Chapter 23

Grooming

Objectives

Hair care, shaving, nail and foot care, and clean garments prevent infection and promote comfort. Such measures affect love, belonging, and self-esteem needs.

People differ in their grooming measures. Some want only clean hair. Others want a certain hairstyle. Some want only clean hands. Others want polished nails. Men may shave and groom their beards. Likewise, women may shave their legs and underarms. Some women use hair removal methods for facial hair.

As with hygiene, the person performs grooming measures to the extent possible. This promotes independence and quality of life. The person may use adaptive devices (Fig. 23-1).

image
FIGURE 23-1 Grooming aids. A, Long-handled combs and brushes for hair care. B, A button hook to button and zip clothing. C, A sock assist to pull on socks and stockings. D, A shoe remover to take off shoes. (Courtesy North Coast Medical Inc., Morgan Hill, Calif.)

See Focus on Surveys: Grooming.

See Teamwork and Time Management: Grooming.

Focus on Surveys

Grooming

Grooming promotes the person's self-esteem and self-worth. Therefore surveyors will observe if patients and residents:

Teamwork and Time Management

Grooming

Some grooming equipment is shared among patients and residents. Shampoo trays, electric shavers, nail clippers, and whirlpool foot baths are examples. Let your co-workers know when you need an item. Schedule the item following agency policy. When done, promptly clean and return the item to its proper place. Do not make your co-workers look for or clean an item.

Hair Care

The look and feel of hair affect mental well-being. The nursing process reflects the person's culture, personal choice, skin and scalp conditions, health history, and self-care ability. You assist with hair care as needed.

See Focus on Long-Term Care and Home Care: Hair Care.

Focus on Long-Term Care and Home Care

Hair Care

Long-Term Care

Beauty and barber shops are common in nursing centers (Fig. 23-2). Residents can have their hair shampooed, cut, and styled. Men can have their mustaches and beards groomed.

image
FIGURE 23-2 Beauty shop in a nursing center.

Skin and Scalp Conditions

Skin and scalp conditions include hair loss, excessive body hair, dandruff, lice, and scabies.

  • • Alopecia means hair loss. Hair loss may be complete or partial. A result of heredity, male pattern baldness occurs with aging. Hair thins in some women with aging. Cancer treatments (radiation therapy to the head and chemotherapy) may cause alopecia in all age-groups. Skin disease, stress, poor nutrition, pregnancy, some drugs, and hormone changes are other causes. Except for hair loss from aging, hair usually grows back.
  • • Hirsutism is excessive body hair. It can occur in men, women, and children. It results from heredity and abnormal amounts of male hormones.
  • • Dandruff is the excessive amount of dry, white flakes from the scalp. Itching is common. Sometimes eyebrows and ear canals are involved. Medicated shampoos correct the problem.
  • • Pediculosis (lice) is the infestation with wingless insects (Fig. 23-3). Infestation means being in or on a host. Lice attach their eggs (nits) to hair shafts. Nits are oval and yellow to white in color. They hatch in about 1 week. After hatching, they bite the scalp or skin to feed on blood. About the size of a sesame seed, adult lice are tan to gray-ish white in color. Lice easily spread to others through clothing, head coverings, furniture, beds, towels, bed linens, and sexual contact. They also are spread by sharing combs and brushes. Lice are treated with medicated shampoos, lotions, and creams specific for lice. Thorough bathing is needed. So is washing clothing and linens in hot water. Lice bites cause severe itching in the affected body area.
    • • Pediculosis capitis is the infestation of the scalp (capitis) with lice. It is commonly called “head lice.”
    • • Pediculosis pubis is the infestation of the pubic (pubis) hair with lice. This form of lice is also called “crabs.”
    • • Pediculosis corporis is the infestation of the body (corporis) with lice.
    image
    FIGURE 23-3 Head lice. (Redrawn from Medline Plus: Head lice. Bethesda, Md., National Institutes of Health.)
  • • Scabies is a skin disorder caused by a female mite (Fig. 23-4). A mite is a very small spider-like organism. The female mite burrows into the skin and lays eggs. After hatching, the females produce more eggs. Infested with mites, the person has a rash and intense itching. Common sites are between the fingers, the wrists, underarm areas, thighs, and genital area. Other sites include the breasts, waist, and buttocks. Highly contagious, scabies is transmitted to others by close contact. Persons in crowded living settings are at risk. So are persons with weakened immune systems. Special creams are ordered to kill the mites. The person's room is cleaned. Clothing and linens are washed in hot water.
    image
    FIGURE 23-4 Scabies. (From Marks JG, Miller JJ: Lookingbill & Marks' principles of dermatology, ed 4, St Louis, 2006, Saunders.)

See Focus on Communication: Skin and Scalp Conditions.

