5. Scenario-Based Lab Skills Assessment
Personal Care and Assistance Course
This scenario-based lab skills assessment aligns with the suggested course assessment 3 in the Personal Care and Assistance course.
To support program consistency, recognized B.C. HCA programs are expected to use case scenario testing to confirm that students are safe and competent before they go into the clinical setting.
As noted in the suggested course assessment for the Personal Care and Assistance course, skills testing could be accomplished through the performance of a scenario simulating the practice environment and may include an opportunity for problem solving. The specific skills tested and expected level of competency may vary depending upon when the first clinical experience occurs within the program. To support student success, it may be helpful to implement a mid-course assessment and/or pre-testing practice session.
For scenario-based or case study assessment, it is typical to have at least four client scenarios for skills testing that students could receive in advance so they can prepare.
On testing day, a scenario will be randomly chosen for each student to perform. The student will have a set amount of time to work in pairs, with one student acting as the client and the other as the HCA. The program may choose to have an instructor or a standardized patient (actor) in the role of the client, but if a student is acting as the client, it is important that the student plays the role seriously. Prompting or cueing by the client is not allowed.
With some scenarios, it may be necessary for the HCA to obtain a partner who will be designated the “helper.” Some components of care may be provided on a mannequin or using simulation aids (e.g., torso with a penis or torso with a vulva).
A care plan is often provided for each scenario for the purpose of student testing.
Assessment Criteria
HCA programs may already have skills testing assessment criteria in place. At a minimum, students should demonstrate their ability to:
- Maintain the comfort and dignity of the client
- Maintain the safety of the client, self, and other members of the health care team
- Perform in an organized manner
- Maintain medical asepsis
- Use proper body mechanics
- Communicate with the client and other health care team members, where appropriate
- Demonstrate competency of the personal care and assistance skills being tested in the scenario
Assessment is typically conducted on a satisfactory/unsatisfactory or a pass/fail basis. Programs implementing a mid-course skills assessment may add a “needs improvement” designation that is followed up with a learning contract.
To ensure fair and reliable student practical skills assessment, there should be established criteria regarding what would constitute unsatisfactory performance. This could include the designation and number of minor infractions that may result in a cumulative fail, or major infractions that may result in an immediate fail.
Elements that may be considered include:
- Skill testing takes longer than established time allotted for testing
- Student leaves client on the side of the bed or leaves client unattended with side rails down
- Student rolls client onto the edge of the bed without raising side rails
- Student performs a lift transfer incorrectly or no safety check
- Student makes offensive or inappropriate comments to the client
- Student leaves the client unattended in bed in the high position.
- Student does not apply brakes to wheelchair, bed, or equipment in an appropriate manner
- Student repeatedly (more than once and/or after prompt or without self-correcting):
- Forgets a portion of the skill
- Dresses client haphazardly/with inappropriate assistance from the client (e.g., clothes, TEDS, shoes)
- Poorly positioning or moving of the client in bed
- Does not collect all supplies pre-scenario
- Provides care in a way that does not flow smoothly or is disorganized
- Does not use the appropriate number of side rails
- Performs morning care or perineal care in the incorrect order
- Contaminates objects by failing to wash hands, change gloves, touching clean objects with dirty gloves or dropping items on the floor
- Does not use proper body mechanics
- Forgets to give client an aid (e.g., glasses or hearing aid)
- Fails to provide a thorough report of the client’s condition
There should also be details set out in regards to requirements for retesting.
See sample case scenarios and rubrics below.
Rubric 1: Scenario-Based Lab Skills
You are an HCA working in a complex care home. Today you are assigned to provide morning care for Edith Blaise, a 92-year-old woman who has recently fractured her left foot. This morning when you enter Ms. Blaise’s room, she asks you to assist her with a bedpan and cut her fingernails. Following this, you will assist Ms. Blaise with a partial bed bath, assist her with dressing, and transfer her to her wheelchair using a full mechanical lift.
Depending on the case scenario, each required skill could be evaluated as outlined in the rubric below.
