Hygiene and Comfort: Nursing Practices

Hygiene and Comfort

• Hygiene is the science of health and its maintenance.
• Maintaining hygiene prevents diseases and illnesses.
• Personal hygiene includes bathing, toileting, and grooming.
• Nurses need to assess how much assistance clients need for hygienic care, especially after elimination or vomiting.
• Cultural beliefs influence hygienic care practices.

Factors Influencing Hygiene

• Cultural norms affect cleanliness values and privacy preferences during bathing.
• Religious practices may include ceremonial washings.
• Finances affect the availability of bathing facilities and hygiene products.
• Hygiene practices vary based on an individual's age and development level.
• Illness can reduce the motivation or energy for hygiene.
• Personal preferences influence the timing and method of bathing (shower vs. tub bath).

Cultural Aspects of Care

• Provide culturally congruent hygienic care, respecting patient preferences and maintaining privacy.
• Accommodate family participation in care and provide gender-congruent caregivers.
• Be aware of cultural beliefs regarding touch, hair care, and toileting practices.

Skin

• The skin is the largest organ and protects against microorganisms, regulates body temperature, and transmits sensations.
• Sebum lubricates the skin and hair and reduces water loss.
• Skin produces and absorbs vitamin D with sunlight.
• Intact, healthy skin is the body's first defense.
• Cleanliness reduces body odors caused by skin bacteria.
• Skin sensitivity varies among individuals.
• Agents used for skin care have specific actions and purposes.

Hygienic Care Types

• Early morning care involves providing a urinal or bedpan, washing face and hands, and giving oral care.
• Morning care includes elimination needs, bathing, perineal care, back massages, and oral, nail, and hair care.
• Hour of sleep or PM care involves elimination needs, washing face and hands, giving oral care, and back massage.
• As-needed (prn) care is provided as required, such as more frequent bathing for diaphoretic clients.

Providing a Bed Bath

• Patients may need total or partial assistance with bathing in bed due to physical limitations.
• Bed baths can be partial, focusing on essential body parts, or complete with no-rinse cleaning products.
• Common bedside skin-cleaning products include bathing cloths, wipes, and no-rinse body wash/shampoo.
• Types of baths include complete bed bath, partial bed bath, sponge bath at the sink, and tub bath.

Bath Types

• A shower provides more thorough cleaning but can cause fatigue.
• Bag baths contain premoistened cloths for ease of use and patient comfort.
• Chlorhexidine Gluconate (CHG) baths reduce hospital-acquired infections.

Special Nursing Considerations for Bed Baths

• Cleanse eyes with water only, wiping from inner to outer canthus with a separate corner of the mitt for each eye.
• Determine if the client would like to use soap on their face due to potential dryness it may cause.
• Wash, rinse, and dry arms and legs using long, firm strokes from distal to proximal areas to stimulate venous blood return.
• Assess bath water temperature and change it as necessary for comfort and cleanliness.

Assessment

• Assess preferences, physical limitations, and skin condition.

Hygiene Nursing Diagnoses

• Bathing Self-Care Deficit
• Impaired Skin Integrity
• Risk for Infection
• Risk for Impaired Skin Integrity

Expected Outcomes

• The patient will be clean and fresh and regain feelings of control and demonstrate understanding of cleanliness.

Giving a Bed Bath skills and actions

• Verify client identity to prevent errors
• Discuss procedure to promote reassurance and knowledge
• Perform hand hygiene and wear PPE to prevent contamination
• Gather equipment at bedside to facilitate task
• Provide client's privacy to prevent loss of body heat
• Prepare the bed and position client while maintaining bed height to prevent body strain
• Loosen top covers and replace, while maintaining warmth of patient.
• Remove the gown of client and keeps them covered in a bath blanket.
• Raise side rails, while making sure water is at comfortable temperature
• Fold the washcloth like mitt so there are no loose ends.
• Lay a towel across the client to cover and prevent chilling.
• Cleanses eyes with inner to outer motion.

