide each group with a catheterization kit, sterile supplies, and a simulation model or
mannequin.
 Allow learners to practice the catheterization technique under supervision.
 Provide feedback and guidance as needed.
 Encourage learners to ask questions and address any concerns they may have.

Debriefing and Discussion (5 minutes)

 Facilitate a group discussion to address any questions, concerns, or challenges

encountered during the practice session.
 Review key points and emphasize the importance of patient comfort, privacy, and dignity
during the procedure.
 Discuss potential complications and strategies for their prevention.

Summary and Conclusion (5 minutes)

 Summarize the main points covered in the lesson.

 Reinforce the importance of following proper technique and infection control measures
during urinary catheterization.
 Encourage learners to continue practicing and seeking opportunities for further skill
development.

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6.5 Administration of Medication and IV therapy

6.5.1 Administration of Intramuscular Injections

Objective: At the end of this lesson, nurses will be able to demonstrate the knowledge and skills
required to safely and effectively administer an intramuscular injection.

Duration: Approximately 60 minutes

Equipments

 Intramuscular injection supplies (syringes,  Medication vials (or pictures/labels for

needles, alcohol swabs, cotton balls or gauze demonstration purposes)
pads, sharps container)  Bandages or sterile adhesive strips

1. Introduction (5 minutes)
 Welcome the participants and introduce the topic of intramuscular injection
administration.
 Explain the importance of proper injection technique and the role of nurses in
administering medications via the intramuscular route.
2. Preparing for an Intramuscular Injection (10 minutes)
 Discuss the selection and preparation of the appropriate medication, including dosage,
expiration date, and any necessary dilution.
 Demonstrate how to draw up medication into a syringe, ensuring accurate measurement
and proper aseptic technique.
 Describe the different types of syringes and needles commonly used for intramuscular
injections and their appropriate selection

PROCEDURE 5 4 3 2 1 0
1. Prepares and administers medications according to “Medication Guidelines: Steps to
Follow for All Medications.”

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2. Selects appropriate syringe and needle, considering volume and type of medication,
and client’s muscle mass.
 Usual syringe size is 1–3 mL.
 Usual needle is 19–23 gauge, 1.5 inch in length.
3. Selects a preferred site for injection and locates site correctly.
4. If client has received other injections, rotates sites.
5. Position client, so the injection site is accessible and the client is able to relax the
appropriate muscles.
a. Deltoid site: Positions client with arm relaxed at side or resting on firm
surface and completely expose upper arm.
b. Ventrogluteal site: Position client on side with upper hip and knee slightly
flexed.
c. Vastuslateralis: Position client supine or sitting.
d. Rectus femoris (because this site often causes more discomfort than others,
use only if all other sites inaccessible and no other route feasible): Positions
client supine.
e. Dorsogluteal (because the sciatic nerve and major blood vessels are located
near this site, use only if all other sites, including the rectus femoris, are
inaccessible and no other route feasible): Positions client prone with toes
pointing inward. Does not attempt to locate this site with the client side-lying or
standing.
6. Cleanses injection site with alcohol prep pad (or other antiseptic swab) by circling
from the center of the site outward. Places alcohol wipe on client’s skin outside the
injection site, with a corner pointing to the site.
7. Allows the site to dry before administering the injection.
8. Dons procedure gloves.
9. Removes the needle cap.
Traditional Intramuscular Method

10. With non-dominant hand, holds the skin taut by spreading the skin between the thumb
and index finger.

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11. Holding the syringe between thumb and fingers of the dominant hand like a pencil or
dart, inserts the needle at a 90° angle to the skin surface.
12. Inserts needle fully.
13. Stabilizes syringe and aspirates by pulling back on the plunger and waiting for 5 to 10
seconds. If there is a blood return, removes the needle, discards, and prepares the
medication again.
14. Still stabilizing syringe, uses thumb or index finger of dominant hand, presses plunger
slowly to inject the medication (5 to 10 seconds per mL).
15. Removes the needle smoothly along the line of insertion.
16. Engages safety needle device, and disposes in biohazard container. If there is no
safety device, places uncapped syringe and needle directly in biohazard puncture-proof
container.
17. Gently massages site with a gauze pad and applies Band-Aid as needed.
Z-Track Administration

18. Follows Steps 1 through 9, above.

19. With the side of the non-dominant hand displaces the skin away from the
injection site, about 2.5 to 3.5cm (1 to 1.5 inches).
20. Holding the syringe between thumb and fingers of the dominant hand like a
pencil or dart, inserts the needle at a 90° angle to the skin surface.
21. Stabilizes the syringe with thumb and forefinger of non-dominant hand.
Does not release the skin to stabilize the syringe.
22. Aspirates by pulling back slightly on the plunger for 5 to 10 seconds. If a
blood return is obtained, removes the needle, discards, and prepares the
medication again.
23. Using thumb or index finger of dominant hand, presses plunger slowly to
inject the medication (5 to 10 seconds per mL).
24. Waits for 10 seconds, then removes the needle smoothly along the line of
insertion; then immediately releases the skin.
25. Engages safety needle device, and disposes in biohazard container. If there
is no safety device, places uncapped syringe and needle directly in biohazard
puncture-proof container.

