This post will cover:
- what are washing and dressing assessments
- why OT’s do them
- How to do a washing and dressing assessment
- How to write a washing and dressing assessment up in the medical notes
- an introduction to small aids that assist with washing and dressing
- Links to videos to show you how to use washing and dressing aids
Hey there readers, I can’t believe it’s been four months since my last post! I’ve rotated again and have been getting to grips the being an OT on a elderly rehab ward. I’ve also been buying a house (with varying degrees of success) so apologies if I’ve not been posting regularly as I should.
So it’s been a year since I’ve done inpatient work and I’m back to doing kitchen and washing and dressing assessments. For regular readers you’ll know I’ve already done a practical guide on how to do a kitchen assessment so today I thought that I would write a post on how to do a washing and dressing assessment.
What is a washing and dressing assessment?
A washing and dressing assessment (sometimes referred to as a PADL assessment or even shortened to just PADL) is a functional assessment. In very simple terms the OT is working out (assessing) whether the client can wash and dress themselves (the function).
Why do we do them?
Functional assessments can be used to predict whether the client would be safe and independent with their personal care on discharge home. It can help us decide whether that person may need a carer to assist with personal care on discharge if no one is able to help at home with this task. This post goes in more detail on how to assess for a package of care for a patient. It can also be used to assess a clients cognitive skills such as initiating a task, planning, sequencing, safety awareness, problem solving and concentration. Washing and dressing assessments can also help us figure out if that person will need bathing equipment on discharge. There’s more here on different types of bathing equipment.
Since starting my rotation on a rehab ward I have also been more involved in using washing and dressing assessments as a therapeutic technique as well as an assessment. For example using it to work on things like standing balance, dynamic balance, leaning forward and sit to stand. I have had to think more about grading these assessments too.
How to do a washing and dressing assessment
Firstly, you’ll need to tell the nursing staff the day before that you intend to do a washing and dressing assessment the following morning so they don’t get that person washed and changed. You could perhaps put a sign above the bed too, just to be sure. Gain consent from the patient, check if they are OK with a male/female helping them with their bathing. Don’t say it’s an assessment, just say you’re coming to help them like the nurses do, keep it informal, as I’ve found people worry if you start saying ‘assessment’.
On the day, check with the nursing staff that they are well enough for the assessment (the patient, not the nursing staff). You may want to let them have their breakfast first to reduce any chances of them feeling light headed etc. Check with the patient too that they feel well enough.
Decide how you are going to do the assessment.
- a stripwash at the bedside with a bowl on their overbed table
- Taking them into the therapy bathroom or ward bathroom for a stripwash with a perching stool
- The ward’s level access shower on shower chair or standing.
Decide how many people you need; one or two? You’ll get this information from your baseline assessment. For example; if they currently need two people to assist from sit to stand, you’ll need two people to help. You’ll be doing sit to stand as you wash and dress. If their sit to stand is poor then I’d start with a bowl at the bedside as if you took them to the therapy bathroom they would have to do more attempts of sit to stand, unless you felt that this was something they needed to practise and you feel that they are ready for it (more of a rehab approach).
Think about how they normally get washed at home. Try and replicate what they do at home. If in doubt, start with a stripwash at the bedside.
Firstly ask them to select what items that they need for the washing and dressing assessment. This will be things like soap, flannel, toothbrush, clothes and pads. You’re looking here to see if they can plan a task and recall what items they need. Dependent on their mobility, when they identify the item, you can fetch it for them out of their locker or they can get it out themselves. If they identify they need an item and they haven’t got it, you could go and have a look to see if the ward has supplies for them to use.
I would fill the bowl with soapy water (if doing it by the bedside), put all the items needed on the over bed table and then only intervene if they need you to, remember you’re trying to see how independent they are. Take a few towels in with you, for covering a patients dignity while they are getting washed.
Prompting and assisting
Ask before you help. Sometimes patients report that they ‘let’ the nursing staff assist in a wash despite reporting that they feel that they can do it by themselves. This could be for a number of reasons such as it’s faster and they don’t want to take up too much of the nursing staff’s time or they have lapsed into a passive patient role. So, make a judgement, if you feel that your patient is having difficulty washing their feet then ask if they would like help. Often towards the end of the assessment, it’s nice to put the patients feet into the bowl of water and let them have a soak, put a towel down on the floor first.
Use your judgement from the baseline assessment. If you know that someone recently needed assistance of 2 sit to stand then you would just assist with this and not wait to be asked. If someone stands with effort with a zimmer frame then they will need a hand pulling down their underwear and pyjama bottoms, changing their underwear or pad and washing their lower body as they’ll need to keep their hands on the zimmer frame in stand.
As you are assessing cognition too, only prompt with the next stage of the task if needed.You’re assessing whether they can sequence, plan and problem solve. start with subtle hints and get more obvious as needed.
Once the assessment is complete and you’ve tidied up, it’s time to complete your documentation. You may have a proforma to complete that guides your assessment. Like this one.
If you don’t have a proforma and are writing in the notes comment on:
- Transfers: getting on and off chair/bed/toilet
- Mobility: what are they walking with? How many people do they need to assist?
- Upper and lower body washing
- Upper and lower body un/dressing
- Range of movement: can they reach their head, feet, back, lift their arms to put on clothes?
- Balance: sitting, standing and dynamic balance
- Cognititon: planning, initiating, sequencing, problem solving, following instructions, concentration. (Is there any confusion that you’ve noticed?
- Mood: how cooperative they are, chatty/not chatty, anxious, etc.
- Equipment used; perching stool, bath board, level access shower etc.
Finally summarise your findings. You can say things like;
Patient X will need a 1 carer on discharge to assist with washing and dressing of lower body and to assist patient lift legs into bath on bath board.
Patient Y will need 1 carer on discharge to prompt with the initiation of tasks and to assist with washing feet and putting on knickers and socks.
Sometimes small aids are forgotten about as we all concentrate on perching stools and bath boards however they are nonetheless important.
Long Handled Sponges
Great for doing feet and back. No need to bend down in seated which is great for people who have difficultly reaching their feet or if people have COPD/breathlessness.
Long handled shoe horns
Again the long handled-ness reduces the need to bend down when putting on shoes, as above. It can also be used to remove socks.
Terry towelling sock aid. Kinder to skin than it’s plastic counterparts. Here’s a video on how to use it. You’re welcome.
Helping hands help in all aspects of life. They are great for picking up clothes from the floor. They can help put lower body items on such as underwear and trousers. I got excited today when I saw them in Home Bargains for 99p. I’ll have two.
The dressing stick is still a bit of an enigma to me. It’s a stick with hooks on which can be used to don and doff shoes, socks, thread legs into pants, put coats and cardigans on and pull up zips. This article is quite helpful. These students have made a video on how to use a dressing stick, there are quite a few on Youtube to help you learn.
Makes buttoning clothes less fiddly.The hook on the other end is for pulling up zips. Good for people with artritis or difficulty with fine motor skills. Here’s a video on how to use it.
Designed by an OT, the Bra Angel helps ladies get their bra on, even one handed. Here’s the Bra Angel video demonstration.
So that’s your lot for today. Hope you found it useful. Have a great Christmas and see you in 2017. I hope your 2017 is going to be as exciting as I think mine is going to be (fingers crossed with the house).