Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed. Assess and plan care with the patient. Note personal preferences, addressing religious and cultural beliefs.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent, and to plan care and encourage participation and independence (Alpers and Hanssen [4], R; NMC [162], C; Tobiano et al. [226], R).
2. 2.Show
   Offer the patient analgesia as appropriate. During the procedure, observe for any non‐verbal cues, such as grimacing or frowning, that may suggest that the patient is experiencing pain or discomfort.
   To maintain patient comfort throughout the procedure (O'Hagan et al. [166], R).
3. 3.Show
   Clear the area of any obstacles, ensuring that the environment is warm. Draw the curtains around the bed or close the doors to ensure privacy and dignity. Use available signage as appropriate.
   To maintain comfort and a safe environment and promote privacy and dignity (NMC [162], C).
4. 4.Show
   Offer the patient the opportunity to use a urinal, bedpan or commode.
   To reduce any disruption to the procedure and prevent any discomfort (NMC [162], C).
5. 5.Show
   Collect all the equipment listed and place it by the bedside.
   To minimize time away from the patient during the procedure. E
6. 6.Show
   Clean the washbowl with hot soapy water before use if a non‐disposable bowl is being used. Fill the bowl with warm water as close to the patient's bedside as possible. Check the temperature of the water with the patient and adjust it as necessary.
   To minimize cross‐infection (Rebeiro et al. [197], E).

   To promote patient comfort. E
7. 7.Show
   Check that the bed brakes are on and adjust the bed to an appropriate height for you to carry out care comfortably.
   To prevent the bed moving unexpectedly and to avoid back strain or injury (Davis and Kotowski [48], R).
8. 8.Show
   Wash your hands and put on disposable gloves and apron in accordance with local guidelines.
   To minimize the risk of cross‐infection (NHS England and NHSI [148], C).

Throughout the procedure

1. 9.Show
   The linen skip should be positioned and kept near to the bed throughout the procedure.
   To reduce the potential dispersal of micro‐organisms, dust and skin cells from the linen into the environment (DH [49], C).
2. 10.Show
   The water used to wash the patient may be changed at any stage during the procedure – for example, if the patient feels the temperature is too hot or too cold. Very soapy or dirty water must be changed before proceeding with the wash, and the water should be changed after washing the genitalia and surrounding area. Ideally utilize single‐use wipes for this area.
   To promote patient comfort. E

   To minimize the risk of cross‐infection or translocation of micro‐organisms (Peate and Lane [177], E; Rebeiro et al. [197], E).

   Disposable flannels or wipes are preferable as this reduces the risk of infection (Martin et al. [122], C).
3. 11.Show
   Avoid wetting drains, dressings and intravenous devices.
   To reduce the risk of infection and prevent any drains or intravenous catheters from becoming dislodged (Peate and Lane [177], E).
4. 12.Show
   Check skin and pressure areas throughout the procedure for evidence of damage.
   To ensure any potential or actual damage is identified and treated early. E

Procedure

1. 13.Show
   Check for hearing aids, spectacles and wrist watches and (with permission) remove these from the patient, putting them in a safe place.
   To ensure that the patient's face is washed thoroughly and to avoid damage to such devices. E
2. 14.Show
   Place a towel across the patient's chest.
   To protect the patient from splashes and to prepare for drying. E
3. 15.Show
   Ask the patient whether they use soap on their face. The face, neck and ears should be washed, rinsed and dried.
   To promote cleanliness and to ensure that the patient's preferences are acknowledged. E
4. 16.Show
   Hearing aids and spectacles should be cleaned and returned to the patient.
   To ensure that the prostheses are in good working order and free from debris and contaminants (Peate and Lane [177], E).
5. 17.Show
   Assist the patient with the removal of their upper clothing. The patient should be covered with a bath towel or sheet before folding back the bedclothes. Areas of the body that are not being washed should remain covered.
   To maintain the patient's modesty and sustain body temperature (Rebeiro et al. [197], E).
6. 18.Show
   Wash, rinse and pat dry the top half of the patient's body, starting with the side furthest away from you.
   To avoid any spills on parts of the body that have already been washed and dried (Rebeiro et al. [197], E).
7. 19.Show
   If pyjama trousers are worn, these should be removed while keeping the patient covered. If worn, antiembolic stockings should also be carefully removed.
   To allow access to the lower half of the body and to assess the skin beneath stockings. E
8. 20.Show
   Wash the patient's legs, rinse and pat them dry, starting with the leg furthest away from you.
   To avoid any spills on parts of the body that have already been washed and dried (Rebeiro et al. [197], E).
9. 21.Show
   Tell the patient that the next step is to wash around the genitalia. Ask the patient whether they wish to wash this area themselves or gain verbal consent from the patient to do it for them.
   To reduce the risk of infection and to maintain a safe environment (NMC [162], C; Rebeiro et al. [197], E).
10. 22.Show
    Using a new disposable wipe, wash around the area and then dry it.

