The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [304]
Florence Nightingale (1859) first noted the importance of good personal hygiene and the essential role nurses have in maintaining this, to prevent infection and increase well-being. Since then, nursing models have provided a conceptual framework for nursing practice and all make some reference to meeting patients’ hygiene needs. Roper et al. 1981 adapted Henderson’s original concept of nursing (Henderson 1966) to develop a model reflecting the activities of daily living. Another example was given by Orem (1980) who focused on the ability of the patient to self-care and who refers to the universal self-care requisites of the skin, nail and hair condition and the patterns of standard hygiene. Gordon (1994) discusses formulation of nursing diagnosis. Following assessment, clusters of actual or potential health problems are established; specific diagnoses are used to describe these. Clinical knowledge is then applied, to provide problem-solving activities to achieve a set outcome.
The nurse’s role is continued provision of appropriate levels of cleanliness (Young 1991), which promotes ‘comfort, safety and well-being’ for the patient and should be carried out with skill and knowledge (Whiting 1999, p.339). Frequently, the time taken to attend to personal hygiene will provide ample opportunity for communication. Wilson states:
… a bed bath facilitates listening and enables the nurse to pick up cues to a patient’s anxieties and fears. It provides the time and opportunity for the nurse to offer support and encouragement when difficult situations have to be confronted, solutions sought and decisions made …
(Wilson 1986, p.81)
This also focuses on the nurse’s ability to be with the patient as well as providing for the patient (Campbell 1984) and is part of the essence of nursing care (Kitson 1999).
It is during the delivery of personal hygiene that the nurse is able to demonstrate a wide range of skills such as assessment, communication, observation and caring for the patient. This can be the most significant social interaction of the day for the patient, as the nurse develops a deeper understanding of the patient’s personality and needs, providing a personal bond between the nurse and patient (Hector and Touhy 1997). This relationship offers the nurse an opportunity to encourage the patient to reclaim autonomy and independence within this care need through participation, which can increase patients’ feelings of self-worth and dignity.
Healthcare assistants with a recognized qualification such as a National Vocational Qualification (NVQ) can complement the role of the qualified nurse in the implementation of planned care. It is vital that health professionals share their knowledge and any changes identified during procedures; personal feedback and documentation are good vehicles for this.
Comfort, cleanliness, availability of washing facilities, privacy and assistance from nurses were expressed as being important in providing hygiene care by patients in a recent ward audit (unpublished) at the Royal Marsden Hospital. The prevention of infection is also pertinent and will be referred to, as is patient education and health promotion.
Within the activity, opportunities may arise for the patient to discuss issues, concerns or fears that they may have regarding admission, treatment, discharge planning or prognosis. This will help to build a therapeutic relationship and highlight health and social care needs.
The world of nursing is ever changing, and there is a risk that activities such as attending to the personal hygiene of patients may become devalued or just another routine (Voegeli 2008). The literature supports the enhanced quality of care for patients, when hygiene needs are attended to by qualified/experienced practitioners (Carr-Hill et al. 1992). Personal hygiene is considered part of the essence of care that