How are you going to assist Adam to maintain his hygiene in a manner he finds acceptable?

In order to assist Adam in maintaining his hygiene in a manner he finds acceptable it is necessary to discuss with him what he would like to do and how he would like to do it. Encouraging and assisting any patient to maintain their usual routine, enabling them to be as independent and feel as in control as possible, is an important aspect of every nurse’s role. However, as indicated in the case study, Adam has sustained a range of injuries that mean he is unable, at present, to be able to follow his normal routine.

If you apply each stage of ‘CLEAN’ (chapter 32) you would:

• Consider and assess Adam’s needs
  • What are his exact personal hygiene needs at the moment?
  • Exactly how much assistance does he require at the moment?
• Listen to the patient’s preferences and devise a plan
  • How does Adam want his hygiene needs to be met?
  • Does Adam have any religious/cultural issues we need to consider?
  • Adam is not able to go to the bathroom at present, so we will need to assist him to meet his hygiene needs whilst he is in bed.
  • Adam must consent to the care we are providing and ensuring he is safe during this is of fundamental importance. Because Adam feels ‘wobbly’ we would need to consider his safety needs (see questions 2 and 3 for more details). If at any point we were uncertain what was appropriate for Adam’s care we would ask for advice.
• Environmental and equipment factors
  • Are we able to safely meet Adam’s hygiene needs in his current environment, or does he need additional care?
  • Will Adam’s additional needs at the present put any of those caring for him at risk, for example, can Adam’s bed be made sufficiently accessible and at an appropriate height to unsure we care for our backs?
  • Do we have all the equipment we need, including Adam’s toiletries?
• Assistance
  • Provide Adam with the care he requires. See question 2 for further details.
• ’Nowledge and skills
  • Whilst providing Adam’s care is there any information we would tell him to ensure that he can continue to maintain his hygiene needs until he is recovered? See question 2 for further details.

Caring for Adam in this way would enable us to promote his independence as far as is possible at the present, take account of his preferences, treat him as an individual and maintain his dignity. It is our role not just to assist Adam to maintain his hygiene to keep him physically clean, but also for personal, social, and psychological reasons.

Which of the step-by-step clinical skills guides would be relevant for Adam’s care? Would you need to make any modifications to these?

The step-by-step clinical skills guides appropriate to Adam’s care would be:

• Bathing a patient in bed
• Shaving
• Teeth brushing

Although Adam has only mentioned having a wash and a shave it would be an opportunity to ask him whether he would also like to clean his teeth.

The modifications you would need to make to these would be similar for all three activities. Adam has told us that he feels ‘wobbly’, so be very careful when asking him to move himself or sit up. If he can manage to tolerate sitting up in bed, resting on a couple of pillows, without feeling too ‘wobbly’, shaving and cleaning his teeth will need to be done in this position. If Adam is not able to sit up at all, shaving and cleaning his teeth can be done whilst he is flat. As Adam has plaster casts on his wrists he will only have very limited, if any ability to use his hands to perform activities for himself, so you will need to perform these for him.

It would be sensible to ask Adam if he would find his care more acceptable if, rather than doing everything in one go, you spread the procedures out over a period of time, so he could rest in between.

What will be your priority and what additional assessments will you undertake?

Your priority would be to maintain Adam’s safety. To ensure this you would make sure he could tolerate each of the procedures without feeling too ‘wobbly’ or causing additional pain. You would also need to make sure that those delivering his care were not being put at risk, from, for example, a back injury.

You would need to constantly assess whether Adam was feeling ‘wobbly’ due to the hygiene procedures, and offer frequent rests. Whilst assisting him to maintain his hygiene you would also assess:

• the condition of his skin
• the many contusions he has sustained
• the cut over his right eye
• that his plaster casts were not rubbing
• the condition of his left ankle
• that Adam was receiving sufficient analgesia and was not in pain.

Using the teeth brushing clinical skill guide, the important health education points you would want to stress to Mohammed would be that:

• He should clean his teeth before breakfast, after meals and at bedtime
• He should hold the brush at 45 degrees and use small circular motions, starting with his upper teeth, brushing all surfaces and paying extra attention to the area where his teeth and gums meet is the most effective way to clean his teeth.

Ideas of how you could do this in a way Mohammed would understand include:

• Making a chart with Mohammed which indicates breakfast, meals and bedtime with space for him to draw a picture of a toothbrush whenever he cleans his teeth
• Use a suitable soft toy/doll and a toothbrush to show Mohammed how he should clean his teeth and then get him to practise on the soft toy/doll.

The priorities in assisting Josette to maintain her hygiene would be:

• Ensuring that her disheveled state is due to her depression rather than another cause, such as a physical illness that is limiting her ability to care for herself
• Devising a plan to enable Josette to be assisted to maintain her hygiene in a manner she finds acceptable that supports her current independence and control.

In order to assist Josette to maintaining her hygiene in a manner she finds acceptable it is necessary to discuss with her what she would like to do and how she would like to do it.

Encouraging and assisting any patient to maintain their usual routine, enabling them to be as independent and feel as in control as possible, is an important aspect of every nurse’s role. However, as indicated in the case study, Josette has a history of depression which may result in her required assistance to maintain her hygiene.

If you apply each stage of ‘CLEAN’ (chapter 32) you would:

• Consider and assess Josette’s needs
  • What are her exact personal hygiene needs at the moment?
  • Exactly how much assistance does she require at the moment?
• Listen to the patient’s preferences and devise a plan
  • How does Josette want her hygiene needs to be met?
  • Does Josette have any religious/cultural issues we need to consider?
  • Is Josette happy to go to her bathroom for a bath or shower?
  • Josette must consent to the care we wish to provide and her safety is of fundamental importance. Josette’s reduced ability to maintain her hygiene may also indicate that she is not taking care of herself in other ways, such as preparing and cooking meals, so we would also assess this at an appropriate time.
• Environmental and equipment factors
  • Are we able to safely meet Josette’s hygiene needs in her current environment, or does she need additional care?
  • Will Josette’s additional needs at the present put any of those caring for her at risk, for example, can we deliver the care Josette requires within her home whilst abiding by manual handling guidelines?
  • Do we have all the equipment we need?
• Assistance
  • Provide Josette with the care she requires.
• ’Nowledge and skills
  • Whilst providing Josette’s care is there any information we would tell her to ensure that she can continue to maintain her hygiene needs until she recovers?
  • Caring for Josette in this way would enable us to promote her independence as far as is possible at the present, take account of her preferences, treat her as an individual and maintain her dignity.

As we are caring for Josette in her own home, we may need to consider whether her needs can be safely met, as we are unlikely to have access to a wide range of additional equipment.

We would also need to assess whether Josette was able to remain within her home, or whether her lack of ability to maintain her hygiene was a sign that her condition had deteriorated sufficiently for her to need a level of care that could not be delivered in this care setting.