Personal hygiene has social and physiological benefits and supports resident wellbeing.
In addition to good personal hygiene, showering provides a unique opportunity to encourage client independence, self esteem and skills use.
The importance of hygiene isn’t purely physical; it’s also psychological and social. The routine of showering can leave an individual feeling refreshed, confident and comfortable, says Lynn Chenoweth, Professor of aged and extended care nursing at the University of Technology, Sydney.
“When you assist someone to shower, you’re not washing a body you’re caring for a person.”
Assisting elderly clients to shower in a way that is sensitive to their care needs and preferences yet preserves their dignity is the subject of an upcoming Aged Care Channel program, Activities of Daily Living: Showering.
“Showering should be an activity that promotes independence, uses their abilities and enhances self esteem and quality of life,” she says.
The regular routine of showering can also provide quality one-to-one time to assess the physical, cognitive and emotional health of a resident.
When providing assistance, it is important to examine for any observable physical or behavioural changes that might indicate a change in their health status, she says.
Impaired vision, disorientation or breathing difficulties are immediate warning signs.
Further note any changes to the physical appearance and condition of a person’s skin including inflammation, the presence of any bumps and bruises or signs of pain. Skin spots should also be regularly examined.
This personal form of care also offers valuable time to assess the emotional state of a resident, including whether they appear withdrawn or distracted.
“If you observe any changes, physical, cognitive or emotional, you must document your observations and report them to your supervisor,” says Chenoweth.
In the absence of hard and fast rules regarding frequency of showering amongst the elderly, individual lifestyle and health factors such as incontinence should be considered.
“Dignity, privacy and respect are critical to all care but even more so during showering when the person is likely to feel exposed and vulnerable.”
Good communication is therefore necessary to help establish trust and to promote the independence and comfort of residents.
Everyone has the right to refuse a shower and you must respect that choice, but a lack of attention to personal hygiene may be an initial symptom of depression, says Chenoweth.
“If the person has a cognitive impairment, they still have a right to choose, so if they refuse, you must stop and seek advice from your supervisor.”
A person’s care plan should be consulted for triggers of refusal and effective communication strategies.
Consistent refusal to shower should be documented and reported.
If initial resistance is experienced, Chenoweth recommends trying to communicate the idea differently, for example by putting the activity in the context of the weather by saying ‘it’s hot out today, it would be nice to have a shower to cool down, wouldn’t it?’
“If that is unsuccessful, you may need to step back and start preparing showering items to cue the person and give them time to think about what you’re asking.”
Planning and preparation
Showering can be a very unpleasant experience if preferred routines are not followed so knowing a person’s preferences and history is necessary to prevent distress.
Start by reading the person’s care plan which will contain important information about a person’s individual needs including their pain management requirements, wound care needs and their preferred shower time and routine.
“When you enter the room, introduce yourself and address the person by their preferred name.”
You must always get someone’s consent before assisting them to shower so explain the process and ask for their permission.
They may give consent by saying yes, or simply by starting to prepare themselves to shower.
When assisting a resident to undress, if someone has a weakness on one side, always remove their clothing from their unaffected side first.
A person’s sense of balance, their degree of coordination and their sensitivity to temperature should also be considered when providing assistance. Awareness of joint pain and arthritis will also reduce further discomfort.
If a resident prefers the use of a showering chair, check that the brakes are on and the footrest is down.
“Showering can be a pleasant and therapeutic experience if it’s conducted sensitively and carefully, ensuring the person is fully informed of what is happening and in control.”
Strong soaps that dry out the skin and the use of talcum powder should be avoided as the fine particles can cause breathing difficulties if inhaled.
Constantly remind the person during the showering process that you are assisting them to wash which will help avoid confusion and prevent sexual behaviours, says Chenoweth.
Dressing and grooming
After washing, pat dry the person gently and thoroughly since moist areas can encourage fungal and bacterial growth.
When assisting someone to dress, always encourage independence and dress their weak side first.
Once dressed, talk to the person about their choice of accessories and cosmetics. Attention to personal presentation will help boost their confidence and self esteem.
Once showering care is completed, fill out the necessary documentation such as the person’s pain and skin chart as well as any progress notes.
Activities of Daily Living: Showering airs on the Aged Care Channel on Wednesday, 12 May.Do you have an idea for a story?
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