12.3.5: Procedure- Back Rub
Back rubs can be given after baths, before bed time, after repositioning, and to help the patient relax. Back rubs help to relax muscles, stimulate circulation, and promote sleep. Back rubs last about 5 minutes. Always ensure that it is okay to provide a back rub. Home Health Aides/Personal Care Aides must check with their supervisor and in the Care Plan. Observe skin condition during back rubs for bruises, red, white, or open areas, and other signs of skin breakdown. Always report and record these observations and any changes in skin condition. It is helpful to use lotion during back rubs to reduce friction and moisturize skin. Lotion on skin also helps to prevent skin breakdown.
- Explain the procedure to patient.
- Wash and dry your hands. Apply gloves as appropriate.
- Assemble equipment (e.g. lotion) per patient preferences.
- Warm lotion in basin of warm water or by running bottle under warm water for a few minutes. Do not use very hot water. To apply lotion to the patient’s skin, rub some between your hands rather than pouring it directly onto their skin. This serves to lubricate your hands during the back rub and to help warm the lotion so the patient does not feel too cold.
- Position the bed to safe working level at waist height. Lower the head of the bed. Lock the brakes. Lower the bed rail nearest you.
- Provide for privacy. Remove patient clothing from only the area you are working on to minimize exposure. Keep blankets on the patient, exposing only their back to provide warmth.
- When working on the patient’s back position the patient on their side or stomach, according to their preferences and comfort level.
- Keep the patient covered, exposing their back only to the top of their buttocks.
- Place a small amount of lotion in your hand and rub your palms together to warm lotion and lubricate hands. Caution the patient that the lotion may still feel cool.
- Rub the patient’s back with the appropriate pressure, according to their preferences. Rub back in a rhythmic motion in the correct direction.
- Start at 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 their upper arms.
- Move your hands up over upper arms, back across the shoulders, and then down along the back toward the buttocks.
- Keep your hands in contact with the patient’s skin during movement to prevent friction against the patient’s skin.
- Repeat for 3-5 minutes, or according to patient preferences. Stop the back rub if at any time the patient reports discomfort or no longer wishes you to continue.
- If the patient wishes, you can gently knead the patient’s skin or apply a gentle tapping motion upward along the patient’s back to their shoulders and arms, and then back down again. To knead skin, gently grasp skin between your fingers and thumb. Move from buttocks upward, along the length of their back, across their shoulders, and then down over upper arms. Work your way back down to the buttocks using the same motion. Depending on patient preference, you can speed up or slow down your movements and pressure.
- Be careful to only lightly massage over bony areas so as not to cause pain to the patient. Do not massage areas that are red or that have broken or irritated skin. Do not apply lotion to areas with a rash. Do not remove dressings to apply lotion. Do not massage these areas.
- When you are almost done with the back rub, let the patient know so they are prepared for the ending of their back rub.
- Wipe away any excess lotion. Assist the patient with dressing and position the patient for comfort.
- Lower the bed to its lowest setting. Ensure the side rails are up.
- Put away equipment and supplies. Dispose of any dirty linens.
- Remove your gloves. Wash and dry your hands.
- Document completion of the task and record any changes in condition or behavior. Report any skin conditions, red, white, or open areas, or pressure sores.