12.3.2: Procedure- Tub or Shower Bath

1. Explain the procedure to the patient.
2. Wash and dry hands according to proper hand washing guidelines.
3. Assemble equipment needed (soap, shampoo/conditioner, wash cloths, towels).
4. Ensure that the bathroom is warm and comfortable. Take care it is not too cold or too hot.
5. Remove any fall risk hazards, such as loose rugs, from the floor.
6. Place any safety devices in the shower as needed (e.g. shower chair, rubber mats).
7. Ensure safety items such as handrails and grab bars are in good working order. Immediately inform a supervisor if they are not.
8. Turn on the water and test water temperature using a bath thermometer. Water temperature should be no higher than 105 degrees Fahrenheit. If providing a tub bath, fill the bath and test the temperature before putting the patient in the tub. Tub baths or very warm showers can lead to a person feeling faint, nauseous, or tired. Baths should not last longer than 20 minutes and should be discontinued at the first sign of patient discomfort, weakness, or complaints of feeling faint.
9. Allow the patient to test the water temperature for their comfort. Adjust as needed.
10. Wash and dry hands. Put on gloves.
11. Assist the patient to the bathroom. If the patient is ambulatory, assist the patient as needed to undress and then transfer them into the tub or shower. Undress the patient immediately before getting them into the shower or tub. This prevents them from chilling.
12. If the patient is independent, give them privacy to bathe, if they prefer. If leaving a patient unattended, check on them every 5 minutes or more frequently as needed. Ensure the patient knows how to use safety items such as shower chairs and grab bars.
13. If the patient is standing to shower, stay in the bathroom and monitor the patient’s need for assistance. If they are weak, always stay with them in the bathroom, providing privacy as able.
14. Never let a weak person stand to bathe or leave them in the bath alone. You can stay in the bathroom and draw the shower curtain to provide privacy. Communicate with them frequently to let them know you are there to provide assistance.
15. Water should be turned off and the tub drained before assisting the patient to transfer out of the tub.

To Transfer the Patient into the Tub:

1. If the patient is in a wheelchair, face the patient and wheelchair toward tub, between the grab bars or safety rails.Lock the wheelchair brakes. Raise the wheelchair footrests. If using a gait belt, ensure it is secure and that the patient has a shirt or towel on, with the gait belt positioned over their clothing. This is to prevent skin irritation and breakdown. Instruct the patient or assist with placing their legs, one at a time, over edge of tub. Ensure feet are planted firmly onto tub floor before assisting them with transferring into the tub.
2. Instruct the patient to grab onto the bars or the side of the tub and assist them into a sitting position on the edge of the tub. Use a gait belt to assist the patient into position and to provide a safe transfer.
3. Bring patient to a sitting position at edge of tub. Lower the patient into the tub by holding around their waist or the gait belt. Instruct them to hold the edge of the tub or the grab bars for support and balance.
4. If using a slide board position the slide board onto the shower chair and under the patient’s buttocks. Assist the patient to move across the slide board in small movements by lifting their bottom up and down, and moving slowly across the board until they are on the shower chair. Never drag a patient across a slide board.
5. Move the wheelchair away from the tub during bathing.
6. Place all supplies to be used during the shower/tub bath within your reach and the reach of the patient. This is to avoid unnecessary stretching to retrieve items. If assisting the patient during the bath, avoid bending over with your back. Position yourself to a safe working level at patient height. You may kneel on the floor using a cushioned mat to protect your knees.
7. Assist the patient to shampoo and condition hair, as necessary.
8. Assist the patient, as necessary, with washing their body. Start with the patient’s eyes and then face, using a clean washcloth. Do not apply soap to the patient’s eyes.
9. Assist the patient to clean their genital and anal areas. Use clean washcloths for these areas. Do not use these washcloths for other areas of the body.
10. Wash the patient’s body from clean to dirty areas. This helps to avoid contaminating clean areas. Make sure all soap is rinsed off completely.
11. If the patient is ambulatory, assist them with the transfer out of the shower/tub. Cover the patient with a towel or robe during transfer to prevent them from chilling.
12. To assist the patient out of the tub if using a wheelchair, assist them to the edge of the tub. Bring the patients’ legs one at a time over the outer edge of tub. Assist them back into the wheelchair. Always ensure wheelchair locks are on during transfer.
13. Help or complete the drying of the patient. Take care to carefully dry areas where there are skin folds, underneath breasts, and in the genital and anal areas. Assist them with dressing.
14. Drain and clean tub/shower area. Discard used linens.
15. Remove gloves. Wash and dry hands.
16. Document completion of the task and record any changes in condition or behavior.