IntroductionPersonalcare means providing care that is related to the patient’s body, appearance, hygiene, and movement. Show
Tasks Related to Personal Care Include:
People may require personal care for a number of reasons. Assistance with personal care may be temporary while a person is recovering from an injury or illness or may be permanent, and is required for the remainder of their lives. Types of Patients Who May Need Personal Care Include:
ProvidingpersonalcareisapriorityfortheHomeHealthAide/PersonalCareAide. It is the most important task they do. Personal care provision demonstrates to the patient concern about their physical health and general well-being. This module will explore the importance of providing personal care and provide instruction with performing tasks related to personal care. The importance of infection control and how Home Health Aides/Personal Care Aides can work to break the chain of infection in order to keep patients healthy is discussed. Bathing, teeth/mouth care, dressing/grooming, toileting, and eating are topics discussed with explanation on how Home Health Aides/Personal Care Aides can provide assistance with these types of personal care. Transferring patients to and from various positions, and assisting with ambulation are detailed. Care of the infant with regard to properly holding, feeding, and bathing is discussed. Finally, for Home Health Aides who will assist with the self-administration of medication, the importance of the five rightsofmedicationself–administration: right patient, right medication, right dose, right route, and right time are reviewed. Unit A: Infection ControlInfectionControlProviding personal care begins with the Home Health Aide/Personal Care Aide and their ability to maintain proper infectioncontrol. Handwashing is the number one way to prevent the spread of infectious agents. An infectiousagent is anything that can cause disease, such as bacteria, virus, or parasites. It is the easiest and most effective way for a Home Health Aide/Personal Care Aide to stop the chain of infection. Chain of InfectionThe chainofinfection is how infection is transmitted (passed). The chain of infection consists of five parts: reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host. 1. Reservoir: A reservoir is the same thing as a host. Reservoirs include humans, animals, and the environment, such as water or soil. This is the person, animal, or place where the infectious agent lives and grows (CDC, 2012). 2. Portalofexit: This is how the infectious agent leaves its host (CDC, 2012). Portals of exit can include the respiratory system, urine, feces, and even the skin. For example, if a person has influenza (the flu), they can transmit the virus to another person when they sneeze. If a person has hepatitis B or HIV, they can transmit the virus through their blood or body secretions. 3. Modeoftransmission: This is how an infectious agent is transmitted (or given) to a person. There are several modes of transmission: direct contact, droplets, airborne, vehicles, and vectors (CDC, 2012).
4. Portalofentry: This is how the infectious agent enters the host or person (CDC, 2012). The portal of entry is often the same as the portal of exit. For example, influenza exits an infected person’s respiratory tract and enters another person’s respiratory tract (CDC, 2012). 5. Susceptiblehost: The susceptible host is the person or animal who contracts the infectious disease. The very young and the elderly are most at risk for contracting an infection. The immune system is not fully developed in a young child. As we age, our immune system is no longer as effective as it was when we are young. People who are already sick or immunocompromised (who have an immune system that is unable to fight infection) are at high risk for becoming a susceptible host. Home Health Aides/Personal Care Aides have an important role in breaking the chain of infection. By properly washing hands, wearing gloves when coming into contact with body fluids and blood, and properly cleaning and sanitizing equipment and the home, HHAs/PCAs can help stop the chain of infection. Other ways that HHAs/PCAs can help break the chain of infection include teaching patients to sneeze or cough into a tissue and then immediately wash their hands. Teaching patients to practice proper hand hygiene before meals, after using the bathroom, and anytime hands become soiled is another important way HHAs/PCAs can help stop the chain of infection. HHAs/PCAs should also teach patients to place used sharps from needles in designated sharps containers. Used needles should never be disposed of in the garbage or left out. This puts others at risk for contracting an infectious disease. Disposal of sharps containers will vary depending on where the HHA/PCA lives. This is an important issue that should be discussed with a supervisor. Handwashing is the number one way to prevent the spread of infection. Hands should be washed when they are visibly dirty or soiled with blood, body fluids, and secretions. Hands should be washed before and after eating and using the restroom. Hands should be washed when arriving at and before leaving the patient’s home. Wash your hands before putting on gloves and after removing them. Wash your hands before and after all patient contact, including contact with the patient’s belongings. When Home Health Aides/Personal Care Aides care for patients, they should always practice proper hand hygiene and use personalprotective equipment (PPE). This includes the use of gloves. Gloves should be worn anytime the HHA/PCA will come into contact with blood or body fluids, such as urine, feces, or vomit. Gloves should always be changed when they are visibly soiled or ripped. The following procedures will discuss proper handwashing, Donning and doffing of gloves. Procedure: Hand Washing
Use of Alcohol-Based Hand Sanitizer:
Procedure: Donning & Doffing glovesGloves should be used any time you will come into contact with blood or body fluids including vomitus, urine, feces, or saliva. Gloves should also be worn when providing a bath, mouth care, when shaving a patient, and when disposing of soiled linens, dressings, and bed pads. Gloves should be worn anytime you have cuts or open areas on your hands in which bacteria could enter your skin. If allergic to latex Home Health Aides/Personal Care Aides should inform their employer so that appropriate latex free gloves can be provided to them. Gloves are only to be used once. Never wash or reuse them. Any time gloves become soiled, torn, or wet, replace them with new ones. Remember to perform hand hygiene prior to and after removing gloves. Donning (Applying) Gloves:
