When you start the process of assisting an individual with bathing What should you do first?

The level of assistance required with personal care, will vary greatly from individual to individual. As a starting point it is advisable to gather as much information as possible from the participant you are assisting, or their parents/carers, as to how much and what type of support they require. This is best done prior to the start of the program.

Table of Contents Show

Bathing and showering
Oral Hygiene

Dressing

Patience is a key consideration in helping a participant get dressed and the participant should be encouraged to do as much for his or herself as they can. This may take some time and encouragement. In helping a participant to dress, consider what they may feel or what they cannot feel. Tight clothing or clothing that is not smoothed over their body may result in unnecessary pressure, causing pressure sores and chaffing of skin.

Helping a participant dress may simply involve helping them to maintain balance or it may require that you remove and put on garments for them. Recognise which parts of the body are less able and place clothing on these parts first. For example, when helping a participant put on a jumper, put the arm that has least movement into the jumper first, then the other arm, place the arm in the air and pull the jumper over the head. To take it off, take out the “better” arm first, pull the jumper over the head and pull out the other arm.

Some participants may be more sensitive to temperature changes, so consider any extra clothing that may be needed as temperatures change.

Bathing and showering

Provide as much privacy as possible during bathing and showering. Only be present with the participant when absolutely required. A shower chair is good for participants who are not able to support their own weight and will assist them to wash themselves.

Where participants can independently wash themselves or at least parts of their bodies, encourage them to do so. It is a good idea to stay on the other side of the shower curtain while the participant washes to provide for privacy, but so you are available to assist as needed. Talking to the participant means you can remain aware, by their responses, of their safety.

It is important to ensure that the participant remains warm. Do not arrange for undressing until you are organised, for example, with the shower water on and temperature adjusted. Fresh clothing should be organised beforehand and put-on as quickly after the shower as possible. Be aware of slippery surfaces. Assist and provide protection where you can. Be careful when transferring a person in the bathroom.

Ensure that water temperature is carefully adjusted before the participant enters a bath or shower. Their sensation to hot and cold may be limited and the participant may not be able to communicate discomfort.

A participant may use special aids or equipment to make bathing easier such as a mitt to hold soap, a non-slip bath mator shower chair. Find out about these and make sure that they are available for use. Familiarise yourself with their operation.

Where a participant needs considerable assistance it may be difficult to provide this without getting wet yourself. It may be useful to put on your swimmers and get in the shower with them. Allow the participant to wash areas they can and assist with the more difficult areas to wash. Talk to the participant and find out what they feel comfortable with and how you can best assist them.

When assisting a participant with a bath or shower, ensure that another leader is nearby to avoid potential suggestions of improper conduct.

Oral Hygiene

All areas of personal hygiene may need to be considered, especially when on camp. Oral hygiene can easily be overlooked. Some participants may need assistance, as they may not have the fine motor skills to maintain their teeth and gums. Participants with disabilities due to cerebral palsy may have tactile hypersensitivity that can cause difficulty in having a toothbrush in the mouth. Discuss the regular oral hygiene practices used with the individual and their parents/carers and ensure that these practices are maintained whilst on camp.

Toileting

Some participants may need little to no assistance in going to the toilet, but may have difficulty in communicating their need to go to the toilet. Establish early in your communications with the participant, their way of letting you know that they need to go to the toilet. Some participants have poor bladder and bowel control and may have a program to be followed ensuring regular toilet attendance. Be aware of the program and make sure that it is followed as closely as possible. This type of information needs to be included on a program registration form.

The amount of assistance that a participant may require to go to the toilet can vary from holding the door open or helping them on or off the toilet. Try not to respond in an embarrassed manner but rather treat the situation in a matter-of-fact way, providing assistance as with any other activity. Either the parents/caregivers will let you know what methods to use or the participant will let you know how best to offer assistance.

A participant may have poor balance while sitting; be sure to support the participant on the toilet if necessary and do not leave them unattended.

Cleanliness and hygiene are very important. Everyone likes to feel and smell good. Make sure that the participant is completely dry and clean. Use sanitary gloves to clean up after bowel or bladder accidents and ensure that you wash your hands thoroughly.

