Providing Evening Care (PM Care) to Patients

Evening care refreshes patients and prepares them for sleep, promoting relaxation, comfort, and recovery. Done well, it improves sleep and patient outcomes.

What is Evening or PM Care?

Evening care (PM care or bedtime care) is the routine that prepares patients for a restful night: activities promoting comfort, relaxation, and hygiene before bed. Tailor it to each patient, communicate clearly, and encourage their participation and feedback.

Purpose of Evening Care

1. Refresh and prepare for sleep. Washing the face, brushing teeth, and changing into clean nightwear promote cleanliness and a psychological readiness for rest.
2. Promote muscular relaxation through light massage, gentle stretching, or repositioning, which reduces discomfort and supports deeper sleep.
3. Prevent bedsores. Inspect the skin for early pressure sores, apply protective lotions, and reposition to relieve pressure on vulnerable areas, especially in bedridden patients.
4. Promote oral hygiene and prevent infections by brushing teeth, cleaning dentures, and keeping the mouth clean, important for patients at risk of aspiration pneumonia.
5. Enhance psychological comfort. Nurse-patient interaction provides emotional support and reassurance, reducing anxiety and building a therapeutic relationship.
6. Ensure a safe, comfortable environment by adjusting lighting, reducing noise, controlling temperature, and keeping essential items within reach.

Components of Evening Care

1. Personal hygiene: washing the face, brushing teeth, and grooming.
2. Skin care: applying lotion to dry areas and inspecting for irritation or pressure ulcers.
3. Oral care: thorough oral hygiene to prevent infection and ensure comfort.
4. Comfort measures: adjusting pillows and bedding, positioning, and addressing pain with prescribed medications or other relief.
5. Environmental adjustments: dimming lights, reducing noise, controlling temperature, and setting up needed items within reach.

Preparation of Patient and Environment

Assembling the Tray of Supplies

A well-prepared tray lets you work without leaving the patient's side. Include:

1. Basin of warm water for washing the face, hands, and other areas; warm water soothes.
2. Alcohol 70% for sanitizing hands and surfaces.
3. Soap in a soap dish, a mild soap for cleansing.
4. Talcum powder for areas prone to moisture and friction, to prevent rashes and bedsores.
5. Hair comb or brush for grooming.
6. Bath towel and washcloth for washing and drying.
7. Pitcher of warm water for rinsing.
8. Mouthwash tray: mouthwash solution, toothbrush, and kidney basin.
9. Linen: fresh bed linens and clothing to replace soiled ones.

Setting Up the Environment

• Lighting: soft, dim lighting for a calming atmosphere, with night lights for visibility without disturbing rest.
• Noise reduction: close doors gently, speak softly, and use soundproofing where possible to block hallway and equipment noise.
• Temperature control: a comfortable, consistent temperature and proper ventilation for fresh air.
• Privacy: curtains, screens, or closed doors; knock before entering and explain each step.
• Accessibility and safety: keep water, tissues, call bell, and belongings within reach; adjust bed rails and clear the floor of obstacles.
• Comfort measures: keep the bed clean, dry, and wrinkle-free, and adjust pillows and blankets to the patient's preference.
• Relaxing ambiance: calming scents like lavender or chamomile via safe diffusers, and soft music or nature sounds if appropriate.

When Not to Provide Evening Care

1. Severe pain or discomfort. Prioritize pain relief, then resume care once the patient is comfortable.
2. Unstable medical condition (acute heart issues, severe respiratory distress, sudden vital sign changes). Stabilize and monitor first; defer care.
3. Post-surgical or post-procedure status. Avoid vigorous movement or repositioning that disrupts surgical sites; adjust the routine with the surgical team.
4. Severe skin conditions or injuries (extensive burns, open wounds, infections). Avoid affected areas and follow wound care protocols.
5. Psychological or emotional distress (acute anxiety, agitation, psychiatric crisis). Prioritize psychological support and a calming environment; revisit care once the patient is settled.
6. Contagious illnesses. Follow strict infection control, minimizing or postponing some activities to protect patient and staff.
7. Severe cognitive impairment or confusion (advanced dementia, delirium). Approach with patience and sensitivity, modifying or delaying care.
8. Recent sedatives or anesthetics. Ensure the patient is adequately awake and oriented before proceeding, to prevent falls.

Procedure for Providing Evening Care

Establishing Rapport

1. Introduce yourself so the patient knows who is assisting them, building trust and a welcoming environment.

2. Verify the patient's identity per facility protocol to ensure safe, accurate care.

3. Explain what evening care entails, why it is needed, and how the patient can participate, fostering cooperation and compliance.

Hand Hygiene and Infection Control

4. Perform hand hygiene, washing hands thoroughly and using hand sanitizer, to prevent the spread of infection.

5. Use personal protective equipment (PPE) such as gloves, based on the patient's condition and facility protocols.

Privacy and Comfort

6. Ensure privacy by closing curtains or doors and covering the patient appropriately to maintain dignity.

7. Adjust the environment to a comfortable temperature with soft, calming lighting for relaxation.

Preparation of Supplies

8. Gather supplies: a basin of warm water, soap, towels, lotions, a hair comb, toothbrush, mouthwash solution, and clean linens, to minimize disruptions.

Basic Hygiene Care

9. Have the patient wash the face and hands with a warm, damp washcloth, doing it for them if they cannot, to refresh them and maintain dignity.

10. Assist with brushing teeth and mouthwash for oral freshness and infection prevention, doing it for them if needed, since oral infections can lead to systemic complications.

Skin Care

11. Check the skin for pressure sores, rashes, or other issues, paying particular attention to areas prone to pressure ulcers, to catch problems early.

12. Apply lotion to moisturize dry areas and talcum powder to areas prone to moisture and friction, to prevent skin breakdown.

Back Care and Massage

13. Turn the patient to their side, unfasten the camisa or gown, and bathe the back, giving access to hard-to-reach areas.

14. Massage the back with alcohol 70% or skin lotion, paying particular attention to bony prominences and reddish spots, to moisturize and reduce pressure ulcer risk.

15. If the patient wears a binder, remove it for back care, inspect the dressing for bleeding or discharge, change or reinforce P.R.N., and return the binder in place.

Hair Care

16. Brush and comb the hair, protecting the back and camisa with a towel to catch debris.

Repositioning and Comfort

17. Fasten the camisa, move the patient to one side, and brush crumbs or dirt from the bed for a clean, comfortable environment.

18. Reposition the patient to enhance comfort and prevent bedsores, in a comfortable sleeping position.

19. Adjust bedding, keeping the bed clean, smooth, and free of crumbs or wrinkles, with pillows and blankets to the patient's preference.

20. Replace the ice cap or hot water bag P.R.N. to maintain therapeutic effect and comfort.

Medication

21. Give bedtime medicine if ordered and attend to all patient requests, supporting continuity of care and patient-centered care.

Final Checks

22. Ensure accessibility of the call bell, water, and personal belongings within easy reach, promoting autonomy.

23. Check safety measures: bed rails positioned appropriately and the floor clear, to prevent falls.

24. Provide final comfort measures, such as an extra blanket or a sip of water.

25. Remove unnecessary items (trays, dishes) and empty the wastebasket for a clean, calm environment.

26. Adjust the screen, blinds, and light to support the patient's circadian rhythm and restful sleep.

Documentation

27. Record the care provided, documenting all activities, observations, and patient feedback in the medical record for continuity of care and communication with the next shift.