Giving baths on CCU

[NurseEcho]

I have been working on CCU (nights, 7P - 7A) and generally like it a lot. But I am curious as to how other CCU's handle baths. There is a lot of pressure on my unit to get most or all baths done on night shift, and it continues to be a sore spot with me.

It's not that I don't want to bathe my patients. Certainly, if they are ventilated and sedated and don't know the difference between night and day, it is a great opportunity to do a full assessment of every square inch and catch/treat skin breakdown problems early.

But, I also get a fair number of patients who are alert and oriented and TIRED. It's bad enough that there is sound and light pollution, round-the-clock meds, labs to be drawn, etc ... it seems downright cruel to me to wake someone from a halfway-decent sleep at 3:30 am and go through the whole bath routine for basically no other reason than day shift's convenience.

Also, we are always short-staffed on nights. Everyone will pitch in and help out with the most critical folks who require multiple assists, but there are only so many hours in the shift. And I only have one back -- I am not going to sacrifice it, or my pt's safety, for lack of assistance.

As it is, I do almost always get at least one of my pts bathed. If they are responsive and able to tell me they're just not up for it, I chart it. Still, I get dirty looks in report for saying a pt has not been bathed. Is this common? How does your unit do baths?

[dorimar, BSN, RN]

Sleep deprivation and the ICU is an ongoing problem. I usually bathe all of my tubed and sedated pateints. For my alert patients during my 4 am assessment or there after, if the patient is awake, I OFFER a bath. If it becomes a problem with the day shift, you can even chart am care offered and refused. Another option is to bathe at night before sleep.

[millkay]

I too have had frustrations re: night baths. I think it's rampant at a lot of hospitals. I have gone to work sometimes and found out that a patient has not had a bath at all during this admission, and it's day 7 or 8. Often I know the nurse that had the patient the night before went out to smoke numerous times, played computer games or read a novel. :angryfire It really looks bad, especially with patients who are awake and alert. Just to let you know NurseEcho, you are not alone.

[ZASHAGALKA, RN]

Every CCU I've worked in has the same rule: people who aren't oriented or wouldn't know they were being bathed on nights get bathed on nights.

Oriented or sleep deprived individuals get bathed on days.

Most vents get bathed on nights with one exception: if it is likely that they will be extubated that morning, a bath can wait till after extubation - generally, we are letting these pts wake up more (or on lower doses of diprivan, etc.) and bathing them on nights just stirs them up and potentially causes early accidental extubations or certainly, more distress.

This rule works quite well, there is some bickering, but it's the normal bickering between shifts and deals more with interpretation of the rule than the rule itself (I think he was more out of it; you could have bathed him!)

~faith,

Timothy.

[utahliz]

We do all our baths on nights, unless the patient was a fresh open heart that day and therefore bathed a few hours post-op. I try to get my baths done before 11 pm, even earlier for someone who hasn't been sleeping well. Day shift in my unit simply doesn't have time to do baths, with everything else going on--procedures, rounds, etc.

[hrtprncss]

Work days and give both of my patients baths right before the end of the shift...well at least change their sheets, freshen them up or whatever...these are mostly intubated and sedated patients.

[Beary-nice]

I'm a little doofy and when I have floated to ICU/CCU, they have already given most of the pt's baths except for those who are A/O etc. What I am saying....I will be giving a bath and have someone else tell me after the fact...you know...we do that at night!!!! Guess that pt will be simply SPARKLING! :rotfl: Old habits are hard to break!

[Dinith88]

That is the major perk for NOT working midnights on my unit :) , Actually, we have the luxury of nurse-aids/interns who do any baths that may be needed. So our nurses skip out of most of them.

[nicolentony]

Every CCU I've worked in has the same rule: people who aren't oriented or wouldn't know they were being bathed on nights get bathed on nights.

Oriented or sleep deprived individuals get bathed on days.

Most vents get bathed on nights with one exception: if it is likely that they will be extubated that morning, a bath can wait till after extubation - generally, we are letting these pts wake up more (or on lower doses of diprivan, etc.) and bathing them on nights just stirs them up and potentially causes early accidental extubations or certainly, more distress.

That's what we do, too!

[RNforLongTime]

In my unit, we give the ventilator pt's baths on nights. Pt's that are a&o would get bathed on days/evenings. At my last place I worked, nocs didn't have to give baths, only if they felt like it.

[Sarah, RNBScN]

Nights we only bath the vented pt. from top to bottom, linen and gown change.

Days we bath or offer assistance to those who require a.m. care.

[hppygrndma]

Most every ICU/CCU I have worked on, gives patiens baths at night. Sedated and vented patients are bathed anytime during the shift, A&O more toward the morning hours. Just one of the drawbacks of the ICU. But on the flip side, it gives you a chance to do a thorough skin assessment on your patients.

LOVE THE ICU THOUGH