Section 2, Module 10 Personal Hygiene Support

Transcription

1 Section 2, Module 10 Personal Hygiene Support Foundations in Community Disability Studies Section 2, Module 10

2

3 Contents Introduction... 1 Learning Outcomes... 1 Unit 1: Core Values... 2 Introduction... 2 Choice... 3 Dignity... 5 Privacy... 6 Unit 2: Personal Hygiene Procedures... 8 Introduction... 8 Safety... 9 Bathing...10 Additional Resources...12 Perineal Care...12 Hair and Scalp Care...13 Care of Teeth and Gums...14 Foot and Nail Care...15 Shaving...16 Dressing...16 Eye Care...16 Ear Care...18 Skin Care...18 Pressure Ulcers...18 Toileting and Incontinence Support...21 A Good Resource...23 Unit 3: Repositioning...24 Introduction...24 Technique for Repositioning a Person in Bed...25 Logrolling...25 References for Module 10: Personal Hygiene Support...27 Self-Assessment...28 Answer Key for Self-Assessment...30

4

5 Module 10: Personal Hygiene Support

6

7 Introduction As a Community Disability Services Worker, an important part of your role may be to assist the people you support with personal hygiene tasks such as bathing, mouth care, hair care, hand and foot care, and dressing. The amount of assistance you give will depend on each person s level of independence. This module discusses the values that should guide you as you provide personal support. It also outlines personal hygiene support procedures and guidelines for moving individuals with restricted mobility who cannot change their position in bed. Learning Outcomes After completing this module, you will be able to: 1. Explain why the people you support need choice, dignity, independence, respect, and privacy when personal hygiene support is provided. 2. Demonstrate personal care procedures. 3. Demonstrate procedures for repositioning an individual in bed. Foundations in Community Disability Studies: Personal Hygiene Support 1

8 Unit 1: Core Values Introduction Values are ideals or beliefs that some individuals or groups deem to be very important to them. 1 Core values in the field of disability services are values that are basic (or foundational) to the work we do. This means that we must strive to ensure that our behaviour, decisionmaking, choices, and language reflect what we consider to be our core values. When supporting people who require assistance with personal hygiene tasks such as bathing and dressing, some key core values are choice and independence, dignity and respect, and Privacy privacy. 2 Choice CORE VALUES Respect Independence Dignity Unit 1 Learning Outcomes After completing this unit, you will be able to: 1. Suggest some choices you could give individuals when you assist them with personal hygiene. 2. Describe how you would support the dignity of an individual with a disability when helping him or her with personal hygiene. 3. Explain why it is important to respect an individual s need for privacy. 4. Recognize that individuals who have not met you before may be uncomfortable if you are providing personal care. This is awkward Learning Activity Describe how you might feel if you needed assistance with personal care. List at least six words that describe your feelings. 1 Values, WordNet Search Patricia Ann Potter and Anne Griffin Perry, Canadian Fundamentals of Nursing, 4 th ed., eds. Janet C. Ross-Kerr and Marilynn J. Wood (Toronto: Elsevier Canada, 2010), Foundations in Community Disability Studies: Personal Hygiene Support

9 Choice When you respect individuals preferences, you contribute to their independence, and you help them to have more control over their lives and to make choices about such things as who provides their assistance, when and where it happens, what products to use, and how routines are carried out. 3 Supporting Choices True choice is made up of three components: 1. Preferences being someone s likes, dislikes, wants and dreams; 2. Opportunities based on what is available, such as people to be with, place to go and even being alone, and 3. Control, which is having the authority to make use of an opportunity to satisfy a preference. 4 Disability support workers must support choice and recognize that everyone has preferences regardless of their disability. Supporting choice is more than Supporting choice is about teaching choice honouring the person you support offering choice finding out someone s preferences acknowledging their preferences finding opportunities to satisfy their preferences 5 Offer the people you support opportunities to make as many choices as possible. You can support their choices in many ways. According to John O Brien and Connie Lyle O Brien, choice is the most powerful word in the disability sector. Everyone is able to make choices at some level when given the opportunity. So always make choices available to the person you support. Examples of choices include: o Offering the widest range of choice. What would you like to wear today? o Offering choices with all items visible. Let s look in your closet. Do you see something you d like to wear? o Identifying several items the person can choose from. Would you like to wear any of these? 3 Potter and Perry, John O Brien and Connie Lyle O Brien, The Little book about Person Centered Planning, Volume 1, 4 th Printing (Toronto: Inclusion Press) Ibid. Foundations in Community Disability Studies: Personal Hygiene Support 3

