What has happened to simple, basic care??? - page 2

I have noticed and been informed by many of the nurses I am working with that a bath, either a full bath or a partial bath, for the patient is not important. Must be true, I have given at least 4... Read More

  1. by   Bipley
    Quote from RNnTraining1973
    I love bathing my patients. This is just one of the many reasons why I chose the ICU. I consider bathtime very important. As the original poster stated, it's a bonding time for me and my patient. I worked last night and spent 45 minutes bathing, shaving, and brushing my patient's hair and teeth. He looked quite spiffy when I was done and I found out more information about the little guy. It's not often I get a chance to converse with my patient since most of them are vented, sedated, or chemically paralyzed. But I get a feeling of satisfaction when I give my patients a thorough scrubbing and/or keep their mouth clean all shift. It frustrates me to get a patient's mouth looking halfway normal, then come back the next night and it's back to square one because the nurse who followed me didn't bother to do oral care all shift.

    I always think about how much better I feel after I shower when I've been sick for a while and that motivates me to give my patients a good bath. I have a little bag with good disposable razors, nice lotion, hair ties (that aren't going to yank a poor girl's hair out), and linen spray for my patients. It's the little things that can make a difference, even if that patient is dying. We had a donor one night who was the mother of 3 children. I knew when the children would be saying their goodbyes, they would be leaning over their mother's face. She smelled like that of someone who was dying. I took some perfume, sprayed it on a 4X4 and slipped it under the sheet near the woman's face. The daughter leaned over, sniffed, and thanked me for making her mom smell good. Basic care is still alive and well.

    Melanie = )
    I am a nurse and as a nurse/patient I recall something that still sticks with me.

    I had been in a major fire. My dx was smoke inhalation. I was in ICU and while the RN was doing an assessment I mentioned that it tasted and felt like I had sand in my mouth. I would have loved nothing more than a shower and to brush my teeth. He handed me a cup of ice water and told me to swish and spit, since I was NPO.

    His clinical skills were beyond superior. He picked up on what I, as an RN/patient didn't pick up on. He was on the money. But darn! I would have traded my eye teeth for a toothbrush.

    I did swish and spit but then I told him.. that didn't cut the mustard. Please, a toothbrush? I'd give him money, honest I would! Nope, no time for that.

    I had smoke, soot, and fire extinguisher dust stuck between my teeth. I would have paid serious money for a toothbrush and an itty bitty tube of Crest Toothpaste. Even generic toothpaste would have sufficed! Okay, shampoo too. My hair was covered in fire extinguisher dust. It itched too.

    I got ice water. It's just not the same.

    That was a verrrry good lesson for me. I am VERY careful to assume my patients can taste their own mouth, even when in a coma. I shampoo their hair, suds them up, do the very best of oral care.

    I think sometimes you have to be in the position of your patient before you can seriously, honestly relate to what they experience. It was sure an eye opener for me. While I realize there is no time, we need to MAKE the time.
  2. by   Bipley
    Quote from QuigRN
    " We had a donor one night who was the mother of 3 children. I knew when the children would be saying their goodbyes, they would be leaning over their mother's face. She smelled like that of someone who was dying. I took some perfume, sprayed it on a 4X4 and slipped it under the sheet near the woman's face. The daughter leaned over, sniffed, and thanked me for making her mom smell good. Basic care is still alive and well."



    Melanie - that is the most heartening thing to hear! I've been hospitalized several times in the past 5 years and it would have been nice to feel fresh in ICU. We need more nurses who feel this way. Technology is important, but people are still people when they're sick. :angel2:

    Eileen:
    A big ditto!
  3. by   Bipley
    Quote from Marie_LPN
    I tell ya, that is one thing that chaps my hide (one of thousands i'm sure) is lack of mouth care. I've lost count HOW many times a pt. has to receive mouthcare in the OR before they can be intubated, it is THAT gommed up. :angryfire:
    Wow. What else can be said but... wow.
  4. by   bethin
    Wow, good hygiene isn't considered important anymore? If that was the case we'd all stink. I worked with an ICU nurse once who told me that a nurse should walk in while the aide is giving a bath to assess the pt. It would be nice because I get asked all these nursing questions that I have no idea what they mean...and I'm studying nursing. They get upset with me if I can't answer their medical questions.

    I'm an aide on a med/surg floor, 7a-7p so I get all the baths. I guess I'm old fashioned but I prefer soap and water. Our hospital now has these bath packs. I hate them, I think they stink but I find myself using them because there just isn't enough time to give everyone a old fashioned bath. Sometimes I'm the only aide for 25 patients and there is no way I can do all those baths by myself. Our NM (who admits she doesn't know how to do pt.care) expects all baths to be done by 11a. So, to get 25 baths done, linens changed and rooms straightened up by 11 I have to run around until I have an anxiety attack (no joke). I don't mean to diss nurses as the ones on this site seem to be exceptional, but our floor is notorious for our lazy nurses. Management won't fire them because they've been there too long.

    Icky mouths are a pet peeve of mine. Our hospital has gone the cheap route on so many things so now we don't have those special swabs that get all the gunk out. We have these cheap little pink things that don't work worth a hoot. Frankly, I am so sick of walking out after my shift and feeling so guilty that I didn't provide good enough care. I guess that's why I want to specialize in critical care. Hopefully I will get to spend more time with my patients.

