There are three parts to this section:
1 Bed bath, immersion bath and showering
2 Facial shave
3 Hair washing
Due to the volume of material on personal hygiene, guidelines for mouth care and skin care are given in separate sections.
Learning outcomes
By the end of this section, you should know how to:
▪ prepare the patient for this nursing practice
▪ collect the equipment
▪ carry out a bed bath
▪ help the patient with an immersion bath or shower
▪ carry out a facial shave
▪ wash the hair of a bed fast or ambulant patient.
Background knowledge required
Revision of the anatomy and physiology of the skin tissue
Review of local policy on pre- and postoperative skin care
Revision of infection control policy in respect of skin care, hair infestation and cleaning of equipment
Review of local policy on moving and handling
Review of local policy on these practices.
Indications and rationale for personal hygiene
A patient may require personal hygiene care:
▪ to clean the skin prior to surgery
▪ postoperatively following major surgery when mobility is restricted
▪ following an acute illness, e.g. myocardial infarction
▪ while in an unconscious state
▪ following trauma, e.g. a patient in traction
▪ when extremely weak and debilitated as a result of the prolonged effects of a disease, trauma or a treatment being administered.
For infection control purposes personal hygiene equipment should be for single-patient use or should be cleaned according to local policy. The nurse should cleanse their hands before and after each practice according to local policy and wear a disposable plastic apron.
BED BATH, IMMERSION BATH AND SHOWERING
Equipment1. Soap, or prescribed antibacterial preparation/aqueous cream/emulsifying lotion
2. Patient’s toiletries such as deodorant and talcum powder
3. Bath towels
4. Two face cloths/sponges or disposable wipes
5. Disposable paper towel or similar
6. Patient’s brush and comb
7. Nail scissors and nail file if required
8. Clean nightdress, pyjamas or clothing
9. Clean bed linen
10. Plastic apron and disposable gloves
11. Continence products if required
12. Equipment for catheter care (seep. 91) if required
13. Equipment for skin care (seep. 297)
14. Equipment for mouth care (seep. 205)
15. Receptacle for the patient’s soiled clothing
16. Receptacle for soiled bed linen
17. Receptacle for soiled disposable items.
Additional equipment
1. Basin of hot water at 35–40°C (bed bath)
2. Trolley or adequate surface (bed bath)
3. Bath thermometer (immersion bath)
4. Chair or shower stool (immersion bath and shower)
5. Disposable floor mat (immersion bath and shower)
6. Bathing/showering equipment aids as appropriate (immersion bath and shower).
Guidelines and rationale for this nursing practice
Bed bath
▪ explain the nursing practice to the patient to gain consent and co-operation
▪ collect and prepare the equipment to ensure that all equipment is available and ready for use
▪ ensure the patient’s privacy to reduce anxiety
▪ observe the patient throughout this activity to note any signs of distress
▪ check that the bed brakes are in use to prevent the patient or nurse sustaining an injury from a sudden uncontrolled movement of the bed
▪ adjust the bed height to ensure safe moving and handling practice
▪ help the patient into a comfortable position permitting the nurse easy and comfortable access to the patient
▪ remove any excess bed linen and bed appliances if in use, allowing easy access to the patient, but leaving the patient covered with a bed sheet to maintain modesty
▪ help the patient to remove their pyjamas or gown and anti-embolic stockings if required to reduce exertion as this can be a strenuous activity for a person who is in a weakened state
▪ check the temperature of the basin of water, ensuring that the water is neither too hot nor too cold
▪ check with the patient whether he or she uses soap on his or her face, ensuring individualised care
▪ wash, rinse and dry the patient’s face, ears and neck; when possible, assist patients to do this for themselves to encourage independence
▪ if the face cloth is not going to be laundered after the procedure, the second face cloth should be used to wash the rest of the body in order to reduce the risk of cross-infection
▪ expose only the part of the patient’s body being washed in order to maintain the patient’s modesty and self-esteem
▪ change the water as it cools or becomes dirty, and immediately after washing the patient’s pubic area, preventing the cooling of the patient and reducing the risk of cross-infection, respectively
▪ wash, rinse and thoroughly dry the patient’s body in an appropriate order, such as the upper limbs, chest and abdomen, back and lower limbs, preventing excessive exertion on the part of the patient
▪ change the water immediately after perineal hygiene or leave this action until last, reducing the risk of cross-infection from the normal skin flora of the perineal region to the rest of the skin
▪ when washing the patient’s limbs, first wash the limb furthest away from you. This will allow the assistant to dry that limb as the other limb is being washed, thus reducing the time during which the patient’s body is exposed to the cooling effect of the environment. When possible, assist the patient to immerse the feet and hands in the basin of water (Fig. 31.1)
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| FIGURE 31.1Foot immersion: the patient’s foot and leg should be supported. The upper limbs can be supported in a similar way |
▪ as each part of the patient’s body is washed, observe the skin for any blemishes, redness or discoloration, which will alert the nurse to the potential problem of pressure sore development (see ‘Skin care’, p. 297)
▪ apply body deodorants and/or other toiletries as desired by the patient, ensuring individualised care
▪ assist the patient to wash, rinse and dry the pubic area using the disposable wipes, washing from the front of the perineal area to the back to prevent cross-infection from the anal region
▪ carry out catheter care or use appropriate continence products if required
▪ help the patient to dress in clean pyjamas or gown and replace anti-embolic stockings if required to reduce exertion on the part of the patient
▪ to prevent injury, reduce the risk of cross-infection and promote self-esteem, assist the patient to cut and clean the fingernails and toenails if required and unless otherwise instructed
▪ to promote patient comfort, remove any soiled or damp bed linen and remake the patient’s bed
▪ assist the patient with mouth care (seep. 205) to promote a positive body image
▪ assist the patient to brush or comb the hair into its usual style, promoting independence and self-esteem
▪ ensure that the patient is left feeling as comfortable as possible while maintaining the quality of this nursing practice
▪ rearrange the furniture as wished by the patient so that any articles needed are within easy reach and the patient is given control of the environment
▪ dispose of the equipment safely to reduce any health hazard.
Immersion bath
▪ discuss the arrangements for the bath with the patient to gain consent and co-operation and encourage participation in care. In the community, the patient should have an assessment carried out; this will assess the need for the use of equipment available from occupational therapy and whether help with bathing and showering should be given by social-care staff
▪ help the patient to collect and prepare the equipment so that everything is ready for use
▪ help the patient to the bathroom; this may include the use of mechanical lifting aids or a wheelchair if the patient has any difficulty with mobilising
▪ ensure the patient’s privacy as far as possible, to respect individuality and maintain self-esteem
▪ help the patient to undress if he or she needs help, giving encouragement for the patient to be as independent as possible
▪ observe the patient throughout this activity to observe any adverse effects
▪ help the patient into the bath. For some patients, mechanical aids may be used as appropriate according to the manufacturer’s instructions
▪ help the patient to wash himself or herself, commencing with the face and neck so that clean water is used first on these areas
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