6.4 Dressing and Undressing

Dressing and Undressing

Helping a resident dress is a daily task that protects dignity and promotes independence while preventing injury to the affected limb. The single most-tested concept is the order in which the affected and unaffected sides are handled.

The Golden Rule

Dress the weak (affected) side first; undress the weak side last.

The weak side is the limb affected by a stroke (hemiparesis), fracture, arthritis, paralysis, or surgery. Putting it through the sleeve or pant leg first, while the garment is loose, requires the least bending and stretching of the painful or immobile limb. The strong side can then assist.

Worked example, resident with left-sided weakness: to put on a shirt, guide the left (weak) arm into the sleeve first, then the right. To remove it, slide the right (strong) arm out first, gather the shirt behind the back, then ease it off the left arm last.

Promoting Independence

• Offer choices - lay out two outfits so the resident decides
• Allow extra time - rushing causes frustration and resistance
• Position clothing in order of use within reach
• Give verbal cues instead of doing every step
• Dress for the weather and the resident's preference, not your convenience

Dressing in Bed

Upper body: assist to a sitting or side-lying position, gather the sleeve, guide the weak arm through and up to the shoulder, then the strong arm, and fasten from the bottom up. Lower body: gather each pant leg, slide it over the weak foot first then the strong foot, pull to the thighs, and have the resident raise the hips (or roll side to side) so you can pull the garment over the buttocks.

Adaptive Equipment

These devices let residents dress themselves and are common exam content:

Special Situations

Intravenous (IV) line: treat the IV as the affected side. Remove the garment from the unaffected arm first, then the IV arm. To dress, gather the sleeve, slide it over the IV bag and tubing first, then the resident's arm, then re-hang the bag. Never disconnect the IV and keep the bag at the correct height so blood does not back up.

Casts and splints: choose loose clothing that fits over the device, dress the casted limb first, and after dressing check the fingers or toes for color, warmth, and movement to confirm circulation is not compromised.

Dementia: simplify to two choices maximum, lay items out in order, give one short cue at a time, and allow extra time. Watch for agitation, and never force a garment over a resisting resident; step back and try again later. Throughout, expose only what is needed, keep the resident covered, and use a gait belt when standing the resident to pull up pants.

Dressing in a Chair

Many residents dress more easily seated. Position the resident comfortably in a sturdy chair or wheelchair with the brakes locked. For the upper body, lean the resident slightly forward, guide the weak arm through the sleeve first, let the strong arm reach through, smooth the fabric across the back, and fasten the front. For the lower body, help the resident cross the weak leg over the strong leg so you can slide the pant leg over the weak foot first, then lower it and dress the strong leg. Stand the resident with a gait belt and support, then pull the pants up over the hips and fasten.

Always keep the resident's feet flat and braced to prevent sliding, and never pull on a weak arm to reposition the resident.

Choosing Appropriate Clothing and Footwear

Good clothing choices prevent falls and protect skin. Encourage non-skid footwear or sturdy shoes with closed backs rather than loose slippers, which slide off and cause falls. Front-opening garments are easier than pullovers for residents with limited shoulder motion, and elastic waists or Velcro spare arthritic hands. Avoid clothing that is too long, too tight, or has dangling ties that could catch in a wheelchair. Check that nothing binds at the waist or compresses an IV site or edematous limb.

After dressing, smooth out wrinkles in clothing and bedding, since a fold under a seated or lying resident can press on the skin and start a pressure injury. Finally, confirm the resident is comfortable, the call light is within reach, and the bed or chair is in a safe position before you leave. Take a moment to inspect the skin under removed clothing while you have access, since dressing is another chance to catch reddened pressure points, rashes, or swelling and report them to the nurse.