Assisting a patient with a complete bed bath

Authors: V.Rednenko 

Editor: V.Rednenko 

Equipment for the practical skill:

• Simulated patient (patient manikin)
• Hospital bed with bedding
• Washcloths
• Towels
• Bath blanket
• Bed protector
• Wash basin
• Bath thermometer
• Soap
• Paper towels
• Gloves
• Clean clothing
• Clean linens (if needed)

Clinical situation:

Patient N. is in the neurological department with acute cerebrovascular accident, she ask a bath. The patient is bedridden. Assist the patient with bed bath.

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.
• Prepare the patient bed:
• Raise the bed to a comfortable working height.
• Make sure the wheels on the bed are locked

Main stage:

• Cover the over-bed table with the paper towels and arrange your supplies. Fill the wash basin with warm water. Use the bath thermometer to verify that the water temperature is between 105° F and 115° F (40-45° C). Place the wash basin on the over-bed table.
• Lower the head of the bed as low as the person can tolerate.
• Help the person move closer to the side of the bed where you are working.
• Remove and fold the bedspread and blanket for reuse. 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.
• Put on the gloves.
• Help the person to remove soiled clothing.

Task 1: Wash the Person’s Face, Neck and Ears

• Place a towel on top of the bath blanket, across the person’s chest. This helps to keep the bath blanket dry while you wash the person’s face, neck and ears.
• Wet the washcloth and make a mitt with it by:
  • Holding a corner of the washcloth between your thumb and fingers.
  • Wrapping the rest of the cloth around your hand and holding it with your thumb.
  • Folding the cloth over your fi ngers and tucking it under the fold in your palm.
• Without using soap, use the washcloth to bathe the eye farther from you. Begin at the inner corner of the eye, near the nose. Then move the washcloth across the eye to the outer corner. Use the towel to dry the eye. Use the opposite end of the mitt and towel to bathe and dry the other eye.

• Using soap sparingly, wash, rinse and dry the person’s face, neck and ears.

Task 2: Wash the Person’s Arms and Hands

• Fold back the bath blanket to expose the person’s arm that is farther from you. Place the towel lengthwise under the arm.
• Wash, rinse and dry the shoulder, arm and underarm (axilla). Use the towel that was under the arm to dry the shoulder, arm and underarm. Place a bed protector on the mattress near the person’s hand, and place the wash basin on the bed protector. Place the person’s hand in the wash basin. Wash, rinse and dry the person’s hand.
• Recover the person’s arm with the bath blanket.
• Fold back the bath blanket on the person’s arm that is nearer to you. Place the towel lengthwise under the arm.
• Wash, rinse and dry the shoulder, arm, axilla and hand.

• Remove the towel from under the arm, and cover the arm with the bath blanket.

Task 3: Wash the Person’s Chest and Abdomen

• Place the towel on top of the bath blanket, over the person’s chest and abdomen (stomach).
• Reach under the towel that is over the bath blanket and fold the bath blanket down to the person’s pubic area without exposing it. Leave the towel in place so that the person is not completely exposed.
• Fold back the towel to expose the side of the person’s chest that is farther from you. Wash, rinse and dry the person’s chest. Inspect under the person’s breast and skin folds as you work.
• Dry the person’s skin completely. Re-cover the chest with the towel.
• Fold back the towel to expose the side of the person’s chest that is nearer to you.
• Wash, rinse and dry the chest as in the same manner

• Wash, rinse and dry the person’s abdomen in the same manner as the chest, doing the farther side first, and then the nearer side.
• Pull the bath blanket back up to cover the chest and abdomen, and remove the towel from underneath.
• Change the water if it becomes too soapy or cool.

Task 4: Wash the Person’s Legs and Feet

• Fold the bath blanket away from the person’s leg that is farther from you. Place the towel lengthwise under the leg.
• Wash, rinse and dry the leg. Use the towel that was under the leg to dry it.
• Place a bed protector on the mattress near the person’s foot, and place the wash basin on the bed protector. Place the person’s foot in the wash basin. Wash, rinse and dry the person’s foot.
• Re-cover the person’s leg with the bath blanket.
• Fold back the bath blanket on the person’s leg that is nearer to you. Place the towel lengthwise under the leg.
• Wash, rinse and dry the leg and foot as in the same manner.

• Re-cover the leg with the bath blanket. Remove the towel from under the leg.
• Change the water.

Task 5: Wash the Person’s Back and Buttocks

• Help the person turn onto one side so that his back is facing you.
• Place the towel on the sheet behind the person’s neck, back and buttocks. Adjust the bath blanket so that it covers the person’s chest, shoulders, abdomen and legs.
• Wash, rinse and dry the person’s neck, back and buttocks.

• Inspect the skin as you work.

Task 6: Wash the Perineal Area

• Place the towel so that it will be under the person’s hips when you help the person back into the supine position. If the person is able to do his own perinal care, provide a fresh washcloth, soap and clean water. Give the person a few minutes alone to complete perineal care. If the person is not able to do his own perineal care, provide perineal care as in Practical Skill Perineal сare for a bedridden patient (female) and Perineal сare for a bedridden patient (male)
• Remove and dispose of your gloves.

Task 7: Help the Person Dress

• Help the person back into the supine position.
• Help the person to apply deodorant or antiperspirant (optional).
• Help the person to put on clean clothing (See Helping a patient to change clothes).
• If the linens are soiled or wet, change the linens.
• Pull up the top linens and remove the bath blanket.

 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.