How clean is a "bathed" patient?

[tiredtech]

What is a bath? When you say you "bathed" someone on your shift, what should I expect was done?

I'm getting frustrated. Being a tech is frequently an icky job, but don't we have an obligation to get people clean? Going after some techs when I change a diaper, it's very clear that the patient's bath wasn't thorough. Dabbing at someone's armpits with a wet washcloth and calling it a day just isn't cutting it.

If I'm paralyzed one day, I hope someone is reeeeally cleaning me to make sure funk isn't building up somewhere on my body. We recently had an MR patient for almost two weeks on our floor. I first had him as a patient about 10 days in. While in bathing I retracted his foreskin to clean and there was... well, a solid sheet of smegma underneath. It was difficult to even move the skin out of the way in the first place and cleaning it was awful. It had clearly been building up since before he was in our hospital, but why -after 10 days under our care- was it still a hot mess?

How does this even happen? I asked around on my floor and no one retracts foreskin during a bath, not even our two male techs. Yes, it's incredibly awkward and distasteful. Yes, I hate doing it, but aren't we obliged to make sure our patients are clean and sanitary everywhere? If they're incapacitated and bounced to us from a nursing home, shouldn't we make sure they're actually clean?

It's increasingly difficult for me to ignore when this stuff happens - like when the patient that was "bathed" still has stool on her perineum and between her lower labia. Sure, it's horrible to clean that up, but it's worse to sit like that.

Just venting. Just angry that it seems like not enough techs that I work with care enough to get under the skin folds, even when they're in ick places, even when the patient is hundreds of pounds overweight. No one likes doing this, but if I'm a patient care tech, shouldn't I be really caring for the patient?!!? When I first started I gave techs benefit of the doubt more often, but 8 months in, not so much. After a while you know who does and who doesn't do the job... I have no idea how to constructively talk about this with coworkers. I doubt the tech that's worked nights for 15+ years would be swayed by anything I did or said. Just had to vent. Thanks for reading.

[gonzo1, ASN, RN]

You are right. Baths are important. It does seem like they are being pushed out of the way in exchange for more testing, blah, blah, blah. Some days my patients are not even on the unit for most of the day. And I hate powder. It gets in the lungs and can cause PNA. Keep up the good work.

[acosenza2]

When I was a nursing student my definition of bathed was what I would want for myself. A Few washcloths with soap everywhere and then a few washcloths with clean water to wash it all off and then dry them, really dry them. I would certainly expect no less if I were the patient that needed full cares.

Now as a nurse I do not have the time to do bathes because I have high amount of patients to care for, but if I do have time I will help to clean a patient after BM etc. I take it seriously because an unclean patient has an increased risk of skin breakdown and skin breakdown is not pleasant or easy to heal and is very easily preventable. The nice thing about our facility is that when someone is bathed they also get a full body assessment by a nurse so I see first hand that our CNAs do a fantastic job of bathing our patients.

[bashiera]

When I give a patient a full bath, I cover the bases I do in the shower- PTA (pits, tits, @ss), feet, behind ears, face, and for patients, skin folds. The hospital I do clinicals at as no-rinse soap so I use that if the patient is totally bed bound, washclothes in soap, then a clean water basin to rinse, then plenty of towels. I make sure their peri-area is free from feces or urine, and make sure it's covered with a nice layer of barrier cream. When I wipe their bottoms after they go to the bathroom, I often wipe up residue left from the last person to clean them, but I always make sure they're clean because I know how gross I feel if I don't shower the important bits at least everyday, let alone a week! Just last week I was cleaning an obese male patient and I retracted his foreskin and saw just tons and tons of smegma behind his foreskin. I felt so bad for him that nobody cleaned him fully before me. I know it's not the most appealing thing to do (clean the glans of an uncut male) but it's an important area to keep clean, and pericare is so important for females because UTIs and lady partsl infections are rampant in facilities because 'it's gross' to clean them well down there. COME ON PEOPLE. It takes 3 minutes to wipe them down well after they BM or urinate with bath towels or a wash cloth, and they'll definitely appreciate it. Things like deodorant, getting their teeth brushed and cleaning their dentures/partials really makes people feel a lot better when they're ill or in a facility.

So, if someone tells me in report they were bathed, I expect clean bottoms, clean pits, clean faces, brushed teeth, barrier ointment to the butt and peri area, and washed/combed hair, and a happy clean patient.

