I will discuss and identify a nursing skill whilst on placement. The nursing skill I will be discussing is bed bathing a male patient.

How I Planned

I carried out the skills demonstration in the Hospital, under the instruction of my supervisor and the senior nurse in charge. As per trust policy I collected the relevant data collection document and produced Tommy’s folder ensuring each document was in the correct order and I was aware of his privacy and dignity.

I asked Tommy for his consent making him aware of my task and how what I am going to carry it on.

However, due to his impaired communication, I approached him in a calm and gentle way and spoke in low tone. A non-verbal cue (i.e. smile)

I spoke to my supervisor, who is also male, about my worries. He reassured me and said that he would assist me with a male bed bath and let me take the lead, and he would then guide me where he felt I needed to do things differently.

I did research on partial bed bath and skills needed and I found out that I was required to organise and prepare the task, paying particular attention to meeting the needs of my patient and have the Ability to competently carry out each task.

Also the use of good Communication with the patient and any other appropriate person throughout the tasks, including the demonstration of consultation with the patient and displays of encouragement and empathy;

Use of appropriate safety and health practices.

Why I choose Tommy:

The rationale for choosing Tommy was because I was involved in his care. I also wanted to emphasise on the function of nursing, which is to assist Tommy to prevent, alleviate to cope positively with problems (actual & potential) related to activities of living (Ropes et al 2000)

I also was requested to demonstrate my skills in order to put in practice all the theory I learnt in the class on how to assist an order person with personal hygiene , I chose bed bath because Tommy resisted the use of hoist and he can walk or stand unsupported .

Being nursed in bed, Tommy was unable to go in the bath as he had resisted the use of hoist, making it dangerous to use. I ensured that Tommy personal hygiene was met. During these periods, Tommy's privacy and dignity was maintained by closing the door to his room. Due to Tommy's doubly incontinence. I ensured Tommy was clean and dry at all times by maintaining his hourly check. I also used appropriate incontinence aid i.e. pads; the rational was to prevent bed sores.

Preparation

To prepare my task I first Checked the supervisor’s orders.

Visited the patient, introduced myself and informed him of the procedure.

Gained Consent

Offered him a bedpan

Checked for the required personal toilet articles and clean linen available in the unit. Cleared the top of his bedside cabinet and placed the cabinet and chair for optimum workspace.

Adjusted the room temperature and provided privacy.

Prepared equipment. Before carrying out my task I ensured that I had all the necessary equipment’s at hand.

I washed my hands prepared and ensured my surrounding place was clear from any obstacles.

No hazards were present

List of the Resources

* Bath Blanket- for covering him in order to avoid expose of his whole body

* Bath Towels- drying him

* Wash Cloths- for wiping him

* Soap – for cleaning him

* Basin- for the water

* Thermometer- for checking the water temperature

* Lotion – for moisturizing his skin

* Gloves- for hygiene reason to prevent reinfection

* Paper Towel – for drying out spills

Step by Step

I carried out a partial bed bath task on my patient, I knocked on his door ,walked in, greeted my patient told him what I was going to do, gained consent then I went on and checked the room for cleanliness whilst maintaining a professional and caring manner. I also made sure the room was free from any hazard during the task.

Step 1- Began with hand washing

Rinse my hands using proper hand-washing procedure, before commencing the work. Put the gloves.

Step 2- Provided information to the patient

Provided a friendly greeting to the patient. Informed him that I was going to be helping help in bathing.

Step 3- Ensured privacy

To preserve the privacy and dignity of the patient, I pulled the curtains on the window and closed the doors of the room.

Step 4- Filled the basin

Filled the basin with water having temperature of 105 to 115 degrees. Also checked the temperature of the water by dipping the finger. Ensured that water was not too cold or too hot for the client to bath.

Step 5- Removed the medical equipments

Took out the medical equipment’s that were not necessary for the patient, at the time of assisting him in bathing.

Step 6- First washed the patient’s face

started with washing the face of the patient with the help of a washcloth. Then, moved down to his arms. Next, washed his chest, abdomen, legs, back and perineal region. In order to avoid the spread of germs made sure I utilized the separate clean cloth for each body part.

Step 7- Changed the linen

change the linen of the patient and provide him fresh linen.

Step 8- Applied the lotion

Checked all the areas making sure all parts were dry and applied lotion to exposed skin.

Step 9- Assisted the patient in returning to their comfortable position after his bath was completed and assisted him to sit down in a comfortable position. Allowing him to dress himself.

