Baths

I've worked a couple different places, been a patient at several different big hospitals, and never, ever was the patient or I ever completely uncovered. Just the part getting washed, the arm, the leg, the back was uncovered. The patient always has the option to cleanse their private parts, and are encouraged to do so if they are able. Privacy of person is respected, and even if the nurse must cleanse private areas, it's done a single area at a time.

To have someone completely naked on the bed for a bed bath..... well, I've never heard of it.

You never keep a patient totally naked and exposed during a bath. That would be out of line. You keep everything that isn't being washed completely covered. We also encourage our patients to clean what they can and we will help with the rest. This works out great on our unit as it often let's the patient take care of private parts and helps to maintain their privacy as much as possible.

See, thats what I always thought, and yet on my unit the techs seem to get the pt completely naked and exposed. It bugs the crap out of me every time I see it happening, but I'm still on orientation and don't know what to say/do/think about it. No one else seems to give it a second thought that I know of. There are multiple issues that I've noticed with the techs on my unit. This one is the most frequent, that I've seen thus far.

So what do I do? I feel like I'm so new that its not really my place to say anything. Maybe if I go to the director and ask her if she knows about these things? I just don't know.

So what do I do? I feel like I'm so new that its not really my place to say anything. Maybe if I go to the director and ask her if she knows about these things? I just don't know.

I wouldn't recommend going straight to the director, that will probably do nothing put anger the techs who, lets face it, will still be working with you after the fact. I would approach the tech(s) doing this at a good time (not when it is happening, before hand, maybe at the beginning of the shift?), pull them aside and say something like "I noticed when you bathed so and so yesterday, the patient was completely uncovered. One of the joint commissions big push-button items is patient privacy. Maybe if we leave the majority of the patient covered, and just uncover the part being bathed at that time, we can allow the patients to maintain some dignity. It's never comfortable to lay there naked and have someone you barely know helping you bath." If they don't' know how, offer to show them. If they blow you off, or ignore you, then go to the charge nurse. Follow the chain of command. And it is your place. As a nurse, you are the patient advocate.

See, thats what I always thought, and yet on my unit the techs seem to get the pt completely naked and exposed. It bugs the crap out of me every time I see it happening, but I'm still on orientation and don't know what to say/do/think about it. No one else seems to give it a second thought that I know of. There are multiple issues that I've noticed with the techs on my unit. This one is the most frequent, that I've seen thus far.

So what do I do? I feel like I'm so new that its not really my place to say anything. Maybe if I go to the director and ask her if she knows about these things? I just don't know.

I would probably start a bath on my own, and ask your tech for "help." It puts you in the lead on the task, and gives you an opportunity to demonstrate how it should be done, as well as allows you to slide in subtle explanations. You know...kind of a "talk while you work" sort of low-key teaching moment. If that doesn't work, go a more direct route....and now you have an actual teaching moment to fall back on: "Remember the other day, when we were talking about patient privacy and body warmth during Mr. Patient's bath.....?"

in school we were taught to expose just what was being washed...a nice thought but not reality in a busy ICU. i wash the patient's face, neck and ears, dry. take their gowns off but keep their covers up to their waists, wash the entire torso, and arms, dry, put the new gown on. pull covers over the chest, wash their private area, dry, pull the gown down. wash both legs and feet. roll them over, wash back and butt and posterior thighs. change the bed linens. i can get a bed, bath and assessment done in about 20 minutes without a patient freezing to death in the meantime

The best, most meaningful compliment I've ever received was from a man in his early 60's who had had a stroke. I was a student, doing things so solidly by the books with keeping him covered. I kept thinking, "What if this were my parent?". I got extra-vigilant with covering. When the bath was finished (took about 20 minutes), he said, "Thanks so much for keeping me covered. My mother-in-law is STILL alive and would have come barging in here even if you told her I was getting a bath. The other people here don't cover me and I get embarassed. Thanks for keeping my private parts private."

I now work Peds ICU. As much as possible, I try to keep what is not being washed covered, especially with the older kids. I've had some extremely modest males (most of our patients are intubated & sedated) who were A&O. I do part of the part, they finish up with their private parts. I've even had to be "bad" nurse and ask mom to leave while her son bathes.

This also bothers me when I see people completely uncovering their patients. I always leave at least half of the patient covered when I'm not washing that half. I'd say the majority of nurses that I've seen totally uncovering their patients had gone to nursing school in other countries, which might have not emphasized the importance of privacy in their programs. I can't say it's ever been brought up in a staff education day or staff meeting or anything.

I've never witnessed anyone keeping their patient uncovered like that. I would say something to them had I seen it.

I also always ask the guests to leave for 20 minutes. If the patient speaks up and asks for someone to stay that's fine but I want to make sure it's not thrust upon them.

I hate to say it, but I have seen many a bath done where the pt was left completely uncovered. It was much worse in the large metro (Magnet!) hospital I used to work in than it is in the small city/county hospital where I am now. In fact, when I was a green PCA at the large metro hospital, the person orienting me did not cover the pt. Fortunately, I did not pick up this bad habit.

As a nurse, I try to set a better example for those I work with. I generally uncover, wash, and re-cover with clean, dry towels as I go. Once the front is done, I put the clean gown on (unless there is a danger of soiling the new one with stool, etc). If I am bathing a pt with a tech and the tech does not cover the pt, I ask them to hand me a towel "so we can keep Mrs. X covered and dry until we are done." This is usually all it takes to make my point in a kind way that emphazises the pt's needs rather than criticizing how someone does their job. :)

IMHO,

A pt should never be totally uncovered for a bath. Usually my CNA's do the baths, but I like to help because it makes my assessment easier, since they are already being turned, etc.

I was always taught that just the part being bathed is uncovered, and that the pt should be able to decline us bathing certain parts they may feel uncomfortable having someone else see.

If your techs are exposing the pts totally to bathe them, it needs to be addressed immediately.

Amy

The easiest way to do a bed bath that I have come across is to put a new trash can liner in a trash can, put 5-6 towels in there, add hot soapy water and then start applying to the patient. Eventually you end up with the patients head being the only part exposed. Start cleaning the area under each towel. After you are down with an area remove the wet towel and replace with a warm blanket or towel. This provides the most pt privacy and keeps the patient nice and warm during the entire bath. Lack of privacy and freezing to death are the two biggest complaints of bed baths that I know of.