Our Lady of Lourdes College Foundation Learning Module

College of Nursing and Midwifery Clinical Practice 100

Instructor: Raquel B. Torres

Module 7 : Bed Bath

LEARNING OUTCOMES
At the end of this module, you will be able to:
1. Describe hygienic care that nurses provide the 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 problem related to hygienic care of the skin, feet, nails,
mouth, hair, eyes, ears, and nose.
5. Identify the purpose of bathing
6. Describe various types of baths.
7. Explain specific ways in which nurse help hospitalized clients with hygiene.
8. Describe steps for identified hygienic-care procedures.
9. Identify steps in removing contact lenses and inserting and removing artificial eyes.
10. Describe steps for removing, cleaning, and inserting hearing aids.
11. Identify safety and comfort measures underlying bed-making procedures.

LEARNING EXPERIENCES AND SELF ASSESSMENT ACTIVITY

Bathing- removes accumulated oil, perspirations, dead skin cells, and some bacteria.
Two categories of baths are given to clients;
 Cleaning Baths
 Therapeutic Baths
Cleaning 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
 Axilla
 Perineal area
 Back
Omitted are;
 Arms
 Chest
 Abdomen
 Legs
 Feet
The nurse provides this care for dependent clients and assists self-sufficient clients confined to bed by
washing their back. 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 pre-soaked disposable washcloths
that contain no –rinse 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.

 Tub bath= tub baths are often preferred to bed baths because it is easier to wash
and rinse a tub. Tubs are also used for therapeutic baths.

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 Our Lady of Lourdes College Foundation Learning Module
College of Nursing and Midwifery Clinical Practice 100
Instructor: Raquel B. Torres

Module 7 : Bed Bath

 Shower= many ambulatory clients are able to use shower facilities and
require only minimal assistance from the nurse Clients in long- term care
setting are often gives shower chair.

Therapeutic Baths are given for physical effects, such as to irritated skin or treat an
area (e.g., the perineum). Medication 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 a 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

Home Care Assessment

Client and environment
 Self-care abilities for hygiene: assess the client’s ability to bathe, to regulate water faucets, to dress
and undress, to groom, and to us the toilet.
 Self –care aids required: determine if there is a need for a tub/shower seat, a hand shower, a non-skid
surface of mat in the tub or shower, hand bars, on the both sides of the tub, or raise toilet seat.
 Facilities: check for the present of laundry facilities and running water.
 Mechanical barriers: note furniture obstructing access to the bath room and toilet, or doorway too
narrow for wheelchair.
Family
 Care giver ability, skills, and responses: Determine whether individuals are available and able to
assist with bathing, dressing, toileting, nail care, hair shampoo, or shopping for hygienic or grooming
aids.
 Education needs; assess whether the care giver needs instruction in how to assist the client in and out
of the tub, on and off the toilet, and so on
 Family roles changes and copping: assess the effects of client’s illness on financial status, parenting,
spousal roles, sexually, and social roles.
Community
 Explore sources that will provide assistance with bathing , laundry, and foot care ( home health aid,
podiatrist )
 Consult a social worker as needed to coordinate placement of a client unable to remain in the home or
identify community resources that will help the client stay in home.
 Consider a consult with a physical therapist to assess, develop, and improve the client’s motor
function ;( b.) a home health nurse to provide follow up care , teaching, and support; and (c) an
occupational therapist to assess and develop abilities to perform ADL.

General Guidelines for skin Care

1. An intact, healthy skin is the body’s first line of defense.
2. The degree to which the skin protects the underlying tissues from injury depends on the amount
of subcutaneous tissue and the dryness of the skin.
3. Moisture in contact with the skin can result an increased bacterial growth and irritation.
4. Body odors are caused by resident skin bacteria acting on the body secretion. Cleanliness is the
best deodorant.
5. Skin sensitivity to irritation and injuries varies among individuals and in accordance with their
health.
6. Agents used for skin care have selective actions and purposes. E.g. soap, detergent, bath oil,
cream, lotion, powder, deodorant and antiperspirant.
Methods of Bathing
• Complete bed bath
• Self- help bed bath
• Partial bath
• Bag bath
• Tub bath
• Shower

