Unit 13

Explaining Personal Care with Dignity

Workplace English for Nursing Assistants

Meet Ida

Watch the video about Ida. Watch what happens.

Case Study Video — Ida

Ida — Distress During Bathing

Talk about it

  1. Why might Ida's bath be upsetting now, when it used to be comforting?
  2. Should you continue the bath despite Ida's behavior? Why or why not?
  3. What alternatives could reduce Ida's distress during bathing?
  4. Write exactly what you would SAY to Ida at the tub-room door when they start to cry.
A caregiver at eye level explains the next step to a client who is covered by a bath blanket in bed.
Figure 13.1 — Say what will happen before you touch — and keep the client covered.

The Two Key Terms

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Personal care requires skill, respect, and clear communication. Healthcare workers should explain each step before touching the client, protect the client’s privacy, and use plain, professional words. They must also watch for signs of fear or refusal and never force a bath. During peri-care, correct washing methods help prevent infection and protect the client from harm.

TermPlain meaning
Peri-careWashing the perineal (private) area — the genitals and between the legs.
ParaphimosisSwelling that traps the foreskin behind the head of the penis when it is not pulled back after washing — painful, and can become an emergency.

Practice 1 — Definitions

A. Definitions

Write a definition for each term in your own words.

1. Peri-care:

______________________________________________________________

2. Paraphimosis:

______________________________________________________________

Before You Touch: Explain It Plainly

The single most common mistake is using the wrong words. Medical words confuse; slang offends. Plain words work.

Wrong words vs. plain words
✘ Don't sayWhy✔ Say
"I'm going to perform peri-care."The client does not know what that means"I'm going to wash your bottom now."
Slang for body partsUnprofessional; may offend or frightenCorrect, plain words
(nothing — just start)Terrifying. This is how a bath becomes a fight"I'm going to lift your arm and wash underneath."
"We're going to have our bath now."Elderspeak (Unit 8) — you are not having a bath"It's your bath day, Mrs. Adler. Shall we start?"
A crossed-out speech bubble says a confusing medical phrase; a checked bubble says the same thing in plain respectful words.
Figure 13.2 — Say It Plainly: Plain, respectful words work.
🗣 Speaking Toolbox: Saying each step before you do it

Check for Understanding

You said it plainly. Did it arrive? This is where the unit's own wordbank comes in — and it asks a different question from the checks in Unit 10.

🗣 Speaking Toolbox: Checking that your explanation worked

Distressed Bathing (Never Force It)

Clients refuse baths for real reasons — a stranger seeing them undressed, pain, cold, feeling ill, or dementia that makes the whole thing confusing and frightening. Be calm, efficient, and genuinely kind.

⚠ Safety — Stop if the Client Becomes Agitated

Never force a bath. If a client becomes angry or agitated — yelling, hitting, pinching, biting — both of you can get hurt, and no bath is worth that.

Stop, cover the client, return them to their room, keep them safe, and finish later once they are calm. Tell the nurse so a better plan can be made.

Four numbered panels show stopping the bath, covering the client, returning them to their room, and telling the nurse.
Figure 13.4 — If the Client Becomes Agitated: Stop, cover, return them to their room, and tell the nurse.

Alternatives that prevent distress

Rinseless systems are gentler on skin, leave no irritating residue, and are faster — which lowers the chance of chilling or agitating the client. They come as peri-cleansers, full-body cleansers, premoistened cloths (Bag Bath®, Ready Bath®), and no-rinse shampoo caps — great for clients with dementia who fear water.

Three panels show a pack of premoistened bathing cloths, a no-rinse shampoo cap, and a bottle of rinseless cleanser.
Figure 13.5 — Rinseless Bathing Tools: Rinseless tools are faster and gentler — good for clients who fear water.

Distraction

If someone is anxious, talk about something else — the weather, their family, a photo on the wall. Choose a topic this person cares about.

Practice 2 — Distressed Bathing

2.1 Choose the best response

1. A client becomes agitated — yelling and hitting — during a shower. You should

  1. finish quickly before they get worse
  2. stop, cover them, return them to their room, and tell the nurse
  3. call more staff to hold them still
  4. leave them alone in the shower to calm down

2. A client gets cold during showers, but there are no clean bath blankets. You should

  1. use a bed blanket to cover the client
  2. wait for laundry to bring bath blankets
  3. ask the next shift to do it
  4. skip covering them and hurry

3. A client with dementia is afraid of water on their face. A good approach is to

  1. insist the bath be done the usual way
  2. wash the hair in the sink or bed, or wash the face last
  3. skip bathing entirely
  4. pour water quickly to finish fast

2.2 Rinseless systems: True or False

  1. ____ Rinseless cleansers can be gentler on the skin than soap and water.
  2. ____ Rinseless bathing is slower because you must rinse twice.
  3. ____ No-rinse shampoo caps are helpful for clients with dementia who fear water.

