Back rubs can conveniently be given after baths, before bedtime, or after repositioning. Back rubs help boost relaxation, stimulate circulation, and promote sleep. Back rubs do not need to be long, and typically take about five minutes of your time. Always ensure it is okay to provide a back rub. Health Care Assistants must check with their supervisor and in the care plan. Again, giving a back rub gives the HCA the opportunity to observe skin condition for rashes, bruises, red, white, or open areas, and other signs of skin breakdown. Always report and record observations of any changes in skin condition.

Purpose for Giving a Back Rub

• To give comfort
• To stimulate blood circulation
• To promote rest and sleep
• To prevent pressure sores
• To assess the skin condition
• To relax and relieve tension in tissues and muscles
• To refresh the client and relieve fatigue

General Instructions for Giving a Back Rub

• Back care is given as a part of morning care and evening care.
• When giving a back rub, use more pressure (gentle) on the upward strokes towards the head and less pressure on the downward strokes.
• Back rubs may be contraindicated in patients susceptible to clotting disorders — check with the supervisor.
• Do not take your hands off of the patient’s back until the end of the procedure.
• Stop the back rub if, at any time, the client reports discomfort or no longer wishes you to continue.

Table 4.5.1 Procedure: Back Rub

STEP	ACTION	REASON
1.	Explain the procedure and position to the patient.
2.	Perform hand hygiene and gather all supplies.	Good organization is time efficient.
3.	Adjust bed to a comfortable height.	Prevent back strain and injury.
4.	Provide privacy, and adjust the light, temperature, and sound within the room.	Client comfort.
5.	Lower the side rails and help the patient assume a prone or side lying position (sim’s position).
6.	Expose the patient’s back, shoulders, upper arms, and buttocks, and cover the remainder of the body.
7.	Use lotion that has been warmed in a basin of warm water, or by running the bottle under warm water for a few minutes.	Do not heat lotion in the microwave. Rationale: It may explode or be too hot and burn the skin.
8.	Place a small amount of lotion in your hand, and rub your palms together to warm the lotion and lubricate your hands. Caution the client that the lotion may still feel cool.	This lubricates your hands during the back rub, and helps warm the lotion so the client does not feel too cold.
9.	Apply both hands to the sacral area (the lower back), applying gentle pressure moving upward along each side of the spine. Massage in a circular motion, strokes moving upwards from buttocks to shoulders, and then back down the outer part of the back (see Figure 4.5.1).	Use gloves only if you or the client have any open cuts, wounds, or sores to prevent infection.
10.	Continue this massage pattern for about 2–3 minutes.
11.	You may change the pattern to small circular motions, either making a circular movement moving upward along the spine and outward from the spine, and laterally alongside the back, down to the iliac crest (hip) or downward and inward toward the spine (see Fig. 4.5.1)
12.	Continue this massage pattern for about 2–3 minutes.
13.	When you are almost done with the back rub, let the client know so they are prepared for the ending of their back rub.
14.	Wipe away any excess lotion. Assist the client with dressing. Position the client for comfort.
15.	Lower the bed to its lowest setting. Ensure the side rails are up.
16.	Put away equipment and supplies. Dispose of any dirty linens.
17.	Wash and dry your hands.
18.	Document the client’s response and record any changes in condition or behavior.