Nurse’s Responsibility in Giving Bed Bath
1. Check the physician’s orders to see the specific precautions if any, regarding the positioning and movement of the client.
2. Assess the client’s need for bathing
3. Assess the client’s ability for self care.
4. Assess the cardio respiratory functioning. Check T.P.R. and B.P.
5. Assess the client’s mental state to follow directions
6. Check the client’s preference for soap, powder etc
7. Check whether the client has taken the meal in the previous one hour
Preparation of Articles
All needed equipment should be at hand and conveniently placed before beginning the procedure so as to avoid leaving the client unnecessarily until the entire procedure has been completed. Arrange articles in the order of use, the following articles are required:
1. Bath basin (1)
Purpose: to take water for bath
2. Small bowl (1)
Purpose: to keep the sponge cloth separately that is used for putting the soap
3. Soap with soap dish
4. Wash clothes (2)
Purpose: one to apply the soap and the other one to clean the skin
5. Bath towels (2)
Purpose: one to protect the bed and the other one to dry the skin
6. Face towel (1) (if available)
Purpose: to dry the face
7. Bath blanket or sheet
Purpose: to cover the client
8. Methylated spirit and powder
Purpose: to treat the pressure points
9. Scissors or nail cutters
Purpose: to cut short the nails
10. Nail file
Purpose: to smoothen the cut surfaces of the nails
11. Comb and oil
Purpose: to attend the hair
12. Kidney tray and paper bag
Purpose: to collect the wastes (nails, hair etc)
13. Jugs (2)
Purpose: to keep hot and cold water
14. Bucket (1)
Purpose: to discard the waste water, when water is changed in between
15. Clean linen (personal and bed clothes as needed)
Purpose: to keep the client clean
16. Bucket or a laundry bag
Purpose: to discard the soiled linen
Preparation of the Client and Unit
1. Explain the sequence of the procedure to the client and explain how the client can assist you
2. Move the unnecessary items from the work area
3. Place the articles needed conveniently on the bedside table
4. Adjust the height of the bed to the comfortable working of the nurse
5. Bring the client to the edge of the bed and towards the nurse to prevent overreaching
6. Check the room temperature and warm it if necessary
7. Close the windows if necessary and put off the fan to prevent draughts
8. Provide privacy by the means of curtains
9. Remove the top bed linen or fanfold them to the foot end of the bed, leaving a sheet or bath blanket over the client. Keep if free at the foot end to allow freedom for the legs
10. Offer bedpan or urinal if necessary (wash hands)
11. Keep the client flat if the condition permits. Remove extra pillows and back rest.
12. Remove the personal clothing and cover the client with the bath blanket. If the client has I.V., remove the gown from the arm without I.V. First, then lower the I.V. bottle, slide gown up the I.V. tubing and over the I.V. container. Rehang the I.V. container and check the rate of flow.
Steps of Procedure
1. Wash hands
Reason: to prevent cross infection
2. Mix hot and cold water in the basin and check the temperature on the back of the hand. Fill the basin half full.
Reason: the skin on the bed of the hand is a sensitive area to assess the temperature of the water
3. Place the towel under the chin. Wash, rinse and dry areas in the following sequence – face, neck, farthest arm, near arm, chest, abdomen, back, farthest leg, near leg and pubic region.
Reason: protect the bed becoming wet. Cleaning is done from the cleanest area to the least clean area. Upper part of the body first, before the lower part of the body.
4. Take a wash cloth, wet it, squeeze the excessive water, make it mitten, apply soap on it and clean the face, ears and neck. Put back the wash cloth in the small bowl provided
Reason: wash cloth used for the application of soap is kept separately in order to keep the water in the basin as clean as possible.
5. Take the other wash cloth, rinse it in water, squeeze it, make a mitten and clean the area where soap is applied. Repeat the procedure till the area is cleaned thoroughly. Put back the wash cloth in the basin.
Reason: the wash clothes are made into a mitten to avoid dragging its cold wet ends over the skin of the client and make him uncomfortable.
6. Dry the face with the face towel
7. Place the bath towel lengthwise under the farthest arm. Clean and dry the farthest arm as described above. Pay special attention to axilla. Support the arm at the joints.
Reason: axilla is moist with perspiration. If not properly cleaned, the soap and dirt will remain in the axilla and harbor microorganisms. Arms are supported to prevent fatigue.
8. Repeat the procedure on the near arm
9. Place the basin on the bath towel at the edge of the bed and let the client place hands in the basin. Rinse and dry thoroughly, paying particular attention to the skin between fingers and nails.
Reason: hands are more contaminated area and soaked in water enable the nurse to clean them thoroughly.
10. Place one corner of the bath towel over one shoulder and the opposite corner folded back and placed on the other shoulder. Both corners are fixed under the back of the client. Fold bath blanket down to the level of the umbilicus
Reason: draping the chest properly provides privacy and warmth while keeping the bath blanket dry for later replacement over the client.
