Home Health Aide Student Portal

Chapter 3

Bathing

There are many ways to bathe your client. If your client is bedbound, you will need to perform a full or partial bed bath. If your client is mobile, a shower or tub bath might be appropriate. See the skills below for each type of bath or shower.

Assisting With a Partial Bed Bath

When: A partial bed bath is given in the morning when the client gets up and in the evening before she goes to bed. The partial bed bath can be given in bed or while the client is sitting on the toilet, whichever the client prefers.

Why: The partial bed bath is a way to freshen up the client who is only taking a shower one to two times per week. It is an important time to take note of the integrity of the client’s skin.

What: Supplies needed for this skill include

• Gloves
• Basin of warm water
• Two washcloths (minimum)
• Two towels (minimum)
• Bath blanket (if available)
• Soap
• Lotion, as desired by the client
• Deodorant, as desired by the client

How:

1. Complete your opening procedure steps.
2. Offer to assist the client to the bathroom or bedside commode, or offer the bedpan or urinal before bathing.
3. Remove glasses and hearing aids that the client may be wearing. Store them in a safe place in the room to prevent falls and breakage.
4. Ask the client if the water is a comfortable temperature.
   • Change the water during the bed bath if it becomes too dirty, cold, or soapy.
   • Discard all wash water into the toilet.
5. Don gloves.
6. Wet one washcloth.
7. Ask the client if she prefers soap to wash her face.
   • If so, apply and lather a small amount of soap into the washcloth.
   • If not, just use the wet washcloth. Do not use soap on the face of a client with dementia.
8. Wring excess water out of the washcloth.
9. With a clean area of the washcloth, start at the inside corner of one eye and wipe toward the outer corner. Wash the second eye in the same manner with a clean area of the washcloth.
10. Open the washcloth completely and wash the client’s forehead, cheeks, chin, and neck.
11. If no soap was used on the client’s face, proceed to Step 13.
12. Wet the second washcloth in the washbasin. This is used to rinse the client’s face. Repeat Steps 8–10 with the rinse washcloth.
13. Then gently pat the client’s face and neck dry with a towel.
14. Uncover the client’s hands. Wash one hand at a time with the soapy washcloth.
15. Using the rinse washcloth, rinse the soap from the client’s hands, one hand at a time.
16. Then gently pat the hands dry with a towel.
17. Assist the client in removing her hospital gown or the pajama top, exposing only her upper body. Cover the top part of her body with a bath blanket, bed blanket, sheet, or towel.
18. Lift the client’s breasts and, with the soapy washcloth, wash underneath where the skin folds meet. Check for any red, rashy, or open areas of skin.
19. If there are any rashy areas under the breasts, after washing, rinsing, and drying this area:
    • Place the washcloths and towel in the linen bag.
    • Remove gloves and discard into the wastebasket.
    • Hand wash or hand sanitize.
    • Don clean gloves.
20. Using the rinse washcloth, rinse the soap from under the client’s breasts.
21. Gently pat the area under the breasts dry with a towel.
22. Lay a dry towel across the client’s chest and breasts.
23. If the client has any abdominal folds, wash, rinse, and dry these areas as was done while washing under the breasts. If the client does not have any abdominal folds, proceed to Step 24.
24. Uncover one arm, and assist the client if she is unable to lift it. Wash the axilla.
25. Uncover the opposite arm and assist the client if she is unable to lift it. Wash the axilla.
26. Using the rinse washcloth, rinse the soap from under both arms.
27. Gently pat the area under the arms dry with a towel.
28. Apply deodorant, as desired by the client.
29. Cover the client so as to expose only the perineum.
30. Complete perineal care.
31. Remove gloves and discard into the wastebasket.
32. Hand wash or hand sanitize as appropriate.
33. Apply lotion as desired by the client prior to assisting her in getting dressed.
34. Assist the client to put on a clean hospital gown or pajamas, or to dress in street clothes.
35. Replace glasses and hearing aids.
36. Don gloves.
37. Wring out excess water from the used washcloths. Place the soiled washcloths, towels, bath blanket, and hospital gown or pajamas in the linen bag.
38. Discard the water from the basin into the toilet. Rinse the basin and discard the rinse water into the toilet.
39. Remove gloves and discard into the wastebasket.
40. Hand wash or hand sanitize, as appropriate.
41. Complete your closing procedure steps.
42. Report drainage and any red, rashy, or open areas of skin promptly to the nurse.