10 o Identifying two items to choose from. Do you want to wear this green shirt or this blue shirt? o Suggesting one choice and asking if it is okay. Would you like to wear this green shirt today? Supporting a person to be independent means accepting the individual s choices, even if they are different from the ones you would make. o In supporting the choices of another person, you are suspending your own. Make sure you offer real choices. Choice: What time do you want to start supper? Command: Do you want to start supper? Offer choices that are realistic and achievable. Make sure you don t violate clients right to make choices. Violation: Eat your dinner now. Choice: Would you like your dinner before or after your shower? Never assume that individuals can t make choices or that their choices will always be the same. o Continue to offer choices even if you anticipate what the individual will say. o By doing so, you support the individuals to take control over their lives. When supporting a person with a disability, it is easy to fall into the trap of influencing choices towards your own preference. An example of this is saying something like, o I was thinking we could go to a movie, but what would you like to do? o Many of the people you support will be influenced first by your suggestion and, therefore, be unable to express their real wishes. Learning Activity 1. Identify two times you received support when you made choices. For example, you may have had advice from family or friends when you chose a career, bought a car, or moved into a different house or apartment. List at least three feelings you had about being assisted. 2. Identify two choices you made without support from anyone else. List at least three feelings you had about making these choices without assistance. 3. Discuss the relationship between choices that are respected by others and feelings of self-esteem. 4 Foundations in Community Disability Studies: Personal Hygiene Support

11 Dignity Dignity is concerned with how people feel, think and behave in relation to the worth or value of themselves and others. To treat someone with dignity is to treat them as being of worth in a way that is respectful of them as valued individuals. In care situations, dignity may be promoted or diminished by: the physical environment; organizational culture; the attitudes and behaviour of the (staff) nursing team and others; and the way in which care activities are carried out. When dignity is present, people feel in control, valued, confident, comfortable and able to make decisions for themselves. When dignity is absent, people feel devalued and lacking control and comfort. 6 As the above quote states, dignity is about feeling valued and being treated with respect by others. Learning Activity Working in pairs (if possible), brainstorm ways you can promote dignity when assisting the people you support with daily living and personal hygiene tasks. Write down your ideas and share them with your colleagues and/or tutor. As a Community Disability Services Worker, you can support a person s dignity in the following ways. Respect the individual s personal preferences (e.g., preferred hygiene products; when and how to bathe, shower, or shave). 7 Focus on ability, not dis ability. Educate and encourage individuals to do their own personal care where possible. 8 Step back, give people the opportunity to independently do what they can manage, and then support them to complete the rest. Help each person to be independent in his or her own way. 9 Ask the individuals what they are able to do if you are not sure (e.g., Can you do up the buttons on your shirt, or would you like some help? ) Royal College of Nursing, The RCN s definition of dignity (RCN Dignity Campaign, 2008). data/assets/pdf_file/0003/191730/ pdf. 7 Potter and Perry, Ibid, Ibid, Ibid, 847. Foundations in Community Disability Studies: Personal Hygiene Support 5

12 Use respectful, age-appropriate language and an adult tone of voice when speaking to the individuals you support. Include individuals you support in conversations happening around them. Be matter-of-fact, sensitive, dignified, and considerate when you assist with personal care. 11 Be empathetic (e.g., This must be hard for you. ), 12 not sympathetic (e.g., I feel sorry for you. ). 13 Empathy supports dignity, while sympathy can be demeaning. Handle individuals personal possessions with care and respect. When helping a person with personal hygiene, explain what you are going to do before each step. (e.g., Now I am going to wash your chest. ) 14 Ask for feedback about what you are doing with the person (e.g., Is the water warm enough for you? ). Enlist the individual s help whenever possible. 15 Be sensitive to cross-cultural issues regarding personal care and hygiene (e.g., in some cultures, it is taboo to shave or cut a person s hair). 16 Whenever possible, women should provide care to women and men to men. 17 Privacy As a Community Disability Services Worker, you are responsible for protecting the privacy of the people you support. The persons privacy includes: their personal space and time; their personal information (e.g., medical and financial records); and the level of intimacy they desire. Equally important is respecting the right of individuals and couples to be cared for and to be in intimate relationships, if they wish. Some suggestions for supporting privacy: Become aware of each individual s need for privacy. Be sensitive when discussing social or emotional issues with people you support. Talking to you about intimate details may be challenging for them. 11 Potter and Perry, Bob Shebib, Choices: Interviewing and Counselling Skills for Canadians, 3 rd ed. (Toronto: Pearson Prentice Hall, 2007), Shebib, Potter and Perry, Ibid, Ibid, Ibid, Foundations in Community Disability Studies: Personal Hygiene Support

13 Respect the individuals wishes and follow agency policy when sharing information about people you support with others. o Remember that all disclosures of abuse, harm to oneself or harm to others must be reported immediately to your supervisor or other designated agent. o Tell people you support about this policy when they first commence service with your organization. Close the bathroom or bedroom door when assisting a person with bathing, toileting, or dressing. 18 o If an individual needs assistance to get out of the bathtub or shower, hold a towel between the person and yourself. o When assisting a person with bathing, expose only the areas that are being bathed at the time and cover all other areas with a towel for privacy and warmth. 19 Make sure the personal, private space within the homes of the people you support allows them to o have uninterrupted relationships, o have sexual intimacy (among consenting adults), and o fulfill their personal needs (e.g., masturbate). Make sure individuals have choices about spending time alone and being with others. Violations of privacy can happen easily. A common one is demonstrated in the following dialogue: Visitor: Can I see John s room? Supervisor: Sure, go on in. He is at work, but I know he won t mind. John said I could show you his room, or Please wait and we can ask John when he comes home. Learning Activity 1. Think about your own needs for privacy and ask yourself, If I were in that person s position, what privacy would I need? Share your ideas with a colleague and/or tutor. 2. Provide two examples of how you might protect the privacy of a person you support in each of the following areas: Control of time; Control of space; Control of personal information; and Level of intimacy. 18 Potter and Perry, Ibid, 846. Foundations in Community Disability Studies: Personal Hygiene Support 7

