25.2: Factors Affecting Hygienic Practices

Learning Objectives

By the end of this section, you will be able to:

• Describe population differences contributing to personal hygiene practices
• Identify physical factors impacting personal hygiene practices
• Identify psychological factors impacting personal hygiene practices

Hygiene measures and practices can promote health and prevent disease. These measures and practices may differ among various groups and people. It is important to remain culturally sensitive when encountering preferences that may differ from your own. The term cultural sensitivity is defined as recognizing and acknowledging that cultural differences exist among people and showing respect and appreciation of others' beliefs, values, practices, and perspectives. Respecting patient differences and preferences in hygiene practices while remaining unbiased is essential to the nursing practice. Nurses must also remember to provide care and education to patients in a nonjudgmental manner.

Population Differences in Hygiene Practices

Cultural practices or behaviors, socioeconomic status, developmental level, and personal preferences are factors that influence an individual’s hygiene practices. These factors may differ greatly from one individual to the next. Understanding these differences and factors that impact how an individual practices personal hygiene is important as a nurse. Nurses may need to modify care and education to meet the needs of the individual patient.

Cultural Preferences

Cultural factors can strongly influence hygiene practices and patient preferences. Identifying those variations and their impact on a patient’s personal hygiene is crucial. Nurses can identify cultural variations by asking the patient about their normal hygiene routines. The nurse should also explain that the reason for asking is not to be offensive, but rather to understand their practices, reminding the patient about the impact hygiene can have on an individual’s physical and mental health. The nurse may need to ask specific questions such as, “How do you clean and take care of your body?” or “Tell me about your oral hygiene routines.”

Cultural preferences may impact hygiene practices in terms of frequency and the type of products used. For example, people in some cultures place a high emphasis on daily bathing; otherwise they feel unclean. There are other cultures in which people may bathe only once a week. In addition, there are some cultures that also consider the use of products to mask body odor essential, while other cultures may deem those products as unsafe and view body odor as pleasant rather than unpleasant. Learned behaviors, such as touch, are also culturally significant. Some cultures may find touch offensive, which is important for the nurse to remember. Asking for permission before touching a patient when helping with hygiene practices is crucial to remember as well. The nurse should keep in mind that some cultures practice communal versus private bathing. Some cultures may prefer the same sex nurse assist with hygiene. Nurses are not to stereotype hygiene preferences based upon one's culture; rather, nursing personnel should ask the patient about their preferences and beliefs to provide care that aligns with the patient as an individual.

Cultural Context

Cultural Considerations and Personal Hygiene

Personal hygiene is especially important to East Indian Hindu culture. To many individuals from this culture, a daily bath is a religious duty. Some Hindus believe that bathing after a meal will result in an injury. Some Hindus also believe water that is too hot will injure their eyes. When preparing a bath, these persons may also believe that hot water can be added to cold water but not vice versa. Once the individual has completed the bath, they must carefully and thoroughly dry the body. Personal hygiene practices can differ among individuals and communities, even within the same religious group. Additionally, modern lifestyles and urbanization may influence personal hygiene habits that differ from the traditional cultural habits. For instance, cultural diffusion is the spreading out and merging of pieces from various cultures. This type of cultural shift is a common practice in today’s ever-evolving society. Cultural appropriation, which is the exploitation of another culture’s religion and/or cultural traditions, can be found offensive by some and should be avoided by the nurse. Understanding and respecting these cultural and religious practices is essential for providing culturally sensitive care and fostering positive interactions with people from the East Indian Hindu culture.

Socioeconomic Status

A person’s socioeconomic status and financial resources often influence the type or extent to which hygiene is practiced. An individual’s socioeconomic status and finances often impact the resources available. Financial limitations may impact the ability to obtain clean clothing or toiletries but could also influence water usage or access. Sometimes a person may have to make a choice between buying food to feed their family and purchasing personal hygiene products. Another example of financial limitations is homelessness. An individual may only be able to access a public bathroom, which limits choices to the type of soap and water that is available. Oftentimes, a public bathroom has only a sink with no shower or privacy. Therefore, the person experiencing homelessness is limited to how much of their body can be cleaned at one time.

