TRINITY VALLEY COMMUNITY COLLEGE
ASSOCIATE DEGREE NURSING
RNSG 1271
PROCEDURE GUIDE AND CHECK-OFF SHEET
PERFORMING A BED BATH
Bathing patients serves the following functions: Removes body secretions, dead skin cells, microorganisms, and
waste elimination, stimulates circulation, promotes relaxation and comfort, decreases body odors, and can provide
positive interaction between the healthcare giver and the patient.
Delegation: This procedure may be delegated to unlicensed assistive personnel; however, using this procedure for
gathering assessment data may be considered a nursing responsibility.
Procedure
The following equipment is needed for this skill:
a) warm water in sink or tub
Scientific Rationale
a.
b) cleansing agent (soap)
b.
c)
c.
bath blanket, towels and washcloths (may
be disposable)
d) fresh gown/apparel
e)
1.
gloves (follow standard precaution
guidelines).
f) soap and rinse water (2 basins) unless
using no rinse soap.
Assess the patient’s ability for self-care and the
need for assistance.
d.
The water temperature should be comfortable to
the patient and must be verified by the caregiver
since all patients may not be able to identify safe
temperatures. The basic bath is not designed to
alter the patient’s temperature, so body temp is
important.
Some patients may be allergic to soaps and this
needs to be determined before proceeding.
Some soaps act as drying agents, especially in the
elderly, and are not appropriate.
Some bathing towels are available with prepared
cleansing agents that are sensitive to skin and are
not required to be removed after use.
Gloves are appropriate if any open wounds,
lesions, or body secretions are present.
2.
Prepare the supplies and position the bed to a
height comfortable for the caregivers.
3.
Place a bath blanket, if used, over the top of
the sheet and gently remove the top sheet.
If linen is not being changed at this time, place
a disposable towel or covering over the lower
sheet. Dispose of any soiled linen per hospital
policy;
retain any linen to be reused by placing it on a
clean environment (i.e. chair).
4.
5.
Some patients may be able to perform parts of their bath
and should be encouraged to do so. Some patients benefit
by having two caregivers attend to the bath for time and
comfort, and/or safety of the caregiver.
By working at a comfortable level – the caregiver avoids
muscle strain and reaching. Lowering side rails if present
also helps. Never leave the patient unattended (or turn
your back) with the bed elevated or the rails lowered.
Provides privacy, comfort, and warmth for the patient.
Standard precautions & decreasing cross contamination of
microorganisms is important. Protect the linen underneath
from becoming wet with bath water.
Procedure
Scientific Rationale
7.
6. Remove the patient’s gown while keeping
the patient covered with towel or blanket.
Prepare a washcloth for use.
8.
Begin washing the face (for total care bath):
Maintaining a sense of privacy is important to patient self
image.
Making a mitt prevents dragging across the skin and
retains heat and moisture.
Systematically clean from the face downward to the feet.
This promotes a sense of cleaning from the cleanest to the
parts deemed less clean.
a. Changing the washcloth to unused portions
between strokes prevents cross contamination or
microorganisms and secretions entering the
lacrimal ducts.
b. Some patient’s prefer not
having soap used on their
faces, due to the drying effect,
so ask first.
6.
a)
Gently wash the patient’s eyes and dry
them. Use a separate part of the
washcloth for each area and stroke. Wipe
from the inner eye toward the outer eye.
b) Cleanse the rest of the patient’s face, ears,
throat, and neck.
c) Dry the areas just cleaned.
9. Wash and rinse the arms and hands:
a. Elevate and support each appendage at
the joints.
Use long, firm, strokes from wrist to
shoulder, including under the arm.
c. Place the patient’s hand in a basin if used,
and allow to soak briefly, then focus on
cleaning the nails and between the digits.
d. Dry each appendage after cleansing.
10. Wash the chest and abdomen:
a. Keep a towel or cover over the breasts while
cleaning.
b. Carefully include skin folds, such as under a
breast.
c. Rinse and dry well.
11. Wash and rinse the legs and feet:
a. Keep a covering over the perineal area.
Remember to protect the lower linens.
b. Cleanse each leg using firm, long stokes
from the ankle to the thigh.
a.
b.
c.
d.
The feet may be washed by placing them in
the basin. Change the water as needed if it
becomes cool or dirty.
Dry each foot carefully, between toes and
spaces between toes.
e. Replace wash and rinse water and wash
cloths prior to washing the back.
12. Place the patient in a comfortable, lateral
position facing away from the caregiver and
b.
c.
a.
b.
Elevation promotes circulation in the extremities
through venous return.
Firm strokes promote circulation.
Immersing the hands in water
helps loosen dirt under the
nails and soothes some patients.
Patient privacy should be maintained.
Skin folds often harbor microorganisms from
perspiration and moisture and are easily irritated.
a.
Privacy and dignity should be retained for the patient.
b.
Distal toward proximal movement promotes
circulation through venous return blood flow.
c.
Remember that dark skin patients have darker cells
that may be removed, and the water may appear
dirty, but that does not mean that the patient is less
clean than lighter skinned patients.
d.
Discuss cross contamination of microorganisms.
Proper positioning decreases back strain and stretching for
the caregiver.
Procedure
wash the backside and then the perineum:
a. Keep the patient covered as much as
possible. Lay a covering over the lower
linen.
b.
c.
Wash and dry from the shoulders toward
the lower back, buttocks, and upper
a. thighs.
Carefully wash and dry between any
gluteal folds.
d. Perform a back massage if appropriate.
13. 13. For patients unable to perform perineal
care, reposition the patient and complete that
portion of the bath. Note: Refer to perineal
cleaning procedure.
14. Remove wet and used linen discarding
according to hospital policy and standard
precautions.
15. 15. Assist the patient with clean apparel (gown
or own clothes) and perform additional hygiene
and grooming activities such as powder, hair
combing, oral care, deodorant.
16. Position the patient for comfort and safety.
Return the side rails and place the bed in the
desired position. Leave the patient with call
light and room controls within easy reach.
17. Document the bath and any assessment data
observed during the procedure.
18. Considerations for the elderly:
Moisturize after the bath and
use powder sparingly.
19. Considerations for the infant:
Sponge baths are suggested
and the infant should be dried
and wrapped immediately.
N:ADN/Procedures/Bed Bath
Scientific Rationale
a.
Keeping the patient covered to provide warmth
and privacy while the bath is completed.
b.
Protect the lower linen unless planning to change
soiled or wet sheets. Cleanse from the least soiled
to the most soiled areas.
Skin folds are moist dark areas and may harbor
microorganisms.
c.
Some patients with upper arm strength and mobility
prefer cleaning themselves. The caregiver is still
responsible for assessing the area.
Use powder sparingly since unnecessary release of powder
can irritate respiratory tracts and excess powder can cause
caking in folds which act as a skin irritant.
Cleaning and straightening the patient’s environment after
bathing is good time management. The caregiver is
responsible for the patient’s environment and an orderly
and safe environment increases self esteem and dignity.
Hospitals may have a checklist format for bath completion,
delineating between partial and total bed baths.
Assessment data would be additional documentation in
the nurse’s notes.
Elderly may have decreased skin oils, fragile skin, and less
elasticity from lack of moisture in the skin.
Daily tub baths are not considered necessary for infants
and the infant’s thermoregulatory system is immature and
allows heat loss more readily.
Reviewed 04/14