Focus on Communication

Skin and Scalp Conditions

Some skin or scalp conditions may alarm you. Remain professional. Do not say things that may embarrass the person.

Report an abnormal skin or scalp condition. Describe what you saw as best as you can. For example:

image Brushing and Combing Hair

Brushing and combing hair are part of early morning care, morning care, and afternoon care. Some people also do so at bedtime. Provide hair care when needed and before visitors arrive.

Encourage patients and residents to do their own hair care. The person chooses how to brush, comb, and style hair. Assist as needed. Provide hair care for those who cannot do so.

Brushing increases blood flow to the scalp. And it brings scalp oils along the hair shaft to help keep hair soft and shiny. Daily brushing and combing prevent tangled and matted hair. To brush and comb hair, start at the scalp. Then brush or comb to the hair ends.

Braiding prevents long hair from matting and tangling. You need the person's consent to braid hair. Report matted or tangled hair to the nurse. The nurse may have you comb or brush through the matting and tangling from the hair ends to the scalp. Never cut the person's hair.

Special measures are needed for curly, coarse, and dry hair. For curly hair, use a wide-tooth comb. Start at the neckline. Working upward, lift and fluff hair outward. Continue to the forehead. Wet hair or apply conditioner, petroleum jelly, or other hair care product as directed. This makes combing easier. Follow the care plan for coarse and dry hair.

The person may have certain hair care practices and products. They are part of the care plan. Also, let the person guide you when giving hair care.

See Caring about Culture: Brushing and Combing Hair.

See Focus on Children and Older Persons: Brushing and Combing Hair.

See Delegation Guidelines: Brushing and Combing Hair.

See Promoting Safety and Comfort: Brushing and Combing Hair.

See procedure: Brushing and Combing Hair, p. 370.

image Caring About Culture

Brushing and Combing Hair

Small braids (cornrows) are common in some cultural groups. The braids are left intact for shampooing. To undo these braids, the nurse obtains the person's consent.

image Brushing and Combing Hair imageimageimage

Quality of Life

Pre-Procedure

  1. 1 Follow Delegation Guidelines: Brushing and Combing Hair, p. 369. See Promoting Safety and Comfort: Brushing and Combing Hair, p. 369.
  2. 2 Practice hand hygiene.
  3. 3 Identify the person. Check the ID (identification) bracelet against the assignment sheet. Use 2 identifiers (Chapter 13). Also call the person by name.
  4. 4 Ask the person how to style hair.
  5. 5 Collect the following.
  6. 6 Arrange items on the bedside stand.
  7. 7 Provide for privacy.

Procedure

  1. 8 Lower the bed rail if up.
  2. 9 Position the person.
  3. 10 Place a towel across the person's back and shoulders or across the pillow.
  4. 11 Ask the person to remove eyeglasses. Put them in the eyeglass case. Put the case inside the bedside stand.
  5. 12 Brush and comb hair that is not matted or tangled.
  6. 13 Brush or comb matted or tangled hair.
  7. 14 Style the hair as the person prefers.
  8. 15 Remove the towel.
  9. 16 Let the person put on the eyeglasses.

Post-Procedure

  1. 17 Provide for comfort. (See the inside of the front cover.)
  2. 18 Place the call light and other needed items within reach.
  3. 19 Lower the bed to a safe and comfortable level for the person. Follow the care plan.
  4. 20 Raise or lower bed rails. Follow the care plan.
  5. 21 Remove hair from the brush or comb. Clean and return hair care items to their proper place. Wear gloves for this step. Remove and discard the gloves. Practice hand hygiene.
  6. 22 Unscreen the person.
  7. 23 Complete a safety check of the room. (See the inside of the front cover.)
  8. 24 Follow agency policy for used linens.
  9. 25 Practice hand hygiene.

image Shampooing

People vary in shampoo frequency—1, 2, or 3 times a week or daily. Factors affecting frequency include hair and scalp condition, hairstyle, and personal choice.

Some persons use certain shampoos and conditioners. Others use medicated products ordered by the doctor.

The person may need help shampooing. The nurse tells you what method to use. The shampoo method depends on the person's condition, safety factors, and personal choice.

Some agencies have commercial shampoo caps. The cap has a cleaning agent that does not need rinsing. Some caps also have a conditioner. To use a shampoo cap:

Dry and style hair as soon as possible after the shampoo. Women may want hair curled or rolled up before drying. Check with the nurse before doing so.

See Focus on Children and Older Persons: Shampooing.

See Focus on Long-Term Care and Home Care: Shampooing, p. 372.

See Delegation Guidelines: Shampooing, p. 372.

See Promoting Safety and Comfort: Shampooing, p. 372.

