1. Decreases muscle tension and promotes relaxation.

2. Increases circulation to the area.

3. Aids in the development of the therapeutic nurse-patient relationship.

The psychological benefits of back massage cannot be overstressed for the hospitalized patient. The following statements illustrate the concept of therapeutic touch as an integral part of the domain of nursing.

1. Touch can be perceived as a manifestation of caring and communication between the nurse and the patient.

2. Tactile communication between healthy and ill individuals can have highly beneficial results.

Therapeutic touch may make some patients uncomfortable; you are entering their personal space and their feelings must be respected, so make sure you ask the  patient if he/she would like a back rub.

Agents used for back massage:

1. Lotions or emollients.

   • Lotions and emollients reduce friction and lubricate the skin.

   • They are appropriate for most patients, especially those with a tendency toward dry skin; that is, elderly patients.

2. Rubbing alcohol.

   • Alcohol evaporates quickly, so it has a cooling but very drying effect.

   • A certain amount of alcohol is absorbed by the skin so it should not be used on infants, elderly patients, or patients with liver disease.
      

3. Powder.

   • Powder reduces friction but also has a drying effect on the skin.

   • It may be appropriate for those patients who perspire freely and/or are confined to bed.

General guidelines.

1. A back massage should take about five to ten minutes and can be given with the patient's bath, before bedtime, or at any other time during the day.

2. Determine if any patient allergies or skin sensitivities exist before applying lotion to the patient's skin.

3. The greatest relaxation effect of a massage occurs when the rhythm of the massage is coordinated with the patient's breathing.

If the patient is alert, question him about his shaving habits, and follow his routine as closely as possible.

1. Gather equipment and supplies.

   • Towels.

   • Washcloth.

   • Basin with hot water.

   • Shaving cream.

   • Razor.

   • Soap.

   • Aftershave lotion.

2. Wet the wash cloth, wring out any excess moisture, and apply it to the beard area (to soften the beard).

3. Apply shaving cream to the beard.

4. Shave the beard on the cheeks and upper lip in the direction that the hair grows.

5. Shave the beard on the neck against the direction of the hair growth.

6. Wash off any remaining shaving cream.

7. With clean water, finish washing the patient's face.

   • Always use an electric razor on patients with bleeding disorders to prevent uncontrollable bleeding from facial cuts.

   • Do not use plugged in electric razors on patients who are receiving oxygen therapy because of the danger of combustion; safety razors or rechargeable battery operated shavers are safe.

   • Consult with the charge nurse before shaving any patient who has had facial surgery or who may have hemophilia.

   • Patients who are combative, suicidal, or disoriented should have supervision and assistance while shaving.

Perineal care is often referred to as "pericare;" it consists of external irrigation of the vulva and perineum following voiding or defecation and is part of the routine A. M. and P. M. care. Patients may be able to perform their own perineal care or may need partial or total assistance from the nurse. Embarrassment on the part of the patient and the nurse can be effectively dealt with by ensuring patient privacy during the procedure and not totally exposing the patient's genital area.

Key points:

1. Ensure patient privacy.

2. Wipe from front to back (vagina toward rectum) on female patients to avoid contaminating the vagina or urethral meatus.

3. Do not use the same washcloth for any other portion of the patient's bath.

Principles for Shampooing the Bed Patient's Hair.

1. The supine position is preferred for weaker patients.

2. Patients with significant heart or lung disease will not tolerate being supine; they must be in a sitting position.

3. Hair care should be given regularly during illness, just as it would be normally.

Purposes of Hair Care.

1. Hair care improves the morale of the patient.

2. It stimulates the circulation of the scalp.

3. Shampooing removes bacteria, microorganisms, oils, and dirt that cling to the hair.

3-14. CLOSING.