Assisting With a Complete Bed Bath

When: A complete bed bath is offered one to two times each week in lieu of the shower or tub bath on the client’s scheduled bath day.

Why: The complete bed bath may be more tolerable for the client who is embarrassed to be seen unclothed, who is in pain or otherwise not feeling well, who cannot physically sit on a shower or bath chair, or who does not like the shower or tub bath.

What: Supplies needed for this skill include

• Gloves
• Basin of warm water
• Four washcloths (minimum)
• Three towels (minimum)
• Bath blanket (if available)
• Soap
• Lotion, as desired by the client
• Deodorant, as desired by the client

How:

1. Complete your starting-up steps.
2. Offer to assist the client to the bathroom or bedside commode, or offer the bedpan or urinal before bathing.
3. Remove glasses and hearing aids that the client may be wearing. Store them in a safe place in the room to prevent falls and breakage.
4. Ask the client if the water is a comfortable temperature.
   • Change the water during the bed bath if it becomes too dirty, cold, or soapy.
   • Discard all wash water into the toilet.
5. Don gloves.
6. Wet one washcloth.
7. Ask the client if she prefers soap to wash her face.
   • If so, apply and lather a small amount of soap into the washcloth.
   • If not, just use the wet washcloth. Do not use soap on the face of a client with dementia.
8. Wring excess water out of the washcloth.
9. With a clean area of the washcloth, start at the inside corner of one eye and wipe toward the outer corner. Wash the second eye in the same manner with a clean area of the washcloth.
10. Open the washcloth completely and wash the client’s forehead, cheeks, chin, and neck.
11. If no soap was used on the client’s face, proceed to Step 13.
12. Wet the second washcloth in the washbasin. It is used to rinse the client’s face. Repeat Steps 8–10 with the rinse washcloth.
13. Then gently pat the client’s face and neck dry with a towel.
14. Uncover the client’s hands. Wash one hand at a time with the soapy washcloth.
15. Using the rinse washcloth, rinse the soap from the client’s hands, one hand at a time.
16. Then gently pat the hands dry with a towel.
17. Assist the client in removing her hospital gown or pajama top, exposing only her upper body. Cover the top part of her body with a bath blanket, bed blanket, sheet, or towel.
18. Working under the blanket, sheet, or towel, wash the client’s chest, breasts, and abdomen, and then rinse with the second washcloth to remove all soap and pat dry.
19. Be sure to lift the client’s breasts while washing, and, with the soapy washcloth, wash underneath where the skin folds meet. Check for any red, rashy, or open areas of skin.
20. If there are any rashy areas under the breasts, after washing, rinsing, and drying this area:
    • Place the washcloths and towel in the linen bag.
    • Remove gloves and discard into the wastebasket.
    • Hand wash or hand sanitize.
    • Don clean gloves.
21. If the client has any abdominal folds, wash, rinse, and dry these areas as was done while washing under the breasts.
22. Ask the client to raise her exposed arm; assist her if she is unable to raise it. Place the dry towel lengthwise under the client’s arm to protect the bed linens. Lower the client’s arm to rest on top of the towel.
23. Rewet the first washcloth and wring out excess water. Apply and lather a small amount of soap.
24. Starting at her shoulder, wash the client’s entire arm, and then her hand and axilla.
25. Using the rinse washcloth, rinse the soap from the client’s shoulder, arm, hand, and axilla.
26. Gently pat the shoulder, arm, hand, and axilla dry with a towel.
27. Remove the towel from underneath the client’s arm and cover the client. Complete Steps 22–26 on the opposite arm.
28. Apply deodorant, as desired by the client.
29. Raise one side rail.
30. Assist the client in removing her pajama bottoms, if worn.
31. Expose the client’s back.
32. Place the dry towel lengthwise close to the client’s back to protect the bed linens.
33. Rewet the first washcloth and wring out excess water. Apply and lather a small amount of soap.
34. Starting at the base of her neck, wash the client’s entire back in long gliding strokes down to the upper crest of her hips.
35. Using the rinse washcloth, rinse the soap from the client’s back.
36. Gently pat the client’s back dry with a towel.
37. Apply lotion, as desired by the client.
38. Ask the client to return to the supine position. Assist the client if she is unable.
39. Expose one leg from the hip to the foot.
40. Ask the client to bend her knee and raise her foot. Assist the client if she is unable.
41. Place a towel lengthwise under the client’s leg to protect the bed linens. Ask the client to lower her leg, keeping it bent and keeping her foot flat on the bed. Assist the client if she is unable.
42. Starting at the client’s hip, wash the entire leg down to the ankle.
43. Using the rinse washcloth, rinse the soap from the client’s hip and leg.
44. Gently pat the hip and leg dry with a towel. Remove the towel from underneath the client’s leg.
45. Cover the client’s leg with the bath blanket, keeping her foot exposed.
46. Complete foot care.
47. If the client is unable to flex her knee to place her foot in a basin and maintain that position, place a towel under her foot.
48. Wash the entire foot with a soapy washcloth, including between the toes, looking for any areas of skin breakdown.
49. Rinse the foot with the rinse washcloth. Gently pat it dry with a towel, making sure to dry well between the toes.
50. If there are any rashy areas on the feet or between the toes, after washing, rinsing, and drying this area:
    • Place the washcloths and towel in the linen bag.
    • Remove gloves and discard into the wastebasket.
    • Hand wash or hand sanitize.
    • Don clean gloves.
51. Apply lotion as desired to the client’s leg and foot.
    • Do not apply lotion between the client’s toes.
52. Move to the opposite side of the bed.
53. Complete Steps 39–51 on the opposite extremity.
54. Wring out excess water from the used washcloths. Place the soiled washcloths, towels, and hospital gown or pajamas in the linen bag.
55. Discard the water from the basin into the toilet. Rinse the basin and discard the rinse water into the toilet.
56. Remove gloves and discard into the wastebasket.
57. Hand wash or hand sanitize, as appropriate.
58. Refill the basin with warm water.
59. Ask the client if the water is a comfortable temperature.
60. Don clean gloves.
61. Complete perineal care.
62. Remove gloves and discard into the wastebasket.
63. Hand wash or hand sanitize, as appropriate.
64. Assist the client to put on a clean hospital gown or pajamas, or to dress in street clothes.
65. Replace glasses and hearing aids.
66. Don gloves.
67. Wring out excess water from the used washcloths. Place the soiled washcloths, towels, bath blanket, and hospital gown or pajamas in the linen bag.
68. Remove gloves and discard into the wastebasket.
69. Hand wash or hand sanitize, as appropriate.
70. Complete your finishing-up steps.
71. Report drainage and any red, excoriated, or open areas of skin promptly to the nurse.

