Essential and Personal Hygiene Skills - Essay Example

Personal Hygiene Essentials: A Closer Look Essay Plan The chosen skills is the of personal hygiene skills to be developed by a nurse practitioner. This was deemed important in the sense that a patient who is not able to take care of themselves properly will need the assistance of a primary carer or more particularly a nurse especially if they stay in a special home or a hospital with regards to all activities of daily living including that of personal hygiene, knowing how to take care of the patient’s hygiene needs is important for a nurse to be able to take care of the patient in the best possible way. Personal hygiene or cleanliness is important to control spread of disease and infection. Included in the introduction will be a brief explanation of personal hygiene and its importance to the nurse and the patient and a short brief on the course of the paper. In the discussion portion of the essay the paper will discuss the proper ways of conducting personal hygiene essentials for the patient. This part of the paper will also highlight specific ways the nurse can help the patient including an assessment on the actual needs of the patient their capabilities to do some personal hygiene tasks like combing or brushing the teeth, the importance of independence for a dependent adult. A discussion on being sensitive about the patients desires will also be considered especially when it comes to modesty, embarrassment and the modicum of independence the patient can exert during tasked specific for personal hygiene, the paper will also highlight the need for the carer to be able to explain to the patient why a specific task needs to be done and to reassure the patient that they are not being embarrassed intentionally and that all are done in the course because it is actually needed to be done and that all accord has been utilized that minimal exposures of body parts and ‘invasion of privacy’ is kept to a minimum. It will also be noted that it is important for a nurse to know the essential body parts that are needed to be kept clean and dry especially for bed bound patients so that pressure or bed sores can be avoided, the areas where pressure sores are likely to develop so that cleaning and taking care of those particular areas will be of benefit to avoiding pressure sores. It is also essential for a nurse professional to know techniques and strategies involved in giving care to patients who already has pressure sores so that it will not be aggravated and that healing will be promoted. The ability to reassure, soothe and convince the patient to follow instruction and not to fight off carers who wish to clean them is essential that problems that arises from patient anger or non compliance will be kept to a minimum, to talk to the patients specially those who are mentally sick and incapacitated, or to their families in the right manner, calmly and armed with enough information so that any questions raised maybe answered at once, so that nurse credibility will not be compromised. It is also essential for the carer or nurse to have some background knowledge of the patient in order to be able to comply with their culture, their cultural heritage, religious beliefs and such should be realized so that the carer will not overstep the boundaries set by these beliefs in order to facilitate full cooperation from patient and patients families with regards to taking care of them. It is just right for the nurse worker to know or have an idea of a patient’s ethnic, religious background so that they will be able to explain and facilitate care of the patient without overstepping their beliefs and in the event that overstepping the boundaries be required in order for a particular task to be done, proper explanation in order for the task to be understood can be facilitated. Ethical issue concerns are raised in times when the patient felt that they were taken advantage of or the privacy was invaded and that they felt that their carer did not do proper protocols with regards to how they were taken care of specially during bathing procedures when certain areas of the bodies will be exposed. The conclusion will include the learning process of the researcher including the acquired knowledge on how to take care of a patient’s hygiene needs and how to properly conduct such. The conclusion will also include writer’s thoughts on how to talk to talk to a patient in order for them to feel calm and reassured in order to prevent ethical concerns from arising in the latter part of the patient’s stay in the hospital or nursing home. The research will include search of various databases MEDLINE, PUBMED, CINAHL and GOOGLE SCHOLAR, plus a variety of web searches utilizing keywords such as personal hygiene, importance of personal hygiene, personal hygiene and nursing assessment in order to find relevant articles that will provide knowledge with regards to the topics at hand. The research will attempt to highlight reports on personal hygiene, proper conduct during hygiene tasks especially with regards to bathing and changing clothes of the patient. And other concerns including ethical, moral and patient concerns when doing the task assigned. The research will also attempt to find articles that will highlight promotion of personal hygiene in the community in order to prevent the spread of communicable diseases. And finally the research will attempt to correlate the learning outcomes with the studies found in order to realize the full extent of the use of the knowledge gain when the researcher finally comes across such instances in practice when knowledge such as personal hygiene task protocols will be needed in order to care for the patient fully and avoid any ethical, moral and legal mishaps for the carer. INTRODUCTION Having a good hygiene is a significant blockade to infectious diseases that are usually transmitted via the fecal-oral route. It provides for better health and general well being of the patient and satisfaction among carers that diseases are avoided in the patients under their care. Personal hygiene