Module 7 – Personal Care (2024)

When does personal care occur?

Personal care will be given three times per day, and whenever the resident requests it. Different kinds of care will be required at different times of the day; the schedule of care, in addition to necessary care tasks, will be detailed in the person’s care plan. NAs should always check with the care plan or check with a nurse if they are unsure about something in a person’s hygiene schedule.

• Morning care begins with gently waking someone and continues after breakfast. Such care may involve brushing teeth or dentures, shaving, using the toilet or commode, and bathing or showering depending on the person’s preferred schedule. Morning care will also involve helping the person dress for the day.
• Afternoon care is done between lunch and the evening meal. Some residents may prefer to shower in the afternoons, while others may not need bathing or dental care but may want their fingernails trimmed. NAs must remember to offer the restroom to people often. Some people will also want to brush their teeth or care for their dentures after their midday meal.
• Evening care involves assisting residents with their bathroom needs, dental care, bathing, and with putting on pajamas. Evening is also the time to care for the resident’s space by changing soiled linens and decluttering.

Assist with hygiene whenever the person requires it. Residents have a right to comfort and to safety, and a person is neither comfortable nor safe when their hygiene needs go unmet.

Resident Rights

It is important that NAs work to provide care tasks in a way that affords the person dignity and respect. They can do this by encouraging as much independence as possible; a person should be prompted to perform whatever care tasks they can perform on their own.

Be patient – even if somebody takes a long time to do something unassisted, if they can and they want to then you should be patient and encouraging for as long as the process takes. Briskness and frustration do not make someone feel cared for.

Always plan for privacy. When assisting somebody with personal care tasks, the NA should ensure that the person has privacy by closing the door to their room and putting the privacy screen in place.

Hygiene care is closely related to both Resident Rights and Infection Control. Write about the connection between hygiene care and the Big Three – why is hygiene important for good Infection Control? What elements of Resident Rights should NAs keep in mind when giving hygiene care? Write for 5 minutes and share your response with a friend or classmate.

Types of baths

The four basic types of baths are a partial bath, a shower, a tub bath, and a complete bed bath.

When deciding what kind of bath to give a resident, always check the care plan, determine the person’s needs, and take their preferences into account. The orders from the doctor or nurse are prioritized over the preferences of the patient in this case; for example, if the doctor ordered full bed rest, then the person cannot get up for a shower, even when they would prefer one to a partial bath. However, the person’s preferences should be accommodated whenever it is possible and consistent with their care plan[1].

• Partial bath: Partial baths can be given while the person remains in bed. A partial bath involves washing the person’s face, underarms, hands, and the genital and anal area (the perineal area), and any area that appears dirty or smelly. Partial baths are useful for people who can’t get up or don’t want to get up for a full bath or shower, have sensitive skin, or who want to freshen up.
• Shower: Residents should shower if they can safely stand for the duration of the shower or are comfortable sitting in a shower chair. Residents who are fatigued or prone to dizziness should avoid showers.
• Tub bath: Tub baths take place in bathtubs. Tub baths are intended for residents who are capable of transferring into and out of a bathtub, and who prefer a bath to a shower.
• Complete bed bath: A complete bed bath is intended for people who cannot get out of bed but who still require a full bath, rather than a partial bath.

The order of bathing

The order of bathing is important, and is part of good infection control practices. The order of a bath is intended to keep potentially harmful microorganisms from spreading to different parts of the body where they could cause infection.

When bathing a resident, the order of the bath must go as follows:

1. Eyes
2. Face
3. Ears
4. Neck
5. Arms and hands
6. Chest and abdomen
7. Legs and feet
8. Back
9. Perineal (genital and anal) area
10. Buttocks

This order is the same for a full bath, shower, bed bath, and partial bath.

Watch the video below for a demonstration on how to give a full bed bath.

