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Posted elsewhere:no response. Tub bath info pls!

Posted

Tub bath. I posted elsewhere and no response. Tomorrow I give a tub bath to an elderly lady. I am wondering how this is dine?

Asking why I need this information? Because my job with HHC is tossing me into this situation. Feeling my job may be at risk due to needing time off because child(ren) issues beyond my control.... Needing this help, please.

Thank you!

roser13, ASN, RN

Specializes in Med/Surg, Ortho, ASC. Has 17 years experience.

Way too few details to give concise answers.

How old is the patient?

How much mobility does she have?

How much does she weigh?

How strong are you?

Truly, if you are a nurse or have had any training in caring for the elderly, I'm guessing you will be able to assess the situation when you get there and figure out the logical, safe way to accomplish the bath.

Edited by roser13

Patient safety is of utmost importance, followed by dignity. As long as you keep those matters in mind, you should be able to get through this. BTW, sounds like you may need to be looking for a new job anyway.

FLArn

Specializes in Hospice, LTC, Rehab, Home Health. Has 20 years experience.

Is this in a facility or a patient's home? Where are you located? In Florida to do personal care in a patient's home you must be either a licensed nurse or a Home Health Aide -- in a facility you must be a nurse or a CNA. I don't know what an RMA is -- you may need to clarify your scope of practice. BE CAREFUL not to overstep your professional boundaries.

Edited by FLArn
spelling error

Pt home. In her 80s. She ambulates wo wheelchair.

I am Registered Medical Assistant who paid a lot of money for an education I can not use.

I found a job as a caregiver. Now this job is asking me to do the responsibility of giving a tub bath. I can't just say no. Hence coming to a community I was hoping to get answers for this situation.

Is it out of my SOP? I am not a CNA. Do I want to keep my job because I need this so my kids have Christmas!? Yes.

I am also already looking for another job.

This company took me off a case already because I refused to admin s narcotic as a caregiver to a pt.

See where this is going? In Jan I can have one year xp under my belt. Hopefully find a job elsewhere.

For now? I just am asking for a run down on how to do this tub bath. Thank you.

Does she have a bath chair that will fit into the tub? That and a hand-held shower nozzle might make the process easier and safer for both of you.

If you don't know about the shower chair or if she doesn't have one, see if you can get your hands on a sturdy plastic folding chair.

Other things to pay close attention to--water temp, slippery surfaces in tub and on bathroom floor, proper draping with towels, keeping soap/shampoo away from eyes. You probably know these things already.

I wish you the best. Let us know how it goes. :up:

roser13, ASN, RN

Specializes in Med/Surg, Ortho, ASC. Has 17 years experience.

The elderly are always cold. Most dislike baths because of that. They feel exposed and cold. Truly, if you can manage to do a full, all-body cleansing without immersion in water, your patient will likely be very happy.

Try having the patient sit on the towel-covered toilet while you stand at the sink and wash her in stages, keeping all the other stages covered/warm with towels.

On the other hand, you may get there and discover that she enjoys her baths and has a firm idea of how to go about it. Don't forget to ask what she would like. She should direct your care if she is at all able to.

Good luck.

If this employer expects you to administer narcotics to patients, clearly not in the scope of practice of a Home Health Aide, you definitely need to find another employer.

I agree. In this economy I am just trying to hold on for xp sake. Pull me through for a year so next perspective employee see I have a good work record.

Thank you for the tips and advice !!!

This is no easy task. The proper sequence should be:

1. Observing how it is done by someone who has experience.

2. Assisting.

3. Performing under supervision.

4. Performing independently.

Looks like you jumped straight to no 4. Call me panic-queen, but that is dangerous IMO. Too much of a risk of serious injury to yourself or/and the person you're taking care of. I would refuse to do it.

Flatbelly, again I will agree with what you and the others have said here. I'm not denying this at all.

I didn't go straight for number 4. My employer said you are taking on a new client and this is what we need from you. Riding on thin ice because of being removed from a case for not administering a narcotic a client a caregiver was strike one. Having to take off three shifts due to dealing with my own personal life (my children beyond my control) was strike two.

This is me now trying to CYA and keep my job. I don't have a license to lose at this point. That doesn't make me any less nervous about giving a bath to someone when I've not been through the process. Hence, my post on these forums asking for help.

RN/Writer: My concern is proper draping of towels. The rest of what you mentioned is purely common sense.

At least when you look up bed bathing you can find several step by steps on how this is done.

Thank you again :)

CrunchRN, ADN, RN

Specializes in Clinical Research, Outpt Women's Health. Has 25 years experience.

