Nose and face wiping may not seem the most obvious or glamorous way of improving wellbeing and whilst it can be an unpleasant experience, if it is done in the most sensitive, and personalised way it could have the potential to be an emotionally nurturing experience and therefore profoundly improve quality of life. We recognise that nose and face wiping may generally be approached as a functional task, done as quickly as possible in order to get on to something else, and that at times this may well be necessary. However, with an activity that can be such a prominent part of a person’s life, often needing to be done multiple times an hour, it may well be worth taking the time, to attend more to nose and face wiping as an important aspect of care.

Guidance and instructions

Factors to consider develop nose and face wiping as an emotionally nurturing practice are:

• Anticipation – awareness that it is about to happen and having enough time to process and prepare.
• The comfort of the tissue or cloth used – is it soft enough to feel nice and prevent chaffing and soreness.
• Personal preferences – regarding the quality of touch used for example soft, medium or firm pressure, wiping or dabbing, how quickly or slowly.
• The quality of the interaction throughout – does it help to be spoken to or is this too much sensory input? Is a reassuring tone preferred? Does humour or distraction help?
• How well dignity and privacy are maintained with –
  • the language and tone that others use to talk about it (e.g. ugh, that’s horrible or kind and reassuring words)
  • the facial expressions that are made by others (e.g. disgust or care and concern)
  • the way that the person is shielded from others being able to see
  • the way that the person’s autonomy is promoted, as far as possible (e.g. supporting the person to wipe their own nose and face, allowing them to push you away and being responsive to indications of preferences). 
• The use of barrier creams or emollients – to protect from soreness, soothe and moisturise. Chaffing and chapping can be caused when the skin is repeatedly wet, exposed to saliva and mucus and from the process of wiping and rubbing. 
• The possibility of wiping or dabbing causing the head to be pushed back – in which case ensure that the person is appropriately physically supported, with their headrest or perhaps using your spare hand to cradle and support the back of their head.
• Removal of stubborn dirt, such as face paint or dried mucus – avoid rubbing as much as possible. A disposable wipe or face flannel made wet with warm water and wrung out can be used and it is often kinder on the skin to use an emollient or moisturiser. Gently massage and loosen the dirt before wiping away; dry the skin gently but thoroughly, applying barrier or moisturiser as required.
• If wearing gloves, consider whether they have any odour and what they will feel like if they come into direct contact with the person’s skin. Gloves can feel unpleasant and cause greater fiction so try to hold the cloth in a way that prevents the gloves touching the person’s skin. 
• The person’s likes, dislikes and preferences to scented or odourless products.

For safety consider:

• Allergies and potential skin drying effects of some soaps and scented products. 
• Whether the action of wiping causes production of saliva – in which case it is usually best to dab as dabbing is less stimulating than wiping. 
• Adherence to infection control and hygiene procedures.

Choice of tissues or cloths

Avoid using kitchen towel, hand paper towels, blue paper roll, toilet paper or any material that is not soft and may cause discomfort and soreness.

Some options (check for softness and effectiveness):

• Soft tissues, preferably with balm for noses (not to be used around the eyes)
• A soft dry cloth to dab away saliva
• A soft wipe made wet with warm water to remove dirt from the face
• Dry patient wipes 

Cost-effective and environmentally friendly alternatives, which can be washed and reused may be:

• Muslin cloths (as used by chefs and for babies).
• Bamboo kitchen roll, which is beautifully soft.
• Reusable wipes are available in a wide variety of fabrics and available online or in environmentally friendly shops
• The use of a handkerchief may be more comfortable, particularly for people who have facial hair or stubble and silk handkerchiefs may be more comfortable on sore or sensitive skin.

Developing anticipation, understanding and autonomy

When the person has their nose or face wiped, do they know that it is about to happen or does it come as a surprise? A flinch response suggests that they are not aware of what was about to happen. A lack of anticipation and preparedness is likely to create negative associations with the experience of having their nose or face wiped, and perhaps touch in general.  Developing anticipation and autonomy, to the extent that it can be, may contribute to increasing tolerance of, and improve the quality of the experience.

Some ways to develop anticipation may include:

• Considering how in other situations the person best understands communication and cues? If objects-of-reference are used or if they respond to music and song to introduce activities, find meaningful objects, songs or other suitable cues for nose and face wiping too. Offering the cloth so that it can be felt in their hand or other body area, if more appropriate, before it comes into contact with their face. Some people who are reluctant to touch with their hands may prefer to feel with their feet.
• If the person is hearing impaired or has better understanding of the world through visual cues, it may be helpful to demonstrate by wiping your own nose or face with your own cloth, communicating in whatever way is most appropriate for the person, my-turn then your-turn. 
• Reciting a rhyme, singing or whistling a tune to cue the person prior to contact. E.g. ‘This is the way we wash our face/wipe our nose…’ from the traditional song – ‘Here we go around the Mulberry Bush’.
• When the cloth comes in contact with the person’s face keep it still for a moment to allow the person to get used to it being there before proceeding to wipe or dab. 
• Throughout wiping it may be appropriate to communicate where you’re wiping or dabbing to increase the person’s understanding of their body.  Or to continue singing or whistling to reinforce the link between the auditory cue and the action.
• Be observant for and responsive to any communicative attempts or signs of emotional or physical responses throughout.
• Where possible support the person to hold the cloth in their hand and wipe or dab their own nose or face.  Touching their own face will help them to process what is happening, and with many repetitions may form a memory which can support anticipation.
• A mirror can be a useful aid to developing awareness of the need for nose and face wiping especially if the person cannot feel what is on their skin that needs wiping but is able to see it. You could try offering the person sight of themselves in a mirror before and after nose and face wiping so that they can see the difference.
• Communicate when wiping has finished and support the person to put the cloth in the appropriate place e.g. rubbish or washing bin. Washing hands may be necessary for hygiene purposes but can also signal the end of nose and face wiping. Remember to offer this in a sensitive way that nurtures emotional wellbeing.
• For a routine to be learnt and understood best it needs to be repeated many times, in the same way and with different people across different situations. Sharing ideas with others involved in the person’s nose and face wiping care is crucial for establishing best person-centred practice.
• One way of promoting consistency or practice would be to devote a page of their communication passport or care plan (or similar) to this aspect of their care. This should be updated as understanding of what best practice looks like for that person develops.  

To further develop your nose and face wiping skills, ask a colleague, friend or family member to wipe your face or nose for you. Or do it yourself but with a thick glove on your non-dominant hand. How did it feel? What was good and not so good? How did the cloth feel?  Did anything make you flinch or wish to stop the experience?  Were there any actions that felt pleasant, soothing, caring or nurturing?

What to observe, assess and record

• Observe and reflect on how the person responds to having their nose and face wiped before putting this guidance into practice and write down your reflections.
• Note any changes that you make to the way that nose and face wiping is carried out as a result of your reflections and putting this guidance into practice.
• Observe for any changes in how the person responds after making any changes and continue to observe over time.
• Notice any changes to skin condition that occur if you make changes to the quality of the cloths, products and approach used.

Contributors

© Julia Barnes, MEd, Special Needs Teacher and postgraduate researcher in nurturing touch at the University of Birmingham and Dr Julie Calveley, BSc(Hons) Psychology, BSc(Hons) Nursing, Registered Learning Disabilities Nurse

Email: [email protected]

Created October 2020