Dwellness^™ • Showering and Grooming

Showering and Grooming

Dwellness^™ customization for:

Your Patient

"The Safe Walk"

General Principles

[NOTE: Before you undertake this routine, please study and practice the principles of Safe Body Dynamics for your patient’s transfers and ambulation.]

→ Breathe! Never hold your breath and bear down when exerting yourself ←
→ Stretching helps prevent injury… stretch before work, and stretch every day ←
→ Keep a low center of gravity during transferring or lifting ←
→ When not transferring or lifting, stand and walk fully erect with abdominals engaged ←
→ Think carefully about each move you make ←
→ Prompt your patient's movements, prepare, and wait for a response before moving yourself ←
→ When in doubt, pause and reconsider your next move ←
→ If he decides to go down to the floor, do not resist; gently lower your patient ←

Showering

[NOTE: Give your patient a shower once every other day or so. In the meantime, use wipes and other cleaning supplies to keep your patient as clean as possible.]

1. Be sure the path to the bathroom is clear and safe
2. Check supplies
• Briefs, prepared for donning
• Adequate supply of wipes
• Adequate supply of exam gloves
• Change of shirt and pants (or summer shorts)
3. Prepare briefs for use after shower
4. Prepare the shower
• Pull the curtain halfway open — it can stay this way throughout the shower
• Position the shower chair to be easier to sit down
• Clear the step-in area
• In the empty shower, remove the handheld shower head and run the hot water to rinse out the shower and bring the hot water up from the heater
• Shut off the shower and replace the handheld shower head

[NOTE: About 10% of the time, your patient may have a neurological physical "stutter" with the left foot. When your patient initiates the left foot to step so your patient can stand up, the left foot does a slight spasm and your patient can’t place it squarely on the floor. Your patient usually moves it back in place under your patient, and immediately tries again. The second time almost always works well and your patient stands up. This does not change anything you should do, except keep a steady hold and encourage your patient to try again.]

1. Navigate into the bathroom
2. Stand behind your patient and allow your patient to hold onto the sink

→ CAUTION: NEVER LEAVE your patient ALONE IN THE BATHROOM. ←
→ CAUTION: When standing in the bathroom, always stand close enough to protect your patient from falling. If you have to reach for something or move sideways, then always keep at least one hand behind your patient. ←




3. Pull down your patient's pants and briefs, just past the knees
4. Remove the shirt and g-tube gauze
5. Turn around to face the shower stall
6. Help your patient step in, just in front of the shower chair
7. Seat your patient in the shower chair – if there is resistance, gently push on one side of the pelvis to ease your patient down to sitting
8. Attach the lap belt for safety

1. Remove the handheld shower head form the holder
2. Aim it away from your patient and turn on the water to the halfway point until the temperature is safe and comfortable

→ CAUTION: Be aware of water temperature every moment — AVOID SCALDING! ←



3. During the shower, regularly check the temperature and adjust for comfort
4. Tip your patient forward and start by washing the rear end – rinse well
5. Wash and rinse the back and tip your patient up to sitting

→ CAUTION: If your patient tips forward, make sure the your patient's feet are both on the floor in front of your patient. If your patient tucks feet under and tips forward, your patient can fall forward. ←





[NOTE: To induce your patient to sit up from a forward tip, sometimes it works just to spray the shower on legs and torso. Do not spray in the face. Try to avoid spraying water into the ears.]

6. Wash and rinse in front

1. Wet down your patient's hair, being careful not to spray into the mouth or ears
2. Replace the handheld shower head in the holder and aim to wall so it won’t spray directly on your patient
3. Apply the first squirt of shampoo and work it in
4. Rinse
5. Apply the second squirt of shampoo and thoroughly massage the head
6. Rinse

1. After turning off the shower, use a bath towel to dry the face first
• Follow with hair, back, front, arms, legs, and feet
2. Stand inside the shower, directly in front of your patient, and detach the seat belt
3. Stand your patient up, help your patient step out, and have your patient hold onto the sink