    Management needs to realize that in order to give quality care we need quality workers, and preferably more of them.
  5. by   SCRN1
    Many nights, I don't even get a chance to go pee the whole shift and we don't get lunch breaks on my shift either. I work my butt off from the time I clock in until after my shift is supposed be to over. I work on an orthopedic/gastric bypass floor (and also all the other med/surg overflow) and we have anywhere from 5-8 patients each. Sometimes, just 5 patients can run ya as much as 10, depending on their needs. We are so bombarded with all the triple charting, 24-hr chart checks & M/SAR checks, that there's barely enough time for patient care at all as it is. This makes me so angry because I went into nursing wanting to actually take care of the patient, not the records. I do agree that skin & oral care are very important!
  6. by   LilRedRN1973
    Our supervisor just invested in a Sun Shower. For those who are not familiar with them, it's a portable "shower" you can take camping. We hang the bag full of hot water on an IV pole and then put a hair washing basin under the patient's head. We are able to wash a patient's hair really well this way. We love that thing. It's a much easier way of doing it then using the hair washing basin by itself and trying to get all the shampoo out of the hair.

    Melanie = )
  7. by   grimmy
    Quote from tweety
    i had four patients by myself the last time i worked and was fortunate to be able to give four baths. i agree, bathtime is good time.

    the day before i was by myself and started with four patients, one of whom was climbing out of bed and incontinent of bowel, then got a 5th patient at noon. by the time 3pm came around i reported to the evening nurse that two of my total care patients did not get their beds and bath due to being overworked and not having the benefit of a nurses aid in my assignment.

    i'd love to give total complete basic care 100% of the time, and i feel guilty when i can't.

    [font="book antiqua"]i would feel guilty, too. when i was a nursing student and working as a pca, i would run myself ragged making sure everyone got cleaned up. i remember finding a pt at the beginning of my shift with dried hardened poop from the top of her back to her knees when i went in to turn her. i was so angry, i had to stand outside the room for a few minutes to seethe. i reported this to the rn i was working with, and she wrote it up. it took us a good 30 minutes to soak her to remove the poop. another i remember so well is a woman who obviously had sores on her head from not having her hair washed in a few days. i went through 3 of those hair-washing caps just to get it manageable. no wonder she couldn't sleep! even today, as i work in the or, we see people coming to the or from the floors who have not had basic care - like clean hands! while i am perfectly aware that some pts refuse baths, and many nurses don't have the time to give full baths or even partials, it breaks my heart that we don't have that time. giving baths was some of the best assessment (physical, mental, spiritual) time i had as a student nurse.
  8. by   Really An Actress
    There's no better way to do a full body assessment than when you're giving a bath. You can see so much about a person's health in their skin and it's also a good time to talk to your patients when you might otherwise be hurried. I used to loathe giving baths because it wasn't exciting, now I find it was one of the best ways to check ROM, ability to follow commands, and just talk to the patients.
  9. by   1Tulip
    I really agree with the Actress. Bed baths are only partly about hygiene (as important as that is!)

    I am glad the ICU types responding on this thread are conscientious about baths. But I gotta tell you, the last time I worked ICU, it wasn't uncommon to get a patient with fresh IV dressings and trach-ties and a clean sheet spread over them, but then find that vaginal discharge had been ignored, no peri-care given, grimey brown gunge around the foley...and oral care consisted of a slap-dash swab around the lips (if that.)

    And another thing! Why are ICU patients always on their backs? Breath sounds consolidated in the bases... every TIME I came on duty. My practice became to keep my pts turning from side to side to side throughout my shift because I knew that was the only time they would be off their backs.

    FUNDAMENTALS!!!! Sheeeesh.
  10. by   LilRedRN1973
    In our unit, we turn our patients every 2 hours. I usually go L, B, R, L, B, etc. So if you were coming on shift and my patients were always on their backs, it doesn't mean they had been on their backs all night. Now, if someone has a bad pressure ulcer on their sacral/coccyx area, I will keep them side to side, unless contraindicated.

    Melanie = )
  11. by   truern
    Last semester I was supposed to d/c a foley....I had to put a warm wet washcloth on the patient's labia to loosen up the gunk before I could get the foley to budge. Bless her heart....she'd been in a wreck and had multiple fractures and obviously *nobody* had given her pericare
  12. by   Super_RN
    Quote from 1Tulip
    I really agree with the Actress. Bed baths are only partly about hygiene (as important as that is!)

    I am glad the ICU types responding on this thread are conscientious about baths. But I gotta tell you, the last time I worked ICU, it wasn't uncommon to get a patient with fresh IV dressings and trach-ties and a clean sheet spread over them, but then find that vaginal discharge had been ignored, no peri-care given, grimey brown gunge around the foley...and oral care consisted of a slap-dash swab around the lips (if that.)

    And another thing! Why are ICU patients always on their backs? Breath sounds consolidated in the bases... every TIME I came on duty. My practice became to keep my pts turning from side to side to side throughout my shift because I knew that was the only time they would be off their backs.

    FUNDAMENTALS!!!! Sheeeesh.
    I wouldn't stick all ICU nurses in this category! I find that just plain poor nursing, not necessarily ICU nursing (I understand you stated this is when you worked ICU though). As for turning patients, I have a system when I come on at 1900. If I know a patient has a CXR ordered in the a.m. (usually come around 0600 where I work) I will turn the patient L-R-B, L-R-B, so they end up on their back when xray comes. If the patient has an ulcer on their butt or coccyx I only turn side to side...then again, it depends on the situation. If the patient's condition tolerates side to side that is. Jeesh! So many things to consider! Sometimes it is more important to weigh having a BP in one hand versus turning the patient and depleting the BP in the other.
    Super
  13. by   Super_RN
    Quote from truesn
    Last semester I was supposed to d/c a foley....I had to put a warm wet washcloth on the patient's labia to loosen up the gunk before I could get the foley to budge. Bless her heart....she'd been in a wreck and had multiple fractures and obviously *nobody* had given her pericare
    Oh my gosh! I am sure she appreciated the extra compassion you showed instead of just pulling it out.

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