[tiredtech]

i can sympathize with the dilemma of being stretched too thin! we have all been there. my unit has very few "walkie-talkies" and many total/turn patients. oh neuro. if they are ambulatory, it's usually a seizure or altered mental status patient - still a fall risk to assist up to the bathroom. we have just over 35 beds and if we're full with only two techs, it can be a total nightmare. on those days my survival strategy is to put all the towels/gown/linen in the room at the beginning of shift, so that i'm ready to bathe the moment the patient has a bm. we can't do it all. but if you say you bathed, please have really bathed, you know?

quote]i came across a patient once who received a "bath" full of baby powder. instead of just cleaning this patient like one normally would before bed, this cna was so lazy they thought the baby powder would suffice for peri-care. it was beyond disgusting.

yes! we definitely have those who love using powder on our unit. oddly, this is something everyone denies doing. it's terrible when i move the bed pads and a visible cloud of powder erupts into the air. gonzo1 made an excellent point

it gets in the lungs and can cause pna.

i wish we would remove baby powder from the floor. you'll encounter patients with thick paste in skin folds from all the baby powder or nystatin caked on. it's difficult to scoop and scrub that off without irritating the patient's skin - especially when it's nystatin and the skin is so raw and tender underneath. (interdry fabric anyone? that stuff is amazing.)

it seems the logic is: baby powder smells good, smelling nice = clean.

i wish the nurses had to do full body assessments after baths. having that accountability would help so much. when the only other person that will see the state of the patient is the next tech, there's not a lot of external pressure to do the job.

[Ellie S.]

I found this very often, and when I used to work as the charge nurse, I had no problem giving them a piece of my mind, and writing them up if the problem persists. Although I do believe in keeping a good relationship with the aids and other staff, I experience a lot of laziness & that I will just not tolerate. I've been an LPN for more than 20 years, and I bust my @$$.

[Ellie S.]

If you cannot adjust to being stretched too thin, than nursing is not for you. No disrespect among aids, and this is not toward anybody directly on this post. Just if aids complain about the workload, they have to "figure it out" just like every LPN and RN has to do!

[ComeTogether, LPN]

That is just nasty! We don't allow ANY powders in our facility.

What about nystatin?

[8jimi8ICURN]

Here's a game i learned in the STICU in Columbia. Speed bath. You may prepare your soap water, towels other linens and completely bare your patient. Time begins when water touches the patient. Time stops when you raise your hands and say hands off.

2 people. patient must be dry.

My best time with a gastrostomy dressing change included is 4minutes and 30 seconds. that is top to bottom, front and back, with good peri care-- including cleaning the foley. AND deodorant roll on.

[MedChica]

Smegma?

That's not showering. Some people just aren't doing the pericare correctly.

'Icky and gross' have little to do with it and I'm sure that anyone with a weak stomach wouldn't be an aide to begin with.

They're not going to listen you.

It's helpful to have them in the room with you on shift. If you do your job correctly, they'll be inspired to as well.

I was giving orientation to this new aide. He says, "You guys really change them." He told me that some people at his prior facilities don't even change the residents.

I said, "Well - they're wet, so...y'know... I wouldn't want to be laying in pee all morning. I don't see how such a thing could happen at your other place with nurses around. So, they never said anything about the entire hall smelling like pee or...? Because you can smell a pi-ssy diaper, y'know?"

He shrugged.

"Well, the aides were lazy...yeah. But it sounds like a bad situation from the top on down. One doesn't do their job. The other just lets it persist. No teaching, counseling, giving the inspiration to do a better job....no boundaries. Those people were just a reflection of their leadership. When groups of workers are 'ate up'...it's usually because their leaders are 'ate up'. So, of course, they would be."

He laughed. "Yeah..."

It was good, though. I think he was testing us to see what would/not be allowed. Some personalities do try to get away with doing the bare minimum, y'know.

If I'm paralyzed one day, I hope someone is reeeeally cleaning me to make sure funk isn't building up somewhere on my body.

Are you kidding? You will likely only deteriorate further.

I would NEVER go to a nursing home or other area long term.

Give me a homecare nurse/aide or you might as well put a bullet in my head. LOL Swear to God, everytime the aide flipped me over to change me? I'd use all the strength in my head to topple prone and suffocate myself in the pillows.

The aides would be like, "No, Ms -- she's doing it again!!!!"

LOL

Let's be honest about things.

There are dedicated aides/techs. Everyone who began is, but the nature of the job burns a helluva lot of people out. Something happens to them. That's why retention is so low.

We're 'task-oriented' to begin with...and the more ppl you have...coupled with the less time that you have to do anything translates to people cutting corners to get things done. Sometimes, they have to.

Now, not doing peri is not excuse. I'm talking about big tasks.

The aides that I work with perform pericare 1-3 times a day. Why not always?

