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18.2 Personal Care Skills

18.2 (a) Infection Control

Hand washing is important in infection control. It helps to prevent the spread of
infections. Infection spreads through contact with infectious agents or micro-
organisms such as bacteria, viruses, and fungi. Home Health Aides and Personal Care
Aides should wear gloves when coming into contact with a patient's body fluids.
They should also wash their hands after removing the gloves. Wash your hands
before and after carrying a task. Hands must be washed before and after contact with
the patient and their belongings, before, during and after meal preparation, before and
after the use of the bathroom, and after changing diapers or after sneezing.
Proper hand washing should be carried out with soap and water. If there is no
water, and the hands are not visibly soiled, then both hands should be cleaned with an
alcohol-based hand sanitizer containing at least 70% of alcohol. HHA/ PCA should
practice proper use of personal protective equipment (PPE) when caring for patients
or when in contact with body fluids. Personal protective equipment (PPE) includes
gloves, masks, boots and aprons. It is important to wear the appropriate PPE when
carrying out a task. Understanding how infections are transmitted is essential in
infection prevention and control.

Chain of Infection
A chain of infection is an infectious process consisting of 6 elements that are
necessary for an infection to occur. It involves a sequence of events that lead to the
establishment of infection. These elements include pathogens, reservoir, mode of
transmission, portal of entry, portal of exit, and a susceptible host. Breaking the chain
of infection is important in effective infection prevention and control.

Pathogen
The pathogen is the first element of the chain of infection. A pathogen is an infect-
ious agent responsible for the occurrence of an infection. Examples of a pathogen
include bacteria, virus, fungi or a parasite. Without a pathogen, there will be no
infection.

Reservoir/Host
A reservoir is the main habitat that harbors the pathogens. It is also known as the host.
The pathogens or infectious agents live in the reservoir where they flourish and
multiply. Examples of a reservoir include human beings, animals, insects or the
environment.

Portal of Exit
This is the route through which the infectious agent leaves the reservoir or host.
Portals of exit include:

 Alimentary canal via the mouth or anus- saliva, vomiting, diarrhea or feces.
 Respiratory tract via the nose or mouth- coughing, sneezing and talking.
 Genitourinary via sexual transmission.
 Skin via skin lesions.
 Transplacental via the placenta. From mother to the fetus.

Mode of Transmission
This is the process by which an infectious agent is transferred from its reservoir to a
susceptible host. There are two types of transmission: direct and indirect
transmission.

Direct transmission: this is transmission that occurs due to direct contact with the
infectious agent. Examples of infections that occur through direct transmission
include, respiratory infections (due to direct contact with the infectious droplets from
the reservoir), tetanus and sexually transmitted diseases (transmission results from
exchange of body fluids and blood during sexual intercourse; e.g HIV).

Indirect transmission: this occurs through animate mechanisms such as vectors (ticks,
mosquitoes, fleas) and inanimate mechanisms such as vehicles of infection (food,
water, biological products, surgical intervention, fomites). Indirect trans- mission can
also be transmitted through airborne. In airborne transmission, pathogens are carried
by dust or droplets in the air. They get into the susceptible host through inhalation.

Portal of Entry
This is the channel through which the pathogens or infectious agents enter the body of
the susceptible host. These include respiratory tract via inhalation through the nose,
gastrointestinal tract via ingestion of contaminated food or water, or through kissing.
Pathogens can also enter the susceptible host through the skin by absorption of
pathogens via the mucous membranes, and broken skin. Absorption can also occur
through the eyes. Pathogens can also get inoculated into the body as a result of
puncture or trauma. It can also get introduced into the body via contaminated medical
devices.

Susceptible Host
This is the last element or link in the chain of infection. Several factors can make one
susceptible to infections. These include age, illnesses, medications, and
socioeconomic factors.

Risk Factors
What can make a person susceptible to an infection? Factors that can make one
susceptible to an infection include:

 Illness: Some illnesses weaken the immune system. Illnesses such as cancer, and
HIV predispose one to infections due to compromised immunity or immu-
nodeficiency.
 Age : At a very young or tender age, the immunity is not fully developed. This
predisposes very young children such as infants to infections. Also, as one ages,
the immunity weakens leading to susceptibility to infections.
 Medications: Some medications weaken the immune response. These medica-
tions are called immunosuppressants such as methotrexate and corticosteroids
(e.g prednisone).
 Poor nutrition.
 Unhygienic practices.
 Other socioeconomic factors.
 Types of Infection
There are different types of infection. These include:

 Urinary tract infection (UTI)

 Respiratory tract infection
 Gastrointestinal infection
 Wound/skin infection
 Sexually transmitted infections such as human immunodeficiency syndrome
(HIV)

Standard Precautions in Infection Prevention and Control

Standard precautions in infection prevention and control include:

 Proper hand washing

 Use of appropriate personal protective equipment (PPE)
 Cleaning and sanitizing equipment
 Cleaning and sanitizing the home
 Proper disposals of contaminated wastes and sharp objects

Ways HHA/ PCA can Help in Infection Control in a Home

 Proper hand washing.
 Wearing of proper personal protective equipment (PPE) such as gloves, and
apron when performing tasks.
 Cleaning and sanitizing equipment and the home.
 Health education: teaching patients to practice proper hand washing and other
hygienic practices.
 Ensuring sharp objects or needles used by patients are properly discarded in
designated sharps containers.
 Safe disposal of contaminated wastes.

Proper hand washing procedures, donning and doffing of gloves are discussed below.

Procedure: Hand washing

 Gather equipment: soap, paper towels.
 Gather towels if no paper towels are available.
 Roll up sleeves and remove the watch and jewelry.
 Wet hand under warm, running water.
 Apply a generous amount of soap and lather hands well.
 Wash the entire surface of hands, between the fingers, around and under the
fingernails, up to above the wrist, according to current CDC guidelines. Interlace
your fingers and use a rubbing motion to ensure all surfaces of your hands and
fingers are washed.
 Use friction by rubbing your hand surfaces together for at least 20 seconds
according to the CDC current guidelines.
 Rinse hands thoroughly under warm, running water with hands lower than your
wrists and your forearms.
 Dry hands using a clean cloth or paper towel.
 Turn off the tap with a paper towel.
 Use alcohol-based hand cleaners in situations where there is no running water or
hands are not visibly soiled.

Use of Alcohol-Based Hand Sanitizer

If there is no water, and the hands are not visibly soiled, then both hands should be
cleaned with an alcohol-based hand sanitizer containing at least 70% of alcohol.

 Apply product to one hand (amount determined by product instructions).

 Rub hands together, covering all surfaces of hands and fingers.
 Interlace your fingers and rub hands together to ensure all hand surfaces are
covered with the sanitizer.
 Use the same friction applied during hand washing to rub your hands together.
 Clean fingers one after the other including the nail beds by rubbing the fingers
and nail beds of one hand into the palm of the other hand.
 Rub hands together until the product has completely dried.

Procedure: Donning & Doffing Gloves

As stated earlier, gloves should be worn when coming into contact with a patient's
body fluids such as blood, urine, vomitus, feces, and saliva. Also, gloves should be
worn when handling soiled linen during laundry, or assisting a patient with personal
tasks such as bathing, mouth care, dressings and toileting. Gloves should not be
reused. Discard gloves when soiled or torn.

Donning (Applying) Gloves

 Wash hands properly
 Dry your hands
 Pick up one glove with your right hand.
 Position glove so that the thumb side of the glove aligns with the thumb on your
left hand.
 Slide glove onto your left hand
 Keep hands above your waist while donning glove to avoid the hands getting
contaminated
 With your gloved left hand, pick up the second glove and slide the other hand
into it (that is your right).

Doffing (Removing) Gloves

 When removing gloves, touch only the outside of the glove. Do not allow the
contaminated gloves to touch your wrist or skin.
 Use one hand and grasp the outer surface of the glove below your thumb. Do not
touch the skin under your glove. Grasp the glove and peel it off your palm, so that
it will be inside out. Keep the discarded glove in the remaining gloved hand.
 With your ungloved hand, put two fingers underneath the cuff of the remaining
glove, taking care not to touch the outside of the dirty glove.
 Peel the glove off your hand in the direction towards your fingers, and away from
your body.
 As you remove the glove, turn it inside out into the other discarded glove. This
keeps the soiled gloves together with their dirty surfaces folded inside, rather than
on the outside.
 Discard gloves and wash your hands as outlined in the hand washing proce- dure.

18.2 (b) Bathing, Back Rubs & Assisting with a Clean Dressing
Assisting a patient with a bath helps him to meet his basic human needs and improves
his overall well-being. Bathing can be complete bed bath, partial sponge bath,
shower/tub bath, and evening care. An illness and immobility can affect the frequency
of bathing. Bathing can be provided to patients recovering from an injury or illness,
those with chronic conditions, those with permanent disabilities, frail and elderly
patients. The type of bathing to be chosen depends on the purpose of bathing and the
condition of the patient. Some patients can bath independently, while others may
require assistance or complete care.
The Care Plan will specify the frequency and the type of bathing that should be
provided to a patient. It is important for HHA/ PCA to follow the instructions in the
Care Plan. Irrespective of the type of bath being provided to a patient, always ensure
the face and genitalia of a patient are cleaned daily. A patient who cannot have a
bath due to his or medical condition can also be given evening care. Evening care
involves face washing, mouth care and any other area a patient wishes to be cleaned.
Complete bed bath can be provided to a bedridden patient or a patient who is
immobile or frail. During a complete bed bad, a patient can also have her hair
shampooed in bed. A weak patient should be given a bed bath or tub bath. A shower
chair should be used during the bathing of elderly patients. Ensure there is handrail or
shower grab in the bathroom.
It is important to allow a patient to do the much they can do for themselves in
personal care. This promotes independence and self-esteem. Always protect a
patient's privacy when assisting him or her with a bath. This can be done by closing
the door, or screening the area where a patient is being given a bath. Also, safety
precautions must be observed when providing a bath to a patient. These include
proper regulation of water temperature and assessment of environmental and
equipment safety. Allow patients to check the water temperature so as to know if they
are comfortable with it. Ensure handrails and grab bars are in place. A patient has the
right to refuse care. Always protect the rights of a patient. If a patient refuses a bath,
gently educate him or her on the importance of good hygiene practices, and find out
the reasons for refusing a service. Document this in the Care Plan and inform your
home health supervisor.
It is also important for HHA/ PCA to observe a patient for physical and emotional
changes when providing a bath to him. Report all changes to your supervisor.
Changes to be reported while performing bathing tasks include skin changes,
dizziness or weakness, changes in mental status and refusal of service. Skin changes
that may be encountered while providing personal care to a patient include change in
skin color, temperature, sores, bruises, swelling, rashes, etc. Ensure you document
these changes and report them to the home health supervisor.
Bath rub promotes relaxation and good circulation. Bath rub can be provided to a
patient after a bath, before bedtime, or during the time of stress. Home Health Aides
and Personal Care Aides should help their patients to relax by providing back rub to
them when needed.
Below are guidelines on how to provide a tub or shower bath, bed bath, shampoo
in bed, assisting a patient into and out of a tub, back rub and non-sterile clean dressing.
Home health aides are not allowed to provide sterile dressing to a patient. However,
they can provide non-sterile clean dressing to their patients, but personal care aides
may not provide medically related tasks.

