Peri-care without gloves?

[lightwing]

I just shadowed for a private in-home position for a quadriplegic gentleman to observe his morning routine.  I found it odd that the peri care (and in fact, all care) is being done without gloves.  The man himself is very cognizant and particular about all his care- he is the one who hires his own staff and is a strong self-advocate.  The caregiver I was shadowing simply said that gloves aren't used because there would be so many glove changes necessary, so instead the routine is to wash hands at different stages.  My impression was that this was not her idea, but rather she was instructed by the client to do it this way.  So, I'm curious to know if this is an appropriate/accepted technique in the larger community.  I've been taking caregiving positions for several years, with diverse clients, but this is a first for me.
 

[dream'n, BSN, RN]

I've seen some nurses that I think overuse gloves. For example, they put on gloves to deliver a meal tray or taking a blood pressure. But for peri-care, heck yes, I'm wearing gloves.

[canoehead, BSN, RN]

I'm in the lesser use of gloves camp. Handwashing is superior for preventing infection. For pericare though, it expresses a certain professional distance between the carer and client.  I wouldnt fault anyone for using gloves every time.

[JKL33]

14 hours ago, Wuzzie said:

Just to be clear. I use gloves now but not using them isn't that horrific. We don't glove when we take care of our children's elimination needs or our own. Soap and water suffices. I do prefer not to have someone elses poo on my hands though. 

I get it. For me personally it's almost more a matter making sure professional lines are drawn/maintained. I don't even have too much problem with the idea that other caretakers may not use them; it's just that it isn't my style. In my mind they help with portraying my strictly clinical involvement.

[nursel56]

Hi lightwing!

I have experienced similar situations working in private duty nursing, so I'll offer what I can in they way of my experiences.  First, when I went through the initial agency orientation the DON specifically mentioned that very often longterm chronically ill clients have developed their routines, usually through trial and error, and many of them will seem unorthodox.  

The main reason I found clients drastically curtail use of certain medical supplies is that they are only allotted a fixed amout per month-- with Medicaid, Medicare definitely.  So, for example it is very common to use one suction catheter per shift.  The caregivers who wore gloves would share one glove on the hand that held that suction catheter, which was rinsed with tap water.

That being said, you need to "pick your battles" when it comes to certain procedures.  For example, one person told me that all the nurses use Vaseline to lubricate the Foley catheter.  I told him I am not doing that, period.  KY jelly is cheap, thank God!

As far as infection transmission, my anecdotal experience is that clients rarely if ever transmit serious infections in the home, but they very often came back from hospital admissions with infections.

In your particular case, I would wear gloves and bring my own along if anybody objected to this.  I can't see anyone having a problem with that in the case of peri-care.  We always need to be aware that a home isn't a hospital, and that some people react to glove wearing nurses as a message that they are "unclean" somehow-- but I think most nurses can use common sense as a guideline on that.  I washed my hands just as I was taught in school eons ago.  I never had anyone freak out when I said, "I need to wash my hands first" (or after or in between providing care).

Best wishes to you!

[FashionablyL8, CNA, LPN]

I would bring my own gloves if I had to- I wouldn't think much of others not wearing them though. One exception  was a coworker who would dive barehanded into the messiest BMs with no gloves or washcloth mitt. Never saw her wash her hands either... 

I also find that in many situations, it's more about respecting professional boundaries than anything else. If I'm going to touch any part of the body that is covered by undergarments- including breasts- I'm wearing gloves. I admit that with poop or bodily fluids, the ick factor is a consideration though. I like that barrier. 

Unless there are special precautions, I don't wear gloves to check VS, brush someone's hair, etc. I was taught that donning gloves before any contact can be insulting to the patient and I agree. 

One thing is that my fingernails can get jagged and I will wear gloves to prevent scratching someone if I'm helping them perform certain tasks eg undressing. 

[AdobeRN]

I do pedi HH on the side - if I am touching a kiddos "No-No Squares" I am wearing gloves.  Other nursing skills - just depends what I am doing.  

I also work as a school nurse - I do not put on gloves for every little abrasion that comes in that needs a quick cleaning and bandaid - again just depends on how messy the job is. 

I do wash my hands constantly....

[quickkarma, BSN]

I have seen it in home care. I sure do appreciate the perspective of our older nurses who have seen the changes in health care through the years! I would bring my own gloves for peri-care if none are provided. I live in a cold state and regularly have dry, cracked skin with small skin breaks. In no way am I going to do peri care without gloves. Protection is for both sides. 

[SmilingBluEyes]

On 1/6/2022 at 5:45 PM, canoehead said:

I'm in the lesser use of gloves camp. Handwashing is superior for preventing infection. For pericare though, it expresses a certain professional distance between the carer and client.  I wouldnt fault anyone for using gloves every time.

YES for me it as much about boundaries as hygiene.

[Frances LeMay, LPN, EMT-I]

On 1/5/2022 at 1:07 PM, Wuzzie said:

Back in the day we didn't have gloves for things like peri care. We folded wash cloths into mitts. It wasn't a big deal. We had soap and water. 

I remember this. In fact, When I worked as a Nurses Aide, No schooling was required, and we learned to perform our patient care by the things our charge nurse told us what was necessary, and that included most everything. In fact, I found a resident in the nursing home where I was working trying to drown herself in a toilet in the restroom. I handled it by standing her up and walking her back to her room. Then another aide and I changed her into some dry clothing.

[Davey Do]

@Frances LeMay: Are you the same Fran from the Blue Side?

If so, ladies and gentlemen, we are in the presence of a legend!

[Hoosier_RN, MSN]

18 hours ago, Frances LeMay said:

In fact, When I worked as a Nurses Aide, No schooling was required, and we learned to perform our patient care by the things our charge nurse told us what was necessary, and that included most everything

My nurses aide training was coming in and shadow for a shift. Then the personnel rep (not HR in those days) would ask "want the job? Be here tomorrow at 3, go to the uniform shop before hand, tell them your size, they'll get you set up (at the new hire's cost of course)

I tell you what, I loved those days, oddly enough

[pinkdoves, BSN]

um EW