is an essential part of our everyday lives, we bathe, brush our teeth, put on fresh, clean clothes and comb our hair, wash our hands before we eat. Personal hygiene is an important aspect of Activities of Daily Living (ADL) that can enhance an individual’s self-esteem aside from minimizing risk of infection and disease spread. Any normal individual can do this most basic function on their own, but there are times maybe secondary to old age, accidents or disease process that an individual is unable to do this by themselves, either temporarily or permanently and totally or partially, it is therefore the job of their primary carer or the nurse to assist them totally or partially in accomplishing this task. It is also the role of the nurse to ascertain that even though the patient is unable to take care of their own personal hygiene totally independently, that the patient has some participation so that they may not feel like they are totally dependent on another person that can affect their psychological well being due to loss of independence and they may also lose their belief in themselves. It is also imperative the primary carer is able to communicate effectively with the patient that they feel secure in the care of that person and that they are not being taken advantage of secondary to their present condition and keep the patient’s dignity intact. Maintenance of a person’s hygiene does not only keep the person clean but improve their physical and emotional well being as well. Assisting them to keep themselves clean in time when they are not able to can help in the overall satisfaction of the patient with their everyday lives. One can realize that hygiene does not only keep a person clean, it also helps the body fight off infection and prevent injuries and diseases by helping remove bacteria in the external body and any other avenues where the bacteria can grow on. Keeping the mouth clean for instance also promotes health by avoidance of mouth sores and such that will hinder proper eating and nutrition of the patient involved. Aside from enhancing the patient’s morale it also keeps the person feeling comfortable and relaxed since they are refreshed. This research will focus on the role of the nurse in the maintenance of their patient’s hygiene, since it is essential that the primary carer or the nurse be knowledgeable with regards to the techniques and strategies for implementing personal hygiene tasks since not all patients are or will be conducive to being assisted with their personal hygiene tasks. Some might be concerned with falling, modesty and dependence factors. It is essential that the primary carer know how to talk to the patient, letting the patient know the importance of the task to the patient and the proper way of conducting the task that will provide safety not only for the patient they are tasked to take care of but to the nurse’s person as well. DISCUSSION Personal hygiene can be construed as the fundamental concept of cleaning grooming and taking care of our body. Even as personal hygiene is keeping our hair and nails clean, our teeth brushed, it is an important aspect of being healthy, especially for health workers (doctors, nurses, nurses aid, etc.) who are often exposed to a variety of bacteria, disease causing elements and other contaminants that may spread disease (State Compensation and Insurance Fund, n.d.). It is important to keep themselves clean as well as their patients who are their primary concerns, especially those that are not able to clean themselves. Personal care includes: 1. Personal Hygiene Bathing, showering, hair washing, shaving, oral hygiene, nail care 2. Continence Management Toileting, catheter/stoma care, skin care, incontinence laundry, bed changing 3. Hair Care Keeping a person’s hair clean is difficult if they are confined to a bed or unable to get to a source of running water like a shower or sink. But you can do it with the aide of a shampoo trough that you can make or buy from a home care supply store. When shampooing in bed: 4. Showering Consider installing sturdy grab bars to help the person get in and out of the tub; Apply non-slip safety mats or treads at the bottom of the tub or shower to prevent falls; Place a nonskid bathmat (not a towel) on the floor in front of the shower or tub; Place a shower bench or seat in the shower so the person can sit down while he/she showers; Check and adjust water temperature prior to patient getting into the tub -- Never turn on hot water when the person is in the shower; Do not give a bath sitting in the bathtub unless recommended by the doctor or nurse – It may be difficult to get back out. 5. Mouth Care Raise the head of the bed unless contraindicated – otherwise, turn person on his/her side; Tuck a towel under the chin; Use a soft toothbrush; Brushing movement should be away from the gums. 6. Dental Prosthesis Care Removing the upper denture Grasp the inner and outer surfaces on both sides of the plate. Insert your forefingers over the upper edge of the plate and press until the seal breaks between the denture and the gums. Pull the denture forward to remove; Removing the lower denture Grasp the inner and outer surfaces with the thumb and forefinger. Turn slightly and pull the denture up and out; Cleaning dentures Use a stiff brush and scrub dentures carefully with toothpaste and rinse thoroughly; it is also wise to make use of a specific denture brush for a specific individual in order to avoid contamination rather than use the same brush for all dentures to be cleaned. Inserting dentures – Wet dentures with cool water. Apply smooth, tender pressure on both sides of the upper dentures to work it into place in the person’s mouth. The lower dentures should placed back last. In order to fully realize the needs of the patient it is essential that the nurse complete a thorough assessment of the patient’s needs and capabilities including that of their functional independence and dependence on ADL where personal hygiene essentially a part of. Questions regarding the patient’s capabilities as to personal hygiene (bathing, nail