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 26. Does not massage the injection site.

6.5.2 IV Cannula Securement

Objective:

 By the end of this lesson, learners will be able to demonstrate proficiency in securing an
IV Cannula using proper technique and infection control measures.
 Duration: 30 minutes

Equipments
IV Cannula Alcohol swabs or disinfectant wipes

Transparent dressing or securement device Gloves

Sterile gauze or transparent film dressing Hand hygiene supplies

Adhesive tape Personal protective equipment (PPE)

Procedure:

Introduction (5 minutes)

 Greet the learners and provide an overview of the lesson.

 Explain the importance of secure IV Cannula placement and proper technique in
patient care.
 Discuss the potential risks and complications associated with IV Cannula
dislodgement.

Preparing for IV Cannula Securement (5 minutes)

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  Explain the necessary steps for preparing the patient and the environment before
securing an IV Cannula.
 Demonstrate proper hand hygiene techniques and the use of personal protective
equipment (PPE).
 Discuss the importance of assessing the IV site for signs of inflammation, infection,
or other complications.

IV Cannula Securement Technique (15 minutes)

 Explain the steps for securing an IV Cannula using proper technique:

a. Cleanse the area around the IV site with an alcohol swab or disinfectant wipe.

b. Allow the area to dry completely.

c. Place sterile gauze or transparent film dressing over the IV site to absorb any exudate or
drainage.

d. Apply a transparent dressing or securement device over the IV site, ensuring it covers the
Cannula insertion site and surrounding area.

e. Smooth out any wrinkles or air bubbles in the dressing to ensure secure adhesion.

f. Use adhesive tape to secure the tubing to the patient's skin, preventing accidental
dislodgement.

g. Ensure the IV Cannula remains patent and properly connected to the IV tubing.

Hands-On Practice (5 minutes)

 Divide the learners into pairs or small groups.

 Provide each group with an IV Cannula, securement supplies, and a simulation arm or
mannequin.
 Allow learners to practice the IV Cannula securement technique under supervision.
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  Provide feedback and guidance as needed.
 Encourage learners to ask questions and address any concerns they may have.
o Debriefing and Discussion (5 minutes)
 Facilitate a group discussion to address any questions, concerns, or challenges
encountered during the practice session.
 Review key points and emphasize the importance of secure IV Cannula placement and
ongoing assessment.
 Discuss potential complications and strategies for their prevention.

Summary and Conclusion (5 minutes)

 Summarize the main points covered in the lesson.

 Reinforce the importance of following proper technique and infection control measures
during IV Cannula securement.
 Encourage learners to continue practicing and seeking opportunities for further skill
development.

6.5.3 Maintaining and regulating an IV infusion

IV Infusion Maintenance and Regulation Lesson Plan for Nurses

Objective: By the end of this lesson, nurses will be able to:

 Understand the principles of maintaining and regulating an IV infusion.

 Demonstrate proper techniques for maintaining sterility during the process.
 Calculate and regulate the infusion rate accurately.
 Identify and respond to potential complications during IV infusion.
 Document and communicate relevant information related to IV infusion.

Equipments

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  IV infusion setup (including IV tubing,  Calculators
infusion pump if available, IV pole)  Handouts or reference materials on IV
 IV catheters and dressings infusion maintenance and regulation
 Sterile gloves  Alcohol swabs

Duration: 1 hour

Part 1: Principles of IV Infusion Maintenance (10 minutes):

 Discuss the principles of maintaining sterility during IV infusion, including hand

hygiene, aseptic technique, and proper site preparation.
 Explain the importance of assessing the patient for appropriate vein selection and
considering factors such as vein size, condition, and patient comfort.
 Emphasize the need for regular monitoring of the infusion site and patient for signs of
complications.

Part 2: Calculating and Regulating the Infusion Rate (20 minutes):

 Review the different methods of calculating the infusion rate, including calculating the
drip rate based on the prescribed infusion rate and the drop factor of the IV tubing.
 Demonstrate the calculation process step-by-step, using examples and practice exercises.
 Explain how to regulate the infusion rate manually using a roller clamp or electronically
using an infusion pump.
 Provide hands-on practice for participants to calculate and regulate different infusion
rates using IV infusion setups.

