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Personal Care

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Aims

• To have a knowledge of different aspects of personal care

• To learn practical skills required to deliver personal care

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National Care Standards

Dignity Privacy Choice Safety Realising Potential Equality and Diversity

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What does Personal Care Include?

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Personal Care Includes

• Bathing, showering, hair washing, oral hygiene & nail care

• Toileting, catheter/stoma care, skin care, incontinence laundry, bed changing

• Assistance with the preparation of food and assistance with the fulfilment of special dietary needs

• Dealing with the consequences of being immobile or substantially immobile

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Personal Care Includes

• Behaviour Management, psychological support, reminding devices

• Assistance with medication (including eye drops), application of creams and lotions, simple dressing, oxygen therapy

• Assistance with dressing, surgical appliances, prostheses, mechanical and manual aids. Assistance to get up and go to bed. Transfers including the use of a hoist

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The Skin

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Functions of the Skin

• Protective covering for body• End organ – pain, touch & temperature• Secretes sebum- oily fluid which keeps skin and hair

moisturised• Absorbs small amounts of oily substances• Origin of hair and nails• Contains cholesterol, substance converted into Vit D by

the action of sunlight• Secretes sweat – removes waste water and salts and

plays important part in regulating body temperature

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Importance of skin care

• Keeping skin clean and fresh is essential for general health and wellbeing

• Dirty skin collects dried sweat, dead skin cells and secretions from the glands – bacteria breeds and causes odours and infections

• It is important to clean the skin at least daily. • If a service user is not willing to either have a bath or a shower then

they should be encouraged to have a daily wash. (even using body wash or baby wipes) especially to folds of skin

• If someone has a skin condition, this should be noted in their support plan.

• Older skin loses elasticity and sensation- be aware of extreme temperatures and use care when drying

• Pressure problems caused by- unable to move position, friction, continence issues, diet etc

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Infection

• Bacteria – UTI, chest infection

• Viruses- common cold

• Fungi- thrush, athletes foot

• Parasites- scabies, head lice

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Cross Infection

Definition Cross infection is the physical movement or

transfer of harmful bacteria from one person, object, or place to another, or from one part of the body to another

(Encyclopaedia of Nursing & Allied Health)

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Infection Control

• Wash hands!!• Check washing facilities are clean• Use handwashing gel if no suitable facilities• Wear gloves and apron where required• Wash hands after taking off latex gloves or before

putting on a new pair• Dispose of waste appropriately• Seek advice if someone has known infection e.g.

MRSA, Clostridium

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Personal Hygiene

• Maximises a feeling of freshness and comfort

• Looks after the skin and prevents damage to it

• Assisting someone with personal hygiene can help to identify early signs of injury, rashes, or skin dryness or soreness

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• Using the bathing/washing period to assess individual progress, can identify change of mood or ability to co-operate

• Note any physical signs, e.g pain on movement of a limb or bruising. This is important as confused or disabled people may be unable to recall a fall or knock.

Personal Hygiene

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Dressing / grooming

• Helps the person retain an interest in their appearance and standard of grooming

• Consider hair styling, make up etc• Respect choices but prompt with appropriate clothing

e.g. for weather• May need to support with sensory aids, prostheses

and orthoses

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The Importance of food & drink

• Food & drink are basic essentials for human beings to survive

• Food is an important part of social events in most cultures and there are often special customs associated with eating

• Meal times are opportunity to spend time with family / friends

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Nutrients required for a balanced diet

• Proteins

• Carbohydrates

• Fats

• Vitamins

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Possible Causes of Poor Nutrition in dementia• Not recognising that it is time for a meal

(orientation)• Forgetting to eat or drink/thought of having eaten

already (memory)• Difficulties cooking food / Not waiting to cook

food properly (concentration)• Food placed wrongly e.g sausages in cleaning

cupboard (confusion)• Physical causes e.g. sore mouth

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Things you might try

• Allow plenty of time to eat• Keep noise or activity around the table to a

minimum• Remove distracting items from table• Keep crockery simple and a different colour from

the table cloth• Make sure there is adequate lighting

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Things you might try (cont)

• Serve one course at a time• Serve food that is familiar to the service user• Keep eating simple- finger foods• Be aware of food temperatures• Check sell by dates etc• Encourage fluids- may not recognise

sensation of thirst• Find out preferences/choices- use pictures,

recipe books, TV programmes

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PEG feeding

• Percutaneous Endoscopic Gastrostomy

• Daily nutritional requirements fed directly into the stomach

• Person may still be able to eat and drink small amounts

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Peg Tube

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Continence & Dementia

• Approximately 50 – 60% of people with dementia are thought to suffer from incontinence. (mostly urinary)

• Rare for someone in earlier stages of dementia to suffer from incontinence.

• More often problems start as dementia progresses from moderate to severe stages.