Chippewa Valley Technical College. (2022, December). Full Bed Bath. [Video]. YouTube. Video licensed under CC-BY-4.0

Safety

Bathing safety is absolutely necessary when assisting with personal care.

The first step in providing a safe bath, of any kind to prepare well. Have everything you need within arm’s reach, and ask for any help that they think might be necessary during the bathing process.

The importance of prepping one’s supplies comes from the need to remain with the person during the entire bathing process – never leave someone alone when they are in the bath or shower.

When preparing a bath or shower, NAs must be conscious of a resident’s diminished sensitivity to temperature sensations and the increased fragility of the resident’s skin. Burns and chilling from water are dangerous if NAs are not conscientious when preparing a bath or shower. The water in a bath or shower should not exceed 105 degrees Fahrenheit.

Perineal care

Perineal care, or the cleaning of the anal and genital region, is completed every time a person bathes or whenever waste or urine is present. Perineal care is extremely important for infection control and promotes comfort by eliminating odors and skin irritants.

Perineal care is especially important for people who have urinary catheters, have had perineal surgery, are actively menstruating, are incontinent of urine or feces, and are uncircumcised (the foreskin of the penis was not removed). All of these factors make somebody more susceptible to perineal infections and concentrations of microbes.

Patients and residents will perform their own perineal care if they are physically able to; some obstacles to a person doing their own perineal care might include lack of mobility and flexibility or an order for complete bed rest.

When providing perineal care, always clearly communicate exactly what you are about to do before doing it. The goal is to always have the person receiving care know what is about to happen and be able to prepare themselves for it, and to have received that information in a way that they understand and helps them stay comfortable and calm.

When providing perineal care, NAs must always follow the Standard Precautions (wear gloves!), the Bloodborne Pathogen Standard, and the protocols of medical asepsis.

Report & Record

NAs should always report and record whenever hygiene care of any kind is given. If care is not properly recorded, the rest of the care staff will assume that care was not given. In addition to the importance of recording that personal care took place, use personal care time to make observations about the person’s condition.

When observing during personal care, it is important to look for any signs of bleeding, skin breakdown, any discharge from the vagin* or urinary tract, any foul or unusual odors, or any changes (positive or negative) in the person’s condition since the last time observations were recorded.

Recording all personal care and any observations made is necessary for providing good care. It is also necessary from a legal perspective, both because records maintenance is a requirement for facilities, and because failing to record care could lead to legal problems resulting from medical negligence. Both the person receiving care and every other member of the care team rely on NAs to report and record thoroughly.

Back rubs

One way that NAs can take some time to closely observe the condition of a person’s skin while helping them feel comfortable and relaxed is to give them a backrub.

To perform a back massage or a back rub, first position the person on their side or on their stomach. Next, warm the lotion between one’s hands or by running the bag or bottle under warm water, and apply lotion to one’s own hands.

Begin moving hands in wide circular motions starting at the base of the spine and reaching up to the person’s shoulders without lifting them off of the person’s back; the massager should use firm strokes on the muscle tissue on either side of the spine, and gentle pressure on bony areas such as the spine and hip bones. The massage should last for between three and five minutes, and communication should continue throughout.

Back massages are a good opportunity for NAs to take note of changes to a person’s skin condition. Prior to beginning the massage, take a moment to closely examine the person’s skin for signs of breakdown.

Chippewa Valley Technical College. (2022, December). Back rub. [Video]. YouTube. Video licensed under CC-BY-4.0

Shampooing

Providing personal care will also involve shampooing residents. Shampooing may be done during the person’s shower or tub bath, at the sink, on a stretcher, or while the person is in bed.