14 Unit 2: Personal Hygiene Procedures Introduction This unit begins with guidelines for protecting your safety and the safety of people you are assisting with personal hygiene. It then outlines specific procedures in the areas of dressing, skin care, hair care, teeth and gums care, nail and foot care, shaving, makeup application, bathing, and toileting. Providing personal care for another person is an intimate process that must be approached with respect and dignity. You or the person may feel embarrassed about this, but you can never let this cause you to overlook the person s hygiene needs. Being professional and sensitive can reduce the level of embarrassment that you and/or the person receiving care may feel. 20 Before providing personal care, you must talk to your supervisor, who will make sure that you are fully trained in all of the procedures needed for the particular individual involved. As support needs change over time, you and the individual involved should be continually evaluating the amount of assistance required. Unit 2 Learning Outcomes After completing this unit, you will be able to: 1. Identify strategies to promote the safety of yourself and the person you support while completing personal hygiene activities. 2. Understand personal care procedures for the following: bath and shower assistance; hair care; foot and nail care; mouth and dental care; and assistance with dressing and undressing. 3. Identify changes in the skin that may lead to skin breakdown, and describe strategies to prevent skin breakdown. 4. Describe activities related to toilet use and incontinence. 20 Potter and Perry, Foundations in Community Disability Studies: Personal Hygiene Support

15 Safety Here are some general guidelines for ensuring your own safety and the safety of the individual you support: Always wash your hands before and after every personal care procedure, and after removing disposable gloves. 21 Close the door for warmth and privacy. 22 When assisting with bathing or showering, o make sure that a bathmat is in place and firmly secured to the floor, o check that anti-skid decals are installed in the bottom of the bathtub, 23 and o wear sturdy, rubber-soled shoes. Baths and showers should be equipped with grab bars. 24 Use bath rails on the wall or handles over the tub for support. 25 Do not use towel bars and soap dishes for support. Check that the shower or tub is clean before using, and wash thoroughly after use. 26 Always check the water temperature to ensure it is safe. o Even momentary exposure to scalding water can cause burns. o Know your organization s safe work practices for testing water temperature using a thermometer. o Water for a hot bath should never be above 40 o C (104 o F). o Find out if there are preset thermostatic valves installed on your point-of-use fixtures (i.e., baths, showers and sinks) to help minimize the risk. Follow principles o for proper posture and movement when providing assistance, o of Universal Precautions and infection control throughout all personal care procedures, and o for safe lifting and transferring as outlined in Ergonomics for Safe Lifting and Transferring. Use transfer belts when you are assisting with bathtub or wheelchair transfers for the first time. o Also use the belts thereafter if they are prescribed by a physiotherapist, particularly if the person you are assisting has poor balance. 27 Wipe up spilled water or other fluids immediately, to prevent falls. If you think a tub bath is unsafe for an individual, do a bed bath or sponge bath instead. Report the safety issue to your supervisor. 21 Potter and Perry, Ibid, Ibid, Ibid, Ibid, Ibid, Ibid, Foundations in Community Disability Studies: Personal Hygiene Support 9

16 Bathing The needs and circumstances of specific individuals determine what kind of bathing process is the safest and most effective for them. There are different kinds of baths: complete bed baths.; partial bed baths; tub baths; and showers. Regular bathing ensures cleanliness, helps control body odour, and contributes to an overall feeling of comfort and well-being. 28 Complete bed baths are for individuals who require total hygiene care to be done by someone else. A complete bed bath includes washing (in this order) 1. the face, 2. arms and hands, 3. chest, 4. underarms, 5. under the breasts of a female, 6. legs and feet, 7. back, 8. abdomen, and 9. genital area. 29 A partial bed bath includes washing those areas that the individual is not able to do themselves and that would cause odour and/or discomfort if not cleaned (e.g., underarms, back, genital area). 30 A tub bath works well for a person who prefers bathing and requires little or no assistance getting in or out of the bathtub. To prevent slipping, the tub should be filled half full before the individual gets in and drained before he or she gets out. 31 Portable bath chairs can be rented or purchased; these are safer and easier for individuals who have difficulty getting in and out of the tub and sitting all the way down. 32 Showers work well for people who prefer showers to baths and are physically independent. However, for people who have difficulty standing while having a shower, a shower seat can be rolled into an accessible shower to assist them. 33 To prevent scalding, always adjust the water temperature before the person enters the shower Potter and Perry, Ibid, Ibid, Ibid, Ibid, Ibid, Ibid, Foundations in Community Disability Studies: Personal Hygiene Support