I think you just need to focus on safety and comfort. Find out how she has done it in the past and what is most comfortable for her.

flyingchange

Specializes in MPH Student Fall/14, Emergency, Research. Has 2+ years experience.

I used to work in home health and have given lots of in-home tub baths; the most dangerous part of them is always transferring into/out of the tub. If her home is set up properly then there should be plenty of things to grab onto and anti-slip mats in the tub and on the floor. If she can't sit properly in the tub she should have a bench. If her house is not set up properly, proceed with caution, and I agree with just keeping her on the toilet for a sitting bath if necessary.

The water temperature should be no more than 40*C (Not sure F, sorry). Lots of risks of overheating and burns to people who can't tell you they're too hot. Make sure you bring lots of towels and washcloths. Encourage independent washing if at all possible. Even if she can't really wash herself, let her try, and then follow up. Give her a towel in the tub (my preference would be one of the dishtowel-sized ones but you get what you get in home care) to cover her shoulders.

My preferred order is body-axillae-groin. Wash her feet if you can access them, a lot of elderly have terrible feet. Then wash her hair last. Might want fresh water from the tap to rinse. Depends if she's cooperative.

When she gets out of the tub dry her feet really well and let her step down. Towels are a slip risk. Get her into slippers asap. This is the worst part IMO because it requires a lot of body strength and bracing because often you are the only thing to hang onto. Then cover her in towels and get her dried off asap .

Hope this helps :)

RN/Writer: My concern is proper draping of towels. The rest of what you mentioned is purely common sense.
I included the common sense items, because you said you did not know what to do. Sometimes when people are anxious about doing a task that is new, the common sense things may not occur.

Here is a link to a very detailed site on bathing an adult:

http://cas.umkc.edu/casww/tubshowr.htm

Feel free to ignore anything that is not worth your time.

As far as draping goes, if you have her sitting on a toilet or a bath chair, you can put one towel over her lap and another around her shoulders. Lift each one to wash and rinse the area beneath. Replace a towel if it becomes too wet. (Have a towel beneath her if she is sitting on the toilet lid. Otherwise, wet skin can stick to the surface and become irritated when she pulls to a standing position.)

When you are finished, use the towels to dry her off and help her into a robe.

Hope this helps.

Edited by rn/writer

I used to work in home health and have given lots of in-home tub baths; the most dangerous part of them is always transferring into/out of the tub. If her home is set up properly then there should be plenty of things to grab onto and anti-slip mats in the tub and on the floor. If she can't sit properly in the tub she should have a bench. If her house is not set up properly, proceed with caution, and I agree with just keeping her on the toilet for a sitting bath if necessary.

The water temperature should be no more than 40*C (Not sure F, sorry). Lots of risks of overheating and burns to people who can't tell you they're too hot. Make sure you bring lots of towels and washcloths. Encourage independent washing if at all possible. Even if she can't really wash herself, let her try, and then follow up. Give her a towel in the tub (my preference would be one of the dishtowel-sized ones but you get what you get in home care) to cover her shoulders.

My preferred order is body-axillae-groin. Wash her feet if you can access them, a lot of elderly have terrible feet. Then wash her hair last. Might want fresh water from the tap to rinse. Depends if she's cooperative.

When she gets out of the tub dry her feet really well and let her step down. Towels are a slip risk. Get her into slippers asap. This is the worst part IMO because it requires a lot of body strength and bracing because often you are the only thing to hang onto. Then cover her in towels and get her dried off asap .

Hope this helps :)

This is pretty much how I handled things this morning. The only thing I didn't do is get her into slippers! I will remember this next time. She has issues with her right arm/shoulder. I treat it as her "weak side." There aren't any bath rails. There is a slip resistant pad in her shower. After the bath I helped her by getting dressed and putting on some body lotion on her back, arms, hands and legs.

Her feet are cracking and dry around the tops of her toes and her heels. The RN suggested she use Vaseline around those areas so I applied that to her toes and heel areas.

My next step is to try to find an CNA course to get into if I'm going to be doing these things I want to feel secure in knowing I am doing them the correct way. Thanks again for all your positive and supportive comments.

Thank you so much for all your support and help.

I included the common sense items, because you said you did not know what to do. Sometimes when people are anxious about doing a task that is new, the common sense things may not occur.

Here is a link to a very detailed site on bathing an adult:

http://cas.umkc.edu/casww/tubshowr.htm

Feel free to ignore anything that is not worth your time.

As far as draping goes, if you have her sitting on a toilet or a bath chair, you can put one towel over her lap and another around her shoulders. Lift each one to wash and rinse the area beneath. Replace a towel if it becomes too wet. (Have a towel beneath her if she is sitting on the toilet lid. Otherwise, wet skin can stick to the surface and become irritated when she pulls to a standing position.)