See procedure: Shampooing the Person's Hair, p. 373.

image Shampooing the Person's Hair imageimage

Quality of Life

Pre-Procedure

  1. 1 Follow Delegation Guidelines: Shampooing. See Promoting Safety and Comfort: Shampooing.
  2. 2 Practice hand hygiene.
  3. 3 Collect the following.
  4. 4 Arrange items nearby.
  5. 5 Identify the person. Check the ID bracelet against the assignment sheet. Use 2 identifiers (Chapter 13). Also call the person by name.
  6. 6 Provide for privacy.
  7. 7 Raise the bed for body mechanics for a shampoo in bed. Bed rails are up if used.
  8. 8 Practice hand hygiene.

Procedure

  1. 9 Lower the bed rail near you if up.
  2. 10 Cover the person's chest with a bath towel.
  3. 11 Brush and comb the hair to remove snarls and tangles.
  4. 12 Position the person for the method used. For a shampoo in bed:
  5. 13 Raise the bed rail if used.
  6. 14 Obtain water. Water temperature is usually 105°F (40.5°C). Test water temperature according to agency policy. Also ask the nurse to check the water. Adjust the water temperature as needed. Raise the bed rail before leaving the bedside.
  7. 15 Lower the bed rail near you if up.
  8. 16 Put on gloves (if needed).
  9. 17 Ask the person to hold a washcloth over the eyes. It should not cover the nose and mouth. (NOTE: A damp washcloth is easier to hold. It will not slip. However, your agency may require a dry washcloth.)
  10. 18 Use the water pitcher or nozzle to wet the hair.
  11. 19 Apply a small amount of shampoo.
  12. 20 Work up a lather with both hands. Start at the hairline. Work toward the back of the head.
  13. 21 Massage the scalp with your fingertips. Do not scratch the scalp with your fingernails.
  14. 22 Rinse the hair until the water runs clear.
  15. 23 Repeat steps 19 through 22.
  16. 24 Apply conditioner. Follow directions on the container.
  17. 25 Squeeze water from the person's hair.
  18. 26 Cover the hair with a bath towel.
  19. 27 Remove the shampoo tray, basin, and waterproof pad.
  20. 28 Dry the person's face with a towel. Use the towel on the person's chest.
  21. 29 Help the person raise the head if appropriate. For the person in bed, raise the head of the bed.
  22. 30 Rub the hair and scalp with the towel. Rub gently. Use the second towel if the first one is wet.
  23. 31 Comb the hair to remove snarls and tangles.
  24. 32 Dry and style hair.
  25. 33 Remove and discard the gloves (if used). Practice hand hygiene.

Post-Procedure

  1. 34 Provide for comfort. (See the inside of the front cover.)
  2. 35 Place the call light and other needed items within reach.
  3. 36 Lower the bed to a safe and comfortable level for the person. Follow the care plan.
  4. 37 Raise or lower bed rails. Follow the care plan.
  5. 38 Unscreen the person.
  6. 39 Complete a safety check of the room. (See the inside of the front cover.)
  7. 40 Clean, rinse, dry, and return equipment to its proper place. Remember to clean the comb and brush. Wear gloves for this step. Discard disposable items. Remove and discard the gloves.
  8. 41 Follow agency policy for used linens.
  9. 42 Practice hand hygiene.
  10. 43 Report and record your observations.

image Shaving

Many men shave for comfort and well-being. Many women shave their legs and underarms. Some women shave facial hair. Other hair removal methods include waxing, hair removal products, plucking, and threading. See Box 23-1 for shaving rules.

Safety razors or electric shavers are used (Fig. 23-9). Some persons have their own electric shavers. If the agency's shaver is used, clean it before and after use. To brush out whiskers or hair, follow the manufacturer's instructions. Also follow agency policy for cleaning electric shavers.

image
FIGURE 23-9 Electric shaver and safety razor.

Safety razors (blade razors) have razor blades. They can cause nicks and cuts. Do not use safety razors on persons with healing problems or for those taking anticoagulant drugs. An anticoagulant is a drug that prevents or slows down (anti) blood clotting (coagulate). Bleeding occurs easily and is hard to stop. A nick or cut can cause serious bleeding. Electric shavers are used.

Soften the beard before shaving. To do so, apply a moist, warm washcloth or towel for a few minutes. Then pat dry the face and apply talcum powder if using an electric shaver. For a safety razor, lather the face with soap and water or shaving cream.

See Focus on Children and Older Persons: Shaving.

See Delegation Guidelines: Shaving.

See Promoting Safety and Comfort: Shaving.

See procedure: Shaving the Person's Face With a Safety Razor.

image Shaving the Person's Face With a Safety Razor imageimageimage

Quality of Life

Pre-Procedure

  1. 1 Follow Delegation Guidelines: Shaving. See Promoting Safety and Comfort: Shaving.
  2. 2 Practice hand hygiene.
  3. 3 Collect the following.
  4. 4 Arrange paper towels and supplies on the over-bed table.
  5. 5 Identify the person. Check the ID bracelet against the assignment sheet. Use 2 identifiers (Chapter 13). Also call the person by name.
  6. 6 Provide for privacy.
  7. 7 Raise the bed for body mechanics. Bed rails are up if used.