17 General Tips for Assisting with Bathing Wash your hands before assisting with bathing, and wear disposable gloves whenever skin is soiled with body fluids and/or bodily products. 35 Respect the person s privacy and independence as much as possible. 36 Ask the person if he or she wants to use the toilet before his or her bath or shower. Always test the water temperature before the person gets in the tub. 37 o Dip your bare hand into the tub up to your elbow. o Swirl your arm through the water to ensure the water is evenly mixed and at an acceptable temperature for this individual. Keep the room temperature comfortable and close doors for privacy. 38 Collect all the bath items together before the person gets undressed. 39 Ask individuals what bath products they prefer, how they like their baths, 40 and which part of the process they would like to complete on their own. 41 Offer assistance only when needed, and encourage the person to assist with the process whenever possible. 42 Take special care to clean areas thoroughly, but gently, where skin touches skin: o between the legs; o under the arms; o under the breasts; o under the scrotum; o between the buttocks; and o between folds of skin in obese clients. 43 During the bath, observe the individual s skin for signs of potential breakdown, including redness or other discoloration, blisters, scrapes or cuts. 44 When doing a complete or partial bed bath, wash areas that generally are cleanest first and in this order: 1. face; 2. neck; 3. arms; 4. armpits; 5. hands; 6. chest; and 7. abdomen. 35 Potter and Perry, Ibid, Ibid, Ibid, Ibid, Ibid, Ibid, Ibid, Ibid, Ibid, Foundations in Community Disability Studies: Personal Hygiene Support 11

18 Wash remaining areas last and in this order: 8. legs and feet; 9. back and buttocks; and 10. genitals. 45 Unless the person prefers it, do not use soap on his or her face. Soap dries facial skin and is not recommended. 46 When you give a bed or sponge bath, o gently wash and pat dry one area at a time, o expose only those areas being bathed, and o cover other areas for warmth and privacy. 47 Rinse all areas well. Some people like to use lotion after bathing, particularly if they have dry skin. Some people may be prescribed lotion for a skin condition by a doctor or skin specialist. Assist the person to put on make-up, if he or she desires it. Additional Resources For more information on safe bathing and showering, check out the Safe Bathing and Showering Training Manual and Video developed by ACDS in partnership with PDD. Perineal Care Perineal care (or peri-care) is the cleaning of the genitals, the anus, and the buttocks. 48 Pericare is particularly important for individuals who are unable to control their bowel or bladder functions and/or wear incontinence products. 49 It may be done as part of the regular bath or separately, as needed. Some people may require only partial assistance to do their peri-care. Ask individuals what parts they would like to do on their own and only assist them to complete the parts that they are not able to do independently. When performing peri-care: wear gloves; always use a separate cloth from the one used to clean other parts of the body; on females, wipe from front to back (i.e., vagina toward rectum) to avoid contamination; and use a separate part of the cloth for each stroke while washing. 50 Women who are menstruating should have their pads changed at least every two to three hours. 45 Potter and Perry, Ibid, Ibid, Ibid, Ibid, Ibid, Foundations in Community Disability Studies: Personal Hygiene Support

19 Hair and Scalp Care Having clean, well-groomed hair can often make a big difference to how a person feels about themselves. 51 And brushing hair helps keep it clean, attractive and healthy. 52 Style or comb an individual s hair regularly and as needed. Also, wear gloves if needed. As with all support, let people make their own decisions regarding their preferred hair styles and which hair products to use. And support people to take as much responsibility as possible for their hair and scalp care 53 When caring for people from different cultures, ask them or their representatives about their cultural preferences for hair care, cuts, and styles. 54 Never cut a person s hair without proper consent. 55 When grooming, minimize pulling by brushing hair in small sections, and going from the scalp to the ends of the hair. 56 It is easier to use a comb on hair that becomes tangled when wet. 57 Comb the hair in sections, but this time begin at the ends of the hair and work up to the scalp. Know how to identify and treat head lice. Information is available at the following web site: (If your browser opens up to a login window, you can click Cancel and the browser will continue to the website page.) A person s hair can be washed in the sink, during a bath or shower, or while they are in bed. 58 Here are tips for washing the person s hair. 1. Brush the person s hair before washing. 2. Offer them a towel or washcloth to cover their eyes; this helps to keep the water out Wet the hair with warm water. 4. Massage shampoo into the hair at the scalp using your fingertips (not fingernails) Use a conditioner or cream rinse if the individual chooses Rinse the hair until it is squeaky clean. 7. Wrap the person s head in a towel. 51 Potter and Perry, Ibid, Ibid, Ibid, Ibid, Ibid, Ibid, Ibid, Ibid, Ibid, Ibid, 865. Foundations in Community Disability Studies: Personal Hygiene Support 13

20 8. Dry the person s face and area around the neck with a separate towel. 9. Towel dry the person s scalp and hair. 10. Comb his or her hair to remove any tangles. 62 Care of Teeth and Gums Teeth are important for chewing and eating food speech a person s appearance and self-esteem Mouth care consists of brushing and flossing the teeth and rinsing the mouth. Proper brushing cleans the teeth of bacteria, plaque, and food particles. Flossing reduces a person s chances of developing gum disease. Gum disease can result in infection and loss of teeth. 63 Ideally, teeth should be brushed at least four times a day; after meals and at bedtime. If this is not possible, brushing needs to be done at least once a day and always at bedtime. 64 Flossing should be done at least once a day. 65 Use fluoride toothpaste and a toothbrush that has a straight handle and a brush that is small enough to reach all parts of the mouth and all tooth surfaces. 66 Replace toothbrushes every three months. 67 Therefore, good dental care stimulates appetite is important for maintaining health enhances a person s sense of well-being and comfort Tips for brushing teeth: Gently brush from the gums to the edges of the teeth, using the side bristles of the brush. Report any redness, irritation, or bleeding to your supervisor. Lightly brush the sides and top of the tongue as part of a complete oral hygiene routine. 68 Offer the individual a cup of water to rinse his or her mouth on their own, if he or she wishes. People you support should go for dental checkups at least every six months 69 unless otherwise advised by their dentist. 62 Potter and Perry, Ibid, Ibid, Ibid, Ibid, Ibid, Ibid, Ibid, Foundations in Community Disability Studies: Personal Hygiene Support