Some pts (males) are heavy, sleep in low beds and are in gerichairs. They're limber and when you need to keep them dry and press on to the next? It's faster and less of a strain to recline that chair, back it against the wall for leverage, toss those legs up and slide that brief under than to be picking these people up and down 10 times a day.

So, they do pericare: When they get them up for the day and when they lay them down for the day.

None of my people have this issue. They're W/C bound. The heavy ones can be moved all over the bed. The gerichair lady that I do have? I can gather her up and transfer myself. So, I pick her 'up and down' because she's light. I'll put her down for her naps inn between meals because she's old and needs her sleep.

I try my best to care for these folks because I know that they're not happy to be there. Would you? If it were me? I'd want someone to clean me properly. I sometimes have to give a modified 'wh..re bath' to 2 of my ladies because they have heavy loose stool and well...it gets in the crevices. It's a stench that regular water and even my periwash (when we have it on stock) can't get out.

Get a cup of water a 3 dimes of antiB soap and get to scrubbing.

It doesn't even take that long. Surprisingly, the soap comes off without going through buckets of water to rinse. I don't even need bath towels.

Showering? If I can get them into the bathroom, they're showered well. Sometimes, if I'm alone I'll give the big ladies a bed bath...but I can only do 1 per day b/c it takes up a lot of my time. Some will work that pt lifter/arm pulley thingy (can't recall the name of it right now. goes to show how much I use it, huh) alone. I don't. It doesn't feel safe and I fear dropping them on that floor.

I'll usually leave the hair for the weekdays. They shower her, so they'll get what I missed.

Sometimes, well...'recently' we haven't had time to shower or do nailcare on our residents. It's been 3 of us and I'm the PRN working 8 hours but I usually stay for 16. No one comes in to help out. So, if I didn't stay? There'd be 2 aides on the floor.

When it comes to that?

Your main goal is to keep them dry.

[rn2be73]

I work in a facility that gets mostly rule out for chest pain and most of them are ambulatory and there for a 24 hour observation stay. I offer them a shower and set them up with supplies or if they arent feeling up to a full shower..offer them a sponge bath. Most of them say i would rather wait till i get home..i chart that i have offered and that they declined. a bedbound pt is a different ballgame altogether....take 10 minutes tops to do a bed bath and a complete bed change with clean gown!!! I have a tough time doing a bed bath when there are 14 relatives in the room and they WILL NOT LEAVE!!! i have asked as politely as possible...do you REALLY need to see me give mom/dad/grandma/grandpa a bath!!!??? we do however have one nurse that WILL NOT take no for an answer....it does not matter how many times the pt refuses me and then consequently her....her way of thinking is EVERYONE MUST HAVE A BATH EVERYDAY NO MATTER WHAT!!! While i do realize that people feel better when they have had a bath...must we bully them?

[arallenrn11]

I'm an RN working night shift on a med/surg tele floor. Recently our hospital cut tech staffing. Frequently we have 1 tech for 12 patients. This is unacceptable. That being said, many people blame short staffing when things don't get done or done properly. Quite often I find people are just lazy or uneducated. Sorry, but it's true. You can't tell me that not one of the people the OP spoke with was unaware they had to retract the foreskin. That's bull. And as for the others who didn't know, they need to be educated. Make sure you chart in detail everything you do and report incidents such as these to your charge nurse. Report it every time it happens. If nothing changes, go up the chain of command. In my opinion the most important task the techs have is cleaning, changing, and repositioning (I feel nurses are responsible for this also BTW and I do this for my patients whenever possible). If nothing else gets done in a shift, that has to get done. If it's not, what are they doing? Also, short-staffing is not an acceptable excuse. If there are 12 patients on a unit and 1 tech, try and get half bathed and alert the oncoming shift as to which baths weren't completed so they can do them. This way everyone gets bathed in a day. Since the staffing cuts I have noticed more and more patients who are in soaked briefs and who stink when I come on. Quite frankly it ****** me off. And the fact that no one at least mentioned that so and so wasn't bathed tells me they didn't even notice. That's what I mean by lazy.

[Sadala, ADN, RN]

I'm a new nursing student but I was hospitalized for about a year (not all at one stretch, but I spent about 3 mos hospitalized off and on during that year). I was ambulatory and if I told the nurse I would get my own shower later, or tomorrow, or whenever, I MEANT it. Trying to bully me would have been a bad idea.

On the other hand, I spent two years providing in home care to a quadriplegic. We did mostly showers for him, but bed bathing as well. And basically, I bathed him as I would have bathed my own child in similar circumstances. It's so important for the prevention of UTI's and skin breakdown.