Procedure

  1. 8 Fill the wash basin with warm water.
  2. 9 Place the basin on the over-bed table.
  3. 10 Lower the bed rail near you if up.
  4. 11 Practice hand hygiene. Put on gloves.
  5. 12 Assist the person to semi-Fowler's position if allowed or to the supine position.
  6. 13 Adjust lighting to clearly see the person's face.
  7. 14 Place the towel over the person's chest and shoulders.
  8. 15 Adjust the over-bed table for easy reach.
  9. 16 Tighten the razor blade to the shaver if necessary.
  10. 17 Wash the person's face. Do not dry.
  11. 18 Wet the washcloth or towel. Wring it out.
  12. 19 Apply the washcloth or towel to the face for a few minutes.
  13. 20 Apply shaving cream with your hands. Or use a shaving brush to apply lather.
  14. 21 Hold the skin taut with 1 hand.
  15. 22 Shave in the direction of hair growth. Use shorter strokes around the chin and lips (Fig. 23-10, p. 376).
    image
    FIGURE 23-10 Shave the face in the direction of hair growth. Use long strokes on the larger areas of the face. Use short strokes around the chin and lips.
  16. 23 Rinse the razor often. Wipe it with tissues or paper towels.
  17. 24 Apply direct pressure to any bleeding areas (Chapter 54).
  18. 25 Wash off any remaining shaving cream or soap. Pat dry with a towel.
  19. 26 Apply after-shave or lotion if requested. (If there are nicks or cuts, do not apply after-shave or lotion.)
  20. 27 Remove and discard the towel and gloves. Practice hand hygiene.

Post-Procedure

  1. 28 Provide for comfort. (See the inside of the front cover.)
  2. 29 Place the call light and other needed items within reach.
  3. 30 Lower the bed to a safe and comfortable level for the person. Follow the care plan.
  4. 31 Raise or lower bed rails. Follow the care plan.
  5. 32 Clean, rinse, dry, and return equipment and supplies to their proper place. Discard the razor blade or disposable razor into the sharps container. Discard other disposable items. Wear gloves.
  6. 33 Wipe off the over-bed table with paper towels. Discard the paper towels.
  7. 34 Unscreen the person.
  8. 35 Complete a safety check of the room. (See the inside of the front cover.)
  9. 36 Follow agency policy for used linens.
  10. 37 Remove and discard the gloves. Practice hand hygiene.
  11. 38 Report nicks, cuts, irritation, or bleeding to the nurse at once. Also report and record other observations.

image Nail and Foot Care

Nail and foot care prevents infection, injury, and odors. Hangnails, ingrown nails (nails that grow in at the side), and nails torn away from the skin cause skin breaks. These breaks are portals of entry for microbes. Long or broken nails can scratch skin and snag clothing.

The feet are easily injured and infected. Dirty feet, socks, or stockings harbor microbes and cause odors. Shoes and socks provide a warm, moist environment for microbes to grow. Injuries occur from stubbing toes, stepping on sharp objects, or being stepped on. Poorly fitting shoes cause blisters.

Poor circulation prolongs healing. Diabetes and vascular diseases are common causes of poor circulation. Foot injuries or infections are very serious for older persons and persons with circulatory disorders. Gangrene and amputation are serious complications (Chapter 44).

Nails are easier to trim and clean right after soaking or bathing. Use nail clippers to cut fingernails. Never use scissors. Use extreme caution to prevent damage to nearby tissues.

Trimming and clipping toenails can easily cause injuries. Some agencies do not let nursing assistants cut or trim toenails. Follow agency policy.

See Teamwork and Time Management: Nail and Foot Care.

See Focus on Long-Term Care and Home Care: Nail and Foot Care.

See Delegation Guidelines: Nail and Foot Care.

See Promoting Safety and Comfort: Nail and Foot Care.

See procedure: Giving Nail and Foot Care, p. 378.

Focus on Long-Term Care and Home Care

Nail and Foot Care

Home Care

The feet soak during a tub bath. Or the person can sit on the side of the tub to soak the feet. Make sure the person can step into and out of the tub. Or have the person use a shower bench to get in and out of the tub (Chapter 22). Otherwise, soak the feet in a basin or a whirlpool foot bath.

If comfortable for the person, he or she can soak the fingers in the sink. Or use a bowl if you do not have a small basin.

Teamwork and Time Management

Nail and Foot Care

Use your time well when giving nail and foot care. The fingernails soak for 5 to 10 minutes. The feet soak for 15 to 20 minutes. You can make the person's bed or straighten the person's unit during soak time. Or you could assist with brushing and combing hair. Check your assignment sheet for other ways to meet the person's needs.