It is also important to be prepared should a female participant have her period, especially during a residential camp. Make sure you get information on this prior to the camp and provide assistance as needed to ensure the participant is comfortable at all times.

In some cases a participant may have their own bedpan, urinal or commode. They are often more convenient to use at night. You will usually be well briefed about these requirements by parents/ caregivers, so do not feel awkward, just find out what to do and assist.

Ensure that all participants go to the toilet before bed. The same applies before going on a bus trip. This will help prevent accidental soiling. If the participant has a history of a lack of control over the bladder and bowels, take clean clothing when going on a trip or hike.

It is important that the participant’s dignity is retained all times. Privacy must be respected and the participant should be provided with as much privacy as possible. It is advisable not to be in situation where you are alone with a participant when you are providing assistance with dressing, showering or toileting. Always have another leader present to avoid potential suggestions of improper conduct. Leaders need to beware of the different interpretations that may be placed on physical contact. What may be considered as a sign of support or show of affection to one may have overtones of physical or sexual intrusion to another.

If it is not possible to have another leader present, think of ways in which you can assist so that other leaders know that you are providing assistance. It may be possible to leave a door open so that others can hear you talking with the participant, and at the same time ensure privacy. It is important that you do not put yourself in a position where a participant may interpret your assistance as inappropriate and as an intrusion of privacy. Limit the amount of time you are alone with a participant and encourage the participant to do as much for themselves as possible, within their abilities, to decrease the amount of physical contact required.

Bathing assistance is provided to those clients who cannot be independent in self care due to either physical or mental limitations.

Purposes of bathing:

To clean and deodorize the skin
To stimulate circulation
To produce a sense of well-being
To promote relaxation and comfort
To prevent and eliminate unpleasant body odors

Clients require varying degrees of help with bathing. Typically, clients can wash themselves with just a little assistance, like rinsing and wringing out the washcloth or washing their backs and feet. In those cases, the aide’s job includes:

Reading the care plan,
Organizing the equipment,
Anticipating what will be needed for this procedure,
Providing privacy and safety,
Offering a helping hand,
Observing the condition of the skin,
Doing the cleanup of the bathroom afterwards.

Reading the Care Plan:

Pay attention to the amount of help the client needs with the bath and make sure the care plan matches what the client needs.
If the care plan says the client needs only a stand-by assist into the shower, but you find that she
Cannot get into the shower at all due to her weakness, call the office and report this to the supervisor.
The supervisor needs to know about any changes in the client’s condition, which may change the plan of care.

Organizing the equipment (wash hands first):

Washcloth 1 or 2 bath towels, soap and shampoo if is part of the shower routine.
Lotion, powder, and deodorant.
Clean clothing, slippers or shoes.
(Basin for soaking feet, if this is sponge bath)

Anticipating what the client will need:

Think about your own daily routine and the things you need in order to complete your own personal care. Proceed in an organized manner.

Check out client preferences, like when to brush teeth – before or after shower?
Remind the client, if necessary, to use the toilet or urinal before bathing.

Providing Privacy and Taking Safety Precautions:

Assist the client as necessary with removing clothing.
As clothing is removed, offer a towel to drape the client.
- Ladies may need 2 towels: one around neck and down the front of chest, another around hips – or one bath towel around her torso and under arms.
- Men should be draped with one towel around the waist.
afety precautions should be taken to avoid wet surfaces and to offer stability during the step into the shower, etc.
Always make sure the floor of the tub or shower has a non-skid surface.
Have a small skid-resistant bath mat, rug, or dry towel for stepping out after showering.
Checking water temperature is a very important part of helping with bathing.
Test it as you would for your own shower or bath.
Have a stool or chair just outside the shower, in case the client becomes weak while bathing.
Have the client use the grab bars on the wall to assist sitting on the bath bench – if available.

Offer a helping hand:

Some clients might need minor guidance into the shower.
Check the water temp. Help direct the shower spray or hand the shower extension to the client.
Remove the privacy drapes discreetly.
The client may need assistance rinsing and wringing out the washcloth.
Offer to wash the client’s back, lower legs, and feet, if necessary.
If steady and not confused, the client can be left alone for a few minutes to complete the bath.
Stay within earshot and announce your re-entry to the bathroom.
Offer towels again and help to drape the client if necessary.
Help to dry the skin in hard-to-reach areas (back, feet, lower legs).
Offer deodorant, lotion, powder, etc.
Help client get dressed, but encourage independence as much as possible.
Provide hairbrush or comb, make-up, etc.

