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Course: Fundamentals of Nursing�Topic: Facilitating Hygiene

The Nurses International Community

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Module Goals

Learners will be able to:

Identify the health benefits and significance of hygiene related to disease prevention.
Describe the essential elements of personal hygiene optional health (skin, oral, nail and hair care, toiliting, etc).
Address hygiene as it relates to skin breakdown in at-risk clients: (impaired mobility, immunocompromised, incontinent, cognitive impairment).
Describe the general best process/routine in providing daily hygiene to a hospitalized client.
Discuss the nurse’s role in hygiene education.

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Hygiene

“Hygiene refers to conditions and practices that help to maintain health and prevent the spread of diseases. Medical hygiene therefore includes a specific set of practices associated with this preservation of health, for example environmental cleaning, sterilization of equipment, hand hygiene, water and sanitation and safe disposal of medical waste.”

WHO, n.d

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Hygiene Includes:

Brookside Press, 2015

Skin Care
Hair Care
Hands and feet Care
Eyes, ears, nose, mouth Care
Back Care
Perineum Care

This includes the bath, components of the bath, bed making, and assisting the client for bed pan, urinal, and bedside commode, etc.

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Population that requires hygiene assistance

Dingwall, 2010

Physically impaired clients
Mentally Impaired clients
Very old population
Very young population
Client with altered level of consciousness
Terminally ill population who require end of life ’care
Client with learning disabilities
Client with cognitive difficulties
Client undergoing chemotherapy and radiotherapy

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Importance of Hygiene

Promotes comfort and physical wellbeing.
Prevents the spread of disease and infections.
Refreshes the client.
Enhances the client's mental, spiritual, confidence.
Maintains client dignity and reduce the embarrassments.
Develops the nurse-client relationship and delivers client- centered care.
Promotes circulation (bath).
Creates an opportunity to assess clients physical and emotional condition.

Dingwall, 2010

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Health Professionals Involved in

Meeting client’s hygienic needs

General medical staffs
Nurse specialist
Dermatologists; orthotics and prosthetics
Primary healthcare staff
Dentist
Opticians, Podiatrists, Audiologists
Occupational therapists
Physiotherapists
Dieticians
Speech and language therapists
Dieticians

Dingwall, 2010

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Nursing Consideration while providing care:

Dingwall, 2010

Assessment of Physical capabilities:

The client's ability to self-care;
Ability to manage their own hygiene needs
What level of help client need (if required)
What interventions will be required by the nurse?

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Nursing Consideration while providing care:

Dingwall, 2010

Understand the Psychological state of the client:

How the client is affected by the disease/condition.
How the disease or condition is taking effect on clients life.
What the client feels about the admission and treatment process.
If the client has any mental health conditions that interferes self care.
Level of anxiety or fears about the aspects of personal hygiene.
Does the client recognise the need to maintain personal hygiene?

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Nursing Consideration while providing care:

Dingwall, 2010

Consider Sociological Factors:

Sociological factors that may interfere with the client’s ability to carry out the hygiene needs.

i.e. Client with HIV are stigmatized
Hygiene preference may change as a person enters in different stages of life

Home circumstances affecting the client ability of self care.

i.e. Assistance (if required)
Availability of materials required for self care.

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Nursing Consideration while providing care:

Dingwall, 2010

Spiritual Aspect:

Identify the client's religious belief regarding hygiene.

Islamic religion may prefer to wash their bodies before praying and may prefer to use water over hand sanitizer.
Buddhism may prefer to bathe before bed.

Accept the difference.
Identify the factors factors relating to hygiene that may affect the client's well-being.

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Nursing Consideration while providing care:

Dingwall, 2010

Respecting Cultural differences:

Identify if there beliefs system of the client regarding hygiene needs.

In some countries, it is common to bathe regularly whereas in some it is not.

Acknowledge the client preferences e.g.

same sex-nursing care.

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Nursing Consideration while providing care:

Informed Consent:

Inform client about the procedure, educate a client about the risks, benefits of the procedure. Let the client make the decision (if competent) if not other close kin will make decision. ¹

Non-Judgemental attitude:

Do not judge the client based on their behaviour or thinking, respect their opinion, speak politely

Shah et al., 2021

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Nursing Consideration while providing care:

One education, 2021

Provide Privacy:

Draw privacy curtains.
Look away while the client gets dressed
Expose only working areas of the body (e.g. perineal area).
Respect personal space.
Don’t disclose the client information to others unless needed to provide care (need to know).