care, oral hygiene, etc.), taking of medications, dressing, oxygen therapy and application of creams/lotion, management of incontinence, need for adult diapers, catheter, etc., basic nutrition including food intake, immobilization concerns, and general assistance with regards to any mobility aids or prosthesis/orthosis (NHS, 2001). A nurse may also be tasked in bathing a bed bound patient, in this sense the nurse must be knowledgeable on how to bathe a patient who is bound in bed and know when full and partial assistance is needed by the bed bound patient, they must be able to ascertain the specific personal hygiene schedule for the individual need of the patient on hand and concerns the patient may have regarding bathing procedures like exposure of body parts, feeling cold and a strangers touch. This helps the carer be able to provide care for the patient while teaching the patient independence in such basic tasks as personal hygiene this does not only help the patient in their hygiene task but also determine the independence of the patient boosting their morale and self esteem while helping the carer lighten their work loads. When caring for an elderly person either at home, nursing homes, or at the hospital, one may note that some elders or mentally incapacitated patient may have certain fears associated with personal hygiene tasks including that of falling, modesty or feelings of coldness. Addressing the origin of the fear is essential so that minimal problems maybe encountered during ADL activities, fear regarding falling maybe addressed by installation of handrails or keeping the patient seated and provided with ample support may minimize this fear, modesty of the patient can be addressed by keeping private parts covered and exposing only the part to be bathe will help this concern as well as the concerns of feeling cold. In bathing a patient who is bed bound nurse can ease the burden of the workload by encouraging the patient (who is abled) to participate in the task as much as they possibly can, a patient who can move their hands can brush their teeth, comb their hair or even wash their face themselves. The following can serve as a guideline in fulfilling this task: 1. Make sure that supplies needed for the bathe including towels, washcloths, soap, shampoo and other toiletries are prepared ahead of time and such must be within reach during bath time. 2. The basin is usually filled 2/3rds full with water of about 120 degrees Fahrenheit; water should be replaced as soon as it gets dirty or cold. 3. Doors or windows should be closed in case of drafts. 4. It is a good habit to keep the hands clean as it is when bathing a patient. 5. It is important to respect the person’s privacy even if they are sick, covering the patient with a light blanket or towel is a good practice for privacy as well as provide warmth. 6. It also wise to place plastic sheets or towels around the patient and on the floor surrounding the bath area. Newspapers on the floor can help absorbed splashed water and prevent the carer from slipping. Although not all individuals are required to receive a full bath on a daily basis, it is important to keep certain areas of the body like the face, underarms and private parts clean. It is also important to encourage an individual who is able bodied to keep themselves clean which can help not only their motor skills but enhance their self esteem and independence as well (NHS, 2002). Sometimes caring for a member of the opposite sex or a parent, the patient as well as the carer may be embarrassed, it is important to be supportive and soothing to the patient without overindulging them. In bathing or washing a patient, it is important to follow steps that will enable the fastest and easiest way to do the assignment. The usual trend is to wash the face first, the go down to the upper torso then down to one arm and legs then the other arm and legs. It is imperative that areas not washed should be covered with a light blanket or towel, to avoid chilling the patient and for the sake of modesty, this is done also after the area has been washed. It is also important to wash the back shoulders and buttocks, back and the ready to wash them and after they have been washed. Then turn the person on one side so the back faces you and wash the shoulders, back and buttocks. It is important to dry each part washed in order to prevent chills, it is also a good practice to apply lotion to prevent drying of the skin. The last to be washed should be the private area from the front to the back making sure that the carer is using fresh, clean and unused water. Special equipments and materials maybe used to cleanse a patient but such maybe costly. It is also imperative that the carer follow instructions by doctors or nurses. It will be noted that generally it will be the aged patients who will need special care and assistance at the personal hygiene level, like patients with Dementia will usually exhibit forgetfulness including care of self like bathing, brushing the teeth, even dressing and eating (Better Health Channel 2007). Aside from bathing and brushing there are also other hygiene issues that needs to be considered in order for the carer to be able to take care of the personal hygiene side of the patient. This other personal hygiene issues can include the following: Toileting/Incontinence Concern – the patient may need help with toilet use. Ensure that the patient’s private areas are clean and dry and that their underwear is clean and fresh, this will help with bed sore/pressure sore concerns, especially if the patient is bed bound or bed ridden. If incontinence is a problem for the patient it is apt to ensure that the patient is carefully washed and cleaned with soap, if possible, and warm water. In this sense the carer should also make sure that all pertinent areas are clean and dried up before putting on any fresh clothes. The patient here can feel embarrassed, if they are still able to understand what is happening regarding wetting themselves, it is important to assure the patient that it is alright and address any concerns