Preview of Understanding Caring

Family Doctor Books

Published in association with the British Medical Association

Family Doctor Books

Preview of Understanding Caring

Good personal care is of vital importance, both to maintain the morale of the person you are caring for, and to prevent minor health problems developing into more serious ones.

Bathing

A daily bath or shower is essential to maintain cleanliness and prevent odours which can develop quickly if a person is immobile. This is an area in which safety is of vital importance; your local occupational therapist, district nurse or the Disabled Living Foundation may be able to suggest useful pieces of equipment to make bathing easier and safer. Before you start to give someone a bath or shower, make sure that you will be able to accomplish the task and that help is available if needed.

Do not use soap if the skin is irritated; alternatively switch to non-irritating soap. Change the water whenever necessary (and also if it cools down). Wear disposable plastic gloves when you wash an inconti-nent person for your hygiene and safety, because of intestinal bacteria. Dry the skin well, especially in the folds of the skin (groins, armpits, between the buttocks and between the toes). This will prevent irritation and soreness developing. Some patients enjoy washing their own hands and face, and may want to wash their hands actually in a bowl of water. This can be balanced on the bed. Allowing the person to wash around their own groin, if able, maintains dignity.

If bathing is too difficult showers are a good alternative but can be expensive to fit. A much cheaper alternative is to buy one of the rubber sprays which can be fitted over existing bath taps and make an effective substitute for a proper shower. Someone who is unsteady would be better sitting on a bath board rather than standing to have a shower.

After washing be sure to rinse well and dry the skin thoroughly, especially between fingers and toes. Pay attention to the underarm area and folds in the breast or groin region. Baby lotion or oil will keep the skin supple and prevent it becoming dry and flaky. A bedbath is a refreshing alternative if a bath or shower is difficult.

If possible, a daily bath or shower maintains cleanliness.	After washing, dry skin thoroughly.

ESSENTIALS FOR BATHING

A non-slip rubber bath mat (available from chemists) is advisable, although these are not suitable for some modern fibreglass baths.
Stick adhesive shapes with anti-slip surfaces to the bottom of the bath.
Side rails on baths are sometimes useful but do not always provide sufficient leverage. It may be necessary to fit a rail across the bath and secure it to the taps.
Bath seats can make it easier to get in and out of the bath.
If your relative prefers to bathe alone, make sure that the bathroom door is not locked and you are within earshot.
Drain the bath of water before getting the person out. If the water is left in the bath it will act as a suction holding the bather in the bath.
Installing a scald-proof temperature control on the water heater is a useful precaution.

HOW TO GIVE A BEDBATH
Washing can be tiresome and painful for someone who is frail and ill. Ensure that you discuss bedbathing with the person you care for and decide on when he or she feels up to it and what time of day is best. Also find out what he or she wants to wash alone. For someone who has to spend long periods of time in bed, washing that person’s hands and face regularly is very refreshing.	To wash someone in bed, you need: A bowl of warm water Towels and flannels Soap.
Make sure that you will not be disturbed and that the room is warm and draft free. Place a towel beneath the person you are going to bedbath. Help with undressing and leave him or her covered with a top sheet for warmth. Wash and dry every part of the body in turn (first the face, then the chest, etc.). Keep to the following routine: Face Chest Arms Back.
Then you may wish to dress the upper part of the body to ensure warmth and dignity. Legs Lower body and groin. Change the water. You can then roll the person on to their side to wash: Lower back Behind the legs Buttocks.

Ear care

Before performing any task like this be sure to wash your own hands properly. Wash ears daily in warm water and rinse well before drying thoroughly. Do not use cotton buds to clean the inner part of the ear, as it is easily damaged. Consult your GP if wax is a problem.

Eye care

Using a small wad of cotton wool soaked in warm water which has previously been boiled, cleanse the eyes from the nose to the outer edge. Use a separate piece of cotton wool for each eye. This will clear the eyes of ‘sleep’ that accumulates overnight and prevent soreness.

Hair care

If hair washing is difficult using a sink or you cannot do it in the bath or shower, there are aids that will help. You may find it easier if your relative has the bowl of water on the knees and bends the head forward.

