The "Bath Wars"

[skd1019]

I work in a 40-bed inpatient hospice setting, and our ongoing "bath wars" have me frazzled. Our nursing assistants complain constantly that the NA's on other shifts don't do their fair share of patient baths. (The current policy is that day shift NA's do odd-numbered rooms, evening NA's do even-numbered, night NA's bathe patients who are LOC 4.) However, fingers still point at other shifts, and a lot of grumbling goes on. Shift RN's are also now reporting that the NA's are so relentlessly focused on cranking out their required baths, they are glaringly unavailable to help with the unscheduled tasks that come up each day (answering call lights, feeding patients, helping to the bathroom, etc.)

My opinion is that most hospice patients do not need a full shower/bath daily. (Special circumstances aside.) My initial idea is to make the general rule that all patients get the basics (hands/face/peri/underarms) daily on each shift. The shift RN can then delegate to the NA which of his/her patients need a full bath. Any other ideas/comments? Help me end the "Bath Wars" once and for all!!

[webblarsk]

Sounds like a good idea to me. Not many terminal pt's do enough in a day to require a daily bath. Unless they are sweating, have vomiting/diarrhea. Sometimes its harder on them to have a full bath instead of just hitting the important areas. I don't work for a inpatient hospice but I still agree with ya!

[Nalini]

I personally like what we do at our facility, maybe it would work for you. We have a Bath book for NAs to chart in that has a schedule for every resident's bath. Our facility does baths every other day for each resident unless they request everyday (few do). I think it's odds and evens, but they are almost all done in the morning. Our facility isn't realy hospice but I thought the information might be helpful.

Nalini

[hospicenurse]

You do have a difficult task. I've never worked inpatient hospice so I don't have that experience to share, but my suggestion is to find a way to empower the NA's, who arguably are some of the most unrewarded, unappreciated of health care workers. I would try letting them find a way to solve this problem - maybe choosing an NA from each shift and have them meet periodically with nursing and being part of the decision making process.

Gail

[Tweety, BSN, RN]

Good idea Gail. Let them come up with the solution.

Be aware that they may try to talk RNs out of a bath if it's not daily. "That patient doesn't need a bath, I don't care what the RN says" kind of deal. Or they might try to manipulate the RN "you don't really want me to disturb Ms. so and so and give her a bath do you?".

Good luck.

[ncamille]

Every day? Most LTC's I've worked in did baths twice a week. The one I work at now does them only once a week, and we have a dedicated bath team. It really bugs me. A lot of patients need at least 2-3 times a week. Every day seems excessive, unless the patient requests it.

[leslie :-D]

has anyone asked the patient if they want a bath?

given the fact that they're in hospice, i would think it to be a major activity that is probably extremly tiring and maybe even painful.

this is not your qd population you're dealing with. they have special needs that should be taken into consideration. for the most part, there's absolutely nothing wrong with a bed bath.

but i maintain, it's the patient who should be asked and shouldn't be anyone else's decision.

leslie

[payo]

The facility I work at has a 50% hospice census. The residents are showered on a bi-weekly schedule by the facility cna's. The hospice home health aid does showers according to a schedule given to her by the hospice RN. If the resident gets more that 2 showers a week then great! We have to remember, it is all about the resident, quality not quanity. If the na's refuse to do showers, assigned tasks, maybe they need to go elsewhere!! As Licensed Nurses,either RN or LVN, WE are RESPONSIBLE for the direct supervision residents AND of the front line staff (cna, na's)!

[bellcollector]

I have to agree with both leslie and payo. Ultimately it should be the pts choice. If the ancillary staff do not want to do the job hired for they should seek employment elsewhere. It literally makes my heart hurt to think that if I were ill and dieing the people who were hired to care for me would be bickering over providing what can and should be a comforting and soothing bath. How demeaning.

[Chad_KY_SRNA]

What we do at my LTC facility is two per week, Day shift does 7-8 per day, Evenings do 7-8 per day, night shift does the ones that don't know if its night or day. We were doing three per week and I absolutely hated it.

[Nurse Hatchett]

We also give baths twice weekly, on all three shifts, used to have a bath aide, but recently changed this. I don't deal with all hospice, but some of my patients are hospice and dealing with geriatrics, a lot of these older people are from the day when you only bathed weekly, to them getting a bath qd would be traumitizing, it's hard enough to convince some of them to go twice weekly!! :argue:

[Chad_KY_SRNA]

Can you legally only bathe your patients once per week? In Kentucky we have to bathe our residents twice a week.