| Skill performed | Unsatisfactory (Indicate where applicable with a check mark) |
Satisfactory (Indicate where applicable with a check mark) |
P=Pass F=Fail R=Redo |
|---|---|---|---|
| Assists with a bedpan | □ Ineffective organization and prioritization (did not gather required supplies and managed time improperly) | □ Effective organization and prioritization (gathered required supplies and managed time properly) | |
| □ Did not perform skill following correct lab procedures | □ Performed skill following correct lab procedures | ||
| □ Performance of skill was unsafe | □ Safe performance of skill | ||
| □ Improper medical asepsis | □ Proper medical asepsis | ||
| □ Incorrect body mechanics | □ Correct body mechanics | ||
| □ Inadequate communication with client | □ Adequate communication with client | ||
| □ Does not attend to client comfort and/or support dignity | □ Attends to client comfort and supports dignity | ||
| Instructor Comments | |||
| Hand care including nail clipping | □ Inadequate communication with nurse supervisor/did not request that the client’s nail be assessed first and the activity assigned, before proceeding with the task | □ Adequately communicated with nurse supervisor and requested that the client’s nail be assessed first, and the activity assigned, before proceeding with the task | |
| □ Ineffective organization and prioritization (did not gather required supplies and managed time improperly) | □ Effective organization and prioritization (gathered required supplies and managed time properly) | ||
| □ Did not perform skill following correct lab procedures | □ Performed skill following correct lab procedures | ||
| □ Performance of skill was unsafe | □ Safe performance of skill | ||
| □ Improper medical asepsis | □ Proper medical asepsis | ||
| □ Incorrect body mechanics | □ Correct body mechanics | ||
| □ Inadequate communication with client | □ Adequate communication with client | ||
| □ Does not attend to client comfort and/or support dignity | □ Attends to client comfort and supports dignity | ||
| Instructor Comments | |||
| Partial bed bath | □ Ineffective organization and prioritization (did not gather required supplies and managed time improperly) | □ Effective organization and prioritization (gathered required supplies and managed time properly) | |
| □ Did not perform skill following correct lab procedures | □ Performed skill following correct lab procedures | ||
| □ Performance of skill was unsafe. | □ Safe performance of skill | ||
| □ Improper medical asepsis | □ Proper medical asepsis | ||
| □ Incorrect body mechanics | □ Correct body mechanics | ||
| □ Inadequate communication with client | □ Adequate communication with client | ||
| □ Does not attend to client comfort and/or support dignity | □ Attends to client comfort and supports dignity | ||
| Instructor Comments | |||
| Assists with dressing | □ Ineffective organization and prioritization (did not gather required supplies and managed time improperly) | □ Effective organization and prioritization (gathered required supplies and managed time properly) | |
| □ Did not perform skill following correct lab procedures | □ Performed skill following correct lab procedures | ||
| □ Performance of skill was unsafe | □ Safe performance of skill | ||
| □ Improper medical asepsis | □ Proper medical asepsis | ||
| □ Incorrect body mechanics | □ Correct body mechanics | ||
| □ Inadequate communication with client | □ Adequate communication with client | ||
| □ Does not attend to client comfort and/or support dignity | □ Attends to client comfort and supports dignity | ||
| Instructor Comments | |||
| Transfer from bed to wheelchair | □ Ineffective organization and prioritization (did not gather required supplies and managed time improperly) | □ Effective organization and prioritization (gathered required supplies and managed time properly) | |
| □ Did not perform skill following correct lab procedures | □ Performed skill following correct lab procedures | ||
| □ Performance of skill was unsafe | □ Safe performance of skill | ||
| □ Improper medical asepsis | □ Proper medical asepsis | ||
| □ Incorrect body mechanics | □ Correct body mechanics | ||
| □ Inadequate communication with client | □ Adequate communication with client | ||
| □ Does not attend to client comfort and/or support dignity | □ Attends to client comfort and supports dignity | ||
| Instructor Comments |
Rubric 2: Scenario-Based Lab Skills
You are an HCA working in a complex care home. Today you are assigned to provide morning care for Edith Blaise, a 92-year-old woman who has recently fractured her left foot. This morning when you enter Ms. Blaise’s room, she asks you to assist her with a bedpan and cut her fingernails. Following this, you will assist Ms. Blaise with a partial bed bath, assist her with dressing and transfer her to her wheelchair using a full mechanical lift.
Depending on the scenario, and the using following criteria (NI = Needs improvement (may be used for mid-point testing), NS = Not Satisfactory, S = Satisfactory) the rubric could be used as outlined below.
| 1. Maintains the comfort and dignity of the client | NI | NS | S |
| Examples and comments
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| 2. Maintains the safety of the client, self, and other members of the health care team | NI | NS | S |
| Examples and comments
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| 3. Communicates effectively with the client and other members of the health care team, where appropriate | NI | NS | S |
| Examples and comments
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| 4. Provides care in an organized manner, gathers supplies, and manages time appropriately | NI | NS | S |
| Examples and comments
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| 5. Maintains medical asepsis and infection control throughout the scenario | NI | NS | S |
| Examples and comments
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| 6. Uses proper body mechanics throughout the scenario | NI | NS | S |
| Examples and comments
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| 7. Performs personal care and assistance skills competently (scenario specific) | NI | NS | S |
| Examples and comments
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i. Assist with bedpan (performed according to correct lab procedures) |
NI | NS | S |
| Examples and comments
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ii. Hand care including nail clipping (performed according to correct lab procedures) |
NI | NS | S |
| Examples and comments
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iii. Partial bed bath (performed according to correct lab procedures) |
NI | NS | S |
| Examples and comments
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iv. Transfer from bed to chair using full mechanical lift (performed according to correct lab procedures) |
NI | NS | S |
| Examples and comments
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Instructor Name Instructor Signature Date
Student Name Student Signature Date