Procedure: Tub or Shower Bath

 Explain procedure to patient.
 Wash hands according to proper hand washing guidelines.
 Assemble equipment.
 Ensure warmth in the bathroom.
 Remove loose rugs from the floor, if necessary.
 Check for safety devices.
 Place rubber mats and shower chairs appropriately.
 Test water temperature.
 Wash hands, as necessary.
 Put on gloves, as necessary.
 Assist the patient into the tub or shower appropriately.
 Assist the patient to wash, if necessary.
 Shampoo hair, if necessary.
 Assist with drying, if necessary.
 Assist the patient out of the tub or shower.
 Drain and clean tub/shower area.
 Wash hands.
 Observe, record and report any changes in condition or behavior.

Transferring patient into and out of the tub

 Wash and dry hands.
 Gather supplies for the patient's bath and keep near the tub.
 If the patient can move, assist him to the tub or shower.
 If the patient is not ambulatory, get the patient into a wheelchair.
 Face the patient and wheelchair toward the tub, between the grab bars.
 Lock the brake of the wheelchair and raise the footrests of the wheelchair.
 Assist the patient in placing his legs one at time, over the tub edge. Feet must be
placed firmly on the tub floor.
 Instruct the patient to grab the safety bars, then assist him into a sitting position
on the edge of the tub. Gait belt can be used to assist the patient into a sitting
position and to provide a safe transfer.
 After the patient is brought to a sitting position on the edge of the tub, lower the
patient into the tub by holding around his waist or the gait belt.
 Instruct the patient to hold the grab bars or edge of the tub for support.
 Remove the wheelchair.
 Assist the patient with the bath. Wash from clean areas to dirty areas. Do not use
the same washcloth for clean and dirty areas of the body.
 Dry patient's body.
 If the patient can move, assist with transfer out of the tub/ shower.
 Cover the patient with a towel or rub to keep him warm.
 If the patient is not ambulatory and needs a wheelchair, then bring the wheelchair
to the tub. Lock the brakes of the wheelchair.
 Assist the patient to the edge of the tub.
 Place the patient's leg one at a time over the outer edge of the tub.
 Assist the patient back into the wheelchair.
 Drain the tub and clean the tub/shower area.
 Remove gloves.
 Wash and dry hands.
 Observe, record and report any changes in condition or behavior.

Procedure: Bed Bath

Complete bed bath can be provided to a bedridden patient or a patient who is
immobile or frail. During a bed bath, a patient can also have her hair shampooed.

 Explain procedure to the patient.

 Wash hands.
 Assemble equipment.
 Provide for privacy and warmth.
 Put on gloves, as necessary.
 Prepare bedding for bath, protecting bed with towels, as necessary.
 Test temperature of water.
 Form mitt with washcloth.
 Wash and dry from head to toe; cleanest to least clean part of the body.
 Wash and dry one part at a time.
 Keep exposure to a minimum.
 Soak and dry hands and feet appropriately.
 Allow the patient to participate as much as possible.
 Change water when needed.
 Wash genitals and buttocks last.
 Apply lotion, if ordered.
 Assist with dressing.
 Allow the patient to rest.
 Clean area and equipment.
 Wash hands.
 Observe, record and report any changes in condition or behavior.

Procedure: Shampoo in Bed

Assisting a patient to wash her hair, promotes good hygiene and relaxation. Ensure
you check for allergies to hair products before using any product. Style hair according
to the patient's preference.

 Explain procedure to the patient.

 Wash hands.
 Assemble equipment.
 Ask the patient which products to use to prevent allergies or reactions.
 Make trough, a hollowed-out depression that allows the water to flow and helps
keep the bed dry.
 Check room temperature.
 Place the towel appropriately.
 Place trough appropriately.
 Put on gloves
 Wet hair and work up a good lather, working from front to back.
 Protect eyes and ears.
 Rinse thoroughly.
 Dry hair.
 Clean area and equipment.
 Wash hands.
 Observe, record and report any changes in condition or behavior. Record any
changes in condition of the patient's skin, scalp or hair.
 Document completion of task.

Procedure: Back Rub

Back rub promotes sleep and relaxation in a patient. It stimulates circulation and
relaxes muscles. Back rub can be given after bath or before bed time. Ensure you
check the Care Plan for instructions. During a back rub, it is important to observe for
skin changes in a patient. Always report and record changes noted.

 Explain procedure to the patient.

 Wash hands.
 Assemble equipment.
 Remove the patient's clothing.
 Position patient on stomach or side.
 Position yourself appropriately.
 Warm lubricant before applying.
 Lubricate hands.
 Rub back with appropriate pressure.
 Rub back rhythmically.
 Rub back in the correct direction. Starting from the top of the buttocks, near the
lower back, and move in long, smooth upward strokes with both hands, using the
palms of your hands to create gentle pressure. Move your hands upward along the
spine, and across the patient's shoulders and then down to their upper arms. Then
move your hands up over upper arms, down across the shoulders, then down
along the back towards the buttocks. If the patient
 wishes, you can tap the back gently in the same direction.
 Observe and massage bony or reddened areas.
 Time procedure according to the patient's wishes.
 Remove excess lotion.
 Assist the patient with dressing.
 Return equipment.
 Wash hands.
 Observe, record and report any changes in condition or behavior.
 Document completion of task.

Procedure: Assisting with Changing a Clean (Non-Sterile) Dressing

Home Health Aides may change clean, non-sterile dressing for a patient. Personal
care aides may not assist with sterile and non-sterile dressing. Both HHA and PCA
may not carry out sterile wound dressing. The procedure below is for Home Health
Aides.

(Using Standard Precautions)

 Explain procedure to the patient.
 Wash hands.
 Assemble equipment.
 Provide privacy.
 Assist the patient to a comfortable position.
 Provide good lighting.
 Remove clothing over dressing, if necessary.
 Place a waste bag near the patient for disposal of dressing/waste products.
 Put on gloves.
 Remove wrappings from new dressing.
 Cut tape.
 Remove old dressing and observe the wound for odor, color changes, drainage,
and healing or non-healing features.
 Report and record any changes noted.
 Discard old dressing and used gloves.
 Wash hands.
 Put on new gloves.
 Clean skin around the wound according to directions in the Care Plan.
 Hand requested items to the patient.
 Apply new dressing to the wound.
 Tape new dressing in place.
 Remove and discard the waste bag.
 Wash hands.
 Store unused supplies.
 Observe, record and report any changes in condition or behavior.
 Document completion of task.

18.2 (c) Teeth & Mouth Care

Good dental hygiene is important for a patient's overall wellbeing. It promotes
confidence and gives a sense of comfort. Dental or mouth hygiene should be carried
out twice per day and as needed by the patient. HHA/ PCA provide oral care for their
patients by assisting in cleaning their teeth and mouth. It gives HHA/PCA the
opportunity to assess the health and condition of their patient's teeth, gums and
tongue.
Patients should be allowed to perform as much oral care as they can by themselves.
This promotes independence in a patient and builds his or her confidence. A
toothbrush can be modified to make it easier for a patient to hold. Hydrogen peroxide
and alcohol based products should not be used in a patient's mouth care. These may
cause irritation in the mouth.
For patients who are unconscious or those who can't have their mouths brushed,
dental swabs can be used to clean the mouth. An unconscious patient needs his or her
mouth cleaned every 2 hours to avoid dryness and mucosal breakdown. Lip care can
be provided by gently wiping the lips and applying lip balm or lip moisturizer. Below
are the instructions on how to provide oral care to a patient.

Procedure: Mouth Hygiene

Mouth Hygiene and Care of Patients who can Brush own Teeth
Procedure
 Explain procedure to the patient.
 Wash hands.
 Assemble equipment (cup, toothbrush, toothpaste, emesis basin, mouthwash and
towel).
 Put on gloves, as necessary.
 Provide rinse water.
 Give patient tissue/towel for wiping.
 Observe the patient to ensure proper tooth care.
 Observe, record and report any changes in condition or behavior.

Patient Unable to Brush own Teeth

Procedure
 Explain procedure to patient.
 Wash hands.
 Assemble equipment.
 Put on gloves, as necessary.
 Place the patient upright or on the side.
 Place a towel under the head.
 Place an emesis basin at the side of the head, against the mouth and cheek.
 Brush teeth gently with up and down circular strokes. If not safe to brush, use a
special mouth swab to clean teeth surfaces, tongue and roof of the mouth.
 Help the patient rinse mouth.
 Examine the mouth for sores, bleeding gums, broken or missing teeth.
 Ensure the mouth and neck are dry.
 Help make the patient comfortable.
 Clean and store supplies.
 Wash hands.
 Observe, record and report any changes in condition or behavior.

Denture Care

Procedure:
 Explain procedure to patient.
 Wash hands.
 Assemble equipment.
 Put on gloves, as necessary.
 Receive dentures from the patient in tissue or break suction and remove dentures
with a tissue. This can be done by placing a tissue, gauze pad, or washcloth
underneath the patient's denture line and gently pulling forward to break the
suction.
 Place dentures in a water-filled container.
 Carry dentures to sink.
 Cushion sink with washcloth (to prevent accidental breakage of denture) and add
water.
 Clean dentures appropriately.
 Assist the patient in rinsing his mouth.
 Apply denture cream or adhesive as needed.
 Insert dentures in the patient's mouth (insert at an angle, pressing firmly on the
gum line), or store dentures in water without an adhesive.
 Wipe the patient's mouth.
 Wash hands.
 Observe, record and report any changes in condition or behavior.

18.2 (d) Dressing & Grooming

Assisting a patient with dressing and grooming is an important task that HHA/ PCA
perform. This promotes a patient's overall well-being and improves his looks or
appearance. Hand and foot care are also important components of physical health.
Patients suffering from diabetes should have their foot inspected daily for early
detection of problems related to poor circulation or diabetic foot ulcers. During hand
and foot care, always observe the patient's skin and nail. Report any changes to the
homecare supervisor. Below are instructions on how to assist a patient with dressing
and grooming.

Procedure: Assisting with Dressing

 Explain procedure to the patient.
 Wash hands.
 Put on gloves, as necessary.
 Allow the patient to select clothing he or she prefers. Always respect a patient's
preferences and wishes.
 Assemble clothes in the order they are to be put on.
 Encourage and allow the patient to do as much self-dressing as possible. Assist
when the patient asks or shows signs of fatigue, frustration, or inability to
perform the task.
 Wash hands.
 Observe, record and report any changes in condition or behavior.

Procedure: For Patients who are Partially Paralyzed, Weak, or Frail

 Explain procedure to patient.

