PAMANTASAN NG LUNGSOD NG MAYNILA

(University of the City of Manila)

General Luna Street comer Muralla Street
Intramuros, Manila

COLLEGE OF NURSING
(Dalubhasaan ng Narsing)

BACON – SKILLS LABORATORY CHECKLIST

Hygiene: Bed Bath (Bathing an Adult Client)

Name: ________________________ Score: ____________________

Year Level and Block: ___________ Clinical Instructor: ___________

Bathing an Adult Client

PURPOSES
 To remove transient microorganisms, body secretions and excretions, and dead skin cells
 To stimulate circulation to the skin and aid in elimination
 To promote a sense of well-being
 To refresh and cleanse client
 To produce relaxation and comfort
 To prevent and eliminate unpleasant body odors
 To prevent bedsore; to prevent pain and congestion

Procedure/Steps Rationale
PREPARATION
1. Assess:
 Condition of the skin.
 Physical and emotional factors that might
affect in giving the bed bath to the client
 Presence of pain and need for adjunctive
measures before the bath.
 Range of motion of the joints.
 Any other aspect of health that might affect
the client’s bathing process.
 Need for use of clean gloves during bath.
2. Assemble equipment
 Basin or sink with warm water.
PLM-CN: NRS 1204 – Basic Concept in Nursing – SKILLS Laboratory Checklist on Hygiene: Bed Bath
  Soap and soap dish
 Linens: bath blanket; two bath towels;
washcloth; clean gown, pajamas, or clothes,
as needed; and additional bed linen and
towels, if required
 Gloves, if appropriate
 Personal hygiene articles
 Shaving equipment if needed
 Table for bathing equipment
 Laundry hamper
3. Determine:
 The purpose and type of bath the client
needs.
 Self-care ability of the client.
 Any movement or positioning precautions
specific to the client.
 Other care the client might be receiving.
 The client’s comfort level with being bathed
by someone else.
 Necessary bath equipment and linens.
Performance
1. Introduce yourself, and verify the client’s identity.
Explain to the client what you are going to do,why
it is necessary and how the client can cooperate.
2. Perform hand hygiene, and observe other
appropriate infection control procedures.
3. Provide for client privacy.
4. Prepare the client and the environment:
 Invite the family member or significant other to
participate, if desired.
 Close the windows and doors to ensure the
room is at a comfortable temperature.
 Offer the client a bedpan or urinal, or ask
whether the client wishes to use the toiletor
commode.
 Encourage the client to perform as much
personal self-care as possible.
 During the bath, assess each area of the skin
carefully
Prepare the bed, and position the client
PLM-CN: NRS 1204 – Basic Concept in Nursing – SKILLS Laboratory Checklist on Hygiene: Bed Bath
appropriately.
5. Position the bed at a comfortable working height.
Lower the rail on the side close to you. Keep the
other side rail up. Assist the client to move near
you.
6. Place a bath blanket over the top sheet. Remove
the top sheet from under the bath blanket by
starting at client’s shoulders and moving the linen
down towards client’s feet. Ask the client to grsp
and hold the top of the bath blanket while pulling
the linen to the foot of the bed.
Note: if the linen is to be reused, place it over the
bedside chair. If it is to be changed, place it in the linen
hamper.

