As a caregiver, you will help the people in your care with the activities necessary for maintaining personal cleanliness and a neat, well-cared-for appearance. Personal cleanliness (hygiene), which is achieved through regularly washing the body and hair and brushing the teeth, is important for both physical and emotional health.
These activities help to keep the skin, hair and mouth healthy by removing infection-causing microbes. In addition, keeping the body and mouth clean prevents odors, which is important for self-esteem. Grooming activities, such as dressing, shaving, and styling the hair, help to maintain a neat appearance and are also important for maintaining a person’s emotional health.
When you help a person with personal hygiene and grooming activities, you help the person feel confident and attractive. A person who feels confident and attractive is more likely to socialize with others, and feel better about himself or herself in general. Think about how you felt on a day when you knew you looked your best, versus how you felt on a day when you had to rush through your normal personal care activities!
The way we appear to others says a lot about who we are and how we view ourselves. The decisions we make that affect our outward appearance, such as how we choose to style our hair or what clothes we choose to wear, are deeply personal because they are so closely tied to our self-image and self-esteem.
Cultural and religious beliefs can influence the decisions a person makes about his or her outward appearance. So can the person’s feelings about his or her own sexuality. Many of the people in your care will need your help to maintain personal cleanliness and a neat appearance. However, this does not mean that they have given up the desire to make their own decisions concerning hygiene and grooming.
When you are assisting with personal care, always try to find out the person’s preferences and honor them. Activities related to personal hygiene and grooming usually take place at predictable times. Scheduling of these activities is necessary because they must be accomplished in addition to other routine events throughout the day, such as meals, home health or hospice visits, appointments, social events, etc.
It is still possible, however, to take an individual’s preferences into account when scheduling these activities. For example, some people may prefer to bathe in the evening instead of in the morning. It is important to try and accommodate the person’s preferences as much as possible when scheduling care. Also, be aware that often, care related to personal hygiene and grooming may be provided outside of the regularly scheduled time. For example, if a person spills food on her blouse while eating, you will help her to change her blouse after the meal.
Illness or disability can make it difficult for a person to maintain her normal personal care routines. For many people, it can be difficult or embarrassing to accept help with activities of such a private, personal nature. Imagine what it would feel like to have a stranger brush your teeth, bathe you, comb your hair and dress you. Be sensitive to the person’s feelings, and remember to provide restorative care by encouraging the person to do as much for himself as he is able. This is important for the person’s self-esteem and sense of independence.
When you get up in the morning, how does your mouth feel? What do your teeth feel like after you eat a meal? Part of your responsibility in assisting with personal care is to help provide mouth care, also called oral hygiene. Mouth care includes care of the teeth, gums, tongue, lips and soft parts of the inside of the mouth, such as the cheeks and the roof of the mouth.
Good oral hygiene is necessary to keep the mouth and the body healthy. Regular brushing and flossing helps to remove plaque, a sticky, colorless layer of bacteria that forms on the teeth. Sugars and starches in the food we eat cause the bacteria in plaque to grow. These bacteria can cause bad breath odors. In addition, they produce acids, which destroy the outer surface of the tooth, leading to tooth decay.
If plaque is not removed by brushing the teeth, it hardens into tartar. Tartar can cause gum irritation and infection, as well as tooth decay and loss. The same bacteria that cause gum inflammation and infection can also cause inflammation and infection in other parts of the body, putting the person at risk for heart disease, stroke and other serious conditions. In addition to removing harmful bacteria, regular mouth care also helps to keep the tissues of the oral cavity moist. A dry mouth is uncomfortable and can alter the taste of food and beverages, making them less appealing.
Mouth Care for a Person with Natural Teeth
Natural teeth are cared for using a soft-bristled toothbrush, toothpaste and dental floss. The soft bristles of the toothbrush remove plaque and food particles from the teeth and tongue and stimulate circulation in the gums, which helps keep them healthy. The toothbrush should be replaced every 3 to 4 months, or when it begins to show wear. A toothbrush with worn or frayed bristles does not properly clean the teeth and may injure the gums. Unless instructed otherwise, use a toothpaste that contains fluoride (a chemical that helps to strengthen the tooth enamel and prevent tooth decay).