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 Our Lady of Lourdes College Foundation Learning Module
College of Nursing and Midwifery Clinical Practice 100
Instructor: Raquel B. Torres

Module 7 : Bed Bath

BED BATH
Purposes of bed bath
• To remove microorganism, body secretions and excretions of dead skin cell.
• To improve circulations
• To promote relaxation
• To prevent or eliminate body-odors and promote self-esteem.
• To promote sense of well –being
• To assess the client’s skin and body parts
• To promote activity and exercise

Nursing Intervention During Bed Bath

• Inform the client and explain purposes of the procedure.
• Provide privacy by closing curtains around bed or shut room door. This is to maintain client’s
dignity.
• Close windows and doors to prevent drafts
• Turn –off electric fan or air conditioning unit to prevent chills.
• Encourage to void before start the procedure, To ensure comfort.
• Place the bed in flat position, if admissible To facilitate movement and change of position.
• Move the client to one side of the bed. To prevent over reaching and prevent muscle strain.
• Remove the patient’s gown. Cover up to shoulder level with the top sheet or bath blanket. To
provide comfort, warmth and privacy
• Use warm water (110-115 )
• Make bath mitt with the washcloth. To retain heat and water better than a loosely held washcloth
and prevent water from dripping on client.

Making a bath mitt, rectangular method

Implementation
Preparation:
Before bathing a client, determine:
a. The purpose and type of bath the client needs
b. Self-care ability of a client
c. Any movement or poisoning precautions specific to the client
d. Other care the client may be receiving such as physical or x rays, in order to coordinate all aspect of
health care and prevent un necessary fatigue;
e. The client’s comfort level with being bathed by someone else
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 fastener along the sleeves may be used. If a special gown is not available, the nurse pays especial
attention when changing the client’s gown after bath (or whenever the gown becomes soiled).

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 Our Lady of Lourdes College Foundation Learning Module
College of Nursing and Midwifery Clinical Practice 100
Instructor: Raquel B. Torres

Module 7 : Bed Bath

Performance
1. Prior performing the procedure, introduce self and verify the client’s identity using agency protocol.
Explain to the client what you are going to do, why it is necessary, and how he/she can cooperate.
Discuss with the client the plan for bathing and explain any unfamiliar procedure to the client.
2. Perform hand hygiene and observe appropriate infection control procedures.
3. Provide for client privacy by drawing the curtains around the bed or closing the door to the room.
Some agencies provide signs indicating the need for privacy. Rationale; hygiene is a personal matter
4. Prepare the client and environment
 Invite family member or significant other to participate if desire.
 Close windows and doors to ensure the room is a comfortable temperature .Rationale: air currents
increase loos of heat from the body by convention
 Offer the client a bedpan or urinal, or ask whether the client wishes to use the toilet or commode.
Rationale: warm water and activity can stimulate the need to void .The client will be more
comfortable after voiding, and voiding before cleaning the perineum is advisable. Self-care as possible
 Encourage the client to perform as much personal Rationale: This promotes independence, exercise,
and self-esteem.
 During the bath , assess each area of the skin carefully
For A Bed Bath
5. Prepare the bed and position the client appropriately
 Position the bed at comfortable working height. Lower the side rail on the side close to you. Keep the
other side rail up. Assist the client move near you. Rationale: this avoids undue reaching and
straining and promotes good body mechanics.
 Place a bath blanket over the top sheet. Remove the top sheet from under the bath blanket by starting
at the client’s shoulder and moving linen down toward the client’s feet. 1. Ask the client to grasp and
hold the top of the bath blanket while pulling linen to the foot of the bed. Rationale: The bath blanket
provides comfort, warmth, and privacy. Note: if the bed linen is to be reused, place it over the bed side
chair. If it is to be changed, place it in a linen hamper, not on the floor.
 Remove client’s gown while keeping the client covered with the bath blanket. Place gown in linen
hamper.
6. Make a bath mitt with the wash cloth. Rationale: A bath mitt retains water and heat better than a cloth
loosely held and prevents end of wash cloth from dragging across the skin. See 2. For triangular and 3.
for rectangular method.
7. Wash the face. Rationale: begin the bath at the cleanest area and work down toward the feet.
 Place towel under client’s head
 Wash the client’s eyes with water only and dry them well. Use a separate corner of the wash cloth for
each eye. Rationale: Using separates corner prevents transmitting microorganism from one eye to the
other. Wipe from the inner to the outer canthus. 4. Rationale: This prevents secretion s from entering
the nasolacrimal ducts.
 Ask whether the client wants soap used on the face. Rationale: Soap has a drying effect, and the face,
which is exposed to the air more than other body parts, tends to be drier.
 Wash, rinse, and dry the client’s face, ears and neck.
 Remove the towel from under the client’s head
8. Wash the arms and hands. (Omit the arms for a partial bath.)
 Place a towel lengthwise under the arm way from you. Rationale: It protects the bed from becoming
wet.
 Wash, rinse, and dry the arm by elevating the client’s arm and supporting the client’s wrist and elbow.
5. Use long firm strokes from wrist to shoulder, including the axilla area. Rationale: Firm strokes
from distal to proximal areas promotes circulation by increasing venous return.
 Apply deodorant or power if desired.
 (Optional) place a towel on a bed and put wash basin on it. Place the client’s hands in the basin and
washing themselves. Rationale: Many client enjoy immersing their hands in the basin washing
themselves. Soaking loosen dirt under the nails Assist the client as needed to wash, rinse and dry the
hands, paying particular attention to the spaces between fingers
 Repeat hand and arms nearest you. Exercise if an intravenous infusion is present, and check its flow
after moving the arm.

