Course

The provision of personal care is a deeply important part of the nurse aide's role as an allied healthcare worker. Personal care is the term used to describe the variety of direct care tasks that are done to maintain a patient's personal hygiene, cleanliness and appearance. Although this list is not all-inclusive, the tasks that fall into the realm of personal care include the following (Helping Hands, 2020):

• Bathing and showering
• Skin care, including application of lotions and creams
• Dressing and preparation for bed
• Oral hygiene, also known as mouth care
• Hair care
• Shaving assistance
• Foot care
• Toileting
• Perineal care and cleansing intimate areas
• Positioning in bed for mobility and bedsore prevention
• Changing or maintaining an ostomy or catheter bag

In addition, personal care is a significant contributor to physical and mental well-being since most patients feel invigorated after a shower or changing positions in bed. Furthermore, personal care routines enable the nurse aide to have the opportunity to form therapeutic bonds with patients that benefit both parties in a truly meaningful manner. During the provision of personal care tasks, the nurse aide also has the golden opportunity to closely inspect patients' bodies and observe for any noteworthy changes in condition. 

The responsibility for providing opportunities to accomplish personal care usually falls upon the members of the nursing department at most facilities such as hospitals and nursing homes. Generally, nurse aides are the members of the healthcare team that tend to deliver the vast majority of personal care due to the massive amounts of time they spend with patients. Always remember that the 'N' in nurse aide stands for 'nurse'! Therefore, the nurse aide is an integral part of the nursing department at most healthcare organizations. 

Patients' personal care routines and hygienic practices are often influenced by factors such as age and culture. For instance, a 95-year-old man who lived in abject poverty during the Great Depression era in the Midwestern United States might prefer to take only two baths per week because he was raised in a household that had no running water. Likewise, a patient may come from a culture that considers it acceptable to not wear deodorant. Even though most cultures value personal hygiene, it means differing "things throughout the world" (Montoya, 2017).

Nurse aides are often called upon to perform hair care for clients, especially in settings such as home health, assisted living or skilled nursing facilities. Hair care, also known as hair grooming, is the sum of activities that are done to maintain the cleanliness, condition and appearance of the hair on one's head. Hair care tasks can include shampooing, applying conditioner, rinsing, drying the hair with a blow dryer, combing, brushing, braiding and styling as requested. 

Meticulous hair care is an important part of personal care because it serves a multitude of functions. Hair care promotes cleanliness, rids the scalp of excess skin cells, distributes natural oils throughout the length of the hair, and prevents tangling and matting. A patient who has not had hair care in many months will frequently exhibit unhygienic features such as residue, buildup of oil and skin cells, matted hair, and offensive odors of the hair and scalp. Thus, hair care is an essential aspect of personal hygiene.  

No standardized guidelines exist for the provision of hair care by nurse aides; therefore, be sure to incorporate the patient's preferences when grooming this part of the body. In general, a patient's hair should be combed at least once per day and as needed to prevent severe tangling. Additionally, other hair care might be needed in order to boost morale, stimulate circulation within the scalp, and prevent matted hair (Brookside Associates, 2015).

Hair care routines differ greatly based on culture, hair type, the patient's age and socioeconomic status. As individuals age, the hair often becomes thinner over time. Due to reduced sebum (oil) gland production, many elderly patients will have drier hair that does not need to be washed on a daily basis. Some patients arrange for all their hair care to be done by a visiting hairstylist, whereas others are totally dependent on the nurse aide and/or family members to groom their hair.  

Nurse aides perform oral care regularly. Oral care is known by a series of other names such as mouth care, dental care and oral hygiene. In general, oral care should be done prior to "breakfast, after each meal and at bedtime" (Brookside Associates, 2015). It is the cleansing of the oral cavity in order to reduce the pathogenic germ count, rid the mouth of bad breath, and minimize the likelihood of infections. Different types of oral care exist including brushing the patient's natural teeth, denture care, and performing mouth care on unconscious patients.