Peri-Care (Respect + Infection Control)

Say It Professionally

Use plain, respectful words — not slang, and not confusing medical terms. Say "I am going to wash your bottom now," not "peri-care" and never slang.

Key Rule — Direction: Urethra First, Front-to-Back

The urethra is the cleanest part (it leads to the sterile bladder), so always start at the urethra and wash away from it, front-to-back. Use a clean area of the cloth (or a clean cloth) for each wipe — about three wipes. Washing back-to-front can drag germs to the urethra and cause a urinary tract infection.

Sequence: expose only the area being washed; place a pad underneath; use fresh warm water. Female anatomy: open the labia, wash top-to-bottom front-to-back. Male anatomy: if uncircumcised, gently pull the foreskin back, wash from the tip down. Then wash the buttocks/anal area front-to-back (wipes first if there is stool). Change to a clean pad; apply barrier cream to intact skin.

⚠ Safety — Replace the Foreskin

On an uncircumcised client, you must pull the foreskin back into place after washing, rinsing, and drying. If you forget, paraphimosis (painful trapped swelling) can occur.

When a client says something sexual

This happens, and it is one of the hardest moments in the job. You are alone in a room, the client is undressed, and they make a sexual remark or a suggestive noise.

Three things NOT to do

✘ Do not laugh it off. Laughing reads as permission, and it will happen again.

✘ Do not say nothing. Silence also reads as permission — and it leaves you carrying it alone.

✘ Do not stop the care and walk out (unless you feel unsafe). The client still needs to be clean.

🗣 Speaking Toolbox: Holding the line, calmly

Say it once, in a level voice, and carry on with the care. You are refusing the BEHAVIOUR, not the person.

Then tell the nurse — every time

Report it even if you handled it well and even if it felt small. Three reasons: it may be a change in the client's condition; the next worker deserves to know; and you should not be carrying it by yourself.

Healthcare workers report being routinely distressed on the job by this kind of thing. Being distressed by it is normal. Saying nothing about it is what makes it worse.

If you ever feel unsafe: leave the room and get help.

Practice 3 — Peri-Care

3.1 Fill in the blank

  1. Always start peri-care at the , the cleanest part of the perineum.
  2. Wash in a (front-to-back / back-to-front) direction.
  3. Use a area of the washcloth for each wipe.
  4. On an uncircumcised client, you must pull the back into place after washing.

3.2 Choose the best response

1. While you complete peri-care, a client makes a sexual remark that makes you uncomfortable. You should

  1. laugh so you do not seem bothered
  2. ignore it and keep going without a word
  3. calmly and professionally say that kind of talk is not acceptable
  4. stop all care and refuse to help them again

2. Telling a client you are about to do peri-care, the BEST wording is

  1. "I am going to perform peri-care now."
  2. "I am going to wash your bottom now."
  3. a slang term so they feel relaxed
  4. nothing — just start washing

3. After you handle a sexual remark calmly and finish the care, you should

  1. say nothing — you dealt with it
  2. tell the nurse, every time
  3. tell only your friends on the unit
  4. wait to see if it happens again

Bed Baths — Partial vs. Complete

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Two kinds of bed bath
TypeWhat it covers
Partial bed bathFace, hands, underarms, under breasts, abdominal folds, and the peri-area. Done morning and evening.
Complete bed bathThe WHOLE body — usually face → arms/trunk → legs/feet → peri-care last. Needs at least 4 washcloths (2 body, 2 peri; more if soiled).
Two body outlines compare the areas washed in a partial bed bath and a complete bed bath.
Figure 13.6 — Partial covers face, hands, folds, and peri-area. Complete covers the whole body.
Check Your Knowledge Chattybot · Check Your KnowledgeScan to answer these questions out loud.
  1. Say "I am going to perform peri-care" in plain words.
  2. Name three things you WATCH for when a client cannot tell you they are frightened.
  3. What exactly do you say to a client who makes a sexual remark?
  4. Name the three things you must NOT do.
  5. Do you report it if you handled it well? Why?

Dialogue Practice

Read these dialogues out loud with a partner.