In some regions of the United States where the water contains high levels of fluoride, dentists may recommend using toothpaste that does not contain fluoride. After brushing, dental floss is used to remove plaque and food particles from between the teeth.
Waxed dental floss slides between the teeth more easily than unwaxed dental floss does. Before flossing a person’s teeth, review the person’s care plan to see whether there are any restrictions or special precautions to be considered. For example, some people taking certain medications may bleed excessively if their teeth are flossed.
Mouth Care for a Person with Dentures
Many people have dentures (false teeth). Complete (full) dentures replace all of the top teeth or all of the bottom teeth. Partial dentures replace only a few teeth. Wearing dentures decreases gum shrinkage after teeth have been removed and maintains the shape of the mouth. With dentures in place, it is easier for the person to chew food properly and speak clearly.
Keeping the soft tissues of the person’s mouth healthy and the dentures clean is important for health and also makes it more likely that the person will want to wear the dentures. Dentures are cleaned by brushing them with a special toothpaste made for dentures. Some people may also soak their dentures in a denture-cleansing solution as part of their routine. Dentures that have been soaking in a solution should be brushed and thoroughly rinsed before placing them in the person’s mouth. A soft mouth sponge is used to clean the soft tissues of the mouth after the dentures are removed for cleaning. Caring for the soft tissues of the person’s mouth keeps the tissue healthy and helps to ensure that the dentures continue to fit properly.
Dentures are removed for cleaning and, ideally, for at least 8 hours every day (usually overnight) to rest the gums. However, some people may prefer to wear their dentures at all times and only remove them for cleaning. When the person is not wearing the dentures, they should be stored in a labeled denture cup in water or denture-cleansing solution to prevent warping. Always handle a person’s dentures carefully, so that they do not chip or break. Also, take care not to lose the person’s dentures. Dentures are expensive and time-consuming to replace, because they are custom-made for the person.
Mouth Care for a Person Who Is Unconscious
An unconscious person is not able to respond to her environment and will be totally reliant on you for mouth care. People who are unconscious breathe through their mouths, which causes drying of the soft tissues of the mouth and leads to the build-up of mucus and other secretions on the teeth and tongue. You must provide mouth care for an unconscious person every 2 hours throughout the day and night to remove these secretions and prevent the mouth from becoming excessively dry.
When providing mouth care for a person who is unconscious, elevate the head of the bed (if allowed) and turn the person’s head to the side to allow fluids to run out of the mouth instead of down the person’s throat. This is important to prevent aspiration (inhalation of fluids or other foreign materials into the lungs). Aspiration can lead to pneumonia. Use a mouth sponge to clean the soft tissues of the person’s mouth and a soft-bristled toothbrush moistened with water or a mixture of mouthwash and water to clean the person’s teeth. Remember to tell the person what you are doing as you are doing it. Even though the person cannot respond to you, he may be aware that something is being done to him.
Hair care, which includes washing, brushing, combing and styling the hair, is necessary to keep the hair and scalp healthy, and to maintain a neat appearance. Washing the hair removes dirt, oil and bacteria from the hair and scalp. Brushing, combing and styling the hair helps to prevent painful tangles from forming and provides for a neat appearance. Many still like to have their hair professionally cut, washed and styled, but you will be responsible for helping the person with hair care in between visits to the salon.
People often have strong preferences regarding what products are used to care for their hair. For example, some people may prefer a certain type of shampoo, or like to use a conditioning rinse in addition to shampoo. People of African descent, who often have very curly hair and dry scalps, may use oils, creams or lotions to make the hair easier to comb and to moisturize the scalp. These products are usually applied to the scalp after shampooing and then massaged into the scalp and hair. When assisting a person with hair care, find out what products the person likes to use, and honor those preferences as much as possible.
Brushing, Combing and Styling the Hair
A comb with widely spaced, blunt teeth is used to remove tangles from wet or dry hair. A brush is used on dry hair to neaten the appearance of the hair. To prevent hair from breaking and to detangle the ends, start brushing or combing from the ends of the hair, working toward the scalp, and work in small sections.