Developmental Level

Hygiene practices are behaviors that most people learn as children from family members or others surrounding them. Those behaviors may include frequency and/or time of day in addition to feelings of modesty and nudity. Infants are dependent upon others for hygiene needs, but as children grow into adolescents, they may become more concerned with personal appearance while adopting individual practices. For example, adolescents may become aware of their body odor and develop preferences for using deodorants or body sprays. The teen may even acknowledge the need to bathe more frequently and make an autonomous choice to practice such a regimen. Adolescents also tend to prefer privacy, performing independent hygiene rather than in the presence of others. Therefore, hygiene education may be impacted when a parent is present. The nurse may need to ask the parent to step out of the room in order to offer privacy for the young adult, properly identify preferences, and provide any needed education.

A person’s developmental level can negatively impact hygiene practices if the ability to understand proper hygiene practices is impaired or limited. A child who wants to be independent may want to perform their own hygiene but may not be able to effectively apply the proper measures to achieve this goal. Older adults may experience mobility limitations that impact the frequency of bathing or ability to reach all areas of the body.

Personal Preference

Personal preference is a significant factor in a person’s hygiene practices. Considering a person’s preferences when scheduling or aiding with hygiene is important. Some preferences may include bathing in a bathtub versus using a shower, morning bathing versus evening bathing, and the types of soaps, shampoos, conditioners, toothbrushes, toothpastes, cloths, or loofahs used to facilitate the individual’s body cleaning. A person’s sexuality and self-concept may also impact their hygiene practices. For example, sexually active women may use a variety of feminine hygiene products after intercourse to promote cleanliness.

Frequency of hygiene practices are influenced by a patient’s personal preferences, possibly stemming from cultural influences, social practices, or hygiene education. Some people prefer to bathe daily, wash their hair every other day, and perform oral care twice a day. Still others may prefer a different frequency schedule. Hair and nail care frequency preferences may depend on nail length or appearance, which a person may use to gauge when they feel that care is warranted. For example, a person who prefers their nails a certain length may use nail length as their cue to perform nail hygiene. Hair preferences may also vary among individuals. Some people prefer the hair a certain length and will use hair length as a cue to get a haircut. Some individuals may prefer their hair to be free of oils and will use the level of oil in the hair as a cue to wash their hair. Also, some people prefer to have a clean-shaven face and will shave or trim the facial hair to keep it at the desired length.

The timing of hygiene practices is also influenced by a patient’s personal preferences. Some patients prefer bathing at the beginning of the day to perk themselves up while others prefer the end of the day, finding bathing to be relaxing instead. Oral care timing preferences may include upon waking, prior to sleeping, or even after meals. For example, a person with braces may perform oral care after every meal to decrease food build up and odors. In the hospital setting, the timing may also be impacted by any tests or procedures scheduled for the patient. This timing could be due to the required prewashing with or without specialized products prior to certain diagnostics.

Patient Conversations

What If You Think Your Patient Is Refusing a Bath?

Scenario: A medical-surgical nurse was completing rounds to assess patients’ hygiene needs. The nurse notices their 62-year-old patient had an odor, food stains on his face and gown, and soiled hair.

Nurse: Hi, Mr. Thomas. I hope you enjoyed your breakfast. Would you like to schedule a bath this morning?

Patient: Well, no. I only like to bathe at night. I like to be clean before I get into bed. My mom always told me when you go to bed without a shower, you’re taking your whole day to your sheets.

Nurse: Okay, Mr. Thomas. I understand. I will make a note of your request, so that the night shift staff can assist you with your bath.

Scenario follow-up: The nurse pulls up the patient’s chart in the patient room to document the patient’s request and noticed that for the last three days, the patient had refused a daytime bath. There was no documentation of the patient’s request for a nighttime bath, so the nurse wondered if the patient was refusing a bath overall.

Nurse: Mr. Thomas, have you told any of the other nurses that you prefer a nighttime bath?

Patient: Well, the first day I just told them no, but I did tell them on the second day I was here that I like nighttime baths. The night nurse never asked me about it though. I just assumed they were too busy.

Nurse: I am sorry about that. I just put in your request for a nighttime bath in the computer and will also make a note on the bath schedule at the charge nurse’s desk. We can always do a bath this morning to get you caught up if you’d like.

Patient: No, dear. I can wait until tonight. I wouldn’t mind just washing my face for now though.

Nurse: We can absolutely do that. Would you like a new gown in the meantime as well?

Patient: Sure. I would like that in case anyone comes to see me today.

Nurse: Okay, great. Is there anything else you would like to do this morning for hygiene?

Patient: No. I already brushed my teeth this morning.

Nurse: Okay. I will get your bath set up for you tonight. Is there anything you need before I leave the room?