Two people having a scripted workplace dialogue.

Dialogue 1Before you touch

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Mrs. Halvorsen, 82, is alert and a little shy. It is her bath day and you are giving a complete bed bath. You have never bathed her before.

You: Good morning, Mrs. Halvorsen. My name's Ana — it's your bath day today. I'm going to help you wash, here in bed, so you don't get cold.

Mrs. Halvorsen: In bed? I usually go to the tub room.

You: We can do either. Would you rather have the tub, or shall we do it here where it's warm?

Mrs. Halvorsen: Here, I think. The tub room's so cold.

You: Here it is. Now — first, I'll close the door and the curtain, so it's just us. Then I'll keep you covered with this blanket the whole time and only uncover the bit I'm washing.

Mrs. Halvorsen: (relaxing slightly) All right.

You: We'll start with your face and work down. Last of all I'm going to wash your bottom — I'll tell you before I do. Am I making sense?

Mrs. Halvorsen: Yes. Yes, that's fine.

You: And would you like to wash your own face? Most people prefer to.

Mrs. Halvorsen: Oh — yes. I'd like that.



Two people having a scripted workplace dialogue.

Dialogue 2Listening to a Nonverbal No

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Mr. Oyelaran, 88, has dementia and a urinary tract infection this week. You are washing his arms in bed. He has said "yes" to everything so far.

You: That's your arms done. Now I'm going to wash your chest — is that all right?

Mr. Oyelaran: Yes. Yes.

But his hand comes up and grips the edge of the blanket. His shoulders have come up toward his ears.

You: (pausing, hands still) You're holding that blanket tight. Are you cold, or are you not keen on this bit?

Mr. Oyelaran: ... Cold.

You: Let's fix that first. I'll get a warm towel and put it right on your chest while I work — you won't be uncovered at all.

She warms a towel, lays it on his chest, and washes underneath it.

You: Better?

Mr. Oyelaran: (shoulders dropping) Mm.

You: Hold this end for me, would you? Just keep it right there.

Mr. Oyelaran: (holding the towel)

You: Is that your family in the photo? Who's the young man in the uniform?

Mr. Oyelaran: (brightening) That's me. Nineteen fifty-nine.

You: Nineteen fifty-nine! Tell me about that while I finish your chest.

Role Plays

Work with a partner.

An older man in bed before his first bath.

Role Play 1First bath

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Situation

Mr. Bergqvist, 79, arrived yesterday. It is his first bath here and he has never met you. He is alert, embarrassed, and says very little. Give a complete bed bath.

Your Goals:

  1. Introduce yourself and say what is going to happen, before you touch anything.
  2. Use PLAIN words — no "peri-care," no slang, no "we."
  3. Say each step BEFORE you do it.
  4. Promise and provide privacy and covering.
  5. Use a Checking for Understanding phrase (not "Do you understand?").
  6. Offer him something to do himself.
An older woman turning her face away.

Role Play 2The unspoken no

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Situation

Mrs. Nakamura, 86, has dementia. She agrees with everything you say. You are giving a bed bath and are about to wash her chest and abdomen. She is cold and does not want to be uncovered, but she will not say so.

Your Goals:

  1. Notice the nonverbal refusal and STOP your hands.
  2. Name what you noticed, out loud, without accusing her.
  3. Find the actual reason and fix it.
  4. Use a distraction that gives her hands a job.
  5. Use a distraction that gives her mind somewhere to go.
  6. Use NO child-directed language at any point.

Cumulative Review

Fill in the Blank

Use a word from the word bank. Each is used once.

supplies • perineal • client • partially bathed • skin • challenge • empathetic • privacy • alternatives • rinseless • showers or tub baths • urethra

  1. Before the bath, prepare a clean, easy-to-reach space for your ________________.
  2. Peri-care is washing the ________________ area.
  3. Adapt bathing techniques to meet the needs and desires of the ________________.
  4. Each client should be ________________ twice a day, except on their bath day.
  5. Always check the client's ________________ while bathing.
  6. Bathing can be a ________________ for clients who have dementia.
  7. During bathing, be ________________ and sincere so the client is more comfortable.
  8. Always provide ________________ when bathing a client.
  9. There are ________________ to traditional tub bathing that make it easier for clients with dementia.
  10. ________________ soap is an effective, gentle way to cleanse clients.
  11. Rinseless shampoo is a good choice for clients who cannot tolerate ________________.
  12. The ________________ is the cleanest part of the perineum.

Multiple Choice

Vocabulary Review Tip

Cover the answers, try from memory, then cross out the choices you know are wrong.

1. Peri-care should be completed

  1. every evening before bed
  2. after changing a soiled incontinence garment
  3. all of the above

2. Lotion should NOT be applied to a client's

  1. feet
  2. back
  3. abdominal folds

3. A client with female anatomy should have peri-care done by cleansing

  1. front to back, starting at the urethra
  2. front to back, starting at the upper thigh
  3. back to front, starting at the urethra

4. A partial bed bath includes all of these EXCEPT

  1. under the breasts
  2. the peri-area
  3. the entire back and legs

5. A complete bed bath typically begins with the client's

  1. hands
  2. face
  3. peri-area

6. When assisting with a shower, you should wash the hair

  1. first, then the face and body
  2. last, so the client does not get cold
  3. either first or last — the client's choice

7. Bathing with a rinseless system instead of soap and water

  1. is more time-consuming
  2. can be gentler on the skin
  3. does not clean as well

8. Before you wash a client's private area, the BEST thing to say is

  1. "I'm going to perform peri-care."
  2. "I'm going to wash your bottom now."
  3. "Let's get our bottom washed, dear."

Back to Ida

Read the case and answer in complete sentences. Use the sentence starters if you wish.

The Case: Ida

Ida lives in your long-term care facility. For the last few days they have felt unwell with a urinary tract infection, and their dementia symptoms are more pronounced. You are assigned to help Ida bathe this morning. Normally Ida enjoys a bath, but when you try to take them into the tub room, they begin screaming and crying.

1. Why might Ida's bath be upsetting now, when it used to be comforting?

______________________________________________________________

2. Should you continue the bath despite Ida's behavior? Why or why not?

______________________________________________________________

3. What alternatives could reduce Ida's distress during bathing?

______________________________________________________________

4. How could you wash Ida's hair to minimize distress?

______________________________________________________________

5. What other bath-day responsibilities do you have for Ida today?

______________________________________________________________

6. Write exactly what you would SAY to Ida at the tub-room door when they start to cry.

______________________________________________________________

For the instructor — not part of the student pages

Instructor Answer Key

Unit 13 — Explaining Personal Care with Dignity

This unit introduces the language and practices used to provide personal care while protecting dignity, privacy, and choice. Learners study how to explain care before touching, respond to distress during bathing, perform peri-care, distinguish partial from complete bed baths, inspect the skin, and maintain professional boundaries. A case study about Ida connects illness and increased dementia symptoms to sudden bathing distress. Through illustrated readings, flashcards, knowledge checks, dialogues, and role-plays, learners practice noticing verbal and nonverbal refusal, stopping their hands, offering alternatives, explaining each step in plain language, preserving privacy, and responding calmly to inappropriate comments.

Practice 1–4 and Review

Practice 1 (definitions, sample): 1. Peri-care — washing the perineal (private/genital) area. 2. Paraphimosis — painful swelling that traps the foreskin behind the head of the penis when it is not replaced after washing.

Practice 2.1: 1-b 2-a 3-b. Practice 2.2 (rinseless): 1. True 2. False 3. True.

R1 Fill in: 1. supplies 2. perineal 3. client 4. partially bathed 5. skin 6. challenge 7. empathetic 8. privacy 9. alternatives 10. rinseless 11. showers or tub baths 12. urethra.

Back to Ida Multiple Choice 1-c, 2-c, 3-a, 4-c, 5-b, 6-c, 7-b, 8-b.

R3 Case Study (sample): (1) The UTI has worsened Ida's dementia symptoms, so a familiar routine now feels confusing and frightening; they may also feel pain or discomfort. (2) No — never force a bath; stop, cover Ida, return them to their room, keep them safe, and try again when calm, telling the nurse. (3) A complete bed bath, a rinseless system, keeping them covered and warm, washing face/hair last, distraction with conversation or a comfort item. (4) Use a no-rinse shampoo cap, or wash hair in the sink or bed, so water does not go on the face. (5) A full set of vital signs, weight, nail care, hair care, a complete linen change, and a skin check — plus watching the UTI symptoms and reporting to the nurse. (6) Answers vary — score whether the student STOPS, reassures briefly, and does not try to persuade Ida through the door.

Suggested drill — the silent client

One student mimes being bathed (fully clothed, seated). They may say only "yes" — nothing else — but they may use their face, shoulders and hands freely. The learner must notice a refusal and stop.