Bed Baths, I dread giving them. - page 7

OK, so now I'm going to split my 0.6 FTE on our small rural hospital 6 bed CCU/Stepdown unit half and half, 12 hour days and 12 hour nights, since some rare weekday dayshifts opened up. I'm keeping... Read More

  1. by   hecete
    Over 3/4 Of The Residents Have A Poa Or Rp. None Are Legally Incompetent, It's Merely Their Choice.
  2. by   RN4NICU
    Medical Power of Attorney does not go into effect until the patient is unable to make or communicate decisions for him or herself. The MPOA is also not allowed to contradict wishes that the patient has made known. So, 1) if the patient is able to express his or her wishes, it is not the MPOA's concern as the MPOA has no right to make decisions as long as the patient is able to do so and 2) the MPOA must abide by the patient's wishes, even after the patient becomes unable to make or communicate decisions.

    If you are just informing the MPOA that a med/treatment has been refused, that seems to be a HIPAA violation, as the MPOA does not go into effect until the patient is unable to make or communicate health care decisions.

    If you are trying to get the MPOA to overrule the patient's decisions, well that is just illegal as they do not have the capacity to interfere with a competent patient's wishes.

    Either way, the practice is a violation of the patient's privacy and rights and is completely unacceptable, whether it is "policy" or not.


    Off my soapbox now, as we return to our regularly scheduled thread...
  3. by   GardenDove
    I agree RN4. I've had some arrogent husbands who have DPOA for their wives, and think it means that they can call all the shots for them in the hospital. The wife will be arguing with her husband, for instance recently a pt's husband wanted her to be transfered to Seattle. The wife was A&O and said "no I don't think that's neccessary". Later the husband strutted up to the nurses station announcing that he had "power of attorney" and so he gets to make all the decisions. I had to explain to him that it only means that he makes the decisions when his wife is unable to speak for herself.
  4. by   Cherish
    Quote from RN4NICU
    Medical Power of Attorney does not go into effect until the patient is unable to make or communicate decisions for him or herself. The MPOA is also not allowed to contradict wishes that the patient has made known. So, 1) if the patient is able to express his or her wishes, it is not the MPOA's concern as the MPOA has no right to make decisions as long as the patient is able to do so and 2) the MPOA must abide by the patient's wishes, even after the patient becomes unable to make or communicate decisions.

    If you are just informing the MPOA that a med/treatment has been refused, that seems to be a HIPAA violation, as the MPOA does not go into effect until the patient is unable to make or communicate health care decisions.

    If you are trying to get the MPOA to overrule the patient's decisions, well that is just illegal as they do not have the capacity to interfere with a competent patient's wishes.

    Either way, the practice is a violation of the patient's privacy and rights and is completely unacceptable, whether it is "policy" or not.


    Off my soapbox now, as we return to our regularly scheduled thread...
    Exactly! :yeahthat:
  5. by   twotrees2
    Quote from elizabeth321
    I can't believe that a nurse of any kind is asking how to do a bed bath? am I missing something?

    Liz
    i got the impression it wasnt so much HOW to do a bedbath but how to save face when doing one and not be embarrassed more than needing to know how. OP i suggest you just do them . the more you do, you will feel less uncomfortable with them. there really is no way to get beyond the fear of doing them then to do them. just remeber you probably arent the only one embarrassed - i simply state what i need to do - that i know it may be uncomfortable for them ( especially if they are a younger male as one can get in a hospital seting) and encourage them to do as much as they can of the private areas to save both any embarassment. good luck.
  6. by   twotrees2
    Quote from PBAJS
    moongirl posted - "Ask a CNA you work with I am sure they would be happy to show you proper techinque"

    If possible, ask and work with a few, or several, CNAs.

    I have worked with a few CNAs that seemed to be very fast. How? They only washed and dried. No lotion used, powder everywhere "because it smells good'. When a patient was incontient of urine, the area was not washed, just the incontient pad or brief/diaper was changed.
    oh yeah - big peeve of mine - when they dont get washed after being incontinent - drives me crazy.

    other peeves- behind and in ears ( think someone mentioned this ) and between the toes! seems to be the most forgotten areas i have seen and under breasts and folds -
  7. by   twotrees2
    Quote from hecete
    Over 3/4 Of The Residents Have A Poa Or Rp. None Are Legally Incompetent, It's Merely Their Choice.
    most people have a POA etc these days however - as i have learned the hard way - the only way i best call the POA is if that POA is actually activated - if it isnt that POA has no legal right to any info yet nor the right to dictate cares - check the chart to be sure the POA is activated.
  8. by   elizabeth321
    Quote from GardenDove
    I agree RN4. I've had some arrogent husbands who have DPOA for their wives, and think it means that they can call all the shots for them in the hospital. The wife will be arguing with her husband, for instance recently a pt's husband wanted her to be transfered to Seattle. The wife was A&O and said "no I don't think that's neccessary". Later the husband strutted up to the nurses station announcing that he had "power of attorney" and so he gets to make all the decisions. I had to explain to him that it only means that he makes the decisions when his wife is unable to speak for herself.
    That is why a POA shouldn't be invoked until it needs to be...there is a trigger of sorts...these are the very things that can happen.