 Wash hands.
 Assemble clothing in the order they are to be put on.
 Put on gloves, as necessary.
 Move the patient to the center of the bed.
 Remove night clothing, if necessary.
 Cover the patient with a sheet.
 Uncover upper body first.
 Assist with a shirt.
 Uncover lower body.
 Assist with underpants or shorts and remainder of clothes.
 Assist with socks and shoes as needed.
 Wash hands.
 Observe, record and report any changes in condition or behavior.

Procedure: Assisting with the Use of Elastic Support Stockings

Support stockings are prescribed for patients who have poor circulation and are at risk
of having thrombotic conditions (blood clotting). They are also used to reduce leg
swelling. Support stockings or compression stockings are prescribed by a physician. It
is important for the HHA/ PCA to follow the instructions in the Care Plan about its
application and frequency. Also, the support stockings manufac- turer’s manual
should be used for directions.

 Explain procedure to patient.

 Wash hands.
 Assemble equipment.
 Put on gloves, as necessary.
 If the patient has been up and around, have him or her lie down with legs elevated
for 15 minutes before applying stockings.
 Make sure the legs are clean and dry.
 The legs may be lightly powdered or, if the skin is dry, lotion may be used.
 Put on stockings as the Care Plan directs: smoothly with no wrinkles. Make sure
the heel of the foot is in the heel of the stocking.
 If the stocking has no toe opening, pull on the tip of the stocking to relieve
pressure.
 Remove at least once a day or as frequently as directed by the Care Plan.
 Bathe the skin underneath, dry, and reapply.
 Observe for changes in skin color, skin temperature, swelling, or sores on legs.
 Wash hands.
 Record changes in skin color, skin temperature, swelling, or sores on legs, and
patient's complaints.
 Also, report any change in skin color, skin temperature, swelling, or sores on legs,
and patient's complaints.

Nail Care
Nail care promotes confidence and comfort in a patient. HHA/ PCA should always
assess the condition of their patient's nail and skin during nail care. It is important to
follow the Care Plan as it will stipulate all the care a patient will receive during
homecare. Patients with diabetes mellitus should have their feet inspected daily, but
they should not be given toenail care.

Procedure: Hand Care/ Fingernails

 Explain procedure to patient.
 Wash hands.
 Assemble equipment and supplies.
 Put on gloves, as necessary.
 Soak the patient's hands in tepid water.
 Dry carefully.
 Push cuticles back.
 Clean under nails.
 File nails, if necessary.
 Massage hands with lotion.
 Observe for irritation.
 Wash hands.
 Observe, record and report any changes in condition or behavior.
Procedure: Footcare/ Toe Nails
 Observe the patient's feet.
 Soak feet in warm water for at least 10 minutes.
 Clean under nails with a soft nail brush.
 Dry feet gently.
 Use an emery board to smooth nails.
 Wash hands.
 Observe, record and report any changes in condition or behavior.

Procedure: Shaving the Patient

 Explain procedure to patient.
 Wash hands.
 Assemble equipment.
 Put on gloves, as necessary.
 Place the towel under the patient's chin.
 Wash the patient's face; leaving it wet.
 Rub shaving cream into the patient's beard.
 Pull skin tightly in the area to be shaved.
 Shave, using gentle, short strokes in the same direction.
 Rinse razor often.
 Rinse face.
 Pat the face dry.
 Apply after-shave lotion.
 Wash hands.
 Observe, record and report any skin irritations, redness, and scaling to the
supervisor.
Electric Razor Procedure
 Explain procedure to patient.
 Wash hands.
 Assemble equipment.
 Put on gloves, as necessary.
 Wash face with soap and water and dry.
 Shave with an electric razor.
 Apply after-shave lotion if the patient desires.
 Wash hands.
 Observe, record and report any skin irritations, redness, and scaling to the
supervisor.

18.2 (e) Assisting with Elimination

Some patients may require assistance with elimination due to immobility or injury.
One of the tasks of HHA/PCA is to assist a patient to meet his or her need of
elimination. Patients can be provided with bedpans if they are unable to use the
bathroom. Male patients who cannot go to the bathroom can use a urinal beside their
bed. Some male patients have condom catheters and indwelling catheters connected to
external urinary bags. An indwelling catheter is inserted into the bladder, while a
condom catheter is applied to the penis. Below are instructions on how to offer a
patient a bedpan or urinal, how to apply a condom catheter, and how to clean genital
area and catheter tubing. Instructions are also provided on how to empty the urinary
drainage bag and how to measure urine output.

Procedure: Use of a Bedpan

Some patients in homecare settings may not be able to walk to the bathroom due to
immobility, injury or a chronic condition. These patients will need to be assisted with
elimination. Such patients will benefit from the use of bedpans. Bedpans are used for
micturition (urination) or bowel movements (defecation). Patients who cannot lift
their hips due to spinal or back injury can benefit from fracture pans. Below are
instructions on how to assist a patient with bedpan.

 Explain procedure to patient.

 Wash hands.
 Assemble equipment.
 Put on gloves, as necessary.
 Warm and powder bedpan.
 Place the protector pad near the patient's hips.
 Place the bedpan on the bed near the patient's hips.
 Maintain patient's privacy.
 Assist patient in lifting hips or assist patient to roll to one side if unable to lift
hips.
 Place the bedpan under the hips.
 Assist the patient to sit, if possible.
 Provide toilet paper and call signals.
 Assist verbally or manually with wiping, if necessary.
 Assist the patient in raising hips.
 Remove the bed pan carefully.
 Assist the patient to wash hands.
 Adjust bed cover.
 Remove the bedpan to the bathroom.
 Observe, measure (if indicated), and dispose of contents.
 Clean bedpan.
 Wash hands.
 Observe, record and report any changes in condition or behavior.

Procedure: Use of a Urinal

Male patients unable to walk to the bathroom can use a urinal to pass urine. HHA/
PCA should position the patient in the most comfortable position during micturi- tion
(urination). Always provide privacy for the patient by leaving the room for few
minutes if the patient can use the urinal by himself. If the patient needs assistance to
use the urinal, then ensure his privacy is maintained by covering the area where he is,
or by covering him with a blanket.

 Explain procedure to patient.

 Wash hands.
 Assemble equipment.
 Put on gloves, as necessary.
 Maintain patient's privacy.
 Place a bed protector, a protective pad or towel under the patient's hips.
 Ensure the patient stays in a comfortable position. The patient can be in a sitting
position in bed or at the side of the bed.
 Give the patient a urinal.
 Place the urinal to collect urine.
 Provide toilet paper and signal bell.
 Assist with hand washing, as necessary.
 Empty urinal.
 Clean urinal.
 Wash hands.
 Observe, record and report any changes in condition or behavior.

Procedure: Assisting with the Use of the Condom Catheter

Condom catheter is a urinary drainage system worn by some male patients to assist
with urination. It is less invasive than indwelling catheter and has low risk of infection.
Male patients with problems of incontinence can benefit from condom
catheters. Condom catheter is connected to an external urinary bag for collection of
urine. Ensure the tubing of the condom catheter remains unobstructed.

 Explain procedure to patient.

 Wash hands.
 Assemble equipment.
 Put on gloves. Maintain patient's privacy.
 Expose genital area only.
 Wash and dry penis carefully.
 Observe skin of penis for sores.
 Apply skin protectant to the shaft of the penis and allow to dry.
 Attach condom to the tubing, if necessary.
 Roll condom catheter onto penis as directed in the Care Plan or by supervising
nurse.
 Check that tubing is one to two inches below the tip of penis.
 Check that the tip of the condom is not twisted.
 Tape tubing to the client as directed in the Care Plan.
 Wash hands.
 Record the application of condom catheter and presence of sores or raw areas.
 Report presence of any sores or raw areas on or around penis.

Procedure: Assisting with Cleaning the Skin and Catheter Tubing

Catheter tubing should be cleaned daily. When providing bathing and perineal care to
the patient, always ensure catheter tubing is cleaned. This reduces the risk of infection.

Explain procedure to patient.

Wash hands.
 Assemble equipment.
 Put on gloves.
 Maintain patient's privacy.
 Place the patient on his/her back so that the catheter and urinary opening are
exposed.
 Put a towel or disposable bed protector under the patient.
 Wash the genitals gently with soap and water.
 Do not pull on the catheter, hold it with one hand while wiping it with the other.
 Gently push back foreskin on the uncircumcised male before cleaning.
 Observe the area around the catheter for sores, crusting, leakage, or bleeding.
 Dry area with a towel.
 Clean the catheter tubing as directed by the Care Plan starting with the tubing
nearest to the patient. A warm soapy washcloth can be used to clean the tubing.
Then rinse with a wet clean washcloth.
 Position the patient so that the catheter and tubing do not pull and are free from
kinks or pulling.
 Tape tubing to the client as directed in the Care Plan.
 Dispose of dirty water into the toilet.
 Discard any disposable equipment.
 Remove the bed protector or towel.
 Clean and store reusable equipment.
 Wash hands.
 Record time catheter care was done.
 Observe, record and report any changes in condition or behavior.

Procedure: Assisting with the Emptying of the Urinary Drainage Bag

Urinary drainage bag is connected to a condom catheter and indwelling catheter to
collect urine produced by the patient. It is important to empty this bag regularly.
Ensure the urinary drainage bag is not obstructed by inspecting it frequently. Never
pull the catheter tubing when emptying the urinary bag as this can cause injury to the
patient.
 Explain procedure to patient.
 Wash hands.
 Assemble equipment.
 Put on gloves.
 Put a measuring pitcher or container below the drainage bag.
 Observe condition of tubing: clear or has particles in it.
 Take the drainage tube on the bag out of its holder.
 Unclamp and open the drainage tube on the bag being careful not to touch the end
of the tube.
 Drain urine from the bag into a container.
 Clean the end of the drainage tube as directed by the Care Plan.
 Clamp the drainage tube and put it back into its holder being careful not to touch
the end with your hand or anything else.
 Measure the amount of urine, if directed by the Care Plan.
 Observe the color, odor of the urine, presence of mucus or blood in the urine, and
condition of the drainage bag and catheter tubing.
 Empty urine into the toilet.
 Rinse pitcher with cool water.
 Clean with soap and brush.
 Store a clean pitcher.
 Wash hands.
 Record amount of urine (if directed by the Care Plan) and observations.
 Report cloudy, strong smelling, or bloody urine.
 Report if there is only a small amount or no urine in the drainage bag when it is
scheduled to be drained.
Procedure: Measuring Urine Output
What is taken into the body is known as intake, while what is taken out is known as
output. Excess fluid in the body is excreted (removed) from the body as urine.
Depending on the condition of a patient, there may be a need to measure urine output.
This will be requested by the physician and documented as an instruction in the Care
Plan. So, it is important HHA/PCA follow the instructions in the Care Plan. Urinals
have measuring lines which can be used to know the amount of urine a patient makes.
Also, urinary drainage bags may have measuring lines that can be used in urine
measurement. If the patient is using the toilet or bedpan, then urine should be emptied
into a pitcher or graduated container for measurement before being discarded.