7. Remove the client’s gown while keeping the client

covered with the bath blanket. Place the gown in
the linen hamper.
8. Make a bath mitt with the washcloth.
9. Wash the face.
 Place towel under the client’s head.
 Wash the client’s eyes with water only, and dry
them well. Use a separate corner of the
washcloth for each eye. Wipe from the inner
canthus to the outer canthus.
 Ask whether the client wants to use soap on her
face
 Wash, rinse and dry the client’s face,ears, and
neck.
 For Males, Shaving is done as desired by the
patient during this time.
 Remove the towel from under the client’s head.
10. Wash the arms and hands
 Place the towel lengthwise under the arm
farther away from you.
 Wash,rinse, and dry the arm by elevating the
client’s arm and supporting the client’s wrist
and elbow. Use long, firm strokes from wrist to
shoulder, including the axillary area.
 Apply deodorant or powder, if desired.
PLM-CN: NRS 1204 – Basic Concept in Nursing – SKILLS Laboratory Checklist on Hygiene: Bed Bath
  Optional: place a towel on the bed and put a
washbasin on it. Place the client’shands in the
basin. Assist the client as needed to wash, rinse
and dry hands, paying particular attention to
the spaces between fingers.
 Repeat for the hand and arm nearer you.
Excercise caution if an IV infusion is present,
checking flow after moving the arm.
11. Wash the chest and abdomen.
 Place a bath towel lengthwise over the chest.
Fold the bath blanket down to the client’s pubic
area.
 Lift the bath towel off chest, and bathe chest
and abdomen with your mitted hand using long,
firm strokes. Rinse and dry well.
 Replace the bath blanket when the areas have
been dried
12. Wash the legs and feet.
 Expose the leg farther from you by folding the
bath blanket towards the other leg, being
careful to keep the perineum covered.
 Lift the leg and place the bath towel lengthwise
under it. Wash, rinse and dry the leg, using the
long, smooth, firm strokes from the ankle to the
knee to the thigh.
 Reverse the coverings, and repeat for the other
leg.
 Wash the feet by placing them in the basin of
water.
 Dry each foot.
 Obtain fresh,warm bath water now or when
necessary.
13. Wash the back and then the perineum.
 Assist the client into a prone or side lying
position facing away from you. Place the bath
towel lengthwise along side the back and
buttocks while keeping the client covered with
the bath blanket as much as possible.
 Wash and dry the client’s back, moving from
the shoulders to the buttocks and upper thighs,
PLM-CN: NRS 1204 – Basic Concept in Nursing – SKILLS Laboratory Checklist on Hygiene: Bed Bath
 paying attention to the gluteal folds.
 Remove and discard gloves if used.
 Perform a back massage now or after
completion of bath.
 Assist the client to the supine position and
determine whether the client can wash the
perineal area independently. If the client
cannot do so, drape the client and wash the
area

14. Assist the client with grooming aids, such as

powder,
Lotion or deodorant.
 Use powder sparingly. Release as little as
possible into the athmosphere.
15. Help the client put on a clean gown or pajamas.

16. Assist the client to care for hair, mouth and nails.
17. Remove the Bath Blanket and Change with New
Top sheet of the patient
 Remove all soiled materials and Dispose
properly.
18. Wash hands
19. Document:
 Type of bath given.
 Skin assessment such as
ecoriation,erythema,exudates,rashes, drainage,
or skin breakdown.
 Nursing intervention related to skin integrity.
 Ability of the client response to assist or
cooperate with bathing.
 Client response to bathing.
 Educational needs regarding hygiene.
 Information or teaching shared with the client
or their family
20. EVALUATION
Note the client’s tolerance of the procedure (e.g.,
respiratory rate and effort, pulse rate, behaviors of
acceptance or resistance, statements regarding
comfort).
TOTAL SCORE
PLM-CN: NRS 1204 – Basic Concept in Nursing – SKILLS Laboratory Checklist on Hygiene: Bed Bath
Total score: _____________

I fully understand how I was graded for this skill and it was properly explained to me.

_____________________________
Student’s FULLNAME & Signature

Date: ______________

I have explained and discussed how I have graded my student for this particular skill.

