1. Hygiene & Environment

Patient hygiene is a core responsibility of the caregiver, maintaining both physical health and psychological dignity for those who cannot perform self-care. The module encompasses seven key skills practised in home and clinical settings.

Bed Bathing

Bed bathing maintains skin integrity, prevents infection, and supports the patient's sense of dignity. The caregiver should gather all supplies before beginning — washbasin, warm water, soap, washcloths, towels, clean linen — to avoid leaving the patient unattended. Work systematically from head to feet, using a clean section of the cloth for each area. Maintain privacy with a modesty towel at all times and ensure the room is warm.

Hair Care

For bedridden patients, hair washing uses either a dry/no-rinse shampoo or an inflatable washing basin. Protect pillows and bedding with waterproof pads. Check water temperature carefully to prevent scalding.

Oral Hygiene

Oral care should be performed at least twice daily. For conscious patients, use a soft toothbrush and fluoride toothpaste. For patients with altered consciousness or dysphagia, use foam swabs with caution to prevent aspiration. Dentures should be cleaned daily and stored in water overnight.

Elimination Hygiene

Bedpan use requires patient positioning on one side to place the pan beneath, then rolling to the back. Warm the pan before use and document urine output and stool characteristics where required. Dispose of waste promptly and wash hands thoroughly.

Occupied Bed Making

Change linen while the patient remains in bed by working from one side at a time — rolling soiled linen toward the patient, placing clean linen, and unrolling it on the other side. Never pull sheets from beneath a patient. Remove wrinkles to prevent pressure injuries.

Home Safety

A safe home environment reduces fall risk and injury. Key measures include: removing trip hazards (loose rugs, cables), ensuring adequate lighting in all areas especially hallways and bathrooms, installing grab bars near toilets and showers, placing non-slip mats in wet areas, keeping frequently used items at accessible heights, and ensuring the patient can always reach a call bell or phone.

2. Mobility & Transfers

Mobility assistance reduces patient deconditioning, prevents pressure injuries, and maintains independence. Incorrect technique causes injury to both patient and caregiver.

Safe Transfer Principles

Always use a gait belt for transfers — it provides a secure grip and prevents injury. Lock wheelchair and bed brakes. Ensure footwear is non-slip. The patient should lead with their stronger side whenever possible. Never lift alone when a patient cannot bear any weight; use a mechanical hoist.

Bed-to-Chair Transfer

Position the wheelchair at a 45-degree angle to the bed on the patient's stronger side. Lock brakes. Have patient sit at edge of bed, place feet flat. Caregiver stands close, grasps gait belt, and guides patient to pivot and sit. Ensure patient is seated fully back in chair before releasing.

Mobility Aids

• Cane: Held in the hand on the stronger side. Advanced simultaneously with the weaker leg. The handle should be at wrist level when the arm hangs naturally.
• Walker: Lift and advance walker ahead, then step into it — never slide. All four legs must contact the floor before weight is applied.

Pressure Injury Prevention

Pressure injuries (bedsores) develop over bony prominences — sacrum, heels, hips, elbows — when sustained pressure restricts blood flow. Prevention requires repositioning every 2 hours for bedridden patients, pressure-relief mattresses, daily skin inspection, adequate nutrition, and moisture management.

Fall Prevention

Falls are the leading cause of injury in older adults. Environmental modifications (grab bars, non-slip surfaces, lighting), medication review, appropriate footwear, and keeping the call bell within reach are essential. Bed rails should be used only as prescribed.

3. Advanced Care & Behaviour

Dementia Care

Dementia causes progressive cognitive decline affecting memory, behaviour, and communication. Effective caregiving strategies include: using simple, calm sentences; maintaining a consistent daily routine; avoiding confrontation and instead redirecting attention; responding to emotions rather than facts; and creating a safe, familiar environment. Validation therapy acknowledges the person's reality rather than correcting it.