Doffing (Removing) Gloves:
Unit B: Bathing, Back Rubs & Assisting with a Clean DressingAssisting a patient with regular bathing is important for patient health and for promoting self-esteem and healing. Patients who are recovering from an injury or illness, have a chronic condition, are permanently disabled, dying, or who are frail may require assistance with performing this essential task. This is an important part of the job of a Home Health Aide/Personal Care Aide. The Care Plan will direct the HHA/PCA as to the frequency and type of bath that should be performed. At minimum, a patient should have their face and genital areas cleansed daily in the morning. In the evening, HHAs/PCAs should offer to assist or provide the patient with evening care. This includes washing the face, brushing teeth, and any other area the patient wishes. Providing for personal care gives Home Health Aides/Personal Care Aides an opportunity to assess a patient’s skin and to communicate with patients about their thoughts and feelings. The HHA/PCA should observe the patient’s skin for changes in color, temperature, swelling, new bruises, open areas, red areas, or sores. These should be documented and the supervisor informed. Home Health Aides/Personal Care Aides should always encourage the patient to perform any personal hygiene task they are able and provide assistance as needed. Some patients may be able to bathe or shower independently, or with minimal assistance. Some patients will require complete (ortotal) care, meaning the HHA/PCA will have to provide their personal hygiene care completely.If a patient is immobile, weak, or frail, bed baths should be provided instead of risking a patient fall in a bath tub. Never allow a weak or frail patient to stand in a shower alone. In these types of situations, a tub or bed bath may be more appropriate. The HHA/PCA can also shampoo the patient’s hair in bed by using a shampoo tray. Patients have a right to refuse any treatment, including bathing. The Home Health Aide/Personal Care Aide should provide education to the patient about the importance of bathing. Try to find out why the patient does not want a bath. Sometimes, the patient may not want a bath at that moment but would be willing to have one at a later time. Document the reason and patient refusal and inform the supervisor. When providing or assisting with a bath, water temperature should be checked. The temperature should be no greater than 105 degrees Fahrenheit. Allow patients to test water temperature to determine if it is comfortable for them. It is very important when providing or assisting with a bath that the patient is provided with privacy. This includes closing doors, drawing curtains, and limiting access of the area to others while the patient is bathing. Towels or bath blankets can be used to cover the patient’s body, exposing only the body part being washed during bed baths. Providing a back rub after a bath, before bed, or anytime a patient needs to relax is an important skill for the Home Health Aide/Personal Care Aide. This is an excellent way to teach a patient how to relax, assess their skin, and promote good circulation. We will discuss the proper way to give a back rub. Instructions for providing a tub or shower bath, assisting with a transferinto and out of a tub, providing a bed bath, shampoo in bed, back rub, and how to assist with changing a clean dressing areprovided in this section. Home Health Aides may never perform steriledressingchanges. They may only assist with non–sterile or cleandressingchanges. PersonalCareAidesmaynotperformany typeofdressingchange. Procedure: Tub or Shower Bath
To Transfer the Patient into the Tub:
Procedure: Bed BathAssisting a patient with regular bathing is important for patient health and for promoting self-esteem and healing. Patients who are recovering from an injury or illness, have a chronic condition, are permanently disabled, dying, or who are frail may require assistance with performing this essential task. This is an important part of the job of a Home Health Aide/Personal Care Aide. Providing for personal care gives Home Health Aides/Personal Care Aides an opportunity to assess a patient’s skin and to communicate with patients about their thoughts and feelings. Home Health Aides/Personal Care Aides should always encourage the patient to perform any personal hygiene task they are able and provide assistance as needed. Some patients will require complete (or total) care. Providing a bed bath allows a patient to receive personal hygiene care with minimal movement on their part.Explain the procedure to the patient.
Procedure: Shampoo in BedWashing a patient’s hair helps to promote good hygiene, comfort, relaxation, and self-esteem. It also provides a chance for Home Health Aides/Personal Care Aides to assess the condition of their patient’s hair, skin, and scalp. When washing a patient’s hair in bed, Home Health Aides/Personal Care Aides should ensure that the bed linens and patient clothing are protected by using towels or waterproof pads under their shoulders. Always assess allergies to products being used, and style hair according to patient preference. Take care to not pull on hair, which could damage the patient’s scalp. Older patients may have thinner, more fragile hair, and extra care should be taken.
Procedure: Back RubBack rubs can be given after baths, before bed time, after repositioning, and to help the patient relax. Back rubs help to relax muscles, stimulate circulation, and promote sleep. Back rubs last about 5 minutes. Always ensure that it is okay to provide a back rub. Home Health Aides/Personal Care Aides must check with their supervisor and in the Care Plan. Observe skin condition during back rubs for bruises, red, white, or open areas, and other signs of skin breakdown. Always report and record these observations and any changes in skin condition. It is helpful to use lotion during back rubs to reduce friction and moisturize skin. Lotion on skin also helps to prevent skin breakdown.
Procedure: Assisting with Changing a Clean (Non-Sterile) DressingHome Health Aides are able to provide assistance with or perform changing of clean dressings. They may not change sterile dressings. Sterile dressings are used over new, open, or draining wounds in which sterile technique must be maintained. This is to prevent introducing bacteria and other pathogens into the wound and causing infection. Clean (non-sterile) dressings are those applied to dry, closed wounds that have less risk of getting an infection. Personal Care Aides may not provide assistance with changing any dressings, whether they are clean or sterile.
