Hygiene Overview
What is Hygiene?
Hygiene practices include:
Bathing and skin care.
Care of specific body areas such as:
Oral cavity
Eyes
Ears
Nose
Hair/Nails
Feet
Perineal and vaginal areas
Why is Hygiene Important?
Good hygiene promotes physical and psychological well-being.
Factors Affecting Personal Hygiene
Culture
Socioeconomic class
Spiritual practices
Developmental level
Health state
Personal preferences
Physical Assessment
Inspection: Deliberate, purposeful observations in a systematic manner.
Palpation: Use of touch to assess skin temperature, turgor, texture, and moisture, as well as vibrations within the body.
Percussion: Striking one object against another to produce sound.
Auscultation: Listening with a stethoscope to sounds produced within the body.
Clinical Judgement Model (CJM)
Steps:
Recognizing cues
Analyzing those cues
Prioritizing hypothesis
Generate solutions
Take actions
Evaluate outcomes
Introduction to Clinical Judgement Model
Recognize Cues (Assess): Systematic assessment to identify health concerns.
Factors to Consider When Examining Skin
Cleanliness
Color
Temperature
Turgor
Moisture
Sensation
Vascularity
Evidence of lesions
Guidelines for Assessing the Skin
Identify any variables known to cause skin problems.
Allow data obtained during nursing history to direct the skin assessment.
Document findings using standard terminology.
Compare bilateral parts for symmetry.
Use a good source of light, preferably daylight.
Incorporate skin assessment during hygiene care.
Learning Activity: Case Study
A community health nurse visits an 89-year-old woman with limited mobility.
Observations include:
Uneven, unstable stairs leading to the front door.
Lack of railings on the porch.
Signs of poor hygiene: unkempt hair, soiled clothing, dry skin, body odor, and halitosis.
Recognizing Cues
Focus on noticeable signs of health issues to guide assessment and care.
Introduction to Clinical Judgement Model
Analyze Cues: Investigate the significance of each recognized cue.
Prioritizing Hypothesis
Prioritize the cues by determining what is most important using the ACB framework (Airway, Circulation, Breathing) and then considering Maslow's Hierarchy of Needs.
Hypothesis at Risk for Skin Alteration
Considerations include:
Lifestyle factors
Changes in health state
Illness
Diagnostic measures
Therapeutic measures
Self-Care Deficit Diagnoses
Categories:
Feeding
Bathing and hygiene
Dressing and grooming
Toileting
Safety: Handwashing
Hand hygiene is the most effective method to prevent the spread of infectious agents to patients and self.
Ensuring Bedside Safety
Guidelines:
Bed is in the lowest position.
Bed controls function correctly.
Call light is functioning and accessible.
Side rails raised if indicated.
Wheels of the bed are locked.
Purposes of Bathing (Part 1)
Benefits include:
Decreasing bacteria/pathogens on skin surface
Acting as a skin conditioner
Promoting relaxation
Boosting circulation
Providing musculoskeletal exercise
Stimulating deeper respirations
Purposes of Bathing (Part 2)
Additional benefits:
Promotes comfort through relaxation and skin stimulation
Provides sensory input
Improves self-image
Strengthens nurse-patient relationship
Methods of Bathing
Types include:
Shower/Tub Bath
Bed Bath
Disposable Bath
CHG (Chlorhexidine Gluconate) Bath: Can be given daily to reduce incidence of Hospital Acquired Infections (HAIs).
Providing a Bed Bath
Guidelines for procedure:
Prepare bathing articles on overbed table or bedside stand.
Ensure patient privacy.
Remove top linens, replace with a bath blanket.
Place cosmetics conveniently for the patient.
Assist patients unable to bathe themselves completely.
Bathing Considerations for Infants, Children, and Adolescents
Infants:
Bathe 2-3 times a week with mild/baby soap.
Do not submerge umbilical cord until it falls off (~2 weeks).
Avoid powders that can be inhaled.
Children:
Never leave young children alone while bathing.
Encourage good hygiene habits.
Adolescents:
Frequent bathing and deodorant use is important due to increased sweat gland activity and hormonal changes.
Respect the need for privacy.
Hygiene Considerations for Older Adults
Impaired Skin Integrity:
Avoid soap, use pH balanced skin cleansers.
Use skin moisturizers and emollients.
Minimize exposure to moisture.
Impaired Oral Mucous Membranes:
Encourage oral hygiene at least twice daily.
Use lip lubricants.
Avoid alcohol-based mouthwash to prevent dry mouth.
Impaired Physical Mobility:
May require toothbrushes with extended handles.
Use assistive bathing devices such as shower chairs, grab bars, and long-handled sponges.
Employ non-slip mats for safety.
Reasons for Providing Back Massage
Relieves muscle tension and promotes relaxation.
Allows the nurse to check for skin breakdown.
Improves circulation.
May decrease pain, distress, and anxiety.
May enhance sleep quality.
Provides a means of communication through touch.
Oral Hygiene: Assessment
Conduct inspection of the oral cavity (mouth, lips, gums, teeth, tongue, and mucosa).
Identify actual or potential oral problems.
Determine appropriate nursing measures for intervention.
Implement the plan and evaluate its effectiveness.
Performing Oral Hygiene
Steps include:
Moistening the mouth.
Cleaning the mouth.
Caring for dentures:
Use cold water.
Protect during cleaning by placing a towel in the sink.
Store in cold water when not in use.
Tooth brushing and flossing.
Using mouthwash.
