Ivy expressed that she wanted to wash her own face and neck and that she wanted to use her soap for this. We then removed Ivy’s nightclothes and cover the bottom half with the draw sheet; this minimized over exposure of the patient and maintained her dignity at all times. Once Ivy had washed her face and neck the water was changed again. I proceeded to wash the top half of Ivy’s body, washing the side that was closest to myself. I washed under Ivy’s breast, due to moisture collection, which Ivy said often caused her some discomfort, so I ensured that this area was thoroughly dried before proceeding with her arms and armpits. Nurse Smith then continued to wash the other side. Once we had washed and dried Ivy’s top half, I asked if she wished to use any toiletries, as I had noticed she had some deodorant and cream in her wash bag. We applied cream to the sore areas under her breasts, which then gave us the opportunity to check that the skin was not broken and still intact. We would then need to investigate the patient further by looking into the patients nutrition needs. It also provides us with the opportunity to enforce the appropriate treatment. This would provide valuable information on the effectiveness of care given, potential areas of concern, and aspects of wound care requiring further nursing research (Dougherty 2004).
Once we had sprayed some of Ivy’s deodorant on we placed on some clean nightclothes, this gives the patient a sense of well-being, minimum exposure and provides warmth (Heath 1995). The water in the washbasin then had to be changed once again as it had started to go cold, Nurse Smith and I then repeated the same procedure with Ivy’s legs and feet. Heath (1995) sates that feet and nails require special attention to prevent infection, odours and injury tissues. Ivy’s feet and nails were healthy and intact. Before continuing with perineal care we asked Ivy for her consent, to prevent the risk of cross infection we used soft clothes, this is due to large amounts of bacteria that are prone to live in and around this area (Gould 1984). Whilst cleaning the genital area we were able to detect any burning sensations the patient may have experienced, Ivy did not complain of any discomfort and there were no visible signs of skin irritation. A healthcare assistant then came and gave assistance with turning Ivy onto her side to wash her bottom, which Nurse Smith carried out. This provided Nurse Smith and I with the opportunity of checking any areas for pressure ulcers.
Once we had ensured that Ivy was thoroughly dried, the bed was then re-made. I could not participate in this procedure as it involved the moving and handling of the patient, which I was not able to do. I observed then proceeded in removing my apron and washing my hands which removed any transient bacteria, and reduced the risk of cross infection, Dougherty (2004) states that strict hand washing before and after patient contact can reduce rates of infection. I returned to Ivy’s bay and asked her if she was comfortable, she asked if I could re adjust her pillows, I asked for assistance with Ivy so that I could place another pillow behind Ivy. The area surrounding Ivy’s bed was cleared and processions were put back into place. I asked ivy if she wished to brush her hair and teeth. This procedure was documented in Ivy’s care plan, this allows us to assess the hygiene and care needs on a daily basis and notice any changes that may occur.
Communication and Inter-personal skills
The personal hygiene of a patient enables us to interact with a patient on a one to one basis. We are able to listen to any concerns the patient may have, this can decrease any barriers between nurse and patient and build a therapeutic relationship (Dougherty 2004). Interpersonal skills are important to nursing as this involves being in close proximity with the patient, and requires immediate feedback, (Gouran, Dennis, Wiethoff and doelger 1994).
This was the first time I had met Ivy, therefore my first interaction with her. It was crucial for me to use effective interpersonal and communication skills in order for Ivy to feel at ease with me. This would involve good observational skills, as the exchange of verbal and non-verbal messages convey feelings, information ideas and knowledge (Wilkinson 1999, Wallace 2001).
When I first introduced myself to Ivy she was turned away and looking out of the window. So I then tapped her softly on the arm. Sheinder (1996) sates that touch is the most common of our bodily senses. Touch in many circumstances may be the first sign of communication with patients. Adler and Towne (1999) spoke of many studies carried out on different forms of communication and the response. They found that the most effective method was a light touch on the arm, which highlighted that people are more likely to co-operate.
Once Ivy had turned to look at me, I then adjusted myself to eye-level with Ivy. I introduced myself as a student nurse, giving her my first name rather than my full name, as that would have felt too formal. Ivy placed her hand to her ear, it soon became apparent that Ivy had impaired hearing. This had not been stated in handover earlier that morning. Because Ivy was impaired of hearing, I learnt new skills, such as the importance of speaking in my normal tone. This proved to be effective, but I had to ensure that my lips were not obscured from the patients view.
Chang (2001) maintains that it is important that healthcare professionals are aware of the influence on communication of factors such as tone, pitch of voice and speech rate…. If I had spoken loudly, this would have alerted the other patients on the ward and invaded Ivy’s privacy and dignity. The verbal and non-verbal interaction combined worked well as Ivy responded positively. Ivy expressed this using non-vocal communication; her facial expression was relaxed along with a smile. I had to observe the whole of her facial expression to appreciate how she was feeling. If she had felt nervous her smile would have been exaggerated and her eyes would have shown her nervousness. One of the easiest ways to pick up messages is by looking for expressions that seem to be overdone (Adler 1999).
