Ethics of patient bathing

[discontentment]

Could someone please help me with this delimna.

First and foremost, I want to start this off by saying.... I dont mind to bathe a patient. I quit one job and took another with a lower patient ratio in order to be able to bathe patients and provide better care for my patients on a daily basis. Herein lies the problem. In working one night recently, i had three patients (work on a icu stepdown unit), one patient was on bedrest till the mornining and didnt want to bathe until he could get up a poop on the commode, he wanted to bathe himself. Another was an 80 yo with PNE, HCAPS she was asked at MN replied it was too late, then asked again at 5 am, replied it was too early. It was explained to her that days may be too busy and would she like to go ahead and bathe now..... still the answer was no (mind you she had had xanax and sonata at 10p before i assumed her care and was quite sleepy) and another patient was a trauma patient, she was tachy, hypertensive, humerus broken in 3 places (not fixed yet) scaplula broken and orbital fractures, and t11-t12 fracture. she was asked multiple times, she was extremetly anxious, she didnt want to be touched, she had a 100% non rebreather on and would desat quickly without it.... wouldnt allow it to be put around her head, she had a washcloth holding it in place. she refused the multiple times she was asked.

all three of the patients were A/O X3, there were no overt signs of filth, infection or otherwise.

the problem? my nurse manager was asking coworkers today if they felt that the patients really felt that way about getting a bath .

I feel that it is unethical to force someone to bath when they do not want to...... AM I wrong???????

Please feel free to be honest.....

I am really perplexed at why you wouldnt just ask the patient if they had been asked to bathe?????

[nrsang97, BSN, RN]

I also work in a neuro ICU. Our patients get little to no sleep for days. If the patient is alert and oriented then I offer once at the beginning of the shift and check back later in the shift. Sometimes they want to bathe, other times they don't. We can't do all the baths either since we accompany all patients off the floor to MRI and CT, those are frequently done at night as well, so sometimes we want to bathe but when you are off the floor for over an hour for MRI and at least 30 minutes for a CT (including travel time), sometimes they don't get done.

[whipping girl in 07, RN]

I've done it both ways. I've worked days and nights and in an ICU where we split the baths between the shifts and in one where nights did them all.

In the unit with all night baths, we tried to do the bulk of them on "evenings" as in, get report, assess the patients, get one bath done before visiting and the other afterwards. Or if you were very efficient and tag-teamed it with another nurse you could probably get 2 or 3 done before visiting. A few times we had 4 nurses and 8 patients and bathed them all before visiting. That was the exception, not the rule. In any case, we had most of them done by the time we wanted them to go to sleep (2200-0000).

When I worked nights in the "split the baths" unit, I usually did my bath right after visiting. Some nurses waited till 5 AM, but every time I did that something happened and I got off work late, which I hate!! If someone was sedated/vented they would usually be a night bath. More AAO patients were day baths and we'd try to cluster it around other care to still give some uninterrupted rest time.

I never offered though, I'd just say, we're doing your bath now. It was rare to have anyone say no. I try not to wake them up if they were sleeping.

[RNKel, ASN, RN]

I never go in and ask if someone wants a bath. 9 times out of 10 they're going to say "no". I ask "would you like your bath now or would you like me to come back in an hour?". That way they pretty much have to choose one, and they get a bath and it's on their terms somewhat.

I think bathing someone at midnight is ridiculous, but that's JMO.

[Batman24]

Our manager is talking of writing people up for not bating the patients but you cant force them, some of the RN's dont give the patients a choice, they just walk in a say.... You are taking a bath and if the patient says they dont want to, the reply is, it will just take a minute and they start bathing them anyway.....

I am not about to enter into the 'battery' zone, especially over a bath. I just feel frustrated over this whole topic and my manager says to document but then pulls stuff like.... do you really think that that lady would tell you she didnt want to bath right then...... who would at MN and 5am after xanax/sonata

Basically, she says to do it anyways as it is in the best interest of the patient... which i agree that bathing is in the best interest of the patient, but everyones personal hygiene habits are not alike.

If they say no you shouldn't proceed and your manager is dead wrong to tell you to do so. That's battery. And doing it at midnight or 5am after they are heavily medicated is absurd. I would hold firm here. Not worth risking your license. Document, document, document. If she writes you up don't sign it and get Risk Management involved at once.

[NeosynephRN]

Exactly what I was wondering. Days gets 3 aids. On nights, we're lucky if we get one. Why? Because it's dayshift's job to do baths. No one would want to get cleaned up at MN or 5am.

The patient is obviously woken up a lot during the night anyways, but there's a difference between a 30 second set of vitals they barely need to move for and a bath.

Funny for us it is the exact opposite..nights always has at least one tech and we never get them during the day, so for our unit it makes more sense to do them at night...we are an ICU so we def bathe the vented sedated at night...walkie talkies well that is different. During the day with no tech and an average of 6-10 doc's per patient...that is another story. I do however do partial baths if not complete almost evertime I clean up a BM...if I have them turned and the help there with me I am going to do all I can!!

[discontentment]

I don't ask my patients "do you want to take a bath?" I usually say something like, "are you ready to get cleaned up?" With the one patient (the trauma) I offered to just wash her front, her groin, her armpits..... some form of bathing, she still said no. I don't mind bathing patients, I helped bath 4 of the other patients on the unit. It is common practice on the floor to just walk in with everything and start bathing the patient, I have been asked by patients why this happens and why people commonly dont ask them if they are ready to take a bath.

I can see doing this on patients that are confused, but only to some extent..... waking an alzheimers patient in the middle of the night and causing them anxiety to me is unacceptable...... but.... then again... where do you draw the line?

To me, a patient should always have a choice if they are alert and oriented.

Now mind you if they are willingly laying in poop,pee that sort of thing, it only takes some common sense to know that that needs remedied...............