When you are finished, use the towels to dry her off and help her into a robe.

Hope this helps.

Thank you so very much, Rn/Writer! This was an awesome find! I will be printing it out and studying it like a hawk. :)

Nothing any of you here have to say is a waste. I soak up and absorb all information I possibly can. I greatly enjoy reading posts and learning new things.

We all have a voice, thoughts, minds and opinions. So yes, thanks again to all of you for your helpfulness!

Edited by rn/writer

CrunchRN, ADN, RN

Specializes in Clinical Research, Outpt Women's Health. Has 25 years experience.

See if the family will not buy a "grab bar". We put one up in the guest bathroom for my mother in law when she steps over the lip of the tub. They are about 10 bucks at Bed, Bath, Beyond and stick right up and handle tons of weight.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

Flatbelly, again I will agree with what you and the others have said here. I'm not denying this at all.

I didn't go straight for number 4. My employer said you are taking on a new client and this is what we need from you. Riding on thin ice because of being removed from a case for not administering a narcotic a client a caregiver was strike one. Having to take off three shifts due to dealing with my own personal life (my children beyond my control) was strike two.

This is me now trying to CYA and keep my job. I don't have a license to lose at this point. That doesn't make me any less nervous about giving a bath to someone when I've not been through the process. Hence, my post on these forums asking for help.

RN/Writer: My concern is proper draping of towels. The rest of what you mentioned is purely common sense.

At least when you look up bed bathing you can find several step by steps on how this is done.

Thank you again :)

I would not refuse I would be sure the proper things are in place first. Frist....is there a bath chair in the tub. It is extremely hard to get a slippery wet patient out of a tub. Be sure there is a non slip bath mat in the tub to help with footing is she wants to sit in the tub instead of being on a chair (rubbermaid type). If she wishes to sit in the tub to "have a bubble bath so to speak" and she is ambulatory here's what to do. I give this advice as a daughter for my parent from a daughter who happends to be a nurse

1) get everything you need first. Towels,soap,wash rags(seperate face pits and privates), a portable heater for the bathroom is nice (they are always cold) non slip bath mat inside and outside of tub. Have enough towels to section the body. one for her hair,one for shoulders,one midsection, one privates and one for each leg (providing maximum coverage)and one for drying the tub to get them out, plus a glass or shower hose for rinsing hair. Get their clothes,underware ect and bring in to the room. NEVER LEAVE THEM any where for a length of time my parents were/are stubborn to the extreme and would be foolish when our backs were turned!

2) Have a cell phone or the cordless land line in the bathroom with you in case they do fall and you need to call for help and can't leave them!

3) set the water temperature prior to placing them in the tub to save your ears! :) dry the tub, put them in the tub and fill the water. Let them wash what they can it is awsome range of motion and physical therapy.

NEVER GO FAR! They can and will get ointo trouble! They think they can do more that they can and will fall!

4) finish with rinsing, begin draining the tub place a towel on their head. This is where they WILL COMPLAIN BITTERLY OF THE COLD! Sometimes if the dryer is close by throw the towels in the dryer to make them hot while they bathe........FEELS GREAT! Now, place a towel around their shoulders to dry and keep warm, as the water drains slowly, add the other towels drying as you go middle, right leg, left leg, privates. Dry the tub before trying to get them out! have a chair on the bathroom for them to sit on if the toilet is not secure or close enough.

ONCE they are DRY! and the tub dried, you can get them out.

5) clean up the towels so they don't slip throw the towels directly in to the washer to limit the mess (or at least offer). and pray they don't fall! :) do teeth (if you have to)

CONGRATULATIONS! they are clean and dry!

If they agree to do the tub with a shpwer chair same principles apply. Do everything as above with a few moderations

1) all of step 1.

2) NEVER FORGET THE PHONE!

3) set the temp, dry tub,get them in and hose em down,soap em up and rinse em off. (just a little humor no disrespect meant):lol2:

4) again with the towels one for the hair,chest,each leg and privates. They are covered for privacy and warmth. all the towels expedites the adventure! Make sure the tub is dry whenever attempting to move them in or out!

5) clean up dress and go!

with a little luck they are clean and tired and want a nap!

:ancong!:

All done as safely and effectively as you possibly can! Go slow, be patient. If they object to your presence explain that it is their saftey the is your upmost concern! Tell them you will turn your back while they wash if they insist you "leave" tell them you will go only as far as the outside door, NO LOCKS ALLOWED!, and you will right outside the door so you can hear if they need help!

Good luch and let us know how it goes!