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Perineal Care:

Taye, 2020

Involves cleansing of genitalia and rectal area.
Prevents infections, odors and irritation.
Can be done as a bed bath, shower or tub bath.
Done more often for clients affected with incontinence, physically dependent clients.

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Perineal Care:

Taye, 2020

Performed independently (if capable) if not, nurse has to do for the client.
Special perineal care is given to clients with an indwelling urinary catheter.
Prevents infection (bladder, kidney).
Always wipe from front to back to prevent UTIs/cross-contamination.
Click the hyperlink to know the steps of providing perineal care for male and female.

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Shaving

Involves cutting/removal of hair by razor or with sharps.
Practiced more by male (facial hair).
Practiced by women (underarms, legs,hands, perineal areas).
Shaving choice and frequency varies individually.
Done independently or with by nurse (dependent client).
Special consideration should be given for the client with anticoagulants (blood thinners), pimples; risk of bleeding.
Skin care like moisturizers, aftershave respectively nourishes dry skin and prevents from infection.
Click here to know the proper steps of shaving.

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Oral Hygiene

Includes brushing teeths, cleaning dentures, flossing, rinsing mouth.
Done at least twice a day and more often as needed.
Done independently or with assistance.
Unconscious clients, clients in ventilators, facial mask, Bipap needs more attention.
Partial and full dentures are also brushed and rinsed.
Special care has to be given to the clients who have bleeding gums, anemic and are on anticoagulants (blood thinners); risk of bleeding.
Click the hyperlink for oral care of conscious and unconscious clients.

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Foot Care

Feet are washed with the bath and more often as needed.
Diabetics and other clients at risk for infections should require special foot and toenail 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.

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Hair Care

Client's hair can be washed with shampoo and conditioner in the shower, bathtub and in bed with a special bed tray or dry shampoo.
Clients should also be encouraged to comb or brush their hair a couple of times a day.

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Nail Care

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.

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Bathing Standards

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.

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Complete Bed Bath

A complete 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 client care technician.

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Partial Bed Bath

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 healthcare team.
The client 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.

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Tube Bath

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.

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What would the nurse do?

You are a nurse assigned to a 68 years old female. On assessment, you see that the skin of the client is dry and scaly.

The client’s husband is worried that she might have diabetes as the wound on her thigh is taking longer to heal.

What would you do?

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Cultural Considerations

In some cultures, clients do not want to be touched by opposite sex; they prefer same sex-nursing care.
In the Hindu culture, some people avoid soap as it contains animal fat; hands are rubbed vigorously with ash or mud and then rinsed with water (WHO Guidelines, 2009).
Alcohol-based handrubs are not prohibited by some religions.
Judaism, Islam and Sikhism have precise rules for handwashing included in the holy texts and this practice punctuates several crucial moments of the day (WHO Guidelnes, 2009).

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Cultural Considerations

In Ghana and and some other West African countries, hands must always be washed before raising anything to one’s lips (WHO Guidelines, 2009).
Buddhism may prefer to bathe before bed (Goldenhart & Nagy, 2020).
In some rural communities of Nepal, people prefer using charcoal over toothpaste.
In Nepal, people usually do not prefer to bathe a baby regularly as it might cause illness and cold (personal observation).
Some elder population in Nepal do not trim their nails and hair on tuesday.

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References:

Dingwall, L. (2010). The Essentials Clinical Skills for Nurses: Personal Hygiene Care (1st ed.). Wiley Blackwell. https://dl.uswr.ac.ir/bitstream/Hannan/138738/1/9781405163071.pdf

Goldenhart AL, Nagy H. Assisting Patients With Personal Hygiene. [Updated 2020 Oct 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563155/

One education. (2021). What is dignity in care: Everything you need to know. Retrieved on 7th of September 2021 from https://www.oneeducation.org.uk/what-is-dignity-in-care/

Registered Nurse (2021, September 21). Personal Hygiene: NCLEX-RN. https://www.registerednursing.org/nclex/personal-hygiene/

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References:

Shah P, Thornton I, Turrin D, et al. Informed Consent. [Updated 2021 Jun 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430827/

Taye, G. (2020, August 28). Perineal Care. My Health. http://www.myhealth.gov.my/en/background/

World Health Organization. (n.d). Overview Hygiene. Retrieved on 05 september 2021 from https://www.afro.who.int/node/5610

WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care. Geneva: World Health Organization; 2009. 17, Religious and cultural aspects of hand hygiene. Available from: https://www.ncbi.nlm.nih.gov/books/NBK143998/

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