• Often the incontinence is as a result of “inappropriate” urinating or defeacating rather than the person being totally unaware of their action

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General obstacles to continence

• Infection – urine infection (UTI)

• Poor diet and/or fluid intake

• Constipation

• Medication – side effects

• Alcohol

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Types of Incontinence

• Stress

• Urge

• Overflow

• Neurogenic

• Functional

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Stress Incontinence

• Weakness of the muscles that support the bladder (pelvic floor muscles)

• Leakage usually happens when coughing, laughing etc.

• Usually affects women• Can be caused by multiple pregnancies

or childbirth

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Urge Incontinence

• A sudden need to empty the bladder and not able to get to toilet in time

• Can be caused by caffeine, alcohol, anxiety or a neurological disorder such as diabetes or a stroke

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Overflow Incontinence

• The bladder remains and does not empty properly (what is passed is overflow)

• There is sometimes a poor flow of urine and constant dribbling

• Common in men with enlarged prostate

• Constipation can cause this by restricting flow of urine from bladder

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Neurogenic Incontinence

• The bladder loses its sensation and empties with no warning

• Treat with regular toileting and perhaps use incontinence pads (these can be supplied by community nursing staff)

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Functional Incontinence

• The inability to reach the toilet on time due to poor mobility, or the inability to interpret the signs of a full bladder

• Common in people with dementia

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Factors affecting continence in people with dementia

• Deterioration in personal hygiene

• Wandering/agitation/restlessness

• Anxiety

• Disturbed behaviour

• Communication

• Aggression

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Factors affecting continence in people with dementia

• Memory- may forget what they set out to do• Orientation – unable to find toilet especially in unfamiliar

environments• Dis-inhibition- where and when appropriate• Recognition- unable to recognise facilities or recognise

sensation of needing toilet• Apathy- motivation to get up and go• Physical difficulties- unable to remove clothing or get on /

off toilet due to e.g. arthritis, poor eyesight

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Promoting Continence - general

• Never accept incontinence as permanent or inevitable• Overcome your own embarrassment- be aware of your

facial expressions, body language and tone of voice• Use language that the person is familiar with• Use short simple instructions- don’t chatter• Consider other factors – e.g. diet, fluids (NB- never cut

down on fluids)

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Using the Toilet

To use the toilet you must be able to:• Recognise you need to go to the toilet• Plan ahead• Be motivated to use the toilet• Delay onset of passing urine• Locate the toilet• Possess the physical ability to get there, adjust

clothing and use the facilities• Remember what you set out to do• Use the toilet

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Things you might try - getting to the toilet

• Establish a routine• Tactful reminders- gentle coaxing, not forcing- ask if

the person wants to go with you• Ensure toilet is within easy reach and sight- perhaps

have vacant toilet door slightly ajar• Label toilet clearly, signposts • Ensure way to toilet is free from obstacles

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Things you might try -in the toilet

• Declutter toilet / bathroom• Clear away other receptacles e.g. bins• Ensure room is comfortable and not too cold / warm• Have floor and toilet seats different colours if possible• Consider aids e.g. handrails, raised seats, commodes• Be aware of your body position – don’t stand over person• Remember correct moving and handling• Keep skin clean- avoid too much soap• If using barrier creams – only thin layer as can reduce

effectiveness of incontinence pads• Remember handwashing – prompt/assist person with dementia

to do so

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Urinary catheters

• A tube passed into the bladder – usually via the urethra, sometimes through the skin above the pubic area

• Used when there is a medical need to drain or measure urine. This may include maintaining the comfort of a person who is very ill or dying.

• A catheter stays in place using a small, inflated balloon which sits in the bladder

• You may be asked to empty/change the catheter bag and assist in keeping the system clean.

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Urinary catheters

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Urinary catheters

• The main hazard is the introduction of infection and trauma• Always wash your hands before and after handling the catheter• Wear disposable gloves when emptying a catheter bag• Make sure there is no drag or pull on the catheter from the bag• Keep the drainage bag below the level of the bladder• Report any signs of redness, swelling or discharge• Unless otherwise directed, it is important the service user has a

healthy intake of fluids

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Stoma Care

• An ‘ostomy’ is a surgically made opening, which connects part of the internal body to the outside.

• Colostomy is an opening in the colon (bowel) to allow the removal of bowel contents.

• The bowel contents bypass the back passage and are collected into a bag (stoma bag) attached to the surface of abdomen

• Ileostomy - opening from the small intestine to the abdominal wall

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Stoma Care

• You may be asked to assist with emptying bags, checking surrounding skin for sores /redness and keeping the area clean and dry.

• Always wash your hands before and after handling the stoma

• Wear gloves when emptying bags• Report any signs of redness, swelling or

discharge

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Stoma Care

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Any questions??

• Practical sessions

• Feedback

• Thank you for listening!