Understanding the 'Affected Side First' Rule: Is It True When helping a client to dress, put clothing on the unaffected side first?

A startling number of new caregivers are taught an incorrect method for dressing a client with one-sided weakness, leading to confusion and unnecessary discomfort.

The industry-standard best practice is not to put clothing on the unaffected side first, but rather the opposite, which we will explore with authority and detail here.

Quick Summary

The rule is to dress the client's affected or weaker side first, not the unaffected side, to minimize discomfort and prevent injury. This proven technique uses the unaffected side as a leverage point to help maneuver the garment, promoting safety and a greater sense of control for the individual.

Key Points

• Dress Affected Side First: Always begin by dressing the client's weaker or affected side first to minimize discomfort and injury.

• Undress Unaffected Side First: Reverse the process for undressing, starting with the stronger, unaffected side.

• Encourage Independence: Use the client's unaffected side to your advantage by encouraging them to assist, promoting their dignity and sense of control.

• Gather and Plan: Prepare all clothing and explain the process to the client beforehand to ensure a smooth and respectful experience.

• Use Adaptive Clothing: Consider adaptive garments with magnetic or Velcro closures to simplify the dressing process, especially for clients with limited dexterity.

• Maintain Privacy: Always ensure the client's privacy and dignity are protected during the dressing procedure.

Debunking the Myth: Dress the Affected Side First

Many caregivers, especially those new to the profession, encounter a contradictory piece of information regarding the correct method for dressing a client with one-sided weakness, often due to a stroke or injury. The statement, "When helping a client to dress, put clothing on the unaffected side first?" is a common misconception and, in fact, the exact opposite of the correct procedure. Following the right technique is crucial for ensuring the client's comfort, dignity, and safety.

The 'Affected Side First' Rule

The cardinal rule for dressing a client with a weakened side is to put the garment on the affected (weaker) side first. This is a foundational principle in caregiver training for several important reasons:

• Minimizes Movement and Discomfort: By starting with the weaker side, you require less movement and manipulation of the more vulnerable limb. This reduces the risk of pain and stress on the affected joints and muscles.
• Prevents Injury: Forcing a garment over an already stiff or painful limb can cause injury. Working with the weaker side first ensures a more gentle approach.
• Maintains Dignity and Independence: By dressing the affected side first, the client can use their stronger, unaffected side to assist in the process. This promotes a sense of independence and control, which is vital for morale and self-esteem.

Conversely, the rule for undressing is to remove clothing from the unaffected (stronger) side first. This allows the garment to be pulled off the stronger side easily before moving to the more delicate, affected side.

Preparing for the Dressing Process

Before you begin, proper preparation can make the entire process smoother for both you and the client.

• Gather All Supplies: Lay out all necessary clothes in the correct order. This prevents interruptions and minimizes the client's exposure.
• Ensure Privacy: Close doors and curtains to respect the client's privacy.
• Communicate Clearly: Explain each step of the process in a calm, reassuring voice. This helps the client feel informed and in control.
• Raise the Bed: If dressing a client in bed, raise the bed to a comfortable working height to prevent back strain for yourself.

A Step-by-Step Guide for Upper Body Dressing

For a shirt or blouse, follow these numbered steps to ensure a smooth and safe process:

1. Start with the Affected Arm: Gather the sleeve of the shirt and slide it onto the client's affected arm. Carefully guide their hand and arm through the sleeve.
2. Move to the Head and Torso: Bring the garment around the client's back and gently guide it over their head. Encourage them to lean forward if they are able.
3. Finish with the Unaffected Arm: Guide the client's unaffected arm into the other sleeve. The client can use their strong arm to help with this step.
4. Adjust and Fasten: Adjust the shirt so it is comfortable and free of wrinkles. Fasten any buttons or zippers.

A Step-by-Step Guide for Lower Body Dressing

To dress a client in pants or shorts, follow this sequence:

1. Help While Seated or Lying: The client can be seated on the edge of the bed or remain lying down, depending on their mobility. If in bed, turn them to their unaffected side.
2. Guide the Affected Leg: Gather the pant leg and put it on the client's affected leg first. Pull the pants up over the foot and knee.
3. Position the Client: If the client is in bed, assist them to roll onto their unaffected side. Pull the pants up over their buttocks and hips.
4. Address the Unaffected Leg: Have them roll back, and then pull the pants up over the unaffected leg, using their stronger side to assist.
5. Adjust and Secure: Pull the pants up to the waist and fasten any closures. Ensure the fit is not too tight.

The Role of Adaptive Clothing

Adaptive clothing can make a significant difference in the dressing process. These garments are specifically designed to accommodate mobility challenges and often feature:

• Magnetic or Velcro Closures: Replacing traditional buttons and zippers.
• Side Openings: Allowing for easier access and dressing.
• Elastic Waistbands: Offering flexibility and ease of wear.

Correct vs. Incorrect Dressing Technique

Feature	Correct Method (Affected Side First)	Incorrect Method (Unaffected Side First)
Starting Point	Begin with the affected limb.	Begin with the unaffected limb.
Comfort Level	High. Minimizes strain and pain.	Low. Causes unnecessary stretching and discomfort for the affected limb.
Risk of Injury	Low. Reduces manipulation of the vulnerable side.	High. Can lead to joint or muscle strain.
Client's Role	Encourages client participation with their stronger side.	Limits the client's ability to assist, promoting dependence.
Caregiver Effort	Controlled and deliberate, leveraging the client's strength.	More difficult, requiring more caregiver effort to maneuver the weaker limb.

Conclusion: The Importance of Best Practice

In the realm of senior care, promoting a client's well-being and dignity is paramount. The seemingly simple action of dressing can have a profound impact. Understanding the correct procedure—dressing the affected side first—is more than just a technique; it's a practice rooted in compassion and safety. It ensures a respectful and positive experience, empowering the client and protecting them from harm. Always follow best practices and continuously update your knowledge. For further reading, consult reputable caregiving resources like those provided by the National Institute on Aging.

Frequently Asked Questions

Why is it important to dress the affected side first?

Dressing the affected side first is crucial because it requires less manipulation of the weaker limb, minimizing pain and discomfort for the client. It also allows the stronger, unaffected side to help pull the garment through, promoting independence.

What is the correct procedure for undressing a client?

When undressing, the process is reversed. You should remove the garment from the unaffected (stronger) side first, and then gently slide it off the affected (weaker) side.

What if my client cannot assist at all with dressing?

Even if a client cannot actively assist, starting with the affected side is still the safest and most comfortable method. It prevents unnecessary stretching or force on a vulnerable limb.

Does this rule apply to all types of clothing?

Yes, the 'affected side first' rule applies to all garments, including shirts, pants, jackets, and socks. The principle remains the same: minimize strain on the weaker side.

How can I remember which side to dress first?

A simple mnemonic is: 'Dress affected first, undress unaffected first.' This helps to remember the core principle, or simply think of dressing toward the difficulty and undressing away from it.

What tools can help with the dressing process?

Assistive tools like long-handled reachers, button hooks, and specialized adaptive clothing with magnetic closures or Velcro can significantly help simplify the dressing process for clients with limited mobility.

How do I dress someone who is bedridden?

For a bedridden client, the same rules apply. You may need to help them roll gently from side to side to get pants on or pull a shirt down, always working with the affected limb first and undressing the unaffected limb first.