Alternatively, you can buy a hair washing bowl to use in bed. You and your relative may prefer to have a mobile hairdresser who will
come to your home and women especially often find having their hair done a good morale booster.

Mouth care

Teeth should be brushed carefully so as to avoid gum damage. An electric toothbrush is an easy way of maintaining independence in
mouth care. Some dentists make domiciliary visits if your relative can’t get to the surgery. Contact the British Society of Dentistry for details of your nearest dentist
with an interest in people with a disability. Mouth washes are refreshing and help to keep the mouth clean but are not a substitute for teeth cleaning. If the lips tend to become dry or chapped, try applying lip salve.

It is important to care well for dentures. If they do not fit properly eating and speaking clearly may become difficult. Dentures should never be cleaned with toothpaste, which is too rough. You can buy special denture pastes, although cleaning with a nail brush and ordinary soap is just as effective. While dentures are out the mouth can be rinsed and gums gently massaged with a soft toothbrush to remove any debris. Food particles trapped under dentures may cause ulceration and discomfort. Check regularly with the dentist that dentures continue to fit well. Weight loss may alter the fit and mean your relative is likely to experience friction and a sore mouth.

Nail care

Toe and finger nails need to be kept short to prevent skin damage from scratching. Toe nails should be cut straight across and finger nails rounded with the rough edges smoothed away. If your relative has problems with ingrown toe nails, or you are having problems cutting his or her toe nails, then he or she will need to see a chiropodist. Ask your GP for a referral. Anyone with diabetes needs thorough and care-ful foot care, and must also see a chiropodist regularly. Socks need to be changed daily. Avoid powdering the feet as powder can accumulate between the toes causing sweating and infection.

Finger nails should be kept short and rounded with rough edges smoothed away	Toe nails should be cut straight across

Over long nails cause injury	Don’t cut nails too short and down at the sides

Shaving

Electric razors are easier to use than the traditional wet razor if your relative has poor vision or an unsteady hand.

Disposal of waste

You should always wear disposable latex gloves when you are dealing with a person’s body fluids such as blood, urine, vomit or faeces. You can get gloves from the district nurse or the chemist. Gloves should also be worn if you are dressing open wounds or giving an injection.

A disposal service for soiled incontinence pads is usually run by the health authority or local authority (check with social services).

Dispose of faeces down the toilet. Place soiled gloves, wipes, pads and the like in a plastic bin bag (you can get ones that are scented with a deodorant) and dispose of them in the dustbin. Always wash your hands after doing any task like this. If you have needles and syringes to dispose of seal them in puncture-resistant tins or special ‘sharps’ boxes – ask your district nurse for advice.

HANDLING AND DISPOSING OF WASTE
Always wear disposable latex gloves	Wash hands thoroughly afterwards

Place all ‘soft’ waste in a strong plastic bin bag	Any needles and syringes must be sealed in puncture- resistant containers

Dressing

Do not rush dressing. If one side of the body is weaker than the other it is usually easier to begin putting clothes on this side first. When undressing take clothes off the stronger side first. Clothing can be adapted to make dressing and undressing as easy as possible. Zips and Velcro are easier to manage than buttons for people with limited coordination or manual dexterity. Socks should fit well and not bunch up under the toes, where they could cause pressure problems. Avoid elasticated tops which can restrict the circulation or make feet swell. Tights may be difficult to get in and out of and many women prefer stockings or pop sox. It is important that shoes support the feet well. It would be best for your relative not to wear slippers all the time as they can allow the feet to swell. Techniques for dressing and adapting clothing, and aids for dressing and fastening, are discussed in the Disabled Living Foundation’s excellent booklet All Dressed Up: A Guide to Choosing Clothes and Useful Dressing Techniques for Elderly People and People with Disabilities. They also produce a range of other useful factsheets on clothing and footwear.

Eating and drinking

It is important for everyone’s physical and mental well-being to eat a nutritionally balanced diet. Nutritional requirements vary according to age, activity and health. In general a healthy diet should contain reasonable amounts of protein, fibre, minerals and vitamins but not too much sugar or animal fat. Whole grains, cereals, fresh fruit and vegetables are high in vitamins and fibre, and so should be eaten as often as possible. Fibre is especially important in helping to prevent constipation in someone who is immobile. If you are concerned about your relative’s diet, your district nurse or GP can advise you or refer you to a dietitian for more specific help.