Teeth, gums, tongue

• To brush a resident’s teeth, gums, and tongue, always communicate with the resident throughout the process.
• After performing the opening procedure and prepping a work station, make sure the resident’s bed is angled to a comfortable upright position and that the bed wheels are locked.
• Cover the resident with a towel, then wet a soft-bristled toothbrush and prepare it with a dab of toothpaste.
• Clean the resident’s whole mouth, including teeth, tongue, and gums with short, gentle brushstrokes. Once finished have the resident rinse their mouth with water and spit into the emesis bin.
• Return mouth care supplies to their location, then empty, rinse, and dry the emesis bin and place it in “dirty” storage. Place used linen in the appropriate receptacle. Make sure the resident is comfortable before returning the bed to its lowest position.

Flossing

• Prepare the station by raising the bed to the appropriate height and gathering the materials. Always use the privacy curtain when providing personal care.
• Wrap either end of the floss around the index fingers of both hands and gently move the floss downward between the teeth in a back-and-forth motion, beginning with the teeth in the back of the person’s mouth. Adjust the floss every two teeth so that there are always working with a clean section of floss.
• Once flossing is completed, offer the resident a glass of water and a basin so they can rinse their mouth and spit.
• When done, the NA can discard the used floss and water, and properly clean and store all supplied. Return the bed to its lowest height setting, and perform the closing procedure.
• Make sure the resident is comfortable and give them the opportunity to converse about whatever they want to talk about, since conversation is rather difficult when one’s teeth are being flossed. Always observe the resident’s mouth closely and report any changes, abnormalities, or bleeding.

Denture care

Many older adults use dentures, or fabricated teeth. Dentures in come in a half set (a full row of teeth on the top or bottom), a full set, a partial plate or a bridge, which replaces sections of missing teeth.

Dentures need to be made according to detailed specifications, and are difficult to make. They are very expensive. Handle dentures, and dental appliances in general, with the utmost care.

If dentures become damaged or chipped then it will likely prevent the person that uses them from eating. If the NA damages a person’s dentures then the facility is legally responsible for their replacement.

• Always practice Standard Precautions when handling dentures by wearing gloves and any other necessary PPE. Never place dentures on a contaminated surface.
• Dentures are cleaned much like teeth are brushed, except they must be removed from their wearer’s mouth before they can be brushed. First the NA should line the sink with a towel, and then fill the sink with water so the dentures will not break if dropped.
• If the resident cannot remove their own dentures, NAs should use a gauze pad to firmly but gently grasp the dentures and pull to remove them.
• Rinse the dentures in cool water (never warm or hot) over the sink before brushing them; dentures can be more easily damaged when they are dry, which is also why they must be kept moist or wet.
• Use the brush to thoroughly clean the dentures with denture cleanser (check the care plan), and then rinse them under cool water again. When finished, put the dentures into their clean container with denture fluid or cool water and place it where it is stored. Give the resident an opportunity to rinse their mouth and spit.
  • If the resident wants to wear their dentures all the time other than during cleaning, the NA can replace them in the resident’s mouth by applying some denture cream and pressing them firmly back into place. Finally, clean the brush and emesis basin and return them to their storage location.

Chippewa Valley Technical College. (2022, December). Denture care. [Video]. YouTube. Video licensed under CC-BY-4.0

Oral care for the unconscious

If someone is unconscious for long periods of time, they still need mouth care. Even if a resident is unconscious, always interact with them as if they were by communicating throughout the process and keeping face-to-face contact. Always practice Standard Precautions and adjust the bed to a comfortable head to provide mouth care.

• Turn the resident on their side, with a towel under their cheek and chin and an emesis bin close by, since the unconscious resident may drool or allow fluid to leak from their mouth.
• Keep the resident’s mouth open with a tongue compressor; using one’s fingers is dangerous for both the NA and the resident.
• NAs won’t brush an unconscious resident’s teeth. Instead, use a sponge swab to apply a cleaning solution to all parts of the person’s mouth. Squeeze the sponge swab in between replenishing it with the cleansing agent and applying it to the person’s mouth; any drippage or excess fluid could cause aspiration. Change out the swab regularly until the mouth is clean.
• Always check the care plan when preparing to care for unconscious residents. The care plan will determine which cleansing agent to use, and include any necessary information to keep in mind. Continue to communicate with an unconscious person as if they are awake; you do not know what they can hear.

