6.2 Grooming, Dressing & Oral Hygiene

Grooming, dressing, and oral hygiene are personal care tasks that directly impact a resident's dignity, self-esteem, and physical health. Helping a resident maintain their personal appearance is a vital part of holistic care. In Oregon, Certified Nursing Assistants must perform these skills in a manner that promotes independence, preserves resident rights, and adheres to strict safety guidelines.

Hair Care and Shaving

Daily hair care involves brushing or combing the resident's hair to maintain neatness and stimulate scalp circulation. The CNA should brush hair from the ends upward to gently detangle it, and style it according to the resident's personal preference. Hair care should be done daily and whenever needed. Shaving is another key grooming task. There are two primary types of razors: safety (disposable) razors and electric razors.

• Electric Razors: These are the safest option and are mandatory for residents who are on anticoagulant therapy (blood thinners such as Warfarin/Coumadin, Heparin, or daily high-dose aspirin) or who have bleeding disorders. Electric razors do not cut the skin, eliminating the risk of bleeding.
• Safety Razors: To shave a resident with a safety razor, the CNA must first soften the beard by applying a warm, damp washcloth to the face for a few minutes. Apply shaving cream. Hold the skin taut with one hand and shave in the direction of hair growth (downward on the cheeks and chin, upward on the neck) using short, gentle strokes. Rinse the razor frequently.
• Oregon Safety Rule: After shaving, the CNA must immediately dispose of a safety razor in a puncture-resistant sharps container, never in the regular trash.

Nail Care and Oregon Scope Limitations

Nail care involves soaking the hands or feet, cleaning under the nails, and filing them to prevent scratching.

• Fingernail Care: Soak the resident's fingers in warm water for 5 to 10 minutes to soften the nails and cuticles. Use an orange wood stick wrapped in cotton to gently clean under the nails. File the nails in a smooth curve, avoiding sharp edges.
• Toenail Care: Soak the feet in warm water for 10 to 15 minutes. Wash and dry the feet, paying close attention to the spaces between the toes.
• Critical Oregon OSBN Scope Limit: Under Oregon State Board of Nursing (OSBN) rules, CNAs are strictly prohibited from clipping or cutting the fingernails or toenails of any resident who has diabetes, peripheral vascular disease (poor circulation), or sensory neuropathy. These conditions impair healing and decrease sensation, meaning a tiny nick from a nail clipper can lead to a non-healing diabetic ulcer, severe infection, gangrene, and eventual amputation. Nail trimming for these residents must be performed by a licensed nurse (RN or LPN) or a podiatrist. CNAs may only file the nails if permitted by facility policy.

Dressing and the POW / TOSS Principle

Assisting a resident with dressing is a core skill tested during the Oregon TMU/Headmaster clinical evaluation. To promote dignity, the CNA must allow the resident to choose their own clothing. When a resident has a weak, injured, or paralyzed side (such as from a stroke or fracture), the CNA must apply the POW / TOSS principle:

• POW (Put On Weak): When dressing the resident, always put the clothing on the weak (affected) side first. This allows the CNA to gently guide the sleeve or pant leg onto the limited-mobility limb without stretching or causing pain to the joints. Once the weak side is dressed, the strong side can easily be dressed.
• TOSS (Take Off Strong): When undressing the resident, always remove the clothing from the strong (unaffected) side first. By freeing the strong limb, the clothing becomes loose and can be slipped off the weak side gently, without pulling or twisting the affected limb. Always ensure the resident is wearing non-slip socks or shoes before transferring them out of bed.

Oral Hygiene for Conscious and Unconscious Residents

Oral hygiene prevents tooth decay, gum disease, and halitosis, and improves the resident's appetite and comfort.

• Conscious Resident: Assist the resident to an upright sitting position. Provide a toothbrush with soft bristles, toothpaste, a cup of water, an emesis basin, and a towel. Encourage the resident to do as much as possible independently. Brush all surfaces of the teeth, the gums, and the tongue. Provide water for rinsing and hold the emesis basin under their chin. Offer dental floss if appropriate.
• Unconscious Resident (Aspiration Prevention): Unconscious residents are at high risk of aspirating (inhaling) fluids into their lungs, which can cause aspiration pneumonia.
  • Positioning: The resident must be placed in a lateral (side-lying) position with their head turned to the side facing you. This allows gravity to drain fluids out of the mouth into an emesis basin.
  • Cleaning: Use a minimal amount of liquid. Moisten sponge swabs (tootlettes) with water or mouthwash, squeeze out excess fluid so it is damp (not dripping), and gently clean the teeth, gums, tongue, and roof of the mouth.
  • Safety: Never place your fingers inside an unconscious resident's mouth, as they may bite down reflexively, causing serious injury. Keep a suction machine nearby if available. Apply lip moisturizer after care.
• Denture Care: Dentures are expensive custom prosthetics.
  • Handling: Always line the sink with a washcloth or fill it with water before cleaning dentures. This cushions the dentures if they are accidentally dropped, preventing them from cracking.
  • Cleaning: Use cool or tepid water to rinse and brush dentures. Never use hot water, as it can warp the plastic shape of the dentures, making them fit poorly or become unusable.
  • Storage: When not in the resident's mouth (usually at night), dentures must be stored in a labeled denture cup filled with cool water or denture cleaning solution. Leaving dentures dry can cause them to warp or crack.