Observing the condition of the skin:

During the bathing process, it is important to notice the condition of the skin.
Report anything unusual: rashes, wounds, redness, swelling, tenderness, or bruises to the supervisor.

Bathroom cleanup:

After the shower, ease the client into a comfortable chair or bed.
Clean the tub or shower (or basin) with the client’s household or bathroom cleaner.
Hang towels to dry.
Put away all supplies.
Wash your hands.

Giving a Partial Bath

Partial baths involve _bathing face, hands, underarms, genitals, back, and buttocks. These body parts develop odors or become uncomfortable if not clean.
Partial bed baths are given to clients who cannot bathe themselves independently and are given on days when a complete bath or shower is not given.
Partial baths can be given at the bathroom sink or at bedside, depending on the client’s condition or preference.
Follow the general guidelines for the complete bed bath.

Complete Bed Bath:

Are ordered for persons confined to bed for medical reasons like illness and paralysis.
Are ordered for bed-bound persons who can help with their bathing procedures and should be encouraged to participate.
Should be done at bedside.

The purposes of bathing, as stated previously, are:

To clean and deodorize the skin
To stimulate circulation
To-promote a sense of well-being
To promote relaxation and comfort
To prevent and eliminate unpleasant body odors

Steps in performing the Complete Bed Bath:

Read the care plan. If you find the client’s condition requires a bed bath when he/she usually receives less assistance, report this to the supervisor because your care will not match the care plan established by the supervisor.

The client may be going through significant changes, which the supervisor should know about.

Prepare the client and the surroundings.
Close windows and doors to eliminate drafts.
Provide privacy.
Assist the client to use the bedpan, urinal, or commode.
Wash hands after handling toilet equipment.
Offer oral care assistance at this time.
(This can be done when the bath is finished.)
Remove heavy blankets from the bed.
Help the client to undress.
Cover client with a light sheet, blanket, or towels. I 0. Privacy drape.
Bath towels can be warmed in the dryer to provide additional comfort.
If using the bed sheet as a cover, loosen the ends from bottom of the bed.
If the client has a soiled incontinence pad, give peri-care and replace the pad before proceeding with the bath.
Make a bath “mitt” by folding the washcloth over your hand to form either a triangle or a rectangle. The mitt retains heat and moisture better than a washcloth that is loosely held.

Face, Head, and Neck

Wash the client’s face. Use warm water – not soap – for eyes-only.
Use a separate corner of the washcloth for each eye.
Wash eyes from inside corner toward outside corner.
Do cleaner areas first to prevent infecting tear ducts with secretions from the eyes.
Ask whether the client wants soap used on the rest of the face.
Wash, rinse, and dry the client’s face, ears, and neck.

Arms and Hands

Place the bath towel the long way under the client’s arm.
Wash, rinse, and dry the arm using long, firm strokes from the wrist to shoulder. This helps to stimulate circulation.
Move the towel under the hand.
Place the basin of water under the client’s hand.
Place the hand directly into the wam1water.
Assist client to wash, rinse, and dry the hand.
Repeat the above for the other arm and hand.

Chest and Abdomen

Fold the cover sheet down to the lower abdominal area.
Cover the chest with the towel.
Wash, rinse, and dry the chest, and abdomen.
Pay special attention to any skin folds of the belly or breasts.
Replace the cover sheet when all areas have been dried.
Check water and change if cloudy or cool.

Legs and Feet

Fold back the cover sheet to expose one leg and foot, keeping the client’s genitals covered.
Place the towel lengthwise under the leg.
Wash, rinse, and dry the leg from ankle to knee, then knee to thigh, with long, firm strokes.
Work from ankle upwards to help promote circulation.
Move basin and protective towel to the foot.
Place the foot in the warm water.
Wash between toes and check feet for breaks in the skin or reddened areas.
Dry the foot carefully.
Repeat the above for the other foot and leg.
Discard the water and start with fresh water. Use another dry towel if necessary.