___________________________________
Clinical Instructor FULLNAME & Signature
Date: _________

Learning Outcomes
Bed Bath – Bathing an Adult cleint
After completing this clinical procedure, you will be able to:
1. Describe hygienic care that nurses provide to clients.
2. Identify factors influencing personal hygiene.
3. Identify normal and abnormal assessment findings while
providing hygiene care.
4. Apply the nursing process to common problems related to hygienic care of the: • Skin. • Feet.
• Nails. • Mouth. • Hair. • Eyes. • Ears.
5. Identify the purposes of bathing.
6. Describe various types of baths.
7. Compare and contrast the task-centered approach and the person-centered approach to
bathing
INTRODUCTION
Hygiene is the science of health and its maintenance. Personal hygiene is the self-care by which
people attend to such functions as bathing, toileting, general body hygiene, and grooming.
Hygiene is a highly personal matter determined by individual values and practices. It involves care
of the skin, feet, nails, oral and nasal cavities, teeth, hair, eyes, ears, and perineal-genital areas. It
is important for nurses to know exactly how much assistance a client needs for hygienic care.
Clients may require help after urinating or defecating, after vomiting, and whenever they become
soiled, for example, from wound drainage or from profuse perspiration.
 Bathing removes accumulated oil, perspiration, dead skin cells, and some bacteria. The
nurse can appreciate the quantity of oil and dead skin cells produced when observing a
PLM-CN: NRS 1204 – Basic Concept in Nursing – SKILLS Laboratory Checklist on Hygiene: Bed Bath
 person after the removal of a cast that has been on for 6 weeks. The skin is crusty, flaky,
and dry underneath the cast. Applications of oil over several days are usually necessary to
remove the debris. Excessive bathing, however, can interfere with the intended
lubricating effect of the sebum, causing dryness of the skin. This is an important
consideration, especially for older adults, who produce less sebum. In addition to cleaning
the skin, bathing also stimulates circulation. A warm or hot bath dilates superficial
arterioles, bringing more blood and nourishment to the skin. Vigorous rubbing has the
same effect. Rubbing with long smooth strokes from the distal to proximal parts of
extremities (from the point farthest from the body to the point closest) is particularly
effective in facilitating venous blood flow return unless there is some underlying condition
(e.g., thrombosis) that would preclude this. Bathing also produces a sense of well-being. It
is refreshing and relaxing and frequently improves morale, appearance, and self- respect.

 Some people take a morning shower for its refreshing, stimulating effect. Others prefer an
evening bath because it is relaxing. These effects are more evident when a person is ill.
For example, it is not uncommon for clients who have had a restless or sleepless night to
feel relaxed, comfortable, and sleepy after a morning bath.

 Bathing offers an excellent opportunity for the nurse to assess clients and opens the door
for establishing trust. The nurse can observe the client’s skin for conditions such as sacral
edema or rashes. While assisting a client with a bath, the nurse can also assess the client’s
psychosocial needs, such as orientation to time and ability to cope with the illness.
Learning needs, such as the need for a client who has diabetes to learn foot care, can also
be assessed.

Categories Two categories of baths are given to clients: cleaning and therapeutic.
 Cleansing baths are given chiefly for hygiene purposes and include these types:
• Complete bed bath. The nurse washes the entire body of a dependent client in bed.
• Self-help bed bath. Clients confined to bed are able to bathe themselves with help from
the nurse for washing the back and perhaps the feet.
• Partial bath (abbreviated bath). Only the parts of the client’s body that might cause
discomfort or odor, if neglected, are washed: the face, hands, axillae, perineal area, and
back. Omitted are the arms, chest, abdomen, legs, and feet. The nurse provides this care
for dependent clients and assists self-sufficient clients confined to bed by washing their
backs. Some ambulatory clients prefer to take a partial bath at the sink. The nurse can
assist them by washing their backs.
• Bag bath. This bath is a commercially prepared product that contains 10 to 12
presoaked disposable washcloths that contain norinse cleanser solution. The package is
warmed in a microwave. The warming time is about 1 minute, but the nurse needs to
determine how long it takes to attain a desirable temperature. Each area of the body is
cleaned with a different cloth and then air dried. Because the body is not rubbed dry, the
emollient in the solution remains on the skin.
• Towel bath. This bath is similar to a bag bath but uses regular towels. It is useful for
clients who are bedridden and clients with dementia. The client is covered and kept warm
throughout the bathing process by a bath blanket. The nurse gradually replaces the bath
blanket with a large towel that has been soaked with warm water and no-rinse soap. The
PLM-CN: NRS 1204 – Basic Concept in Nursing – SKILLS Laboratory Checklist on Hygiene: Bed Bath
 client is then gently massaged with the warm, wet, soapy towel. The wet towel is replaced
with a large dry towel for drying the client’s skin.
• Tub bath. Tub baths are often preferred to bed baths because it is easier to wash and
rinse in a tub. Tubs are also used for therapeutic baths. The amount of assistance the
nurse offers depends on the abilities of the client. There are specially designed tubs for
dependent clients. These tubs greatly reduce the work of the nurse in lifting clients in and
out of the tub and offer greater benefits than a sponge bath in bed. Sponge baths are
suggested for the newborn because daily tub baths are not considered necessary. After
the bath, the infant should be immediately dried and wrapped to prevent heat loss.
Parents need to be advised that the infant’s ability to regulate body temperature has not
yet fully developed. Infants perspire minimally, and shivering starts at a lower
temperature than it does in adults; therefore, infants lose more heat before shivering
begins. In addition, because the infant’s body surface area is very large in relation to body
mass, the body loses heat readily.
o Shower. Many ambulatory clients are able to use shower facilities and require only
minimal assistance from the nurse. Clients in long-term care settings are often
given showers with the aid of a shower chair. The wheels on the shower chair
allow clients to be transported from their room to the shower. The shower chair
also has a commode seat to facilitate cleansing of the client’s perineal area during
the shower process. The water for a bath should feel comfortably warm to the
client. People vary in their sensitivity to heat; generally, the temperature should
be 43°C to 46°C (110°F to 115°F). Most clients will verify a suitable temperature.
Clients with decreased circulation or cognitive problems, however, will not be able
to verify the temperature. Therefore, the nurse must check the water temperature
to avoid burning the client with water that is too hot. The water for a bed bath
should be changed when it becomes dirty or cold.