Brushing and combing

Brushing and combing is a regular part of early morning and afternoon care, and should be provided whenever the resident wants it, and always before they receive visitors. NAs should encourage residents to perform as much of their haircare as possible, and assist them as they need it.

The person will choose how their hair is brushed, combed, and styled. NAs should never cut a person’s hair because it is matted or tangled; instead, check in with the nurse and the person about appropriate ways to manage hair care. Specific measures are required for brushing and combing curly, coarse, and dry hair. A person’s haircare routine and preferences will be included in their care plan.

Skin and scalp conditions

Skin and scalp conditions can impact a person’s quality of life. Carefully observe for skin conditions during hair care, and always remain composed and respectful not matter how someone’s head looks.

• Alopecia is a term meaning hair loss, and alopecia to different degrees is experienced by most people throughout aging in the form of balding or thinning. Other causes of alopecia include cancer treatments, skin diseases, stress, poor nutrition, pregnancy, side affects from drugs, and changes in hormones.
• Hirsutism is a term for an excessive or abnormally high level of body hair. Hirsutism occurs in men, women, and children due to heredity and high testosterone.

• Dandruff occurs when the scalp or eyebrow skin produces a lot of flakes; people with dandruff may require medicated shampoos to address the itching and flaking.
• Pediculosis is the medical term for infestation with head lice. Lice are nearly impossible to see with the naked eye. Lice are highly communicable and can travel through contact, clothing, furniture, towels and linens, or shared items like hats and combs.
  • Symptoms of lice include complaints of tickling or movement in one’s hair, itching and skin irritation, sores on the head or body from scratching, or a rash.
  • If you think someone may have pediculosis, alert the nurse right away and follow the care plan for treatment.

Shaving

People shave for comfort, mental wellbeing, and self-esteem. NAs will likely need to shave a person’s face, legs, and underarms at different intervals. NAs will use either an electric razor, a safety razor, or a disposable razor to shave a person.

• After performing the opening procedure, communicate with the resident while preparing the station with razors, shaving cream, a basin of warm water, and a sharps container. Before beginning to shave, the wet the person’s skin with warm water and then lather the area with shaving cream.
• While shaving, hold the person’s skin taut and shave in the direction of hair growth; if shaving a person’s face, this will involve shaving down the cheeks and up the neck. To shave the spaces just below and above the lips, have the person pull their lips into their mouth and over their teeth to keep the skin tight.
• The razor blades in facility settings will likely become dull before the shave is over, so multiple blades will needed; razors must be disposed of in the sharps bin when dull. NAs should always try to keep the razor blades fresh for a close, comfortable, and cut-free shave.

Some residents cannot use safety razors or disposable razors, especially if they have difficulty healing or are on drugs that inhibit blood clotting. For these residents, NAs will use an electric razor. Make sure the razor is clean before using, and never use an electric razor around water or oxygen.

People with mustaches and beards will need daily facial hair care. NAs should always ask the person how they want their facial hair groomed, and should never trim or alter a mustache or beard without asking first.

Once shaving and facial hair care is complete, clean and dry the supplies, and tidy the area so it is free of any loose hairs. Loose hairs can be irritating in a person’s bed or clothing.

When shaving a person’s body hair, the NA should never assume somebody wants particular hair gone. For example, many women do not shave their legs or underarms by choice. NAs must respect this and take the possibility of these preferences into consideration.

Video by Allie Tiller is licensed under CC BY-NC 4.0

Foot care for a person with diabetes

People with diabetes will require attentive foot care. Because of their weakened immune system and poor circulation, people with diabetes are highly susceptible to infections of the feet. If their feet are not properly cared for, and if infections are not noticed and addressed early, then the person’s foot may take months to heal and may even need to be amputated. NAs must keep the feet of people with diabetes clean and dry[3].