Medication Administration

The Five Rights of medication safety are: Right Patient, Right Drug, Right Dose, Right Route, and Right Time. Maintain a written medication log, store medications correctly (some require refrigeration), dispose of unused medications safely, and never crush or alter medications without pharmacist guidance.

Medical Procedures

• Eye drops: Wash hands, tilt patient's head back, pull down lower eyelid to form a pocket (conjunctival sac), instil drop without touching the eye or dropper tip, ask patient to close eye gently and press the inner corner for 1 minute.
• Insulin injections: Rotate injection sites systematically to prevent lipodystrophy. Common sites: abdomen (fastest absorption), thigh, outer arm, buttock. Use correct gauge needle and syringe; dispose in sharps container.
• G-tube feeding: Verify tube placement before each feed, flush tube before and after with water, hang feed bag no more than 12 inches above the stomach, check residual volume if required, keep head elevated 30–45° during and 1 hour after feeding.
• Oxygen therapy: Store cylinders away from heat, flames, and smoking. Never adjust flow rate without clinical advice. Check tubing for kinks and ensure correct mask/cannula fit.

Caregiver Wellbeing

Caregiver burnout is characterised by emotional exhaustion, depersonalisation, and reduced sense of accomplishment. Early signs include chronic fatigue, social withdrawal, irritability, and neglecting personal health. Prevention strategies include regular respite care, joining caregiver support groups, delegating tasks, maintaining personal hobbies, and seeking professional counselling when needed.

4. Immediate Response

Immediate response covers the first actions taken at any emergency, using the Primary Survey to rapidly identify and treat life-threatening conditions.

Primary Survey: DR ABC

• D — Danger: Ensure the scene is safe for you and the casualty.
• R — Response: Check for consciousness by shouting and tapping shoulders.
• A — Airway: Open the airway using head-tilt, chin-lift (or jaw thrust if spinal injury suspected).
• B — Breathing: Look, listen, and feel for no more than 10 seconds.
• C — Circulation/Compressions: If not breathing normally, begin CPR immediately.

Recovery Position

Used for unconscious patients who are breathing normally. Place patient on their side with the top knee bent forward for stability, head tilted back to maintain airway. This prevents aspiration of vomit. Babies are held face-down along the forearm.

CPR — Cardiopulmonary Resuscitation

CPR maintains circulation and oxygenation during cardiac arrest. For adults: 30 chest compressions to 2 rescue breaths, at a rate of 100–120 compressions per minute, depth 5–6 cm. Compress on the lower half of the sternum. Allow full chest recoil. Minimise interruptions.

Hands-only CPR (compression-only) is equally effective for adult witnessed cardiac arrest if you are unwilling or unable to give breaths. Compress continuously at 100–120/min.

For children (1–puberty): use one hand; same rate and ratio. For infants (under 1): use 2 fingers or encircling thumbs; compress to 4 cm depth; give 5 rescue breaths before compressions.

AED — Automated External Defibrillator

An AED analyses heart rhythm and delivers a shock for shockable rhythms (VF/pVT). Turn on and follow voice prompts. Attach pads to dry skin as shown in the diagram. Ensure no one is touching the patient before analysis/shock. Continue CPR immediately after shock — do not pause to check pulse.

5. Choking & Breathing

Adult Choking

A choking adult who can cough should be encouraged to do so. If unable to cough effectively: deliver 5 firm back blows between the shoulder blades with the heel of the hand; if unsuccessful, perform 5 abdominal thrusts (Heimlich manoeuvre) — stand behind patient, make a fist above the navel, grasp with the other hand and thrust inward and upward. If the casualty becomes unconscious, begin CPR and check the mouth before each breath attempt.

Infant Choking

Abdominal thrusts are contraindicated in infants due to risk of organ damage. Instead: deliver 5 back blows face-down over the forearm, followed by 5 chest thrusts (two fingers on lower sternum). Never perform blind finger sweeps.