 Therapeutic baths are given for physical effects, combines water and additives to soothe
and relax the client or to soothe irritated skin or to treat an area (e.g., the perineum). It is
given to clean the skin to relieve inflammation and pruritus, and soften and remove
crusts, scales, debris, and old drugs. A balneotherapy bath, used primarily for antipruritic
and emollient actions, aslo constricts surface blood vessels and has an inflammatory
effect. Oatmeal powder, soluble constarch, or soybean complex may be added to create a
colloid bath, which has a soothing effect on generalized itching. Oil baths are useful for
lubricating dry skin and easing eczematous eruptions. Sodium bicarbonate produces an
alkaline bath that a cooling effect and helps relieve pruritus. A medicated tar bath may be
used to treat psoriasis. The film of tar left on the skin works in combination with
ultraviolet light to inhibit the rapid cell turnover characteristic of psoriasis. A bedridden
client may benefit from a local soak with the therapeutic additive instead of a therapeutic
tub bath. Medications may be placed in the water. A therapeutic bath is generally taken in
a tub one third or one half full. The client remains in the bath for a designated time, often
20 to 30 minutes. If the client’s back, chest, and arms are to be treated, these areas need
to be immersed in the solution. The bath temperature is generally included in the order;
37.7°C to 46°C (100°F to 115°F) may be ordered for adults and 40.5°C (105°F) is usually
ordered for infants. Skill 33–1 provides guidelines for bathing clients.
BATHING AN ADULT CLIENT
PLM-CN: NRS 1204 – Basic Concept in Nursing – SKILLS Laboratory Checklist on Hygiene: Bed Bath
PURPOSES
 To remove transient microorganisms, body secretions and excretions, and dead skin cells
 To stimulate circulation to the skin and aid in elimination
 To promote a sense of well-being
 To refresh and cleanse client
 To produce relaxation and comfort
 To prevent and eliminate unpleasant body odors
 To prevent pain and congestion

