Nurse Assisting
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Chapter 19 Expanded Skills

Click on the skills to review expanded skills discussed in this chapter.

Starting-Up Steps

  1. Knock before entering, identify the client, and introduce yourself.
  2. Complete hand hygiene.
  3. Provide for privacy.
  4. Explain to the client what you will be doing before you start doing it.
  5. Assemble your supplies.
  6. Ensure that the bed is at a good working height and is locked; or, if the bed is not in use, you are in an ergonomically correct position to assist the client.

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Shampooing With Shower or Tub Bath

When: During a shower or tub bath.

Why: To maintain clean hair for the client.

What: Supplies needed for this skill:

  • Shampoo
  • Medicinal shampoos if indicated on the care plan
  • Conditioner if desired by the client
  • Washcloth
  • Cup or pitcher

How:

  1. Ask the client if they prefer their hair to be washed during the tub bath. If so, hand the client a washcloth to cover their eyes.
  2. Submerge the cup or pitcher under water to fill it. Pour the water over the client’s head to completely wet their hair, starting at the roots.
  3. Place a small amount of shampoo in the palm of your hand, then rub your hands together to evenly distribute the shampoo before rubbing it into the hair. Lather the shampoo through the hair, from the roots to the ends.
  4. Medicinal shampoos—if the client requires a medicinal shampoo, first verify this on the care plan. Then follow the manufacturer’s directions to wash the client’s hair.
  5. Submerge the cup or pitcher under water to fill it, and pour the 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.
  6. If the client desires conditioner, place a small amount in the palm of your hand, then rub your hands together to evenly distribute the conditioner before rubbing it into the hair. Lather the conditioner into the client’s hair, from the roots to the ends.
  7. Submerge the cup or pitcher under water to fill it and 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.
  8. Ask the client to remove the washcloth from their eyes. Wet the washcloth, and then wring out excess water.
  9. Complete the remainder of the shower or tub bath.

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Shampooing Hair in Bed

When: ​The client should have the hair washed at least one time each week, or more often when requested. Shampooing is done on the scheduled bath day.

Why: ​To keep hair clean, healthy, and manageable.

What: ​Supplies needed for this skill include:

  • Gloves
  • Basin of warm water
  • Bucket
  • Washcloth
  • Four towels (minimum)
  • Bed protector
  • Shampoo trough
  • Cup or pitcher
  • Shampoo
  • Conditioner, as desired by the client
  • Comb or brush

How:

  1. Complete your starting-up steps.
  2. The client should be lying in bed on their back, with the bed flat.
  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.
  5. Don gloves.
  6. Remove the pillow from under the client’s head and place it on a clean surface, such as the chair.
  7. Ask the client to lift their head. Assist them if they are unable.
  8. Place a bed protector under the client’s head, with the bed protector slightly hanging over the side of the bed where you will place the bucket.
  9. Position the shampoo trough on top of the bed protector, under the client’s head. The spout should be hanging over the same side of the bed as the bed protector. Position a bucket on the floor next to the bed, directly underneath the spout of the trough.
  10. Place a towel folded lengthwise under the client’s neck on top of the trough.
  11. Ask the client to lay their head back so that their neck is resting on the towel. Assist them if they are unable.
  12. Place a washcloth folded lengthwise over the client’s eyes. Ask the client to hold it in place if they can.
  13. Submerge the cup or pitcher in the basin of water to fill it. Pour the water over the client’s head to completely wet their hair, starting at the roots.
  14. Place a small amount of shampoo in the palm of your hand, and then rub your hands together to evenly distribute the shampoo before rubbing it into the hair. Lather the shampoo through the hair, from the roots to the ends.
    1. Note any red, open, or scabbed areas on the scalp or behind the ears.
  15. With the second towel, wipe the excess lather from your hands.
  16. Submerge the cup or pitcher in the basin of water to fill it. Pour the water from the cup or pitcher over the client’s hair to remove all shampoo, starting at the roots.
  17. If the client desires conditioner, place a small amount in the palm of your hand, and then rub your hands together to evenly distribute the conditioner before rubbing it into the hair. Lather the conditioner into the hair, from the roots to the ends.
    1. If the client does not want conditioner, proceed to Step 20.
  18. With the second towel, wipe the excess conditioner from your hands. Place this towel in the linen bag.
  19. Pour the water from the cup or pitcher over the client’s head to remove all conditioner from their hair, starting at the roots.
  20. Gently squeeze the client’s hair from the roots to the ends to wring out excess water.
  21. Remove the washcloth from the client’s eyes and place it in the linen bag.
  22. Ask the client to lift their head. Assist them if they are unable.
  23. Remove the trough from the bed, leaving the bed protector in place. Place the trough on the overbed table. Remove the towel from under the client’s neck and place it in the linen bag.
  24. Wrap the client’s head with the third dry towel, gently squeezing their hair from the roots to the ends to wring out excess water. Lay the client’s head on the bed protector.
  25. Remove gloves and discard into the wastebasket. Hand wash or hand sanitize, as appropriate.
  26. Raise the head of the bed to a Fowler’s position.
  27. Ask the client to lift their head. Assist them if they are unable.
  28. Remove the bed protector from behind the client’s head and place it in the linen bag.
  29. Place the pillow behind the client’s head. Cover the pillow with the fourth towel.
  30. Remove the third towel from the client’s head, and towel dry their hair as needed with this towel, and then place it in the linen bag. Remove the towel from the pillow and place it in the linen bag.
  31. Comb or brush the client’s hair. Replace glasses and hearing aids.
  32. Complete your finishing-up steps.
  33. Report any red, open, or scabbed areas promptly to the nurse.

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Using Medicinal Shampoo

When: During a shower or tub bath.

Why: To maintain clean hair for the client.

What: Supplies needed for this skill:

  • Medicinal shampoo

How:

  1. Ask the client if they prefer their hair to be washed during the tub bath. If so, hand the client a washcloth to cover their eyes.
  2. Submerge the cup or pitcher under water to fill it. Pour the water over the client’s head to completely wet their hair, starting at the roots.
  3. Place a small amount of shampoo in the palm of your hand, then rub your hands together to evenly distribute the shampoo before rubbing it into the hair. Lather the shampoo through the hair, from the roots to the ends.
  4. Medicinal shampoos—if the client requires a medicinal shampoo, first verify this on the care plan. Then follow the manufacturer’s directions to wash the client’s hair.
  5. Submerge the cup or pitcher under water to fill it, and pour the 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.
  6. If the client desires conditioner, place a small amount in the palm of your hand, then rub your hands together to evenly distribute the conditioner before rubbing it into the hair. Lather the conditioner into the client’s hair, from the roots to the ends.
  7. Submerge the cup or pitcher under water to fill it and 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.
  8. Ask the client to remove the washcloth from their eyes. Wet the washcloth, and then wring out excess water.
  9. Complete the remainder of the tub bath.

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Finishing-Up Steps

  1. Ensure that all of the client’s needs have been met and that the client is positioned as desired.
  2. See to safety. Replace any alarms or positioning devices, as indicated on the care plan or individual service plan. The bed is in the low position and is locked.
  3. Place the call light within easy reach.
  4. Clean and replace equipment, and return supplies to the designated place in the client’s room or facility storage area.
  5. Leave the room clean and in order. Ensure that the bed is made. Remove trash and dirty linens from the room.
  6. Complete hand hygiene.
  7. Report and document, as required by your facility.

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