Assisting With a Shower

When: The shower is offered one to two times each week on the client’s scheduled bath day, or as requested by the client in acute care.

Why: The shower provides complete body bathing for the client. It encourages cleanliness and can be refreshing for the client. It is also a time when the nursing assistant can observe all areas of the skin for anything outside normal findings.

What: Supplies needed for this skill include

• Gloves
• Washbasin (optional)
• Shower chair
• Child’s potty seat (optional)
• Three washcloths (minimum)
• Six towels (minimum)
• Shampoo
• Soap
• Conditioner, as desired by the client
• Lotion, as desired by the client
• Deodorant, as desired by the client
• Clean clothes, including socks and shoes or nonskid slipper socks
• Comb or brush
• Disinfectant

How:

1. Complete your opening procedure steps.
2. Offer to assist the client to the bathroom or bedside commode, or offer the bedpan or urinal before bathing.
3. Transport the client to the shower room.
4. Remove glasses and hearing aids that the client may be wearing. Store them in a safe place in the room to prevent falls and breakage.
5. Help your client undress. Place soiled clothes, pajamas, or hospital gown in the linen bag.
6. Cover the client with a bath blanket. Put nonskid slipper socks on the client’s feet.
7. Lock the brakes on the shower chair and the wheelchair.
8. Transfer the client as indicated in the care plan onto the shower chair.
   • If the client is very small, choose a small-sized shower chair. If a small shower chair is not available, consider placing a child’s potty seat in the seat of the shower chair, or wrap the shower seat with towels for comfort.
   • If the client is very large, ensure that you are using a bariatric-approved shower chair.
9. Remove the nonskid slipper socks and gait belt if used, and set them aside in a clean place in the room.
   • If the client’s legs are dangling, flip a washbasin over and ask the client to place her feet on top of the upside-down basin for comfort.
10. Turn the shower on, away from the client.
11. Adjust the water temperature until it is comfortably warm when testing it on the inside of your arm. Verify the water temperature by
    • asking the client to hold out her hand while you run the stream of water over it.
    • adjusting the water temperature until it is comfortable for the client.
12. Don gloves.
13. Cover the client’s breasts with one towel and her genital area with another.
    • You can work around and underneath these towels during the entire bathing process.
    • Or remove and place them in the linen bag if they make the client cold after getting wet.
14. Hold the stream of water over the client, covering her with water to keep her warm.
15. Ask the client if she prefers her hair to be washed. If so, hand the client a washcloth to cover her eyes. If not, proceed to Step 16.
    • Saturate the client’s hair with the stream of water.
    • Lather the shampoo through the hair, from the roots to the ends.
    • Pick up the shower head and rinse all shampoo from the hair completely.
    • If the client desires conditioner, lather conditioner into the client’s hair, from the roots to the ends.
    • Pick up the shower head and rinse all conditioner from the hair completely.
    • Ask the client to remove the washcloth from her eyes, and place it in the soiled linen bag.
16. Wet a washcloth under the stream of water and wring out excess water.
17. Ask the client if she would like soap on the washcloth to wash her face. If so, apply and lather a small amount of soap into the washcloth.
18. Hand the washcloth to the client to wash her face. Assist the client if she is unable.
19. If the client is able to wash any of the upper part of her body, rewet the washcloth, and apply and lather soap into it. Ask the client to wash.
20. Wet the second washcloth, apply and lather soap into it, and wash the client’s back.
