Personal Hygiene: NCLEX-RN
In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of personal hygiene in order to:
- Assess the client for personal hygiene habits/routine
- Assess and intervene in client performance of activities of daily living
- Provide information to the client on required adaptations for performing activities of daily living (e.g., shower chair, hand rails)
- Perform post-mortem care
Personal hygiene, which is one of the basic activities of daily living, includes:
- Bathing, showering and washing
- Foot care
- Hair care
- Nail care
- Perineal care
- Mouth and oral care
- Denture care
There are a wide variety of different factors that influence and impact on our clients' hygiene habits and routines. For example, cultural practices and beliefs, religious practices and beliefs, the client's level of growth and development, economic factors and economic constraints, the client's level of energy, the client's level of cognition, environmental factors including things like the environmental temperature and the client's state of homelessness, the client's overall state of health and their own particular personal preferences in terms of their personal hygiene habits and routines impact on client choices, their preferences and practices relating to hygiene and hygiene practices.
Cultures and cultural practices relating to hygiene vary around the globe. In North America, for example, there is a high cultural value on cleanliness, daily bathing, an odor free body and the absence of leg hair on females. Other cultures, however, may only bathe once a week or less and they are not offended with bodily odors or the presence of underarm and leg hair among females. Some cultures bathe communally, whereas other cultures value privacy when bathing. There are also some biocultural differences in terms of hygiene. For example, bodily odors tend to be more prevalent and stronger among African Americans and Caucasians than they are among Native Americans and those from Asian cultures.
Some of the religions practices and beliefs that may impact on our clients include those relating to religious ceremonious bathings and washings; the client's age and level development impacts on how and how often an infant will be washed and bathed and the client's age and developmental status may also restrict the client from independent self care in terms of their personal hygiene, for example; and economics and economic constraints may alter hygiene processes when, for example, when the client lacks the funds for basic hygiene needs like soap, shampoo, lotions, and even hot water. The client's level of energy, the client's level of cognition, and the client's overall level of health are also factors that can both positively and negatively impact on the client's hygiene practices and routines. For example, clients with impaired cognition, with poor overall health and with a low level of energy may not be able to perform hygiene self care and they may not even tolerate someone providing hygiene measures to them. Environmental factors including things like the environmental temperature of the room in which the client is bathing or showering and the provision of privacy can also impact on the client's hygiene practices. Lastly, the client's personal preferences in terms of their personal hygiene habits and routines also vary. For example, some clients may prefer to bathe in the morning and others may prefer to bathe in the evening before bed, some male clients may shave daily and other male clients may only shave twice a week, and some females may shave their legs and underarms on a daily basis, others may shave once a week or less often, and still more may not shave their legs and underarms at all. Despite all of these factors, all care, including hygiene care, must be tailored to meet the client's unique needs, preferences, practices and routines.
Nurses assess the client's ability to perform their activities such as personal hygiene, mobility, ambulation, toileting, personal care and hygiene, grooming, dressing, and eating. Some clients are wholly compensatory in terms of their self care activities. These clients need the nurse and other members of the nursing team to provide this care to them; other clients are partly compensatory and they can perform their activities of daily living with the help and assistance of another, and still more are considered independent in terms of performing the activities of daily living and these clients may only need the support of others in terms of their activities of daily living including hygiene, according to Dorothea Orem's Self Care Theory.
As the nurse is assessing the client's ability to perform hygiene measures, they compare the client's actual performance with established standards relating to these tasks and, then, they may educate the client about the proper methods of performing the particular task, including safety measures and the use of assistive devices to facilitate their self care hygiene.
The primary purpose of bathing is to cleanse the body of all dirt, sweat, germs, exfoliated skin, and other things. This cleansing protects our first level defense against infection, and it also promotes good circulation and client comfort.
In the health care setting, there are three different types of baths. They are a complete bed bath, a partial bath, and a tub or shower bath.
- A compete bed bath is one that is given in the bed to the client by a nurse or another member of the health care team like an unlicensed assistive staff member such as a nursing assistant or a patient care technician.
- A partial bed bath is one that is given in the bed, like the complete bed bath, but the client only needs the assistance of the nurse or another member of the health care team. The client themselves is able to perform some or most of the bathing tasks. For example, the nursing staff member may only have to collect and present the client with the necessary supplies and equipment or wash the client's back.
