Practice No.
143 / Version 1 / Page 1 of 4 / New
March 2009
Reference: 10/06 / HCC AS 10/06 141
HCC AS 10/06 142 / NMC Code of Professional Conduct
GSCC Code of Practice
Delivery of Personal Care –Personal Appearance: Mouth and Hair Care

HampshireCounty Council Adult Services recognises the right of the individual service user to live a lifestyle of his/her own choosing, subject to appropriate Risk Assessment.

These guidelines address the identification of choices forself presentation and personal hygiene, the assessment of any associated risks, and the way in which the service enables the individual to exercise those choices in such a manner as to promote self-confidence and a healthy lifestyle. They should be read in conjunction with guidelines 141 and 142:

  1. Getting to know the individual

It is important to remember that everyone has their own practices and preferences around personal hygiene and self presentation. The way in which we care for our appearance is integral to our identity, and long standing methods and familiar materials help us to maintain our sense of identity and promote our independence. The clothes we wear, our hair style, the toothpaste we use and even the order in which we put on our clothes, all contribute to stating who we are. Looking good is closely related to feeling good, and an individual should always have the choice of what they wish to wear each day. Residents should NEVER be dressed in clothing which does not belong to them and, in residential care, all items of clothing should be discretely labelled, preferably with sewn or ironed on names tapes. It is not acceptable to write the resident’s name directly onto the clothing.Any missing buttons or other fasteners should be replaced before the resident next wears the garment, in order to preserve their dignity.

Within the requirements of the Mental Capacity Act 2006, it is important to acknowledge that individuals may not be prepared to accept direction on how they present themselves. Individual choice should be respected within the bounds of appropriate risk assessment.

  1. Mouth Care

The mouth is a primary area of sensation. We taste and touch with lips and tongue and, where oral hygiene is neglected, the mouth rapidly becomes dry, sore and infected. The tongue becomes coated and the breath foul smelling. Similar effects may also be created by some medications and this can become demoralising for the individual. Dryness, mouth ulcers, sore gums and infections can all be prevented to a great extent by effective oral hygiene. Good hydration and pain control alsopromote good oral health. A dry mouth can be alleviated with very cold drinks or sucking ice cubes, and sparkling water makes an effective mouth wash. Where lips are dry a proprietary brand of lip salve can be used or plain petroleum jelly (Vaseline) applied.

Oral hygiene

The most effective way of maintaining oral health and hygiene is by use of a toothbrush and toothpaste. The use of mouthwashes can be counterproductive, as they may change the ph balance of the mouth, (acidity level), and create a breeding ground for fungal infection such as ‘thrush’.

One of the primary considerations when cleaning teeth is the size of the toothbrush. It may be necessary to consider if an adult toothbrush is appropriate and if a smaller, softer, ‘child’ size brush should be used in the mouth. The adult brush can be retained for brushing dentures. Teeth should be brushed at least twice a day and preferably brushed or rinsed after each meal.

Toothpaste is equally important, as an unfamiliar taste, or one that is perceived as unpleasant will not only compromise oral hygiene, but may contribute to a poor appetite.

Dentures

The cleaning of dentures is as important as the cleaning of teeth. Dentures that are inadequately cleaned are likely to become heavily populated by bacteria. For adequate cleaning, dentures should be brushed at least twice daily, preferably rinsed after each meal and soaked overnight in a denture cleaning solution. They should be thoroughly rinsed before being replaced in the mouth.

Initially, care planning should explore individual practice and preferences and where possible, individuals should be encouraged and assisted to maintain their own hygiene.(care plan S.3.7)

Assisting mouth care

  • Check the person is ready to clean their teeth and understands what is to be done
  • Put on gloves and a protective apron and assemble the necessary equipment
  • Ensure the person is sitting comfortably at a bowl or basin
  • Cover the chest and shoulders with a towel to protect clothing
  • Wash hands and put on disposable gloves
  • Wet the toothbrush and apply a small amount of toothpaste or assist the individual to do this if required
  • If necessary, ask the person to open their mouth or gently do so, ensuring fingers are kept clear of the teeth and tongue
  • Gently brush the outside of the upper teeth downward from the gum line. Use the front tip of the toothbrush to brush the insides of the upper teeth.
  • Brush the bottom teeth upward from the gum line. Use the front tip of the toothbrush to brush the insides of the lower teeth.
  • Brush the tops of the back teeth with a gentle back and forth motion.
  • Gently brush the front of the tongue avoiding the back as this could cause ‘gagging’.
  • Provide a glass of water for rinsing where possible.
  • Ensure the person’s face is dry.
  • Dentures should be brushed and rinsed in a similar way and the individual assisted to put them back into place.
  1. Hair Care

Whether the hair is natural, prosthetic or simply sparse, clean tidy hair can boost the morale and self esteem of the individual. Equally, loss of hair can be a very traumatic experience. It is possible that older persons will not wish to experiment with new styles, but where the hair is thinning or there is hair loss, a professional hair dresser may be able to advise on changes that will minimize the effects and enhance appearance. Where there is a professional hairdresser in attendance at the home or day centre, both male and female residents and service users can be offered the opportunity for skilled attention. As part of the care plan, it should be established whether and how often the person normally has their hair washed, cut and dressed.