Promoting Safety and Comfort

Nail and Foot Care

Safety

To cut fingernails, use nail clippers. Clip the fingernails straight across (Fig. 23-11). Then file the nails.

image
FIGURE 23-11 Clip fingernails straight across. Use nail clippers.

Remember, some states and agencies do not let nursing assistants cut and trim toenails. The RN (registered nurse) or podiatrist (foot [pod] doctor) cuts toenails and provides foot care for the following persons. You do not cut or trim the toenails for persons who:

Check between the toes for cracks and sores. These areas are often overlooked. If not treated, a serious infection could occur.

The feet are easily burned. Persons with decreased sensation or circulatory problems may not feel hot temperatures.

After soaking, apply lotion or petroleum jelly to the feet. This can cause slippery feet. Help the person put on non-skid footwear before you transfer the person or let the person walk.

Breaks in the skin and bleeding can occur. Follow Standard Precautions and the Bloodborne Pathogen Standard.

Comfort

Sometimes you just trim the fingernails. Sometimes you just give foot care. To do both, the person sits at the over-bed table (Fig. 23-12). Provide for warmth and comfort.

image
FIGURE 23-12 Nail and foot care. The feet soak in a whirlpool foot bath. The fingers soak in a kidney basin.

Promote your own comfort during nail and foot care. Sit in front of the over-bed table to clean and trim fingernails. For foot care, rest the person's lower leg and foot on your lap. Or position the feet on the floor and kneel on the floor. Lay a towel across your lap or put a bath mat on the floor to protect your uniform. Use good body mechanics. Always support the person's foot and ankle during foot care.

image Giving Nail and Foot Care imageimageimage

Quality of Life

Pre-Procedure

  1. 1 Follow Delegation Guidelines: Nail and Foot Care, p. 377. See Promoting Safety and Comfort: Nail and Foot Care, p. 377.
  2. 2 Practice hand hygiene.
  3. 3 Collect the following.
  4. 4 Arrange paper towels and other items on the over-bed table.
  5. 5 Identify the person. Check the ID bracelet against the assignment sheet. Use 2 identifiers (Chapter 13). Also call the person by name.
  6. 6 Provide for privacy.
  7. 7 Assist the person to the bedside chair. Remove footwear and socks or stockings. Place the call light and other needed items within reach.

Procedure

  1. 8 Place the bath mat under the feet.
  2. 9 Fill the wash basin or whirlpool foot bath image (two-thirds) full with water. The nurse tells you what water temperature to use. (Measure water temperature with a bath thermometer. Or test it by dipping your elbow or inner wrist into the basin. Follow agency policy.) Also ask the person to check the water temperature. Adjust the water temperature as needed.
  3. 10 Place the basin or foot bath on the bath mat.
  4. 11 Put on gloves.
  5. 12 Help the person put his or her bare feet into the basin or foot bath. Both feet are completely covered by water.
  6. 13 Adjust the over-bed table in front of the person.
  7. 14 Fill the kidney basin image (two-thirds) full with water. See step 9 for water temperature.
  8. 15 Place the kidney basin on the over-bed table.
  9. 16 Place the person's fingers into the basin. Position the arms for comfort (see Fig. 23-12).
  10. 17 Let the fingers soak for 5 to 10 minutes. Let the feet soak for 15 to 20 minutes. Re-warm water as needed.
  11. 18 Remove the kidney basin.
  12. 19 Dry the hands and between the fingers thoroughly.
  13. 20 Clean under the fingernails with the orangewood stick. Use a towel to wipe the orangewood stick after each nail.
  14. 21 Push cuticles back with the orangewood stick or a washcloth (Fig. 23-13).
    image
    FIGURE 23-13 Push the cuticle back with an orangewood stick.
  15. 22 Clip fingernails straight across with the nail clippers (see Fig. 23-11).
  16. 23 File and shape nails with an emery board or nail file. Nails are smooth with no rough edges. Check each nail for smoothness. File as needed.
  17. 24 Apply lotion to the hands. Warm lotion before applying it.
  18. 25 Move the over-bed table to the side.
  19. 26 Remove and discard the gloves. Practice hand hygiene. Put on clean gloves. (NOTE: Some state competency tests require clean gloves for foot care.)
  20. 27 Lift a foot out of the water. Support the foot and ankle with 1 hand. With your other hand, wash the foot and between the toes with soap and a washcloth. Return the foot to the water for rinsing. Make sure you rinse between the toes.
  21. 28 Repeat step 27 for the other foot.
  22. 29 Remove the feet from the basin or foot bath. Dry thoroughly, especially between the toes. Support the foot and ankle as needed.
  23. 30 Apply lotion or petroleum jelly to the tops, soles, and heels of the feet. Do not apply between the toes. Warm lotion or petroleum jelly before applying it. Remove excess lotion or petroleum jelly with a towel. Support the foot and ankle as needed.
  24. 31 Remove and discard the gloves. Practice hand hygiene.
  25. 32 Help the person put on non-skid footwear.