General Considerations
 Avoid unnecessary exposure and chilling. Only the area to be washed should be exposed.
Dry immediately
 During the bath, observe patient for physical signs as rashes, swellings, discolaration,
pressure sores, abnormal discharges and burns
 Special attention must be given to the regions behind the ears, axillae, under the breast,
umbilicus, pubic region, groin and spaces between the fingers and toes
 The bath should be done quickly in a quiet, soothing manner and using even, smooth and
firm but gentle strokes. Long smooth strokes on the arm and legs that are directed from
the distal to the proximal increase the rate of the venous flow
 If possible treatments such as enema and vaginal douche should be given before the bath
 Change water after washing arms, after washing back, after washing leg and feet, before
proceeding to genitalia or as condition permits
 Do not use soap for washing the eyes
 Wash patient’s/client’s back with patient/client lying on his/her abdomen if possible
 Wash, rinse and dry well the creases and massage bony prominences. Moving the body
joints through their full range of motion helps to prevent loss of muscle tone and improve
circulation
 Offer bedpan after bath
 The patient may participate within the limits of his/her physical condition and if the
situation/condition permits
 Change linens after bath
 Give back rub using lotion or cream after bath if not conta-indicated and if the
patient/clients agrees to it
 Give perineal care after bath to elderly patients, post-partum, bedridden and patients
with catheter
 Give “abbreviated bath” for patient/client who refuses bath or to those who do not
require bath. Abbreviated hygiene – includes washing patient’s hands, back, axilla,
perineal are and provide oral hygiene and massage body prominences
ASSESSMENT
Assess
 Condition of the skin (color, texture and turgor, presence of pigmented spots,
temperature, lesions, excoriations, abrasions, and bruises). Areas of erythema (redness)
on the sacrum, bony prominences, and heels should be assessed for possible pressure
sores
 Physical or emotional factors (e.g., fatigue, sensitivity to cold, need for control, anxiety or
PLM-CN: NRS 1204 – Basic Concept in Nursing – SKILLS Laboratory Checklist on Hygiene: Bed Bath
 fear)
 Presence of pain and need for adjunctive measures (e.g., an analgesic) before the bath
 Range of motion of the joints
 Any other aspect of health that may affect the client’s bathing process (e.g., mobility,
strength, cognition)
 Need for use of clean gloves during the bath

PLANNING
DELEGATION
The nurse often delegates the skill of bathing to UAP. However, the nurse remains responsible for
assessment and client care. The nurse needs to do the following:
 Inform the UAP of the type of bath appropriate for the client and precautions, if any,
specific to the needs of the client.
 Remind the UAP to notify the nurse of any concerns or changes (e.g., redness, skin
breakdown, rash) so the nurse can assess, intervene if needed, and document.
 Instruct the UAP to encourage the client to perform as much self-care as appropriate in
order to promote independence and self-esteem.
 Obtain a complete report about the bathing experience from the UAP.
IMPLEMENTATION
Preparation
Before bathing a client, determine (a) the purpose and type of bath the client needs; (b) self-care
ability of the client; (c) any movement or positioning precautions specific to the client; (d) other
care the client may be receiving, such as physical therapy or x-rays, in order to coordinate all
aspects of health care and prevent unnecessary fatigue; (e) client’s comfort level with being
bathed by someone else; and (f) necessary bath equipment and linens.
 Caution is needed when bathing clients who are receiving IV therapy. Easy-to-remove
gowns that have Velcro or snap fasteners along the sleeves may be used. If a special gown
is not available, the nurse needs to pay special attention when changing the client’s gown
after the bath (or whenever the gown becomes soiled).
 In addition, special attention is needed to reassess the IV site for security of IV
connections and appropriate taping around the IV site.
 The nurse should use universal precautions when bathing a client, particularly when
performing perineal care.
 It is not necessary, however, to wear gloves while providing a bath and the nurse should
use clinical judgment when deciding to wear gloves and offer an explanation to the client.