If a patient that receives care in a hospital, nursing home, assisted living facility or home health setting is unable to brush his own teeth, the nurse aide must assist with performing oral care while being mindful of safety measures. The nurse aide must maintain the patient in a high Fowler's (upright seated) position to minimize the risk of aspirating fluids and toothpaste into the lungs. After, the nurse aide should drape a small towel over the patient's chest to ensure his clothing does not get wet. Then, the nurse aide should apply gloves. The next step is to "apply toothpaste to the wet toothbrush" (Michaels, 2014).

1. Ask the patient to open the mouth and start brushing. 
2. Using a circular motion, gently scrub the teeth, tongue and gums.
3. Allow the patient to to rinse the mouth. 
4. As the patient rinses, hold an emesis basin to the chin.
5. Verify no blood comes out when the patient spits.
6. Dry the patient's mouth with the towel that was used to drape.

Denture care is another personal care task that nurse aides routinely complete. Since dentures are capable of accumulating massive amounts of pathogenic germs if left uncleaned, these expensive prosthetic devices must receive care regularly in order to maintain cleanliness and prevent infection. Dentures should be brushed over a lined sink just in case they drop. It is theorized that it is better for dentures to drop on a liner than onto a bare floor where they may crack, break or become cross-contaminated. Dentures must never be brushed or soaked in hot water since this warps them.

Nurse aides might need to perform oral care on unconscious patients. Unconsciousness is when a patient "is unable to respond to people and activities" (MedlinePlus, 2020). The nurse aide should place a towel or linen protector under the unconscious patient's head to keep the pillows and and linens from getting wet. A toothbrush with soft bristles or "gauze-padded tongue blade may be used to clean the teeth and mouth; the patient should be positioned in the lateral position with the head turned toward the side to provide for drainage and to prevent aspiration" (Brookside Associates, 2015). A minimal amount of water should be used when providing oral care to unconscious patients.

The shaving of facial hair is a personal care routine that many men prefer to continue throughout their adult lives regardless of age or disability. Shaving, the removal of body hair by cutting it extremely close to the skin's surface with a razor, should lead to a well-groomed face that feels smooth if done properly. The nurse aide frequently assists male patients with shaving due to reasons such as weakness, tremors and/or disability.

Several factors related to safety must be taken into account when preparing to shave patients. Firstly, electric razors should not be utilized in the same room where compressed oxygen tanks are in use due to the risk of explosion. Many hospitals, assisted living facilities and nursing homes provide disposable safety razors that are designed for one-time use. Secondly, the nurse aide should be careful to avoid nicking and/or cutting the patient's skin while shaving. 

Third, the nurse aide should remain mindful that certain disease processes can greatly increase the risk of injury and/or infection while shaving. For instance, some bleeding disorders will cause the patient to bleed longer than usual if he is cut while being shaved. If this happens, apply pressure to the area that is bleeding and notify the patient's nurse. Also, diabetes mellitus leaves patients substantially more susceptible to infections if a cut or nick occurs during routine shaving. Nurse aides can uphold safety while shaving patients' facial hair by following the listed steps below (HCPro, 2006):

• If the patient wears dentures, ensure he has them in his mouth
• Place a towel under the resident's chin and across his chest
• Wear gloves and apply shaving cream if the patient requests it
• Hold the resident's skin taut with one hand 
• Always shave in the direction of the hair growth
• When done shaving, apply aftershave or moisturizing lotion
• Remove the towel from under the resident's chin and across his chest

As a general rule of thumb, facial hair should be softened with lukewarm water or shaving cream at least several minutes prior to commencing the shave because the wetness makes the hair slightly easier to remove. Dry hair is more difficult to shave and leads to a less smooth result. For most skills that involve warm or hot water, the nurse aide should get into the habit of asking the patient to check the temperature of the water prior to starting the care to promote safety and comfort.

Fingernail care is a fundamental part of one's personal hygiene routine for an array of important reasons. Cleanly and short fingernails are absolutely imperative to most patients' overall health and safety. Pathogenic germs that cause foul odors, disease and various types of infection can rapidly aggregate underneath the fingernails without even being visible to the naked eye. Thus, careful hand hygiene and fingernail care are excellent ways to prevent the buildup of germs and fungus. 