    • Female patients: wash from the front to the back.
    • Male patients: the foreskin needs to be drawn back gently when washing the penis of uncircumcised male patients.
    To ensure the area is cleaned and dried. E

    To prevent the translocation of bacteria (Lloyd Jones [111], E; Peate and Lane [177], E).
11. 23.Show
    If the patient has an indwelling catheter: put on clean gloves and wash the tubing, moving the disposable cloth down the tube away from the genital area, then dry the tubing. Remove your gloves and dispose of them as per hospital policy.
    To reduce the risk of catheter‐associated urinary tract infection (RCN [195], C).
12. 24.Show
    Ensure the patient is covered and has a call bell within easy reach. Change the water and put on clean gloves.
    To maintain cleanliness and to preserve dignity and privacy (NMC [162], C).
13. 25.Show
    Request assistance as necessary to roll the patient onto their side. Cover the areas of the patient that are not being washed. Wash their back, assessing the skin and pressure areas accordingly.
    To prevent and treat pressure ulcers. E

    Disposable flannels or wipes are preferable as this reduces the risk of infection (Martin et al. [122], C).
14. 26.Show
    Using a disposable flannel or wipe, wash the sacral area, then rinse and dry the area. Gloves should be removed and hands decontaminated.
    To minimize the risk of cross‐infection (NHS England and NHSI [148], C).
15. 27.Show
    Keep the patient on their side while changing the bottom bed sheet. Return the patient onto their back, ensuring that they remain covered. Roll the patient onto the other side as required (to change the bottom sheet). Apply toiletries as required.
    To enable the sheets to be changed with minimal disruption to the patient. E
16. 28.Show
    Allow the patient to choose what clothing they would like to wear.
    To enhance patient comfort, to promote positive body image and to promote the #EndPJparalysis campaign (NHS England [146], C).
17. 29.Show
    Encourage the patient to do as much for themselves as they are able. For patients who require help in dressing, it is advised to put clothing on the weak or paralysed side first.
    To encourage self‐care, independence and rehabilitation. E
18. 30.Show
    Inspect the patient's fingernails. If necessary, clean under the nails. Cut or clip fingernails to the top level of the finger, shaping the edges with an emery board if necessary.
    To enhance positive body image and patient comfort and reduce the risk of infection (NMC [162], C).
19. 31.Show
    Check the feet for any areas of skin dryness, inflammation or calluses. The need for podiatry referral should be assessed. Refit antiembolic stockings as necessary, measuring according to local policy (see Procedure guideline 16.1: Measuring and applying antiembolic stockings).
    To ensure adequate foot care. E

    To maintain venous thromboembolism (VTE) prophylaxis (as determined by a VTE risk assessment) (Roberts and Lawrence [200], E).
20. 32.Show
    Provide appropriate equipment and assist the patient to brush their teeth and/or rinse their mouth (see Procedure guideline 9.14: Mouth care).
    To maintain good oral hygiene and prevent infection (Rebeiro et al. [197], E).
21. 33.Show
    Style the patient's hair as desired.
    To enhance patient comfort and to promote a positive body image (NMC [162], C).
22. 34.Show
    Assist male patients with facial shaving if required, using either a disposable razor (see Procedure guideline 9.3: Shaving the face: wet shave) or an electric shaver (see Procedure guideline 9.4: Shaving the face: dry electric shaver).
    To enhance patient comfort and to promote a positive body image (NMC [162], C).
23. 35.Show
    Remake the top bedclothes.
    To ensure the patient is adequately covered, maintaining comfort and dignity (NMC [162], C).
24. 36.Show
    Help the patient to sit or lie in their desired position, considering the previous position.
    To enhance patient comfort and reduce the risk of pressure area breakdown (NMC [162], C).

Post‐procedure

1. 37.Show
   Remove your apron and gloves, disposing of them according to local regulations.
   To prevent cross‐infection (NHS England and NHSI [148], C).
2. 38.Show
   Remove the equipment from the patient's bedside and replace the patient's possessions. Place the locker, bedside table and call bell within the reach of the patient.
   To maintain a safe environment and promote patient independence (NMC [162], C).
3. 39.Show
   Document any changes in planned care.
   To provide recorded documentation of care and aid communication to the multiprofessional team (NMC [162], C).