Unit C: Teeth & Mouth CarePerforming or assisting with mouth hygiene is an important task of the Home Health Aide/Personal Care Aide. Mouth hygiene should be performed at least twice per day, with morning and evening care. Mouth hygiene may also be performed after eating meals and any time the patient requests. Regular, daily flossing helps to remove plaque and food debris which promotes bacteria, from the patient’s mouth. Unclean mouths harbor bacteria, which can cause additional health problems for the patient. Having a clean mouth promotes a sense of comfort and self-esteem for a patient. Providing oral care also gives Home Health Aides/Personal Care Aides a chance to assess the health of their patient’s teeth, gums, and tongue. Home Health Aides/Personal Care Aides should encourage their patient to perform as much mouth care independently as possible. For patients who are unable to grasp the handle of a toothbrush, special toothbrushes may be available for them. A split rubber ball or tape can be used to build up the handle of the toothbrush to make it easier for the patient to hold. An electric toothbrush may also be used. Avoid using hydrogen peroxide or alcohol based products because they promote mouth irritation and mucosal membrane breakdown. For a patient in which using a toothbrush is unsafe, such as those who are unable to spit or who is unconscious special mouth swabs are available for use. Mouth care should be provided every two hours for patients who are unconscious or unable to drink. This helps to prevent dryness and breakdown of mouth surfaces. When finished providing mouth care, apply lip moisturizer or petroleum jelly to lips to prevent skin breakdown, chapping, and drying of the lips. Procedures: Mouth HygieneProcedure: Patients Who Can Brush Their Own Teeth or Need Some Assistance
Procedure: Patients Who Are Unable to Perform Mouth Hygiene Independently, Such as an Unconscious Patient
Procedure: Denture Care
Procedure: Flossing
Unit D: Dressing & GroomingProviding assistance with dressing and grooming is an important task of the Home Health Aide/Personal Care Aide. Maintaining a person’s appearance is important especially during times of illness. It helps people to feel more like themselves and helps the patient appear familiar to family, which is important during times of stress and illness. Providing hand and foot care helps to maintain good physical health. By performing hand and foot care, the Home Health Aide/Personal Care Aide has an opportunity to assess the patient’s skin and nail health. Patients, especially those with conditions such as diabetes in which there is poor circulation to the feet, should have their feet inspected daily. Any red, open, bleeding, or problematic conditions should be reported to the supervisor. This section provides instruction about how to assist with patient dressing, apply compression stockings, provide hand and foot care, and shave a patient. Complete these tasks as directed by the Care Plan. Keep in mind patient preferences and respect the patient’s wishes. Procedure: Assisting with Dressing
For Patients Who Are Weak, Frail, or Paralyzed
Procedure: Assisting with the Use of Elastic Support StockingsSome patients may be prescribed by their doctor special elasticsupportstockings or compressionstockings to wear on their legs. These stockings are used for patients with poor circulation who are at risk for getting a blood clot. They are also used to help prevent or reduce swelling. Stockings should be placed on the patient’s legs prior to them getting out of bed in the morning. Follow manufacturer instructions in applying stockings. Follow instructions written in the Care Plan for guidelines for when to apply, how long the patient should wear stockings each day, and when to remove stockings.
Nail CareProviding nail care for a patient allows Home Health Aides/Personal Care Aides an opportunity to assess the health of their patient’s skin, nails, and the strength of their hands and feet. It also provides a sense of comfort and promotes self-esteem for the patient. While many patients may enjoy having their hands and feet cared for, take special care with patients who do not find this a pleasurable experience. Some patients have very sensitive feet and may be ticklish. Home Health Aides/Personal Care Aides should always tell a patient when they are going to touch their feet and inform them of what they are doing so that they expect the touch. Make sure to follow directions from a supervisor and those written in the Care Plan for nail care performed. Never use a nail clipper to clip finger or toe nails. Use an emery board to smooth nail edges. Home Health Aides/Personal Care Aides should inform their supervisor if advanced nail care needs to be performed. Never perform toenail care on a patient who has diabetes. These patients require special care from a podiatrist. It is acceptable to cleanse and inspect these patient’s feet, but never clip their toenails. Procedure: Hand Care
Procedure: Foot Care
Procedure: Shaving the PatientShaving facial hair may help a patient feel good about themselves and helps them to maintain their appearance in the way it was prior to becoming unable to provide their own care. It also helps the patient to appear familiar to their family and friends, which can be comforting during periods of illness. Before shaving a patient, Home Health Aides/Personal Care Aides should obtain their consent. Inquire about their preferences as to products used such as shaving cream and aftershave, and the style they prefer to wear their facial hair. Always wear gloves during shaving due to the risk of bleeding. Use the type of razor a patient prefers. Always check with a supervisor and the Care Plan to ensure that the patient can be shaved with a razor that has a blade. Some patients are on medication or have conditions that put them at a higher risk of bleeding. Their doctor may only want them to use an electric razor. Shaving cream should always be used with razor blades. Shaving cream is not to be used when using an electric razor. Never use someone else’s razor on a patient. Blood borne diseases can be spread this way due to the possibility of blood on the patient’s razor.
To assist with shaving underarms and legs, follow the same procedures and guidelines as above. Shave leg hair from ankle to knee, using short, smooth strokes upward. Some women also like to shave their knee to thigh area. Ask the patient what their preference is. Apply shaving cream to legs or underarms prior to shaving. Ensure the razor used is sharp, not dull. Shave underarm hair in short, smooth strokes. Underarm hair can grow in all directions. Always shave in the direction of hair growth. Unit E: Assisting with EliminationEvery patient has elimination needs. There are a number of ways the Home Health Aide/Personal Care Aide can assist a patient by providing for elimination needs. Patients who are unable to get out of bed due to mobility issues or injury may benefit from using a bedpan. Male patients may benefit from using a urinalat the bedside to prevent having to walk to the bathroom. Some male patients have condomcatheters, which are external urinary drainage systems where a condom is applied to the penis and attached to a urinary drainage bag. Other patients may have indwellingcatheters in which the catheter is inserted into their bladder. The catheter is attached to an external urinary drainage bag. The Home Health Aide/Personal Care Aide has an important role in providing assistance with elimination and cleansing the genital area after elimination. This section will explore how to offer a patient a bedpan or urinal, how to apply a condom catheter, and how to cleanse the genital area and catheter tubing. Instruction is provided about how to empty urinary drainage bags that are attached to condom catheters and indwelling catheters and how to properly measure urine output. Procedure: Use of a BedpanPatients who are unable to get out of bed may need to use a bedpan when urinating or for bowel movements. The standard bedpan looks like a toilet seat and has a wide, high rim. These types of bedpans are placed under the patient with the widest end under their buttocks. The fracture pan has a lower, thinner rim. The smaller, flatter end is placed under the buttocks. The higher end with the handle is placed facing the patient’s feet. The fracture pan should be used for patients who are unable to lift their hips for bedpan placement after back or spinal injuries or surgeries.
