Bath: Shower or Tub, Assisting With PDF

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ƒ–ŠǣŠ‘™‡”‘”—„ǡ••‹•–‹‰‹–Š 43 ‹˜‹‰ƒƒ–Š•‹‰ƒ‹•’‘•ƒ„Ž‡‡ŽˆǦ ‘–ƒ‹‡† ƒ–Š‹‰›•–‡ continued cloth in trash receptacle. 18. Change bed linens as Apply skin barrier, as described in Skills 11 and indicated. 12. Dispose of soiled linens 17. Remove gloves. Assist according to facility policy. the patient to put on a 19. Remove gloves and clean gown. Perform additional PPE, if hand hygiene. Assist used. Perform hand with the use of other hygiene. personal toiletries.  ͝         A shower may be the preferred method of bathing for patients who are ambulatory and able to tolerate the activity. Tub baths may be an option, particularly in long-term care or other community-based settings, depending on facility policy. Make any necessary adaptations for indi- vidual patients. For example, if the patient is confused and becomes agi- tated as a result of overstimulation when bathing, reduce the stimuli. Turn down the lights and play soft music and/or warm the room before taking the patient into it (Johnson, 2011). Bathing is performed in a matter-of- fact and dignified manner. If this approach is followed, patients generally do not find care by a person of the opposite gender to be offensive or embarrassing. DELEGATION CONSIDERATIONS The implementation of a shower or tub bath may be delegated to nurs- ing assistive personnel (NAP) or unlicensed assistive personnel (UAP), as well as to licensed practical/vocational nurses (LPN/LVNs). The decision to delegate must be based on careful analysis of the patient’s needs and circumstances, as well as the qualifications of the person to whom the task is being delegated. Refer to the Delegation Guidelines in Appendix A. EQUIPMENT Personal hygiene supplies Robe and slippers or nonskid (deodorant, lotion, and socks others) Gown or pajamas, or clothing Skin-cleaning agent Laundry bag Emollient and skin barrier, as Shower or tub chair, as needed indicated Nonsterile gloves, as indicated Towels and washcloths Additional PPE, as indicated 44 SKILL 9 ASSESSMENT Assess the patient’s knowledge of hygiene practices and bathing preferences: frequency, time of day, and type of hygiene products. Assess for any physical-activity limitations. Assess the patient’s ability to bathe him- or herself. Assess the patient’s skin for dryness, redness, or areas of break- down, and gather any other appropriate supplies that may be needed as a result of the assessment. NURSING DIAGNOSIS Bathing Self-Care Deficit Risk for Infection Risk for Impaired Skin Integrity Deficient Knowledge OUTCOME IDENTIFICATION AND PLANNING Patient will be clean and fresh, and without injury. Patient regains feelings of control by assisting with the bath. Patient verbalizes positive body image. Patient demonstrates understanding about the need for cleanliness. IMPLEMENTATION ACTION RATIONALE 1. Review the patient’s health Identifying limitations prevents record for any limitations patient discomfort and injury. In in physical activity. Check some settings, a medical order is presence of medical order required for showering. for clearing the patient to shower, if required by facility policy. 2. Check to see that the bath- A clean bathroom prevents trans- room is available, clean, and mission of microorganisms. Mats safe. Make sure showers and and nonskid materials prevent tubs have mats or nonskid patients from slipping and fall- strips to prevent patients ing. Having a place for a weak or from falling. Place a mat or physically disabled patient to sit towel on floor in front of in a shower prevents falls; warm shower or tub. Put a shower water could cause vasodilation or tub chair in place, as and pooling of blood in lower appropriate. Place ‘occupied’ extremities, contributing to light- sign on door of room. headedness or dizziness. Use of sign allows others to be aware of use of room and ensures patient privacy.  ƒ–ŠǣŠ‘™‡”‘”—„ǡ••‹•–‹‰‹–Š 45 ACTION RATIONALE 3. Gather necessary hygienic Bringing everything to the bath- and toiletry items, and lin- ing location conserves time and ens. Place within easy reach energy. Arranging items nearby of shower or tub. is convenient, saves time, and avoids unnecessary reaching and possible falls. 4. Perform hand hygiene. Hand hygiene prevents the spread of microorganisms. 5. Identify the patient. Discuss Identifying the patient ensures the procedure with the the right patient receives the patient and assess the intervention and helps prevent patient’s ability to errors. Discussion promotes reas- assist in the bathing surance and provides knowledge process, as well as personal about the procedure. Dialogue hygiene preferences. encourages patient participation and allows for individualized nursing care. 6. Assist patient to bathroom to Voiding or defecating before void or defecate, if appropri- the bath lessens the likelihood ate. that the bath will be interrupted, because warm bath water may stimulate the urge to void. 7. Assist the patient to put on This ensures the patient’s pri- a robe and slippers or non- vacy, prevents chilling, and skid socks. Cover IV access decreases the risk for slipping site(s) according to facility and falling. Coverage of IV site policy. prevents loosening of dressings from exposure to moisture, and maintains integrity of IV access. 