The best opportunity to wash hair is in the shower or bath and wherever possible the individual should be encouraged or assisted to wash their own hair. The frequency will depend on the personal preference of the individual, and in some cases it may be appropriate to suggest an opportunity if no regular hairdressing appointment is planned.

Assisting with hair care.

  • Ensure the person is aware of and in agreement with the process
  • Put on gloves and a protective apron and assemble the necessary equipment
  • Offer a dry face cloth to protect the eyes
  • Gently rinse the hair with clean, warm water, using a shower attachment or a jug. It is important to check that the person is comfortable with the water temperature especially where hair is thin. If possibly, use a specialist ‘lean back’ washbasin
  • Apply shampoo and gently lather
  • Rinse the hair with clean, warm water, preferably using a shower attachment or jug
  • Repeat the shampoo or apply conditioner using the same method, if required
  • Wrap the hair in a warmed towel and gently pat off the excess water
  • Using a brush or comb, tease out the hair until the desired style can be created or styling rollers can be used
  • The individual may prefer to allow the hair to dry naturally or a hair dryer may be used. If using a hair dryer, ensure that the person is aware and does not object, and that the temperature is comfortable and not too hot. Whichever method of drying is used, ensure the individual does not become chilled.
  • Where it is not possible to use water to wash the hair, a suitable ‘dry’ shampoo can be used and the same principles as a wet wash should be followed.

Facial Hair

Where a male resident or service user normally wears a beard, if he is unable to maintain this, he should be assisted to wash, dry and trim it to the required style. It may be appropriate to do this by regular visits to or from a qualified barber.

Male residents or service users may also require assistance with shaving and if possible this should be done with an electric razor for greater safety. Where a wet shave is required, single use disposable razors should be used for hygiene and safety and disposed in a ‘sharps’ container following use. If an individual insists on the use of a ‘cut throat’ style razor, shaving must be undertaken by a qualified barber, either by visiting the Barber shop or engaging a visiting barber.Staff must not undertake the use of a ‘cut throat’ razor.

Where removal of facial hair is required for a female resident or service user, a depilatory cream may be used, subject to a full risk assessment and the purchase of a suitable chemical. Alternatively, gentle use of a disposable razor, as below, is acceptable, subject to the individual’s agreement.

The best condition under which to shave is when the skin is warm and supple. This lessens the chance of skin damage. It is therefore best done in or after a bath or shower. If this is not possible, for example when the individual is confined to bed, a face cloth rinsed in warm water and wrung out can be applied to the beard area for a few seconds to create similar conditions.

Assisting with Shaving

  • Ensure the person is aware of and in agreement with the process and is in a comfortable position in front of a mirror if required.
  • Where the individual is shaving themselves, they may prefer to stand in front of a mirror, particularly when wet shaving, or they may be happy to sit and shave by touch with an electric shaver
  • Put on gloves and a protective apron and assemble the necessary equipment
  • If using a disposable razor, ensure that there is a ‘sharps’ container available, or a container in which to place the razor until it can be taken to a suitable disposal point. It is also advisable to have hæmostatic strips available in case of nicks and scratches as warm skin bleeds freely
  • If necessary, warm the beard area and observe the direction of hair growth on the different areas of the face and neck
  • If wet shaving, a suitable shaving foam or lotion must be used. This will be according to the individual’s choice. It may be applied by brush after wetting a block of shaving soap, or sprayed onto hands from an aerosol and applied to the face, with help if required
  • Particular care needs to be taken when shaving over deep facial creases, chin clefts and dimples. Also any areas of scarring.
  • Where help is needed, ensure the skin is taut, (the individual will usually know how to arrange his expression to achieve this), and apply the razor with even, gentle pressure, in smooth strokes in the direction of the hair growth. This will vary over the face, being downward on the cheeks and upward on the neck. The order in which the areas are shaved will vary with individual choice, regardless of the type of razor
  • On completion of the shave, ensure that all shaving foam is removed and the skin patted dry with a soft towel
  • Unless specifically requested to do so, DO NOT apply ‘after shave’ to freshly shaved skin. If necessary, this can be applied when the skin has cooled and the pores closed. Alternatively, if the fragrance is the requirement, it can be applied as a dab behind the ears for required effect.
  • If the skin is nicked, the hæmostatic strip should be applied as directed and care should be taken to ensure that the bleeding has ceased

NB (Note well)

EVERYONE ENJOYS BEING COMPLIMENTED ON THEIR APPEARANCE

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