Procedure: Use of a UrinalThe use of a urinal helps the male patient to privately and safely urinate without having to ambulate to the bathroom or commode. Many male patients may find it easier to urinate in a high sitting or a standing position. Assist the patient into the position they are most comfortable and can safely assume during urination. Home Health Aides/Personal Care Aides may need to assist some patients with positioning and holding the urinal while they urinate.
Procedure: Assisting with the Use of a Condom CatheterCondom catheters are worn by some males to assist with urination. This urinary drainage system allows a patient to engage in their normal activities, while not having to be concerned about problems with urination such as incontinence. It is a less invasive urinary drainage system than an indwelling catheter and has a low risk of infection. It is important for Home Health Aides/Personal Care Aides to ensure the tubing to this urinary drainage system is not kinked or twisted, and that the drainage collection bag is worn below the level of the bladder.
Procedure: Assisting with Cleaning the Skin and Catheter TubingProviding personal hygiene care is an important part of the Home Health Aide/Personal Care Aide’s job. Cleaning the catheter tubing should be completed on a daily basis when providing bathing and perineal care for the patient.
Procedure: Assisting with Emptying of the Urinary Drainage BagDrainage bags on urinary collection systems, such as those from indwelling catheters or condom catheters need to be emptied on a regular basis. Home Health Aides/Personal Care Aides should frequently check that the tubing on catheter systems is not twisted or kinked. Home Health Aides/Personal Care Aides should always ensure that drainage bags are below bladder level. Never hang them from bed rails as the bag will move when bed rails are raised or lowered.
Procedure: Measuring Urinary OutputFluid that is taken in must be eliminatedfrom the body. Urine that is excreted from the body is called output. It is important for Home Health Aides/Personal Care Aides to measure the output of their patients to ensure optimal health. A patient may have a condition in which the healthcare provider wants to ensure that their intake equals their output. This helps to ensure adequate fluid balance. Fluids are usually measured using milliliters (mL). The agency will specify the unit of measurement Home Health Aides/Personal Care Aides should use. Urinals and catheter drainage systems have measuring lines on the system. The amount of urine at the number indicates the amount of output. For patients who use a toilet, commode, or bedpan, urine contents can be emptied into a graduated or other measuring pitcher to provide an accurate measurement of output. Contents can be disposed of down the toilet once the urine has been measured.
Unit F: Assisting with EatingAn important part of the job of a Home Health Aide/Personal Care Aide is to assist patients with eating. This may include planning and preparing meals, shopping for ingredients, serving food, and feeding. Home Health Aides/Personal Care Aides can provide an atmosphere that is pleasant during meal time. Ensure there are no unpleasant odors. Empty trash cans, and remove urinals and bedpans from sight. Offer to assist the patient to the bathroom and to perform mouth care prior to eating. Ensure patients who wear dentures place them in their mouths prior to eating. This allows the patient to better chew and digest their food. Patients should always be positioned in an upright position during mealtimes. This helps to prevent choking. For patients who have swallowing or choking problems, they should be kept in an upright position for 30-60 minutes once their meal is complete. Patients with visual impairments may need to be instructed about the position of food on their plate. An easy way to do this is to use the clock method. Instruct patients about position of food using the face of a clock as a guide. For example, “The peas are at 2:00, the meatloaf is at 6:00 and the rice is at 9:00.” Some patients may only need assistance with preparing food and are able to eat independently. Many types of adaptive equipment such as special plates, cups, and eating utensils are available to help people be as independent as possible while eating. Other patients will require complete care during eating and the Home Health Aide/Personal Care Aide will need to feed the patient. HHAs/PCAs should sit next to patients while feeding and offer to keep those who are independent eaters company. Mealtime is a good time to get to know the patient. Patients who prefer to pray or have religious or spiritual practices prior to meals should be allowed to practice these rituals. Give privacy as appropriate and requested. Home Health Aides/Personal Care Aides should offer foods that are appealing to their patient and allow them to choose the foods they would like to eat, as appropriate. Follow ChooseMyPlate guidelines as discussed in Module 8 when selecting and preparing food to serve to patients. Follow Care Plan guidelines when preparing special diets. Refer to Module 8 for specific instruction about preparing special diets. Procedure: Assisting with Eating
SpecialNeeds
Procedure: Measuring IntakeTo maintain adequate health, we need to take in a certain amount of fluid per day. Depending on a patient’s condition, they may either be encouraged to drink fluids or limit their fluid intake. Fluid that is taken in is called intake. Fluids are usually measured using milliliters (mL). One cup of liquid is 8 ounces or 240 mL. The amount of food that is eaten can also be measured. This can be done by weighing the food prior to serving and subtracting the amount left to get the total intake. Food intake can also be measured by determining percentage eaten. If all the meal is consumed, the intake is 100%. If none of the meal is consumed, the intake is 0%. A quarter of the meal consumed would be 25% and half the meal consumed would be 50%. The agency will specify the unit of measurement to be used.
