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What has happened to simple, basic care???

I have noticed and been informed by many of the nurses I am working with that a bath, either a full bath or a partial bath, for the patient is not important. Must be true, I have given at least 4 baths every night I have worked this week. Oral care is a dying art. Come on nurses, lets hear how it is done where you work. I cannot be the only nurse who thinks baths are just a part of patient care, and even if it's done at 10:00am or 22:00 pm, it is necessary for comfort, promotes good skin care, allows you to assess the patient, and helps build a bond with the patient. :nurse: :nurse: :nurse:

Antikigirl, ASN, RN

Specializes in Education, Acute, Med/Surg, Tele, etc.

I believe in that being important as well! However, the probelm seems to be one of time/money in most facilities now a days.

It seems that facilities really need to make this a priority with the number of staff to handle it! Many times in my shifts I can't get the time to feed a patient let alone bathe them...and it is a juggling act to just get meds done. This is silly! Facilites...especially places that charge thousands of dollars for a stay a day...should have staff that does oral care/baths/gen hygeine for patients unable to do that on their own! Whether this means lower ratios for the nurses, or hire more CNA staff to cover patients basic needs more throughly!

Basic hygeine is very essential, makes the patient feel better, patient families will certainly be happier (that is one of the number one complaints I hear..."oh my father isn't shaved...or, mom's dentures stink, don't you guys clean them???". It reduces skin issues or infection (especially oral care!) and sure does a good job with PR!

I never sit idle, if I have time I have at least gotten warm wash cloths for people to refresh themselves (which seems very appreciated...like being in first class on a airplane...really shouldn't be that big of a deal...but it really seems to be one to the patients) if I am strapped for time. It sure makes a difference when I do this :) at least!

LilRedRN1973

Specializes in ICU, psych, corrections.

I love bathing my patients. This is just one of the many reasons why I chose the ICU. I consider bathtime very important. As the original poster stated, it's a bonding time for me and my patient. I worked last night and spent 45 minutes bathing, shaving, and brushing my patient's hair and teeth. He looked quite spiffy when I was done and I found out more information about the little guy. It's not often I get a chance to converse with my patient since most of them are vented, sedated, or chemically paralyzed. But I get a feeling of satisfaction when I give my patients a thorough scrubbing and/or keep their mouth clean all shift. It frustrates me to get a patient's mouth looking halfway normal, then come back the next night and it's back to square one because the nurse who followed me didn't bother to do oral care all shift.

I always think about how much better I feel after I shower when I've been sick for a while and that motivates me to give my patients a good bath. I have a little bag with good disposable razors, nice lotion, hair ties (that aren't going to yank a poor girl's hair out), and linen spray for my patients. It's the little things that can make a difference, even if that patient is dying. We had a donor one night who was the mother of 3 children. I knew when the children would be saying their goodbyes, they would be leaning over their mother's face. She smelled like that of someone who was dying. I took some perfume, sprayed it on a 4X4 and slipped it under the sheet near the woman's face. The daughter leaned over, sniffed, and thanked me for making her mom smell good. Basic care is still alive and well.

Melanie = )

when i was in the hospital i could not shower...i was hooked up to two ivs on in my hand/wrist area on my right hand and one in my left foot/ankle area and i was in the hospital for five days. i could not get to the bathroom on my own because i needed my iv unhooked and also since i had an iv in my ankle i could not walk to the bathroom so i needed to get into a wheelchair (to go about 5 or 6 yards no less) but the nurses did not clean me...i mean when they would bring me to the bathroom while i was in there they would change my sheet that goes over the sheet that is on the bed a kind of cover sheet. then a certian one would wash my bum area to make sure it was clean the others just wiped me and brought me back to my bed and helped me get comfterable. but the only part of me that was washed was my bum and that was only one nurse. my mouth was not cleaned (yes i could have done that my self but when you are doped up on phenlphalene (spelling) you do not think of that kind of thing.)

" We had a donor one night who was the mother of 3 children. I knew when the children would be saying their goodbyes, they would be leaning over their mother's face. She smelled like that of someone who was dying. I took some perfume, sprayed it on a 4X4 and slipped it under the sheet near the woman's face. The daughter leaned over, sniffed, and thanked me for making her mom smell good. Basic care is still alive and well."

