Human Resources
Actress (Patrícia Bossolani Charlo): presents the video and records the scenes in which guidance is provided by the healthcare professional on patient hygiene and comfort care - the bed bath, skin hydration, and change of lying position (decubitus).
Actress (Rosely Marcão Coutinho): will play the role of the patient.
Equipment and consumables: basins; warm water; blanket and sheet; mobile sheet; soap; plenty of clean towels; gloves, if necessary; moisturizing lotion; pillows and/or cushions.
Location: internal space of the Laboratório de Simulação clínica e Habilidades [Clinical Simulation and Skills Laboratory] (SimuLab) of the Centro Universitário de Maringá (UniCesumar) . |
Scene 1. Video opening scene
- Hello, and welcome to the first educational video for informal caregivers of technology-dependent people. I’m Nurse Patricia, and in today’s video I’m going to explain to you how the bed bath, skin hydration, and changing of the lying position are performed. |
Scene 2. Patient presentation
The nurse enters the room and addresses the patient; the camera follows the actress (nurse) as she enters.
Woman lying on the hospital bed; the camera has both characters in frame.
- Hello, Rosely. My name is Patricia. I’m a nurse, and I’m going to give you a bed bath. I will guarantee your privacy by not allowing people to enter the room, okay?
At this moment, Patricia goes to the doors and windows and closes them to ensure that there are no drafts.
- I’ll prepare the material and then return, okay? |
Scene 3. Preparing the bath
Camera shows Patrícia gathering the material for the preparation of the bath. The materials gathered for the bed bath were: two basins, jar with warm water, washcloth, bath towel, compress, glove, soap, comb, gown or pajamas, bedclothes. The nurse fills the two basins with warm water, which was used to wash and rinse the patient. The temperature of the water is tested with the forearm (elbow) region. The water is pleasant to the touch. When choosing the soap, Patrícia prefers a neutral type and avoids exfoliating and alcohol-based soaps, because they dry out the skin. She prefers to put the soap in one of the wash basins, but she can also apply it directly on the patient’s skin. She reiterates that sponges or scrubs can hurt or eliminate the skin’s natural barrier, so their use should be avoided. Patrícia keeps all the materials near the bed, with plenty of towels and compresses for situations in which water spills over the patient or the aforementioned materials get dirty. In order to avoid discomfort due to a wet bed, Patricia places two towels under Rosely. To place the towels under the patient, the nurse turns her on her side and places the towel under her, returns her to a horizontal decubitus position, and repeats the procedure on the patient’s other side. To ensure that the patient remains warm and private, Patricia uses a sheet over Rosely’s body during the entire period in which the bath was performed. The bath began with the removal of Rosely’s clothes, and by folding the sheet and placing it over the patient’s bottom part. Her shirt was removed and the same procedure was performed with the lower part of the patient, covering her upper part and removing her lower garment. The nurse made sure that the patient was covered as much as possible while removing her clothing. She followed the technique of using the same cleansing and rinsing method for Rosely’s whole body, applying the soap to her skin. Patrícia used a washcloth wet with water and soap to clean and remove dirt, then used another washcloth with clean water from the second basin to rinse. After, she dried her. The nurse used material resources very gently so as not to be uncomfortable with the patient’s skin. The same process was performed all over Rosely’s body, and the water in the basins was changed whenever Patricia thought it was necessary. The whole process was presented in a detailed manner in “Scene 4”. |
Scene 4. Performing the bed bath
Camera points to Patrícia, who approaches Rosely with the goal of reaching the bedpan. Soon after, Patricia lowers the bed’s headboard and removes the pillow. Face - Gently, Patricia starts the bath by washing her face, ears, and neck area with soap and water. She then rinses and dries the cleaned area with separate towels for the two processes. Hair - The nurse lifts the patient›s head carefully and places it on top of the basin, pouring water over the head to wash the scalp with shampoo, while taking care that the water doesn›t reach Rosely’s eyes or ears. Patricia proceeds by rinsing the hair with clean water and drying it with a dry towel. Left shoulder and arm - The nurse folds the sheet covering Rosely’s body up to the hip. She then places a towel under the arm to expose the region and begins the process of washing it with soap, rinsing with clean water, and drying, these three processes with different towels. Patrícia is extra careful when bathing the armpit area to avoid skin irritation and proliferation of infectious microorganisms, keeping Rosely covered and warm whenever possible. Right shoulder and arm - The same process performed on the left side was performed on Rosely’s right side. Thorax, abdomen, and sides - To wash this anatomical region, Patrícia folds a sheet up to Rosely’s waist and, with