The Dreaded Death Bath and a Moral/Ethical Dilemma?

If the pt was on all those drugs.... and was still able to maintain adequate BP and oxygenation when turned/bathed, then no she was not wrong. That is good nursing care.

But if the pt dropped his bp or sats while this was going on, she was endangering his life for the sake of a bath.

If someone is at high risk of skin breakdown, they get a fancy pants mattress that can do at least some of the alterations in pressure points.

If I can, I always bathe. If they are too unstable, I don't.

If they have unstable C-spine/open chest/new VAD/ECMO that really can't get rolled, we used to use a jordan frame to lift them straight up and at least change the bed and wash the bits we could get at. Was a huge undertaking with lots of people.

We did have one cardiac surgeon once who would not permit us to roll new LVAD patients to the right for 24hrs postop because they could drop their flows so much just from reduced flow thru the LV apex in that position.

they'll asign you tomorrow. Just kidding---You may bget something like this on orientation but after that they should ease you into what you're comfortable with after orientation. That's how we do it with newbies...we tend to retain nurses when we do it this way.

Treat your patients like they were your Mom, Dad, little brother. What would you like someone to do for them? Not turn them? My Dad got heel ulcers in our hospital ICU. They were too concerned for his heart to pay any attention to turning. Being his daughter- meant I didn't know my stuff. The ICU nurses were okay with him having his feet on the bed all the time, why was I so nutty about it? Well he recovered to be transfered to the SNF floor--for heel ulcers so big- he didn't have heels anymore. Long story short--he had his legs both amputated. What do you do- turn or not turn? Do what you would do for your own loved one!

yeah thats bad a dead dad mavbe worse?

We've had patients who roll into us on death's door...and have gotten VERY good at the art of the 20-second bed change. Make a bed roll, have it ready to rock, and get ALL the coworkers in there to help make it happen.

Even if I can't roll them, I can wipe their face, put a little cornstarch under their arms (condition permitting) and talk to them, so they know they're not alone.

You do what you can. Some days it's just not enough, and we come up short, but while they're my responsibility, they get the best care I can provide...even if that means NOT performing a measure CMS seems to feel we should.

This is why we are ICU nurses...to use our brain to make the decision as to how to best care for our patients. It's sure not the doctors in there with them 24-7, troubleshooting every physiologic crisis that arises.

u know what's funny, why does it take 2 nicu nurses to turn a baby on a vent or HFOV when they weigh around a pound! This is so true about turning. Some do not tolerate it well and when they are doing good on the HFOV and I have to pop them off to put at the other end of the bed I don't always do it but pass in report that they need to be turned. And the desating with parent/family touching drives me nuts. Have your DH rub/stroke one spot on your body for a half an hour and see what it does to you. We have developmental touch that we can quote don't know what you guys in adults have to say to tell the people to back off with the handling/touching. (Smile)

I know exactly what you mean. A month or so ago, me and another nurse decided to turn a DNR, DNI pt of her's and we turned him to his side and BOOM: complete desat. He was dead in 5 min. Fortunately, the family was in the lounge and close enough to come see him. We dubbed it "The Turn of Death." I think that it takes individual discretion as whether to turn a patient or not. For instance, there was a pool nurse who had a patient whom was on our unit for 50+ days with ca mets in her lungs, brain, breast, bone, etc. Her tidal volumes were around 100 and her lungs sounded stiff as bricks. The nurse was hell bent on turning this woman every 2 hours. I told her I wouldn't help because it would kill her. She wound up getting one pillow under the pt's behind when her a-line pressures dropped and her tidal volumes and sats. It's really a tough call. What I ask myself is, "Is all this worth a pillow under their back?" Alot of times, it's the own nurse's ocd nature to want to turn that patient every 2 hours. Sometimes, it's not feasible.

...and there comes a point when they're dying anyway, and in so much pain, that to do anything other than medicate them for the pain and leave them the heck alone is just cruel.

We have an intensivist on our unit who does not allow bathing of a post-op patient in the first 24 hours on the unit, no matter how stable they may be. He's gone so far as to formally order it in some cases. He also does not permit us to put the child in the mom's arms in the first 24 hours post-extubation, unless it's as part of withdrawal of life-sustaining therapies. We all just accept this as a quirk of his, knowing that he has what he feels are good reasons for it. And he has. Death Bath... seen it. Death Turn... seen it. Death CXR... seen it too. And we've seen kids who looked perfectly fine one minute turn around and code in mom's arms. For all that, we have a low incidence of anything worse than a stage 1 PRI.

I don't really think that "repositioning" a patient has to mean turning them side-to-side. If I can turn their head even a smidgen and slip a folded receiving blanket under a shoulder or hip (or pull it out), they've been repositioned and the pressure points have changed. I always pay special attention to their ears, having seen many very red, folded pinnae, and I take great care to ensure there are no bed trinkets under or around the patient. I tidy up other nurses' beds while I'm talking to them, surreptitiously most of the time, but with some people I make it quite obvious that they've left a 3mL syringe under a baby's shoulder. Ouch!