Melanie - that is the most heartening thing to hear! I've been hospitalized several times in the past 5 years and it would have been nice to feel fresh in ICU. We need more nurses who feel this way. Technology is important, but people are still people when they're sick.

Eileen:

justjenny

Specializes in NICU- now learning OR!.

it is necessary for comfort, promotes good skin care, allows you to assess the patient, and helps build a bond with the patient. :nurse: :nurse: :nurse:

I think no one will disagree with you! I am a GN and during my nursing school rotations I got to see many different institutions and different nurse/patient ratios!

My last rotation was on a Med/Surg unit at a local hospital. It was not uncommon for a nurse to have 7 patients! The "norm" was usually 5-6 patients. As we all know Med/Surg is a variety of patient types...from the 90 yr old with sepsis in SWR who is "complete care" to an end stage cancer patient in extreme pain to a 30 yr old with acute mental status changes. It was the nursing assistants job to give baths, otherwise there is NO WAY it would ever have gotten done! These wonderful nurses RAN THEIR BUTTS OFF (as did we)

I, too have chosen an ICU situation because I feel that they are better staffed and the RN can provide better care. (this is my opinion only)

Jenny

I'm not a nurse, I'm a PCA right now. I work the 3-11 shift and you would not believe how many patients tell me they've been there a week and have never had or even been offered a bath! However, there is just not even time for the poor aides on the 7-3 shift either sometimes. I would LOVE to be able to give baths to my patients but I hardly have time to eat on my shifts.

When I help people up to the bathroom I make sure their peri area is as clean as it can be and I try to get their legs and tummy area so they at least feel a little cleaner. It just sucks that there isn't enough time to give each patient a nice full bath. :(

I love bathing my patients. This is just one of the many reasons why I chose the ICU. I consider bathtime very important. As the original poster stated, it's a bonding time for me and my patient. I worked last night and spent 45 minutes bathing, shaving, and brushing my patient's hair and teeth. He looked quite spiffy when I was done and I found out more information about the little guy. It's not often I get a chance to converse with my patient since most of them are vented, sedated, or chemically paralyzed. But I get a feeling of satisfaction when I give my patients a thorough scrubbing and/or keep their mouth clean all shift. It frustrates me to get a patient's mouth looking halfway normal, then come back the next night and it's back to square one because the nurse who followed me didn't bother to do oral care all shift.

I always think about how much better I feel after I shower when I've been sick for a while and that motivates me to give my patients a good bath. I have a little bag with good disposable razors, nice lotion, hair ties (that aren't going to yank a poor girl's hair out), and linen spray for my patients. It's the little things that can make a difference, even if that patient is dying. We had a donor one night who was the mother of 3 children. I knew when the children would be saying their goodbyes, they would be leaning over their mother's face. She smelled like that of someone who was dying. I took some perfume, sprayed it on a 4X4 and slipped it under the sheet near the woman's face. The daughter leaned over, sniffed, and thanked me for making her mom smell good. Basic care is still alive and well.

Melanie = )

You are an angel Melanie. God Bless you!

CseMgr1, ASN, RN

Specializes in Case Management, Home Health, UM.

It went out the door when Managed Care took over, like everything else. When I was hospitalized seven years ago with pneumonia, no one even asked or offered to help me bathe during the three days I was tied down with an IV. Needless to say, I STUNK by the time I got home, and I couldn't get into that shower fast enough!!

Tweety, BSN, RN

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

I had four patients by myself the last time I worked and was fortunate to be able to give four baths. I agree, bathtime is good time.

The day before I was by myself and started with four patients, one of whom was climbing out of bed and incontinent of bowel, then got a 5th patient at noon. By the time 3pm came around I reported to the evening nurse that two of my total care patients did not get their beds and bath due to being overworked and not having the benefit of a nurses aid in my assignment.

I'd love to give total complete basic care 100% of the time, and I feel guilty when I can't.

Unfortunately, good hygiene went out when the bean counters decided that 1 aide =1 nurse, when it came to staffing.