21. If the client is unable to wash all or part of her upper body, continue to wash her where needed, starting from her neck and working down to her waist.
22. Lift the client’s breasts and any abdominal folds and wash well.
23. If there are any rashy areas under the breasts, after washing, rinsing, and drying this area:
    • Place the washcloths and towel in the linen bag.
    • Remove gloves and discard into the wastebasket.
    • Hand wash or hand sanitize.
    • Don clean gloves.
24. Rewet the washcloth and reapply soap as needed throughout the bathing process.
25. After washing the client’s upper body, wash each leg entirely, starting at the hip and working down to the feet.
26. Wash the feet, making sure to inspect between the toes, looking for areas of skin breakdown.
    • Wring out excess water from each washcloth used to wash the client’s body.
    • Place the washcloths and towel in the linen bag.
    • Remove gloves and discard into the wastebasket.
    • Hand wash or hand sanitize.
    • Don clean gloves.
27. Pick up the shower head once more, and test the water temperature. Continue to adjust the water temperature until it is comfortable for the client.
28. Rinse the client’s body entirely. Make sure to lift the client’s breasts and all abdominal folds to rinse the soap out from under them completely.
29. Wet the third washcloth under the stream of water, and wring out excess water. Apply soap and lather into the washcloth.
30. Complete perineal care.
    • You may need to use several washcloths for perineal care.
    • When done, wring out excess water from each washcloth, and place them in the linen bag.
31. Remove gloves and discard into the wastebasket.
32. Hand wash or hand sanitize, as appropriate.
33. Don a clean pair of gloves.
34. Pick up the shower head once more, and test the water temperature. Continue to adjust the water temperature until it is comfortable for the client.
35. Rinse her perineal area completely.
36. Turn off the water.
37. Remove the towels from the client’s breasts and perineal area, if you have not done so already. Wring out excess water. Place the towels in the linen bag.
38. Place the bath blanket over the client for warmth if so desired.
39. Wrap the client’s head with a dry towel, gently squeezing her hair from the roots to the ends to wring out excess water, and place this towel in the linen bag.
40. Then drape a dry towel over the client’s head to help keep her warm.
41. With a dry towel, gently dry off the client’s body, paying attention to areas where there is skin-on-skin contact, such as under her breasts and abdominal folds, and between the toes.
    • Use as many towels as necessary to dry the client completely.
    • Place all used towels in the linen bag promptly.
42. Apply lotion and deodorant, as desired by the client.
43. Assist your client in dressing the upper part of her body. Put on her underpants and pants up to her thighs, and then her socks and shoes or nonskid slipper socks.
44. Lock the brakes on the shower chair and on the wheelchair.
45. When the client stands up from the shower chair, dry her buttocks; then pull up her underpants and pants.
46. Transfer the client to the wheelchair as indicated by the care plan.
47. Remove gloves and discard into the wastebasket.
48. Hand wash or hand sanitize, as appropriate.
49. Comb or brush the client’s hair. Apply makeup, if she desires. Replace glasses and hearing aids.
50. Transport the client to her desired location.
51. Return the client’s supplies to her room.
52. Don gloves. Disinfect the shower chair with a facility-approved disinfectant. Rinse thoroughly.
53. Remove gloves and discard into the wastebasket. Hand wash or hand sanitize, as appropriate.
54. Complete your closing procedure steps.
55. Report any drainage and red, excoriated, or open areas of skin promptly to the nurse.

