So my coworkers and I were discussing a patient who had died recently during bathing. Well, let me clarify..patient didn't actually die during bathing, but the stress of bathing caused a chain of decompensating events that we colloquially call the "Death Bath." This is a pretty common (and anecdotally well known) event in ICUs. With this specific patient another nurse (mind you jokingly) responded "WHY DID YOU BATHE HER??" to which the nurse taking care of said patient replied "She was dirty!"
This made me realize a very interesting moral/ethical dilemma within nursing. With insurance companies, medicare/medicaid cutting reimbursements for patients who recieve HAI's/pressure wounds, should you or should you not perform preventative wound care on patients who are terribly hemodynamically unstable?
One point you could bring up is that the patient who is so unstable that turning/bathing ultimately leads to their demise is statistically not likely to survive long anyway. But one case we have is a patient who went from horrid septic shock crashing to..."recovering" who is now still in our ICU on day 28, but hemodynamically stable. So, had we been doing q2 hour turns on him during his bad phase while he was on multiple pressors and CRRT, we could've possibly killed him (The Death Turn, the evil cousin of the Death Bath). On the other hand if we don't turn him and he gets a decubitus and survives, we don't get reimbursed.
Now, I hate to make you guys think that this is all about money...buutttt....I work in a Level I trauma center which also happens to be the safety net hospital. Money is a huge issue at our hospital and with the increasing costs and reimbursement cuts in healthcare...it's a semi-valid point argument. We're kind of backed into a corner on this one.