Providing personal care

Our aim is to keep the skin dry and intact. The skin of the person you're caring for may be dry, itchy, extra sensitive and fragile, or it may be clammy and damp due to excess sweating. In either case, extra care is needed.

The skin is affected by everything that goes onto or into the body, including creams and medications, food and drink, and therapeutic treatments. It will also be influenced by what’s happening within the body, such as weight loss, incontinence and disease progression, as well as factors like age and pre-existing skin conditions (e.g. psoriasis or dermatitis).

The following measures will help protect skin health

• Use cotton clothing and bedding
• Regular changes of position as tolerated
• Use a skin moisturiser
• Use pressure relieving equipment

Pressure injuries can happen when mobility is limited, and we stay in one position for a long time. They usually start as reddened areas, often on bony areas and the bottom.

The best time to assess the skin is when you’re providing personal care, bathing, showering or a bed-wash.

Your Hospice care team can give you advice on keeping pressure injuries from developing or getting worse. For more on common pressure injuries and prevention options, click here.

If the person you're caring for can’t get out of bed for a bath or a shower, you can give them a wash in bed.

It’s important to keep them clean, not only for hygiene and skin health, but for their psychological health. We all feel better when we're clean, smelling good and wearing our favourite comfortable clothing.

Bed Bathing Process

• Assemble all equipment: including: bowl of warm water, towels, face cloths, body wash/soap, moisturiser/creams, and clean clothes

• Start with the eyes, cleaning from the inside corner to out. Use a different part of the face cloth for each eye
• Continue to clean the rest of the face, remembering ears too. Pat dry
• Work one side or half the body at a time, keeping the areas not being washed covered with a towel for modesty and warmth
• Wash arms and chest. Ensure washing underarms, under breasts, in folds and creases
• Wash hands and between fingers. Check bony areas for any redness. Pat dry and apply cream
• Cover this area and expose abdomen
• Wash in folds/creases. Pat dry and apply cream
• Cover top half of body and uncover groin
• With a separate cloth, gently wash area with clean warm water
  *for women – wash front to back. Ensure creases and folds are thoroughly washed and dried.
  *for men – where necessary ensure under foreskin is washed and dried carefully with foreskin returned to over tip of penis when done.
• Dry and apply creams
• Cover groin area and expose legs
• Whilst washing legs it can be a good time for gentle massage and passive exercises if tolerated Ensure between toes is washed and dried, check heels for any redness. Pat dry and apply moisturiser and or barrier cream (especially to heels)
• Roll the patient onto their back. If the patient can help, get them to hold onto the side of the bed or rails for stability
• Wash and gently massage back. Check spine and bottom for any signs of redness or pressure. Dry well and apply cream with passive massage if tolerated
• When done, roll the patient back into a comfortable position

The more time your loved one spends in bed, the more important it will be to change the sheets regularly. There may come a time when you need to do this while they’re still in the bed, because they don’t have the strength to get out.

Changing Linen with a person in the bed - Step by Step Process

• Prepare all linen including top and bottom sheets, kylie, pads etc. Make sure these items are within arms’ reach
• This may need x2 people if the person is unable to assist
• Ensure your person is aware that you are changing the linen with them still in the bed
• Loosen all linen. Take off extra blankets, duvets etc. Untuck sheets
• Make sure catheters and syringe driver or any other equipment is out of the way and safe
• Roll person on to side with their help or 2nd person to help keep person safe and on their side
• Roll all dirty linen from under person length ways along person’s back and tuck in tight to body
• Get clean bottom sheet and unfold
• Put over mattress as if making bed and tuck in sides and ends
• If using a kylie put this in place over top of sheet
• If using blue incontinence sheets, pads put these in place on top of kylie
• Roll all this together lengthways along person back again
• Let person know there will be a ‘lump’ under them when they roll over
• Roll person onto other side
• Remove dirty linen first from under person
• Then pull through clean linen and straighten linen under person, ensuring it is crease-free underneath
• Position person on to back again
• Fasten pads, get incontinence products into place and secure. Put syringe driver back in place if needed
• Take off dirty top sheet and replace with a clean sheets and blankets

To watch a video of the process on YouTube click here. 

Good oral health is essential for speaking, chewing and swallowing, and any deterioration can have a big impact on quality of life.

If the person you're caring for can brush their teeth, encourage them to continue doing this. If you need to brush their teeth for them, an electric toothbrush will make it easier.

If it’s no longer possible or appropriate to use a toothbrush, clean the mouth and teeth with mouth swabs or sponges. Contact your Hospice care team if you need further support.