    Liz
  9. by   KellieNurse06
    Quote from GardenDove
    OK, so now I'm going to split my 0.6 FTE on our small rural hospital 6 bed CCU/Stepdown unit half and half, 12 hour days and 12 hour nights, since some rare weekday dayshifts opened up. I'm keeping nights for my weekend obligation. In our unit, baths are done on days. I have never worked days in my 13 years of being a nurse. I told my manager today that my worst fear is giving baths. I have a great manager, btw.

    Any tips on giving bedbaths? Really, I'm totally unskilled at giving bedbaths. Anyone else scared of them?
    Oh Yes! I have two nurses who do bed baths for my daughter.....they literally use hand towels as a towel when bathing her.....it drives me bananas!!! That couldn'tr even cover a baby for pete's sake!!! Please remember to use a full sized towel!!!!!!lol!
  10. by   rehabhereIcome
    OK so I was surprised to find this thread when I typed it in the search bar..and then to see pages and pages about it too! I have been a nurse a decade plus but not hospital until recent. Bed baths are not an issue for me in terms of how to do them...but what I am curious to know is...in a rush rush world where patients need to get up for there therapies by x time and having 4-6 patients...most all needing near complete help with there baths...what do you all think an acceptable/efficient amount of time would be to bathe all these patients...I see some nurses done there care in 1 hour and I sometimes scratch my head when I take an hour and a half to 2 hours depending on the number of patients. I know that once you know the patients you have the advantage of knowing all there little quirks likes and dislikes and being in my particular position I dont have that continuity of care with the same patient load so am always having to learn about the patients. Heck if they need to be go up in an overhead lift or stand up lift after and I need to hunt down another nurse to assist me getting them up that takes more time too.
    So lets break it down.....average amount of time to bathe/fully dress and get a patient up...what should I be aiming for here!!!???:wink2:
  11. by   pfongk
    When I was working agency in nursing homes, I aimed to take about 20 minutes on average with each of my residents.
    Another thing that no-one seems to have mentioned and is a pet peeve of mine is navels, nipples and foreskins. I've seen some fairly disgusting things come out of these when bathing people, I swear some people just didn't think of cleaning these areas when bathing residents.
  12. by   Flatbelly
    Quote from rehabhereIcome
    So lets break it down.....average amount of time to bathe/fully dress and get a patient up...what should I be aiming for here!!!???
    It takes me 30 minutes to give a complete bedbath, but I work with experienced CNAs who manage to give a bedbath in about 20 minutes. If the pt is very heavy, has severe contractions, is on a vent or for any other reason can't cooperate, it of course takes longer. We do, however, use no-rinse soap, just lather it up and dry the skin with towels. Very dirty pts also need more time, especially when their hair has to be washed.
    Ask the patient if he/she has a problem with nudity, you'll be surprised how many of them don't mind being stark naked, as long as it's only you in their room This makes the job a lot easier and quicker. Be tactful, some pts are... ashamed to admit they are ashamed, you have to 'feel' them.

    Some tips (I assume I don't need to explain the basics of bedmaking, precautions, ect.):

    1. Turn the heat up, I set in on 80! Don't forget to turn it down when you are finished. Pause tube feeding, check all IVs and caths, so that nothing gets ripped out while giving the bath. Don't ask how I know this

    2. Get the clean linens, the gown and the bathing supplies. Assume the worst, get the barrier creams, powder ect. even if you think they may not be needed, it's very annoying when you have to run out of the room for things, especially when bathing a pt in isolation. Some things may pop out during the bath, you can't always check beforehand. Pts who need bedbaths often have skin in bad condition.

    I use at least 10 washcloths, so that I don't have to rinse them in the basin, just throw them into the 'dirties' bag. Fill the basin with very warm (almost hot) water as it cools on the washcloth, place everything you need within reach. A lot of washcloths also means you don't have to change the water, or change it only once when it becomes too cold. Put all washcloths in the basin in advance.
    I double glove for patients that passed stool.