Unit G: Assisting with Transfers, Turning and Positioning, and Body MechanicsProcedure: Proper Body MechanicsProper body mechanics means using your body in an efficient and safe way. Using proper body mechanics prevents Home Health Aides/Personal Care Aides from injuring themselves or their patient. Proper body mechanics involves always using good posture, keeping your back and trunk straight and aligned with your hips, and keeping your head facing forward toward the direction you are working. This prevents twisting, which increases your risk of injury. Turn your entire body, including your legs in the direction you move. Never twist the trunk or waist. Bend your legs and not your back while working. Your feet should be about 12 inches apart to provide a strong base of support and balance for you to work. Use the larger and stronger muscles of your thighs, hips, shoulders, and upper arms while bending or lifting objects. This protects your back and smaller muscles from injury. Keep objects close to your body when lifting or carrying them. Home Health Aides/Personal Care Aides should always raise the bed to waist height when working with a patient who is in bed or making a bed. This prevents unnecessary bending of the back. When pushing, place one leg forward. When pulling, move one leg back. This provides you with a stronger and more stable base of support. Keep in mind when moving a patient that your path, or direction in which you are moving should be clear of objects that could get in the way and cause potential injury. Home Health Aides/Personal Care Aides should always lock the brakes on the bed and wheelchair before transferring a patient. This prevents the bed or wheelchair from moving and causing potential injury to them or the patient. Procedure: Standing
Procedure: Lifting
Procedure: Using Proper Working Height
Turning and Positioning the PatientTurning a patient in bed is an important task of the Home Health Aide/Personal Care Aide. It is very important to protect the patient’s skin any time they are turned or moved. Friction (rubbing of two surfaces together, such as the skin rubbing against a sheet) and shearing(when skin sticks to a surface, such as a sheet, and the muscles underneath slide in the direction the body moves) can cause skin breakdown and injury. Friction and shearing can also occur when the patient slides down in bed. To reduce friction and shearing, use a drawsheet orbedpad (these are special linens placed underneath patients to help lift them in bed) when moving a patient. When lifting or moving patients in bed use at least two people to assist as often as possible. Never pull on a patient’s body part to lift or turn them, as this can cause a serious injury. Patients should be turned every two hours to prevent development of pressure ulcers. There are a number of positions in which patient can be placed. Alternate the positions used to help prevent pressure ulcers and to provide patient comfort. Position pillows under bony areas to prevent pressure ulcers. If patients prefer to stay in one particular position, a pillow should be placed under one buttock or hip to prevent pressure ulcers. This pillow can be rotated to the other side with the next position change. For example, the patient has a pillow placed under their right buttock at 10 am. With the 12 noon turn and position, the pillow can be moved to under the left buttock. Positions:
Pillows should be placed under bony prominences to prevent pressure ulcers. Examples of Bony Prominences That Are at Risk for Pressure Ulcers:
Before repositioning the patient, Home Health Aides/Personal Care Aides should also offer the use of the restroom, bedpan, or urinal. Patients should also be offered a glass of water at this time to ensure proper hydration. Ensure the patient’s body is in proper alignment once you are done positioning them, and that pillows are used to support body parts. Procedure: Turning the Patient in Bed
Procedure: Positioning the PatientPatients who are bedbound or who are unable to turn themselves must be turned and repositioned every two hours. This helps to prevent pressure ulcers development. There are a variety of positions Home Health Aides/Personal Care Aides can choose to rotate the patient to. OnBack (Supine Position)
LateralPosition (Also Calleda Side-Lying Position)
Prone Position (onAbdomen)
Assisting Patients to Transfer to and from Different PositionsPatients may require assistance moving among positions. They may need assistance moving from a lying down to a sitting position and from a sitting upright position to moving to the edge of the bed. If the patient would like to get out of bed, the Home Health Aide/Personal Care Aide should assist them to a sitting position and allow them to sit at the edge of the bed for a few minutes prior to standing. This helps their bodies adjust to changes in blood pressure and helps prevent falls. This section provides instruction for how to assist patients move from a lying down to a sitting position, from a sitting upright position to the edge of the bed, and finally to a standing position. Assisting with walking (ambulation) is also discussed. This is an important skill for the Home Health Aide/Personal Care Aide. Patients benefit from exercise in order to maintain and improve muscle and bone strength. Instruction is also provided for assisting patients transfer to a wheelchair, chair, toilet, commode, and shower. Proper positioning of a patient while in a wheelchair is also discussed. Patients who spend a great deal of time in wheelchairs are at risk for pressure ulcers. They should be encouraged or assisted to turn and position every two hours. Pillows may be used to relieve pressure points. Procedure: Transfer to the Sitting Position in BedPatients may require instruction or assistance with sitting up in bed. Sitting up in bed allows a patient to eat, engage in visits with loved ones, or participate in other activities. Some patients may become dizzy or feel faint if they sit up too quickly. Home Health Aides/Personal Care Aides should always watch their patient for signs of dizziness and inquire as to whether they feel faint when changing positions from a lying down to a sitting position. If dizziness or faintness persists once the patient is in a sitting (Fowler’s) position Home Health Aides/Personal Care Aides should , assist them back into a lying down (supine) position and inform their supervisor.
Procedure: Helping the Patient to Sit at the Side of the BedIt is helpful when transferring a patient or assisting with ambulation to first assist a patient from a lying down to a sitting position. Care Plans may provide instructions for Home Health Aides/Personal Care Aides to assist patients to dangle (sit at the edge of the bed) for a certain amount of time per day. Care Plans may also instruct Home Health Aides/Personal Care Aides to allow their patient to dangle at the edge of the bed prior to standing or transfer. They should always watch their patient for signs of dizziness and inquire as to whether they feel faint when changing positions from a lying down to a sitting position. If dizziness or faintness persists once the patient is in a sitting position, assist them back into a lying down position and inform a supervisor.
