INTRODUCTION: Bathing is important intervention to promote hygiene.

Choice of the
method depends on the nurse's judgement as well as the medical plan care regard the client's
activity leveland mental and physical capabilities of performing self-care. Several types bath
can used depending on the client's need. The clients who bath in bed are those who are in
plaster casts and traction, on strict bed rest, paralysed, unconscious, chronic ill patient or
those who have undergone surgery.
RELATED ANATOMY AND PHYSIOLOGY : The skin is one of the sensory and
excretory organ. It has important functions such as protection, secretion, excretion,
temperature regulation and sensation.
The skin consists of three layers – Epidermis, Dermis and Subcutaneous
The epidermis is the outer layer and is composed of several thin layers of cells undergoing
different stages of maturation, The innermost layer of epidermis generates new cells that
migrate slowly towards the epidermal surface that is the stratum corneum. These cells replace
the dead cells that are continuously shed from the skin's outer surface. The epidermis also
contains melanocytes, which produce melanin, or dark pigment of the skin. The epidermis
shields the underlying tissues against water loss, mechanical and chemical injury and
prevents the entry of pathogenic organisms.
The dermis is a thicker layer containing collagen and elastic fibres to support the epidermis,
It contains nerve fibres, blood vessels, sweat glands, sebacious glands and hair follicles.
Sebum from sebacious glands lubricates the skin and hair. There are two types of sweat
glands-eccrineglandsandapocrineglands.Theeccrineglandsarepresentthroughoutthe skin but
more in forehead, palms and soles. The apocrine glands are found in axillary and genital
area.
The subcutaneous tissue contains blood vessels, nerves, lymph and loose connective tissue
filled with fat. The fatty tissue serves as a heat insulator for the body. This layer also provides
support for the upper skin layers and helps to withstand pressure without causing injury.
DEFINITION: Bed bath is a procedure of cleaning the entire body of a dependent patient or
giving bath to a patient who is confined to bed and is not physically or mentally capable of
doing and maintaining self care.
Bedbathis2types: Complete bed bath(washing entire body),partial bed bath (washing face,
neck, upper extremities, lower extremities).

PURPOSE:
 To clean the dirt and bacteria off the body
 To prevent bedsores
 To stimulate circulation
 To increase elimination through the skin
 To relieve fatigue.
 To regulate body temperature
 To provide active and passive exercises
 To induce sleep
 To provide comfort to the client
INDICATIONS:
 Bed ridden patients
 Coma patients
 Major surgery
 Orthopaedic patients with surgery
 Mentally ill patients
 Critically ill patient
CONTRAINDICATION:
 Burn
 Open wound
GENERALINSTRUCTIONFOR GIVINGABEDBATH:
1. Maintain privacy of the clients by means of screens, curtains or drapes.
2. Only small area of the body should be exposed and bathed at a time.
3. Each stroke should smooth and long rather short and jerky.
4. A thorough inspection of skin especially at the back should done to find the
signs of bedsore.
5. All the skin surfaces should be included bathing process with special care in cleaning
and drying the folds and bony prominences etc. since these most to be excoriated
moisture, pressure, friction and dirt.
6. Cleaning from the cleanest area to less clean area. e.g. upper part of the body should
be bathed before the lower parts.
7. Avoid bathing a client immediately after mealas it depletes blood supply to the digestive
organ and interfere with digestion.
8. Do not touch the body with bare hands. It is unpleasant to the clients.
9. The temperature of the water should be adjusted for the comfort of the client.
The temperature for sponge bath should be in 110 to115 degree F (43 – 45
degree C)
10. Powder are used to prevent friction and to absorb moisture but should not be used on
open draining areas, since powder can make or form crust, causing irritation.
11. Creams and oil are used to prevent drying or excoriation of skin.