11. With the left hand raise the towel and the right hand mitted, cleanse the chest as before. Replace the towel over the chest between wash, rinse and dry periods. Remember to wash under the breasts.
Reason: observe the chest and breasts for any abnormalities. Note the respirations.
12. While the towel remaining on the chest, fold back the bath blanket down to the pubic region, clean and dry the abdomen. Give special attention t the cleanliness of the umbilicus and creased folds of abdomen.
Reason: observe the abdomen for abnormalities
13. Remove the towel and put back the bath blanket and cover the client completely
Reason: care is taken to prevent draughts
14. Change water. The waste water is discarded into the bucket
Reason: to get clean water for back care. Changing water at intervals, maintain a comfortable temperature
15. Turn the client to a prone or side lying position with the face away from the nurse. Make sure that the client will not fail to the ground.
Reason: allows the visualization of the back when the client is turned away from you.
16. Fold back the bath blanket from the shoulder to the thighs and tuck the edges securely around the thighs. Place the towel over the bed, close to the back, lengthwise.
Reason: the entire back is exposed from the shoulder to the buttocks for the thorough cleaning of the back
17. Wash, rinse and dry the back from the shoulders to the buttocks with brisk circular movements. After drying the back give a thorough back rub with methylated spirit and powder. Pay particular attention to the pressure points.
Reason: a thorough cleaning, a back rub and the application of spirit and powder prevents bedsores. The spirits hardens the protein. Therefore, it toughens the skin and make the skin more resistant to pressure. Powder absorbs moisture and keeps the skin dry. It also protects the skin against friction.
18. Put on the upper garments and cover him with the bath blanket
19. Change water
20. Expose the farthest leg. Place the bag towel lengthwise under the leg. Flex the knee so that the sole of the foot is supporting on the mattress. Place the basin on the towel and keep the foot in the basin. Wash and rinse the thigh and leg with the wash clothes. Clean the foot under the water paying particular attention to the toes and nails.
Reason: placing the foot in the water and cleaning facilitates thorough cleaning. The feet are considered to be the least clean area. Observe the legs.
21. Remove the basin and dry the entire leg and repeat the procedure on the near leg.
22. Wash the pubic area. It can be done by the client if he is able. If he is not able to do it for himself the nurse does for him making sure that the entire area is washed thoroughly and dried.
Reason: the cleanliness of the pubic area is often neglected by the clients and by the nurses.
After Care of the Client and Articles
1. Replace the client’s personal clothing
2. Straighten the bed linen
3. Remove the bath blanket and put it for washing
4. Change the bed linen if needed
5. Offer a hot drink if permitted
6. Cut short the finger nails and the toe nails. The nail cuttings should be received in the kidney tray
7. Comb the hair and arrange the hair
8. Position the client for comfort and proper alignment
9. Take all articles to the utility room. Disinfect the bath basin and the wash clothes.
10. Send the soiled linen to the laundry. Put back all the articles in the proper places after cleaning. Personal articles are replaced into the bedside table.
11. Wash hands. Record the procedure in the nurse’s record with time and date and the type of bath. Record any abnormalities observed.
12. Take the opportunity to reach the client or his relatives about the personal hygiene.
Types of Cleansing Bath
1. Bed Bath
Complete bed bath, partial bed bath, self-help bath. The client can have a complete bed bath or a partial bath. In complete bed bath, the whole body is bathed out, but in a partial bed bath only the areas where the secretions accumulate are cleaned e.g., the face, hands, axillae, back and perineum. Sometimes the term self administered bed bath is used in which the clients is confined to bed but is able to bathe himself completely except for his back and legs. The nurse provides everything for bath within the easy reach of the client.
2. Bathroom Bath, Shower Bath, Tub Bath
In past years, most clients were bathed in bed. As emphasis increased on preventing complications of immobility, the clients are now encouraged to bathe out of bed. In the bathing room, the clients can take a shower bath or a tub bath. The nurse, while sending the clients for a bath in the bathroom, should keep in mind the safety of the clients. The bathrooms should be equipped with some types of signaling device and the clients need to be cautioned to call for help when feeling weak or faint. Collect needed items and place them conveniently for the clients. The bathroom should not be locked but, an “occupied” sign on the door will provide privacy. The client should be protected from chills before, during and after the bath.
3. Partial Bath (Back Rub)
The clients who are prone to bedsores, must have their back treated two hourly or more frequently. The back is washed with soap and water, dried and massaged with powder. Using powder or any other lubricant prevents friction between the hands and the client’s body. Massaging helps to increase the blood supply to the area and prevents bedsore.
Stroking with both hands from buttocks towards shoulders and back again to buttocks, completes one round. Continue the technique, at least 8 to 10 times and cover the whole back. Attending to other pressure points at iliac crests, ankles, heels, elbows etc. are beneficial to the clients to prevent bedsores. Dry the area by patting and not by rubbing.