 Explain to the patient the need to measure urinary output.

 Ask the patient to use bedpan, urinal, or commode when he or she wants to pass
urine.
 Get the patient's cooperation by asking the patient to report when he or she has an
urge to pass urine. (This will not be necessary if the patient has a urinary drainage
bag.)
 Wash hands.
 Assemble equipment.
 Put on gloves, as needed.
 Pour or drain urine from bedpan, urinal, commode, or urinary drainage bag into a
measuring pitcher that is on a flat surface. Some urinary drainage bags may have
measuring lines which can be used for urine measurement.
 Record amount that is in pitcher or urinary drainage bag. Amount of urine should
be recorded in milliliters (mL).
 Discard urine unless a specimen is needed.
 Clean reusable equipment.
 Store reusable equipment.
 Wash hands.
 Observe, record and report any changes in condition or behavior, such as strong
smelling urine, cloudy urine, blood in the urine, very small amount of urine, or if
the patient has pain or difficulty when passing urine.
18.2 (f) Assisting with Eating
One of the ways HHA/ PCA help their patients to meet their basic human needs is by
assisting them with eating. They assist a patient in meal preparation, food shopping
and feeding. Depending on the condition of the patient, some may be able to feed
independently, while others may need assistance and total care during mealtime.
Adaptive devices such as special plates, cups and adaptive utensils may help a patient
to be as independent as possible during mealtime. Encourage patients to use their
adaptive equipment when eating. Patients with visual impairment can be provided
with details of food positions in a plate using the clock method if they can feed
themselves. Encourage them to wear their eye glasses for better vision.
Always respect a patient's preferences during meal preparation. Allow patients to
choose the type of food they want to eat. Food preferences as stated in previous
discussions in this book are influenced by cultural and religious backgrounds. Make
the food appealing and nutritious by varying food colors and food sources. As we
discussed in chapter 15, ChooseMyPlate is a useful resource used in planning menu.
Follow the guidelines in ChooseMyPlate when selecting food for a patient. For
patients who need special diets, follow the instructions in the Care Plan when
preparing their meals.
The goal in assisting patients with feeding is to make sure they enjoy their meals.
Providing mouth care prior to eating and ensuring dentures are well fixed in a
patient's mouth (for patients who use dentures) before feeding will enable a patient to
enjoy his or her meal. Ensure patients are positioned in an upright position when
eating to avoid choking or aspirations. Also, patients who have swallowing
difficulties and choking tendencies should be kept in an upright position for 30 to 60
minutes after eating.
Always make the mealtime a pleasurable moment. Sit beside the patient while he
or she eats. Use the mealtime as an opportunity to know a patient better. Encourage
them to reflect on their past memories. For patients who have chewing or swallowing
difficulties, limit conversations during mealtime. Remember to document and report
changes in appetite or condition of a patient to the home health supervisor.

Procedure: Assisting with Eating

 Explain the procedure to the patient.
 Wash hands.
 Assemble equipment (e.g bowl, plates, cup, eating utensils, napkins).
 Put gloves on, as necessary.
 Arrange food attractively on the plate.
 Allow the patient to choose foods to be eaten.
 Encourage the patient to do as much as capable.
 Assist only when it is necessary.
 Cut food into small pieces if the patient is unable.
 Place a napkin on a patient's chin and replace it when soiled.
 Use forks and spoons gently.
 Wipe the patient's mouth, if needed.
 Use straws or a training cup for liquids. (For visually impaired). Explain where
food is located on a plate, and what is on eating utensils.
 Special plates with guards and padded eating utensils may make feeding easier
for the patient and promote independence.
 Feed to the strong side (in case of a facial weakness or paralysis on one side).
 Clear the table once the patient finishes eating. Clean used dishes.
 Assist the patient with hand and mouth hygiene when he is done eating.
 Wash hands.
 Observe, record and report any changes in condition or behavior.

Procedure: Measuring Intake

Depending on a patient's health condition, there may be a need for fluid and food
intake to be measured. In patients with heart failure, fluid may be restricted. Thus, to
effectively manage some patients, there may be a need for intake measurement. Fluids
can be measured in milliliters, while food can be weighed or measured in percentages.
The Care Plan will specify the measurement to be used. Serving containers can be
measured ahead of time to make the process easy. Subtract the leftover from the total
amount in the serving container to get the actual amount of intake.
Using the percentage method, each plate of food is seen as 100%. If a patient eats
half of the plate, intake will be written as 50%. If he eats none, then intake is written
as 0%. Food can be weighed before serving. To get the actual intake, the leftover is
subtracted from the total amount weighed prior to serving.
 Explain to the patient the need to keep track of intake. Get the patient's
cooperation by asking the patient to tell when they have had something to drink
and to report how much they have had.
 Wash hands.
 Assemble equipment.
 Serve liquids in containers (bowls, glasses, or cups), measured ahead of time.
 Measure serving containers ahead of time.
 Assemble equipment (measuring cup, bowl, cup and/or glasses that will be used
each time the patient drinks or eats something; paper; and pencil).
a. Fill the first serving container with water.
b. Pour water into a measuring cup.
c. Write down this amount on paper.
d. Discard water.
e. Repeat steps b, c, d, and e for each serving container.
f. Keep this list for use each time the patient's intake is measured.
 Write down types and amounts of liquids served to the patient.
 When the patient is finished, remove serving containers.
 Measure each type of liquid that is left.
 Subtract leftover amount from amount served to patient.
 Add all of these together.
 Write this down.
 Clean measuring and serving equipment.
 Store measuring and serving equipment.
 Wash hands.
 Record total amount of intake for a particular time.
 Observe, record and report any changes in condition or behavior.

18.2 (g) Assisting with Transfers, Turning and Positioning, and

Body Mechanics

Body Mechanics
As stated in chapter 17, use of proper body mechanics ensures safety for both the
Home Health Aide/Personal Care Aide and the patient. Body mechanics simply
means the way the body moves and maintains its balance. It is important to use proper
body mechanics when moving or transferring patients, when moving objects in a
home, and in daily patient care. Always make the best use of the body's strength when
lifting or moving objects to avoid straining the muscles and joints. When lifting and
moving a patient, the following basic rules of proper body mechanics should be
applied.

Procedure: Proper Body Mechanics

 Use good posture. Always keep your back straight.
 Place one foot ahead of the other while working.
 Use a wide and firm base of support by keeping your feet 12 inches apart when
performing tasks.
 Keep back straight, never overextend your back when performing tasks.
 Bend at hips and knees when lifting or stooping. Don't bend at your waist.
 Face your work and the direction of movement. Do not twist.
 Turn your whole body when turning or while carrying an object/ person. Don't
twist at your waist. Turn with your head, body and feet.
 Keep objects being lifted close to the body. Objects being lifted should be carried
close to your body.
 Use the weight of your body when pushing or pulling.
 Whenever possible, ask someone to help you with lifting, rolling or moving
patients.
 For prolonged standing, stand with one foot up.
 Do not perform tasks that may be dangerous to you.

Turning the Patient in Bed

Some patients in homecare settings may have difficulty with mobility. The degree of
immobility depends on the condition of the patient. For example, a patient that
suffered from a cerebrovascular accident (stroke) may have hemiplegia (paralysis of
one side of the body) or paraplegia (paralysis of both legs). Other patients may have
spinal or back injury. These make it difficult for the patients to move freely. Thus,
bedridden patients or patients who are bedbound are assisted with turning and
positioning in bed. Therefore, turning patients in bed is an important task of the
Home Health Aides and Personal Care Aides.
 Bedridden patients should be turned every two hours to prevent bedsores or
pressure ulcers. Turning also helps to promote comfort. Do not pull or drag a patient
in bed to avoid frictions. This can lead to skin damage and injury. Turning a patient
involves alternating different positions to prevent pressure sores. Pillows can also be
kept beneath bony areas of the body to prevent the development of pressure sores.
Below are instructions on how to turn a patient in bed.

Procedure: Turning the Patient in Bed

 Explain procedure to patient.
 Wash hands.
 Put on gloves, as necessary.

To turn the patient towards you

 Stand on the side of the bed to which you want to move the patient.
 Lower the side rail on the side closest to you.
 Ensure the side rail of the bed is up on the side the patient is turning from.
 Move the patient to the appropriate side of the bed.
 Place the arms of the patient correctly. Cross the patient's arms over his or her
chest.
 Place legs correctly. Bend or cross the patient's leg nearest to you over the
farthest leg.
 Place one hand on the patient's shoulder and the other hand on the patient's hip.
 Support legs correctly.
 Roll the patient appropriately from the opposite side of bed while ensuring the
patient's safety. The entire body of the patient should roll at once.

To turn the patient away from you

 Stand on the side of the bed opposite of the side to which you want to move the
patient.
 Lower the side rail on the side closest to you.
 Ensure the side rail of the bed is up on the side the patient is turning to.
 Place the arms of the patient correctly. Cross the patient's arms over his or her
chest.
 Place legs correctly. Bend or cross the patient's legs farthest from you over his or
her lower leg.
 Place one hand on the patient's shoulder and the other hand on the patient's hip.
 Support legs correctly.
 Roll the patient appropriately to the opposite side (away from you), while
ensuring the patient's safety.

Lifting the patient towards the head of the bed for patients who can assist
 Adjust the head of the bed and make it flat.
 Shift the pillows.
 Lower the side rails of the bed on the side you are standing.
 Use proper body mechanics.
 Place one arm under the patient's shoulders and the other under the patient's
thighs.
 Instruct the patient to bend his or her knees and push down against the mattress
with the feet and hands.
 Shift your weight to your front leg after rocking back and forth.
 Move the patient up.

Lifting the patient alone towards the head of the bed with a draw sheet or bed pad
 Adjust the head of the bed and make it flat.
 Shift the pillows.
 Stand behind the head of the bed.
 Use proper body mechanics.
 Roll and grasp the top of the draw sheet or bed pad on either side of the patient's
shoulders.
 Pull the draw sheet or bed pad up towards the head of the bed.

Moving a patient to the side of the bed

You can move the patient in segments or with a draw sheet/bed pad.
To move the patient in segment:
 Move the upper part of the body first by placing your hand underneath the neck
of the patient and grasp their far shoulder (the shoulder farthest from you) from
underneath his or her body.
 Use the other hand to place under the middle of the patient's back, around their
waist area.
 Then move their upper body towards you.
 To move the patient's torso, place one arm under the patient's waist and the other
under his or her thigh.
 Use proper body mechanics.
 Move the trunk towards you.
 To move the legs and feet, place your arms under the patient's thighs and calves.
 Move the legs and feet towards you.

