The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [308]
Prepackaged cloths
Prepackaged cloths impregnated with cleanser and moisturizers are a cost-effective and evidence-based alternative to soap and water (Sheppard and Brenner 2000). They require no rinsing and are as effective at cleansing and more skin preserving than soap and water (Byers et al. 1995).
Skin care consists of four main areas: cleansing, hydrating/moisturizing, protection and replenishing (Voegeli 2008). Individual care actions often address more than one area at once, for example washing with water-based aqueous cream and water will cleanse and moisturize the skin.
Cultural and religious factors
The nurse must respect and consider the patient’s cultural and religious factors, while maintaining privacy and dignity at all times; for example, some people prefer to sit under running water as opposed to sitting in a bath (Hollins 2009, Sampson 1982). Some religions do not allow hair washing or brushing, while others may require the hair to be covered by a turban. Similarly, in some countries facial hair is significant and should never be removed without the patient’s/relatives’ consent. Always establish any preferences before beginning care (Hollins 2009) (Box 9.3).
Box 9.3 Religion-specific considerations related to personal hygiene
Those following Islam must perform ablution (wudhu, to use the Islamic term) before the daily prayer, which is the formal washing of the face, hands and forearms, and so on. One of the criteria for cleanliness is washing after the use of the lavatory. Any traces of urine or faeces must be eliminated by washing with running water, at least. The use of toilet tissues for cleaning is not sufficient. With such emphasis on washing and personal hygiene, adhering to the practical teaching of Islam on washing would enhance personal hygiene for the individual and therefore reduce the chance of disease and sickness individually and subsequently for the whole society.
Hindus also place importance on washing before prayer; they believe the left hand should dominate in this process and therefore do not eat with the left hand as it is deemed unclean.
Sikhs place great importance on not shaving or cutting hair, choosing to comb their hair twice a day and wash regularly. Male Sikhs wear their hair underneath a turban as a sign of respect for God.
Clothing
Effort should be made to encourage and empower patients to dress in their own clothing during the day, where possible, and in their own nightwear to sleep. This increases independence and well-being, encourages normality and promotes dignity. If the patient is too unwell or does not have their own clothing, hospital provision should be made available to protect their modesty (Wilson 2006).
Bed bathing
Before commencing this procedure, read the patient’s care plan, manual handling documentation and risk assessment to gain knowledge of safe practice. Prior to each part of the procedure, explain and obtain agreement from the patient (NMC 2008a). Planned care is negotiated with the patient and is based on assessment of their individual needs. Planned care should be documented and changed according to the patient’s/carer’s needs on a daily basis. Prior to commencing each step, the patient should be offered the opportunity to participate if able to, to encourage dignity, independence and autonomy.
Privacy and dignity must be maintained throughout, doors and curtains kept closed and only opened when absolutely necessary, with the patient’s permission.
Procedure guideline 9.1 Bed bathing a patient
Essential equipment
Disposable apron
Non-sterile gloves
Clean bedlinen
Bath towels
Laundry skip, applying local guidelines for soiled and/or infected linen
Flannels, preferably disposable wipes
Toiletries, as preferred by patient
Comb/brush
Equipment for oral hygiene
Clean clothes
Clean wash bowl
Optional equipment
Antiembolic stockings