4.2 Grooming, Dressing & Shower Safety

Grooming, Dressing & Shower Safety

NCCT's test plan separates assisting patients with bathing (for example, bed bath or shower) from assisting with grooming (for example, hair care, nails, oral care). Section 4.1 covers bed baths, perineal care, and oral care. This section covers the rest of personal care: hair, shaving, nails, feet, dressing, eyeglasses, and showers and tub baths. Grooming is more than appearance. A patient who looks and feels like themselves eats better, participates in therapy, and is less likely to become depressed. It is also a chance to inspect the skin, scalp, and feet for problems.

Guiding Principles

• Ask first and follow preferences. Hairstyle, products, shaving, and clothing choices belong to the patient. Cultural and religious practices (head coverings, beard and hair customs) are respected.
• Promote independence. Set up supplies and let the patient do what they can. Offer help with the rest instead of taking over.
• Protect privacy and warmth, and keep the call light within reach.
• Observe and report what you see: scalp sores, lice, rashes, skin tears, and foot wounds.

Hair Care

• Brush or comb hair daily. For tangles, start at the ends and work up toward the scalp while holding the hair above the tangle so it does not pull.
• Use a wide-tooth comb and the patient's own products for curly or tightly coiled hair, and ask how they prefer it styled. Never cut hair without the patient's consent.
• Shampooing in bed: use a shampoo tray or trough, or a rinse-free shampoo cap. Protect the bed with a waterproof pad and keep water away from IV sites and dressings. Patients with neck or spine injuries are not positioned for shampooing without an order.
• Report scalp lesions, bleeding, flaking with redness, or signs of lice (nits attached to the hair shaft near the scalp). Lice require Contact Precautions until treated.

Shaving

Safety razor technique: soften the beard with a warm, damp washcloth and shaving cream, hold the skin taut, and shave in the direction the hair grows with short strokes. Rinse and dry the face, apply after-shave or lotion if the patient wants it, and discard a disposable razor in the sharps container. Never share razors. Report nicks that keep bleeding.

Nail and Foot Care

• Soak the hands or feet in warm water if allowed, clean under the nails with an orange stick, and dry thoroughly, especially between the toes, to prevent maceration and fungal infection.
• File fingernails smoothly. Where policy allows the PCT to trim nails, cut them straight across.
• Do not cut or trim nails for patients with diabetes, peripheral vascular disease or poor circulation, or anticoagulant therapy, or when nails are thick, ingrown, or fungal. A small nick can become a nonhealing ulcer or infection. Report the need to the nurse, who may arrange podiatry.
• Apply lotion to dry feet but not between the toes. Inspect the feet of patients with diabetes at every opportunity and report blisters, cracks, redness, or wounds right away.

Dressing and Undressing

• Let the patient choose clothes that suit the weather and activity, and use adaptive clothing when helpful (elastic waistbands, hook-and-loop closures, front openings).
• Weak-side rule: with one-sided weakness, paralysis, a painful arm, or an IV, dress the weak or affected side first and undress the strong side first. Remember: "Dress weak, undress strong." This keeps the sleeve from forcing a painful or immobile joint into position. It is the same rule used for changing a gown around an IV line (Section 4.5).
• Offer dressing aids that occupational therapy has provided, such as a reacher, sock aid, long-handled shoehorn, or buttonhook.
• Put non-skid footwear on before the patient stands.

Eyeglasses and Contact Lenses

Clean glasses with water or lens cleaner and a soft lens cloth, not a paper tissue, which scratches lenses. Hold them by the frame, store them in a labeled case, and keep them within the patient's reach. Report eye redness or discharge. Contact lenses are removed before surgery and stored in labeled cases with fresh solution.

Shower and Tub Safety

Bathrooms are among the most common places for hospital falls and burns.

1. Check the order and activity level. Some patients may not shower until a dressing, drain, or telemetry transmitter is protected or removed; ask the nurse.
2. Prepare the room: dry floor, non-skid mat, shower chair with locked wheels, grab bars, towels and clothing within reach, and the emergency call cord where the patient can reach it.
3. Set the water before the patient enters. Run the water, adjust it, and test it with a bath thermometer or the inside of your wrist (bath water for adults is kept at about 105°F–110°F, or 40.5°C–43.3°C, in this guide's bed bath standard). Start the spray away from the patient.
4. Stay nearby. Never leave a weak, confused, or fall-risk patient alone. For others, stay within calling distance and check frequently.
5. Tub baths: fill the tub before the patient gets in, avoid bath oils that make the tub slippery, limit the soak to about 20 minutes if the patient tires easily, and drain the water before the patient gets out.
6. Watch for dizziness. Warm water dilates blood vessels, so patients can become lightheaded and faint. Have them sit on the shower chair; if they feel faint, turn off the water, keep them seated or lower them safely, and call for help.
7. Dry the patient well, especially skin folds and between the toes, and inspect the skin.

Clinical Trap: The Helpful Toenail Trim

A PCT notices that a 78-year-old patient with diabetes has long, thick toenails and trims them during the bath. A week later one toe is red, swollen, and draining. Reduced sensation and poor circulation turn small injuries into serious infections in diabetic feet. The correct action was to clean and dry the feet, inspect them, and report the need for nail care to the nurse.