4.7 Nail Care

Nail Care

Providing nail care for a client provides an opportunity for HCAs to assess the health of their client’s skin, nails, and the strength of their hands and feet. It also provides a sense of comfort and promotes self-esteem for the client. While many clients may enjoy having their hands and feet cared for, take special care with clients who do not find this a pleasurable experience. Some clients have sensitive feet and may be ticklish. Health Care Assistants should always tell a client when they are going to touch their feet, and inform them of what they are doing, so that the client expects the touch. Make sure to follow directions from a supervisor and those written in the Care Plan for any nail care that is performed.

** Never use a nail clipper to clip fingernails or toenails.  Use an emery board to smooth the client’s nail edges. Health Care Assistants should inform their supervisor if advanced nail care needs to be performed. Never perform toenail care on a client living with diabetes. These clients require special care from a podiatrist or specially trained nurse. It is acceptable to cleanse and inspect these client’s feet, but never clip their toenails (Sorrentino, et al., 2019; McLain, et al., 2018).

Hand Care​

Table 4.7.1 Procedure: Hand Care​

 
STEP ACTION REASON
1. Explain the procedure to the client.
2. Wash and dry your hands. Put on gloves as necessary.
3. Gather equipment and supplies as needed. Follow the Care Plan.
4.
  • Use proper working height by raising the bed to waist level if the client is bed bound.
  • If the client is sitting in a chair or wheelchair, Home Health Aides/Personal Care Aides may sit next to them to avoid bending their back.
  • Keep the back straight, feet planted on the floor, and face the direction you are working.
5.
  • Soak client’s hands in warm (not hot) water.
  • Soak hands for at least five minutes, or according to client preferences.
  • Clean under nails with a soft nail brush or nail stick.
 Temperature should be no greater than 105 degrees Fahrenheit.
6.
  • Remove the client’s hands from the water and wash with a soapy washcloth.
  • Rinse and dry well. Be sure to rinse and dry between fingers.
7. Remove basin from the client area.
8. File nails as necessary and as requested, with an emery board or nail file to keep edges smooth and free of rough edges or hangnails.
Figure 4.7.1 Filing Fingernails (Image courtesy of RODNAE Productions/ Pexels.) Pexels License
9. Massage hands with lotion.
10. Apply nail polish as the client requests.
11.
  • Discard the water and rinse the basin.
  • Put away equipment and supplies.
12. Lower the bed to its lowest level and ensure side rails are up.
13. Remove your gloves. Wash and dry your hands.
14. Record and report any changes in behavior or skin conditions observed.

Foot Care

Table 4.7.2 Procedure: Foot Care

 
STEP ACTION REASON
1.
  • Fill a basin with warm water.
  • Do not exceed 105 degrees Fahrenheit.
  • Have the client test the water for comfort.
2.
  • If providing foot care in bed, place the client in a semi-fowlers position.
  • Soak and work with one foot at a time.
  • Place the basin of water over a waterproof pad or towel at the foot of the client’s bed.
  • If the client is sitting, place the basin on the floor with a towel or waterproof pad underneath.
  • Ensure the client’s feet and ankles are supported. Feet should be flat against the bottom of the basin.
3.
  • Soak the client’s feet in warm (not hot) water for at least 10 minutes.
  • Add warm water to the basin as needed.
  • Clean under their toenails with a soft nail brush.
4.
  • Working with one foot at a time, remove a foot from the basin and wash with a soapy washcloth.
  • Take care to clean between toes.
  • Rinse their foot well. Make sure no soap is left between the toes.
5. Dry the client’s foot. Take special care to dry well in between toes.
6. Repeat for the other foot.
7.
  • File toenails as needed.
  • Do not cut client‘s toenails the same as fingernails.
  • Discuss any needed advanced toenail or foot care with a supervisor.
A pair of hands uses an emery board to file another person's toenails.
Figure 4.7.2 Filing Toenails (Image courtesy of Amy the Nurse/ Flickr.) CC BY-NC-ND 2.0
8.
  • If applying lotion on feet, take care to not apply lotion between the toes.
  • Place socks and/or other footwear on client once done.
9. Apply nail polish as the client requests.
10.
  • Discard the water and rinse the basin.
  • Put away equipment and supplies.
11. Lower bed to its lowest level and ensure side rails are up.
12. Remove your gloves.

Wash and dry your hands.
13. Document completion of task and record and report any changes  behavior and any discoloration of the feet, blood, drainage, ingrown toenails, thickened toenails, reddened heels, or foot/ankle swelling.

Watch the video, How to Care for Nails, presented by the St. Elizabeth Foundation on YouTube CareChannel (2019). This video demonstrates the techniques for Personal Hygiene Care when you care for a client’s nails.

 

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Personal Care Skills for Health Care Assistants Copyright © 2023 by Tracy Christianson and Kimberly Morris, Thompson Rivers University. is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

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