NVQ UNIT 218 Support Individuals With Their Care Needs

1. NVQ UNIT 218 Support Individuals With Their Care Needs

2. Aims By the end of this session you will be able to : • Support your patients to maintain their personal hygiene. • Understand the importance of maintaining cleanliness. • Support your patients to use toilet facilities. • Assisting a client to dress. • How to prepare yourself and maintain your safety during the procedure • The importance of reporting key changes in your patients condition.

3. Objectives By the end of this session you will understand the reasons for : 1) The importance of gaining your clients consent before a procedure. 2) Ensuring that you provide support for your patient while respecting the clients choice and individuality. 3) Providing the support understanding the reasons why the support is needed and how to do it safely.

4. Scope Areas covered in this unit include : Communication With your client using their preferred language and using effective listening skills. Their families and friends, other carers, and the nurses in charge. Liasing with the multidisciplinary team including Doctors, specialised nurses, physiotherapists and other professionals the patient will come into contact with. Toilet facilities Which include the toilet, commode, bed pan or urinal.

5. Scope The patient Problems and changes in the patients health, difficulties in washing and going to the toilet, concerns with body waste and changes in the patients skin condition. Emotional changes in the patient that change motivation and ability to carry out personal cleansing and grooming. Health and Safety The patient ability to carry out the procedure, risk assessments and the other factors to be taken into account when assisting a patient to wash or go to the toilet and the use of equipment in relation to The Health and Safety at Work Act 1974, and The Manual Handling Regs 1992.

6. Introduction Keeping clean is something most people do for themselves on a daily basis without much thought of what is involved or the reasons why it is necessary. When people become ill, disabled or in need of care they rely on others to assist with their personal cleanliness. Most people take pride in their appearance and consider how they look very important. How you look has an impact on your emotional well being and your self esteem. When you become ill or you need care you may be able to manage some of the washing process but need guidance or specialised dressing equipment so they can remain as self managing as possible.

7. Covers the entire body including the cornea and also lines the body orifices.It is the largest organ in the body. It is composed of two layers. The Epidermis – Found on the outside it is composed of skin cells which are continually being renewed from the the lower part of the epidermis –pushed upward to the surface where they are shed. Also on the surface of the epidermis are pores and hairs. The epidermis surface is rigid-fingerprints. The Skin

8. 2) The Dermis – Found on the inside and is much thicker layer than the epidermis.It is composed of connective tissue containing:- a) Sweat glands which excrete water, salt waste and helps to control body temperature. b) Hair follicles that contain a hair root and hair shaft. c) Hair follicle muscle which when contracted causes the hair to stand trapping the air below and conserves heat. (goose pimples) d) Sebaceous glands which are connected to the hair follicles, secrete sebum that makes the skin waterproof and also softens skin and hair. e) Nerve cells detect different sensations, temperature, touch, pressure and pain. f) Blood vessels are small known as capillaries that bring nutrients to the skin and also assist temperature control. The Skin

9. Below the Dermis is a layer of fat for insulating and energy store. Functions Of The Skin Protection against bacteria, radiation. Waterproof keeps body fluids in and external fluids out. Sensation gives the brain the information about the environment. Excretion- water, salt, and waste. 5) Production of vitamin D. 6) Temperature control. Allergy, hormones, emotion, age, drugs and disease may affect the skin. The Skin

10. The skin becomes dirty because of exposure to the environment, but it also collects dry sweat, dead skin cells and oily sebum from the sebaceous glands. All of these provide an ideal breeding ground for bacteria, which cause offensive odours and can lead to infections, therefore the skin needs to be regularly washed to remove them. Some form of cleaning should be taken every day. If the patient is not able or willing to have a daily bath, shower or a wash an accumulation of dirt will build up causing problems. Areas of the body most at risk are the patients Axilla= Armpits Extremities= Fingers and Toes Genital area= Underneath, down below, private parts or what ever the patient is comfortable with. Abdomen= Stomach, tummy Cleanliness

11. The best possible situation would be where the patient could look after themselves. All the carer would have to do is ensure that the patient can access the facilities they need. Check the patient can : Reach the bathing facilities Consider safety aspects Know how to use the equipment that is available to assist people and you have discussed this with the patient. If the patient needs assistance an assessment of the patients needs should be carried out with them to ensure that the care given to the patient is what they need and is known to all staff. How To Ensure Cleanliness

12. The patient should have easy access to use facilities if you need to assist them to wash. Assist the patient to collect their own toiletries and towels help the patient to feel at ease by talking and arranging the care you will assist them with. Ensure that the bathroom or area where you assist the client is private shut the bathroom door or ensure the curtains are closed. Ensure you have all the equipment you need before you start the procedure. Do not impose your own ideas or force the patient to wash, this is abuse. Ensure the patient has been assessed by the care team to be able to wash if any equipment is used or if you intend to leave the patient unattended if a risk assessment has been carried out. How To Ensure Cleanliness