Procedure: Helping a Patient to StandBefore ambulating a patient, Home Health Aides/Personal Care Aides should assist them to a standing position. Allow the patient to stand in place for 1-2 minutes to ensure that they are steady on their feet and to allow their body to adjust to the change in position. Many patients may become dizzy or feel faint when moving from a sitting to a standing position. If dizziness or faintness persists, Home Health Aides/Personal Care Aides should assist the patient back into a sitting position and inform their supervisor. The use of a gait belt is helpful to assist a patient during transfers. It helps to prevent falls and injury. The belt should be applied over the patient’s clothing and around their waist. Never apply a gait belt to bare skin as it could cause skin breakdown.
Procedure: Helping the Patient to Ambulate (Walk)Many patients will benefit from ambulation (walking), even for short distances. It helps to promote strength, endurance, and to improve circulation. It can also provide distraction and a sense of empowerment for a patient. Never push a patient to walk further than they feel able. Always follow the Care Plan for guidelines and instructions in ambulating a patient.
When transferring a patient to a wheelchair, chair, or commode, Home Health Aides/Personal Care Aides should position the chair the patient is transferring to on the patient’s strongest side. When transferring a patient back to the bed, wheelchair, or another chair, they should reverse the procedure, following the same safety rules. Home Health Aides/Personal Care Aides should always use proper body mechanics to ensure the safety of themselves and their patient.
Procedure: Positioning Patient in Chair or WheelchairPositioning a patient comfortably and safely in a chair or wheelchair is an important task of the Home Health Aide/Personal Care Aide. Just as in bed, patients need to be re-positioned every two hours when they are in a chair or wheelchair. Patients can also slide down while in a wheelchair or chair, and may require assistance to maintain a proper sitting position. Patients should sit on pressure distribution devices, such as wheelchair cushions. This helps to prevent pressure ulcer formation. If the patient is able, Home Health Aides/Personal Care Aides should instruct them to shift their weight from side to side every two hours to relieve pressure on their buttocks. Use a draw sheet/bed pad under a patient sitting in a wheelchair or chair. This will help a HHA/PCA with safely repositioning and lifting the patient.
Procedure: Transfer from Wheelchair to ToiletWhen transferring a patient from a wheelchair to toilet, Home Health Aides/Personal Care Aides should position the wheelchair chair next to the toilet, or at an angle facing the toilet. When transferring a patient from the toilet to the wheelchair, reverse the procedure, following the same safety rules. Home Health Aides/Personal Care Aides should always use proper body mechanics to ensure the safety of themselves and their patient. Remember to offer toileting at least every two hours, and more frequently as needed.
Procedure: Transfer from Wheelchair to Shower and Assisting with ShowerAssisting a patient who is in a wheelchair to bathe is an important task of the Home Health Aide/Personal Care Aide. A patient may be assisted into the shower from a wheelchair by using a gait belt and being guided first to sit on the edge of the tub and then to move into the shower. Home Health Aides/Personal Care Aides should always stay in the same room as patients who are weak or frail. Encourage the patient to provide as much care for themselves as possible. Provide assistance as needed.
Procedure: Transfer from Wheelchair to Stool or Chair in TubA person may be transferred from a wheelchair into a shower chair or stool in the tub. A shower chair is water and slip resistant. If the shower chair has wheels, ensure the brakes are locked during transfers and while the patient is using it.
Unit H: The Patient’s EnvironmentBeds should be made on a daily basis, usually in the morning after providing morning care. Having clean, dry sheets promotes comfort, prevents skin breakdown, and helps to promote a sense of well-being for the patient. Home Health Aides/Personal Care Aides should always ensure linens are wrinkle-free as this helps to prevent skin breakdown and pressure sore formation. Linens should be changed when they are wet, soiled, or if the patient requests. The Care Plan will direct Home Health Aides/Personal Care Aides as to how often linens should be changed.For patients who are bedridden, Home Health Aides/Personal Care Aides will have to make the bed or change the linens while the patient is in the bed. This is called “Making an Occupied Bed” and instructions are provided on how to do this in this section. While making an occupied bed, patients are turned to the opposite side the HHA/PCA is working. Procedure: Making an Unoccupied Bed
Procedure: Making an Occupied Bed
Unit I: Special Equipment used by Home Care PatientsPatients may have a number of special types of equipment that have been prescribed for them to use in order to be as independent as possible. Home Health Aides/Personal Care Aides should always be sure they know how to use the equipment correctly prior to using it with a patient. BedEquipmentPatients may be using their own bed or they may have a prescribed hospital bed. Learn how to properly use a hospital bed by practicing using the buttons to raise and lower the bed prior to using it with a patient. Mobility EquipmentPatients may have any number of equipment to help them with mobility. Learn which types have been prescribed to the patient and how to correctly use them. An important task of the HHA/PCA is to use and teach patients how to properly use mobility devices. Types of Mobility Equipment Include:
Toileting EquipmentPatients may have special equipment to use which will assist them with toileting if they have problems with mobility. These types of equipment help to meet the patient’s elimination needs and maintain as much independence as possible. Remember to offer toileting at least every two hours, or more frequently if the patient requires. Use proper safety procedures for transferring a patient to a toilet or bedside commode. Types of Toileting Equipment:
ScalesOne of the tasks of the Home Health Aide/Personal Care Aide may be to measure the patient’s weight on a regular basis. This helps to determine if the patient is maintaining an adequate weight. Some patients may be on a special diet to lose weight, while others are prescribed diets to help them gain weight. Patients with conditions such as kidney or heart failure may have to be weighed on a daily basis in order to measure if the patient is retaining fluid. Retaining fluid can lead to a worsening of their health condition. Accuracy is important when weighing a patient. Always ensure the scale is balanced to zero before weighing a patient. When weighing a patient, Home Health Aides/Personal Care Aides should encourage them to empty their bladder and bowels first. Weigh them first thing in the morning, and while they are wearing light clothing, such as pajamas. Depending on the patient’s mobility, they may have a bed scale, chair scale, balance scale, or bathroom scale. Learn how to properly use each type of scale. It is important to ensure the safety of the patient while weighing them. If a patient appears unsteady and unable to stand in order to be weighed, inform the supervisor. Remember too that people may be sensitive about their weight. Never chastise (scold) or be judgmental toward a person about their weight. Maintain privacy while weighing a patient and do not disclose a patient’s weight to others outside of the healthcare team, unless the patient states it is okay. Types of Scales:
This section will provide instruction about how to properly weigh a patient, use a hydraulic lift, and a slide board. The Home Health Aide/Personal Care Aide should always seek training from their agency to ensure they can correctly complete any procedure. Procedure: Weighing a Patient
Procedure: Assisting with the Use of a Hydraulic LiftAt least two people should assist during patient transfer with a hydraulic lift. This provides for patient safety. One person can operate the mechanical lift while the other ensures the patient moves on the lift safely by guiding and protecting their body as the lift moves them.