PRELIMINARYASSESSMENT:
 Check the physician order to see the specific precaution if any, regarding the
positioning and movement of the client.
 Assess the client need for bathing
 Assess the client ability for self care.
 Check the linen and equipment available in the unit.
 Check whether theclienthastakenthemealintheprevious1hour.
 PREPARATIONOFUNIT:
Steps Rationale
1. Close the windows and put off To prevent draughts
the fan.
2. Provide the screen or curtain To maintain privacy
3. Switch on the lights.

PREPARATIONOF CLIENTS:
Steps Rationale
1. Identify the patient and explain To win the cooperation of patient
the procedure to the patient.

2. Adjust the height of the bed To prevent overreaching and to work

3.Bring the client to the edge of the bed and comfortably

towards the nurse

4.Remove the top sheet and fold it to the foot To maintain privacy of the patient.
end of the bed, leaving a sheet or bath blanket
over the client.

PREPARATIONOF ARTICLES:
Steps Rationale
A clean tray containing
1. BathBasin-1 To mix the hot & cold water
2. Jugs-2withhotwaterandcoldwater To keep hot water and cold water(water
(water of 43 – 450 C) of 43 – 450 C)
3. Smallbowl-1 To keep the sponge cloth used for putting
soap
4. Spongeclothe-2 One to apply soap and other to clean the
skin
5. Soap with soap dish To remove dirt from the skin
6. Bathtowel-1 To dry the body
7. Facetowel-1 To dry the face
8. Bath blanket/Sheet1 To cover the patient
9. A kidney tray and a paper bag To discard the waste
10. Alaundrybag-1 To discard the soiled linen
11. Bucket-1 To discard the used water
12. Clean gloves To prevent cross infection
13. Disposableapron-1 To prevent contamination from body
secretion
14. Lotion/ Powders(optional) To maintain the moisture level
15. Change of bed linen(1set) To change the soiled linen
16. Change of patient dress(1 set) To change the dress of the patient.
17. Mackintosh with towel To protect the linen
18. Gauze/ cotton piece To clean eyes
19. Comb To attend the hair
20. Nail cutter To cut the nails
21. Screen/Curtain To maintain privacy

PREPARATIONOF NURSE:
Steps Rationale
1. Wash hands To prevent cross-infection
2. Wear gloves and disposable apron To prevent the contamination from
secretions.

PROCEDURE:
Steps Rationale
1. Mix the hot water and cold water in the To prevent the risk of burn
basin and check the temperature by
placing elbow in water.

2. Remove the patients clothing and cover Ensure privacy and prevent chills for the
with a bath blanket /sheet. Expose the part patient.
of the body which is to be washed.

3. Make mitten with sponge clothes. Mitts conserve heat of water and prevents
tip of wash cloth from trailing and dripping
over patients body.
4. Wash, rinse and dry the areas in the Cleaning should be done from cleanest area
following sequence: face, neck , farthest to least clean area.
arm, near arm, chest and abdomen,
back, farthest leg, near legs, pubic
region.

5. Wash face : Prevents soiling of pillow and linen

 Place the mackintosh with bath towel
under patient’s head Bath mitt retains temperature of water.
 Wet bath mitten, squeeze water from
it, so that it is not dribbling
Prevents transmission of organisms from
 Wash patient's eyes using sterile gauze one eye to another, wiping from inner to
piece for each eye and wipe from outer canthus prevents secretions from
inner canthus to outer canthus. entering naso-lacrimal duct.
Soap if remains on skin will cause
 Ask patient if he/she prefers using irritation.
soap for the face (in unconscious
patients avoid soap).

 If using soap, apply soap with the

second mitt and then rinse the first mitt,
 Till the soap is completely removed.
 Wash, rinse, and dry patient's face,
neck, and ears(Observe for any
abnormality)

6. Wash arms and hand: Protects bed linen from becoming wet. Firm
 Place bath towel lengthwise under arm strokes from distal to proximal areas will
farther to you. increase venous return.
 Wash, apply soap, rinse, and dry Rubbing may cause skin injuries.
arms using long strokes from distal to
proximal areas.
 Pat dry using the second bath towel.
Do not rub.
 Wash axilla well. Exercise precaution,
if there is an IV infusion on arm.
 Place folded towel on bed under hands
and place basin on it. Attend to inter
digital spaces. Immerse hand in basin
and assist patient in washing hand.
 Repeat entire procedure for other arm.