8. Assist the patient to the This prevents accidental falls. shower or tub. 9. Close the curtains around the This ensures the patient’s pri- shower or tub, as appropri- vacy and lessens the risk for loss ate and close the door to the of body heat during the bath. bathroom. Adjust the room Adjusting the water temperature temperature, if necessary. to 100°F to less than 120°F to Shower: Turn shower on. 125°F decreases risk of burns Check to see that the water and drying of the skin. The lower temperature is safe and temperature is recommended for comfortable. children and adults over 65 years 46 SKILL 9 ACTION RATIONALE Tub: Fill tub halfway with of age (Burn Foundation, 2012). water. Check to see that the Warm water is relaxing, stimu- water temperature is safe and lates circulation, and provides for comfortable. more effective cleansing. Water temperature should be 100°F to less than 120°F to 125°F. 10. Explain the use of the call Use of the call device allows the device and ensure that it is patient to call for help if neces- within reach of the shower sary. or tub. 11. Put on gloves, as indicated. Gloves are required if contact Help the patient get in and with blood or body fluids is out of the shower or tub, as anticipated. Gloves prevent the necessary. Use safety bars. transmission of microorganisms. For a tub: Have the patient This prevents slipping and grasp the handrails at the falling. side of the tub, or place a chair at the side of the tub. The patient sits on the chair and eases to the edge of the tub. After putting both feet into the tub, have the patient reach to the opposite side and ease down into the tub. The patient may kneel first in the tub and then sit in it. 12. If necessary, use a hydrau- This prevents slipping and falling lic lift, when available, and prevents strain and injury to to lower patients who are patients and nurses. unable to maneuver safely or completely bear their own weight. Some community- based settings have walk-in tubs available. 13. Adjust water temperature if These actions promote safety. appropriate, based on patient Health personnel should be able preference. Keep room door to enter with ease if the patient unlocked. Remain in room needs help. Gloves are required with patient to offer assistance, if contact with blood or body flu- as appropriate. If assistance is ids is anticipated. Gloves prevent needed with bathing, put on the transmission of microorgan- gloves. Otherwise, check isms. on patient every 5 minutes.  ƒ–ŠǣŠ‘™‡”‘”—„ǡ••‹•–‹‰‹–Š 47 ACTION RATIONALE Never leave young children or confused patients alone in the bathroom. 14. Assist patient out of shower This prevents slipping and fall- or tub when bathing is com- ing. Use of additional personnel plete. Obtain the assistance prevents strain and injury to of additional personnel as patients and nurses. appropriate. Use safety bars. For a tub: Drain the water from the tub. Have the patient grasp the handrails at the side of the tub. Assist the patient to the edge of the tub. Have the patient ease to a chair placed at the side of the tub, then remove feet out of tub. The patient may kneel first in the tub and then move to the side of the tub. 15. If necessary, use a hydraulic This prevents slipping and falling lift, when available, to raise and prevents strain and injury to patients who are unable to patients and nurses. maneuver safely or com- pletely bear their own weight. 16. Put on gloves, as indi- Gloves are required if contact cated. Assist the patient with blood or body fluids is with drying, application of anticipated. Gloves prevent the emollients, and dressing as transmission of microorganisms. appropriate or necessary. Prevents chilling and promotes Remove cover from IV patient comfort. Use of emol- access site. lients is recommended to restore and maintain skin integrity (Voegeli, 2010). 17. Remove gloves, if used. Removing gloves properly Assist patient to room and reduces risk for infection trans- into a position of comfort. mission and contamination of other items. Promotes patient comfort and safety. 18. Clean shower or tub Reduces risk for infection trans- according to facility policy. mission and contamination of Dispose of soiled linens other items. Allows others to according to facility policy. make use of room. Remove ‘occupied’ sign from door of bathroom.