On our floor, if we had an aide to help with personal care for the patients, then the floor was shorted one RN by the staffing department. :angryfire

Marie_LPN, RN, LPN, RN

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

I tell ya, that is one thing that chaps my hide (one of thousands i'm sure) is lack of mouth care. I've lost count HOW many times a pt. has to receive mouthcare in the OR before they can be intubated, it is THAT gommed up. :angryfire: I am aware that there are some pts. whose mouths get nasty in no time after mouthcare, but the ones i've seen lately, it's quite OBVIOUS it's been a long time.

And don't get me started on filthy bellybuttons!! :angryfire:

I'll never forget the woman (basically unresponsive) who we thought was Hispanic, when in fact she was Caucasian, the tannish skin was from DIRT. She'd come from a NH that day, apparenty no full body bath in a long time. And judging by the raging yeast infection, no recent PTA baths either! :angryfire

I get so angry with some of the staff where I work...they just don't care to do too much of anything. And unfortunately, good workers are hard to come by in LTC (some areas), so management keeps whoever they can.

I have written up so many and counseled many more about proper care with bathing and oral care.

I usually end up doing many baths and potty breaks myself during the day and get far behind myself with my own work, but my patients are so much more worth it......

I love bathing my patients. This is just one of the many reasons why I chose the ICU. I consider bathtime very important. As the original poster stated, it's a bonding time for me and my patient. I worked last night and spent 45 minutes bathing, shaving, and brushing my patient's hair and teeth. He looked quite spiffy when I was done and I found out more information about the little guy. It's not often I get a chance to converse with my patient since most of them are vented, sedated, or chemically paralyzed. But I get a feeling of satisfaction when I give my patients a thorough scrubbing and/or keep their mouth clean all shift. It frustrates me to get a patient's mouth looking halfway normal, then come back the next night and it's back to square one because the nurse who followed me didn't bother to do oral care all shift.

I always think about how much better I feel after I shower when I've been sick for a while and that motivates me to give my patients a good bath. I have a little bag with good disposable razors, nice lotion, hair ties (that aren't going to yank a poor girl's hair out), and linen spray for my patients. It's the little things that can make a difference, even if that patient is dying. We had a donor one night who was the mother of 3 children. I knew when the children would be saying their goodbyes, they would be leaning over their mother's face. She smelled like that of someone who was dying. I took some perfume, sprayed it on a 4X4 and slipped it under the sheet near the woman's face. The daughter leaned over, sniffed, and thanked me for making her mom smell good. Basic care is still alive and well.

Melanie = )

I am a nurse and as a nurse/patient I recall something that still sticks with me.

I had been in a major fire. My dx was smoke inhalation. I was in ICU and while the RN was doing an assessment I mentioned that it tasted and felt like I had sand in my mouth. I would have loved nothing more than a shower and to brush my teeth. He handed me a cup of ice water and told me to swish and spit, since I was NPO.

His clinical skills were beyond superior. He picked up on what I, as an RN/patient didn't pick up on. He was on the money. But darn! I would have traded my eye teeth for a toothbrush.

I did swish and spit but then I told him.. that didn't cut the mustard. Please, a toothbrush? I'd give him money, honest I would! :) Nope, no time for that.

I had smoke, soot, and fire extinguisher dust stuck between my teeth. I would have paid serious money for a toothbrush and an itty bitty tube of Crest Toothpaste. Even generic toothpaste would have sufficed! Okay, shampoo too. My hair was covered in fire extinguisher dust. It itched too.

I got ice water. It's just not the same.

That was a verrrry good lesson for me. I am VERY careful to assume my patients can taste their own mouth, even when in a coma. I shampoo their hair, suds them up, do the very best of oral care.

I think sometimes you have to be in the position of your patient before you can seriously, honestly relate to what they experience. It was sure an eye opener for me. While I realize there is no time, we need to MAKE the time.

" We had a donor one night who was the mother of 3 children. I knew when the children would be saying their goodbyes, they would be leaning over their mother's face. She smelled like that of someone who was dying. I took some perfume, sprayed it on a 4X4 and slipped it under the sheet near the woman's face. The daughter leaned over, sniffed, and thanked me for making her mom smell good. Basic care is still alive and well."

Melanie - that is the most heartening thing to hear! I've been hospitalized several times in the past 5 years and it would have been nice to feel fresh in ICU. We need more nurses who feel this way. Technology is important, but people are still people when they're sick.