Post-Procedure

  1. 33 Provide for comfort. (See the inside of the front cover.)
  2. 34 Place the call light and other needed items within reach.
  3. 35 Raise or lower bed rails. Follow the care plan.
  4. 36 Clean, rinse, dry, and return equipment and supplies to their proper place. Discard disposable items. Wear gloves.
  5. 37 Unscreen the person.
  6. 38 Complete a safety check of the room. (See the inside of the front cover.)
  7. 39 Follow agency policy for used linens.
  8. 40 Remove and discard the gloves. Practice hand hygiene.
  9. 41 Report and record your observations.

Changing Garments

Hospital patients usually wear patient gowns or other sleepwear. Nursing center residents wear street clothes during the day and sleepwear at bedtime. Garments are changed:

image Dressing and Undressing

When assisting with dressing and undressing, follow the rules in Box 23-2.

See Focus on Communication: Dressing and Undressing.

See Focus on Children and Older Persons: Dressing and Undressing.

See Focus on Long-Term Care and Home Care: Dressing and Undressing.

See Delegation Guidelines: Dressing and Undressing, p. 380.

See Promoting Safety and Comfort: Dressing and Undressing, p. 380.

See procedure: Undressing the Person, p. 380.

See procedure: Dressing the Person, p. 382.

Focus on Communication

Dressing and Undressing

Allow for personal choice and independence when assisting with dressing and undressing. You can ask:

image Undressing the Person imageimageimage

Quality of Life

Pre-Procedure

  1. 1 Follow Delegation Guidelines: Dressing and Undressing. See Promoting Safety and Comfort: Dressing and Undressing.
  2. 2 Ask a co-worker to help turn and position the person if needed.
  3. 3 Practice hand hygiene.
  4. 4 Collect a bath blanket and clothing as requested by the person.
  5. 5 Identify the person. Check the ID bracelet against the assignment sheet. Use 2 identifiers (Chapter 13). Also call the person by name.
  6. 6 Provide for privacy.
  7. 7 Raise the bed for body mechanics. Bed rails are up if used.
  8. 8 Lower the bed rail on the person's weak side.
  9. 9 Position him or her supine.
  10. 10 Cover the person with a bath blanket. Fan-fold linens to the foot of the bed.

Procedure

  1. 11 Remove garments that open in back.
  2. 12 Remove garments that open in the front.
  3. 13 Remove pullover garments.
  4. 14 Remove pants or slacks.
  5. 15 Dress the person. See procedure: Dressing the Person, p. 382.

Post-Procedure

  1. 16 Provide for comfort. (See the inside of the front cover.)
  2. 17 Place the call light and other needed items within reach.
  3. 18 Lower the bed to a safe and comfortable level for the person. Follow the care plan.
  4. 19 Raise or lower bed rails. Follow the care plan.
  5. 20 Unscreen the person.
  6. 21 Complete a safety check of the room. (See the inside of the front cover.)
  7. 22 Follow agency policy for soiled clothing.
  8. 23 Practice hand hygiene.
  9. 24 Report and record your observations.

image Dressing the Person imageimage

Quality of Life

Pre-Procedure

  1. 1 Follow Delegation Guidelines: Dressing and Undressing, p. 380. See Promoting Safety and Comfort: Dressing and Undressing, p. 380.
  2. 2 Ask a co-worker to help turn and position the person if needed.
  3. 3 Practice hand hygiene.
  4. 4 Ask the person what he or she would like to wear.
  5. 5 Get a bath blanket and clothing requested by the person.
  6. 6 Identify the person. Check the ID bracelet against the assignment sheet. Use 2 identifiers (Chapter 13). Also call the person by name.
  7. 7 Provide for privacy.
  8. 8 Raise the bed for body mechanics. Bed rails are up if used.
  9. 9 Lower the bed rail (if up) on the person's weak side.
  10. 10 Position the person supine.
  11. 11 Cover the person with a bath blanket. Fan-fold linens to the foot of the bed.
  12. 12 Undress the person. (See procedure: Undressing the Person, p. 380.)

Procedure

  1. 13 Put on garments that open in the back.
  2. 14 Put on garments that open in the front.
  3. 15 Put on pullover garments.
  4. 16 Put on pants or slacks:
  5. 17 Put socks and non-skid footwear on the person. Make sure socks are up all the way and smooth.
  6. 18 Help the person get out of bed. If the person stays in bed, cover the person. Remove the bath blanket.