How to clean someone’s teeth

• Assemble everything you need before you start, including a bowl and cups of water for rinsing the mouth; a towel; mouth sponges or soft toothbrush, and toothpaste; plus lip balm or mouth moisturiser
• Remove dentures if necessary and clean them separately
• Clean your person’s teeth as you would your own, being mindful that you need to be very gentle. Give clear instructions and tell them what you’re doing
• If using sponges, dip the sponge in water then use it to gently swab the lips, inside the cheeks, along the teeth on both sides and across the tongue
• Don’t worry if your person sucks on the sponge, just keep dipping it in water and rinse as often as necessary
• If your person clamps down or purses their lips to keep the sponge out of their mouth, don’t force it, just try again later
• When finished, apply mouth moisturiser or lip balm to keep their lips moist and comfortable.

Illness can cause the eyes to produce too much secretion and become sticky, or too little and become very dry.

Follow the steps below to keep your person’s eyes clean and comfortable. Contact your Hospice care team for further support or if their eyes become very dry.

Keeping eyes clean

• Remove contact lenses or glasses first
• Make sure you have two clean face cloths or gauze (plus extra for drying), a bowl of warm, clean water and a clean, dry towel
• Soak cloth or gauze in water
• Gently tilt your person’s head to the side of the eye you will work on first
• Working from the inside corner, nearest the nose, gently wipe along the lash line to the outer edge
• With a clean part of the cloth or gauze, wipe over the entire eye surface. Repeat as many times as necessary to make sure the eye is clean, then dry with a clean towel
• Tilt your person’s head to the other side to repeat the process with the other eye, using a clean cloth or fresh gauze
• Apply eye cream if desired. If eyes become very dry, discuss this with their GP or Hospice care team.

Catheters are commonly used during palliative care and, as your loved one becomes more unwell, you may need to attend to their catheter.

If this happens, you will be given instructions by your District Nurse. If you need further support don't hesitate to ask. 

Call Your District Nurse immediately if:

• The catheter comes out; do not try to replace it
• The patient has a temperature of 38.3° C or higher
• They are making less urine than usual
• There is foul-smelling urine
• There is bright red blood or large blood clots in the urine
• The patient has abdominal pain and no urine in their catheter bag. 

Catheter care tips

• Always wash your hands before and after handling a catheter
• Make sure that urine is flowing out of the catheter into the urine collection bag
• Make sure the catheter tubing does not get twisted or kinked
• Don't tug or pull on the catheter
• Keep the urine collection bag below the level of the bladder
• It is generally okay to shower with a catheter and urine collection bag in place
• Check for inflammation or signs of infection in the area around the catheter, such as excessive discharge or irritated, swollen, red and tender skin
• Clean the area around the catheter twice a day with water. Dry with a clean towel
• Do not apply powder or lotion to the skin around the catheter
• A person should not have sexual intercourse while wearing a catheter
• At night it may be helpful to hang the urine collection bag on the side of the bed
• While your person has a catheter in place, encourage regular drinks if tolerated.

Note: You may see some blood or urine around where the catheter enters your body, especially when walking or having a bowel movement. This is normal, as long as urine is draining into the drainage bag. If this isn't happening, call your District Nurse.

Emptying a Catheter Bag

• Wash your hands
• If the person is able, get them to stand over the toilet and empty it in directly.
• If they cannot stand over the toilet:
  • Gather equipment: Jug or urinal bottle
  • Ensure catheter is hanging below bladder height
  • Put on gloves
  • Place jug under the end valve
  • Slide blue valve over until urine starts to flow through
  • Once bag is empty, slide the blue valve to the other side and ensure it's closed
  • Empty urine into toilet
  • Clean jug, remove gloves and wash hands again.

For further information about catheter care refer to your District Nurse.

Medication is available in various forms and there are three main ways it is commonly given. You may hear your Hospice care team and other health professionals use the following phrases and names when describing these methods of delivery.

• Oral – preferred method of taking medication (tablets, sprays or liquids), for as long as your person can manage it.
• Rectal – used infrequently due to its invasive nature, but it can be effective if needed.
• Subcutaneous – injection under the skin attached to a syringe driver (CSCI). A syringe driver is a small, portable, battery operated device that administers medicines over a selected time period, usually 24 hours. 

  Medications can be given either

• Regularly at set times throughout the day, or
• As needed (PRN) for helping to keep on top of symptoms, including breakthrough pain.

Your Hospice care team will train you on how to give medications if necessary. Please contact them if you have any questions.