Moving the patient with a draw sheet or bed pad with an assistant
 Roll up the draw sheet or bed pad on the side closest to you.
 Second person should do the same on the other side of the bed.
 On the count of three, rock backward, and pull the patient towards you.
 As you pull, lift the patient slightly to avoid dragging the patient across the bed.
 Ensure the patient's body is properly aligned at all times.
 Adjust the pillow for the head correctly.
 Ensure patient's comfort.
 Readjust bed to proper safe height.
 Ensure side rails are in place for the safety of the patient.
 Wash hands.
 Observe, record and report any changes in condition or behavior

Positioning the Patient in Bed

There are different types of positions that a patient can be kept in bed. These include
supine position, prone position, fowler’s position (cardiac position), and lateral
position. Whichever way a patient is positioned in bed, ensure the patient is
comfortable with it.
Some positions can help relieve distress in a patient, or improve the symptoms.
For example, for patients who have orthopnoea (difficulty breathing when lying down)
due to heart failure, it will be needful to place such a patient in fowler's position
which is also known as cardiac position as it improves cardiac symptoms. In cardiac
or fowler's position, the patient is kept in an upright position. The bed can be raised at
the head region to enable the patient to be in fowler's or cardiac position. For beds that
are not adjustable, piles of pillows can be used to raise the head and upper body of the
patient to enable him to be in an upright, fowler's or cardiac position.
Ensure to turn and reposition patients who are bedbound or bedridden every two
hours to prevent pressure ulcers. After positioning a bedbound patient in bed, ensure
pillows are placed under bony prominences of the patient's body to prevent pressure
sores. Examples of bony prominences that are at risk of pressure sores include:
 Back of the head
 Heels
 Elbows
 Ankles
 Hips
 Sacrum (lower back)
 Coccyx (tailbone)

Positions:
Fowler's (cardiac) position
As stated earlier, in Fowler's position, a patient is placed in an upright position or
sitting up position. Beds can be adjusted to enable the patient to be in an upright
position. Piles of pillows can also be kept at the head of the bed or behind a patient's
head to enable him to be in this position. To prevent pressure sores, pillows can be
kept under the buttocks, elbow, and ankles of the patient. This prevents the
development of pressure sores.

Supine position
A patient in supine position is placed in a lying position with his face positioned up
and his back against the bed. Pillows can be kept behind the head, buttocks, arms and
ankles of the patient to prevent the development of pressure sores.
Prone position
In a prone position, a patient is positioned face down with their abdomen (belly)
against the bed. Arms may be gently bent at an angle at the patient's side. Do not
place the arms underneath the patient. Pillows can be placed under the arms, feet, and
head for comfort and to prevent bedsores.

Lateral position
Patient in a lateral position is placed on one side. Pillows can be placed on the arm,
head, feet and in between the knees to provide comfort and to prevent bedsores.
Pillows can also be placed under the patient's head and neck, back, top arm, top leg
and foot.
Below are instructions on how to place a patient in different positions discus- sed
above.

Patient on Supine Position (Lying on the Back)

 Explain procedure to patient.
 Wash hands.
 Assemble equipment.
 Put on gloves, as necessary.
 Center patient safely in bed.
 Turn the patient safely on back.
 Align the patient's body.
 Place pillows or folded towels appropriately: under head; under leg; under small
of back; alongside hips.
 Position arms appropriately.
 Support and cover feet appropriately.
 Make the patient comfortable and safe.
 Wash hands.
 Observe, record and report any changes in condition or behavior.

Patient on Lateral Position (Lying on the Side)

 Explain procedure to patient.
 Wash hands.
 Assemble equipment.
 Put on gloves, as necessary.
 Center patient safely in bed.
 Turn the patient onto his side.
 Align the patient's body.
 Place pillows or folded towels/blankets appropriately: under head and neck; at
back; under top leg (that is in between the legs); under foot; under top arm.
 Position hips and legs appropriately.
 Position shoulders and arms appropriately.
 Cover patient, making him comfortable and safe.
 Wash hands.
 Record and report appropriately.
Patient on Prone Position (Lying on the Abdomen)
 Explain procedure to patient.
 Wash hands.
 Assemble equipment.
 Put on gloves, as necessary.
 Move the patient to the side of the bed.
 Turn the patient onto his abdomen.
 Align the head and turn the head to the side.
 Place a pillow under the patient's head.
 Place arms appropriately.
 Support lower legs and feet.
 Cover the patient appropriately.
 Wash hands.
 Observe, record and report any changes in condition or behavior.

Transferring Patients to and from Different Positions

Due to difficulty with mobility, patients may need assistance with ambulation or to
move from one point to another. They may also need assistance to transfer to different
positions in bed. It is important for HHA/ PCA to know how to assist a patient with
ambulation. Assisting with ambulation is one of the major tasks of HHA/ PCA. They
should learn how to operate adaptive equipment used by patients for ambulation such
as wheelchairs, canes, walkers etc.
 This section of chapter 18 focuses on how to assist a patient to move from a lying
position in bed to a sitting position in bed; from a lying position in bed to a sitting
position at the side of the bed; from a lying position to a standing position; and
assisting a patient with ambulation or walk. How to assist in positioning a patient in a
chair or wheelchair is also discussed. Finally, this section will discuss how to help a
patient (who cannot walk) to complete activities of daily living by assisting him or her
with transfer to the bathroom and toilet using a wheelchair.

Procedure: Transfer to the Sitting Position in Bed

Patients having difficulty with mobility may need assistance to sit up in bed to eat,
take medications or engage in activities. Below are instructions on how to assist a
patient to sit up in bed.

 Explain procedure to patient.

 Wash hands.
 Put on gloves, as necessary.
 Raise the head of the bed.
 Face head of bed. Place your outer foot forward. Maintain 12 inches apart
between your feet. Slightly bend at the knee while keeping your hips aligned.
 For a patient who can move, ask him to push down on the mattress with his or her
hands and feet, while bending the knees as they move up in bed into a sitting up
position.
 For a patient who cannot move, place one arm (the arm closest to the patient)
behind the patient's shoulders. Then, place the other arm under the patient's
thighs.
 Pull the patient to a sitting position by rocking. This can be done by rocking
forward and backward. Ensure your back is aligned while rocking. Also, at the
count of three, shift your weight from your front leg to your rear leg to create a
good balance and support. Use the rocking motion to pull the patient up to a
sitting position.
 Place pillows behind the patient's head and back to help him or her maintain an
upright position.
 Cover the patient for warmth and comfort.
 Check the patient for dizziness, weakness, etc.
 Remove gloves.
 Wash hands.
 Observe, record and report any changes in condition or behavior.

Procedure: Helping the Patient to sit at the Side of the Bed

 Explain procedure to patient.
 Wash hands
 Put on gloves, as necessary.
 Position feet with a wide base of support.
 Roll the patient on the side facing self.
 Bend patient's knees.
 Place other arm under the neck and shoulder area.
 Reach one arm over to hold him/her in the back of knees or thighs.
 On the count of “three”, shift weight to the back leg.
 While doing this, swing the patient's legs over the edge of the bed while pulling
his/her shoulders to a sitting position.
 Remain in front of the patient with both hands on him/her until you are sure the
patient is able to safely sit alone.
 Remove gloves.
 Wash hands.
 Observe, record and report any changes in condition or behavior.

Procedure: Helping a Patient to Stand

Change in position from a lying or sitting position to a standing position may lead to
postural/ orthostatic hypotension (change in blood pressure to a lower level due to
abrupt change in position), especially in elderly patients. This may make a patient feel
dizzy and faint. HHA/ PCA should always allow a patient in a lying position to first
sit at the edge of the bed and dangle his or her legs for a few minutes before standing
up. This will give the body time to adjust.
Furthermore, before assisting a patient to walk, allow him to be in a standing
position for a few minutes to ensure he can stand on his feet. This will help to prevent
falls. More so, using a gait belt during the transfer of patients will help to prevent falls.
HHA/ PCA should always inform their supervisor if a patient complains of dizziness
or feels faint during change of position. If a patient feels dizzy or faint after getting up
from the bed, lower him or her down in bed and inform your supervisor immediately.
 Explain procedure to patient.
 Patient is sitting at the edge of the bed.
 However, if a patient is lying down in bed, first bring the patient to a sitting
position at the edge of the bed by following the procedure above on “helping
patient to sit at the side of the bed.”
 If necessary, put the bed in the lowest position. Make sure the bed locks are on.
 Wash hands.
 Put on gloves, as necessary.
 Face the patient. Place one foot forward between the patient's feet. If the patient
has a weak knee, brace your knee against his/hers by placing the inside of your
knee against the outside of his/her knees.
 Tell the patient to put the strongest foot under him/herself so as to use that foot to
provide a base of support during standing position.
 Bend knee and lean onto forward foot. Your hips and back should align.
 Place both arms around the patient's waist.
 Hold patient closely.
 If the patient is using a gait belt, ensure the gait belt is secure and over the
patient's clothing. Then, grasp the gait belt securely in both hands, with one hand
on either side of the patient's waist while standing in front of the patient.
 Tell the patient to push down on the bed with arms and lean forward.
 Gently rock the patient backward and forward to provide a propelling motion, and
begin to count. On the count of “one -two -three”, assist the patient to stand.
Assist the patient by rocking weight to the back foot and lifting as you reach three.
 Support the patient until it is sure he/she is able to safely stand alone.
 Wash hands.
 Observe, record and report any changes in condition or behavior.

Procedure: Assisting a Patient with Ambulation (Helping a Patient to Walk)

Ambulation helps a patient to maintain and improve muscle and bone strength.
Assisting a patient with an exercise, even if it is for short distances will improve
circulation, alertness, mood and strength of the patient. The home health team will
specify in the Care Plan all the instructions regarding ambulating a patient. Some
patients may not be allowed to engage in any exercise until they recover from a
serious medical condition. It is important for the HHA/ PCA to follow the instructions
on the Care Plan.

 Explain procedure to patient. Ensure the patient understands the importance of

ambulation.
 Reassure patient.
 Instruct the patient regarding shoes to wear.
 Assist the patient in practicing standing and shifting weight.
 Walk slowly, taking small steps.
 Walk with the patient on the patient's weak side using correct positioning and
offering support to the patient.
 Note any sign of tiredness while walking. Assess strength and balance of the
patient.
 Encourage the patient to use adaptive devices such as a walker, or cane while
walking.
 Walk for short distances. Take breaks often if the patient feels fatigued.
 If the patient starts to fall while walking, widen your stance, and provide support
by bringing the patient's body close to you. Then, bend your knees and use the
strength of the muscles of your thighs to lower the patient to the ground. If the
patient falls, inform your supervisor immediately. Do not get the patient back up
until he/she has been evaluated by the home health doctor or registered nurse. In
the case of a fall, a HHA/ PCA may be required to write an incident report. Guide
on how to write an incident report can be gotten from your supervisor.
 Document the distance walked by the patient and the assistance provided during
ambulation.
 Remove gloves.
 Wash hands.
 Observe, record and report any changes in condition or behavior.

