Supplement of Textbook

By Foreigner Care workers Support Center Inst.

POINTS FORNURSING SKILLS EVALUATION TESTOF
SPECIFIED SKILLS WORKER VISA

Author: Bunji InoueIssuer: Foreigner Caregivers Support Center Inst.

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By Foreigner Care workers Support Center Inst.

POINT TO REMEMBER FOR NURSING CARE SKILLS EVALUATIONTEST
A. PHYSICAL CARE
1. Assistance with movement
In walking, the care worker stands behind the affected side to prevent theuser (“user” means a person who receives care service) from falling.
In the three-motion walking with a cane, the legs are put out in the order of(1) cane -> (2) affected side -> (3) healthy side.

In the two-step walking with a cane, the legs are put out in the order of (1)cane and affected side -> (2) healthy side.

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When going up the stairs by walking with a cane, the user shall step out inthe order of (1) cane-> (2) healthy side-> (3) affected side. (Only theascending stairs reverse the order of putting out feet)
When going down the stairs of walking with a cane, put feet in the order of(1) cane-> (2) affected side-> (3) healthy side.
When assisting the user with a cane in going up the stairs, the care worker
stands one step behind the user's affected side.
The care worker stands one step down in front of the user with a cane whenassisting the user in going down the stairs.
The length of the cane is adjusted so that the handle comes to the position of
the user's greater trochanter (70 to 80 cm).
When assisting visually handicapped persons, care workers should standaside and half a step ahead of the user.

In the assistance for a visually handicapped person, the user grabs the elbowof the care worker.
In moving assistance for a visually handicapped person, care worker stops
once in front of the stairs.
In moving assistance for a visually handicapped person, the user moves up
and down after confirming the position of the stairs with a white cane or thetip of a foot.

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When a visually handicapped person sits on a chair, ask the user to checkthe position of the chair back and seat.
At the station platform, care worker guides the visually impaired user to aposition inside the braille block.
When leaving the visually impaired user for a while, the care worker shallguide the user to a position where the user can touch a pillar or a wall.
When transferring from a bed to a wheelchair, the wheelchair is placed on
the healthy side of the user.
When transferring from a bed to a wheelchair, the user holds the arm
support with the hand on the healthy side.
When transferring from a bed to a wheelchair, the care worker stands on theaffected side of the user and protects the affected knee.

When transferring from a bed to a wheelchair, the user stands up leaning
forward and rotates to sit in the wheelchair.
In wheelchair assistance, care worker pushes the wheelchair more slowly
than he/she walks.

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When the wheelchair crosses the step, the care worker steps on the tipping
lever and raises the caster to cross the step.
In wheelchair assistance, push the wheelchair forward in the ascent of theslope.
In wheelchair assistance, the wheelchair must go backward when going
down the slope.
In wheelchair assistance, in case of gravel road, push the wheelchair withthe casters lifted.

In body mechanics, care worker shall have a low center of gravity and a large
support base area.
In body mechanics, the user's body is put together to make it small.

In body mechanics, the care worker shall move the user by moving care
worker’s center of gravity.

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In body mechanics, the centers of gravity of the user and the care worker are
brought closer together, and the bodies are brought into close contact.
In body mechanics, turn the care worker's feet and body in a moving
direction.
In the lateral position, keep the healthy side down.
In the semi-sitting position (Farer position) on the bed, put a cushion under
the knee of the user to prevent slipping to the foot side.
In the end-sitting position, open feet to the shoulder’s width and secure thesole.
To prevent bedsore, it is recommended to change the position about once
every two hours.
Secure time to sit down to prevent bedsore.
Clean body to prevent bedsore.
Prevent wrinkles on sheets and clothing to prevent bedsore.
To prevent bedsore, improve nutritional status.
The most prone part for bedsore in the supine position is the sacral region.

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2. Assistance with eating
Clean hands and mouth before eating.
To prevent aspiration, the head is bent slightly forward.
For meal assistance in case of a hemiplegic user, care worker sits on thehealthy side of the user.
For meal assistance, check swallowing every bite of food.
During meal assistance in the sitting position, the table is adjusted to aheight that allows the forearm to be placed naturally when the user bends
the elbow lightly.
In assisting meals in the supine position, put a cushion or the like on theaffected side of the user and tilt it slightly toward the healthy side.
In the meal assistance for the visually impaired, the explanation is based on
the clock position.
It is difficult to swallow if the temperature of the meal is the same as thebody temperature.
Nutrients that are good for osteoporosis are calcium, vitamin D, and vitaminK.
Tea, juice and miso soup are easy to get aspiration.
Peanuts and cookies are easy to get aspiration.
Bread and donuts are low in moisture and difficult to swallow.
The daily amount of water required is about 2,500 ml, and it is necessary toconsume 1,000 to 1,500 ml of water a day other than from meals.