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 Our Lady of Lourdes College Foundation Learning Module
College of Nursing and Midwifery Clinical Practice 100
Instructor: Raquel B. Torres

Module 7 : Bed Bath

9. Wash the chest and abdomen (omit the chest and abdomen for partial bath. However, the areas under
the women’s breast may require bathing if this area is irritated or if the client has significant
perspiration under the breast.)
 Place the bath towel lengthwise over the chest .Fold the bath blanket down to the client’s pubic area.
Rationale: This keep the client warm by preventing unnecessary exposure of the chest.
 Lift the bath towel off the chest, and bath the chest and abdomen with your mitted hand using long,
firm strokes.6. Give especial attention to the skin under the breast and any other skin folds particularly
if the client is overweight. Rinse and dry well.
 Replace the bath blanket when the areas have been dried.
10. Wash the legs and feet. (omit legs and feet for a partial bath)
 Expose the legs farthest from you by folding the bath blanket toward the other leg being careful to
keep the perineum covered. Rationale: Covering the perineum promotes the privacy and maintains the
client’s dignity.
 Lift leg and place the bath towel lengthwise under the leg. Wash, rinse, and dry using long, smooth,
firm strokes from the ankle to the knee to the thigh.7. Rationale: Washing from the distal to proximal
areas promotes circulation by stimulating venous blood flow.
 Revers the covering and repeat for the other leg.
 Wash the feet by placing them in the basin of water.8.
 Dry each foot. Pay particular attention to the spaces between the toes. If preferred, wash one foot after
the leg before washing the other leg.
 Obtain fresh, warn bath water now or when necessary. Rationale: Water may become dirty or
cold .Because surface skin cells are removed with washing, the bath water from dark-skinned clients
may be dark, and however, this does not mean the client is dirty. Lower the bed refilling the basin.
Rationale: This ensures the safety of the client.
11. Wash the back and then the perineum
 Assist the client into prone or side lying position facing away from you .Place the bath towel
lengthwise alongside the back and buttocks while keeping the client covered with the bath blankest as
much as possible . Rationale: This provides warmth and prevent undue exposure.
 Wash and dry the client’s back, moving from the shoulders to the buttocks, and upper thighs, paying
attention to the gluteal folds. 9.
 Perform a back massage now or after completion of bath.
 Assist the client to the supine position and determine whether the client can as the perineal area
independently .If the client cannot do so, drape the client.
12. Assist the client with grooming aids such as powder, lotion, or deodorant.
 Use powder sparingly .Release as little as possible into the atmosphere. Rationale: This will avoid
irritation of the respiratory tract by powder inhalation .Excessive powder can cause caking , which
lead s to skin irritation
 Help the client put on a gown or pajamas
 Assist client to care for hair, mouth, and nails. Some people prefer or need mouth care to their bath.
For a tub bath or shower
13. Prepare the client and the tub
 Fill the tub about one-third to one-half full after at 43 - 46 degrees centigrade Rationale: Sufficient
water is needed to cover the perineal area.
 Cover all I.V catheter or wound dressings with plastic coverings, and instruct the client to prevent
wetting these areas if possible.
 Put rubber bath mat or towel on the floor of the tub if safety trips are not on the tub floor. These
prevent slippage of the client during the bath or shower.
14. Assist the client into the shower or tub
 Assist the client taking a standing shower with the initial adjustment of water temperature and water
flow pressure, as needed. Some clients need a chair to sit on in the shower because of weakness. Hot
water can cause elderly people to feel paint.
 If the client requires considerable assistance with a tub bath, a hydraulic bath tub chair may be may be
required.
 Explain how the client can signal for help, leave the client for 2-5 minutes, and place an “occupied”
sign on the door.