21 Dentures Dentures are replacements for natural teeth, but still enable people to enjoy a variety of foods. Some people prefer to take their dentures out at night, which helps to prevent bacterial build-up and gives the gums a rest. 70 They should be stored in fresh, cool water in an enclosed cup or case provided by the manufacturer. 71 To clean dentures, soak them in the sink in a commercial solution or brush them with dental paste. Line the sink with a facecloth so they won t be damaged if accidently dropped. 72 Ill-fitting dentures can be very uncomfortable, causing irritation and difficulty eating. If a person you support has redness around the gums or problems eating, be sure to arrange for a dentist appointment. Foot and Nail Care Nails grow about 3-4 mm each month. 73 Trim fingernails and toenails regularly with nail clippers. This will prevent painful ingrown toenails. Use nail clippers to trim fingernails and toenails straight across. 74 Then file the nails straight across. Do not file down the corners of toenails. 75 Soak feet regularly to soften the cuticles, and make sure they are thoroughly cleaned and dried. 76 Watch for cuts, dryness, and/or signs of infection, and report these to your supervisor. 77 People who have diabetes or circulation problems 78 should wash their feet daily but should not soak them because of risk of infection, should have their nails trimmed by someone with specialized training, and are at risk of developing foot ulcers because of poor blood circulation to the feet. Good foot care also means having shoes that are properly fitted, are comfortable, and have good support and treads to prevent slipping. 70 Potter and Perry, Ibid, Ibid, The Ultimate Canadian Medical Encyclopedia: Understanding, Preventing, and Treating Medical Conditions, ed. Martine Podesto (Richmond Hill: Firefly Books, 2010), Potter and Perry, Ibid, Ibid, Ibid. 78 Ibid. Foundations in Community Disability Studies: Personal Hygiene Support 15

22 Shaving As a support worker, you may be asked to help women shave their legs and/or underarms or assist a man with trimming or shaving a beard or moustache. Ask individuals how they like this to be done. 79 For religious and cultural reasons, never shave or trim a beard without proper consent from the individual or guardian, where appropriate. 80 Before shaving, moisten skin with water and use a mild soap or shaving foam. To avoid cuts to the skin, gently pull the skin with one hand until it is taut, and with the other hand, use firm, short strokes that go in the direction in which the hair grows. 81 Individuals who tend to bleed easily should use an electric razor. 82 Dressing When assisting a person to dress, it is important to remember the following points. Encourage people to choose their own clothing by asking them what they would like to wear. Don t rush the person. Make this a pleasant and calm experience. Be gentle with the person: gently pull, don t push, arms through sleeves. Explain to the person what you are doing and ask for his or her assistance when possible. Respect the person s privacy and dignity by closing the door. Eye Care To clean the eyelids and around the eyes Moisten a washcloth. Gently wipe from the inner area to the outer, making sure to avoid any part of the actual eye. 83 Use a different part of the cloth for each eye to avoid passing any infection from one eye to the other. 84 In general, people should yearly check-ups with an eye doctor. Immediately report any signs of eye problems in the people you support to your supervisor. 79 Potter and Perry, Ibid, Ibid, Ibid, Ibid, Ibid, Foundations in Community Disability Studies: Personal Hygiene Support

23 Eyeglasses Information on symptoms of eye problems is available at Although eyeglasses are made of materials that are shatter-resistant, they can break and/or get scratched, so it is important to ensure that they are handled carefully. Follow the manufacturer s instructions for cleaning and maintaining glasses, particularly for plastic lenses, which are easily scratched. 85 Most eyeglasses can be cleaned and dried with cool water and soft cloths. Do not use paper towels, as they can scratch the lenses. 86 Report any signs of irritation on the nose or behind the ears from the frames to your supervisor. Contact Lenses Contact lenses are small, round discs that fit over the cornea of a person s eye and are designed to correct some vision problems. There are currently three types of lenses available: 1. Daily wear: To prevent infection, remove these lenses each night and clean and disinfect them. 2. Extended wear lenses: These lenses can be worn up to 30 days without being taken out at all. 3. Disposable lenses: Replace these lenses every one to two weeks. 87 Follow the manufacturer s instructions for cleaning and maintenance. The following are general tips for care of contact lenses. 88 Use special solutions recommended by the optometrist or manufacturer for cleaning and disinfecting. Never use a fingernail to remove dirt from a lens. If a lens is dropped, o moisten a finger with the cleaning solution, o touch the lens with the end of your finger, o and pick it up. o Then clean and disinfect the lens. Keep lenses moist between wearing. Store in a lens storage case that is filled with a cleaning solution. o Change the solution daily. 85 Potter and Perry, Ibid, Ibid, Ibid, 867. Foundations in Community Disability Studies: Personal Hygiene Support 17