Variation: Bathing Using a Hydraulic Bathtub Chair

A hydraulic lift, often used in long-term care or rehabilitation settings, can facilitate the
transfer of a client who is unable to ambulate to a tub.
The lift also helps eliminate strain on the nurse’s back.
• Bring the client to the tub room in a wheelchair or shower chair.
• Fill the tub and check the water temperature with a bath thermometer. Rationale: This
avoids thermal injury to the client.
• Lower the hydraulic chair lift to its lowest point, outside the tub.
• Transfer the client to the chair lift and secure the seat belt.
• Raise the chair lift above the tub.
PLM-CN: NRS 1204 – Basic Concept in Nursing – SKILLS Laboratory Checklist on Hygiene: Bed Bath
 • Support the client’s legs as the chair is moved over the tub. Rationale: This avoids injury to
the legs.
• Position the client’s legs down into the water and slowly lower the chair lift into the tub.
• Assist in bathing the client, if appropriate.
• Reverse the procedure when taking the client out of the tub.
• Dry the client and transport him or her to the room.
EVALUATION • Note the client’s tolerance of the procedure (e.g., respiratory rate and effort,
pulse rate, behaviors of acceptance or resistance, statements regarding comfort). • Conduct
appropriate follow-up, such as determining: • Condition and integrity of skin (dryness, turgor,
redness, lesions, and so on). • Client strength. Note range of motion and circulation, movement,
and sensation for all extremities. • Percentage of bath done without assistance. • Relate to prior
assessment data, if available.
Lifespan Considerations
INFANTS • Sponge baths are suggested for the newborn because daily tub baths are not
considered necessary. After the bath, the infant should be immediately dried and wrapped.
Parents need to be advised that the infant’s ability to regulate body temperature has not yet fully
developed and newborns’ bodies lose heat readily.

CHILDREN • Encourage a child’s participation as appropriate for developmental level. • Closely

supervise children in the bathtub. Do not leave them unattended.

ADOLESCENTS • Assist adolescents as needed to choose deodorants and antiperspirants.

Secretions from newly active sweat glands react with bacteria on the skin, causing a pungent
odor.

OLDER ADULTS • Changes of aging can decrease the protective function of the skin in older
adults. These changes include fragile skin, less oil and moisture, and a decrease in elasticity. • To
minimize skin dryness in older adults, avoid excessive use of soap. The ideal time to moisturize
the skin is immediately after bathing. • Avoid excessive powder because it causes moisture loss
and is a hazardous inhalant. Cornstarch should also be avoided because in the presence of
moisture it breaks down into glucose and can facilitate the growth of organisms. • Protect older
adults and children from injury related to hot water burns.
General Guidelines for Bathing People with Dementia
Focus on the person rather than the task.
• Cover! Keep the person covered as much as possible to keep warm.
• Time the bath to fit the person’s history, preferences, and mood.
• Move slowly and let the person know when you are going to move them. Or, ask the client to
move his or her own arm or leg.
• Evaluate to determine if the person needs pain control before the bath.
• Use a gentle touch. Use soft cloths. Pat dry rather than rubbing.
• Be flexible. Adapt your approach to meet the needs of the person.
• Consider adapting your methods (e.g., distracting the person with singing while bathing), the
environment (e.g., correct size of shower chair, reducing noise, playing music), or the procedure
(e.g., consistently assigning the same caregiver, inviting family to help).
• Encourage flexibility in scheduling of bath based on the individual’s preference.
• Use persuasion, not coercion.
PLM-CN: NRS 1204 – Basic Concept in Nursing – SKILLS Laboratory Checklist on Hygiene: Bed Bath
• Give choices and respond to individual requests.
• Help the person feel in control.
• Use a supportive, calm approach and praise the person often.
• Be prepared.
• Gather everything that you will need for the bath (e.g., towels, washcloths, clothes) before
approaching the person.
• Stop when a person becomes distressed. It is not normal to have cries, screams, or protests
from the person.
• Stop what you are doing and assess for causes of the distress.
• Adjust your approach.
• Shorten or stop the bath.
• Try to end on a positive note.
• Reapproach later to wash critical areas if necessary.
• Ask for help.
• Talk with others, including the family, about different ways to help make the bath more
comfortable for the person.
From “Dementia-Friendly Bathing,” by S. Hoban, 2012, Long-Term Living, 61(10), pp. 41–42;
“Practical Care: Creative Strategies for Bathing,” by R. H. Johnson, 2011, Nursing & Residential
Care, 13(8), pp. 392–394; and “Nursing Home Bathing Transformed,” by E. F. Barbera, 2011,
Long-Term Living, 60(10), pp. 41–43.

Prepared by:
PROF. MANUELA P. TIRAZONA
PROF. ANIELYNE G. PENETRANTE
PROF. EDNA P. LOR
Updated and Modified by: Dr. Jennifer P. Reyes , 2nd Semester 2020 - 2021

PLM-CN: NRS 1204 – Basic Concept in Nursing – SKILLS Laboratory Checklist on Hygiene: Bed Bath