Fingernails that grow too long and/or develop jagged edges can scratch and cut the patient's skin, possibly leading to localized infection. Furthermore, fingernails with jagged edges can inadvertently snag clothing, causing permanent damage to delicate fabrics. Hence, the nurse aide is regularly called upon to complete the personal care task of fingernail care. Some facilities do not permit nurse aides to clip fingernails due to liability issues, so this task is dependent upon the policies of the employer.

If a patient that needs fingernail care has a disease process such as diabetes mellitus or peripheral artery disease, he or she will require the professional assistance of a licensed healthcare professional. Patients with diabetes require special fingernail care; therefore, nurse aides "SHOULD NOT cut the nails of diabetic patients or patients with peripheral vascular disease" (Leahy, Fuzy, and Graf, 1999). In these situations, the nurse aide should only file the nails to prevent potential cutting of surrounding skin.

Nail clippers should be utilized during fingernail care. The nurse aide should not use scissors to clip fingernails. To provide fingernail care, follow the steps in the order listed below (Leahy et al, 1999):

1. Fill basin or tub with warm water and wear gloves. 
2. Have the patient test for comfort level. 
3. Soak hands for 5 to 10 minutes to soften and cleanse nails. 
4. Gently clean under nails with orangewood stick. Clip as needed. 
5. Use nail file to shape and smooth rough edges. 
6. Apply lotion after drying the hands and feet. 
7. Note for any redness or problems and report to the nurse.

Bathing refers to the orderly cleansing of one’s body parts from head to toe, usually with soap and warm water. Bathing, which includes tub baths, bed baths and showers, is done for a wide variety of reasons. Individuals bathe to remove sweat, dirt, excess skin cells and disease-causing germs from their bodies. In addition, bathing promotes robust circulatory flow due to the amount of movement involved in the process, as well the warmth of the water leading to widespread blood vessel dilation.

Finally, bathing results in improved self-confidence for the patient. It reduces and/or eliminates offensive body odors, increasing the likelihood that the patient will engage in healthy socialization. Nurse aides frequently deliver bathing assistance to their patients. Providing assistance with bathing can be a somewhat sensitive personal care task for some patients due to the exposure of private areas. Nonetheless, the professionalism displayed by the nurse aide throughout the process can make the situation go very smoothly, resulting in a pleasant experience for all parties. 

Tub baths are not advised for disabled, confused or frail elderly clients due to safety reasons revolving around increased difficulty getting out of the tub. Clients in the home health or personal care group home settings who are not bedridden and possess the ability to safely walk might request a tub bath on occasion. The nurse aide should follow the list of instructions below to administer tub baths (Brookside Associates, 2015):

1. Wear gloves. Assist patient into the bathtub. 
2. Instruct patient on use of the call light, if applicable.
3. Fill bathtub with warm water (109ºF or 43ºC). 
4. Have patient test water; adjust temperature if needed. 
5. Check on patient every 5 minutes. 
6. Do not allow the patient to remain in tub more than 20 minutes.
7. Return to room when patient signals. Knock before entering.
8. Assist patient out of tub and with drying. 

Patients who are bedridden and cannot safely transfer from the bed to a shower chair due to unstable health conditions are often more appropriate for bed baths. Bed baths are prevalent in hospitals and nursing facilities due to the large numbers of very sick patients with poor mobility and limited transferring abilities. The nurse aide should follow the list of instructions below to administer bed baths (Missouri Career Education, n.d.):

1. Apply gloves. Remove patient's gown or pajamas. 
2. Fill bath basin with warm water (115 degrees F). 
3. Check temperature with inner aspect of arm. Ask patient to check water. 
4. Wet washcloth and squeeze out excess water. 
5. Wash eyes first. Start at inner corner and work out. 
6. Use different area of washcloth for each eye. Do not use soap on the face. 
7. Wash, rinse and dry face, ears, nose and mouth.
8. Wash, rinse and dry the rest of the body, leaving the perineal area for last.
   
9. Apply warmed lotion and deodorant as needed.
   
10. Put clean clothing on patient, ensuring to avoid over-exposure.

When assisting a patient with a shower, the nurse aide should start with the cleanest parts of the body such as the face, and end the procedure with the areas that are less clean, such as the genitalia. The nurse aide should preferably start with the face, then progress downward in an orderly manner to the arms, torso, back, legs, feet, groin, genitalia and anal area. This progression starts with the cleanest parts and ends with the least clean areas of the body.

