Assisting a patient to change clothes

• Authors: V.Rednenko 

Editor: V.Rednenko 

Equipment for the practical skill:

• Simulated patient (patient manikin)
• Hospital bed with bedding
• Bath blanket
• Clean clothes

Clinical situation:

Patient N. is in the neurological department with acute cerebrovascular accident, he is assigned to to change clothes. The patient is bedridden.  Carry out the prescribed procedure.

Order of the skill performance:

Preparatory stage:

• Introduce yourself
• Identify patient
• Obtain informed consent to the procedure (if the patient's condition allows it)
  • Give all the information to the person about what the procedure involves, including the benefits and risks, whether there are reasonable alternative, and what will happen without this procedure
  • Explain what you are going to do.
  • Ask the patient to consent to procedure.
  • Explain to the patient how he can help.
• Make sure you have the necessary equipment and put it on the over-bed table (the chair next to the bed)
• Sanitize your hands, put on gloves
• Prepare the patient bed:
• Raise the bed to a comfortable working height.
• Make sure the wheels on the bed are locked

Main stage:

Task 1: Assist the patient with undressing

• Lower the head of the bed as low as the person can tolerate.
• Cover the person and the top sheet with the bath blanket (to provide privacy and warmth). Ask the person to hold the edge of the bath blanket (or tuck the edges under the person’s shoulders) while you fold the top linens down to the bottom of the bed.
• Help the person remove her clothing.
  • Tops that pull over the head:
    • Undo any fasteners, such as buttons or zippers.
    • Help the person remove her strong arm from the top first, then her weak arm, by sliding the sleeves down the arms.
    • Gather the top around the person's neck.
    • Assist the person to raise her head and shoulders off the pillow.

• • • Remove the top by lifting it over the person’s head. (If the person cannot lift her head and shoulders from the pillow, turn the person onto her side and remove her arm from the sleeve on that side. Repeat the process on the other side, and then turn the person back into the supine position.)
  • Tops that fasten in the front:
    • Undo any fasteners, such as buttons or zippers.
    • Assist the person to raise her head and shoulders off the pillow. Help the person to remove her strong arm from the top first, then her weak arm, by sliding the sleeves down the arms.
  • Bottoms:
    • Undo any fasteners, such as buttons or zippers.
    • Ask the person to bend her knees and place her feet firmly on the bed, so that she can raise her hips off the bed.
    • Reach under the bath blanket and slide the pants down over the hips. 

• • • If the person cannot raise her hips off the bed, turn the person onto her side and pull the pants over the buttocks and hip on that side. Repeat the process on the other side, and then turn the person back into the supine position.

Task 2: Assist the patient with dressing

• Help the person put on undergarments.
  • Underpants:
    • Gather the leg opening to the waistband.
    • Help the person place her weak foot through the leg opening first, then her strong foot, and slide the underpants up the person’s legs as far as they will go.
    • Ask the person to bend her knees and place her feet firmly on the bed, so that she can raise her hips off the bed.
    • Reach under the bath blanket and pull the underpants over her hips. (If the person cannot raise her hips off the bed, turn the person onto her side and pull the underpants over the hips and buttocks on that side. Repeat the process on the other side, and then turn the person back into the supine position.)
  • Bra:
    • Help the person place her weak arm through the strap of the bra, then her strong arm.
    • Slide the straps onto the person’s shoulders, and adjust the cups of the bra so that they cover the person’s breasts.
    • Assist the person to raise her head and shoulders off the pillow and fasten the bra in the back.

• • Undershirt:
    • Gather the hem of the undershirt to the neck opening.
    • Slip the undershirt over the person’s head. Assist the person to put her weak arm through the arm opening, then her strong arm.

• • • Assist the person to raise her head and shoulders off the pillow and pull the undershirt down.

• Help the person to put on outerwear.
  • Pants:
    • Use the same technique used for putting on underpants. Fasten any fasteners, such as zippers or hooks.
  • Tops that fasten in the front:
    • Face the person and put your hand through the wrist opening of the top. Hold the person’s hand and slip the sleeve off your hand and onto the person’s arm(Figure 5).

• • • Adjust the sleeve so it sits properly on the person’s shoulder.
    • Assist the person to raise her head and shoulders off the pillow and bring the top around the person’s back.
    • Assist the person to place her other arm in the sleeve.
    • Fasten any fasteners, such as zippers or buttons.
  • Tops that fasten in the back:
    • Face the person and put your hand through the wrist opening of the top.
    • Hold the person’s hand and slip the sleeve off your hand and onto the person’s arm.
    • Adjust the sleeve so it sits properly on the person’s shoulder. Repeat on the other side.
    • Assist the person to raise her head and shoulders off the pillow so that you can fasten the top in the back.
• Help the person put on footwear.
  • Socks or stockings:
    • Gather the opening of the sock or stocking to the toe.
    • Guide the person’s foot into the sock or stocking, adjusting the sock or stocking so that it fi ts properly on the foot.
    • Pull the sock or stocking up the leg, smoothing any wrinkles.
  • Shoes or slippers:
    • Loosen any laces.
    • Guide the person’s foot into the shoe or slipper, and tie the laces or secure other fasteners.

Final stage:

• Ensure the person’s comfort and good body alignment.
• Adjust equipment for safety: Lower the bed to the level specified in the person’s care plan. Make sure the wheels on the bed are locked. Place the person’s method of calling for help within reach. Lower or raise the side rails according to the person’s care plan.
• Clean up your work area.
• Wash your hands.