→ CAUTION: When standing in the bathroom, always stand close enough to protect your patient from falling. If you have to reach for something or move sideways, then always keep at least one hand behind your patient. ←



4. Dry in the crotch and the backs of legs

1. To work on the left side, place your right foot behind your patient's right foot
2. Lunge to the left and reach your right hand around to the front of your patient's left leg
3. Place left side of the briefs on your patient's left leg
4. To work on the right side, place your left foot behind your patient's left foot
5. Lunge to the right and reach your left arm around to the front of your patient's right leg
6. Place right side of the briefs on your patient's right leg
7. Repeat this process for pants or summer shorts
8. Put on a shirt, encouraging your patient to help push arms through the sleeves
9. Brush your patient's hair

[NOTE: As you leave the bathroom, have your patient shut off the light. For reference, see Input for All Senses.]

Grooming

Wash his hair at the sink

• Prepare the bathroom
  • Bath towel
  • Shampoo bottle near the sink
  • Plastic bowl in the sink
  1. Use the "The Safe Walk" to transfer into the bathroom
  2. Stand behind your patient at the sink and remove the shirt
  3. Drape the bath towel across the front and fold it behind the neck to hold it in place
  4. Run the water into the bowl until it's a comfortable temperature
  5. Narrate to your patient as you lean the head forward and pour water over the hair
  6. Shampoo and rinse
  7. After you turn off the water, pull the towel up to dry face and hair
  8. Put the shirt back on

[NOTE: Be sure your patient is seated and secured in a chair. Provide a distraction with the drum machine on your patient's lap. Remember to narrate what you are doing for your patient – stay upbeat.]

1. Use the Remington Vacuum Haircut Kit model HC6550-AT(PDF)
2. With the 1” attachment, sweep over the top of your patient's head from the front left to right rear
• Give a little extra cutting to the rear crown of the head – the "cowlick"
3. Use the ¾” attachment to sweep upward on the sides of the head, behind the ears, and up the back of the head
4. With the ½” attachment, sweep halfway up the back of the head to blend in the cut
5. The ¼” attachment is good for just a little blending the cut at the sideburns, behind the ears, and up the back of the neck
6. Preferably, give your patient a shower after the haircut

[NOTE: Carefully watch the chamber that holds the cut hair. As soon as it’s full, empty it. This will be necessary several times during the haircut.]

• Clip fingernails and toenails regularly
1. Be sure your patient is seated and secured in a chair
2. Patiently provide a distraction
• Upbeat music is a favorite
3. Narrate excitedly as you proceed
• Your patient's favorite is for you to say, "I’m clipping your Pirate nails!" "Aargh, matey!"
4. Use either the nail scissors of a nail clipper
5. Be extra cautious not to clip nails too close

[NOTE: Your patient will resist. Your patient doesn’t like having the nails clipped. But be very patient and encourage your patient. Make it sound like fun. Feel free to break this task down into several stages across the day.]

1. Be sure your patient is seated and secured in a chair
2. Provide a distraction
• It almost always works well to give your patient the loud drum machine on your patient's lap
3. Lay a kitchen towel on the table
4. In the bathroom, fill a bowl with hot water and wet a wash cloth with hot water
5. Set the bowl, a razor, and shaving crème on the towel
6. Apply the hot wash cloth to your patient's face
• This calms your patient, and preps any stubble for shaving
7. Apply the shaving crème and shave your patient

[NOTE: Always narrate with an upbeat tone as you do any task. Talk, sing, make funny sounds. Patience is key to keeping things moving smoothly.]

1. Be sure your patient is seated and secured in a chair
2. Use the Philips brand Norelco NT5600 Trimmer, with the Rotary Trimmer
3. Narrate in a patient and cheerful way while you trim your patient's nose hair
4. If there is resistance because of the sensory overload, simply discontinue and try again later

1. Your patient should be seated and secure
2. Use the DeVilbiss Vacu-Aide suction machine
3. Use a suction toothbrush
4. Use only a tiny bit of toothpaste – your patient tends to choke on the normal amount
5. Finish with plain water to "rinse"