If the hair is very tangled, wet the hair and apply conditioner before combing, and then wash and rinse the hair after you have removed all the tangles. Remember to comb and brush hair gently so that you do not pull it out. With age, hair becomes drier and more fragile. In addition, some medications and medical treatments cause hair to become brittle or fall out.
When styling a person’s hair, be sure to ask about the person’s preferences and follow them as closely as you can. For example, most people have a preferred side for parting their hair. Provide the person with a mirror, so that she can see what you are doing. If you must make decisions about how to style a person’s hair, choose an age-appropriate, attractive style. Some people with very curly hair may find it easier to keep their hair tangle-free if it is braided. Check with the person to make sure that she wants her hair braided. If she does, be careful not to braid the hair too tightly, because hair tends to draw tighter as it dries and may pull too tightly on the scalp.
Shampooing the Hair
Shampooing cleans the scalp and hair and stimulates blood flow to the scalp. Many people find it very relaxing to have the head and scalp gently massaged as part of the shampoo, and having clean hair can help a person to feel better in general.
How often the hair is washed varies from person to person. Older people tend to have drier skin and hair and are usually less active than younger people, so they may only need to wash their hair once or twice a week. People with oily skin and hair or people who are very active may need to wash their hair every day. Take into account the person’s preferences when working out a schedule for shampooing the person’s hair. Also, be aware that sometimes an unscheduled shampoo can help a person to feel better (for example, if the person is feverish and the hair has become sweaty).
Shampooing is often accomplished in the shower or tub while bathing. If the person is unable to get out of bed, his hair can be washed while he is in the bed using a shampoo tray (a device that funnels the water into a wash basin placed on a chair or the floor beside the bed).
If a shampoo tray is not available (for example, in the home setting), one can be improvised using a large plastic trash bag. Place a rolled towel inside the bag. Twist it into a C shape. Place the person’s head in the center of the C. Drape the sheet or bag toward the side of the bed so that water drains into a washbasin placed on a chair. A shampoo cap can also be used to wash a person’s hair in bed. The cap, which contains a rinse-free cleanser, is placed over the person’s hair, and the hair and scalp are massaged through the cap to remove dirt and oils.
Shaving is done to remove unwanted hair from the body. Many men shave their faces daily, either in the morning or at bedtime, to remove facial hair. Women may shave leg and underarm hair. This type of shaving is most easily done at bath time.
Removal of unwanted hair can be accomplished in a variety of ways. A safety razor is used with warm water and shaving cream, gel or soap. An electric razor is used after applying a pre-shave lotion. Men who have very curly beards may prefer not to shave, but to use a depilatory cream or powder to chemically dissolve and remove facial hair. Many women also use a depilatory product to remove unwanted leg, underarm or facial hair.
Shaving with a Safety Razor
When using a safety razor, it is easy to nick the skin, causing bleeding. Because people with certain medical disorders or who are taking certain medications can bleed excessively if they are cut, check the person’s care plan or ask the nurse before assisting a person to shave with a safety razor. For people with conditions that can cause them to bleed excessively, an electric razor is usually preferred.
Before helping a person to shave using a safety razor, inspect the skin for moles or other raised areas. Shave carefully around these areas to avoid scraping or cutting them, which could cause bleeding. Apply shaving cream, gel or soap to soften the hair and help the razor glide over the skin. Many men will prefer to finish the shave by applying aftershave lotion, which has a nice scent and helps to soothe the skin. The alcohol in most aftershave lotions also acts as an antiseptic and can help to stop bleeding from small nicks or cuts.
Always take standard precautions when helping a person to shave with a safety razor. Because blood particles may be left on the razor blade and can spread infection, make sure each person has his own safety razor. When the blade on a safety razor becomes dull, it is more likely to nick the person’s skin. Depending on the type of safety razor, the entire unit may be disposable, or you may just need to replace the blade. Always handle razors and blades carefully to avoid nicking yourself, and dispose of them properly. To store a safety razor between uses, place it blade-end down in a container without recapping it. You may accidentally cut yourself if you attempt to recap the razor.
