Assisting clients at bath time is part of the job of a nursing assistant. Do the CNAs at your workplace know how important this routine task is to their clients? Do they use bath time as an opportunity to observe their clients closely? By sharing the following information and tips at your next CNA inservice meeting, you may give your aides a new outlook on personal care.
The Joys of Bathing
Bathroom Towel Stand
Imagine this: You've had a rough day at work. You're feeling sweaty and tired. You're looking forward to taking a nice hot relaxing shower. Now, imagine how it would feel if instead of being able to simply hop in the shower, your physical condition required you to:
Take your clothes off in front of a stranger. Hold onto grab bars because you were afraid of falling in the shower. Ask for help washing the private areas of your body. Stand and shiver while waiting for someone to bring you a towel.
Suddenly, the idea of a nice hot shower doesn't seem so appealing, does it? Your clients used to be able to take care of their own bathing needs. Now, many of them need your help. And, they probably aren't happy about that! Being dependent on others for bathing probably makes them feel:
Old and useless. Ashamed. Scared about what else they might have to give up doing for themselves.
Bathing clients requires patience, strength, compassion and skill. Keep reading to learn ways to make bathing a safer, more efficient process for you and your clients.
8 Benefits of Bathing
Bathing is important because it:
1. Cleanses the body by removing dirt and dead skin cells.
2. Promotes comfort by cooling and refreshing the skin and relaxing the client.
3. Controls body odor by removing bacteria and germs from the skin.
4. Prevents infection.
5. Provides an opportunity for clients to move their muscles and joints.
6. Stimulates circulation.
7. Helps prevent skin breakdown.
8. Gives you an opportunity to communicate with the client and to observe his or her body for changes.
Making Observations at Bath Time
Bath time gives you a terrific opportunity to observe your clients for physical changes. Keep an eye out for problems and report any changes right away.
Check the hair and scalp for head lice. (Lice can happen to anyone-no matter how young or old, dirty or clean, rich or poor.) Look for white lice eggs (known as "nits"). They look like small bits of dandruff, but do not wash or flake off. Instead, they stick firmly to strands of hair. As you comb or wash your client's hair, observe the scalp for scaling, crusting, irritation, bruises, bleeding, lumps or large areas of missing hair. Look over the whole body, making note of any areas of redness, rashes, bed sores, moles or other changes in the skin. Check the entire body for puffiness or swelling, broken skin, redness, bruises or bleeding. Report any unusual body odors. A strange odor may be a symptom of an illness. Watch out for clients who seem to sweat too much, too little or who tend to sweat a lot at night. There are medical conditions that can cause sweating problems. (In fact, it can be life-threatening if a person doesn't sweat at all.) Look for white or yellow areas on finger and toe nails. Your client may have a nail fungus. Check for itching, cracked skin between the toes or on the soles of the feet. These are signs of infections such as "athlete's foot". Watch for black warts on the soles of the feet.
Bath Time Tips
Let your supervisor know if you feel a bath is ordered too often or too seldom for one of your clients. In addition, be sure to report if your client needs a different kind of bath. For example, a client who is getting stronger may be able to switch from a sponge bath to a shower. Or, a client who is getting weaker may need to stop taking tub baths.
Take your clients' suggestions and feelings into consideration. As much as possible, stick to the same bathing routines that your clients had before they needed your help.
Remember that slowing the pace of the bathing process may allow older people to do more for themselves. If you rush them, you may be robbing them of the opportunity to remain semi-independent.
If possible, ask a physical or occupational therapist to teach you techniques for making bath time safer for a particular client.
Praise your clients when they participate in their own personal care. For example, "Your arm seems stronger today. You were able to scrub your back by yourself." or "Your hair looks lovely. You did a great job brushing it."
Safety Issues
The greatest danger in a bathroom comes when clients get in and out of the tub or shower. The risk of falling is high! As you assist clients in and out of the tub or shower, you are at risk for falling, too. Most of these "double" falls happen:
At the end of the bath when the client is tired and/or relaxed. If a client's physical condition has worsened. While transferring a client out of a tub- because the client's body, the tub and the floor are wet and slippery.
Your clients may be physically dependent on you for help at bath time. For example, a client with arthritis may not be able to turn the water faucets on and off. A client may also be psychologically dependent on you. For example, he or she may be afraid to take a bath alone for fear of falling.
If you work in clients' homes-and have access to a cell phone-consider keeping it in the bathroom during bath time. You'll be able to call for help if you and/or the client falls down.
Keep the bathroom well-lit during bath time. Make sure it is well-ventilated, too, so that the room doesn't become too hot. (You-and your client-may become faint in the heat.)
Remember that older people are more sensitive to heat and cold. Test the temperature of the water before your elderly clients get into the tub or shower. If you use a bath thermometer, it should read between 105 and 110 degrees F. After reading the thermometer, test the water on the inside of your wrist...and consider asking your client to do the same.
Empty the tub before you help your client out of it. Getting out of an empty tub is easier than getting out of a filled one.