gentle movements, washes and rinses the thorax, being careful with the breast region, belly, and sides of Rosely’s body, as these are regions where we may find microorganisms. Legs - Patricia uncovers Rosely’s right leg up to the waist and starts the bath with the sequence of washing, rinsing, and drying techniques, from the upper leg region to the foot. The same procedure is performed on the left leg. At this moment, the nurse notices the need to change the water in the basins, considering that the patient has already had half of her body cleaned. Patricia asks Rosely to turn her body sideways; she presents difficulty in doing so. The nurse checks to see if the patient is close to the edge of the bed to prevent her from falling and starts to help her turn on her side. Patricia approaches the bedpan and places it under Rosely. Attention must be paid to the handling of Rosely’s probes, drains, and catheters, which can be accidentally moved and even removed during the procedure. When moving the patient in bed, Patricia is careful not to drag her on the mattress. Avoiding friction is very important as the skin is more susceptible to injury. Back and buttocks - To expose and wash the back, Patrícia folds the sheet. She then washes, rinses, and dries Rosely’s back from the ventral part of the neck, going along the back and reaching the buttocks area. Genital area and anus - Patricia puts on disposable latex gloves and offers the patient the compress with the soap to proceed with intimate hygiene. Rosely finds it difficult to do this, so Patricia lifts the patient’s leg to wash it using a front to back movement, and then rinses and dries it with different towels. The nurse makes sure to dry the hard-to-reach areas, such as the folds, to make sure they are clean and dry. When finished, Patricia dresses Rosely in clean clothes and begins the skin moisturizing procedure. Keeping clothes clean, dry, and taut is important in decubitus ulcer prophylaxis.
ATTENTION: During the bath, Patrícia observes the conditions of the skin and bony protrusions to prevent injuries. She also makes sure that there are no wound dressings to be performed, because if there were, she should protect them and then change them(2121 Polit DF, Beck CT. Fundamentos de Pesquisa em enfermagem: avaliação de evidências para as práticas da enfermagem. 9ª ed. Porto Alegre (RS): Artmed; 2019.-2222 Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M. Bathing, bed making, and maintaining skin integrity. In: Clinical Nursing Skills: Basic to Advanced Skills. 9th ed. New York, NY: Pear-son; 2017.). |
Scene 5. Skin hydration after the bath
After the bed bath, Patrícia informs Rosely that she will hydrate her skin, because this helps in the activation of blood circulation and to maintain skin elasticity, thus avoiding lesions and dryness. With the help of moisturizers or essential fatty acids (EFA), better known as sunflower oil, Patrícia applies a minimal amount of the product, spreads it on her hands, and massages Rosely’s entire body with soft, firm movements. ATTENTION: Moisturizers after bathing should be encouraged; and talc (preferred by many elderly people) should be avoided because they increase dryness and contribute to obstructing pores, which will impair the skin’s perspiration function(2121 Polit DF, Beck CT. Fundamentos de Pesquisa em enfermagem: avaliação de evidências para as práticas da enfermagem. 9ª ed. Porto Alegre (RS): Artmed; 2019.-2222 Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M. Bathing, bed making, and maintaining skin integrity. In: Clinical Nursing Skills: Basic to Advanced Skills. 9th ed. New York, NY: Pear-son; 2017.). |
Scene 6. Change in decubitus
Patrícia, lastly, changes Rosely’s decubitus, who, due to being bedridden, has altered/reduced vascular permeability. While inspecting the skin during bathing, the nurse notices pressure points on the skin, which can result in lesions, possibly leading to new infections. Patricia carefully evaluates regions of bony prominence, such as the sacral region, trochanters, heels, and/or ankles to verify the positions of least pressure in which Rosely feels most comfortable. Decubitus changes are tools used to prevent pressure ulcers (PUs), especially in people with reduced mobility or who are in the same situation as Rosely. In bedridden situations, postural changes should be scheduled, which was Rosely’s case.
Right/left lateral decubitus - Patricia chose to position Rosely to the right side and use a pillow or blanket wrapped around her dorsal region, repositioning her head on the pillow. Patricia used pillows between the regions of bony prominence contact, such as the knees, to avoid friction and shear and to give Rosely more comfort.
Dorsal decubitus: After a few hours, which on average is two to three hours, Patricia performed decubitus change, keeping Rosely with her abdomen facing upward. The nurse used a pillow to reposition the head and shoulders and to keep the legs and knees elevated.
ATTENTION: Patricia avoids movements that promote friction, which can compromise the integrity of Rosely’s fragile skin. In addition, the nurse performs decubitus changes according to the position in which the patient feels most comfortable in bed, which reduces the incidence of skin cracks that lead to pressure injury.
|