Part 3: Recognizing and Responding to Complications (15 minutes):

 Discuss common complications associated with IV infusions, such as infiltration,

phlebitis, infection, and air embolism.
 Describe the signs and symptoms of each complication and appropriate interventions.

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  Provide case studies or scenarios for participants to identify potential complications and
discuss appropriate nursing interventions.

Part 4: Documentation and Communication (10 minutes):

 Explain the importance of accurate and timely documentation of IV infusion details,

including the start time, infusion rate, site assessment findings, and any interventions or
complications.
 Discuss the communication strategies for effectively sharing information related to IV
infusions with other healthcare team members.
 Provide examples and templates for documentation and communication related to IV
infusion.

PROCEDURE STEPS 5 4 3 2 1 0
1. Checked client’s medial record for correct solution, additives and
time of infusion.
2. Performed hand washing
3. Evaluated infusion site for signs of infiltration, inflammation, clot in
catheter or kink or knot in tubing
4. Verified with client how vein puncture site feels
5. Checked IV solution of accuracy and volume
6. Calculated flow rate of existing IV
7. Readjusted rate if not accurate
8. Monitored infusion rate and IV site hourly
9. If using pump, assessed patency and integrity of system when alarms
sound
10. Observed client for signs of over-hydration or dehydration
11. Documented as per agency policy

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6.6 Oxygen Administration

Objective: By the end of this lesson, learners will be able to demonstrate proper technique and
safety measures for administering oxygen therapy to patients.

Duration: 30 minutes

Equipments

 Oxygen source (oxygen cylinder or wall-  Flowmeter

mounted oxygen supply)  Humidifier (if applicable)
 Oxygen delivery system (nasal cannula,  Personal protective equipment (PPE)
oxygen mask, or other appropriate device)
 Patient simulation equipment (mannequin or
simulated patient)

Procedure:

Introduction (5 minutes)

 Greet the learners and provide an overview of the lesson.

 Explain the importance of oxygen therapy in respiratory care and the indications for its
use.
 Discuss the potential risks and complications associated with oxygen administration.

Oxygen Delivery Systems (10 minutes)

 Introduce different oxygen delivery systems, such as nasal Cannula, oxygen mask, and
non-rebreather mask.
 Describe the indications, advantages, and limitations of each delivery system.
 Demonstrate how to assemble and set up the selected oxygen delivery system.

Safety Measures (5 minutes)

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  Discuss the safety measures to be followed during oxygen administration:

a. Ensure a secure and functioning oxygen source.

b. Check the oxygen cylinder or wall-mounted system for proper pressure and functioning.

c. Confirm the oxygen flow rate prescribed by the healthcare provider.

d. Use a flow meter to adjust and maintain the appropriate oxygen flow rate.

e. Ensure proper positioning and fit of the oxygen delivery device.

f. Monitor the patient's oxygen saturation levels and respiratory status regularly.

g. Educate the patient and caregivers about fire safety precautions and the risks of smoking near
oxygen sources.

List of Steps 5 4 3 2 1 0

1. Wash hands.

2. Verify the written order.

3. Explain procedures and hazards to client.

4. Fill humidifier to fill line with distilled water and close container.

5. Attach humidifier to oxygen flow meter.

6. Insert humidifier and oxygen flow meter into oxygen source.

7. Apply oxygen delivery device and adjust until it fits snugly and
comfortably.

8. Attach to flow meter and turn it into prescribed flow rate.

9. Observe for proper function of Oxygen delivery device.

10. Check for bubbling in the humidifier

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 11. Monitor client’s response to changes in the oxygen flow rate.

12. Wash hands

Hands-On Practice (5 minutes)

 Divide the learners into pairs or small groups.

 Provide each group with the necessary equipment and a simulation mannequin or
simulated patient.
 Allow learners to practice assembling and administering oxygen therapy using the
selected delivery system.
 Provide feedback and guidance as needed.
 Encourage learners to ask questions and address any concerns they may have.

Debriefing and Discussion (5 minutes)

 Facilitate a group discussion to address any questions, concerns, or challenges

encountered during the practice session.
 Review key points and emphasize the importance of safety measures and proper
technique in oxygen administration.
 Discuss potential complications and strategies for their prevention.

Summary and Conclusion (5 minutes)

 Summarize the main points covered in the lesson.