Procedure: Transfer to Wheelchair, Chair, or Commode

Observe all safety precautions when transferring a patient to a wheelchair, chair or
commode. Position the chair the patient is being transferred to on the patient's
strongest side. Use proper body mechanics in carrying out procedures. Ensure the
brakes of the wheelchair are locked during the transfer.
 Explain procedure to patient.
 Wash hands.
 Put on gloves, as necessary.
 Ensure the bed is in its lowest position and that the bed locks are on.
 Angle wheelchair, chair or commode next to bed. It should be slightly turned
towards the bed.
 If using a wheelchair, lock wheelchair brakes.
 Place a safety belt on the patient, if needed.
 Dangle the patient's legs over the side of the bed.
 Stand patient up using the procedure discussed above on “helping a patient to
stand.”
 Rotate the patient until the back is facing the wheelchair.
 Back up patient until patient feels the chair with the back of legs.
 Maintain good body mechanics.
 Ask the patient to place his/her hands on the armrests of the wheelchair.
 Lower patient into the wheelchair.
 Adjust footrests. Patient's feet should be placed comfortably on the footplates of
the wheelchair.
 Observe the patient for signs of dizziness, or weakness.
 If the patient starts to fall while being transferred, widen your stance, and provide
support by bringing the patient's body close to you. Then, bend your knees and
use the strength of the muscles of your thighs to lower the patient to the ground.
If the patient falls, inform your supervisor immediately. Do not get the patient
back up until he/she has been evaluated by the home health doctor or registered
nurse. In the case of a fall, a HHA/ PCA may be required to write an incident
report. Guide on how to write an incident report can be gotten from your
supervisor.
 If the patient had no signs of dizziness and tolerated the procedure, then cover the
patient for comfort, warmth and privacy.
 Release the brakes of the wheelchair for transfer.
 Wash hands.
 Observe, record and report any changes in condition or behavior.
Procedure: Positioning Patient in Chair or Wheelchair
A patient may need assistance for proper positioning in a chair or wheelchair. Ensure
the patient is repositioned every two hours to prevent pressure ulcers. Place a safety
belt on the patient if needed. Place a draw sheet or bed pad under the patient's
buttocks for easy repositioning. Observe all safety precautions.

 Explain procedure to patient.

 Assemble equipment.
 Wash hands.
 Put on gloves, as necessary.
 Lock the brakes of the wheelchair.
 Use proper body mechanics.
 If the patient is able to assist, move footrests out of the way. Apply a gait belt if
using. Ask the patient to hold on to the armrests and to push down when
instructed, while you face the patient bracing his/her legs and knees with yours.
On the count of three, instruct the patient to push down on the armrests while
you pull him/her up to a standing position.
 As the patient stands, straighten and properly fix the draw sheets and chair pads.
 When putting the patient back in the wheelchair, reverse the procedure used to
assist the patient to stand.
 Place the patient's hips back in the chair.
 Place feet appropriately. Feet should be placed comfortably on the footrests.
 Check for the position of male genitals. Ensure a male patient is not sitting on his
scrotum.
 Place pillows appropriately. A pillow can be placed on the patient's back for
comfort.
 Support arms with pillows, or on armrests.
 Make the patient comfortable and safe.
 Reposition the patient every two hours to prevent pressure ulcers. Wheelchair
pillows can help to prevent development of pressure ulcers. Draw sheets can also
be used in repositioning a patient.
 Remove gloves.
 Wash hands.
 Observe, record and report any changes in condition or behavior.
Procedure: Transfer from Wheelchair to Toilet
Patients having difficulty with mobility may need to be assisted to complete activities
of daily living such as toileting. Due to their immobility, they may need to be
transferred to the toilet using the wheelchair. It is important that HHA/ PCA learn
how to transfer a patient from one area in a home to another using the wheelchair.
When transferring a patient to the toilet using the wheelchair, always position the
wheelchair close to the toilet. Observe all safety precautions. Use proper body
mechanics to ensure safety of yourself and the patient. Below are instructions on how
to transfer a patient to the toilet using the wheelchair.

 Explain procedure to patient.

 Wash hands.
 Put on gloves, as necessary.
 Check the toilet for supports and grab bars.
 Follow the guidelines of the procedure “Transfer to a Wheelchair, Chair, or
Commode”.
 Place wheelchair, facing toilet.
 Lock wheels.
 Raise or remove footrests.
 Assist patient to stand using the guidelines on the procedure “Helping a Patient to
Stand”.
 Rotate the patient until the back is toward the toilet.
 Arrange clothing.
 Ask the patient to hold onto the grab bars in the toilet for support and balance.
 Assist the patient to sit on the toilet. Encourage him/her to hold onto the grab
bars.
 Allow privacy. If the patient is weak, stay with him/her.
 Assist in cleaning the patient after toileting.
 Wash hands.
 Assist the patient to wash hands.
 Assist with transfer of patient back to the wheelchair. Reverse steps seven to
nine.
 If the patient starts to fall during transfer, widen your stance, and provide support
by bringing the patient's body close to you. Then, bend your knees and use the
strength of the muscles of your thighs to lower the patient to the ground. If the
patient falls, inform your supervisor immediately. Do not get the patient back up
until he/she has been evaluated by the home health doctor or registered nurse. In
the case of a fall, a HHA/ PCA may be required to write an incident report. Guide
on how to write an incident report can be gotten from your supervisor.
 If the patient had no signs of dizziness and tolerated the procedure, then complete
transfer.
 Wash hands.
 Remove gloves.
 Observe, record and report any changes in condition or behavior
Procedure: Transfer from Wheelchair to Shower and Assisting with Shower
One of the important tasks of HHA/ PCA is to help a patient to complete activities of
daily living (ADL). HHA/ PCA may need to assist a patient in a wheelchair to the
shower. Patient will first need to be made to sit at the edge of the tub before getting
into the tub. Always be around to assist the patient during shower. If a patient requires
privacy, then you can excuse him/her by standing outside the bathroom, but ensure
you check on the patient every 5 minutes by staying close to the door without getting
inside.
Below are instructions on how to transfer a patient to the shower using the
wheelchair.

 Explain procedure to patient.

 Wash hands.
 Assemble equipment (shower gel or soap, washcloth, towel, shower chair).
 Put on gloves, as necessary.
 Position wheelchair at appropriate angle to shower. The wheelchair should face
the shower.
 Place a towel on shower chair/stool.
 Lock wheels.
 Raise footrests.
 Stand patient up appropriately by following the guidelines on the procedure
“Helping a Patient to Stand”.
 Pivot patient so back is toward shower chair.
 Assist the patient to sit in shower chair.
 If assisting into the tub, assist the patient in placing one leg at a time over the
edge of the tub.
 Ask the patient to grab the bars or the side of the tub. Then assist the patient into
a sitting position on the edge of the tub first.
 Assist the patient into the tub by lowering him into the tub. If the patient can
move his body by himself/herself, assist the patient into the tub by instructing
him/her to do so.
 Place toiletries and bath linens within the patient's reach.
 Allow patient privacy. If the patient is weak, stay with him/her.
 Ensure that soap is rinsed off the patient.
 Assist in drying the patient.
 Get clean clothing ready.
 Assist the patient out of the tub. Reverse steps seven to nine.
 Cover the patient to avoid chilling.
 Assist the patient with dressing as needed.
 Put soiled linens and clothing in the hamper. Remove equipment and bath
supplies. Clean shower/ tub.
 If the patient starts to fall during transfer, widen your stance, and provide support
by bringing the patient's body close to you. Then, bend your knees and use the
strength of the muscles of your thighs to lower the patient to the ground. If the
patient falls, inform your supervisor immediately. Do not get the patient back up
until he/she has been evaluated by the home health doctor or registered nurse. In
the case of a fall, a HHA/ PCA may be required to write an incident report. Guide
on how to write an incident report can be gotten from your supervisor.
 If the patient had no signs of dizziness and tolerated the procedure, then complete
transfer.
 Wash hands.
 Remove gloves.
 Observe, record and report any changes in condition or behavior.

Procedure: Transfer from Wheelchair to Stool or Chair in Tub

A patient may need to be transferred from the wheelchair into a shower chair or stool
in the tub. Always observe all safety precautions during transfers. Below are
instructions on how to transfer a patient from the wheelchair to the shower chair or
stool in the tub.

 Explain procedure to patient.

 Wash hands.
 Assemble equipment.
 Put on gloves, as necessary.
 Place a not-slip mat in the tub.
 Place a covered chair/stool in the tub.
 Fill the tub with water.
 Position wheelchair parallel to tub.
 Ensure wheelchair locks are on.
 Place toiletries and bath linens within the patient's reach.
 Provide for privacy.
 Assist in removing clothing.
 Assist the patient to stand and to sit at the edge of the tub applying the procedure
above.
 Push the wheelchair out of the way.
 Assist patient onto chair in tub.
 Assist with bathing and drying the upper body.
 Using reversed steps of the procedure, assist the patient out of the tub.
 Dry lower body.
 Assist with dressing and grooming.
 If the patient starts to fall during transfer, widen your stance, and provide support
by bringing the patient's body close to you. Then, bend your knees and use the
strength of the muscles of your thighs to lower the patient to the ground. If the
patient falls, inform your supervisor immediately. Do not get the patient back up
until he/she has been evaluated by the home health doctor or registered nurse. In
the case of a fall, a HHA/ PCA may be required to write an incident report. Guide
on how to write an incident report can be gotten from your supervisor.
 If the patient had no signs of dizziness and tolerated the procedure, then complete
transfer.
 Make the patient comfortable and safe.
 Clean area.
 Wash hands.
 Observe, record and report any changes in condition or behavior.

18.2 (h) The Patient's Environment

Beds need to be made daily to promote comfort and good sleep. To promote good
hygiene, bed linens should be changed when wet, or soiled. Follow the instructions in
the Care Plan as regards to how often the bed sheets should be changed. Bedridden
patients may have their beds made while they are lying in bed. This is known as
occupied bed making. Below are instructions on how to make unoccupied and
occupied beds.

Procedure: Making an Unoccupied Bed

 Wash hands.
 Assemble equipment (bottom or fitted sheet, bed pad, top or flat sheet, blanket,
bedspread, pillow cases).
 Put on gloves, as necessary.
 Remove and fold bedding to be reused.
 Smooth mattress pad.
 Place the bottom sheet in the correct position.
 Tuck in the top.
 Miter corner. To miter a corner of the bedding, grasp the edge of the bedding
about 18 inches away from the end of the bed. Bring it up to the top of the bed.
Hold it tight at about 45 degree angle, forming a triangular shape. Tuck the loose
sheet hanging below underneath the mattress. Pick up the triangular shaped piece
you made, place it over the side of the mattress, and tuck it under.
 Tuck in the side.
 Position top covers correctly.
 Tuck in at bottom.
 Miter corner.
 Go to the opposite side of the bed.
 Repeat steps 4 to10, pulling and smoothing sheets.
 Add spread, and tuck in at bottom.
 Turn the soiled pillowcase inside out.
 Open the clean pillowcase.
 Grasp clean pillowcase in center of bottom seams.
 Fold pillowcase over hand.
 Grasp the end of the pillow through the pillowcase in the center.
 Pull clean case over pillow with other hand.
 Remove soiled linen.
 Wash hands.