13. Cultural Needs of Your Patients You need to consider the cultural or the religious beliefs of your patients in every aspect of care. You need to provide support that respects your patients diversity. When cleansing a patient will need to continue to follow their normal routine wherever they are. For example: • Muslims and Hindus will need to be provided with running water in which to wash if at all possible. Muslims need to be able to wash their hands, face and feet in running water. • Hindus will prefer a shower to a bath and will use a bidet rather than paper to clean themselves after using the toilet. • Sikhs and Rastafarians believe the hair should not be cut. • Hindus and Muslims will only accept treatment from a carer of the same gender.

14. Explain the procedure to the patient, listening to what they want and gain their consent. Ask the patient if they need to use the toilet, commode or a bedpan and get assistance Ensure the patients privacy before the procedure. Gather all the equipment that you will need which will include Soap Bowl of water Towels (2) Flannels (2) Change of clothing for patient Small disposable waste bin (for pads or hand towels.) You will need Personal Protective Clothing. Trolley or bedside tray to put the bowl on. Always inform the staff where you will be. How to Bed Bath a Patient

15. Ensure the patient feels comfortable, laying flat would be the best position for a bed bath but if the patient has had surgery or back pain this may not be possible, ask for assistance if you are not sure. Fill the bowl with water ¾ full with hand hot water. Take the top bed clothes and undress the patient, then cover the patient with a loose sheet or a towel to maintain the patients dignity. Wash, rinse and dry the patients face, ears and neck with one of the flannels. Remember to ask the patient if they use soap on their face or if they have a separate cleanser for this. Change to the other flannel and wash, rinse and dry each hand in turn, and clean the fingernails. Wash, rinse and dry each arm Bed Bathing

16. Paying particular attention to the underarms, making sure they are thoroughly dried. Wash the chest and abdomen. Be very careful to dry the area under the breasts for women, and any stomach creases where moisture can build up, cause soreness and the development of fungal infections. Change the water and continue washing each leg. Place the largest towel under each leg when you are washing and rinsing Wash each foot in turn, and then ensure that you dried each leg well, especially between the toes to stop the growth of fungal infections Roll the person in order to wash their back. If you are by yourself roll the person towards you to prevent them falling off the bed Bed Bathing

17. When you have finished washing the patients body, change to a different flannel or wipe and wash and clean the genital and anal area. If you are using disposable wipes they should be discarded into an appropriate disposable bag. When bed bathing a patient this is a good opportunity to check for the development of pressure sores and ensure that you have taken the correct preventative measures. If you notice any changes in the patients skin eg rashes, inflammation, redness or breaks you need to inform the nurse in charge Extra Tasks If the patient is unable to get out of bed use this opportunity to change the bottom sheet while the patient is rolled on one side. Bed Bathing

18. Bed Bathing • If the patient can get out of bed this would be a good opportunity to change the nightdress, and assist the patient to sit in the chair while you remake the bed. • Check whether the patient needs their hand or toenails cut if so inform the nurse in charge you are not advised to do this. If the nail is brittle or if the patient is Diabetic a Chiropodist may do this instead of the nurse.

19. Again gain the consent from your client and be competant to carry out the procedure Collect the equipment for this procedure which will include Razor Shaving foam A towel Bowl of water ¾ full of hand hot water Any moisturiser or conditioner used by patient. Ensure client is comfortable and ready for the procedure Ensure privacy for your patient For facial hair on men listen to the patients preferred method for shaving You shave with the growth i.e. downwards if you go against the grain you will irritate the hair follicles and cause damage. Shaving A Patient

20. Wet the patients skin with a flannel and apply the shaving foam Start with the left side of the face from the cheek bone downwards working your way to the end of the chin, then the right side. Don’t forget with each stroke to clean the razor in the water. Across the chin in small downward strokes. Under the chin be careful to follow the contours of the patients face asking him to tilt his head for ease of shaving Under the nose the moustache and around the mouth use small downward strokes paying attention to the patient and give reassurance asking him to move his head if needed. You may need to pull the skin taught by placing your hand gently on the patients neck when shaving under the chin follow what the patient requires. Rinse the patients face and dry with a towel dispose of the razor in the sharps bin. Shaving A Patient