24 If a person who wears contact lenses has red or watery eyes, pain or sensitivity, or a change in ability to see, report this to a supervisor right away. 89 An appointment should be made with the professional who prescribed the lenses. Ear Care To clean the ears, gently rub the end of a moistened washcloth into the entrance of the ear canal. 90 Ear wax can build up and can affect hearing particularly in children and older adults. Ears should be regularly checked by a physician, who may prescribe irrigation to remove excess ear wax. 91 Never use sharp objects (e.g., paper clip, bobby pin) or Q-tips to remove ear wax. Skin Care The skin is the largest organ in the body, and it makes up about 15% of an individual s body weight. 92 It has very important functions, including: 93 Helping to control body temperature (e.g., sweating). Protecting against disease by preventing pathogens from entering the body that could cause infection. Sensing pain, heat, cold, touch, etc. Aiding in the production of Vitamin D, which is critical for health. As a Community Disability Services Worker, you need to be aware of factors that can contribute to skin breakdown and how to prevent it. Watching for signs of skin damage can reduce the likelihood of serious problems occurring. Pressure Ulcers Pressure ulcers (also known as pressure sores, decubitus ulcers, or bedsores) are sores on the skin and the tissue underneath the skin that are caused by: Pressure: Pressure on the skin for a long time reduces blood flow to the cells. The cells die and cause breakdown. 94 Skin breakdown occurs most often in areas where bones press against the surface of the skin. 95 The pressure can come from sitting, lying in bed, catheters against the skin, braces, or casts. 89 Potter and Perry, Ibid. 91 Ibid. 92 Anette B. Wysocki, Anatomy and Physiology of Skin and Soft Tissue, in Ruth Bryant and Denise Nix, Acute and Chronic Wounds: Current Management Concepts, 3 rd ed. (St Louis, MO: Mosby, 2007), quoted in Patricia Ann Potter and Anne Griffin Perry, Canadian Fundamentals of Nursing, 4 th ed., eds. Janet C. Ross-Kerr and Marilynn J. Wood (Toronto: Elsevier Canada, 2010), Potter and Perry, Ibid, Ibid, Foundations in Community Disability Studies: Personal Hygiene Support

25 Friction and Shearing: Skin can be torn or damaged when a person is pulled or slid across a surface (e.g., across bed sheets or into a chair or bed). 96 Moisture: When the skin is moist, it is more susceptible to damage. 97 The following factors increase the risk of a person developing pressure ulcers: 98 Age: As a person ages, the skin can become dry, irritated and more susceptible to tearing and breaking into sores. This is often due to decreased blood circulation. Lack of mobility: When a person remains in the same position for a long time (e.g., sitting in a chair or wheelchair, laying in bed), circulation becomes reduced as blood flow is cut off to the areas where bones are close to skin (e.g., knees, elbows, hips, toes, heels). This in turn forms pressure ulcers. People who are not able to move themselves or shift their weight independently are at particular risk. 99 Poor diet: People who do not get the proper nutrition to maintain good health are at risk of developing pressure ulcers. Exposure to moisture: Too much moisture softens the skin and results in skin breakdown. People who have incontinence problems, sweat a lot, or have wounds that are draining are particularly at risk. Mental, neurological and other physical problems: People with a reduced sensitivity to pain and pressure tend not to move their bodies as much, which increases the risk of developing pressure sores. People who are confused or disoriented may not be able to communicate their symptoms. 100 Exposure to bed sheets and chairs with wrinkled sheets or hard objects: Sheets that are wrinkled and objects left in the bed or on the chair can increase the risk of pressure ulcers developing. Past history of pressure ulcers: People who have had pressure ulcers in the past are more likely to get them again. Preventing Pressure Sores Pressure o Every two hours, reposition a person who is unable to turn themselves independently in bed. A qualified professional will determine if an individual requires more frequent turning. 101 o Encourage people in wheelchairs and chairs to move their position every 15 minutes. 102 People should never remain in a sitting position for any longer than two hours Alene Burke, Nursing Assistant Education, (Alene Burke and Associates, 2010), (Link no longer available.) 97 Potter and Perry, Burke, Nursing Assistant Education. 99 Potter and Perry, Ibid. 101 Ibid, Ibid. Foundations in Community Disability Studies: Personal Hygiene Support 19