 Reinforce the importance of following proper technique and safety measures during
oxygen administration.
 Encourage learners to continue practicing and seeking opportunities for further skill
development.

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6.7 Wound Care

Objective: By the end of this skill lab, nurses will be able to:

 Perform a comprehensive wound assessment, including wound measurement and

documentation.
 Demonstrate proper wound cleansing techniques using sterile solutions.
 Apply appropriate wound dressings based on wound characteristics.
 Perform wound closure techniques (suturing or stapling) as needed.
 Recognize signs of wound complications and implement appropriate interventions.
 Practice infection prevention and control measures during wound care procedures.

Duration: 2 hours

Equipment
 Wound care models or simulated wounds  Wound cleansing solutions (e.g., normal
 Sterile dressings (e.g., gauze, hydrocolloid, saline, wound cleansers)
foam, alginate)  Suturing or stapling supplies (if applicable)
 Personal protective equipment (gowns,
 Sterile gloves
masks, goggles)
 Sterile instruments (e.g., forceps, scissors,
needle holders)

Introduction (5 minutes):

 Welcome the participants and explain the objectives of the skill lab.
 Emphasize the importance of hands-on practice in developing wound care skills.
 Discuss the significance of infection prevention and control during wound care
procedures.

Part 1: Wound Assessment and Documentation (15 minutes):

 Review the key components of a comprehensive wound assessment, including wound

location, size, depth, color, drainage, and surrounding tissue.

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  Demonstrate proper wound measurement techniques using wound care models or
simulated wounds.
 Explain the importance of accurate and detailed wound documentation, including wound
characteristics, interventions, and patient response.

6.7.1 Wound Dressing

Procedure 5 4 3 2 1 0
1. Confirm the physician’s order for wound irrigation; note the type and strength of the
ordered irrigation solution.

2. Assess the client’s pain level and medicate with analgesic 30 minutes before
procedure if the medication is to be given PO or IM.

3. Explain the procedure to the client.

4. Place a waterproof pad on the bed. Assist the client onto the pad. Then assist the
client into a position that will allow the irrigant to flow through the wound and into the
basin.

5. Wash hands and don the disposable gloves; remove and discard the old dressing.
6. Assess the wound’s appearance and note quality, quantity, color, and odor of
drainage.

7. Remove and discard the disposable gloves, and wash hands.

8. Prepare the sterile irrigation tray and dressing supplies. Pour the room-temperature
irrigation solution into the solution container.

9. Don sterile gloves.

10. Position the sterile basin against the lower edge of the wound to “catch” the irrigant.

11. Fill the piston or bulb syringe with irrigant and gently flush the wound. Refill the
syringe and continue to flush the wound until the solution returns clear and no exudate
is noted.

12. Dry the edges of the wound.

13. Assess the wound’s appearance and drainage.
14. Apply a sterile dressing. Remove sterile gloves and wash hands.
15. Document all assessment findings and actions taken.
Wound Complications and Infection Prevention (20 minutes):

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  Review common wound complications and their signs and symptoms.
 Discuss appropriate interventions for wound complications, such as infection, dehiscence,
or evisceration.
 Reinforce the importance of infection prevention and control measures during wound
care procedures, including hand hygiene, proper use of personal protective equipment,
and appropriate disposal of contaminated materials.

Conclusion (10 minutes):

 Summarize the key points covered in the skill lab.

 Encourage participants to ask questions and seek clarification on wound care techniques.
 Provide additional resources for ongoing learning and skill development.

6.8 CPR (Cardiopulmonary Resuscitation)

Objective: By the end of this skill lab, nurses will be able to:

 Recognize the signs of cardiac arrest and initiate the CPR response.
 Perform high-quality chest compressions, including proper hand placement and
compression depth.
 Demonstrate effective rescue breaths using appropriate technique and ventilation rate.
 Utilize an automated external defibrillator (AED) to deliver a shock, if available.
 Understand the importance of teamwork, communication, and coordination during CPR.

Equipments

CPR manikins (adult and infant) AED pads for training purposes

Pocket masks or bag-valve masks for rescue breaths Timer or metronome for compressions

Automated External Defibrillator (AED) training CPR training videos or instructional materials
device (if available)
Handouts or reference cards on CPR guidelines

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Duration: 2 hours

Introduction (5 minutes):

 Welcome the participants and explain the objectives of the skill lab.
 Discuss the importance of CPR skills in emergency situations.
 Emphasize the significance of teamwork and effective communication during CPR.

Part 1: Recognizing Cardiac Arrest and Initiating CPR (15 minutes):

 Review the signs and symptoms of cardiac arrest.