Care of Eyes
Clean from inner to outer canthus with a wet, warm cloth, cotton ball, or compress.
Use artificial tears or normal saline every 4 hours if blink reflex is absent.
Provide care for eyeglasses, contact lenses, or artificial eyes if indicated.
Ear and Nose Care
Wash the external ear with a washcloth-covered finger; avoid using cotton-tipped swabs.
Provide teaching and care for hearing aids if necessary.
Clean the nose by instructing the patient to blow it if both nares are patent.
Remove crusted secretions around the nose using warm, moist compresses.
Providing Hair Care
Identify the patient’s usual hair and scalp care practices and styling preferences.
Note any history of hair or scalp issues, such as dandruff or hair loss.
Address any infestations like lice and ticks.
Groom and shampoo hair.
Cares for beards and mustaches.
Assist with unwanted hair removal.
Test Your Knowledge
Statement: Pediculosis (lice) can be spread directly by contact with infested areas as well as indirectly through clothing, bed linens, brushes, or combs.
Answer: A. True
Rationale: Pediculosis can be transmitted directly through contact or indirectly through contaminated items.
Nail and Foot Care
Assess nails for color, shape, intactness, cleanliness, and tenderness.
Gather history on nail and foot problems.
Soak nails and feet, assist with cleaning and trimming if not contraindicated.
Massage feet to promote relaxation and comfort.
Provide diabetic foot care if needed.
Perineal and Vaginal Care
Assess for perineal or vaginal issues (inflammation, discoloration, tenderness, discharge).
Inspect genitalia and perineum for rashes, lesions, and skin breakdown.
Perform perineal care in a dignified manner according to procedure.
Cleanse the vaginal area with soap and water, from least contaminated to most contaminated.
For uncircumcised males, retract foreskin to clean, remembering to return it afterward.
Gently pat dry to reduce moisture.
Hygiene with Toileting Needs
Options:
Toilet
Bedside commode
Bedpan
Urinal
Linen and Bedding Change
Follow the WIPE method:
Wash hands
Introduce yourself
Provide privacy
Explain the procedure.
Gather supplies (linen, gown, protective pads, linen hamper).
Apply gloves and raise bed to comfortable working height.
Check for personal items in linen before removing and discard them appropriately.
Avoid placing dirty linen on the floor or against clothing.
Specialty beds may have specific linen requirements.
Early Morning Care
Assist patient with toileting.
Provide comfort measures to refresh the patient for the day ahead.
Wash face and hands.
Provide mouth care.
Morning Care (A.M. Care)
After breakfast, complete morning care procedures:
Toileting
Oral care
Bathing
Back massage
Special skin measures
Hair care and cosmetics
Morning Care (A.M. Care) continued
Tasks:
Positioning for dressing.
Ensure patient comfort.
Refresh and tidy up, changing any bedside linens.
Afternoon Care (P.M. Care)
Ensure patient comfort after lunch:
Offer assistance with toileting, handwashing, and oral care.
Straighten bed linens.
Help patient with mobility to reposition self.
Hour of Sleep Care (H.S. Care)
Before patient retires:
Offer assistance with toileting, washing, and oral care.
Provide a back massage.
Change any soiled bed linens or clothing.
Position the patient comfortably.
Ensure call light and essential objects are within reach.
As Needed Care (PRN Care)
Provide individual hygiene measures as required, including:
Change clothing and bed linens of patients experiencing diaphoresis.
Offer oral care every 2 hours if indicated.
Evaluate: Hygiene Outcomes for Clients
Assess desired outcomes for clients related to their hygiene:
Level of patient participation in the hygiene program.
Elimination or reduction of factors affecting independent execution of hygiene measures.
Changes concerning specific skin problems and independent management of prescribed treatment programs.
Talking with Your Patient
Steps for Effective Communication:
Clearly introduce yourself: "Hi, my name is [Your Name], and I’m a nursing student working with your nurse today.”
Use a warm, respectful tone and address them as Mr./Mrs. unless stated otherwise.
Start with small talk: Ask how they are feeling and if they rested well.
Listen actively: Nod, make eye contact, and avoid interrupting.
Show empathy: Rather than saying, "I know how you feel," you may say, "That sounds tough."
Keep communication simple: Avoid medical jargon, e.g., say "walk" rather than "ambulate."
Ask open-ended questions, for example: "Can you tell me more about your pain?" instead of asking if it hurts.
Check understanding: Ensure they understood by asking them to explain back what you communicated.
Respect their space and privacy: Knock before entering, close curtains/doors for sensitive discussions.
Close on a supportive note: Ask if there’s anything you can do to make them comfortable now.
Examples of Patient Interaction
Scenario 1:
Student: (knocks) “Hi Mr. Lee, I’m Anna, a nursing student working with your nurse today. How are you feeling this morning?”
Patient: “Not great. My stomach still hurts.”
Student: “I’m sorry you feel that way. Can you tell me more about the pain—when does it bother you the most?”
Scenario 2:
Student: (knocks) “Good morning, Mrs. Johnson, my name is [Your Name], a nursing student working with your nurse today. How are you feeling?”
Patient: “I’m nervous, I don’t like being in the hospital.”
Student: “That is understandable. Is there something I can do to help you feel more comfortable right now?”
Importance of Touch
“No other form of communication is as universally understood as touch. The compassionate touch of a hand or a reassuring hug can take away our fears, soothe our anxieties, and fill the emptiness of being lonely.”
Source: Randi G Fine