Personal Care II

Baths, Showers, Perineal Care and Backrubs

Objectives:
After you take this class, you will be able to:

  1. Provide baths, showers, perineal care and back rubs according to the patientsí or residentsí unique needs.

  2. Adhere to basic safety, identification and standard precautions principles when providing personal care.


Introduction

Our patients and residents have a right to high quality personal care and hygiene. This class will give you a review about how to provide:

  • Baths
  • Showers
  • Perineal care
  • Back rubs

The course called Personal Care I covers mouth care, denture care, hair care, foot care, nail care and shaving.

The Special Needs of Some Patients and Residents

Our patients and residents are different in terms of how much personal care they can do their own. Some patients and residents:

  • can take care of their own personal care needs without our help;
  • others need a little help;
  • some need a lot of help with this care;
  • and still others can do nothing on their own. They need the nursing assistant to provide all of their personal care to them.

Nursing assistants do not have to do anything, other than providing privacy, when a patient is able to do all of their personal care without any help. Self care and independence should be encouraged for these people.

Nursing assistants have to give their clients as much help as needed when a patient is not able to provide their own personal care. Nursing assistants must often provide total personal care to patients when they are too young, too ill, too confused or physically unable to do it themselves.

Some Personal Care Principles

When providing personal care to patients and residents:

  • wash your hands and put on gloves before you provide personal care. Use standard precautions.

  • provide privacy. Pull the curtain. Close the door. Knock before you enter a room if the person is doing their own personal care.

  • introduce yourself to the person and tell them what you are going to do before you do it.

  • determine the identity of the patient. Accurate patient identification is part of all processes, including personal care.

  • maintain the safety of the patient at all times. Never leave the bed in a high position when you are not next to the bed. Never leave an infant, young child or confused person in a bathtub alone. They could drown even in a little bit of water. Check the temperature of the bath water before you use it. Make sure that grab bars are in place and that they are strong enough to hold the weight of the person. Keep the floor dry. Wet floors lead to slips and falls.

  • let the person choose when they want personal care. All patients do not need a bath before lunch. Some may prefer it in the evening.

  • observe the patient during personal care. Look at the person. Check their skin condition. Report any skin tears or signs of skin breakdown. Is the skin pale? Is it intact?

  • Listen to the person. Do they have any fears or concerns? Are there any changes in their mental state? Are they more or less confused than they were in the past? Are they aware of the day of the week, the date and where they are?

  • Feel the person's skin. Is it hot? Is it cold? Is it wet or moist?

  • Smell. Does the person have any odors?

  • immediately report any unusual findings to the nurse.

  • document all personal care. A flow sheet is often used to document personal care and activities of daily living.

  • get organized. Gather all the supplies and equipment that you will need.

  • make personal care an enjoyable aspect of the person’s life. Treat all your patients with respect and kindness.

Bathing

Baths clean the skin and keep it free of dirt, germs and sweat. It is also helps the blood flow in the body. Baths give us a chance to observe the person and their skin. Baths are also very comfortable and relaxing to the client.

Most baths are given in the morning but this is not always necessary. People can also shower or take a bath before bed. Let the person choose what they want.

A tub bath and a shower may only be necessary every other day if the person chooses this. Other people may need some bathing several times a day. People that are incontinent of urine and/or stool and those that sweat a lot may need to be bathed with a sponge (cloth) bath several times a day.


There are three different kinds of baths that are given in the healthcare setting:

  • Complete bed bath
  • Partial bed bath
  • Tub bath

Showering will be taught in the next section. A complete bed bath is given completely by the nursing assistant or other healthcare provider. A partial bed bath is one that is shared between the healthcare provider and the client. The client may just need the nursing assistant to gather up the basin, water, cloth and towel or the client may be able to wash their whole body except their back and their feet. If the person needs help washing their back and feet, the nursing assistant will only bathe these areas.

Partial and complete bed baths are given in the bed. Tub baths, with a doctor's order, are taken in a bathtub with or without the help of the nursing assistant. Showers also, with a doctor’s order, are taken with or without the help of a nursing assistant.

The temperature of ALL bath and shower water should be 110 degrees and not hotter. Hot water causes burns. Many hospitals, nursing homes and assisted living homes use regulators on showers and thermometers for bathtubs to make sure that the temperature is correct. If you do not have a thermometer, test the temperature of the water on your wrist before you use it.

Do NOT ever leave a young child, weak or confused person alone in a bathtub or shower. These people need privacy but they also need close monitoring so that they do not slip, fall or even drown.