Post-Procedure

  1. 19 Provide for comfort. (See the inside of the front cover.)
  2. 20 Place the call light and other needed items within reach.
  3. 21 Lower the bed to a safe and comfortable level for the person. Follow the care plan.
  4. 22 Raise or lower bed rails. Follow the care plan.
  5. 23 Unscreen the person.
  6. 24 Complete a safety check of the room. (See the inside of the front cover.)
  7. 25 Follow agency policy for soiled clothing.
  8. 26 Practice hand hygiene.
  9. 27 Report and record your observations.

image Changing Patient Gowns

Many patients wear patient gowns. So do some nursing center residents. Gowns are usually worn for IV (intravenous) therapy (Chapter 28). Some agencies have IV therapy gowns that open along the sleeve and close with ties, snaps, or Velcro. Sometimes standard gowns are used.

For injury or paralysis, remove the gown from the strong arm first. Support the weak arm while removing the gown. Put the clean gown on the weak arm first and then on the strong arm.

See Delegation Guidelines: Changing Patient Gowns.

See Promoting Safety and Comfort: Changing Patient Gowns.

See procedure: Changing a Patient Gown on a Person With an IV.

Delegation Guidelines

Changing Patient Gowns

Before changing a gown, you need this information from the nurse and the care plan.

image Changing a Patient Gown on a Person With an IV imageimage

Quality of Life

Pre-Procedure

  1. 1 Follow Delegation Guidelines: Changing Patient Gowns. See Promoting Safety and Comfort: Changing Patient Gowns.
  2. 2 Practice hand hygiene.
  3. 3 Get a clean gown and bath blanket.
  4. 4 Identify the person. Check the ID bracelet against the assignment sheet. Use 2 identifiers (Chapter 13). Also call the person by name.
  5. 5 Provide for privacy.
  6. 6 Raise the bed for body mechanics. Bed rails are up if used.

Procedure

  1. 7 Lower the bed rail near you (if up).
  2. 8 Cover the person with the bath blanket. Fan-fold linens to the foot of the bed.
  3. 9 Untie the gown. Free parts that the person is lying on.
  4. 10 Remove the gown from the arm with no IV.
  5. 11 Gather up the sleeve of the arm with the IV. Slide it over the IV site and tubing. Remove the arm and hand from the sleeve (Fig. 23-24, A).
    image
    FIGURE 23-24 Changing a gown. A, The gown is removed from the arm with no IV. The sleeve on the arm with the IV is gathered up, slipped over the IV site and tubing, and removed from the arm and hand. B, The gathered sleeve is slipped along the IV tubing to the bag. C, The IV bag is removed from the pole and passed through the sleeve. D, The gathered sleeve of the clean gown is slipped over the IV bag at the shoulder part of the gown.
  6. 12 Keep the sleeve gathered. Slide your arm along the tubing to the bag (Fig. 23-24, B).
  7. 13 Remove the bag from the pole. Slide the bag and tubing through the sleeve (Fig. 23-24, C ). Do not pull on the tubing. Keep the bag above the person.
  8. 14 Hang the IV bag on the pole.
  9. 15 Gather the sleeve of the clean gown that will go on the arm with the IV infusion.
  10. 16 Remove the bag from the pole. Slip the sleeve over the bag at the shoulder part of the gown (Fig. 23-24, D). Hang the bag.
  11. 17 Slide the gathered sleeve over the tubing, hand, arm, and IV site. Then slide it onto the shoulder.
  12. 18 Put the other side of the gown on the person. Fasten the gown.
  13. 19 Cover the person. Remove the bath blanket.

Post-Procedure

  1. 20 Provide for comfort. (See the inside of the front cover.)
  2. 21 Place the call light and other needed items within reach.
  3. 22 Lower the bed to a safe and comfortable level for the person. Follow the care plan.
  4. 23 Raise or lower bed rails. Follow the care plan.
  5. 24 Unscreen the person.
  6. 25 Complete a safety check of the room. (See the inside of the front cover.)
  7. 26 Follow agency policy for used linens.
  8. 27 Practice hand hygiene.
  9. 28 Ask the nurse to check the flow rate.
  10. 29 Report and record your observations.

Focus on Pride

The Person, Family, and Yourself

Personal and Professional Responsibility

Grooming promotes comfort. Self-esteem and body image improve when the person likes how he or she looks. Clean hair, nails, and garments all help mental well-being. So does a clean-shaven face or a well-groomed beard or mustache.

Your attitude is reflected in the way you give care. To show that you value the person's self-esteem and comfort:

Also, care for your own appearance. Patients, residents, and family members notice when others are not well groomed. If you are not groomed well, they may question the quality of care you provide. Have a professional appearance.

