12. Principles of hygiene needs
for the woman
CHAPTER CONTENTS
Role and responsibilities of the midwife 94
Summary 94
Self-assessment exercises 94
References 94
LEARNING OUTCOMES
Having read this chapter the reader should be able to:
• discuss the ways in which the midwife facilitates personal hygiene
• describe the ways in which vulval and oral toilets are undertaken
• identify the principles applied for the making of an occupied or unoccupied bed
• discuss the midwife’s role and responsibilities in relation to each of these aspects of care.
This chapter considers the skills required to meet the complete range of hygiene needs of the woman. Cleanliness and attention to physical appearance can be significant in promoting psychological wellbeing, as well as physical health. The principles of bed making are considered as well as personal, vulval and oral hygiene.
Personal hygiene
Cleanliness is a basic human right. It is something for which individuals will set their own standards; Downey & Lloyd (2008) suggest that it is inappropriate for health professionals to apply their own standards to the women that they care for. However, the Healthcare Commission (2007) found that approximately one-third of the complaints received related to failures in meeting personal hygiene and standards of privacy for inpatients in NHS Trust hospitals.
Meeting hygiene needs
Midwives work with women for whom their level of independence is generally sufficient for them to care for their own hygiene needs. The occasions when assistance may be required include:
• immobility: epidural or spinal analgesia, surgery or existing mobility problem
• intensive or high dependency care
• prescribed bed rest, e.g. antepartum haemorrhage.
Maintaining personal hygiene affects several aspects of care. Psychologically, most people feel ‘better’ when clean, in particular knowing that there are no offensive odours around them. This is especially the case with postnatal women and their perineal care. In addition, the skin itself is the largest body organ and needs to be kept free from breaks and infection in order to protect the inner organs. Where a wound does exist, good standards of hygiene are often the means of preventing colonisation and so aiding healing. Perineal trauma is one such example (Steen 2007). Vulval toilet is discussed below. Pressure-area care (see Chapter 53) – particularly when incontinence is also an issue – is an important aspect of care that maintains the skin’s integrity and is hindered by poor hygiene.
In ensuring that the woman’s hygiene needs are met the midwife should consider facilitating as much independence as is possible. Many people will feel embarrassed to have someone else undertaking very personal aspects of care. Mobility is also encouraged (when appropriate) to reduce the thromboembolic risks that accompany child bearing (see Chapter 54). Consequently, the following measures are often preferable to being bathed in bed:
• assisting a woman to sit with a bowl, or at the sink, midwife assisting as necessary
• assisting a woman into a bath or shower, remaining with her or returning after a few minutes to assist as required.
When assisting a woman to facilitate her own needs, care should be taken to ensure that all that she needs is with her (clean clothes, toiletries, pads, etc.) and that she has access to a call bell.
Assisting with hygiene needs (in whatever way) does necessitate a risk assessment. The use of infection control strategies (standard precautions and personal protective equipment) and moving and handling guidelines should be employed accordingly (Pegram et al 2007). Consideration should also be given to upholding individual preferences and dignity with privacy. Analgesia may be given and allowed to take effect before the procedure begins.
Bed bathing
Bed bathing aims to meet the complete hygiene needs of a woman if she is confined to bed, although Baker et al (1999) indicate that bed bathing is the least effective method of patient hygiene. If required, it is a task that can bring psychological wellbeing from the period of uninterrupted individualised care, it is also a time in which holistic care is completed. The following aspects of care should accompany a bed bath:
• observation of consciousness and levels of pain (on both resting and moving)
• observation of the skin, particularly areas of pressure (see Chapter 53), inflammation, infection or allergy
• general health and nourishment, oral intake of diet and fluids
• ante- or postnatal examination
• assessment of vital signs
• wound care
• catheter or bladder care, vulval toilet
• bowel care
• attention to circulation, passive or active exercises, observations for varicosities or oedema, prevention of complications associated with immobility (see Chapter 54)
• care of intravenous infusion and fluid balance
• oral hygiene
• hair washing, pedicure or manicure
• therapeutic touch, communication, education
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