4. Ideal Time for Bath
The ideal time for bath is in the morning before breakfast along with the morning care given to the client. It should not be given immediately after a meal so as to interfere with the process of digestion. Wait for at least 1 hour after taking the meal.
Bed bath means bathing a client who is confined to bed and who does not have the physical and mental capability of self bathing. The clients who need bath in bed are those who are in plaster casts and traction, on strict bed rest, paralyzed, unconscious and those who have undergone surgery.
1. To clean the body off dirt and bacteria
2. To increase elimination through the skin
3. To prevent bedsores
4. To stimulate circulation
5. To induce sleep
6. To provide comfort to the client
7. To relieve fatigue
8. To give the client a sense of well being
9. To regulate body temperature
10. To provide active and passive exercises
11. To observe objective symptoms
12. To give the nurse an opportunity for health teaching
13. To establish an effective nurse-client relationship
General Instructions for Giving a Bed Bath
1. Maintain privacy of the clients by means of screens, curtains or drapes
2. Explain the procedure to win the confidence and the cooperation of the client
3. Wash hands before and after the procedure
4. All articles used in bed bath should be absolutely clean
5. Client’s unit should be warm and free of draughts
6. All needed equipment should be at hand and conveniently placed before beginning the procedure so as to avoid leaving the client unnecessarily until the entire procedure has been completed
7. Conserve the energy of the client by avoiding unnecessary exertions
8. Remove the soap completely to avoid the drying effects of soap residue left on the client’s skin
9. Only small area of the body should be exposed and bathed at a time
10. The wash clothes should be held with the corners tucked securely on the palm of the hand to avoid dragging its cold and wet ends over the skin
11. Each stroke should be smooth and long rather than short and jerky
12. Support should be given to the joints in lifting the arms and legs while washing and drying these areas
13. Provide active and passive exercise whenever possible unless it is contraindicated
14. Wash the hands and feet by placing them in the basin because it promotes thorough cleaning of the finger nails and toe nails
15. Cut short the nails, if they are long
16. A thorough inspection of the skin especially at the back should be done to find out the early signs of bedsore. A redness in the skin, an excoriation of the skin etc., should be reported immediately and treated adequately to prevent development of bedsores
17. All the skin surfaces should be included in the bathing process with special care in cleaning and drying the creases and folds and the bony prominences etc., since these parts are most likely to be excoriated by moisture, pressure, friction and dirt.
18. Special attention is given to axillae and groins to prevent disagreeable body odors due to the decomposition of organic materials.
19. Cleaning is done from the cleanest area to the less clean area, e.g., upper parts of the body would be bathed before the lower parts
20. Avoid bathing a client immediately after a meal as it depletes the blood supply to the digestive organs and interfere with the digestion
21. Frequency and the time at which a cleaning bath is given should be adjusted for the comfort of the clients and on the physician’s orders. A critically ill client may tolerate only a partial bath
22. Do not touch the body with hands. It is unpleasant to the clients.
23. The temperature of the water be adjusted for the comfort of the client and the water should be charged at intervals to maintain a comfortable temperature. The temperature for the sponge bath should be 43.3 to 46.1 degree celcius. For tub baths or bathroom bath the temperature of the water should be 32.2 to 37.8 degree celcius.
24. Powders are to prevent friction and to absorb moisture but they should not be used on open draining areas, since powder can make or form curst, causing skin irritation
25. Use only a small amount of spirit in the back care. The rapid evaporation of spirit causes rapid and excessive cooling of the body and also causes drying of the skin
26. Use soaps which contain less alkali
27. Creams or oils are used to prevent drying or excoriation of the skin
28. The nurse should maintain good posture and balances of the body during bed bath. Keep the client near to the edge of the bed to prevent over reaching and strain on the lower back
Personal Hygiene – Bathing (Types, Nurse’s Responsibility, Preparation, Procedure and After Care)
Bathing is an important intervention to promote hygiene. Choice of the method depends on the nurse’s judgment as well as the medical plan of care in regard to the client’s activity level and mental and physical capabilities to perform self-care. Several types of bath can be used depending on the client’s need. Baths may be used for cleansing or for therapeutic measures related to some skin problems.
Types of Therapeutic Bath
1. Sitz bath
Purpose: to decrease pain and inflammation after related or perineal surgery or pain relief from haemorrhoids.
2. Hot water bath
Purpose: to relieve muscle spasm and muscle tension
3. Warm water bath
Purpose: to relax and soothe
4. Cool water bath
Purpose: to decrease fever and to reduce muscle tension
5. Oatmeal or aveneo
Purpose: to sooth irritated skin, softens and lubricates dry scaly skin
6. Corn starch
Purpose: to sooth skin irritation
AUTHOR: VIKRAM THAKUR