Skin Cleansing

INTRODUCTION

As the skin ages it becomes less able to perform its key barrier functions and skin breakdown becomes an increasing risk. This can have a detrimental impact on quality of life with major economic implications among the elderly (Gardiner et al, 2008), so skin health is essential to the wellbeing and a central component of nursing care. Maintaining skin barrier function is an essential part of ensuring health and well-being for older people (Pegram et al., 2007). The aim of this paper is to critically appraise the body of research on skin cleansing practices for older people. The research objective was to examine the quality and findings of studies since 1990 on skin cleansing practices for older people. Nurses are in a prime position

Methodology

An integrative review process was followed as this allows inclusions of the broadest range of studies, combining findings of different research designs. Literature review by searches of the electronic databases Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Premier, psycINFO, Web of Science, SCOPUS and the Cochrane Library, using firstly key words and exclusion criteria, then citations and reference searches. Studies included were alternative bathing protocol or bathing product interventions. Seven studies met the methodological requirements for inclusion.

Results

There is no consistency in research approach across the studies, and they were all small in scale. Research design was generally not explained in detail, and design flaws were evident few studies reported as RCTs where randomised according to ‘room location to maximise staff convenience’, and does not specify the randomisation process. Three studies employed The Skin Condition Data Form (SCDF); the authors were not able to trace the origins of this form to ascertain its validity and reliability. Each study reports modifying the original tool, although the nature of changes is not documented. It is not clear whether Questionnaire used are validated. A small number of studies claim statistically significant results, but the lack of detail in data analysis

At present, skin cleansing practices are not high on the nursing agenda. However, with an ageing population and a new generation of older people and their families who may have higher expectations of care standards, the time has come to develop an evidence base for such practices. This study has appraised the body of literature on skin cleansing practices for older people. It demonstrates that there is a dearth of studies investigating the impact of such practices on skin barrier function and preservation of skin integrity. It is essential that new knowledge is built on firm foundations and used to shape practice (Reed, 2008). The absence of rigorously developed and contextually appropriate guidelines means that much of the skin cleansing practice is based on experience and opinions of clinicians (Gardiner et al., 2008). This review has helped to identify key gaps and a focus for