Individuals, whenever possible, should be encouraged to perform their own personal hygiene so that their independence is promoted. Bathing may involve assisted washes in or out of bed, bed bathing, showering or immersion in a general bath. Care must be taken throughout to keep wounds or dressings dry, and such considerations may influence the mode of choice.
Equipment:
The equipment required will vary according to individual client needs but may include soap, face cloth, two towels (one face and one bath), disposable wipes, clinical waste disposable bags, toiletries (for example, deodorant, perfume, aftershave), client’s comb/brush, bowl of hot water (35–40ºC), gloves and apron, lotion thermometer, suitable bath/shower, chair/shower stool, disposable floor mat, appropriate aids if bathing/ shaving, clean nightdress/pyjamas or clothing as required, clean bed linen/linen skip and a trolley/adequate surface. The procedures and rationales of bed bathing are given below.
Procedure
|
Rationale
|
Plan activity around
client’s daily routine and
in line with other
nursing activities
|
Promote normal routine and reduce unnecessary disturbance
|
Explain the
procedure to the client
|
To gain informed consent and client’s co-operation and
participation in the activity
|
Collect and prepare
the equipment
|
To ensure all equipment is ready to use
|
Prepare the
environment so that it is warm.
Close windows and
ensure privacy
|
Avoids chilling the client
|
Adjust the height of
the bed if necessary.
Check brakes of bed
are on
|
Client comfort and safety
|
Ensure adequate
space around bed area for
equipment
|
Easy, comfortable access
|
Ask client if they
wish to empty their bladder
and/or bowels and
ensure that they are pain
free before bathing
|
Client may otherwise be anxious and unco-operative during
procedure
|
Help the client into
a comfortable position
|
Client co-operation and easier access for the nurse
|
Remove bed linen but
leave one sheet
covering the client
|
To maintain client’s privacy and dignity
|
Assist the client to
remove nightwear if
necessary
|
Client may be unable to do this without assistance
|
Be aware of
intravenous lines, catheters,
drains, injuries and
client’s level of mobility, and
sequence removal of
nightwear accordingly
|
To avoid injury and discontinuing lines
|
Fill the bowl and
check the temperature of the
water using lotion
thermometer. If client is
co-operative ask
them if the water
temperature is to
their liking
|
Client comfort and safety. Meeting individual’s preferences
|
Ask client if they
use soap on their face
before commencing
|
Negotiated care. Also, persistent use of some soaps can
alter the pH of the skin leading to drying. Soap can also
irritate the eyes
|
Involving the client
as much as they desire and
are able, wash the
face, taking care to be
particularly gentle
around the eyes. Use a
clean area of the
cloth for each eye and clean
the eyes from the
inner to the outer canthus.
Wash and check the
ears. Rinse and dry
|
To promote independence and activity/ movement.
Prevents debris being dragged into the tear ducts and
pathogens being transferred from one eye to the other.
To prevent unnecessary cooling
|
Wash the neck. Rinse
and dry
|
To prevent unnecessary cooling
|
Continue washing,
rinsing and drying the
client, exposing
each area to be washed as
follows:
|
Protects modesty and promotes dignity
|
Arms (wash from the
hands, paying particular
attention to the
nails), washing the arm
furthest away from
the nurse first;
|
Allows assistant to dry and reduces the risk of cooling
|
Chest and abdomen;
continue in the same
manner washing the
back, lower limbs and
feet, exposing only
the area being washed
|
Ensures that all parts of the body are washed and moves
from ‘clean’ to ‘dirty’ systematically, thus facilitating
team working
|
A towel can be used
to protect the bottom
sheet during the
procedure
|
This prevents the client having to lie on a wet sheet
|
Pay particular
attention to the axillae, umbilicus,
skin folds of
breasts, abdomen and groin,
carefully rinsing
flannel or disposing of wipes
after each use
|
Axillae are usually heavily colonized by bacteria,
therefore flannels should not be reused without cleansing. Wipes are better
disposed of. Prevents odour, skin irritation. Prevents cross-infection
|
Change the water as
it cools or becomes dirty
|
Prevents cooling of the client, increases cleanliness and
promotes client comfort
|
Pay particular
attention to the toenails and
areas between the
toes
|
To reduce the actual/potential pain and risk of infection.
NB It is generally not acceptable to cut clients’ nails due to
risk of injury, particularly of those of clients with diabetes in whom wound
healing is usually poor. Referral to a chiropodist is preferable (check local
policy)
|
If desired and
appropriate help client to
immerse hands and
feet in bowl of water,
supporting the limbs
|
To promote relaxation and client comfort
|
Leave perineal
hygiene until last. Change
water, put on gloves
and use disposable wipes.
Always clean from
front to back using as
many wipes as
necessary to cleanse the area
|
Prevents transmission of microorganisms from anus to
urethra
|
Dispose of soiled
disposable materials including
gloves into a
clinical waste bag when finished
|
Prevention of cross-infection
|
Throughout procedure
observe and assess
the client’s skin
for blemishes, bruises,
swelling and
redness. If present report same
and document in
client’s records
|
To monitor client’s condition and reduce the likelihood of
the development of pressure sores
|
Assist client to
dress in clean nightwear/clothing
of their choice.
Apply deodorant/perfume/
make-up in keeping
with client preference
|
Promote patient comfort, independence and self-esteem
|
Change bed linen as
necessary
|
Prevent cross-infection
|
Provide a mirror to
encourage client to comb/
brush hair in
preferred style
|
Promotes self-esteem
|
If necessary assist
client with brushing teeth
and/or rinsing mouth
(see ‘Assisting individuals
with oral hygiene’,
below)
|
To promote good oral hygiene
|
Remove all equipment
and leave the area
clean and tidy
|
Safety of the client and the environment.
Prevents transmission of infection
|
Ensure that the
client is comfortable with
desired articles
within easy reach
|
For ease of access and to promote client independence
|
Remove apron, wash
hands
|
Prevent risk of cross-infection
|
Document client’s
reaction to the procedure
in nursing care
plan. Report any abnormal
findings or adverse
reactions and update
care plan
accordingly
|
Legal requirement. Facilitates good communication
amongst health care staff
|
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