26 o A physiotherapist or occupational therapist can recommend proper seating and positioning equipment, pads, and procedures for beds, chairs, and wheelchairs. 104 Do not use donut pillows or rigid pillows as they reduce blood flow to the area. 105 Friction and Shearing: To prevent shearing o Use a sheet to lift individuals rather than dragging them across the bed. 106 o Make sure that bed sheets are not wrinkled and objects are not left in chairs or beds, where they could cause irritation or damage to the skin. o If possible, raise the head of the bed to 30 degrees or less to prevent the person from sliding down the sheets. 107 Moisture o Change incontinence products regularly to avoid body fluids (e.g., urine, feces, saliva, sweat, wound drainage) from touching the skin. Make every effort to keep the individual dry. o Use warm water and cleansers with nonionic surfactants for cleaning the skin. 108 Dry skin thoroughly. Gently rub in a small amount of lotion to lubricate the skin but not saturate it. 109 o When changing incontinence products, gently wash and dry the area and apply a thick layer of barrier cream to protect the skin from moisture from urine and feces. 110 Nutrition o Ensure that the person eats nutritional meals and drinks lots of fluids. Wound healing depends on adequate protein, vitamins (especially A and C), minerals (particularly zinc and copper), fat, and carbohydrates. 111 Monitoring o Regularly check the skin of people who are at risk of skin breakdown and who are not capable of monitoring their skin condition independently. A good time to check the skin is while doing personal care and/or bathing a person. o Report to your supervisor immediately any signs of skin breakdown (e.g., redness, blistering, cuts, scrapes, and/or cracking). Early identification of symptoms can prevent ulcers from developing Potter and Perry, Ibid. 105 Ibid. 106 Ibid, Ibid, Ibid, Ibid. 110 Ibid, Ibid, Ibid, Foundations in Community Disability Studies: Personal Hygiene Support

27 Toileting and Incontinence Support Toileting When you assist people who need help to use the toilet, it is important to protect their dignity, comfort, privacy, and safety. Ask what assistance is needed. Position and transfer individuals safely. Assist with wiping. Remind or help them to wash their hands. Detailed information on safe lifting and transferring techniques is provided in Ergonomics for Safe Lifting and Transferring. Incontinence Incontinence is a condition where a person cannot control the loss of urine (urine incontinence) 113 and/or feces from the rectum (fecal incontinence). 114 There are many causes of incontinence. 115 Poor muscle control due to aging. A physical condition. Illness. Not experiencing the sensation that tells them that they need to urinate or defecate, so are not able to get to the toilet in time. Incontinence can be distressing for people because consequences are embarrassing and uncomfortable. People need understanding and acceptance, as well as regular peri-care. Protective underpants and/or pads make it possible for many people to assume regular daily routines and avoid uncomfortable incidents at night. Anyone experiencing incontinence should see a doctor, as incontinence can be treated, and in many cases cured. Treatment options include pelvic muscle exercises, medication, and surgery. 116 A doctor may prescribe a catheter in cases where other options are not suitable and incontinence is chronic. 117 Catheters are sterile tubes that are inserted into the bladder and facilitate the drainage of urine into a plastic drainage bag. 113 Alberta Health Services: Foothills Medical Centre. Pelvic Floor Clinic Mayo Foundation for Medical Education and Research Fecal incontinence. 116 Pelvic Floor Clinic. 117 Potter and Perry, Foundations in Community Disability Studies: Personal Hygiene Support 21

28 Catheters are either intermittent or in-dwelling. Intermittent catheters Are introduced just long enough for a person to drain the bladder (5-10 minutes). Are used if a person has difficulty draining the bladder fully (e.g., due to a spinal cord injury). Can be used in the hospital and in the community. Can be re-used many times. o Wash with soap and water and leave to air-dry between uses. 118 o Wear latex gloves when handling and cleaning catheters. In-dwelling (or Foley) catheters Remain in the bladder until the individual is able to void completely. 119 Empty the drainage bag before it is completely full. Regularly clean the area around the catheter insertion site with soap and water or skin cleansers. 120 Some people you support may have ostomies for the removal of feces from the body. 121 An ostomy is the surgical procedure that creates a hole in the stomach to allow human waste to go directly from the bowel to the outside of the body rather than via the rectum. A stoma is the section of the person s bowel that is visible outside the abdomen and is connected to a pouch that receives the body wastes. Further information about ostomies is available online at Guidelines for proper management of catheters and ostomies should be obtained from a doctor or nurse. People who are incontinent need opportunities to dress well and according to their own particular taste. Stylish clothing is available that hides catheters and drains and makes it easy to change the bags. Adapted clothing for people with catheters and ostomies can be purchased at some medical supply stores and from the internet. A local source is Alberta Clothing Supplies Ltd., which can be found online at Waterproof seat covers can be used to protect furniture and wheelchair cushions. Further information about incontinence can be found at the following links Potter and Perry, Ibid. 120 Ibid, United Ostomy Association of America. What is an Ostomy? 22 Foundations in Community Disability Studies: Personal Hygiene Support

29 A Good Resource IEP Resources has published a plain language manual entitled Personal Success: An Illustrated Guide to Personal Needs. It is an illustrated instructional manual designed to assist people with cognitive and/or communication challenges in the area of personal care. The guide is available through Amazon or by contacting the publisher at: IEP Resources Attainment Company, Inc. PO Box Verona WI USA Phone: Fax: Web: Foundations in Community Disability Studies: Personal Hygiene Support 23