Step 10- After finishing the work, I rinsed my hands

Dispose the supplies used for the bath and gloves. Then, washed my hands again.

Checked if my patient was fine and comfortable. Opened the curtains

Place the over bed table next to the patient

“OK, Goodbye Mr. Tommy If you need anything, please press the call button.”

Just before walking out of the door, I said to him that “I’ll report that I had performed a partial body bed bath to the nurse and recorded it in his chart”

him every opportunities and freedom he required and I respect his beliefs.

Evaluation of my task

After completing the task, I feel the most important thing for me was communication. This is an important nursing attribute and creating that environment for conversation is equally as important (Peate 2009). As I communicated more with my patient the more at ease I felt with completing my task, I knew we were starting to build a rapport and my nerves were starting to disappear. At all times I remained courteous and ensured my body language didn’t give my nerves away (Essence of care 2010).

I felt the self-achievement in myself as I could see my patient was comfortable with a smile on his face.

I have learnt the importance and rationale for reviewing and becoming familiar with evidence based learning and of linking theory with practice. I learned the importance of being honest and treating the patient with respect. On reflection.

To help further build my confidence, my aim is to do more male bed baths as possible. Having my supervisor to guide me really helped, I listened effectively to the information he gave me, and I intend to put it into practice in the future. Team work was also a very important aspect which ensured we delivered safe & high quality care (Leonard, M. et al.2004)

My Communication with my client

Effective communication is central to encouraging service users to express their preferences and views, and also to help them achieve independence.

My communication with Tommy was excellent as I was aware of the importance of having effective communication between service providers and service users which helps in building relationship. Having good communication helps in exchanging information, messages etc.

I spoke slowly, at a normal level (not too loud), using a low-pitched (rather than a "Minnie Mouse") voice. In addition, I had to gain consent verbally in order to start my bed bath task.

I approached Tommy in a calm and gentle way and spoke in a low tone. A non-verbal cue (i.e. smile, touch) was also used in my communication with him, the rational was to show warmth, acceptance and interest.

I spoke to my patient as an adult even though I did not know how much he was understanding, the rationale for this was to make him comfortable

I spoke to him in a professional and respective manner

I was fully aware that speaking rapidly, loudly, or in a very high-pitched voice can be overwhelming or upsetting for someone with his condition.

Body language

My body language was very open and welcoming towards my patient so he would not feel intimidated by me. I listened to my patient. I was fully aware that speaking rapidly, loudly, or in a high-pitched voice can be overwhelming or upsetting for someone with condition. I also used the active listening skills and facial expression.

I spoke in a clear and coherent manner so that my patient could understand what I was saying. I also gave him and his wife some feedback on Tommy`s care, health and how well he was doing, because it is essential that the patient knows at all times what her condition is and how the treatment care is going.

Used humour whenever possible.

His body language gave me a good insight into how glad he was, he expressed a smile on his face which indicated he was happy throughout the task. he seemed relaxed and not troubled or uncomfortable

My body language was very open and welcoming towards my patient so he would not feel intimidated by me the rationale for this was to make him feel comfortable. I listened to my patient

I was happy with his nonverbal communication. His body language gave me a good insight into how well I was carrying out the task as he smiled indicated he was happy throughout the task Tommy looked relaxed and comfortable tensed.

Good eye contact

I was at all-time facing him whenever I was speaking (rather than carrying on a conversation out of his line of sight). reason for this is to have a good eye contact

My posture was excellent and I gave my patient eye contact the whole way through the conversation. I was at all-time facing him whenever I was speaking (rather than carrying on a conversation out of his line of sight).

I had to gain consent in order to start my bed bath task.

I gave my patient eye contact the whole way through the conversation and my posture was excellent

I was fully aware that speaking rapidly, loudly, or in a high-pitched voice can be overwhelming or upsetting for someone with condition.

How I made him feel comfortable

Assisted him with his independency by giving him the option to clean up his lower parts and by letting him choose the cloths and which way he wanted his partial bed bath done.

Made sure I knocked on his door and waited for his permission to enter. by closing the door, I also helped to reduce drafts for more comfort

During the task I provided him with emotional support, especially at times when he need arises for the bed . Informing him about health and assuring him of better results.

Being able to show empathy towards patients will give the patient a better experience as this shows that I am able to listen to him and aware of his feelings. As this enables a platform for effective understanding communication and positive relationship which then brings a scene of trust. Communication with the patient with empathy will be able to establish the state the person is and any further help they might need such as counsellors.