Assisting With a Tub Bath

When: The tub bath is offered one to two times each week on the client’s scheduled bath day, or as requested by the client in acute care.

Why: The tub bath provides complete body bathing for the client. It encourages cleanliness and can be refreshing for the client. It is also a time when the nursing assistant can observe all areas of the skin for anything outside the normal findings.

What: Supplies needed for this skill include

• Gloves
• Three washcloths (minimum)
• Six towels (minimum)
• Cup or pitcher
• Shampoo
• Soap
• Conditioner, as desired by the client
• Lotion, as desired by the client
• Deodorant, as desired by the client
• Clean clothes, including socks and shoes or nonskid slipper socks
• Comb or brush
• Disinfectant

How:

1. Complete your opening procedure steps.
2. Offer to assist the client to the bathroom or bedside commode, or offer the bedpan or urinal before bathing.
3. Transport the client to the tub room.
4. Remove glasses and hearing aids that the client may be wearing. Store them in a safe place in the room to prevent falls and breakage.
5. Help your client undress. Place soiled clothes, pajamas, or hospital gown in the linen bag.
6. Cover the client with a bath blanket. Put nonskid slipper socks on the client’s feet.
7. Lock the brakes on the wheelchair.
8. Transfer the client as indicated in the care plan onto the tub chair.
   • There are many types of whirlpool tubs; refer to the facility protocol for exact transferring information.
   • If the client is very large, ensure that you are using a bariatric-approved tub chair.
9. Remove the nonskid slipper socks. Set them aside in a clean place in the room.
10. If using a tub with a hydraulic lift, raise the tub chair and swing the client’s legs over the side of the tub before lowering the client into the tub, or transfer the client into the tub after opening the tub door. The system you use will depend on the type of whirlpool tub the facility uses.
11. Turn the water on slowly so that it does not splash onto the client.
12. Adjust the water temperature until it is comfortably warm when testing it on the inside of your arm. Verify the water temperature by
    • asking the client to hold out her hand while you run the stream of water over it.
    • adjusting the water temperature until it is comfortable for the client.
13. Then plug and fill the tub and remove the bath blanket from the client.
14. After the tub is full or the level of the water is higher than the level of the jets, turn on the whirlpool jets.
15. Don gloves.
16. Cover the client’s breasts with a towel, if she desires.
    • You can work around and underneath these towels during the entire bathing process.
    • Or remove and place them in the linen bag if they make the client cold after getting wet.
17. Ask the client if she prefers her hair to be washed. If so, hand the client a washcloth to cover her eyes. If not, proceed to Step 18.
    • Submerge the cup or pitcher under water to fill it. Pour the water over the client’s head to completely wet her hair, starting at the roots.
    • Lather the shampoo through the hair, from the roots to the ends.
    • Pour water over the client’s hair to remove all shampoo from the hair completely. Continue as many times as necessary until the hair is completely rinsed.
    • If the client desires conditioner, lather the conditioner into the client’s hair, from the roots to the ends.
    • Pour the water over the client’s hair to remove all conditioner from the hair completely. Continue as many times as necessary until the hair is completely rinsed.
    • Ask the client to remove the washcloth from her eyes, and place it in the soiled linen bag.
18. Wet a washcloth and wring out excess water.
19. Ask the client if she would like soap on the washcloth to wash her face. If so, apply and lather a small amount of soap into the washcloth.
20. Hand the washcloth to the client to wash her face. Assist the client if she is unable.
21. If the client is able to wash any of the upper part of her body, rewet the washcloth, and apply and lather soap into it. Ask the client to wash.