they may have and come up with certain strategies that one will help the patient in avoiding embarrassing situations as such and in the event that it does happen strategies that can enable the patient to help themselves if at all possible. Extra hair shaving concerns – at the first, the patient may only need reminders to shave, although especially for the oldest patients assistance maybe needed after a while. Electric razors are generally safe, so the patient can make use of this for the longest possible time but traditional razors which can cut the patient may need assistance earlier rather than risk the patient getting hurt. Changing clothes – in order to feel clean or fresh, it is important a fresh set of clothes be worn by the patient, it is at first important for the carer to encourage the patient to change clothes everyday and later on it is imperative for the carer to change the patients clothes. It is important to compliment the patient for looking clean and fresh to encourage them to desire the need for being clean and fresh Dental/Denture care – the patient should be encouraged to visit the dentist regularly and if the patient is in the advanced stages of the disease process, the carer may need to clean the teeth or false teeth of the patient for them. It is important to let the patient know the significance of keeping their dentures and oral cavity in general clean Fingernails and toenails – again another good practice with hygiene is to keep the fingernails and toenails, patients who are sick is no exception, it is important to keep the patients nails clean. A podiatrist maybe employed to do this. It may also be wise to realize if the patient enjoys having a manicure and pedicure sessions and if this helps in their relaxation and esteem. Hair – is the crowning glory of any individual caring for it properly even when one is sick is an important aspect of being clean, fresh and healthy. The carer should be able to develop a way to wash the patients hair that is comfortable and acceptable to the patient and the carer. Sometimes especially for a sick patient it can be very distressing to have to depend on someone else to care for their hair, in this sense it is important to let the patient feel comfortable and soothe them into complying with what needs to be done. Conclusion This study focused on personal hygiene for the patient and the caregiver as well and how it is an essential part in nursing care and assessment of patients. One may derive that part of a good health care environment is keeping it clean and free from germs that can and will harm the patient and the carers themselves. Prior to implementation of the NHS and Community Care Act (1990) in the study area, if age or health problems prevented a patient from managing their own personal hygiene care they had to rely on informal carers or district nursing services, in this regard it is important that nurses, nursing assistants and other carers know how to conduct personal hygiene and other ADL tasks properly in order to avoid complications arising from taking care of these unable patients. In the absence of any other provision, justification for referral to these services was based on the broad criteria of social good; a notion which in turn provided a tacit rationale for nursing care. This was a common practice countrywide and in essence, district nursing services had become a culturally acceptable service for assisting individuals unable to manage their own care (RCN, 1990). In order to gain the greatest benefits, it is important to not only improve hygiene but the sanitation and water supply as well as making better nutrition policies and augment incomes. Personal hygiene encompasses a large area of keeping healthy, this study focused on personal hygiene in older patients who may not be able to take care of themselves in the later years especially those who are afflicted with debilitating disease like dementia or alzheimer’s. Keeping these people clean and fresh not only helps their self esteem and individual pride but also helps the carer’s minimize the risk of infections and other communicable disease from spreading by ensuring a clean and healthy environment for the patient’s concern. The personal hygiene tasks given to a nurse, a primary carer and immediate person who takes care of the patients is an essential part of the nursing task, in the sense that, aside from the personal gain the patient may derive keeping a person, a place and the immediate environment helps stop the spread of disease and minimize the risk of more work for the health workers concerned. It might be noted that a number of observers have noted that the transfer of personal hygiene care to social carers arranged by Social Services as a challenging issue and identified the health/social care divide as an area of strife (Hadridge, 1993) The justification initiated for making available nursing assistance for personal hygiene care relates to the opportunities this activity presents for skilled nursing observation and health teaching rather than the task itself. References Better Health Channel (2007) Dementia and personal hygiene retrieved 29 April 2008 from http://www.betterhealth.vic.gov.au/BHCV2/bhcArticles.nsf/pages/Dementia_and_personal_hygiene?OpenDocument Deparment of Health (2001). National Service Framework for Older People. Department of Health, London. Department of Health (2006) Essence of care: Benchmarks for promoting health. Department of Health, London Department of Health (2007) Essence of care: Care environment benchmark. Department of Health, London Hadridge P. (1993). Health Care Needs in Later Life: Consumers Views. East Anglian Health Authority. McGeoghan (2002) Health Risk Assessment, Journal of Community Nursing 16 9:28-30 NHS (2002), Free personal and nursing care leaflet. Retrieved 26 April 2008 from http://www.scotland.gov.uk/health/freepersonalcare Royal College of Nursing. (1990) Community Care: The Consumer and the Nurse. Royal College or Nursing, London. State Compensation Insurance Plan (n.d.) 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