Procedure – Shampoo in Bed

Washing 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.

1. Explain the procedure to the patient.
2. Wash and dry your hands. Don gloves.
3. Assemble equipment (shampoo, conditioner, bath towel, hand towel, pitcher, shampooing basin, or disposable shampoo cap).
4. Ask the patient for preferences of products and ensure the patient is not allergic to products.
5. Position the patient in a supine position. Place a waterproof pad or towel under the patient’s head and shoulders. Place a towel over shoulders and chest area to keep this area dry and warm. Ensure the rest of the patient’s body is kept warm and covered with a blanket.
6. Protect the patient’s eyes and face from getting wet. Wet hair by pouring clean, warm water using a pitcher over the patient’s hair, starting from hairline at the scalp and working towards the neck.
7. Apply shampoo to your hands and rub them together. Work shampoo into a lather, working from the front of the patient’s head to the ends of their hair.
8. Use your fingertips to massage shampoo against the patient’s scalp, using a circular motion. Take care not to use your fingernails or scrape the patient’s skin or scalp with your nails. Ensure soap and water does not get into patient’s eyes or ears.
9. Rinse hair thoroughly until water runs clear and no suds are visible. Rinse from the scalp line at the patient’s forehead to the ends of their hair, protecting the patient’s eyes and ears.
10. If using conditioner, repeat steps 7 through 9.
11. If using a shampoo cap, follow steps 1 through 5. Apply the shampoo cap to the patient’s hair, tucking in any loose hair ends so that all hair is within the cap.
12. Massage scalp so the dry shampoo is evenly distributed throughout hair. Allow 1-5 minutes for shampoo to fully saturate hair. Remove cap and discard used cap. Dry and style patient’s hair as you normally would.
13. Wipe water from patient’s face, head, and neck using a dry towel and a blotting motion.
14. Dry and comb hair, according to patient preferences. If using a blow dryer, ensure that the hot air and the tip of the blow dryer is not placed onto or too close to the patient’s skin or you could cause a burn.
15. When working on untangling hair, hold a section of hair above the tangle. This avoids painful pulling on the scalp. Gently comb through the tangle. Conditioner or a detangler could be applied to assist with removing tangles.
16. When brushing hair, brush hair in sections, brushing from root to ends of hair. Be gentle with your strokes, taking care not to harshly scrape the patient’s scalp or to yank on hair, which could cause injury to the patient’s scalp.
17. Once finished with hair care, lower bed to its lowest height. Ensure side rails are up for safety.
18. Clean the area and store equipment.
19. Remove your gloves. Wash and dry your hands.
20. Document completion of task and record any changes in condition or behavior. Record any changes in condition of the patient’s skin, scalp, or hair.

Procedure – Back Rub

Back 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.

1. Explain the procedure to patient.
2. Wash and dry your hands. Apply gloves as appropriate.
3. Assemble equipment (e.g. lotion) per patient preferences.
4. Warm lotion in basin of warm water or by running bottle under warm water for a few minutes. Do not use very hot water. To apply lotion to the patient’s skin, rub some between your hands rather than pouring it directly onto their skin. This serves to lubricate your hands during the back rub and to help warm the lotion so the patient does not feel too cold.
5. Position the bed to safe working level at waist height. Lower the head of the bed. Lock the brakes. Lower the bed rail nearest you.
6. Provide for privacy. Remove patient clothing from only the area you are working on to minimize exposure. Keep blankets on the patient, exposing only their back to provide warmth.
7. When working on the patient’s back, position the patient on their side or stomach, according to their preferences and comfort level.
8. Keep the patient covered, exposing their back only to the top of their buttocks.
9. Place a small amount of lotion in your hand and rub your palms together to warm lotion and lubricate hands. Caution the patient that the lotion may still feel cool.
10. Rub the patient’s back with the appropriate pressure, according to their preferences. Rub back in a rhythmic motion in the correct direction.
11. Start at the top of the buttocks, near the lower back (the sacrum), and move in long, smooth upward strokes with both hands, using the palms of your hands to create gentle pressure. Move your hands upward along the spine, and across the patient’s shoulders and then down their upper arms.
12. Move your hands up over upper arms, back across the shoulders, and then down along the back toward the buttocks.
13. Keep your hands in contact with the patient’s skin during movement to prevent friction against the patient’s skin.
14. Repeat for 3-5 minutes, or according to patient preferences. Stop the back rub if at any time the patient reports discomfort or no longer wishes you to continue.
15. If the patient wishes, you can gently knead the patient’s skin or apply a gentle tapping motion upward along the patient’s back to their shoulders and arms, and then back down again. To knead skin, gently grasp skin between your fingers and thumb. Move from buttocks upward, along the length of their back, across their shoulders, and then down over upper arms. Work your way back down to the buttocks using the same motion. Depending on patient preference, you can speed up or slow down your movements and pressure.
16. Be careful to only lightly massage over bony areas so as not to cause pain to the patient. Do not massage areas that are red or that have broken or irritated skin. Do not apply lotion to areas with a rash. Do not remove dressings to apply lotion. Do not massage these areas.
17. When you are almost done with the back rub, let the patient know so they are prepared for the ending of their back rub.
18. Wipe away any excess lotion. Assist the patient with dressing and position the patient for comfort.  Lower the bed to its lowest setting. Ensure the side rails are up.
19. Put away equipment and supplies. Dispose of any dirty linens.
20. Remove your gloves. Wash and dry your hands.
21. Document completion of the task and record any changes in condition or behavior. Report any skin conditions, red, white, or open areas, or pressure sores.