I observed Ivy throughout this procedure for any signs of discomfort. Such as withdrawing from eye contact, and her body posture. Adler (1999) maintains that each of us is a kind of transmitter that cannot be shut off, No matter what, we give off information about ourselves. Therefore it is important for me as a student nurse to recognise the non-verbal behaviour as this may give clues to your patient and how they may be thinking and feeling.
Once nurse Smith had joined me we asked Ivy if she would like to have to have a bed bath. By asking Ivy in this way it had an impact on Ivy’s response. This gave Ivy the choice and enabled Ivy to answer and open the interaction. Once Ivy had washed her own face and neck, we removed ivy’s nightclothes, I maintained eye contact, as I found this particularly important to maintain when she was talking as it showed I was listening.
As a student nurse I have to be aware of the use of eye-contact, as not every patient is comfortable with eye-contact or even able to give or receive eye contact due to eye impairments or purely the feeling uncomfortable doing so. During this procedure it was not always possible to maintain eye contact with ivy, for example once ivy had been turned onto her side to wash her bottom and genital area. Ivy could hear faintly, this required patience on my behalf, as Ivy required extra time to consider any posed questions and formulate appropriate answers. At this point I had to adopt my method of communication by speaking slowly and distinctive. By using active listening, I was able to show my interest through my own verbal responses. For example Ivy was talking about her family and how many grandchildren she. I was then able to say “how many?” and “aren’t you lucky to have such a big family”. Adler (1999) states that when responding to a message, it consists of observable feedback to the speaker, and that listeners do not always respond visibly, and research suggests that we should. However, this is not always achievable, especially whilst nurses are carrying out certain procedures. If I had moved round the bed every time Ivy needed a response, Ivy would have felt uncomfortable this would also of disrupted the procedure as observations also had to made concerning any pressure areas. Once Nurse Smith and I had finished the procedure Ivy thanked me, and I felt that I had built a rapport with this patient.
Conclusion
I have learnt a lot of valuable skills through this procedure. I feel that communication is a vital part of a nurses work. In addition you have to be able to communicate effectively with staff as well as patients. This involves sharing information, and good communication skills are then beneficial to all staff and patients. I have also found that assertive behaviour is crucial, a nurse is then in control of their own actions, it is also then a balance of an appropriate expression of your own need while understanding the needs and rights of others. This required patience, listening, and observing.
To reflect on my clinical skills during this procedure, I felt that I would have been more involved if I had been able to move the patient with Nurse smith as this broke the interaction between Ivy and myself. I also felt that a thermometer should have been used to test the water rather than the patient test it by placing her fingers in the bowl. I understand that this was promoting the patients’ independence, and choice, but it could of also posed a serious situation especially if the water had spilt on the patient and it had caused scalding.
References
Adler, R.B and Towne, N. (1999) Looking Out Looking In ninth edition fort worth : Harcourt Brace College Publishers.
Chang, S.O (2001) the conceptual structure of physical touch in caring. Journal of advanced nursing . 33 (6) 820-827
Heath, B.M and Prof Hooper, E. (1995) Potter And Perry’s foundations In Nursing Theory And Practice Mosby: Time Mirror International pub LTD
Department of health (2001) standard principles for preventing hospital-acquired infection. Journal of hospital infection 47 (suppl), 527-537.
Dougherty, L. and Lister, S. (2004) The royal Marsden Hospital Manual Of Clinical Nursing Procedures. Sixth edition. Oxford. Blackwell publishing LTD.
Sheinider, E . (1996) The Power Of Touch. Massage For Infants And Young Children . 8 (3) 40-55
Gould, D. (1994) helping the patient with personal hygiene. Nursing Standard. 8 (34) 30-32
Gouran, Dennis, wiethoff, W.E and Doelger, J.A (1994) Mastering Communication. 2nd edition. Boston: Allyn and Bacon
Wallace, P.R (2001) improving palliative care through communication Journal of palliative nursing. 7 (2) 86-90
Wilkinson, S. (1999) communication: it makes a difference cancer nursing 22 (1) 17-20.
Appendix One
Equipment used for procedure
Two clean towels/flannels- the two towels/flannels may not both be used but this is to avoid disturbance and leaving the patient in order to fetch another one. if possible it would be good practice to use one towel for the face and for the body, however many patients are only used to using one towel at home.
A pack of soft clothes- used on the genital area, they are easily disposed of in the correct waste, and stop the risk of cross infection.
Wash Bowl- this was reserved for the patient in her cupboard. It should be clean and dry.
Soap and toiletries- patients preference body wash.
Draw sheet- to maintain the patients’ privacy, dignity and warmth.
Clean nightclothes- should be the patients’ preference, but also consider that the night clothes should be placed on the patient with ease and not be tight fitting.
Laundry Skip- to protect against cross infection. It also ensures the safety of the area if the linen is placed straight into the laundry skip.
Bed pan or commode- this would be provided for the patients comfort and avoid disruption of the procedure.