Shaving with an Electric Razor
An electric razor lifts the hair away from the skin before slicing it off with the blade. Thus, an electric razor carries a lower risk of cutting or nicking the skin and is preferred for people with blood-clotting disorders and those who are taking medications that affect the blood’s ability to clot. Applying a pre-shave lotion can help to soften the hairs and may result in a smoother shave when using an electric razor.
Electric razors are small appliances, so remember to take the same precautions when using them that you would with any electrical appliance. Inspect the razor before using it to make sure that the cord is not frayed and that it is operating normally. If the razor is malfunctioning (for example, it stops and starts, or is making a strange sound), do not use it. To keep the razor in good working order, take it apart and clean it after each use.
DRESSING AND UNDRESSING
Clothing changes occur several times throughout the day. At minimum, people usually change clothing in preparation for the day ahead and in preparation for sleep. In addition, whenever an article of clothing becomes soiled or wet, it must be changed.
Many people will be able to dress and undress with minimal assistance from you. Assistive devices such as shoehorns, buttoning aids and zipper pulls can help a person function more independently with dressing and undressing. So can choosing clothing that is easier for the person to put on and take off. For example, pants with elastic waistbands may be easier for a person to manage than pants with zippers, buttons or ties.
For some people who are receiving care, it can be very difficult to make the effort required to get dressed each day. However, it is important to encourage them to do so, unless they are very ill. Getting dressed every day helps people to maintain their sense of identity and purpose. Encourage the person to do as much as he can, and provide help as needed.
It is also important to allow people to make their own decisions about what they want to wear. If the person has trouble making decisions, limit the number of choices, but still allow the person to choose. When helping a person select clothing, consider:
The person’s preferences.
The person’s physical capabilities.
What the person will be doing that day.
The weather and the season.
Clothing should fit properly and be in good condition. Sometimes there will be special circumstances that you must take into account when helping a person to dress. When helping a person with a weak, paralyzed or injured arm or leg to dress, put the garment on the affected arm or leg first. Then, do the opposite when you are helping the person to undress: Remove the garment from the affected limb last.
VISION AND HEARING AIDS
Many of the people in your care will use eyeglasses, hearing aids or both. These devices help the person interact with others and are therefore important to the person’s overall quality of life.
Eyeglasses are worn to correct vision problems. Encourage the people in your care who have glasses to wear them, especially when they are out of bed. This is important for safety.
Eyeglasses are expensive and it can be inconvenient to replace them if they become broken or lost, so always handle them carefully. When the person is not wearing them, they should be stored in their case. The person may need help keeping the glasses clean. Clean the glasses with soap and water or eyeglass-cleaning wipes, which are moistened with a cleansing agent meant specifically for cleaning eyeglasses. If soap and water are used to clean the glasses, dry them with a soft, clean cloth to avoid scratching the lenses.
A person with impaired hearing may use a hearing aid. Hearing aids are battery-operated devices worn in or behind the ear to make sounds louder. Some in your care may need help inserting or removing their hearing aids and keeping them clean. Follow the manufacturer’s instructions for cleaning. Make sure the person keeps an extra battery on hand, so that the battery can be replaced promptly when necessary.
Like other assistive devices, hearing aids are expensive to replace if they are lost or damaged. Moisture and hair care products (such as hair spray) can damage a hearing aid, so help the person to insert the hearing aid after providing hair care. Store the hearing aid in its case, and out of reach of children, pets and confused adults who might mistake the battery for something that can be swallowed.
Perineal care is the cleansing of the area between the legs, including the genitals and the anus. Perineal care is provided during a bath or shower, but it may also be provided any time it is needed. For example, a person who is incontinent of urine or feces will need perineal care after each episode of incontinence. Urine and feces are very irritating to the skin and if not removed, they can lead to skin breakdown. Also, removing urine and feces from the skin is necessary to prevent odor and protect the person’s dignity and self-esteem.