Patient: No, I think I am good.

Nurse: Okay, well I will send in Suzie (unlicensed assistive personnel, UAP) to come help you with washing your face and getting you a new gown. Let me put your call light within reach, and you can always call us if you need us while we aren’t in here.

Patient: Thanks a million.

Scenario follow-up: The dayshift nurse made a note on the bath schedule at the nurse’s station and in the patient’s chart. The UAP helped the patient get set up to wash his face and provided the patient with a new gown. At shift change, the nurse also informed the night shift nurse of the patient request. The patient received his bath that night and his linens were also changed. The charge nurse was also aware of the situation and provided education to all nurses to ensure they are marking patient preferences in the chart and on the bathing schedule as well as communicating any special requests to the appropriate shift nurses to ensure patient requests are being met.

Physical Factors Affecting Personal Hygiene

A person’s physical condition will greatly impact personal hygiene. Mobility status and health state are important for a nurse to identify when caring for a patient and planning the individual’s hygiene care.

Mobility Impairment

People with mobility impairment have limited hygiene measures and options. For instance, paralyzed patient may require a bed bath performed by another person. Identifying the best practices for this patient and a hygiene schedule to protect their skin, increase comfort, and control odor is important. Providing a bath every day ensures a comprehensive skin assessment can be conducted, and taking extra steps to reposition more frequently will promote circulation as well as improve skin integrity.

Health Status

The status of a person’s health plays an important role in any plan of care. Injury, surgery, or disease can diminish an individual’s capability or the desire to perform hygiene. With hygiene, a patient in the late stages of an illness may lack the energy or dexterity to perform their own personal hygiene. Some diseases may incapacitate or exhaust a patient, thus warranting the need for the caregiver to perform all aspects of this practice. For example, a person with serious pulmonary conditions may not be able to tolerate activities and may require a great deal of assistance.

Psychological Factors Affecting Personal Hygiene

Psychological factors that may affect personal hygiene include cognitive diseases as well as an individual’s mental health status. The psychological factors will impact a person’s ability to perform hygiene as well as the patient’s motivation for or memory of these practices. It is imperative the nurse asses for any psychological factors that might inhibit a person’s personal hygiene habits.

Cognitive Diseases

Some cognitive diseases or disorders that may affect personal hygiene include Alzheimer disease, attention deficit disorder, autism, intellectual disabilities, substance use disorder (SUD), and multiple sclerosis. Careful consideration by the nurse is necessary when planning hygiene for persons with any type of cognitive diseases or disorders due to the impact on a person’s memory, focus, visual perception, abstract reasoning, and ability to learn or perform hygiene practices. For example, a person with a developmental disorder may struggle to learn the importance of self-care as well as how to perform the task. Patients with Alzheimer disease may lose the ability to remember to perform hygiene, struggle with emotions, and become agitated.

Clinical Judgment Measurement Model

Recognize and Analyze Cues

Before recognizing cues, nurses must make sure enough information about a patient’s situation has been gathered and assessed before interpreting the information and developing a plan of care. For example, an individual with Alzheimer disease may struggle to perform hygienic activities. This person may also struggle to regulate emotions, becoming upset or embarrassed about being undressed in front of someone else. The patient may feel rushed or confused when being coached in performing various hygiene measures. The nurse must observe the patient and recognize the individual’s Alzheimer disease stage of progression. In addition, the nurse must analyze the person’s cues and assess the patient’s ability to perform hygiene. A person’s readiness to receive assistance in order to develop the patient’s individual plan of care must also be considered.

Mental Illness: Depression

Hygiene can be greatly impacted by depression. People with depression may struggle with self-esteem and the motivation to perform hygiene measures. Depression may cause fatigue and cognitive effects such as negative thought patterns, memory problems, and brain fog. Individuals with depression may also struggle with executive dysfunction that impacts their ability to maintain hygiene and carry out the practices.

Body Image

Body image can also impact hygiene. People with depression often have a negative body image or do not care about their image. Those individuals with a negative body image may possess this image due to body shape, body size, or feelings of being ugly. A negative self-image can lead to stress regarding the undressing involved in the process of bathing. Often, patients experiencing this situation will avoid normal hygiene practices. The person with a negative body image may notice an improvement in self-esteem after performing hygiene or may lack the desire to perform hygiene. Those people with a positive body image may have the drive to establish and commit to a good hygiene routine in order to maintain the image of themselves in their mind.