Skin undergoes a series of predictable changes that come with aging, including dryness, thinness and reduced elasticity. Skin that becomes drier, thinner and not terribly elastic tends to be more prone to injuries such as skin tears, abrasions, shearing and pressure ulcers, also known as bedsores. Therefore, the nurse aide plays a huge role in the prevention of these aforementioned problems by providing meticulous skin care as part of the overall personal hygiene routine.

Numerous patients in hospitals and skilled nursing facilities are afflicted with incontinence, defined as the lack of control of the bowel and bladder. Incontinence is known to cause skin problems in the groin and perineal region. Incontinence is a major risk factor in pressure ulcer development since "it reduces the skin’s tissue tolerance by increasing its permeability and decreasing resistance to friction" (Nix and Ermer-Seltun, 2004). Thus, good skin care after each episode of incontinence is crucial to prevent skin problems such as the development of pressure ulcers.

After each incontinent episode, the nurse aide must clean the perineal area thoroughly to remove all traces of urine and stool. Once the perineal area has been dried, the nurse aide should apply a predetermined amount of topical barrier cream as ordered to the buttocks and groin for skin care. Barrier creams and ointments create a barrier to protect the patient's skin against breakdown and damage from prolonged moisture. It is recommended to utilize barrier cream with all incontinence care; additionally, do not wipe it off (DeFeo, 2016).

The back rub is a procedure that entails rubbing the skin on the back in a circular manner for several minutes to encourage circulation, relaxation, warmth and relief of muscular stiffness. On occasion, nurse aides may be entrusted with performing a back rub procedure as part of a patient's overall skin care routine. The nurse aide should follow the steps below to administer a back rub (Brookside Associates, 2015):

1. Warm lotion by rubbing in hands. 
2. Begin massage by starting in sacral (tailbone) area using circular motions. 
3. Stroke upwards to shoulders. 
4. Use firm, smooth strokes to massage over shoulder blades. 
5. Continue to upper arms with one smooth stroke down along side of back to hips. 
6. Do not break contact with patient’s skin. Complete massage in 3 to 5 minutes.
7. With long, smooth strokes, end the massage. 
8. Remove excess lotion from patient’s back with towel, and help him/her dress.

Foot care is a personal hygiene tasks that consists of providing routine care to the feet, including cleansing and moisturizing. Foot care serves a myriad of important purposes. It allows the nurse aide to inspect the feet for signs of problems such as discoloration or skin breakdown. It provides the opportunity to cleanse the feet of residue, sweat and odor-causing microbes, thereby reducing the chances of infection. Finally, foot care helps prevent dryness and scaliness. 

Certain patients, such as diabetics and individuals with other diseases that can cause poor circulation, require regular foot care to prevent infections. A good foot care routine also enables nursing staff members to catch small problems before they turn into massive issues. Patients with diabetes mellitus are more likely to develop infections than those without the metabolic disorder. Therefore, a small wound on the foot of a diabetic patient can turn into an infected ulcer that requires amputation if not addressed early enough. 

Patients with poor circulation are also more likely to develop non-healing wounds than their counterparts with healthier circulatory systems. Disease processes such as peripheral artery disease frequently result in insufficient circulation of the feet, leading to problems such as cool skin and arterial ulcers. Therefore, the nurse aide must be very watchful for potential problems when caring for the feet of these patients. To perform foot care, the nurse aide should adhere to the following steps (Brookside Associates, 2015):

1. Wear gloves and ensure patient is seated in a chair.
2. Place a disposable mat or linen protector under patient's feet.
3. Fill bath basin with warm water.
4. Have patient check water temperature.
5. Help patient place feet into basin and soak feet for 10 minutes.
6. Scrub feet with a soapy washcloth and rinse feet with water.
7. Dry feet thoroughly and moisturize with warmed lotion.
8. Place socks pack onto patient's feet as needed.