    3. Close the door. If it's not a single pt room, draw the bed curtains. Get the bed up as high as you need.

    4. Do oral care first, as it can be done without lowering the head of the bed. Ditto for washing the face and hands. Include the forgettables - the neck, throat, ears. The gown does not have to be taken off for this. If possible, let the pt do this him-/herself. People feel better when not treated as complete invalids. I use a separate washcloths for the
    - face (no soap)
    - hands
    - throat, neck and ears

    5. Lower the head, remove blanket and sheet, wash the front of the body, including legs (1 washcloth) and armpits (separate washcloths for each pit). If the pt wants to be covered up with a bath sheet, break up the job into 2 parts: upper body first, lower second. Don't forget to clean the area under the breasts. If I have a big breasted lady, I put some powder underneath the breasts. I also put some powder on the armpits, unless the pt wants deodorant/antiperspirant or nothing at all. Ask before you do anything and always check the skin before applying anything. I've had some pts develop a horrible rash after using the antiperspirant provided by the hospital

    6. Pericare. If the pt is incontinent and has a soiled diaper, some stool may work its way up, you will need a few washcloths for this job. Tuck the front of the diaper under the buttocks, so not to smear the stool. Remove as much stool as you can with toilet paper, except when the skin is irritated - dragging dry paper over irritated skin can make it worse. Get into all the nooks and crannies, dry completely and use powder only in the skin folds. Some pts may need to have a protective or barrier cream applied.

    7. Roll pt to his/her side, wash back and legs (1 washcloth), buttocks and anus last (1 washcloth, more if stool is present). Roll up the sheets, place new ones under the pt, put a new diaper (if needed) under the pt. Use creams mentioned above if necessary. We don't use any creams on pts with healthy skin.

    8. Roll pt to other side, pull sheets and diaper into proper position, roll pt to his/her back, close diaper, dress pt in a clean gown.

    9. Cover pt, place a towel under his/her feet, wash the feet.

    10. Cover feet, tuck the corners of the sheet and blanket under mattress.

    11. Comb the pt's hair. It's better to do rise the head of the bed for this.

    12. Lower the bed and pull up the rails. Clean up and turn the heat down.

    Of course, if the pt is getting up after the bath instead of staying in bed, leave the bedmaking for later.

    I like giving bedbaths, as it is the time I make best contact with the pt. If the pt doesn't want to or can't talk back, I talk to him/her anyway and always try to explain what I am about to do and why. Except, of course, in the case of pts I already know. If it's evident the pt is getting tired or irritated by my talking, I shut up

    I always try to use lotion, it gives the pt a feeling of luxury in the rather dismal place a hospital can be. Applying lotion doesn't take long, and the massage associated with it is soothing, especially on the back. I put the bottle of lotion in warm water when I prepare the bedbath, co it's not cold when applied. I carry a extra bottle in my cart, as lotion is among the things that disappear from the pyxis faster than Speedy Gonzales can run. Soap does too!

    If the pt is very smelly and a regular bedbath doesn't remove the funk, we use a bit (only a bit!) of iodine in the bathwater. It really helps! We often have neglected pts from bad nursing homes, homeless pts - some of them so dirty you wouldn't believe The homeless usually come from the ER where they had a quick shower, but these showers are really 'quick' and only remove the worst stuff.

    If the pt has dentures, remove, clean and place them in the denture cup before the bath. This way they are ready to be put back in the pt's mouth when you're finished bathing. I've had some pts sleep with their dentures in, mainly because the night shift CNA forgot to remove them So check this.

    It takes time to become an expert My first bedbath took me over an hour! And I'm still far from being an expert. Never plan your day to the minute, a bedbath can be full of surprises that will eat up time: dressings that have to be changed, additional stool coming out when a pt with diarrhea coughs (always right after you change the sheets) and the rest of the usual stuff that is supposed to be expected, but hoped not to happen. For the same reason, leave the extras, like braiding the hair, for later, when you're done with all of your patients.
  13. by   twotrees2
    great pet peeves!! as are between toes ( especially on diabetics ), and behind the ears and in ears, as well as any folds if any and higher up crack of rear , and contracted hands - the palms and between fingers are often not done well probably due to it is painful for the patient to have to bend them slightly to get in there but it is important to do so .....!! very often neglected areas that tend to break down real real fast if not kept clean - and oral care is often neglected as well. cant tell ya the number of patients i have had to dig crust off of roof of thier mouths and tongues because it wasnt done well or often.......


    Quote from pfongk
    When I was working agency in nursing homes, I aimed to take about 20 minutes on average with each of my residents.
    Another thing that no-one seems to have mentioned and is a pet peeve of mine is navels, nipples and foreskins. I've seen some fairly disgusting things come out of these when bathing people, I swear some people just didn't think of cleaning these areas when bathing residents.

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