Procedure: Slide Board Transfer ProcedureA slide board, or transfer board, is sometimes used to help a patient transfer to a bed, chair, or bath stool when they are unable to walk or bear weight on their legs. Home Health Aides/Personal Care Aides should always ensure that the patient has clothing on so that the slide board does not touch bare skin. Rubbing against the slide board with bare skin can cause injury to the patient’s skin. A slide board should only be used for patients who have the strength to move themselves across it. Never drag a patient across the slide board. Always use a series of small movements to assist them cross the slide board.
Unit J: Care of the InfantProcedure: Handling the InfantHome Health Aides/Personal Care Aides may work with families who have an infant whom they must help care for.Sometimes, a mother or other caretaker may not be available to help care for the infant. They may also have health issues which prevent them from caring for the infant at that time. Always keep in mind family, cultural, religious, and social differences. Be respectful of the family’s beliefs, customs, and wishes. Remember, it is their child. The Home Health Aide/Personal Care Aide is there to provide support and to help care for the infant. When caring for a baby, it is very important for Home Health Aides/Personal Care Aides to be conscious of ensuring they prevent the spread of bacteria. Infants do not have a fully developed immune system. They are at very high risk for getting an infection. Home Health Aides/Personal Care Aides should always wash their hands before and after handling a baby, their clothing, bottles, and equipment. Wear gloves when providing diaper and bath care. Infants require constant supervision. They are not able to protect or care for themselves. Never leave a baby unattended, especially when providing a bath. The only safe place to leave a baby is in their crib lying on their back with their face up or with an adult holding them. Home Health Aides/Personal Care Aides should always ensure they lift and hold a baby safely. The head, neck, and back must always be supported. When traveling with a baby, the HHA/PCA must ensure the infant travels in a car seat specific to the baby’s weight. The infant should be secured in the car seat prior to the car being started. When feeding a baby, remember to keep their head higher than their body to prevent choking. Babies must be burped in between and after feedings. This helps to prevent choking and aids with digestion. Follow the feeding schedule as directed by the caretaker and Care Plan. When they are finished feeding and burping the baby, they should change his/her diaper. Concerns about the well-being or safety of the baby should be documented and brought to the attention of the supervisor. Procedure: Picking up the Infant
Cradle Hold
Shiftingtoa “Football” Hold
Positioning the Infant for Feeding and Feeding the Infant
Burping a BabyWhen the baby has finished feeding, or if she stops sucking, burp her. You may need to burp the baby during the feeding, periodically stopping the feeding to burp the baby. To burp the baby, lift the baby to your shoulder, supporting her head. Use a burp cloth or towel over your shoulder to catch any spit up. Alternatively, you can hold the baby on your lap, supporting the baby’s head by holding her chin with your thumb and forefinger. Ensure her head does not fall backward. You can also lay the baby down on a burp cloth positioned over your lap. The baby will be face down on their stomach. Your arm should be placed under the baby’s chest, supporting the neck and hand. Pat or massage up the back with the palm of your hand. Once the baby has burped, you can return her to a safe position or continue with the feeding. Clean the baby’s face with a warm, wet washcloth. Changing a DiaperAfter feeding, change the baby’s diaper. Always wear gloves when changing a baby’s diaper. Remove and discard the soiled diaper. Do not leave the baby unattended to discard the diaper. You can set it aside and discard it later if a garbage can is not within reach. Cleanse the baby’s perineal area with a warm, wet washcloth or baby wipes. Ensure the perineal area is completely clean and completely dry. Leaving urine or feces on a baby can lead to diaper rash or infection.Always wipe from front to back for female babies. Apply powder, ointment, or cream as directed in the Care Plan. Unfold the diaper and place it flat under the baby’s bottom. To place the diaper under the baby’s bottom, gently grasp her feet in your hands and lift just high enough to slide the diaper under her bottom. The tabs should be toward the back of the diaper, on either side of the baby. Pull the front of the diaper up, between the baby’s legs. Fold the right and left sides of the diaper toward the middle. Peel tape on the tabs open and secure diaper by gently pressing them against the front of the diaper. Replace any soiled clothing with clean clothing. Ensure the baby is placed in a safe area, such as her crib. Documenting the Baby’s Intake and OutputInput can be measured by measuring the amount you put in the bottle and subtracting the amount of fluid left. Output is usually recorded by number of diapers for urine output and number of bowel movements. Some agencies may require that you weigh the wet diaper. Record and report any observations, such as changes in the baby’s feeding habits, difficulty for the baby sucking during feeding, or an unusual amount of spit up.