Do not ever apply lotion between the patient's toes during foot care because the added moisture could contribute to the development of fungus. Observation of the patient's feet is also an important aspect of foot care. Observing the feet requires a careful look at all areas of each foot. Notify the patient's nurse if any redness, swelling, drainage, cuts, bruises, discoloration, foul odors, or other changes in condition are noted during visual inspection of the patient's feet. 

Elimination is a basic human need. In addition to oxygen, water and food, all humans need to use the restroom in order to empty their bowels and bladders. Providing toileting care and assisting with proper elimination of the bowel and bladder is one of the primary responsibilities of nurse aides. Assuring that patients get to use the restroom in a prompt manner upholds their sense of dignity and prevents the embarrassment of contending with soiling accidents or unintended incontinent episodes

When delivering toileting care, it is often the case that the nurse aide is expected to be present for safety reasons such as unsteady gait or predetermined fall risk. If the patient is ambulatory (able to walk), the nurse aide should accompany the patient to and from the restroom, offer to clean the perineal area as needed, and anticipate some of the toileting needs in advance. Accompanying the patient to and from the restroom could potentially prevent a fall. 

During the provision of toileting care, the nurse aide should observe for any problematic issues related to passing stools as diarrhea or constipation. Any actual or potential problems should be reported to the patient's nurse so that corrective interventions can be implemented before it turns into a more serious matter. If left untreated, diarrhea can leave a patient severely dehydrated. Meanwhile, constipation can turn into a severe bowel obstruction.

Nurse aides are sometimes asked to empty colostomy bags. A colostomy is the creation of a stoma from part of the colon (large bowel), where the intestine is brought through the abdominal wall and attached to the skin, diverting stool "through the stoma instead of the anus" (Doyle and McCutcheon, 2015). A colostomy bag (pictured below) covers the stoma, and stool empties into it. The nurse aide must promptly empty the colostomy bag as needed whenever stool is present. 

Failing to empty the colostomy bag as needed might result in leakage or bursting of the bag. This could create a foul-smelling mess on the patient's clothing, bedding or personal items. In addition, leakage of this type could result in massive embarrassment and a range of negative emotions for the patient. Thus, the nurse aide must do everything possible to keep the colostomy bag emptied as soon as stool is seen.  

Brookside Associates. (2015). Basic Patient Care Procedures. Retrieved April 21, 2020 from https://brooksidepress.org/basic_patient_care/

DeFeo, E. (2016). Wound Care Program for Nursing Assistants. Retrieved April 22, 2020 from https://homecarenh.org/wp-content/uploads/2016/06/Wound-Care-Program-for-Nursing-Assistant1.pdf

Doyle, G.R. and McCutcheon, J.A. (2015). Clinical Procedures for Safer Patient Care. Victoria, BC: BCcampus. Retrieved from https://opentextbc.ca/clinicalskills/

HCPro. (2006). Shaving the male resident. Retrieved April 21, 2020 from http://www.hcpro.com/LTC-63784-1983/Shaving-the-male-resident.html

Helping Hands. (2020). Personal Care. Retrieved April 20, 2020 from https://www.helpinghandshomecare.co.uk/home-care-services/personal-care/

Leahy, W., Fuzy, J., & Graf, J. (1999). Providing home care: A textbook for home care aides. (3rd ed.) Albuquerque, NM: Hartman Publishing, Inc.

MedlinePlus. (2020). Unconsciousness - first aid. Retrieved April 21, 2020 from https://medlineplus.gov/ency/article/000022.htm

Michaels, T. (2014). CNA Skills Set: Dental Care for CNAs. Retrieved April 21, 2020 from https://cnaexamcram.com/cna-test-dental-care-for-cnas/

Missouri Career Education. (n.d.). Procedure for a Complete Bed Bath. Retrieved April 22, 2020 from http://www.missouricareereducation.org/doc/ciha/Proc_BedBath.pdf

Montoya, R. (2017). Personal Hygiene & Cultural Differences. Retrieved April 20, 2020 from https://classroom.synonym.com/personal-hygiene-cultural-differences-12082978.html

Nix, D., and Ermer-Selton, J. (2004). A review of perineal skin care protocols and skin barrier product use. Ostomy Wound Manage, 50(12), 59-67.