The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [307]
Methods for care of the ears and nose
Lack of attention to cleaning the ears and nose can lead to impairment of the senses. Usually these small organs require minimal care but observation for a build-up of wax in the ears and deposits in the nose is essential to maintain patency. The outer ear can be cleaned with cotton wool or gauze and warm water (Alexander et al. 2007).
Patients undergoing enteral feeding and/or oxygen therapy should have regular nasal care to avoid excessive drying and excoriating of the delicate air passages. Gentle cleaning of the nasal mucosa with wool/gauze and water is recommended. Coating the area with a thin water-based lubricant to prevent discomfort can be beneficial, but petroleum jelly is not recommended as a nasal skin barrier when oxygen therapy is in progress as it is highly flammable. These interventions will remove debris and maintain a moist environment (Geraghty 2005).
Patients who have had piercing to the ears or nose will require cleaning of the holes to avoid the risk of infection. Gently cleaning around the pierced area with cotton wool/gauze and warm water and then towel drying is recommended. Observe for inflammation or oozing; if this occurs, inform the patient and doctor and seek permission from the patient to remove the device.
Legal and professional issues
Benchmarking
Benchmarking is a valid framework by which nurses can establish and share best practice throughout the work environment. Three benchmarks – hygiene, self-care and privacy and dignity – cited in the Essence of Care (DH 2001), are important to consider when reviewing patient hygiene and the care needs should be carried out to an uncompromising standard (Geraghty 2005) (Box 9.2).
Box 9.2 Essence of Care benchmarking standards for hygiene, self-care and privacy and dignity
All patients are assessed to identify the advice and/or assistance required in maintaining and promoting their individual personal hygiene.
Planned care is negotiated with patients and/or their carers and is based on assessment of their individual needs.
Patients have access to an environment that is safe and acceptable to the individual.
Patients are expected to supply their own toiletries but single-use toiletries are provided until they can supply their own.
Patients have access to the level of assistance that they require to meet their individual personal hygiene needs.
(DH 2001).
Preprocedural considerations
Non-pharmacological support
Soap
Persistent use of some soaps can alter the pH of the skin and remove the natural oils, leading to drying and cracking (Smoker 1999), which provide an ideal environment for bacteria to multiply (Holloway and Jones 2005). According to Ersser et al. 2005, patients with dry skin have a 2.5-fold greater likelihood of skin breakdown. In addition, patients may like to use moisturizers and this should be respected. Care should be taken with skinfolds and crevices, paying particular attention to thorough drying of the areas and observing for any breaks in the skin. It is recommended that the skin is patted and not rubbed, to reduce damage caused by friction (Ersser et al. 2005).
Emollient therapy
Current evidence recommends a move away from the traditional washing using soap and water, and recent research demonstrates that surfactants found in soap are irritant to the skin (Voegeli 2008). Penzer and Finch (2001) and Burr and Penzer (2005) recommend the use of emollient therapy for washing and moisturizing to seal the skin. In a literature review of hygiene practices, the use of soap and water remained common practice but several studies suggest that skin cleansers, for example emollient creams, followed by moisturizing may be less likely to disrupt the skin barrier and have a therapeutic benefit (Ersser et al. 2005). These products allow the patient