Unit 9
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Factors Influencing Hygiene
Personal Preferences. Patients have individual desires and preferences about when to perform hygiene and grooming care. These have been developed over a lifetime and should be respected and accommodated as much as possible.
Health Beliefs and Motivation.The phrase 'cleanliness is next to Godliness' was a strong driver in the very late 1700s and throughout the 1800s thought to have come from John Wesley as an idea that physical cleanliness—and moral purity, were connected. Residents that were raised with this belief may be insistent on 'scrubbing up' every morning. While a farmer who was reared with hand pumping water in from the well in draughts stricken Western Kansas may very well have a much more water thrifty concept of baths only every Saturday.
Cultural Variables. Culture is a strong driver in so many of life's choices. Culture and religion can be sensitive points to a resident do not assume that you know what they will want always ask and respect.
Physical Condition. Imagine having a debilitating condition with limited mobility. It is not difficult to understand how this could have a great influence on hygiene. It is the responsibility of the C.N.A to communicate with the resident to discover if the resident would like more frequent self care and hygiene but is limited due to physical conditions or if the resident is truly content with their current practice.
We must remember, there is absolutely no law or regulation that requires a set amount of bathing or hygiene. The only factor is the resident's desire and the rights of those in proximity to a clean and odor free environment. Women and men both have the right to choose if they wish to be shaved or not. Residents with diabetes or on blood thinners should use electric razors and only an LPN or RN should cut the nails, but C.N.As may lightly file and clean, paint the nails.
Encourage independence
As with any task, the CNA should always encourage the resident to participate in their own care. This may mean providing the resident with adaptive equipment or to take a little extra time while you wait for them, as it may take them longer to complete the task than if you were to just do it for them. If possible, set the resident up to do the task while you are busy doing something else or take care of another resident. Just make sure that you come back in a reasonable amount of time to help the resident move on to the next task. For example, Mr. Chan can brush his own teeth but it takes him a very long time and he can't stand at the sink by himself. The CNA could instead set him at a chair in front of the sink with his supplies in easy reach and a call light at his side. Then the CNA could leave to help Mr. Milnore next door before returning to Mr. Chan to help him dress.
When assisting someone with dementia it is particularly important to provide ways for their own participation. While many residents with dementia are fully capable physically, they can become overwhelmed or lose track of what they are doing very easily. Therefore, it is best to use task segmentation, giving directions in small steps so the resident can accomplish them. For example, rather than handing the resident an entire outfit and telling them to get dressed, direct them to remove their pajamas, then put on their shirt, button up the front, put on their pants, tuck in the shirt, etc. In this way the resident can complete the task of getting dressed just in small step by step ways.
If a resident is incapable of physically participating in the activity, try to find other ways to involve them. For example, have them watch the activity in the mirror, offer two acceptable outfits and let them pick which one, or have them raise their arms while you assist threading on their sleeves. Any amount of participation should be encouraged.