When you are helping a client with a partial bed bath or helping a person with a tub bath or giving a complete bed bath, you should follow these steps after you have gotten all the supplies together, washed your hands, put on gloves, checked the temperature of the water, introduced yourself to the client, explained what you are about to do, identified the patient and given privacy:

  • raise the bed up to a good working height with the side rail up on the side that you are NOT next to,

  • remove the person's gown and cover the person with a bath blanket to give them privacy and to keep them warm,

  • wash, rinse and dry only one part of the body at a time and then re-cover the person with the bath blanket,

  • protect the bed linen by putting a towel under each body part as it is being washed,

  • wrap the wash cloth so that the ends of the cloth are turned inward and around your hand like a mitt,

  • rinse the cloth after each body part,

  • change the water when it is no longer clear or it is too cold,

  • starting at the top of the body, wash, rinse and dry the one eye from the inside near the nose to the outside using soap if the person wants it,

  • rinse the cloth,

  • then wash the other eye from the inside near the nose to the outside using soap if the person wants it,

  • then rinse the cloth,

  • wash the face, behind the ears and the neck,

  • then rinse the cloth,

  • wash the chest, then the arms and then the hands if you can do both sides of the client as you are standing on one side of the bed. If you have to move to the other side of the bed, take care of one whole side of the patient before moving to the other side of the bed,

  • then rinse the cloth,

  • wash the abdomen,

  • wash the groin using the male or female perineal care steps described below under Perineal Care,

  • safely turn the person on their side and wash, rinse and dry their back,

  • then rinse the cloth,

  • do a backrub with gentle circular strokes from the bottom of the spine up to and around the shoulders using the steps described below under Back Rubs,

  • put a clean gown on the person,

  • wash, rinse and dry the upper part of the legs down to and including the feet,

  • let the feet soak in the water if possible so that foot washing and nail care can be done well,

  • place the person in a comfortable position,

  • then lower the bed and the side rail,

  • clean up all the supplies and equipment.


Showering

As with all procedures, including personal care, you must wash your hands, put on gloves, introduce yourself to the client, explain what you are about to do, identify the patient and maintain privacy, standard precautions, caring, respect, comfort and safety throughout the task.

Showering and tub bathing require special safety measures.

  • Never leave a young child, a weak or confused person in the shower unattended.
  • Use a shower chair if the client has one and they need it.
  • Keep the floor dry.
  • Use non-skid bath and shower mats.

When you are helping a person with a shower, follow the same bathing steps as above and let the person be as independent as possible.

Perineal Care

Perineal care is the washing of the genital and rectal areas of the body. Perineal care should be done at least one time a day during the bed bath, shower, or tub bath. It is done more often when a client is incontinent. Perineal care prevents infection, odors and irritation.

Perineal care is done when a patient has a urinary catheter in place. It is also done when the client does not have a urinary catheter. Perineal care is done differently for men and women.

As with all procedures, wash your hands, put on gloves, introduce yourself to the client, explain what you are about to do, identify the patient and maintain privacy, standard precautions, caring, respect, comfort and safety throughout the task.

Perineal care for male patients without a urinary catheter has these additional steps:

  • fill the bath basin with clean water at 110 degrees,
  • position the male patient on their back,
  • put a protective cover over the bed linen,
  • wash the groin from the front to the back starting at the groin area and then going to the inside of the thighs,
  • then rinse the cloth or use a new washcloth,
  • pull back the foreskin if the patient is not circumcised,
  • wash and rinse the tip of the penis downward while using gentle, circular motions and then the scrotum,
  • rinse the cloth,
  • turn the person on their side,
  • and wash, rinse and dry the rectal area.


Perineal care for female patients without a urinary catheter has these steps:

  • fill the bath basin with clean water at 110 degrees,
  • position the female patient on their back,
  • put a protective cover over the bed linen,
  • separate the labia and wash, rinse and dry the urethral area first with short downward strokes alternating from side to side and proceeding until the exposed area around the urethra is done,
  • then rinse the cloth or use a new washcloth,
  • wash the groin on the outside of the labia from the front to the back starting outside the labia and then going to the inside of the thighs,
  • then rinse the cloth,
  • turn the person on their side,
  • and wash, rinse and dry the rectal area.

Perineal care for male and female patients with a urinary catheter has the above steps followed by these additional steps:

  • with a clean washcloth and soap, wash the catheter starting at the urinary opening with short strokes to about 4 inches away from the body
  • using a new washcloth, rinse the catheter starting at the urinary opening with short strokes to about 4 inches away from the body

Back Rubs

Back rubs should be given with every bed bath and more often. They are also helpful at bedtime to promote relaxation and every time you reposition a person that is unable to move on their own. Back rubs are comforting, they promote blood flow to the back and they prevent skin breakdown.

The steps of a back rub are:

  • warm the skin lotion in warm water,
  • wash your hands using warm water,
  • put on your gloves,
  • place the person on their side,
  • put the lotion on the palms of both hands,
  • apply the lotion to the person's back,
  • starting at the bottom of the spine and using long, smooth strokes move up to and around the shoulders and then down the sides of the back with special attention to the tail bone area where most pressure ulcers begin.


Summary

This class has given you information about some personal care procedures. Take the class called Personal Care I so you can also learn about oral care, denture care, hair care, shampooing, foot care, nail care and shaving.

References

Berman, Audrey, Shirlee Snyder, Barbara Kozier and Glenora Erb. (2010). Kozier & Erb's Fundamentals of Nursing: Concepts, Process, and Practice. 8th Edition. Pearson Prentice Hall.

Copyright © 2010 Alene Burke



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