Managing First-Line Patient Care

It is very important to keep the patients clean. Ill people would rather worry about coping to their illness than to bathe, brush teeth, and stay clean. That is why nurses should observe the patients whether they can clean themselves and assist them if necessary, especially in bathing.

Hydrotherapy plays a vital role in managing acute and chronic diseases. Proper giving of bath gives a tonic, eliminative, and antipyretic action. The essence of giving bath is not just to keep the patients clean, but also to reduce temperature, to stimulate their body, and to make them relax. (Crawford, 1910)

To stimulate patients, cold bath is advisable. When the patient needs to be relaxed, because of nervousness or anxiety, a warm bath should be provided. If the patient’s temperature is increasing and needs to be reduced, either warm bath or cold bath should be applied depending on the case. (Crawford, 1910)

Warm bath will definitely help in reducing the stench of sweat and will provide freshness. If the patient is at the height of fever, bath is not advisable, especially the cold bath. Moreover, regular bath or cold sponging is not suitable for patients who are sick, bed ridden and elderly but a warm sponge bath can be applied instead.  (Kakkilaya, 2003)

Hygiene is very personal, and individual’s practices of keeping themselves clean may vary according to one’s culture or religion. It is very important to make the patients meet their personal needs rather than to carry out standard routines. And also, the patient’s beliefs and privacy should also be respected.

Patients may be bathed daily in the hospital but if the patient has a dry skin, bathing should be limited to once or twice a week to avoid further drying out of his skin.  (World Health Organization, 2005)

For patients who can walk may be assisted by the nurse or family members to the shower or tub. Prepare a chair in the bathroom for the patient to sit on. Help the patient to wash and dry off, and in putting on clothes.

In doing a bed bath, make sure all the doors and windows are closed, to protect the patient’s privacy. Prepare the basin of warm water, soap, clothes, bath blankets, and towels. Cleanse the face, ears, and neck. Next is the right arm, hand and axilla; repeat with left arm. Then cleanse the chest area.  Lastly, cleanse the legs and feet of the patient. Change the bath water once or twice. After bathing, change the bed linen. (World Health Organization, 2005)

Next, I will discuss another bath procedure for patients called the Hot Sitz Bath, also known as the Hip Bath. This is done to relieve muscle contraction, to alleviate exudates, to speed up suppuration process and healing, and to lessen congestion and provide relief in the perineal area.  This is applicable for patients with hemorrhoids. (pobisnar, 2006)

Do not use warm water if the patient already shows a sign of congestion. Monitor the patient is getting weak or fainting during the bath.When the patient has been positioned in the tub or chair; check if the thighs and legs are being pressured. Support the back of the patient all through out the bath. (pobisnar, 2006)

Use the appropriate tub for the size of the patient, to make him comfortable while taking a bath. Prepare towels and bathmat, bath blanket, inflatable ring, and clean clothes. Prepare the linen in the bathroom. Only one-third of the tub should be filled with water. Check the temperature of water with bare hands, temperature of water should be between 105°F and 110°F (40.5°C to 43.3°C).

Check all the necessary towels and inflatable rings, making sure these are just within reach to save time and effort. Make certain the patient is informed what the whole procedure is about and how it will be done. Then instruct the patient to undress, especially the hip is exposed. Before he goes into the tub, use a thermometer first and check the temperature of the water. A temperature of 43-46° C will create relaxation while a temperature of 34-37° C will help promote healing of wound. (pobisnar, 2006)

Support the patient and position him appropriately. Make sure he is comfortable in his position. Put the bath sheet around the patient’s shoulders and wrap the ends over the tub to keep him away from chilling. In case the patient’s condition warrants, particularly when he is already vomiting, his skin is paling, and the pulse rate becomes faster, stop the bath.

Warm water can be added to maintain the desired temperature but make sure the water is agitated by stirring it as hot water and added to prevent burns. Never leave the patient alone to ensure security of the patient. After fifteen to thirty minutes of bathing, assist the patient out of the tub, help him dry himself and cover him satisfactorily. Let him lie down to rest until normal circulation returns.  (pobisnar, 2006)

The concept of giving bath is very necessary for nursing students, one of the basic concepts they should learn first for their careers. Though anyone, even not under the medicine field may also learn the proper procedure of giving bath to patients.

Now, how these procedures can be effectively taught? People have different learning traits. We have different ways to absorb knowledge based on our personality and personal experiences.

Basically, there are four types of adult learners: The commonsense learner, the dynamic learner, the innovative learner, and the analytical learner. The common sense learner must first practice and integrate the concepts into experience. The dynamic learner likes teaching himself and shares his knowledge with others. The innovative learner asks for reasons for learning and finds personal meaning in the instructions. Lastly, the analytical learner should be provided with information then integrates them, reflecting on concepts with application analysis. (Evans, 2007)

First, present the concept using visual aids such as power point presentation, etc. Explain what is being taught and why the concept should be taught. Explain its application (the correct methods and rationale behind the procedures) and the opportunity to practice whether they can do it or not, especially for the students under innovative and analytical type. Then, prepare an activity related to the subject matter to make them experience the concept. For example, you can use a dummy to show the actual procedures or prepare a video clip of a professional practicing the concepts for proper presentation.

Then give them a chance to practice it for themselves. Train them, until they all get the proper procedure. Interact with the participants, and focus on students who belong to the innovative learner type. Then solicit feedback and conduct a group evaluation to know how far they have learned from you. Teaching means communicating skills and knowledg, verbally giving instructions and offering presentations. Your students knowledge will depend on your ability to teach. (Evans, 2007)

Works Cited

• Crawford, M. L. (1910). Why, When, and How to Bathe a Fever Patient. The American Journal of Nursing , 314-317.
• Evans, P. (2007, March 13). The adult learner: Training your labor force. Retrieved October 04, 2007, from http://www.thefabricator.com/ShopManagement/ShopManagement_Article.cfm?ID=1577
• Kakkilaya, D. B. (2003). Is Bathing Contraindicated in Fever? Retrieved October 04, 2007, from Rational Medicine Org: http://www.rationalmedicine.org/bath.htm
• pobisnar. (2006). Nursing Procedure: Hot Sitz Bath (Hip Bath). Retrieved October 04, 2007, from Nurse’s Diary: http://nursediary.pid.com.ph/p16.htm
• World Health Organization. (2005). Daily Care of the Patient. Retrieved October 04, 2007, from WHO site: http://www.wpro.who.int/internet/files/pub/85/33-49.pdf