Asthma Attack

Help the person sit upright (not lie down). Assist with their blue reliever inhaler (salbutamol) — up to 10 puffs, one at a time, waiting 30–60 seconds between each. If no improvement after 5 puffs, call emergency services. Use a spacer if available for better drug delivery.

Anaphylaxis

Anaphylaxis is a severe, life-threatening allergic reaction causing airway swelling, breathing difficulty, and circulatory collapse. Action: call 999 immediately; administer adrenaline auto-injector (EpiPen) into the outer thigh, hold for 10 seconds, massage the site; lay patient flat with legs raised (unless breathing is difficult); give a second dose after 5–15 minutes if no improvement. All anaphylaxis cases require hospital assessment.

Drowning

Remove the person from water safely. If unresponsive and not breathing normally, give 5 rescue breaths first (before compressions — unlike standard CPR) as oxygen deprivation is the primary problem. Then continue standard CPR ratio. Call 999. Do not attempt in-water CPR unless trained.

6. Trauma & Illness

Severe Bleeding

Apply firm direct pressure with a clean cloth or dressing. Maintain pressure continuously for at least 10 minutes. Elevate the injured limb above the level of the heart if possible. A tourniquet is used only as a last resort for life-threatening limb bleeding when direct pressure fails. Do not remove an embedded object; build padding around it.

Burns

Cool the burn with cool running water for at least 20 minutes. Do not use ice, butter, toothpaste, or any home remedy — these worsen tissue damage. Remove jewellery and clothing near the burn (if not stuck). Cover loosely with cling film or a clean non-fluffy dressing. Seek medical attention for burns larger than a 5p coin, on face/hands/feet/genitals, or that are full thickness.

Sprains & Strains — RICE

• Rest: Stop activity immediately.
• Ice: Apply ice wrapped in a cloth for 15–20 minutes every 2–3 hours.
• Compression: Apply a bandage to reduce swelling.
• Elevation: Raise the injured part above heart level.

Head Injuries

Red flags requiring immediate emergency services include: loss of consciousness, confusion, unequal pupils, clear fluid from nose/ears, seizures, repeated vomiting, or deteriorating level of consciousness. If spinal injury is suspected, do not move the head — maintain in-line stabilisation and use jaw thrust to open the airway.

Seizures

During a seizure: protect the head from injury; do not restrain the person; time the seizure; remove surrounding hazards; do not put anything in the mouth. After the seizure, place in the recovery position and stay until fully conscious. Call 999 if: the seizure lasts more than 5 minutes, a second seizure follows, or the person does not recover.

Cardiac Emergencies

Heart attack signs: central chest pain (often described as crushing or pressure), pain radiating to arm, jaw, or back, sweating, nausea, breathlessness. Call 999 immediately. Give aspirin 300mg if conscious and not allergic. Keep patient still and as calm as possible; be prepared to start CPR.

Hypoglycaemia (Low Blood Sugar)

Signs: pallor, sweating, confusion, shakiness, hunger. If the person is conscious and able to swallow: give a fast-acting sugary drink (fruit juice, glucose tablets, regular fizzy drink). Follow with a starchy snack. If unconscious: do not give food or drink; call 999 immediately and place in recovery position.

Poisoning

Call emergency services or a poison control centre immediately. Do not induce vomiting unless specifically instructed — some substances cause greater damage on the way back up. Take the container or substance to the hospital if safe to do so. If the person is unconscious, place in recovery position and monitor breathing.

Splinting

A splint immobilises a fracture to prevent further damage and reduce pain. Immobilise the joint above and below the fracture. Check circulation, sensation, and movement (CSM) before and after applying the splint. Do not attempt to realign the bone. Use padding between the splint and skin.

Heatstroke

Heatstroke (core body temperature >40°C) is a medical emergency. Move the person to a cool environment immediately. Cool rapidly using any available method — cool water, ice packs to neck/armpits/groin, fanning. Call 999. Do not give food or drink. Do not use cold water immersion unless trained — it can cause cardiovascular shock.