When providing perineal care, it is especially important to take steps to protect the person’s dignity and privacy. Always ask the person’s permission first, and explain what you are going to do using words the person can understand. For example, you can say, “I’m going to clean the area between your legs now.” Use a towel to cover the person so that only the perineal area is exposed. Allow the person to provide for his or her own perineal care to the greatest extent possible.
Assisting a person with perineal care may also be embarrassing for you. Although these feelings are normal, if the person senses that you are embarrassed or uncomfortable, he or she will likely become embarrassed or uncomfortable, too. A straightforward, professional approach can help to put the person at ease. Think about how you would feel if you were unable to provide for your own perineal care. Would you feel better about the situation if the person helping you was kind, competent and professional?
Practice proper infection-control measures when providing perineal care. Wear gloves, because contact with body fluids is likely. Also, use proper technique for washing, rinsing and drying to avoid contaminating clean areas of the person’s body with microbes from dirtier areas. The digestive tract contains microbes that are passed from the body with feces, through the anus. It is important not to contaminate other parts of the body, such as the urethra or vagina, with these microbes, because they can cause an infection if they are introduced into parts of the body where they do not normally live. When assisting a person with perineal care, wipe from front to back. Cleaning in this direction avoids contaminating the urethral opening (and the vaginal opening in women) with bacteria from the anal area.
Men may be uncircumcised or circumcised
Circumcision is the surgical removal of the foreskin (the fold of skin that covers the head of the penis). When providing perineal care for an uncircumcised man, you must pull the foreskin back to wash, rinse and dry the head of the penis. Always return the foreskin to its natural position after you are finished.
Have you ever had to be bathed by another person? If so, how did you feel? Was the person who bathed you sensitive to your feelings? When you are assisting a person to bathe, be aware that the person may be embarrassed about needing help. Encourage the person to complete as much of the bath as he or she can independently, and take measures to keep the person warm and protect his or her modesty.
When you are scheduling bath times, take into account the person’s preferences as well as your employer’s policies. Be aware that the people in your care do have the right to refuse a bath. However, if this happens too frequently, you will need to talk to the office because regular bathing is necessary for good hygiene.
Close attention is needed to prevent accidents when bathing. Water on hard bathroom surfaces can be very slippery. Make sure that showers and tubs have nonskid mats and surfaces and that grab bars are tightly fastened to the wall. To prevent burns, check the temperature of shower or bath water. Use the inside of your wrist to check the temperature.
Assisting a person with a bed bath
A complete bed bath involves bathing all parts of a person’s body while she is in bed. A partial bed bath involves bathing only the face, hands, axillae (armpits), perineal area, back and buttocks. A partial bath may be given on days when a complete bath is not scheduled. A partial bath can also be a useful compromise when the person refuses a complete bath.
When assisting with a bed bath, help the person maintain her independence by discussing with her how she can help. A person may be able to help only by washing her face, but any amount of self-care is good. If the person has more ability, you may suggest that she do her own perineal care. In this case, hand her the washcloth and provide privacy for her, after making sure she is safe.
Assisting a person with a shower or tub bath
People who are able to get out of bed will take a shower or a tub bath. Shower stalls are normally large enough to accommodate a shower chair, so that the person can sit down while showering. A shower chair should be used if the person is not reliably steady on his feet.
You may see several different types of bathtubs throughout your caregiving career. Walk-in tubs have a door that swings open so that the person can easily enter the tub without stepping over a high edge. Some tubs may be equipped with a lift device that the person sits on to be lowered into the tub. If using a standard bathtub, make sure that the person can get in and out of the tub safely.
The person should be:
Able to bear all or most of his own weight.
Able to stand on one foot and lift the other foot over the edge of the tub with minimal assistance.
Able to lower his body into the tub.
Back rubs promote blood flow to the skin and can be very relaxing for the person. Often a back rub is provided as part of the bed bath. Alternatively, you may give a person a back rub before bed to help the person relax and sleep better. During a back rub, you can also check the person’s skin for reddened areas or other changes that could signal the beginning of a pressure ulcer.
Before giving a back rub, check the person’s care plan. Back rubs are not allowed for people with certain conditions, such as those who are recovering from back surgery.