TITLE: BED BATH PURPOSE: 1. To make client clean and feel comfortable. 2. To increase sense of wellbeing. 3.

To promote muscular relaxation and relieve feelings of fatigue. OBJECTIVE:   Provide baths, showers, perineal care and back rubs according to the patients or residents unique needs. Adhere to basic safety, identification and standard precautions principles when providing personal care.

DEFINITION: It is a type of bath given while the client is on bed. KNOWLEDGE BASE: Bathing of clients is an essential component of nursing care. Whether the nurse performs the bath or delegates the activity to another health care provider, the nurse retains the responsibility for assuring that the hygienic needs of the client are met. The type of bath provided will depend on the purpose of the bath and the client s self-care ability. The two general categories of baths are cleaning and therapeutic. Cleaning baths are provided as routine client care. The purpose of a cleaning bath is personal hygiene. The five types of cleaning baths are shower, tub, self-help, or assisted bed bath, complete bed bath, and partial bath. Shower Most ambulatory clients are capable of taking a shower. Clients with limited physical ability can be accommodated by placing a waterproof chair in the shower (Figure 31-28). The nurse provides minimal assistance with a shower. Self-Help Bath A self-help, or assisted, bed bath is used to provide hygienic care for clients who are confined to bed. In the self-help (assisted) bed bath, the nurse prepares bath equipment but provides minimal assistance. This assistance is usually limited to washing difficult-to-reach body areas such as the feet and back. Complete Bed Bath A complete bed bath is provided to dependent clients confined to bed. The nurse washes the client s entire body during a complete bed bath. Partial Bath

A partial (or abbreviated) bath consists of cleaning only body areas that would cause discomfort or odor if not washed thoroughly. These areas are the face, axillae, hands, and perineal area. The nurse or client may perform a partial bath depending on the client s self-care ability. Partial baths may be performed with the client lying in bed or standing at the sink. PATIENT S EDUCATION: EQUIPMENT:             Bath towels Washcloths Bath blanket Washbasin Soap Soap dish Lotion Deodorant Powder Clean gown Clean linen Disposable gloves

PROCEDURE: 1. Assess client s preferences about bathing. 2. Explain procedure to client. 3. Prepare environment. Close doors and windows, adjust temperature, provide time for elimination needs, and provide privacy. 4. Wash hands. Apply gloves. Gloves should be changed when emptying water basin. 5. Lower side rail on the side close to you. Position client in a comfortable position close to the side near you. 6. If bath blankets are available, place bath blanket over top sheet. Remove top sheet from under bath blanket. Remove client s gown. Bath blanket should be folded to expose only the area being cleaned at that time. (Top sheets may also be used for bath blankets.) 7. Fill washbasin two-thirds full. Permit client to test temperature of water with his or her hand. Water should be changed when a soap film develops or water becomes soiled. 8. Make a bath mitten with the washcloth. To make a mitten: grasp the edge of the washcloth with the thumb; fold a third over the palm of the hand; wrap remainder of cloth around hand and across palm, grasping the second edge under the thumb; fold the extended end of the washcloth onto the palm and tuck under the palmar surface of the cloth. 9. Wash the face. Ask the client about preference for using soap on the face. Use a separate corner of the washcloth for each eye, wiping from inner to outer canthus. Wash neck and ears. Rinse and pat dry. Male clients may want to shave at this time. Provide assistance with shaving as needed. 10. Wash arms, forearms, and hands. Wash forearms and arms using long, firm strokes in the direction of distal to proximal. Arm may need to be supported while being washed. Wash axilla. Rinse and pat dry. Apply deodorant or powder if desired. Immerse client s hand into basin of water. Allow hand to soak about 3 to 5 minutes. Wash hands, interdigit area, fingers, and fingernails. Rinse and pat dry.

11. Wash chest and abdomen. Fold bath blanket down to umbilicus. Wash chest using long, firm strokes. Wash skinfold under the female client s breast by lifting each breast. Rinse and pat dry. Fold bathblanket down to suprapubic area. Use another towel to cover chest area. Wash abdomen using long, firm strokes. Rinse and pat dry. Replace bath blanket over chest and abdomen. Cover chest or abdomen area in between washing, rinsing, and drying to prevent chilling. 12. Wash legs and feet. Expose leg farthest from you by folding bath blanket to midline. Bend the leg at the knee. Grasp the heel, elevate the leg from the bed and cover bed with bath towel. Place washbasin on towel. Place client s foot into washbasin. Allow foot to soak while washing the leg with long, firm strokes in the direction of distal to proximal. Rinse and pat dry. Clean soles, interdigits, and toes. Rinse and pat dry. Perform same procedure with the other leg and foot. 13. Wash back. Assist client into prone or side-lying position facing away from you. Wash the back and buttocks using long, firm strokes. Rinse and pat dry. Give back rub and apply lotion. 14. Perineal care: Assist client to supine position. Perform perineal care. 15. Apply lotion and powder as desired. Apply clean gown. 16. Document skin assessment, type of bath given, and client outcomes and responses.

RATIONALE 1. Provides client opportunity to participate in care. 2. Enhances cooperation. 3. Protects from chills during bath and increases sense of privacy. 4. Reduces potential for transmission of pathogens. 5. Prevents unnecessary reaching. Facilitates use of good body mechanics. 6. Prevents exposure of client. Promotes privacy. Protects from chills. 7. Prevents accidental burns or chills. 8. Prevents ends of washcloth from dragging across skin. Promotes friction during bath. 9. Some clients may not use soap on their face. Using separate corners of washcloth reduces risk of transmitting microorganisms. Patting dry reduces skin irritation and drying. 10. Long strokes promote circulation. Soaking hands softens nails and loosens soil from skin and nails. Strokes directed distal to proximal promote venous return. Powder removes excess moisture. 11. Promotes privacy and prevents chills. Long strokes promote circulation. Perspiration and soil collect within skin folds. 12. Supports joints to prevent strain and fatigue. Soaking foot loosens dirt, softens nails, and promotes comfort. 13. Exposes back and buttocks for washing. Back rub promotes relaxation and circulation. 14. Removes genital secretions and soil. 15. Lotion lubricates skin. Powder absorbs excess perspiration. 16. Provides evidence of nursing care.

SPECIAL NOTES:    It is always preferable to have the patient assist with the bath as much as possible, particularly with perineal care. The bed bath is a good time to establish rapport and expand the nurse patient relationship. During and after the bath, the bed linen is changed, and the two activities are usually combined.

After giving a bed bath, always ask the patient if he feels comfortable; make sure the bed is in low position, rails up, and call bell is within reach

DOCUMENTATION: REFERENCE: Adion, D.R. and Dizon E.C. (2009). Manual and Checklists on Health Care Procedures (First Edition). Dougherty and Lister (2009). The Royal Marsden Hospital Manual of Clinical Procedures (Sixth Edition). ATTACHMENT: