Nursing care of patients, back care procedure

1. Back care
Prepared by: Pooja Koirala
Lecturer
NMCTH

2. Definition
• Back care means cleaning and massaging
back, paying special attention to pressure
points.
• Specially back massage provides comfort and
relaxes the client
• It facilitates the physical stimulation to the
skin and the emotional relaxation

3. Purpose
• To improve circulation to the back
• To refresh the mood and feeling
• To relieve fatigue, pain and stress
• To induce sleep
• To prevent pressure sore
• To provide an opportunity to observe the
condition of patient’s back
• To stimulate and relax muscles

4. Indications
• Bed ridden patients
• Patients with poor personal hygiene
• Malnourished patient
• Obese patients
• Very thin patients
• Unconscious and serious patients
• Paralyzed patients
• Edematous patients
• Patient with loss of movement

5. Principles
• Hand washing before the procedure
• Proper explanation and privacy should be
maintained
• Back care should be given as a part of morning
and evening care and when necessary according
the condition and need of the individual patient
• When the skin is greasy, moist and about to break
the powder should be used to reduce friction

6. Principles cont…
• When giving back rub, use more pressure on
upward strokes towards the head and less pressure
on the downward strokes
• The nurse must use good body mechanism while
doing procedure
• Keep the patient in proper position
• Consider cultural preferences of patient.

7. Principles cont…
• Do not give massage if any discoloration /
infection of skin is present
• Water temperature should be 105 to 110 degree
F

8. Articles required
• Screen
• A clean trolley containing:
– Basin (medium steel bowl) with warm water: (2)
• Tray containing
– Soap with soap dish: 1
– Sponge cloth: 2 i.e. 1 for wetting the back, 1 for
rinsing
– Mackintosh: 1
– Big towel: 1 for covering a mackintosh
– Oil / powder (according to the skin condition)

9. Procedure
• Check the patient’s identification and condition
• Explain to the client about the purpose and the
procedure
• Wash hands with soap and water
• Assemble all articles required
• Put all required articles to the bed side and set up
• Close all windows and doors and put the screen

10. Procedure cont..
• Adjust light, temperature and switch off the fan
• Position the patient in the prone or lateral/ side
lying or Sim’s or prone position with back
towards you and observe it
• Expose back, shoulders, upper arms and buttocks
and cover the rest of the body
• Place the mackintosh and towel close to the
patient’s back or under the back

13. Procedure cont…
• Use warm water 105 – 110 degree F
• Wash / wet the patient’s back thoroughly from
cervical spine to the coccyx with the help of
sponge towel
• Apply soap on your hands and then rub the back
in circular motion over the shoulder, length of the
back and buttocks with special attention to bony
prominences (both scapulae, right and left iliac
crests)
• Clean the soap with sponge clothes

14. 1. Effleurage
• Apply back rub lotion / oil and apply hands first
to sacral area massaging in the circular motion.
• Effleurage is applied in an upwards direction
towards lymph nodes.
• Stroke upward from buttocks to shoulders
• Continue using light pressure in one smooth firm
stroke from upper back to arms

15. Effleurage cont…
• Massage over scapula with smooth, firm stroke
• Then move down without circular motion along sides
of back, down to iliac crests
• Do not take the hands off from patient’s back till the
end of the procedure
• Continue for at least 1 minute
• Effleurage must always follow the direction of venous
return back to the heart and the direction of lymphatic
drainage towards the nearest group of lymphatic nodes.

16. Effleurage cont…

17. Effleurage cont…
• Effleurage increases blood circulation towards
the heart, using long strokes to help increase
temperature of the soft tissues.
• Effleurage is effective to stimulate the
lymphatic system.

18. 2. Kneading (Petrissage)
• Knead gently by grasping tissue between the thumb
and fingers
• Knead upward along one side of spine from buttocks
to shoulders and around the nape of the neck
• Knead downward towards the sacrum, repeat along
other side of the back
• This activity helps to improve blood circulation to the
tissue

20. Five types of tapotement
• Beating (closed fist lightly hitting area),
• Slapping (use of fingers to gently slap),
• Hacking (use the edge of hand on pinky finger
side)
• Tapping (use just fingertips) and
• Cupping (make your hand look like a cup and
gently tap area

22. 3. Tapotement /Cupping
• Perform tapotement (tapping movements with
medial and lateral aspects of hands on side of
spine from sacral region upwards)
• It is a massage technique in which local suction is
created on the skin by making the hands cup
shaped.
• It increases blood circulation and is effective to
release tight muscles, fascia (band of connective
tissue) and reduce high tone (tension of muscles).

23. Tapotement /Cupping cont…
• By creating suction and vacuum pressure, it can
soften tight muscles and tone, loosen adhesions
and lift up restrictive connective tissues.
• The specific technique brings hydration and
blood flow to the body's tissues.
• It can be used to move deep inflammation to the
skin surface for release and drain excess fluid and
toxins by opening lymphatic pathways.

24. 4. Compression and friction cont..
• The compression technique applies pressure into
muscles, it is then held and released.
• It can be done using whole hand (palm side), closed
fist, knuckles, heals of hand and fingers
• Compression is an effective massage technique
performed by laying hands over a muscle area and
pushing down onto the tissues.
• Hands are then lifted and moved to a different area and
then repeated.

26. Compression cont…
• The pressure of compressions can range from
light to very deep.
• Compressions can also be performed with a
slight rocking movement that can encourage
the parasympathetic nervous system and
promote relaxation

27. 5. Vibration
• Vibration massage technique is a fine, gentle, trembling
movement performed with hands or fingers.
• For this, one hand is placed above the another hand
perpendicularly and then gentle trembling movement is
done.
• A vibration massage creates a vibrating and shaking
motion onto the muscles that can be performed in a
soothing or stimulating way.
• It can be done in an up and down movement or side to
side movement.

28. Vibration cont…
• Vibrations can be used to stimulate soft tissues in
the body, stimulate nerves, relieve muscular
tension, decrease stress and loosen soft tissue.
• Lighter vibration techniques can help stimulate
the parasympathetic system and help the muscles
relax.
• Vibration techniques stimulate an increase of
temperature by friction against the skin.

29. Vibration cont
• Vibration helps restore circulation to the
muscles and it increases the amount of new
blood cells to the area stimulating the healing
process.

30. Procedure cont…
• End the massage with long stroking movements for an
additional 1 minute with total time of 3-5 minutes
• Wipe excess lubricant to back as required
• Remove mackintosh and towel
• Help to put on cloths and tighten the bed, if needed
• Keep the patient in comfortable position and open
curtains

31. Procedure cont…
• Educate to the patient and family about the
importance of cleanliness, dryness, massage and
position change
• Replace all equipment in proper place
• Record in the patient’s chart including date, time
and patient’s general and back condition
• Report to the senior staffs if found any
abnormalities

32. Any queries??

33. Thank you