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 Our Lady of Lourdes College Foundation Learning Module
College of Nursing and Midwifery Clinical Practice 100
Instructor: Raquel B. Torres

Module 7 : Bed Bath

 For safety reasons, do not leave a client with decreased cognition or clients who may be at risk ( hx of
seizures, syncope.)
15. Assist the client with washing and getting out of the tub.
 Wash the client’s back, lower legs, and feet, if necessary.
 Assist the client out of the tub. If the client is unsteady , place a bath towel over the client’s shoulder
and drain the tub of water before the clients attempt to get out of it . Rationale: Draining the water
first lessen the likelihood of a fall. The towel prevent chilling.
16. Dry the client, and assist with follow –up care.
 Follow step 12
 Assist the client back to his or her bed.
 Clean the tub or shower in accordance with agency practice, discard the use linen in the laundry
hamper, and place the “ unoccupied” sign on the door
17. Document
 Type of bath give ( complete, partial, or self-help) This is usually recorded on a flow sheet
 Skin assessment, such as excoriation, erythema, exudates, rashes, drainage, or skin breakdown.
 Nursing interventions related to the skin integrity
 Ability of the client to assist or cooperate with bathing
 Client response to bathing
 Educational needs regarding hygiene
 Information or teaching shared with the client or the family

1. Wash body as follows:

a. Eyes, face, ears , nose
b. Farther arm
c. Nearer arm
d. Hands
e. Chest and abdomen
f. Farther leg
g. Nearer leg
h. Feet
i. Back and buttocks
j. Perineum ( finishing the bath )

 Exposure, wash and dry one body at a time. To promote privacy and chills.
 Rinse off soap thoroughly. To prevent skin irritation.
 May apply cream, lotion or powder on the skin.
 Change gown. Do bed making.
 Do after-care of equipment and articles
 Document relevant data
Special Nursing Considerations When Bathing a Client in a Bed

1. Cleanse eyes with water only, wiping from inner to outer canthus. Use separate corner of mitt for each
eye.
Rationale: Washing eye from inner to outer cantus prevents secretions from entering and irritating
nasolacrimal ducts. Using separate corner for each eye prevents transfer of microorganism from one eye
to another.
2. Determine if client would like to use soap on face. Consider individual preferences.
Rationale: Soap can be drying especially to the face. Some clients use especial cleansing solution for their
faces.
3. Wash, rinse and dry the arms and legs using long stroke from distal to proximal.
Rationale: Stroking from distal to proximal areas stimulates venous blood return.
4. Assess bath water temperature and change water as necessary.
Rationale: To ensure warm temperature of water for comfort. Changing water as necessary ensure

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 Our Lady of Lourdes College Foundation Learning Module
College of Nursing and Midwifery Clinical Practice 100
Instructor: Raquel B. Torres

Module 7 : Bed Bath

cleanliness of the water used for bathing the client.

