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Sandra is a 35 year old female that looks after her mother at home. He mother is called Mary Ann and is 85 years old. Mary Ann had dementia, diabetes, anaemia and is bedbound. Sandra needs to do all her personal care for her.

Mary Ann takes metformin and iron tablets orally with good tolerance.

Sandra is worried because Mary Ann has lost her appetite, is not eating much lately and she looks very thin. Sandra also tells you she finds difficult to move and handle her mother when trying to put body cream on her skin, as this is intact but very dry and when having to change her incontinence pads. Sandra explains her mum is double incontinent.

Sandra is worried about her mothers personal care. She has never cared for someone this way and is asking for your advise.

How does this situation make you feel?

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Using the information in the link attached to the picture, discuss what advise would you give to Sandra regarding keeping her mother clean.

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Keeping yourself or someone you care for clean is essential. Poor hygiene can cause discomfort, skin complaints and infections, and can lower self-esteem.

Staying clean: the basics

To keep someone clean, make sure they:

wash their hands after going to the toilet

wash their genitals and bottom area every day

wash their face every day

have a bath or shower at least twice a week

brush their teeth twice a day

Regular dental checks are also important. Find out more about dental treatment for people with special needs.

How to help someone with washing and bathing

For most people, washing is a very private activity. If you're helping someone wash or have a bath, be sensitive and try to maintain their dignity.

To make washing and bathing as appealing and comfortable as possible:

use pleasant-smelling shampoo, bubble bath or soap

play music they like and are familiar with

if the person you're washing is confused, explain what's happening as you go along

be sensitive to their mood

If you're caring for someone who won't wash, try getting them involved with activities that are followed by showers, such as swimming. It may help if they see other people showering.

Maintaining their dignity

Be aware of the emotional state of the person you care for when you're helping them wash. For example, some people are anxious about deep bath water. Bathroom and shower adaptations, such as seats or recliners, can reduce anxiety. Reassure the person that you won't let them get hurt.

Overhead showers can be frightening to some people. If you have no bath, or there's a good reason for showering rather than bathing, use a handheld shower.

Ask the person how they would prefer to be helped and allow them as much independence as you think is safe.

If they had a routine before you began caring for them, find out what it was and stick to it as much as you can. Find out which shampoo, shower gel or soap they prefer to make the experience more familiar to them.

Many people become self-conscious when undressed in front of others. Be sensitive to the situation and approach it in the way you think is best.

The person you care for may feel isolated if you leave them alone - bring clothes and towels with you so you don't have to leave the bathroom if they don't want you to.

Safety tips

If you or the person you're looking after has limited mobility or problems balancing, make sure:

the floor is not slippery - dry it if necessary

the room is a comfortable temperature

the water is comfortably warm - older people particularly feel the cold, so bear this in mind when adjusting the temperature

the locks are removed from the door - you or the person you care for may want privacy, but other people may need access in an emergency

If you're caring for someone, make sure to protect your own safety - for example, by getting advice on helping someone get in and out of the bath. See more on moving and handling.

Giving a bed bath

If the person you care for cannot move or has extremely limited mobility, you may need to give them a bed bath. Be extra careful when you move or handle them.

Specialist disposable baths are available for people who need to be fully in the water.

Getting help with hygiene

If you're finding it difficult to cope with washing or general hygiene, contact your local authority, a local carers' organisation, or call the Carers Direct helpline on 0300 123 1053.

Alzheimer's Society has more tips on how dementia affects washing and dressing.

Continence services

As many as 1 in 3 people have difficulty controlling their flow of urine. And while someone may not have a problem controlling their bowel or bladder, a mobility problem can make it difficult to get to the toilet in time.

Continence problems can cause skin irritation and infection, as well as embarrassment and loss of confidence.

Your GP can advise you on NHS services that can help. They can provide support, advice and information, and may refer you to continence advisers or specialists, occupational therapists, physiotherapists and dietitians.

A continence adviser may be able to provide many small items and other equipment that can help with continence, including:

plastic or PVC covers to protect beds

disposable or washable continence pads

waterproof pants

Your social services department should be able to provide small aids and adaptations for the home, including:

hand rails

commodes

raised toilet seats

You can also buy continence equipment directly. The Bladder & Bowel Community has a directory of incontinence products.

Laundry services

Some social services departments provide a laundry service for people who have incontinence or bowel and bladder problems. In addition, some local authorities provide laundry services for people who find it difficult to manage their laundry.

Ask your social services department if they provide this service. Your local council will usually carry out a needs assessment to work out what the best service is for you.