 Explain the steps for initiating the CPR response: activating the emergency response
system, assessing the victim's responsiveness, and calling for help.
 Discuss the importance of early CPR initiation and the potential impact on patient
outcomes.
 Provide examples and scenarios to reinforce the recognition of cardiac arrest situations.

Step-by-Step Procedure for CPR (Adult):

1. Assess the Scene and Ensure Safety:

 Check the surrounding area for any potential dangers or hazards.
 Ensure your safety and the safety of the victim before approaching.
2. Activate Emergency Response System:
 Call for help by dialing the emergency number specific to your location
 Request an ambulance or emergency medical assistance.
3. Check Responsiveness:
 Shake the victim gently and shout, "Are you okay?"
 If there is no response, proceed to the next steps.
4. Position the Victim:
 Place the victim on their back on a firm surface.
 Ensure the victim is lying flat and their airway is clear.
5. Open the Airway:

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  Tilt the victim's head back gently with one hand on their forehead while lifting the chin
with your other hand.
 This maneuver helps to open the airway and aligns the head and neck.
6. Check for Breathing:
 Look, listen, and feel for breathing for no more than 10 seconds.
 Watch for chest rise, listen for breath sounds, and feel for airflow on your cheek.
7. Begin Chest Compressions:
 Place the heel of one hand on the center of the victim's chest, between the nipples.
 Place your other hand on top, interlocking your fingers.
 Position yourself vertically above the victim's chest, keeping your arms straight.
8. Perform Compressions:
 Push hard and fast, compressing the chest at least 2 inches (5 centimeters) deep.
 Compress the chest at a rate of 100 to 120 compressions per minute (about 2
compressions per second).
 Allow the chest to fully recoil between compressions without lifting your hands.
9. Provide Rescue Breaths:
 After 30 compressions, give 2 rescue breaths.
 Maintain an open airway by tilting the head back and lifting the chin.
 Pinch the victim's nose shut and place your mouth over their mouth to create a seal.
 Deliver a breath lasting about 1 second, watching for chest rise.
 Repeat the process, providing a second rescue breath.
10. Continue Cycles of Compressions and Breaths:
 Repeat the cycle of 30 compressions followed by 2 rescue breaths.
 Aim for a compression-to-ventilation ratio of 30:2.
11. Use an Automated External Defibrillator (AED):
 If an AED is available, follow the voice prompts and visual instructions provided by the
device.
 Apply the AED pads to the victim's chest as directed.
 Stand clear and allow the AED to analyze the heart rhythm.
 If advised by the AED, deliver a shock by pressing the shock button.

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12. Continue CPR until Help Arrives:
 Continue performing CPR until trained medical personnel take over or the victim shows
signs of life.
 If you become exhausted, switch with another trained individual if available.

CHAPTER SEVEN- CONCLUSION

In conclusion, the implementation of a skill lab protocol for nurses at St. Amanuel Mental
Specialized Hospital is a transformative initiative that has the potential to greatly enhance the
quality of nursing care provided to patients. By creating a dedicated space for hands-on training,
simulation exercises, and standardized assessments, the skill lab protocol equips nurses with the
necessary skills, knowledge, and confidence to deliver optimal patient outcomes.

The skill lab protocol offers numerous benefits for nurses. It provides a safe and controlled
environment where nurses can practice and refine their clinical skills, ensuring proficiency and
competence in various aspects of patient care. Through simulation-based training, nurses can
immerse themselves in realistic scenarios, allowing them to develop critical thinking, decision-
making, and problem-solving abilities. This experiential learning approach enables nurses to gain
valuable experience and build confidence in their clinical practice.

The incorporation of standardized assessment tools within the skill lab protocol ensures objective
evaluation of nursing competencies. This feedback-driven approach allows nurses to identify
areas for improvement and receive targeted training interventions. By continuously assessing and
refining their skills, nurses can enhance their professional growth and deliver care that is
evidence-based, safe, and of the highest quality.

It is important to recognize that the success of the skill lab protocol for nurses relies on ongoing
support, resources, and a commitment to professional development. Regular evaluation and
adaptation of the protocol are necessary to align with emerging best practices and address the
changing needs of nursing practice.

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In conclusion, the skill lab protocol implemented at St. Amanuel Mental Specialized Hospital
represents a significant investment in the professional development and advancement of nursing
practice. By empowering nurses with the necessary skills and knowledge, the protocol elevates
the standard of care provided to patients, ultimately leading to improved outcomes and patient
satisfaction. The skill lab protocol positions St. Amanuel Mental Specialized Hospital as a leader
in nursing education and sets a benchmark for excellence in mental health nursing.

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