Eileen:

A big ditto!

I tell ya, that is one thing that chaps my hide (one of thousands i'm sure) is lack of mouth care. I've lost count HOW many times a pt. has to receive mouthcare in the OR before they can be intubated, it is THAT gommed up. :angryfire:

Wow. What else can be said but... wow.

Wow, good hygiene isn't considered important anymore? If that was the case we'd all stink. I worked with an ICU nurse once who told me that a nurse should walk in while the aide is giving a bath to assess the pt. It would be nice because I get asked all these nursing questions that I have no idea what they mean...and I'm studying nursing. They get upset with me if I can't answer their medical questions.

I'm an aide on a med/surg floor, 7a-7p so I get all the baths. I guess I'm old fashioned but I prefer soap and water. Our hospital now has these bath packs. I hate them, I think they stink but I find myself using them because there just isn't enough time to give everyone a old fashioned bath. Sometimes I'm the only aide for 25 patients and there is no way I can do all those baths by myself. Our NM (who admits she doesn't know how to do pt.care) expects all baths to be done by 11a. So, to get 25 baths done, linens changed and rooms straightened up by 11 I have to run around until I have an anxiety attack (no joke). I don't mean to diss nurses as the ones on this site seem to be exceptional, but our floor is notorious for our lazy nurses. Management won't fire them because they've been there too long.

Icky mouths are a pet peeve of mine. Our hospital has gone the cheap route on so many things so now we don't have those special swabs that get all the gunk out. We have these cheap little pink things that don't work worth a hoot. Frankly, I am so sick of walking out after my shift and feeling so guilty that I didn't provide good enough care. I guess that's why I want to specialize in critical care. Hopefully I will get to spend more time with my patients.

Management needs to realize that in order to give quality care we need quality workers, and preferably more of them.

Many nights, I don't even get a chance to go pee the whole shift and we don't get lunch breaks on my shift either. I work my butt off from the time I clock in until after my shift is supposed be to over. I work on an orthopedic/gastric bypass floor (and also all the other med/surg overflow) and we have anywhere from 5-8 patients each. Sometimes, just 5 patients can run ya as much as 10, depending on their needs. We are so bombarded with all the triple charting, 24-hr chart checks & M/SAR checks, that there's barely enough time for patient care at all as it is. This makes me so angry because I went into nursing wanting to actually take care of the patient, not the records. I do agree that skin & oral care are very important!

LilRedRN1973

Specializes in ICU, psych, corrections.

Our supervisor just invested in a Sun Shower. For those who are not familiar with them, it's a portable "shower" you can take camping. We hang the bag full of hot water on an IV pole and then put a hair washing basin under the patient's head. We are able to wash a patient's hair really well this way. We love that thing. It's a much easier way of doing it then using the hair washing basin by itself and trying to get all the shampoo out of the hair.

Melanie = )

i had four patients by myself the last time i worked and was fortunate to be able to give four baths. i agree, bathtime is good time.

the day before i was by myself and started with four patients, one of whom was climbing out of bed and incontinent of bowel, then got a 5th patient at noon. by the time 3pm came around i reported to the evening nurse that two of my total care patients did not get their beds and bath due to being overworked and not having the benefit of a nurses aid in my assignment.

i'd love to give total complete basic care 100% of the time, and i feel guilty when i can't.

i would feel guilty, too. when i was a nursing student and working as a pca, i would run myself ragged making sure everyone got cleaned up. i remember finding a pt at the beginning of my shift with dried hardened poop from the top of her back to her knees when i went in to turn her. i was so angry, i had to stand outside the room for a few minutes to seethe. i reported this to the rn i was working with, and she wrote it up. it took us a good 30 minutes to soak her to remove the poop. another i remember so well is a woman who obviously had sores on her head from not having her hair washed in a few days. i went through 3 of those hair-washing caps just to get it manageable. no wonder she couldn't sleep! even today, as i work in the or, we see people coming to the or from the floors who have not had basic care - like clean hands! while i am perfectly aware that some pts refuse baths, and many nurses don't have the time to give full baths or even partials, it breaks my heart that we don't have that time. giving baths was some of the best assessment (physical, mental, spiritual) time i had as a student nurse.

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