Rights and Respect

People have different grooming preferences. Ask what the person prefers. For example, ask what he or she would like to wear. Or ask how to style the person's hair. Follow the person's grooming routines whenever possible.

You may not like the person's hairstyle, clothing choices, or personal care products. Do not judge the person by your own standards or impose your choices on the person. Do not make the person feel badly about his or her choices. Respect the person's right to choose. Assist with grooming in a way that improves the person's self-esteem.

Independence and Social Interaction

Some family members want to help with grooming. For example, they want to style the person's hair. Or they want to apply lotion to the person's hands and feet.

With the person's permission, allow family members to assist with grooming measures as much as safely possible. This promotes social interaction. It also involves the family in the person's care.

Delegation and Teamwork

Grooming takes time. You, the person, the nurse, and other team members work together to plan and organize care. For example, Mr. Horn had a stroke. He needs help with grooming. He eats breakfast at 0800, has speech therapy at 0930, has physical therapy at 1030, and his wife visits during lunch. Mr. Horn prefers to comb his hair, shave, and change his clothes after breakfast but before his wife visits. He also likes to rest after physical therapy. You plan to assist Mr. Horn with grooming after breakfast and before speech therapy.

Grooming is important. Do not neglect grooming because of a busy schedule. Plan ahead to meet the person's needs at a time best for the person and the team.

Ethics and Laws

Patients and residents have the right to be free from mistreatment and restraint (Chapter 2). The following is a case where a nurse did not follow these ethical principles.

A nurse told a patient that she was going to cut his hair and trim his beard. The patient repeatedly stated that he did not want a haircut or his beard trimmed. The patient protested and resisted the nurse's actions. She continued her actions while 2 other staff members restrained the patient.

The patient reported the incident to his social worker. An internal investigation was conducted.

The nurse lost her job. The United States Court of Appeals agreed that the nurse's termination was warranted because of:

(L. Taylor v Department of Veterans Affairs, 2006.)

Never force a care measure on a person. If a person resists or refuses care, stop. Do not proceed. Politely ask the person for the reason. Tell the nurse. You, the nurse, and the person can discuss a solution.

Special care measures are needed for persons with confusion or dementia who resist care. See Chapter 49. Patience, kindness, and problem solving are needed. A co-worker or family member may need to give care. Or care may need to be given at a different time. Provide care in a way that protects the person's rights and shows dignity and respect.

Focus on Pride: Application

The family cares about the person's appearance. They notice when grooming differs from usual. The family may tell you what they expect. Why are their comments important? How can you show that you value their input?

Review Questions

Circle T if the statement is TRUE or F if it is FALSE.

1. T F Scabies is contagious.

2. T F Mustaches are trimmed weekly.

3. T F Feet are soaked for 5 to 10 minutes.

4. T F Fingernails are clipped straight across.

5. T F Wear gloves when giving nail care.

6. T F Clothing is removed from the weak side first.

7. T F The person chooses what to wear.

8. T F A person has poor circulation in the legs and feet. You can trim the person's toenails.

9. T F You can cut matted hair.

Circle the BEST answer.

10. A person with alopecia has

a Excessive body hair

b Dry, white flakes from the scalp

c An infestation with lice

d Hair loss

11. Which prevents hair from matting and tangling?

a Bedrest

b Daily brushing and combing

c Daily shampooing

d Cutting hair

12. A person's hair is not matted or tangled. When brushing hair, start at

a The forehead and brush backward

b The hair ends

c The scalp

d The back of the neck and brush forward

13. Brushing keeps the hair

a Soft and shiny

b Clean

c Free of lice

d Long

14. A person requests a shampoo. You should

a Shampoo the hair during the person's shower

b Shampoo hair at the sink

c Shampoo the person in bed

d Follow the care plan

15. When shaving a person's face with a safety razor

a Discard the razor in the wastebasket when done

b Shave against the direction of hair growth

c Hold the skin taut

d Shave when the skin is dry

16. A person is nicked during shaving. Your first action is to

a Wash your hands

b Apply direct pressure

c Tell the nurse

d Apply a bandage

17. Fingernails are cut with

a An emery board

b Scissors

c A nail file

d Nail clippers

18. Fingernails are filed

a Before soaking

b After soaking

c Before trimming toenails

d After trimming toenails

19. Garments are applied

a To the weak side first

b To the strong side first

c To either the weak or the strong side first

d In the same way they are removed

20. When changing the gown on a person with an IV

a Keep the IV bag below the person's arm

b Stop the IV pump to change the gown

c Have the nurse check the flow rate afterward

d Disconnect the IV to change the gown

See Review Question Answers at the back of the text.

Focus on Practice

Problem Solving

A resident with dementia has long fingernails. Some are broken and have rough edges. As you begin nail care, she resists. She swings her arms at you and yells. What do you do? Why is nail care important for this resident? How might you provide care safely?