If the person you care for has a poor appetite it may help to serve small meals which are light and nutritious and attractively presented. Allow plenty of time to eat meals and serve them in comfortable, quiet surroundings. Remember, if your relative spends a great deal of time in bed they may not have a big appetite. In any case it isn’t easy to eat lying down, so it may help if they can have their meals sitting at a table. If your relative has difficulty getting food to their mouth, you may need to help them, or you can buy specially adapted crockery and cutlery (an occupational therapist will be able to advise you on this). When you are helping someone to eat, sit beside them and offer small mouthfuls, allowing plenty of time for chewing and swallowing before offering a further mouthful. Consider ways of keeping food hot (like stay-warm plates) if time is needed to finish a meal.

Confused people sometimes lose concentration when eating so it may be advisable to sit with them and prompt them to eat. If chewing is difficult, reducing the size of mouthfuls and providing a drink with meals can help. A speech therapist will be able to give advice on chewing and swallowing difficulties. Check also that dentures are well-fitting and in place at mealtimes. If necessary mash or liquidise food. If your relative is eating only a small range of foods you may want to consider vitamin supplements.

Communication

Communicating effectively with the person you care for is vitally important. Difficulties in this area can be very frustrating for both of you. Imagine how you would feel if you were confined to bed and couldn’t tell someone you needed to use the toilet. The problems
may not relate simply to hearing and speaking; communicating is really about keeping in touch and being understood. Body language, including touch, expression,
holding hands and so on, is also an important part of communication and can signify a great deal, as well as making your relative feel wanted and secure.

When you speak try to do so slowly and clearly. Ask questions you know your relative will be able to answer, even if only by shaking or nodding their head. Give the person plenty of time to respond. Some people may have difficulty because they are blind or have a particular disease or disorder, and you need to be aware of this. For example, someone with Parkinson’s disease may need time to start speaking; not answering you immediately may be because they are thinking about what to say and trying to form the words. If you misunderstand their silence and carry on speaking yourself, they may lose their opportunity to communicate with you. People with dementia may use the wrong words to express something simply because they are the only words they can find. Try to interpret what you feel the person is saying more than the words you hear if this is the case. Be aware that in some cases you may hear ‘mixed messages’. Be aware too that your relative may respond with verbal abuse, probably because of frustration or because the wrong words come out. Try not to let this bother you.

Sometimes there may be practical help that will improve communication. Difficulties after a stroke may be helped by a speech therapist. Difficulties in hearing may be helped by a hearing aid, although they are not always the answer; someone who is confused or who has arthritis, for example, may find one difficult to use, and it can take months of practice to get used to a new hearing aid. Your GP can refer your relative to an NHS hearing aid clinic, where a doctor will assess them, fit a suitable aid and teach them how to use it. Hearing aids are also available privately, but they may be expen-sive and you should get advice from your NHS clinic first. Other aids are also available, such as stereo listeners for radio or television. The Royal National Institute for Deaf People can give you more advice.

AIDS TO COMFORT

It is extremely important to make sure your relative is comfortable, both for the sake of their general feeling of well-being and to prevent complications. Particularly:

Ensure the bottom sheet has no wrinkles or crumbs.
Bed clothes should be loose enough to allow movement – duvets are preferable to blankets.
Pillows should be positioned to give support to the back when your relative is sitting up.
Special pressure-relieving mattresses and beds can be obtained although they are expensive. Ask your district nurse or local Disabled Living Foundation centre about foam, gel or air cushions.
Pillows may be positioned to prevent friction and relieve pressure.
Remember that you have to be extra careful when making the bed, if your relative is using a special mattress such as a low air loss mattress, so that you don’t impede its working.

KEY POINTS

Good personal care is of vital importance to maintain morale and prevent health problems
A daily bath or shower is essential for your relative
Always wear disposable latex gloves when dealing with body fluids
Clothing can be adapted to simplify dressing
It is important for everyone to eat a nutritionally balanced diet

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