I made my client comfortable by listening to him and giving the chance to choose his cloths

I supported Tommy by the knowledge of handling and praised all time during the task in order to make him feel worth and well

When I finished the task I made sure I gave feedback to Tommy. I praised him on how well he was doing. He thanked me numerous times.

I was at all times showing empathy and support to my client made sure I reinforced by giving him good feedback every time he did well.

Praise, support and empathy

I praised Tommy by saying good job Tommy you doing good.

With consent I then removed his clothes, ensuring at all times he was covered using towels to maintain his privacy, dignity and (NMC 2008b, C). I could see he had his own body wash so I placed some in the water. I made a comment to my patient of how nice the wash smelt and how nice he would smell all day, he laughed and joked with me which helped to break the ice and for me to relax.

I supported him by my handling knowledge and talking at a low and calm voice

I showed empathy by letting him choose his choose his cloths and wash gel.

I reinforced him by letting him play his hand ball games he liked most eg the bowling game.

Made sure his needs were met and also made him aware as a service giver I have a sense of care to avoid making them feeling isolated, unheard or depressed.

His social needs are very important. I could see my client was very happy every time.

Health and safety

I was aware of my client’s health and safety during my task and was abending to “The Safety, Health and Welfare at Work Act 2005” and “The Safety, Health and Welfare at Work (General Application) Regulations 2007”. The risk assessments were carried out and the patients’ health and safety was the main concern at all times. I was wearing gloves and washed my hands before and after the task at all times to ensure that cross-contamination is prevented and hygiene is promoted

* I put the bed rail guard up on the side that I wasn’t on and made sure I checked on him regularly I also made sure that Tommy was comfortable, lying on a clean, dry and comfortable bed, the rationale for the rail guard was to avoid and prevent the risk of him falling out of his bed

* Hazard Identification made sure the floor was not slippery or anything was in my way as I performed the task. Make recommendations in relation to identified hazards to minimise the risks to the service user group.

* The room was comfortable and good room temperature

The water was comfortably warm – older people particularly feel the cold, so I had to bear this in mind when adjusting the temperature

* I also ensured I was wearing the appropriate shoes , the non slip shoes and proper for the health care settling.

* Made sure no obstacles were around the room as I performed the task.

* Inspected the room to see nothing would in danger my patient

* To help him maintain a safe environment I made sure his buzzer was within easy reach so that if he needed anything, he could always call for assistance and not attempt to do it herself. To help him maintain his own body temperature

* Hygiene- To prevent the spread of bacteria or infection

I have benefited as a result of this Work placement, as it has taught me the importance of the showing empathy and I have become more efficient

I have learnt:

* The patient’s Privacy and dignity are paramount when assisting with personal hygiene needs.

* The Importance of showing empathy and patience while communicating with a with a patient. sometimes they may become frustrated that they are failing to communicate something and may also be frustrated because they don’t understand what is being communicated to them. It is crucial to show understanding, empathy and patience.

* Bathing a patient is an essential component of nursing care.

* Memory and intellect deteriorate as conditions progresses, yet people with dementia continue to interact. How we as carers respond can have profound effects on a person’s wellbeing.

* Refer to patients by their names. Avoid pronouns like “he,” “she,” and “they” during conversation. Names are important when greeting a patent

* my experience with working with people with Parkinson disease has made me realise the importance of eye contact and open ended questions and answers.

* I have learnt the main important aspects of caring for person which is confidentiality

* People with Parkinson disease need more care and patience when dealing with them

* In my task I learnt the importance of gaining consent from the patent

* I have learnt the importance of empathy and confidentiality when caring for a person

* Improving the patient’s communications is the most important thing in this course

What I would change:

* I would try and give Tommy a shower while he sits on his chair instead of partial bed bath as I feel the help of running water would help him relax more than just wiping him.

* I would recommend use of wipes instead of wet cloths

* I would recommend doing the bath while he sitting up as I feel it would be easy for washing his back

* I would recommend participation in music programmes, watching movies, visits to the church, activity wise

* In order to help further build my confidence, I would work on doing more male bed baths as possible. Having my supervisor to guide me really helped, I listened effectively to the information he gave me, as I intend to put it into practice in the future.

Personal learning from the task

My involvement with Tommy has improved my skills and attitude especially my non-verbal communication skills.