SHAMPOOING A PATIENT'S HAIR IN BED

• Bed shampoos can be performed for patients unable to shower; shampoo caps are an option.
• Before starting, assess hygiene preferences, activity limitations, and inspect the scalp.
• Possible diagnoses include bathing self-care deficit, impaired physical mobility, and impaired transfer ability.
• Goal is for clean hair and increased comfort while patient tolerates the shampoo with minimal difficulty.

Shampooing a patients hair in bed skills and actions

• Review Limitations that may cause discomfort and injury to patients. Also confirm a shampooing order.
• Perform hand hygiene to prevent spread of contamination
• Explain procedure to patient, to validate that equipment is working properly
• Put equipment on over bed table for Organization.
• Close Privacy curtains for Patient.
• Raise bed head, while lowering patient for working procedure, also place pads under clothing
• Slowly put water in with pitcher to wet shampoo
• Apply soap in sections to clean
• Carefully wipe off soap from area
• Brush patients hair after procedure has been completed, while making sure clothing are safely intact

ASSISTING WITH ORAL CARE

• Adequate oral hygiene is essential for well-being and prevents oral cavity deterioration.
• Good oral hygiene limits pathogens, reducing the risk of pneumonia and other systemic diseases.
• Teeth should be brushed and flossed twice daily, and the mouth should be rinsed after meals.
• For cognitively impaired patients, choose a calm time, enlist family help, break tasks into steps, distract, and allow participation.

Oral Assessment

• Assess oral hygiene preferences, physical limitations, and the oral cavity for inflammation, lesions, and signs of dehydration.

Oral Care Relevant Diagnoses

• Risk for aspiration
• Impaired Oral Mucous Membrane
• Deficient Knowledge

Oral Care Actions

• Hand hygiene and PPE prevents microorganisms.
• Patient identify to ensure they the correct patient
• Assemble equipment for easy access

ASSISTING THE PT WITH ORAL CARE - Skills and Actions:

• close the room or curtains to maintain privacy
• place bed at comfort working height to prevent back pressure
• patients that aren't able, assist patient to sit upright
• moisten tooth brush and apply tooth paste
• place brush at 45 degree angle to clean all area
• brush tongue gently removing any unwanted debris

PROVIDING NAIL CARE

• Nail care prevents pain and infection, especially for those with diabetes or peripheral vascular disease.
• Assess nail care preferences, physical limitations, and signs of nail problems.
• Relevant diagnoses include risk for injury, bathing self-care deficit, and impaired physical mobility.
• The aim is for trimmed and clean nails with smooth edges and intact cuticles without trauma.

Nail Care - Nail Trimming Skills and Actions:

• Review past records to see if limitation may take affect, and preform procedure has ordered.
• Use proper hand washing habits with gloves to prevent spread
• Explain procedure to patient so they comply and cooperate
• Organize area for procedure
• Keep safe with privacy during the procedure
• Use equipment that provides the best results and reduce body trauma
• Use orangewood stick to push down any unwanted debris
• avoid cutting whole nail, and making too much damage to the patient

Making an unoccupied bed skills an actions

• Hand hygiene to prevent skin spread of contamination
• Expalliantina is key during treatment to reassure patient is safe under your supervision.
• Make sure items have been out on overbed table, for easy cleaning methods

Occupied bed skills actions

• Follow a set procedures like safety limitations for patients
• Check with team to come and help, to lift a patent side to side
• Always remind patents to stay flat to prevent body strain

PROVIDING BACK RUB

• A back massage benefits general relaxation and increases circulation while even reducing pain
• Review contraindications, such as back surgery or fractured ribs, before giving a back massage
• Techniques include Effleurage using a smooth and light motion

Back Rub / Massage Treatment and Actions:

• Hand washing is an important first step when meeting patients.
• Explain treatment to patients is good and safe.
• Glove is a must
• Keep a patients respect in mind provide private section
• Have the patient do assessment using the right tool to reduce false alarm
• Properly make contact with patients to provide comfort