21. Gain consent from the patient and discuss the procedure with the patient and the nurse in charge. Ask the nurse in charge do not put a patient in danger making them do something they are not able to do. Carry out a risk assessment. There are a wide range of aids available see handout. Most care settings have an obligation to provide bathing aids if they are required. There would be situations when it would not be safe to allow someone to bathe alone, or if you needed guidance yourself DON’T PUT YOUR PATIENT OR YOURSELF IN DANGER. Work in two’s with the client until you build up confidence working alongside an experienced member of staff. Gather all the equipment you will need. There is nothing worse than leaving an undressed client while you leave them to get the forgotten items. Bathing A Patient

22. Bathing a patient gives you a good opportunity to notice any significant changes to their skin. You need to receive training to assist the patient into the bath with or without the use of aids and this type of procedure should not be done without the correct training, due to the Manual Handling Regulations 1992. Wear PPE. Run the water and prepare the bathroom close the window and make sure that the environment is warm enough for the patient. Check the temperature of the water with a thermometer which should be at 40 degrees. Assist the patient to get into the bath either by the use of a manual aid like a bath lift or an electrical bath also helpful is the use of a bath mat and hand rails. Bathing A Patient

23. Listen to your patient to how they want to wash and give them time to do as much for themselves as possible. Do not leave the patient unattended if they have been assessed as unsafe to be left alone. If you need immediate assistance for the patient pull the nurse call bell. Assist the patient to wash in the same order as the bed bath. If the patient wants to wash their hair ensure you have a shower attachment or a jug to rinse, after washing. The patient may also want to have a flannel to protect their eyes during this procedure. Getting the patient out of the bath is just as, if not more hazardous as they are wet and may slip and fall. Put a towel on the floor for the patient to step onto and have a chair for the patient to sit on while they dry themselves. Bathing A Patient

24. Dispose of any soiled pads or wipes in the clinical waste procedure. Bathing A Patient • It is important that the patient is given assistance to dry themselves properly. • Ensure that the patient is given enough assistance to redress and return to their bed. • Return to the bathroom and ensure that it is left in a clean condition and the floor is kept dry to prevent accidents. • You may be asked to document the procedure in the patients notes.

25. If a person needs assistance to dress or undress you need to ensure the patients dignity is maintained. Give the patients choices ask them how they want to dress and prepare the clothes they have brought with them. Use any dressing aids the patient has to maintain their dignity discussed on page . Ensure the patients privacy and dignity are maintained Ensure you are dressing the patient in clothes they want to wear and not clothes you have chosen. Grooming is just as important as dressing and this includes the application of make-up. Hair care is the way we style our hair and shows how we feel about ourselves. It is important for the patient to be given time and assistance to wash and brush their hair, the unit may have a mobile hairdresser. Dressing a Patient

26. Jacket /Jumper/Shirt - Slip your hand through the sleeve from the cuff and hold the persons hand. Pull the sleeve up and around the shoulder. Remember, if the person has had a stroke you need to start with that arm. Trousers/Pants- While the patient is on the bed, pull the trousers over the feet. Pull them up as far as possible. Ask the person to lift their buttocks off the bed while you ease up the trousers up to the waist. Fasten them. Putting on Clothes

27. Once you have dressed the patient You need to know if they wear any supports, prostheses and orthoses. Supports – include hearing aids, glasses, and voice synthesisers. Prostheses – include, artificial limbs, wigs and dentures Orthoses – includes surgical stockings, callipers, surgical collar and trusses. It is important to ensure that aids and appliances are used properly and that the patients are wearing them correctly. If they are broken or causing the patient discomfort you must report this to the nurse in charge. Supports, Prostheses and Orthoses

28. Dealing With Problems and Conflicts Often the most difficult problems to face when caring for others is the standards of their hygiene may differ than your own. You need to ensure that your client is comfortable when receiving care. Many people will find the break in their normal routine makes them wary and the idea of assistance to wash embarrassing. You need to be tactful and discreet when helping people to wash and dress and remember they may also be in pain.

29. Dealing With Problems and Conflicts When a patient refuses to have a wash, shower or bathe, this situation can cause problems when in a residential or hospital environment. Others object to the persons body odour and it then becomes the care teams responsibility to discuss this with the patient. The nurse must speak to the patient and give clear advise without pressurising the patient. When you talk to the patient you must clearly point out the problems when washing does not take place. Failure for the advice to have an effect could signify a problem in the facilities, incorrect assessment of the patients ability or the patients own mental health.

30. Enable a Patient to Use Toilet Facilities In normal circumstances we use the toilet and dispose of our waste in private. Being continent is the ability to retain body waste until we are in an appropriate place to dispose of it, usually in our case the toilet. We would find it a problem in society being incontinent which means that you cannot for a reason control when you retain your waste. The person is likely to suffer a high degree of humiliation, low self esteem and embarrassment. We as a society only accept this behaviour from very young children.