This experience has made me realised that caring for patients with advanced condition could be both physically and emotionally stressful as they solely dependent on the carers, but it was worth it.

It has also helped me understand more in depth the care and provision for the older person. I have had the chance to get the feeling of caring for an older person in practice. The task went on very well and understandable I did not face any challenges in doing this.

I have learnt the importance and rationale for reviewing and becoming familiar with evidence based learning and of linking theory with practice. I learned the importance of being honest and treating the patient with respect. On reflection, I consider that my strength is that I am mature enough to have gained the confidence to recognise when I need help and when and whom to ask for support. NMC (2004:9) stated that, "you must acknowledge the limits of your professional competence and only undertake practice and accept responsibilities for those actions in which you are competent." I feel this quotation from the professional code of conduct encapsulates what I have learned from completion of this task.

My strength and weaknesses

I felt very nervous, but continued to wash the patients face. I feel I was too over careful, I consider that my strength is that I am mature enough to have gained the confidence to recognise when I needed help and when and whom to ask for support. NMC (2004:9) stated that, "you must acknowledge the limits of your professional competence and only undertake practice and accept responsibilities for those actions in which you are competent." I feel this quotation from the professional code of conduct encapsulates what I have learned from completion of this task

Chronic illness

Chronic illness is characterised as a condition that requires ongoing adjustments by the affected person and interactions with the health system. The Centre for Disease Control's National Centre for Chronic Disease Prevention and Health Promotion (2000) broadly defines chronic disease as illnesses that are prolonged, do not resolve spontaneously and are rarely cured completely. Chronic illness may get slowly worse over time. It may cause permanent body changes to the body and it certainly affects the persons quality of life (Locker 2003, cited by Scambler 2003).

Long term chronic illness does not merely have an impact on people's physical health, it affects their emotional well - being, their careers, relationships and social existence. These social, psychological and emotional challenges can destroy lives.

Chronic illness may be inherited, but many lifestyle and environmental factors, such as smoking inappropriate diet, inactivity and heavy alcohol consumption are known to significantly increase risks. These factors are to some extent within the control of a wee - informed person. Besides early diagnosis and management a very important aspect of primary care is aimed at prevention and healthy behaviour.

Types of chronic illness

* Asthma - a respiratory condition marked by attacks of spasm in the bronchi of the lungs, causing difficulty in breathing. It is usually connected to allergic reaction or other forms of hypersensitivity.

* Dementia

* Diabetes - a disorder of the metabolism causing excessive thirst and the production of large amounts of urine.

* Breast Cancer - Breast cancer is a malignant tumor that starts in the cells of the breast. A malignant tumor is a group of cancer cells that can grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body. The disease occurs almost entirely in women, but men can get it, too.

* Epilepsy - a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain.

Different support groups for these illnesses?

* Asthma Society of Ireland

* Action Breast Cancer

* Diabetes Federation of Ireland

* Brainwave – The Irish Epilepsy Association

End of life issues for the older person

Role of the external and voluntary services that promote the well being of the older person

Conclusion

To conclude I will say my involvement with Tommy has improved my skill and attitude especially my non-verbal communication skills.

This experience has made me realised that caring for a patient with advanced dementia could be both physically and emotionally stressful as they solely dependent on the carers, but it was worth it.

I was able to achieve all my aims and objectives that I had set for this task . my Client was more relaxed and comfortable in my care , my ability to carry out this task was effective and correct

I practiced excellent organisational skills throughout the task and all the staff I need were available.

I would say the skills benefited mt client has it provided him with cleanness and relaxed his muscle from the bed bath due to the warm wash cloth I was using.

Recommendations

* I would shower while he sits on his chair instead of partial bed bath as I feel the help of running water would help him relax more than just wiping him.

* I would recommend use of wipes instead of wet cloths

* I would recommend doing the bath while he sitting up as I feel it would be easy for washing his back

* I would recommend participation in music programmes, watching movies, visits to the church, activity wise

* I would get a male nurse to help me shower my patient as it would help both me and the patient to get things done quicker.

* I would recommend use of disposable wipes instead of wash cloth because I feel they are more hygienic.

Bibliography

Carpenito, L, J2000. Nursing diagnosis: application to clinical practice 8th ed. Philadelphia

References

http://www.hsa.ie/eng/Publications

http://www.sa.agedrights.asn.au/residential_care

https://youtu.be/4qdD4Ny34cc