7. Wash chest and abdomen. Give special

care to wash skin folds under breast in
female patients, keep the chest covered Prevents unnecessary exposure of patient.
between wash and rinse period. Drywell.

 Fold bath blanket up to pubic area.

Place towel over the chest and abdomen.

 Wash, rinse, and dry chest and

abdomen giving special attention to
skin folds under breasts in female
patient keep the chest covered between
wash and rinse period. Dry well.

8. Change water if cold, dirty, or soapy.

9. Wash back of patient:

 Turn patient to side lying or prone
position and expose back.
 Place towel length wise along side
back of patient.
 Wash, rinse, and dry using long,
firm strokes from neck to buttocks.
 Giveback massage.

10. Change bath water.

11. Turn patient back to supine position.

 12. Wash legs:

 Place towel length wise under farther

leg away from you.

 Bend leg at knee, supporting under

leg and ask patient to hold position. If
patient is unable to do it, ask another
nurse/family member to support leg.

 Use long, firm strokes wash from distal

to proximal/from ankle knee and to Moving from distal to proximal
thigh. Do not use such long strokes in improves venous circulation and
patients having blood clot in lower removes dirt from skin pores.
extremities. example; deep vein
thrombosis as it may dislodge the clot.
 Wash , rinse the extremity.
 Fold towel place beneath of patient.
Place basin with water under the
foot and clean mitt.
 Take the foot and dry the extremity.
 Discard water.
 Repeat entire procedure for other legs.

13. Encourage patient to clean perineal

area with mitt. Discard it into a kidney
tray. If patient is not able to do it for
Promotes patient's independence.
himself the nurse does it making sure that
the entire area is washed and dried.

14. Position patient in a

comfortable position.
Ensures patient well being
15. Apply moisturizer or body lotion
if patient prefers or skin is dry.
Lotions prevent drying and chapped skin.
16. Assist patient dressing.

17. Comb hair

Ensures that the patient is well groomed
which promotes well-being.

TERMINATION:
Care of patient:
1. Ensure the comfort of the patient.
2.Ask and observe the patient for complication.

2.Care of the Articles:

1Discard the water and disinfectant the steel articles with0.5 % hypochloride solution. Clean it
trough running water, soap water, running water and dry the articles. Put back into the
inventory.
2.Disinfect the linen articles and send it to laundry.
3.Discard the gauze piece in yellow BMW bag.
4.Put back all the articles in the proper place after cleaning. Personal articles are replaced into
the patient bedside.
Self care after procedure:
1. Remove the gloves, apron and discard it into red plastic bag.

2. Wash hands thoroughly with soap and water following hand washing steps.

DOCUMENTATION:
Record the procedure on the nurses note with date and time, types of bath given.

CONCLUSION: Giving a bed bath is essential part of providing quality care to patients who
are unable to bathe themselves .The procedure should be carried out with care , patience and
dedication realizing the psychological insecurity experienced by patients. It is not a mere
mechanical practice , but a therapeutic action capable of contribute to the patient’s recovery of
health and promote welfare.
REFERENCES:

1. Sr. Nancy, Principles & Practice of Nursing, 6th edition, N.B Publishing House, Page no:
259- 267
2. Potter & Perry, Fundamentals of Nursing, 7thedition2011,Published by Elsevier
publication. Page no: 850 - 855
3. Annamma Jacob Clinical Nursing Procedures: The art of Nursing Practice,4th edition,
Jaypee publication, Page no: 90-93
4. Lippincott, Manual of nursing Procedure, 8thedition,wolter Kluwer publication.
5. Fundamentals Of Nursing, A procedure manual Published by TNAI2nd edition.