31. Monitoring a patients waste is an excellent indicator of what is happening internally. Body waste needs to be disposed of in a safe and hygienic way that does not pose a threat to the patient or the nurse. Body waste is always considered to be a product, comprised of bacteria and potentially infectious materials and can cause contamination and cross infection if not dealt with properly. Body waste is often monitored for its colour and smell. Urine is tested to indicate infection, pregnancy and often other conditions like kidney problems or Diabetes. The nurse will monitor urine output when the patient has a Catheter or when the patient has been dehydrated. This would be recorded on a Fluid Balance Chart. Body Waste

32. Ensure the patient is offered choice. Find out the patients ability to be as independent as possible and ask them during assessment what they need remembering to maintain dignity and confidentiality throughout the assessment process. Share the information you have found out with the rest of the team. Find out any cultural needs and ensure that the terminology you use is understood by patients for whom English is not their first language. E.g. Avoid saying ‘spending a penny’ or ‘having a tinkle’ Remember the patient will feel embarrassed so try to treat the process of assisting the client to the toilet as a normal function of care and by doing this you will let the patient relax and be able to trust you to assist them. Getting To The Toilet

33. When assessing a patients abilities you need to consider the patients Mobility- Whether the patient needs assistance not only to get to the toilet but to adjust their clothing and to get onto the toilet when they get there. The frequency - Of the patient going to the toilet and how many staff will be required to assist the patient. The urgency with which the patient needs to go to the toilet. Someone with poor mobility may be able to get to the toilet but not be able to adjust their clothes when they get there. Some patients may have urgency related to the muscles in the bladder which means that they have very little warning when they need to void urine. Getting To The Toilet

34. Discuss this with the patient and assess their needs with the equipment you have available on the unit. The patients condition will dictate what you need to use also. Some facilities that may be available are; The adapted toilet seat which is a frame that fits over the normal toilet. The commode which is a toilet on wheels with a bowl that can be taken out and washed in a sterilliser. A bedpan which is a flat plastic or metal toilet shaped devise that can be placed under the patient if they where on bed rest. The urinal used for men to void urine into which can be made of plastic or be disposable. Toilet Facilities

35. Bedpan – Wash your hand and use PPE Ensure as much privacy as possible. Ask the patient to raise their buttocks off the bed by raising their knees with the feet flat on the bed and lifting the hips. Roll the patient on their side if they are unable to lift their buttocks.This is a two carer job to avoid accidents. Assist the patient to sit up and cover them with a sheet Leave them alone to use the bedpan, making sure that the buzzer is within reach for when it is needed. Check the patient after ten minutes Assist the patient to adjust their clothing and to wipe themselves Provide a bowl of water, soap, and flannel to allow the patient to wash their hands Cover the bedpan and take to the sluice, measure or test urine before it’s disposal. How to Assist Patients to Use Facilities

36. Commode – Arrange care with the patient. Discuss their needs and be sure that you provide assistance without taking over the procedure.If the patient has a disability be aware of any aids you will need to assist the patient. The questions you will need to ask will be Are you able to clean yourself, or do you need help Do you use paper or do you prefer a disposable wipe Do you need to pass urine or do you need to open your bowels. The client may be able to get to the toilet but need assistance to wipe themselves as the twisting movement needed to clean requires some skill that may be lost if the patient has arthritis or has had a stroke. The commode normally has wheels so that if the patient cannot walk they can still be able to use it by the bed. Encourage Patients To Use Facilities Themselves

37. If your hair is collar length it must be tied back with navy, black or plain clips/bands and appear tidyFalse nails including jel nails cannot be worn recent research has proven that this has spread infection and can be directly linked to cross infection between care assistant and client. 1)    Keep nails short, clean and polish free 2)   Avoid wearing wristwatches and jewellery, especially rings with ridges or tones. 3)   Artificial nails must not be worn 4)   Any cuts and abrasions should be covered with a waterproof dressing. Infection Control

38. Before you wash your hands you need to ensure that you have removed your wrist watch any bracelets and roll up your sleeves. Facilities should be widely available and easy to use. Soap dispensers and elbow operated mixer taps with paper towels rather than air driers with foot operated bins used. The use of Alcohol gel also discussed, as an alternative to soap and water but is not seen as a cleaning agent. The correct method for the drying of hands seen as being as important as the correct technique for hand washing. When hands have not been dried correctly could lead to the hands becoming recontaminated. Infection Control

39. Before you wash your hands you need to ensure that you have removed your wrist watch any bracelets and roll up your sleeves wet your hands under the tap and put the liquid soap onto your hands. At a recent study day the infection control nurse from Arrowe Park Hospital in the Wirral suggested that washing your hands should take as long as singing ‘Happy Birthday’ twice, using The Six Step Guide. Hand Hygiene

40. Hand Washing Guide