Procedure: Making an Occupied Bed

 Explain procedure to patient.
 Wash hands.
 Assemble equipment.
 Put on gloves, as necessary.
 Remove and neatly fold the bedspread.
 Loosen bedding on one side.
 Loosen top sheet at foot.
 Slide the top sheet under the blanket, leaving the blanket on the patient.
 Remove all pillows except one under the patient's head.
 Turn the patient onto the side.
 Fold/roll bottom sheet(s) up to and under the patient's head, back, and legs.
 Smooth mattress.
 Position clean bottom sheet.
 Fold clean bottom sheet next to and under soiled sheets. Tuck in the bottom sheet
at head.
 Miter corner at head. To miter a corner of the bedding, grasp the edge of the
bedding about 18 inches away from the end of the bed. Bring it up to the top of
the bed. Hold it tight at about 45 degree angle, forming a triangular shape. Tuck
the loose sheet hanging below underneath the mattress. Pick up the triangular
shaped piece you made, place it over the side of the mattress, and tuck it under.
 Tuck in the bottom sheet along side.
 Position draw sheet, fold under soiled bottom sheet, and tuck in along side. Turn
the patient to the clean side of the bed.
 Go to the opposite side of the bed.
 Loosen and remove bedding.
 Place soiled linen appropriately.
 Smooth mattress pad.
 Tuck in at head, corner, and sides.
 Remove soiled pillow cases appropriately.
 Put on clean pillowcases correctly.
 Remove soiled linen.
 Wash hands.
 Observe, record and report any changes in condition or behavior.

18.2 (i) Special Equipment Used by Home Care Patients

In order to adapt to their condition and to promote independence, patients may use
different types of special equipment prescribed by their healthcare provider. It is
important that HHA/ PCA learn how to use these equipment to take care of their
patients. Training should be given to the HHA/ PCA on use of special equipment to
ensure they know how to use the equipment prior to using it with the patient.
One of the tasks of HHA/ PCA is to teach patients how to use adaptive devices.
Thus, it is important they learn how to use special equipment used by patients. The
different types of special equipment that HHA/ PCA may encounter during their work
with patients include special beds, mobility equipment such as wheelchairs, walkers,
canes, hydraulic lift, transfer or sliding board, electric lift chair, gait belts, braces,
special shoes or boots and prosthetic limbs. Patients who are bedridden may use
toileting equipment such as bedpan, urinal, catheters, and bedside commode to
meet the needs of elimination. Below are instructions on how to weigh a patient, use a
hydraulic lift and a sideboard.

Scales
A patient's weight may need to be monitored during care. This depends on the
condition of the patient. Patients with obesity that are being managed for weight
reduction may need their weight regularly assessed. Those with malnourishment may
also need their weight measured to monitor progress. Patients being managed for
heart failure may also have their weight measured to know if there is fluid retention. It
is important for HHA/ PCA to know how to accurately measure the weight of a
patient. Also, patients may be sensitive to their weight. HHA/PCA should never be
judgmental concerning the weight of a patient.
Scales should be balanced to zero before weighing a patient. This ensures
accuracy in the weight measurement. HHA/ PCA should weigh patients first thing in
the morning. Patients should be encouraged to empty their bladder and bowels before
having their weight measured. Weight measurement is better carried out when
patients are wearing light clothing.
There are different types of weighing scales that can be used to monitor a patient's
weight. These include bathroom scale (digital and standard), chair scale, balance scale,
and bed scale. When weighing a patient, ensure his or her privacy is protected.
Observe all safety measures when carrying out procedures. Ensure the patient is
supported during the procedure. Assist the patient to stand on the balance scale and
offer support. For a patient that has difficulty with mobility, chair scale, or bed scale
can be used. To encourage a mobile patient to check weight first thing in the morning,
a bathroom scale can be used.

Procedure: Weighing a Patient

 Explain procedure to patient.
 Wash hands.
 Assemble equipment.
 Put on gloves, as necessary.
 Check that the needle of the scale is at “0”. If not, re-adjust.
 Help the patient onto scale.
 Provide support while the patient steadies himself.
 Note weight after the dial stops moving.
 Observe any problems the patient has during this procedure, such as inability to
stand on scale.
 Help the patient off the scale.
 Record the weight.
 Report any changes in any condition or behavior (such as a gain or loss of more
than five pounds or patient's concerns about weight).
 Store the equipment in a safe place.
Procedure: Assisting with the Use of Hydraulic Lift
To ensure patient safety, always get someone to assist during the use of a hydraulic
lift. Operate the lift, while your assistant guides and protects the body of the patient as
the lift moves the patient.

 Explain procedure to patient.

 Wash hands
 Assemble equipment.
 Put on gloves, as needed.
 Check whether valves are working on lift.
 Clear the floor around the area you are working.
 Open legs of lift stand to the widest position.
 Bring a wheelchair or chair close to bed.
 Lock wheels of wheelchair and bed (if hospital bed). If possible, raise or lower
height of bed to accommodate height of lift. If available, raise the side rails on the
far side of the bed.
 Roll one edge of the sling up to one-half of width.
 Place the sling on the bed on the far side of the patient.
 Sling should be midway between the head and thigh of the patient.
 Roll the patient toward self and move the sling so it covers one-half of the
patient's back.
 Roll the patient back onto the sling and over on the other side (over the hump of
the sling).
 Keeping the patient rolled away from self, unroll the sling, making sure it is flat
and unwrinkled.
 Roll the patient onto back and adjust the sling so that it is midway between the
patient's head and thigh.
 Raise the lift (close valve and pump up the lift arm).
 Steady the swinging bar as it is positioned over the patient.
 Lower arm and attach the chains or hangers to the sling (longer chain to the thigh
part of the sling and shorter chain to the head area), being sure the chain or
hangers are away from the patient's body.
 Tell the patient when starting to pump up the lift and before moving the lift away,
check all connections to make sure they are fastened tightly and working properly.
 Pump the lift until the patient is in a half-sitting position.
 Lift the patient's feet and remove from bed.
 Move to the handle or bar of the lift for steering.
 Gently and slowly move the base of the lift out from under the bed, and slowly
turn it toward the wheelchair or chair.
 Position the lift so the patient is over the wheelchair or chair.
 Lower the patient to the seat by slowly opening the valve until the patient is just
above the seat.
 Hold the sling near the head and put knees against the patient's knees.
 Support the patient's upper body against self.
 Use knees to push gently on the patient's knees.
 Then, release the valve so that the patient sits in the wheelchair or chair.
 Remove the S-shaped hooks while holding onto the bar.
 Close the valve, and pump the lift up out of the patient's way.
 Move lift away.
 Wash hands.
 Observe, record and report any changes in condition and behavior or problems
with equipment.

Procedure: Slide Board Transfer

Patients with mobility difficulty can be assisted with a slide board. A slide board is
used to transfer a patient to a bed, chair or bath stool. Ensure a patient's body is
covered with clothing during slide board transfer to prevent injury to the skin. Gently
help patients to move across slide boards.

 Explain procedure to patient.

 Wash hands.
 Assemble equipment.
 Put on gloves, as necessary.
 Place the wheelchair or chair at a 45 degree angle to the bed or alternate chair.
 If wheelchair, lock brakes and remove armrests if able.
 If the patient is without clothing, the board should be covered with a pillowcase.
 Place the slide board like a bridge between bed and wheelchair, chair to chair,
etc.
 Have the patient lean away from the slide board.
 Place the slide board under the buttocks, transferring towards the patient's strong
side if possible.
 Ensure that the slide board is securely placed before the patient begins transfer.
 Direct patient to place hands on the slide board at each side adjacent to thighs.
 Direct the patient to take a series of small push-ups across the board until the
patient reaches the other side of the board.
 Assist the patient with each push-up, as necessary.
 Use a gait belt, as necessary.
 Clean and store slide board when transfer is complete.
 Wash hands.
 Observe, record and report any changes in condition.

18.2 (j) Care of the Infant

Infant care is one of the important tasks of HHA/PCA. There are situations when a
HHA/ PCA may be required to supervise and take care of an infant in a home. A new
mum who is overwhelmed may require assistance to take care of her baby. More so, a
sick mum who cannot care for her baby may need the services of HHA/ PCA to assist
in the care of her baby. Families of a sick loved one may need assistance with infant
care during stressful family situations.
The main goal of personal care of a well baby is to ensure the baby meets his
basic human needs. It is also important to understand the cultural, religious, and social
diversity pertaining to childcare. Respect family values and preferences when
providing assistance with the care of a baby in a home.
Babies need close monitoring and supervision. Never leave a baby unattended. If
you are busy with household tasks, it is safer to leave a baby in her crib. Babies
should be laid down at their back with their face up. Ensure babies are lifted and
handled correctly. Infants do not have good head and neck control. Thus, it is
important to always support the head and neck of a baby when lifting, carrying or
handling a baby. When traveling with a baby, ensure the baby is kept in an
appropriate car seat for his or her weight.
A baby needs to be fed gently. Burp the baby in between and after feeding to aid
digestion and prevent choking. Always make sure the baby's head is higher than their
body during feeding. How often a baby should be fed will be documented in the Care
Plan. It is important for HHA/ PCA to follow the instructions in the Care Plan. Ensure
diapers are changed regularly.
Due to a poorly developed immune system, babies are at higher risk of getting an
infection. HHA/ PCA should always wash their hands before and after handling a
baby and the baby’s things. Wash hands properly before touching a baby's feeding
bottle, clothing and equipment. Ensure a baby's feeding bottles are properly sterilized.
Wear gloves when providing an infant bath and diapering. Below are instructions on
how to handle, feed and bathe an infant.

Procedure: Handling the Infant/ Picking up an Infant

Follow the instructions below:

 Wash hands.
 Put on gloves, as needed.
 Put one hand under the buttocks.
 Put the other hand under the head, neck, and shoulders of the baby.
 Raise the baby appropriately.
 Wash your hands after handling the baby.
 Document the procedure and any observations or changes in the baby's
condition.

Cradle Hold
 Ensure the baby's head and neck are cradled. Baby's head and neck should rest in
the crook of your elbow, while you hold the baby close to your body.
 Support the baby's back with one or both hands. With the arm that is not cradling
the baby's head and back, hold the baby's legs securely and gently close to you.

