The nurse must respect and consider the patient's cultural and religious values and beliefs, while maintaining privacy and dignity at all times; for example, some people prefer to wash under running water rather than sitting in a bath (Fowler [67], Pols [187]). Some religions do not allow hair washing or brushing, while others may require the hair to be covered (Peate [174]). Similarly, in some cultures facial hair is significant and should never be removed without the patient's or their relatives’ consent. Always establish any preferences before beginning care (Mujallad and Taylor [140]; Padela et al. [173]) (Box 9.2).

Effort should be made to encourage and empower patients to dress in their own clothing during the day, where possible, and in their own nightwear to sleep. This increases independence and wellbeing, encourages normality and promotes dignity. This approach was championed by NHS England with the #EndPJparalysis campaign (NHS England [146]), which aimed to get patients up, dressed and moving, citing the many benefits relating to reduced immobility and expedited recovery (Oliver [169], Peate [175]). If the patient is too unwell or does not have their own clothing, hospital provision should be made available to protect their modesty (Fitzgerald [63]).

A bedbath is not the most effective way of washing patients, and wherever possible patients should be encouraged and supported to shower or bathe. However, a bedbath can be performed if it is the only way to meet a patient's hygiene needs (Lopes et al. [113]).

Before commencing this procedure, read the patient's care plan and manual handling risk assessment to gain knowledge of safe practice. Prior to each part of the procedure, explain and obtain verbal consent from the patient where possible (NMC [162]). It is important that the nurse engages in appropriate conversation with the patient. If two nurses are present during bedbathing, the patient should not be excluded from any conversation. Where necessary, complex language and terminology should be adapted to meet the needs of the patient and ensure that they understand the procedure (O'Hagan et al. [166]).

Planned care should be negotiated with the patient and based on assessment of their individual needs; this should be documented and changed according to the patient's needs. Prior to commencing each step, the patient should be offered the opportunity to participate if able, to encourage dignity, independence and autonomy. Privacy and dignity must be maintained throughout; doors and curtains should be kept closed and only opened when absolutely necessary, with the patient's permission.

Also available are commercial dry shampoos and disposable shampoo caps. They can make shampooing easier to accomplish and less of a physical stress for the patient (Spencer [217]). Be sure to follow the manufacturer's instructions and local policies (Peate [174], Treas and Wilkinson [230]).

Shaving to remove hair is a common cosmetic practice for men to maintain a well‐groomed appearance (Maurer et al. [123]). The process of shaving to remove facial hair is one more commonly associated with men; however, it should be remembered that there may be some instances when female patients wish to remove unwanted facial hair (Bloomfield et al. [21]), although in females the hair of the axilla and legs is more frequently shaved (Burton and Ludwig [30]).

If a patient requires help to shave, then the nurse should make themselves aware of personal preferences with regard to shaving as well as any religious and/or cultural considerations. Some religions (e.g. Sikhism) do not permit the removal of any body or facial hair and so for male Sikh patients, beards will require rolling and netting (Peate [174]).

An assessment of the patient's history and blood results should be carried out prior to shaving to ascertain the risk of bleeding. Patients at risk of bleeding should use an electric razor to shave (Spencer [217]). The skin functions as an important barrier to external pathogens (Jones [97], Marks and Miller [118], Maurer et al. [123]). Compromising this barrier by cutting the skin while shaving, coupled with the fact that male skin displays slower wound‐healing rates than female skin (Maurer et al. [123]), could lead to an infection. The patient's immunity and infection status should also be reviewed prior to shaving with a razor; it may be advisable to use an electric razor to minimize the risk of cutting the skin. Only the patient's own razor or a new disposable razor should be used to shave the patient; this is to prevent the risk of cross‐infection (Bloomfield et al. [21]).