22. Wet the second washcloth, apply and lather soap into it, and wash the client’s back.
23. If the client is unable to wash all or part of her upper body, continue to wash her where needed, starting from her neck and working down to her waist.
24. Lift the client’s breasts and any abdominal folds and wash well.
25. If there are any rashy areas under the breasts, after washing, rinsing, and drying this area:
    • Place the washcloths and towel in the linen bag.
    • Remove gloves and discard into the wastebasket.
    • Hand wash or hand sanitize.
    • Don clean gloves.
26. Rewet the washcloth and reapply soap as needed throughout the bathing process.
27. After washing the client’s upper body, wash each leg entirely, starting at the hip and working down to the feet.
28. Wash the feet, making sure to inspect between the toes, looking for areas of skin breakdown.
    • Wring out excess water from each washcloth used to wash the client’s body.
    • Place the washcloths and towel in the linen bag.
    • Remove gloves and discard into the wastebasket.
    • Hand wash or hand sanitize.
    • Don clean gloves.
29. Wring out excess water from each washcloth used to wash the client’s body. Place them in the linen bag.
30. Submerge the cup or pitcher to fill it, and pour the water over the client to rinse the soap from her upper body.
31. Lift the client’s breasts and all abdominal folds to rinse the soap out from under them completely.
32. Wet the third washcloth and wring out excess water. Apply and lather soap into the washcloth.
33. Wash the client’s genital area by submerging your hands and arms into the water.
34. You will not be able to wash the rectal area; the whirlpool action of the tub is designed to cleanse this area. Be sure to inspect the skin of the perineal area once the tub has been drained.
35. Wring out excess water from each washcloth and place these in the linen bag.
36. Remove gloves and discard into the wastebasket. Hand wash or hand sanitize, as appropriate.
37. Don a clean pair of gloves.
38. Remove the towels from the client’s breasts, if you have not done so already. Wring out excess water. Place the towels in the linen bag.
39. Place the bath blanket over the client for warmth if so desired.
40. Unplug the tub and let it drain completely.
41. Wrap the client’s head with a dry towel, gently squeezing her hair from the roots to the ends to wring out excess water, and place this towel in the linen bag. Then drape a dry towel over the client’s head to help keep her warm.
42. With a dry towel, gently dry off the client’s body, paying attention to areas where there is skin-on-skin contact, such as under her breasts and abdominal folds, and between the toes.
    • Use as many towels as necessary to dry the client completely.
    • Place all used towels in the linen bag promptly.
43. Remove the client from the tub either by using the hydraulic lift or by opening the tub door.
44. Apply lotion and deodorant, as desired by the client.
45. Assist your client in dressing the upper part of her body. Put on her underpants and pants up to her thighs, and then her socks and shoes or nonskid slipper socks.
46. Lock the brakes on the tub chair and on the wheelchair.
47. When the client stands up from the shower chair, dry her buttocks and then pull up the underpants and pants.
48. Transfer the client to the wheelchair as indicated by the care plan.
49. Remove gloves and discard into the wastebasket.
50. Hand wash or hand sanitize, as appropriate.
51. Comb or brush the client’s hair. Apply makeup, if she desires. Replace glasses and hearing aids. Transport the client to her desired location. Return the client’s supplies to her room.
52. Don gloves. Disinfect the tub chair with a facility-approved disinfectant. Rinse thoroughly.
53. Remove gloves and discard into the wastebasket. Hand wash or hand sanitize, as appropriate.
54. Complete your closing procedure steps.
55. Report any drainage and red, excoriated, or open areas of skin promptly to the nurse.