What has happened to simple, basic care??? - page 3
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
Jan 6, '06Baths are important as is mouthcare. We are so busy in nursing these days that it's great when patients can help themselves in some way. However, those that need mouthcare should get it. The techs on my floor usually do that but often I will just to do it and make sure it gets done.
We nurses generally don't have time to do baths. If I have someone a diltiazem gtt, another on nitro gtt, an new admit, and tons of meds, I'm not gonna even think about giving a bath. I mean to be real, the above mentioned things are extremely important especially if people are not completely stable on the gtts. Second of all, most of my patients that can't help each other get some kind of bath on days, I work nights. Second of all, if I'm late on meds and let a guy's HR stay tachy because I wasn't titrating the dilt gtt (I was giving a bath), the Dr. might have a problem with that. "But Dr, I gave a full bedbath to your other patient, so what's the problem?" PRIORITIES!
Cleanliness for patient is important and conducive to recovery, please don't think I understand that fact too.
Jan 6, '06Most of my experience (and that was a while ago) was ICU. So with only one or two patients, I could usually work a bath into my shift at some point.
I can't say categorically that I'll never leave a patient unwashed, but I believe my priorities would focus on (naturally) my bedfast pts, keeping their linen dry, and turning them regularly... plus visually inspecting them head to toe, front and back for any breakdown, doing mouth care and pericare. This could take 30 to 45 minutes and I might not have that kind of time in one block. But, as long as each item got addressed by the end of my shift, I think the patient would be well served.
Whereas an old-fashioned bed bath might be considered a luxury or a "comfort measure", skin inspection, pericare (especially where a foley is present) and mouth care are about portals of entry and keeping bacterial load at a minimum.Last edit by 1Tulip on Jan 6, '06
Jan 8, '06I've noticed that the nursing students (RN) are not performing any hygiene, personal care or asst with mobility during clinical, their instructors will have them call for the cna or co-assigned nurse to do any sort of care. They say "that's not what they're here for. They already know how to give a bath."
The LPN students will give excellent care, however. Will do or help with anything.
(note,I am an lpn to rn)
When I was a student, our instructor (older woman, very old school) said as nurses, our essential duty to our pts was as follow:
1. keep them clean
2. keep them comfortable
3. keep them moving
4. keep them nourished
Maybe it seems oudated or old fashioned, but I think it still holds true.
Jan 8, '06As a frequent flyer, because of my asthma, I have had multiple admissions over the past several years. And have generally been so sick, I really do not care if I bath or not. And apparently neither do the nurses and CNAs who care for me. I can recall twice where I was given a bed bath and a complete change of linens, after having run a temperature. Generally it was a change of the bed pad or draw sheet and that was it. And forget mouth care. Unfortunately, for a number of reasons, bed baths and oral hygiene have fallen to the way side, along with back rubs.
Jan 8, '06When I was 18 years old I was septic from a kidney infection and went into preterm labor with twins and delivered them. They died in the delivery room and after a few hours I fell into a drugged, foggy sleep. I was REALLY sick. I had felt awful and hadn't eaten anything for a week or so. I was depressed, in shock, in pain, and stiff and sore as could be. This nurse, not too much older than me, gave me a bed bath and washed my long hair and brushed it all the way through (in bed...I know that's so hard to do!). I had been laying there, covered with dried blood for over 24hrs. I know I hadn't had a chance to brush my teeth for about 48hrs.
Now, as a healthy young woman the thought of having someone help me bathe is absurd! But, at that time, I felt like I was 100 years old. She was like an angel to me, and I have never felt anything as good as that warm washcloth. I cannot count the number of patients who have thanked me profusely for helping them feel clean and comfortable.
With that said, there have been days (not the majority) that I have not been able to do anything beyond mouth care x1 (it should definitely be x2 in a 12hr shift) and warm washcloth to the face. It's a source of guilt for me when that happens. I do have a question though -- there have been a few elderly patients whose dentures I have NOT been able to get out! I think they are crusted into their mouths with ancient gunk. Does anyone have any tips for this?Last edit by MarySunshine on Jan 8, '06
Jan 8, '06Quote from barefootladyI 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 baths every night I have worked this week. Oral care is a dying art. Come on nurses, lets hear how it is done where you work. I cannot be the only nurse who thinks baths are just a part of patient care, and even if it's done at 10:00am or 22:00 pm, it is necessary for comfort, promotes good skin care, allows you to assess the patient, and helps build a bond with the patient.
Jan 8, '06I'd love to give total complete basic care 100% of the time, and I feel guilty when I can't.
Jan 8, '06In my ACCU, EVERY patient is bathed at least once a day; by rule, the non-vented patients are bathed during the day, and vented patients at night. However, most nurses end up giving their patients a bath at least once during their shift. I went to the CC consortium recently, and one speaker made a pretty funny joke about how obsessive ICU nurses are about keeping their patients clean. I think it just depends on where you work.....
Jan 8, '06How sad that they make a joke of it. Nurses just are not taught how to do that anymore. The RN programs now spend a large amount of time on how to do paperwork and some technical skills. I guess they think the new nurses either will never have to do that or that they will learn on the job.
I have heard far too many nurses say that basic care is not their job.I am from the old school. There was a time when our hospital expected that every patient would get a backrub at HS. It didn't matter how busy you were. Now the patients are luck to get their hair brushed or clean linen on the bed.
I am very unhappy that with all the technological advances we have made, the patients right to the most basic care has been lost.
Jan 8, '06Simple basic care is also related to STAFFING. You can't do baths when you have an unsafe number of patients and that is one of the links to higher infection and mortality rates. No oral care for vented patients is linked to pnuemonia and so on. We have to make the link on staffing to administraors and to the public, we need to unite over this, it is not fluff it's vital.
Jan 9, '06Well, if the nurse has 5 or more patients, the techs have to draw the bloods, do other tech things, glucoscans, state EKGs, stock rooms, do the basic temps, pulses, B/Ps, give bedpans, do in/outs, just how much time is left for baths in a hi acuity hospital, especially on a floor where frequent VS are being taken, frequent assessments say for femoral sites post CATH.
It is not the bedside nurse creating the problem but the management who has not understood what the patient needs and provided it