Shifting to a “Football” Hold

 Support baby’s head, neck, and buttocks. Swing the baby to the side of your body
so that the infant rests on the hip while the hand and arm cradle the infant,
providing support. To do this, one hand is used to hold the baby's head, and the
forearm of the same hand is used to support the baby's back.
 Wash hands.
 Observe, record and report any changes in condition or behavior.
Positioning the Infant for Feeding and Feeding the Infant
Infant feeding can be by breastfeeding or bottle feeding. Apart from being convenient,
breastfeeding has several benefits for both the nursing mother and her baby. Infants
who are breastfed have stronger immune systems, thus, there are less cases of
gastroenteritis, respiratory and ear infections amongst breastfed infants. The mother’s
antibodies in the breast milk helps to protect the infant from illness, leading to less
hospitalization and lower rate of infant mortality.
Breast milk provides sufficient and easily absorbed nutrients for the baby. This
provides adequate nourishment for the baby and also reduces cases of diarrhea,
constipation, and allergy. Breastfeeding increases the bonding between a mum and
her baby. It also promotes physical and emotional well-being of a nursing mum.
Breastfeeding mums have lower risk of cancers and other chronic diseases. Mothers
should be encouraged to breastfeed their babies.
However, there are situations when a mum cannot breastfeed her baby. For
example, when she is sick or on some medications that may be harmful to the baby.
Moreso, a mother who cannot produce sufficient breast milk cannot breastfeed her
baby. Thus, bottle feeding has its own benefits. Bottle feeding can be provided to the
baby by anyone. It helps the mother to keep track of the nutritional intake of her baby
and it can be given to the baby in public.

Below are instructions to follow when feeding a baby:

 Wash hands.
 Assemble equipment (bowl, feeding bottle, cup, utensils, water, formula,
washcloth, wipe).
 Prepare the bottle and formula as directed in the Care plan. Use a sterilized bottle
to prepare formula. Feeding bottles must be sterilized using a sterilizer or by
placing the bottle, caps and nipple in boiling water for 5 to 10 minutes.
 Warm the bottle using a bottle warmer. You can also warm the bottle by running
it under warm tap water or immersing it in a bowl containing warm tap water for
a few minutes.
 Shake the feeding bottle to mix the content well. Put a few drops of bottle content
on your wrist to test for temperature. Content must be warm, not hot or cold.
 Sit in a comfortable chair. Maintain good posture. Position the baby in a cradle or
football hold.
 Stroke the baby's lips with the bottle nipple until her mouth opens. Place the
bottle nipple inside the baby's mouth gently.
 Always keep the baby's head higher than her body while feeding to prevent
choking.
 Make the atmosphere soothing and relaxing for the baby by singing to her gently.
 Burp the baby in between and after feeding to aid digestion and prevent choking.
 Record and report any observations or changes in the condition of the baby such
as changes in the baby's feeding habit, excessive cries, difficulty sucking during
feeding or unusual amount of spit up.
 Document completion of task.

Burping a Baby
 Burp the baby in between and after feeding to aid digestion and prevent choking.
 To burp a baby, place a burp cloth or towel over your shoulder to catch any spit
up.
 Lift the baby to your shoulder, supporting her head and neck.
 Pat or massage up the back with the palm of your hand.
 Once the baby has burped, keep her in a safe position or continue with the
feeding.
 Clean the baby's face with a warm, wet washcloth.

OR
 Place a burp cloth over your lap.
 Lay the baby down on the burp cloth that is on your lap, making sure the baby
faces down on her stomach.
 Place your arm under the baby's chest, supporting the neck and hand.
 Pat or massage up the back with the palm of your hand.
 Once the baby has burped, keep her in a safe position or continue with the
feeding.
 Clean baby's face with warm, wet washcloth.

Changing a Diaper
 Wash hands.
 Wear gloves.
 Remove and set aside or discard the soiled diaper.
 Using a warm, wet washcloth or wipe clean the baby's perineal area.
 Gently apply ointment, or powder as directed in the Care Plan.
 Unfold the diaper and place it under the baby's bottom.
 Pull the front of the diaper up between the baby's legs.
 Fold the right and left sides of the diaper toward the middle.
 Peel tape on the tabs open and secure the diaper by gently pressing them against
the front of the diaper.
 Return the baby to her crib.
 Document completion of task.

Documenting the Baby's Intake and Output

Input
1. After preparing the formula, measure the amount of fluid in the feeding bottle and
record it as the total amount.
2. Then, measure the amount of fluid left in the bottle after feeding the baby as the
leftover.
3. Subtract the leftover from the total amount. This is the baby's input or intake.
4. Discard the leftover formula in the bottle.
5. Wash the feeding bottle, nipple and ring in hot soapy water with a bottle brush.
Rinse well. Ensure you sterilize it before using it again.
6. Discard gloves and wash hands.

For example,
The amount put in the bottle (total amount) was measured to be 50mLs. The Leftover
was measured to be 20mLs.

Total amount: 50mLs

- Leftover: 20mLs
Input = 30mLs
Output
 This can be measured by the number of diapers for urine and bowel movements.
Wet diapers can be weighed.
 The method of measurement will be stipulated in the Care Plan. So, it is
important that HHA/ PCA follow the Care Plan.
 Record and report any observations or changes in the condition of the baby.
 Discard gloves and wash hands.

Procedure: Infant Bath

Babies should be bathed at least once per day. Assisting a family with an infant bath
is one of the important tasks of HHA/ PCA. Always support the head and neck of the
baby with one hand during bath. Never leave a baby unattended. Always keep a baby
warm. Below are instructions on how to carry out an infant bath.

 Wash hands.
 Assemble equipment (baby wash, baby shampoo, baby lotion, bath linens, clean
basin, or infant tub bath, clean diaper, powder/ointment/cream). Your supplies
should always be nearby. Never leave a baby unattended.
 Ensure proper temperature of room. Room temperature should be warm.
 Prepare changing area.
 Prepare bath water at correct temperature.
 Put on gloves, as needed.
 Bring baby to bath area.
 Undress and cover baby.
 Lower baby gently into water. Support the head and neck of the baby always.
One hand should hold the baby, while the other is used to wash the baby. Head
and face of the baby should NOT be immersed into water.
 Using a warm, wet washcloth clean the baby's face and pat dry.
 Shampoo, rinse, and dry head.
 Wash the body, from neck down to feet.
 Wash genitals correctly. From front to back.
 Dry baby.
 Apply lotion, ointment, and powder as directed on Care Plan.
 Diaper and dress baby.
 Give nail care, if needed.
 Wash hands.
 Observe, record and report any changes in condition or behavior.

18.2 (k) Assisting with Self-administration of Medication

Assisting with self-administration of medication is different from administration of
medication. Only licensed healthcare providers can administer medication to a patient.
Home Health Aides can assist with self-administration of medication if they are
trained to provide assistance with self-administration of medication, and are assigned
to carry out the task. This depends on the country and the U.S state. Some countries
and states in the USA do not allow a Home Health Aide to assist with self-
administration of medication. Personal Care Aides are not allowed to assist with self-
administration of medication.

Ways Home Health Aides can assist a patient with self-administration of a

medication include:

 Reminding the patient to take his or her medication.

 Bringing the medication container to the patient.
 Bringing water for the patient to take medication.
 Bringing all the equipment needed to take the medication.
 Positioning the patient in an appropriate position before he or she takes
medication. For example, for a medication that is taken orally, HHA should assist
the patient to be in an upright position before swallowing the medication to
prevent choking.
 Reading the instructions regarding medication on the Care Plan to ensure
medications are taken correctly.
 Reading the container label of the medication to the patient to ensure the 5 rights
(5Rs) of medication (right patient, right medication, right dose, right time and
right route) are followed to avoid medication errors.
What to Report to Home Health Supervisor when Assisting with Self-
Administration of a Medication

When HHAs are assisting patients with self-administration of medication, it is

important they know what to report to the home health team. If any of the following
situations occur while assisting a patient with self-administration of medication,
report the incident immediately to the home health supervisor.

1. If the information on the Care Plan regarding medication does not match the
information on the container label of the medication. For example, if the med- ica
tion name, dose, route, time of administration do not match the informationon the
container label of the medication. Also, if the name of the patient on the Care
Plan does not match the patient's name.
2. Poor compliance: If the patient refuses to take medication.
3. If there are other medications such as herbal medicines, supplements and
medications that a patient is taking without informing the home health team.
4. Drug allergy: if the patient reacts to the medication.
5. Incorrect self-administration of medication: if the patient is not taking the
medication the correct way or as stipulated on the Care Plan. For example, if a
patient crushes the medication before taking it (if it's not written that way on the
Care Plan), or mixes it with other medications.
6. Ensure you record and report all incidents that occur while assisting a patient
with self-administration of medication.

The Five Rights of Medication

The five rights of medication are used to avoid medication errors. These include:
1. The right person
2. The right medication
3. The right dose
4. The right time
5. The right route

Below are instructions on how to check the five rights of medication to ensure
proper administration of medication.
Procedure: Checking the Right Person

 Wash hands.
 Read the container label.
 Check the name on the label to make sure it is the same as the patient's name.
 Check the name on the label against the name on the Care Plan.
 If they are the same, give the container to the patient and/or assist with
administration as ordered on the Care Plan.
 If they are not the same, contact the supervisor for further instructions.
 Explain to the patient the reason for this.
 Record and report any problems about the medication in question.

Procedure: Checking the Right Medication

 Wash hands.
 Read the container label.
 Check the expiration date.
 Check the name of the medication on the label against the name of the medication
on the Care Plan to make sure they are the same.
 If they are the same, give the container to the patient and/or assist with
administration as ordered by the Care Plan.
 If they are not the same, contact the supervisor for further instructions: explain to
the patient the reason for this.
 Record and report any problems about the medication in question

Procedure: Checking the Right Dose

 Wash hands.
 Read the container label.
 Check the dose on the label against the dose for that medication on the Care
Plan.
 If they are the same, give the container to the patient and/or assist with
administration as ordered by the Care Plan.
 If they are not the same, contact the supervisor for further instructions.
 Explain to the patient the reason for this.
 Record and report any problems about the medication in question.

Procedure: Checking the Right Time

 Wash hands.
 Read the container label.
 Check the time for taking the medication against the time specified on the Care
Plan.
 If they are the same, give the container to the patient and/or assist with
administration as ordered by the Care Plan.
 If they are not the same, contact the supervisor for further instructions.
 Explain to the patient the reason for this.
 Record and report any problems about the medication in question.

Procedure: Checking with the Right Route

 Wash hands.
 Read the container label on the medication bottle.
 Check the route for taking the medication listed on the bottle of the medication
against the route specified on the Care Plan. If they are the same, proceed to hand
the bottle to the patient and/or assist with administration as ordered on the Care
Plan.
 If they are not the same, or there is no information specified on the Care Plan
regarding the route of administration of the medication, contact the supervisor for
further instructions.
 Explain to the patient the reason for this.
 Record and report any problems about the medication in question.

© Copyright: Udochi Precious Anosike 2021

REFERENCE/ SOURCE

This copyrighted material is from the instructor’s book, “Improving Home Healthcare
Practice: A textbook for Home Health Aides, Personal Care Aide, Nurse Aides and
Caregivers” by Dr. Udochi Precious Anosike.
Other References For Module 18
i. New York State Department of Health. (2006;2007). Home Care Curriculum.
ii. McLain, K.B, O’Hara-Leslie, E.K, Wade, A.C. Foundations for Assisting in Home Care. Open
SUNY Textbooks.