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3. Assistance with elimination
In excretion care, in consideration of shame, close the curtains, remove odors
and sounds, and create an environment where the user can relax andexcrete.
Grasp the excretion rhythm of the user and assist according to the timing ofexcretion.
The female genital area is wiped from front to back to prevent bacterial
infection of the urinary tract.
As a response to constipation, a diet containing dietary fiber and lactic acidbacteria is good.
Maintain water intake as a response to constipation.
As a response to constipation, massage the abdomen along the run of theintestines (likewise “の” of Japanese hiragana character).
Warm the abdomen as a response to diarrhea.
In order to prevent dehydration due to diarrhea, take small amounts of plain
hot water or normal temperature sports drinks.
As a response to diarrhea, pay attention to infection prevention and perform
standard precautions.
As a response to diarrhea, after defecation, wash with lukewarm water alittle and dry and clean the skin.

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4. Assistance with grooming
Respect the user's preference in removing / attaching care and have themchoose clothing.
Adjust the room temperature so that it is not cold in removing / attachingcare. (18 ℃ -24 ℃)
Care should be taken to protect privacy, such as closing the curtains inremoving / attaching care.
In removing / attaching care, the care worker stands on the affected side ofthe user.
When taking off the outerwear in removing / attaching care, the user takes
off the sleeve on the healthy side and then the sleeve on the affected side.
When wearing the outerwear in removing / attaching care, pass the sleeve on
the affected side of the user and then the sleeve on the healthy side.
In removing / attaching care, the buttock area should be attached andremoved while standing, and the limbs area should be attached and detachedwhile sitting.

Encourage users to change their clothes between day and night to keep theirrhythm of life.
Pre-meal oral care has the effect of promoting saliva secretion.

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Post-meal oral care reduces the number of bacteria in the oral cavity andprevents aspiration pneumonia.
In oral care, user gargles before brushing if possible.
In oral care, choose a toothbrush with a small brush part.
In oral care, the toothbrush is lightly gripped like a pencil.
Remove the denture from the lower jaw.

Attach the denture from the upper jaw.
Wash dentures with water or warm water, not hot water.
Dentures are removed at night and placed in a container, soaked in water.

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5. Assistance with bathing and basic hygiene
In the bathing scene, accidents such as falls and drowning, and suddenchanges such as strokes and heart attacks are likely to occur.
Bathing has the effect of maintaining cleanliness and preventing infection.
By bathing and massaging and washing the body, it promotes blood
circulation, accelerates the healing of bedsore, and eliminates constipation.
By bathing, rehabilitation effects can be expected such as making the jointsof the limbs easier to move.
Bathing has the effect of relieving stress, relaxation, restful sleep, andappetite.
The temperature of the bath water should be between 38 °C and 41 °C.
If the temperature of bathing is over 42 °C, blood pressure and heart rate
will increase.
Eliminate the temperature difference between the dressing room and thebathroom to prevent heat shock.
The time spent in the bathtub is limited to about 5 minutes.
Since bathing has sweating and diuretic action, users must take water before
and after bathing.
The care worker checks the water temperature of the shower and bath tub
first, and then the user checks the temperature.
Hot water is applied from user’s feet, far from the user's heart.

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In the case of hemiplegic users, ask them to wash the places they can washthemselves, and the care worker assists the healthy side, which is difficult
for users to wash.
For hemiplegic users, enter the bathtub from the healthy side.
For dry bathing, wipe from the periphery toward the center.

Wipe face from the top of eyes to the bottom of eyes to prevent infection.
In giving foot bath on the bed, gatch up to about 15° and put a cushion on thefeet.
In giving foot bath, care worker prepares hot water of about 39 degree
Celsius and check the hot water temperature in the order of (1) the careworker, then (2) the user.

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6. Assistance with housework
As a safe living environment, lighting should be at least 200 lux.
As a safe living environment, lighting such as footlights will be installed toprevent falls at night.
As a safe living environment, eliminate steps on the floor.
As a safe living environment, the width of the corridor should be at least 80
cm if the user moves with a self-propelled wheelchair (standard manualwheelchair).
As a safe living environment, when handrails are attached to the corridor,
their height should be about the height of the user’s greater trochanter(70-80cm).
As a safe living environment, the door should be a sliding door.
As a safe living environment, the edge of the bathtub should be about 40cm
height.
As a safe living environment, the depth of the bathtub should be about 50cm.
As a safe living environment, install a handrail on the healthy side when theuser goes
down the stairs.
Use benzine for chocolate and lipstick stains.
For blood stains, do not use hot water, but wash with warm or lukewarm
water.
Chlorine bleach is not used for colored clothes.
Oxygen bleach is used for colored clothes.

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To prevent food poisoning, wash hands before cooking and heat meat andfish at 75 °C or more for 1 minute or more in the center.
To prevent food poisoning, chopped boards of meat and fish should becleaned and sterilized after each use.
To prevent food poisoning, keep the refrigerator below 10 ° C and the freezer
below minus 15 °C.

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By Foreigner Care workers Support Center Inst.

October 14th 2019
Author: Bunji InoueIssuer: Foreigner Caregivers Support Center Inst.
5-15-14 Yawata, Ichikawa, Chiba, Japan
http://caregiverjapan.org------------------------------------------------------------------------------------------------------------------------Copyright © 2019 Bunji Inoue, Office I Helper, Foreigner Caregivers Support Center
Inst. All Rights Reserved.
Copying all or part of the contents of this document without permission is prohibited
except as permitted by law.

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