Perineal – Genital Care

Purposes of Perineal-Genital Care

 To remove normal perineal secretions and odor
 To prevent infection
 To promote comfort

Nursing Intervention During Perineal-Genital Care

 Inform the client and explain purpose of the procedure
 Provide privacy. To maintain client’s dignity
 Position and drape the clients as follows:
 Female: dorsal recumbent position. Drape the client diagonally
 Male : supine position
 For female clients , use forceps to hold balls for cleaning the perineum.
 For male clients, wear clean gloves .
 For female clients
 Use anterior to posterior ( front to back) stroke to prevent contamination of urethral meatus and
vagina with microorganisms from the anus.
 Use cotton balls for each stroke
 Cleanse perineum with soap/antiseptic solution. Include the inner thigh.
 Rinse the area with copious amount of water. To remove soap adequately and prevent irritation of
the perineal area.
 Dry perineum thoroughly. Moisture supports microbial growth
 For male clients
 Wash and dry penis using firm strokes, to prevent erection of the penis.
 Use circular motion, from the tip of glans penis toward the penile shaft.
 If the client is uncircumcised, retract the prepuce (foreskin). This is to remove smegma that
collects under the foreskin and facilitates bacterial growth.
 Wash and dry the scrotum and buttocks.
 For delivery or menstruating females, apply a perineal pad as needed from front to back, this
prevents contamination of urethra and vagina from anal area.
 Keep the client comfortable
 Do the after - care of equipment and articles
 Document relevant data

Total:

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 Our Lady of Lourdes College Foundation Learning Module
College of Nursing and Midwifery Clinical Practice 100
Instructor: Raquel B. Torres

Module 7 : Bed Bath

RUBRIC
5 POINTS - The answer is complete, correct and very clear.
4 POINTS - The answer is complete, clear but with minimal error in the concept.
3 POINTS - The answer is incomplete, correct and clear.
2 POINTS - The answer is incomplete and partially correct.
1 POINT - The answer is incomplete and incorrect.

MODULE EVALUATION

Circle the number corresponding to your rating for each indicator. Please refer to the following rating scale.

4 - Strongly Agree 3- Agree 2 - Disagree 1 - Strongly Disagree

Indicators Rating
1. Provides a brief yet compelling overview of the topic. 4 3 2 1
2. States learning outcomes following the SMART principles. 4 3 2 1
3. Discusses contents logically and clearly. 4 3 2 1
4. Presents contents in an engaging manner through effective use 4 3 2 1
of narration, examples or illustrations.
5. Provides opportunities for self-checking of understanding. 4 3 2 1
6. Provides a summary of the key concepts of the lesson. 4 3 2 1
7. States specific instructions all throughout the module. 4 3 2 1
8. Conducts assessment that are well-aligned to the learning 4 3 2 1
outcomes.
9. Develops independent learning and higher order thinking skills 4 3 2 1
of the learner.
10. Indicates necessary citations and references. 4 3 2 1

REFERENCES

Carter, Pamela J. (2007), Lippincott’s Essential for Nursing Assistants

Perry and Potter Clinical Nursing Skills and PracticeCarter, Pamela J. (2007), Lippincott’s Essential for
Nursing Assistants; A humanistic Approach to Care giving, Lippincott Williams and Wilkins Kozier,
Barbara et. Al. (2004) Fundamental of Nursing, Concept, Process and Practice, Vol. 1-2 7 th Edition.
Pearson Educational Inc

Hark reader, Helen. [Link] (2005) Fundamentals of Nursing, Caring and Clinical Judgment, 2 nd
Edition,An Imprint of Elsevier Inc.

Udan, Josie Q. (2004) Mastering Fundamentals of Nursing, Concept and Clinical Application 2 nd
Edition, Educ. Publishing House

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