30 Unit 3: Repositioning Introduction People with restricted mobility may need help to move and turn in their beds in order to prevent pressure ulcers (bed sores) from forming. How often a person needs to be turned or repositioned depends on many factors, including age, physical condition, and skin condition. 122 Everyone should be moved at least once every two hours, but some people may require more frequent repositioning. 123 Repositioning stimulates circulation, helps to prevent pressure ulcers, helps respiratory and gastrointestinal function, reduces muscle deterioration from lack of activity, and makes the person feel more relaxed and comfortable. 124 A qualified professional (e.g., Registered Nurse, physician, physical therapist) should be able to assist you in implementing a repositioning routine tailored to the needs of the person you support. Staff training in repositioning techniques should be supervised by a physical therapist. Unit 3 Learning Outcomes After completing this unit, you will be able to: 1. Demonstrate how to reposition a person in bed. 2. Demonstrate how to reposition a person whose body must stay in a straight alignment (logrolling). 122 Potter and Perry, Ibid. 124 Brookside Associates Medical Education Division, Nursing Fundamentals 1. Lesson 4 Body Mechanics; Section I Techniques of Body Mechanics; 4.09 Reasons for Changing the Position of a Patient Foundations in Community Disability Studies: Personal Hygiene Support

31 Technique for Repositioning a Person in Bed 125 Two people are required to complete this repositioning procedure. Logrolling Gently turn the person on his or her side by o standing on the side that the person will be facing after being repositioned and then o reaching over them and grabbing the draw sheet on the opposite side. 126 o Then gently pull the draw sheet towards you while the other caregiver gently pushes the person s hip and shoulder towards you. 127 To provide support and help prop the person up on his or her side, place a pillow or foam wedge o firmly at the person s back and under the draw sheet, and o between the person s knees. Some people may like to have their arms propped up with pillows for added comfort. It is recommended that a person alternate his or her position between the back, right side, and left side at least every two hours. 128 When the person is lying on his or her back, you can place a pillow under the knees and/or raise the foot of the bed if possible so the knees are bent. o This helps prevent a person from sliding down the bed and irritating the skin. o A pillow placed under the ankles keeps pressure off the skin on the heels. 129 Logrolling is a technique for repositioning a person who must stay in a straight position and be turned in one movement without twisting the body (e.g., someone with a spinal cord injury). 130 IMPORTANT Wash your hands before repositioning the person. Wear sturdy shoes for safety. Place a draw sheet under the person being repositioned before the procedure begins. 125 Angela Morrow, How to Position a Person in Bed, About.com, last updated Feb, Ibid. 127 Ibid. 128 Ibid. 129 Ibid. 130 Brookside. Nursing Fundamentals 1. Foundations in Community Disability Studies: Personal Hygiene Support 25

32 Logrolling Technique This technique requires three people Explain the procedure to the person and ensure that it will be done in private. 2. Where possible, adjust the bed to a flat position at a height that is comfortable for caregivers. 3. Lower the side rails. 4. Two caregivers stand on the side of the bed to which the person will be turned and the other is on the opposite side. 132 a. Caregivers should stand close to the side of the bed with their knees flexed and feet comfortably apart. 5. Put a pillow between the person s knees Gently cross the person s arms across his or her chest Roll up the edge of the draw sheet to provide handholds for the caregivers. 8. On the count of three, move the person in one smooth, continuous movement Place pillows against the person s back and gently lean the person toward the pillows. Learning Activity The following link has a video on the use of slide sheets (or draw sheets) to reposition a person Potter and Perry, Ibid. 133 Ibid. 134 Ibid. 135 Ibid, Foundations in Community Disability Studies: Personal Hygiene Support

33 References for Module 10: Personal Hygiene Support Alberta Clothing Suppliers LTD. Alberta Health Services: Pelvic Floor Clinic. Attainment Company. Brookside Associates Medical Education Division, Nursing Fundamentals I. Lesson 4 Body Mechanics; Section I Techniques of Body Mechanics; 4.09 Reasons for Changing the Position of a Patient. Calgary Health Region. Head Lice: Facts and Treatment. Mayo Foundation for Medical Education and Research ( ). Fecal incontinence. Morrow, Angela. How to Position a Person in Bed. About.com. Last updated February 24, Potter, Patricia Ann, and Anne Griffin Perry. Canadian Fundamentals of Nursing, 4 th ed., edited by Janet C. Ross-Kerr and Marilynn J. Wood. Toronto: Elsevier Canada, Prevent Blindness America. Signs of Eye Problems in Adults. Royal College of Nursing. The RCN s definition of dignity. RCN Dignity Campaign, data/assets/pdf_file/0003/191730/ pdf. Shebib, Bob. Choices: Interviewing and Counselling Skills for Canadians, 3 rd ed. Toronto: Pearson Prentice Hall, Sliding Sheets. YouTube video, 5:59. Posted by joeyjoejoeiv. July 20, Ultimate Canadian Medical Encyclopedia, The: Understanding, Preventing, and Treating Medical Conditions, edited by Martine Podesto. Richmond Hill: Firefly Books, United Ostomy Associations of America (UOAA). Ostomy, Colostomy, Ileostomy, Urostomy, Continent Diversion Support Groups. UOAA. What is an Ostomy? WordNet Search 3.1. Values. Wysocki, Anette B. Anatomy and Physiology of Skin and Soft Tissue. In Ruth Bryant and Denise Nix. Acute and Chronic Wounds: Current Management Concepts, 3 rd ed. St Louis, MO: Mosby, Quoted in Patricia Ann Potter and Anne Griffin Perry, Canadian Fundamentals of Nursing, 4 th ed., edited by Janet C. Ross-Kerr and Marilynn J. Wood. Toronto: Elsevier Canada, Foundations in Community Disability Studies: Personal Hygiene Support 27