Some councils make a small charge for their laundry service, or only launder large items such as bedding.

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How to help someone you care for keep clean - Care and support guide

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Advice on washing, bathing, laundry and general hygiene, maintaining dignity and continence services.

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Pressure ulcer prevention and assessment 

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Pressure ulcer prevention and assessment 

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Please give the main points you would take to your own practice when trying to prevent and assess your patient on pressure ulcers.

What are the risk factors for pressure ulcer development?

Use the PDF linked.

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Patient safety is the avoidance of unintended or unexpected harm to people during the provision of health care. We support providers to minimise patient safety incidents and drive improvements in safety and quality. Patients should be treated in a safe environment and protected from avoidable harm

Please read the document attached and draw some key point that you will take to your own practice to keep patients safe.

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Marie Berigan is a 67-year-old lady who is admitted due to severe dehydration secondary to diarrhea and vomiting. Currently being investigated for Acute Gastroenteritis. She is currently NBM and on intravenous fluids.

Past Medical History: Cardiac Failure, DM, COPD, Morbidly Obese (BMI: 41).

Social History: Smokes 2 packs a day. Works as a Receptionist in a Veterinary Clinic.

A: Patent

B: Speaks in broken sentences, RR (26), O2 Saturations (93% RA)

C: BP (108/58mmHg), HR (104beats per min), Cold clammy skin

D: Urinary Catheter. Incontinent of faeces (type 7).

E: Moisture lesion peri-anal area, and under skin folds. Bipedal oedema.

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What do you think about the following points in relation to the video?

What are the Sequence of events?

How do these nurses Promote professionalism and trust?

How do these nurses show practice of safety?

How do these nurses practice values such as Kindness and Respect?

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This year has marked my fifth anniversary as Chief Nursing Officer for England, and this has given me the opportunity to reflect on these last five years and all that has taken place. We have learnt many lessons from the past and the evolving health and care landscape is now influencing our understanding of health, wellbeing and the types of care required by our diverse populations now and in the future.

Nurses and midwives form the largest proportion of the registered health and care workforce and work with individuals and communities of all ages and across all sectors. The world is changing, and nurses and midwives are key leaders in ensuring that we can meet the current and future challenges. We all have a role to play and this is being supported by new roles and routes into the profession to ensure the delivery of changing models of care by an adaptable, contemporary and professional workforce.

Following some difficult years we have rebuilt public confidence and pride in the profession; and this impact was highlighted in a recent Ipsos Mori survey which showed that the public trust us more than any other professional group. However we must never ever be complacent. We must ensure that as our work changes, our values remain aligned, recognised and understood.

Central to our professional way of working is to continue to ensure the consistent provision of safe, effective, person-centred outcomes that support people and their families and carers, and to achieve an optimal status of health and well-being.

I am privileged to personally witness examples across the country where colleagues in different roles and organisations continuously demonstrate this definition of professionalism with inspiring skill, compassion and resilience on a daily basis.

I am truly delighted to have been able to work with my CNO colleagues and the Nursing and Midwifery Council on this ‘Enabling Professionalism’ publication. We previously worked in partnership on the successful implementation of professional revalidation and this has been a natural next step for us to come together and draw on collective experience and knowledge to support nursing and midwifery professionalism.

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Before we start...

What is personal care?

What actions does personal care involve?

What can make a patient need help with personal care?

What nursing values will be important when doing the personal care of a patient? And why?

What actions can we take to make sure those values are present during personal care?

If you were having personal care done to you... what would be your biggest worry? what would you value the most?

Do nurses need to be involved is the patients personal care? When? Why? If not who can do it?

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Please make a list of what you would do to ensure that you prepare your patient, prepare the environment, prepare your equipment and that you prepare yourself...

Patient preparation (for example, check identity)

Environment preparation (for example, good lighting)

Equipment preparation (what equipment would you need for changing the bed?)

Personal preparation (am i ready to do this?)

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Find in Chapter 8 the procedures for personal care that you have seen in the video and compare them.

Can we do anything different?

What advise would you give to the nurses in the video to perform this procedures better?

Why would you make those changes?

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Using the Royal Marsden Manual - go to page 950.

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Using the Waterlow pressure ulcer risk assessment, assess the risk of Mary Ann.

What is her score?

What can we put in place to prevent pressure ulcers from happening?

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What do you think about the following points in relation to the video?

What are the Sequence of events?

How do these nurses Promote professionalism and trust?

How do these nurses show practice of safety?

How do these nurses practice values such as Kindness and Respect?