NAs must examine and clean a diabetic resident’s feet every day with gentle soap. The resident’s feet should be soaked for about 15 – 20 minutes per day and washed with a washcloth. Pat the person’s foot dry when done, and then apply the appropriate lotion. Always check the care plan.

It is important that people with diabetes do not get any cuts or scrapes on their feet. Check the feet thoroughly, including under the toenails, for dry or cracked skin, bumps, temperature changes, and any other abnormalities[4].

Do not trim their toenails; only use a file.

Reporting and recording

NAs play an important role in monitoring a wound’s healing process. When observing a wound, NA should take note of its color, size, and shape. Note the type and amount of drainage, and whether the person’s wound dressing needs additional changing.

It is also important to ask the person about their pain levels. After making the observations, NAs should chart them every time, including observations gathered, the, time of observation, and any care given.

Skin tears

Skin tears are common wounds in long-term care settings. A skin tear is a break or a rip in the outer layers of skin where the top skin layer separates from the underlying tissues – it can look like the skin is peeled back and the cavity filled with blood. Because older adults tend to have thin and fragile skin, skin tears can be caused by only slight pressure.

The best way NAs can work to prevent skin tears is by consistently providing careful and safe care. Attentively avoiding furniture and corners while ambulating and always making one’s movements gently and smooth are some ways NAs can work to prevent skin tears and further injury. Note a resident’s level of awareness before helping them move or ambulate

Skin tears can be caused by friction, shearing, or pulling and pressure on one’s skin. They can also be caused by falls or bumps on any hard surface. NAs can accidentally cause skin tears by holding on to a person too tightly, removing adhesives, or brushing the resident’s skin against a hard surface while bathing or getting dressed.

Skin tears are infection risks because they are portals of entry for microbes. NA should report skin tears to the nurse at once.

Pressure ulcers

The first thing to keep in mind when learning about how to treat pressure ulcers is that they are much easier to prevent than to cure.

Pressure ulcers occur when a person is in bed for a long period of time and their circulation is reduced; the reduction in circulation can result in the process of skin breakdown or a dying off of skin tissue due to lack of nutrients and oxygen.

Breakdown usually begins in areas with a bony prominence, or an area where the bone sticks out or projects from the flat surface of the body. Some examples are the back of the head, shoulder blades, elbows, hips, spine, knees, ankles, heels, and toes. Bony prominences are also called pressure points.

Risk factors for the formation of pressure ulcers include:

• skin breaks
• poor circulation in a localized area
• excessive moisture or dryness
• irritation caused by waste
• poor nutrition
• dehydration
• wrinkled linens

Pressure ulcers occur when a person is lying or sitting in the same position for too long. This makes people who are comatose, paralyzed, or healing from hip fractures at especially high risk. If a person is at high risk for pressure injuries, and especially if they have altered mental awareness, NAs should take extra care to make sure that person is re-positioned regularly, is free of excess moisture, has healthy skin, and moves to keep their circulation flowing.

The areas most at risk for pressure injuries are the side of one’s head, the ear, shoulders, hips, buttocks, knees, ankles, collarbone, under the breasts, on the abdomen, under the scrotum, knees, toes, spinal base or sacrum, between the legs, and on one’s heels. Any place where friction occurs, or where pressure restricts circulation, is a risk factor for pressure ulcers.

Image by BruceBlaus, CC BY-SA 4.0

The best way to address pressure ulcers is to prevent them before they can form. The nurse will assess a person for their pressure ulcer risk upon admission, and determine what preventative measures to include in their care plan. Managing moisture, good nutrition and fluid balance, and relieving excess pressure are all key measures to preventing pressure ulcers. Always follow the care plan.

Report and record any signs of skin breakdown immediately. NAs should take every opportunity to observe the person’s skin closely, and tell the nurse if any abnormalities are noticed, even if they seem slight or insignificant.