Procedure: Infant BathInfant bathing is an important task for the Home Health Aide/Personal Care Aide. Infants should be bathed at least once per day, and according to the Care Plan. Never leave a baby unattended during a bath, not even for one minute. Home Health Aides/Personal Care Aides must always support the baby’s head and neck with one hand, while using their other hand to wash the baby. Remember, babies are unable to regulate their own body temperature. Home Health Aides/Personal Care Aides should always ensure they keep the baby covered whenever possible, and immediately after their bath, wrap a towel or blanket around them.
Unit K: Assisting with Self-administration of MedicationThe assistance of self-administration of medications by Home Health Aides is not allowed in every state or country. You should be specifically trained and assigned to provide assistance with medications. PersonalCareAidesarenotallowedtoassistwithadministrationofmedicationunderanycircumstance. Assisting with self-administration of medications is different than administering medications. Only licensed providers such as physicians, nurse practitioners, registered nurses, and licensed practical nurses may administer medications to patients. Home Health Aides may ASSIST patients with self-administration of medication. PersonalCareAidesmustneverassistwith medicationsinanyway. Assisting with medications means the HHA may remind patients about taking their medications, bring the medication to the patient, and bring other equipment needed to take the medication such as an inhaler to the patient. The HHA may bring liquid such as water to the patient so they can take their medication. Home Health Aides should assist the patient into the correct position so the patient may take their medicine. For example, for medications taken by mouth the patient should be in a fully upright position. This helps to prevent choking and allows the medication to move down the esophagus into the stomach. Medication should never be crushed unless the Care Plan specifically states. Remember to always keep medications stored in a locked area. If the Home Health Aide notices a patient taking a medication incorrectly or if the patient has a reaction to the medication the HHA should inform the supervisor.If medications are dropped or mixed up with other medications the HHA should inform the supervisor. If the HHA becomes aware of herbs, supplements, and medications the patient is taking and which they have not told the healthcare team about they should inform their supervisor. Home Health Aides may also show the patient the medication and read the label to the patient so that the right patient, right medication, right dose, right time, and right route may be checked. Understanding and following the 5 Rights of Medications helps to avoid medication errors. The Five Rights of Medications include: The Right Patient, The Right Medication, The Right Dose, The Right Time, and the Right Route. If Home Health Aides ever have a concern about any of these rights, they should speak to their supervisor immediately. The safety and well-being of a patient depends on their Home Health Aide. Procedure: Checking the Right Person (Patient)
Procedure: Checking the Right Medication
Procedure: Checking the Right Dose
Procedure: Checking the Right Time
Procedure: Checking the Right RouteThe routeformedication means the method by which the patient will take the medication. Routes for taking medications can include the: mouth, ear, eye, rectum, inhalation, and vagina.
Post-test
Check your answers! Post-Test Answers: 1 True 2. All are times when hands should be washed 3. False 4. All 5. All are ways to break the chain of infection 6. All are times when gloves should be changed. 7. A 8. False 9. True 10. False 11. False 12. All are reasons to offer a back rub 13. B 14. C 15. True 16. True 17. True 18. True 19. True 20. False 21. B 22. True 23. True 24. True 25. B, A, D, C 26. True 27. All are areas of high risk for pressure ulcer development 28. True 29. True 30. True 31. B 32. True 33. B 34. True 35. False 36. A 37. False 38. All 39. B 40. C Return ReferencesAmerican Dental Society. (2012). How to floss. Retrieved from http://www.mouthhealthy.org/~/media/MouthHealthy/Files/Kids_Section/ADAHowToFloss_Eng.ashx Center for Disease Control (2014). When and how to wash your hands. Retrieved from www.cdc.gov/handwashing/when–how–handwashing.html Centers for Disease Control and Prevention. (2012, May 18). Lesson 1: Introduction to epidemiology. In Principles ofepidemiologyinpublichealthpractice. Anintroductiontoapplied epidemiologyandbiostatistics(3rd ed.). Retrieved from http://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson1/section10.html Craven, R. F., & Hirnle, C. J. (2009). Fundamentalsofnursing: Humanhealthandfunction (6th ed.). Philadelphia, PA: Wolters Kluwer. Leahy, W., Fuzy, J., & Grafe, J. (2013). Providinghomecare: Atextbookforhome healthaides (4th ed.). Albuquerque, NM: Hartman. Sorrentino, S. A. & Remmert, L. N. (2012). Mosby’stextbookfornursingassistants (8th ed.). Saint Louis, MO: Mosby. What is a nurse's most appropriate response based on current research when asked about spanking as a disciplinary technique?What is a nurse's most appropriate response, based on current research, when asked about spanking as a disciplinary technique? "Spanking is strongly suggestive of negative role modeling."
Which step would a newly assigned nurse take first when revising the care plan of a client who refused the previous nurses care and insisted on completing self care?What should be the newly assigned nurse's initial step in revising the client's plan of care? 1. Get a full report from the first nurse and adjust the plan accordingly.
Which of the following is a principle of proper body mechanics when lifting or carrying objects?"Which of the following is a principle of good body mechanics when lifting or carrying objects? D - Maintaining a wide base of support and bending at the knees allows for good body mechanics. Locking the knees may cause strain on the lower back, as can bending at the waist.
When lifting remember to use the large muscles of your?Remember to lift with the large muscles of your legs.
This is one the most damaging movements to the spine. To avoid twisting, pivot your feet to complete the lift.
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