- A tub bath is a bath that the clients are usually able to take themselves, but they may still need assistance, such as getting in or out of the tub or shower, so it is important for the nursing staff member to be available and present to help the client as needed.
With all types of baths, the water temperature must be checked to insure that it is safe and < 110 degrees. A shower chair, tub chair, grab bars, a nonskid bath or shower mat are also highly important to prevent accidents. When clients prefer to shower or tub bathe rather than take a bed bath, they will often need assistance getting in and out of the shower or tub to prevent a fall and injury.
The following are the steps for a complete bath and a partial bath.
- Identify the client, introduce yourself and explain the bathing procedure to the client.
- Provide privacy.
- Raise the client's bed to a height that is the most comfortable and safe, in terms of body mechanics, for you to work at. Make sure that the side rail on the side of the bed opposite to you is up and locked in place. Raise the head of the bed to a height that is comfortable for the client.
- Remove the client's blankets.
- Place towels under the areas that are being washed to protect the fitted bottom sheet from moisture and only uncover the areas that are being washed rather than the entire area to maintain client warmness.
- If a bath mitt is not available, a washcloth should be wrapped around your hand in a mitt like fashion.
- Each part of the client's body is washed, rinsed, dried and then covered with a bath towel or a blanket.
- Rinse the wash mitt or washcloth after each part of the body is washed.
- Change the bath water in the basin when it cools off or becomes too soapy.
- Make sure that every area, including the face, behind the ears, chest, back, arms, legs, hands, fingernails, perineal area, and feet are thoroughly washed, rinsed and dried thoroughly.
- Like physical assessment, the bath is given from head to toe. The first area to be washed is the inner canthus of each eye; the neck area is the face and neck, after which the bath is given downwards towards the toes.
After the bath is complete, the height of the bed to lowered to its lowest position to insure client safety.
Perineal care, like bathing of the skin, prevents infections, odors and irritation in that area. Perineal care is done with the bed bath, shower or tub bath and it is done more often for patients affected with incontinence and diaphoresis, for example. Special perineal care is given to patients with an indwelling urinary catheter.
Male clients often want a facial shave once a day or once every couple of days; female patients usually want their underarms and legs about once a week. Shaving for patients is often not risky except when the patient is taking an anticoagulant blood thinner which places them at risk for nicks and bleeding.
Oral hygiene is done at least twice a day and more often as needed. Oral hygiene consists of brushing the teeth, flossing the teeth, and rinsing the mouth. Partial and full dentures are also brushed and rinsed.
Feet are washed with the bath and more often as needed. Diabetics and other patients at risk for infections should get special foot and toe nail care and monitoring. For example, the feet must be completely cleaned and dried and examined daily for any signs of skin breakdown, corns, bleeding, broken, chipped or absent nails, as well as blue or pale nail beds.
Patient's hair can be washed with shampoo and conditioner in the shower, bathtub and in bed with a special bed tray or dry shampoo. Patients should also be encouraged to comb or brush their hair a couple of times a day.
Client nail care is another important area of hygiene and client's nails need to be checked daily, to observe them for any irregularities. The client's nails should appear clean, because dirt can cause infection, trimmed short, and smooth, as jagged nails have the ability of causing injuries to the client or to the staff attending to them.
Providing Information to the Client on Required Adaptations for Performing Activities of Daily Living
Clients in need of assistive devices and other adaptations to insure safety and/or maximum independence should be instructed on their proper use and reminded to use them consistently. Some of these devices and adaptations include shower chairs, grab rails, hand rails, back sponges and special tools for nail care.
Postmortem care consists of washing and drying the patient's entire body and removing all medical equipment such as indwelling urinary catheters and intravenous lines. The deceased patient's hands and legs are gently placed in good alignment, the eyes and the jaw are held closed and the body is then wrapped in a shroud after an identification tag has been placed on the client's greater toe and on the outside of the shroud prior to transfer to the morgue.
Standard precautions are maintained after a patient's death when providing postmortem care.
- Assistive Devices
- Non Pharmacological Comfort Interventions
- Nutrition and Oral Hydration
- Personal Hygiene (Currently here)
- Rest and Sleep