I remember about 6 years ago, it was an abnormally slow day in the ER where I worked. This gentleman was brought in by EMS, more for a social situation, although he did have some medical issues as well. I remember him being so disheveled, unkempt, his beard was nearing ZZ Top proportions, and not because he wanted it that way. He just seemed so 'sad'. He kept apologizing for his appearance, "I am usually so clean shaven but I haven't been well lately." I let him talk as I listened because it seemed to help him relax. When I was done his EKG, and drawing his blood I asked him if he'd like me to help him wash up at the sink and I would give him a shave. He said no at first, "You're too busy, I couldn't ask you"....but he hadn't asked and I was not busy at all. So that's what we did, and I remember his smile and actual tears in his eyes. "Thank you so much, you don't know how much better I feel just being cleaned up a bit."
I was reminded of this today as my Grandmother cried on the phone when I called her in a hospital three and a half hours away, where she has been for a month recovering from bypass surgery. Three weeks. Her hair has not been washed in three weeks. The last time it was washed was three weeks ago when I travelled to see her and I washed it for her. Everyday the nurses go in and get her up to a chair, wash her, change her bed and put her back. And in three weeks no one has had the time to wash her hair. "I know I'd feel so much better if I could just manage to wash my own hair, I feel aweful" is what she told me today.
I've been a nurse for almost 10 years. I know, and I can appreciate the compromises nurses have been forced to make because of cutbacks, lay offs, shortages and overcrowding. And patient care has suffered directly because of it. But I also know that surely to heaven, there must have been 15 minutes in the last three weeks that someone, ANYONE could have spared to wash my grandmother's hair.
I'll be leaving right after work tomorrow to drive 180 miles each way so I can wash my Gram's hair and see her spirits lifted just a bit.
When my Mom was in the hospital, she actually had a nurse stay late and color her hair. Now that was awesome! Unfortunately, where I work, some days just the fact that nobody dies or gets worse is an accomplishment, let alone gets their head washed. I've had to learn to prioritize...bedpan or pt crashing? I'd love to be able to do "total patient care" and meet every little need, but that's just not realistic in a lot of hospitals today. It's sad, this whole "more with less" trend.
I do agree with what you are saying. I know the "realities" of nursing all too well. I worked ER for most of my career, the place where the doors never close and we can never say "We're Full!!!" There's always room at the Inn when you work in the ED. But I also know that most of the rewards I have felt in my nursing career are from those genuine hugs, smiles and tears with "thank yous" that my patients or their families have said over the years, or maybe the joke that a patient told me that cracked me up and the fact that they made me laugh made their day. Sounds corny right? I've come to learn that sometimes the patients don't care if they get their meds at exactly 0800, but they darn sure do appreciate the fact that you washed their dentures for them. Organization and learning to prioritize is essential to surviving in nursing, but learning what's important to the patient and keeping their "entire" well being in perspective sometimes makes all the difference to them. And that's who it's all about isn't it?
I suppose I should just be happy that she survived her MI, pulmonary edema (twice) two rounds on the BiPap, quadruple bypass and a pacemaker insertion due to 3rd degree HB, and I am, I'm eternally greatful for the nurses and doctors who have worked so hard where my grandmother is concerned. But I personally think it's more unbelievable that no on has had time in three weeks to wash her hair, than if someone actually did take the time to do it.
When you go visit her, you will be able to see for yourself, what their set up is like. You would think it is reasonable; at my facility it is. There are many facilities where it would be impossible as sad as that is to say (unless the nurse stays on their own time or OT and management often does not allow the later).
To be honest, I have always involved the family in pt care. It is therapeutic for them and the pt. When there is no family around we do our best to do the private care. Often, it is the fastest method that gets the job done.
We used to have "beauty shop" on night shift for patients going to surgery in am or patients needing hair washing. Someone, usually an aide, would travel up and down the floor with a cartload of haircleansing stuff. I helped, or did the task, several times and it was kinda fun to interact with the patients on a friendly basis. Sometimes the cart was just used to give people the right product and get them into the shower on their own. I would write up that unit because the hair is part of the body and needs to be kept clean!
I know during my clinicals we had to give a pretty good reason to our instructors if one of our patient didn't get a bath or a shampoo. But of course as a nursing student you had a "heavy load" of you had 3 patients, so there was more time. We had a very contracted patient who was very jerky and it was very hard giving him a bath, and don't even think about giving him oral care, he would have jerked his head and got impaled on the toothbrush. He had to get an EGD done, and while we had him in the OR and sedated we decided that that would be the best time to just give this man a very thorough bath and oral care. We all pitched in and it took about 5 minutes. Our CRNA did oral care and was joking around about how he thought thats why he went to Graduate School, so he wouldn't have to give baths anymore. The patient was a cocaine overdose, I don't know if he even knew he was clean, but if he did I hope he felt better. I know the floor nurses appreciated our help, because usually it took 2-3 nurses to keep him from jerking so you could clean him.
Or shaving. A lot of men don't get shaved during their bath either. I asked one nurse about washing a patient's hair and she said "we have to have a doctors order". Has anyone else heard this? I can understand if they are a trauma patient with sutures or whatnot, but not your everyday bedbound patient that can't wash it themselves.
Yeah I have hit that "not without a doctor's order" with head trauma too. But there are ways and ways of washing hair that is not traumatic. Personally my fav is the old plastic bin liner tucked uner the neck with a hole cut in the bottom of the bin liner and tuck it into a bucket. I can give a quick hair wash in about 10 minutes.
As for mouth care - why can't someone invent a combination toothbrush/squirter and sucker???? I have a picture in my mind of a bulb of water on a yanhauer sucker that has bristles on the end. Squeeze teh bulb and it sqirts water in the mouth or place your finger over a hole to suction.
I work in dialysis so I can no longer do bed baths, shampoos or "fluff and buff" pts. Those are my favorite nursing duties- the providing of hygeine and physical comfort for pts. I really miss doing those things.
I recently had a bilateral L3-4 laminectomy with foramenotomies for severe stenosis (the neurosurgeon said he'd never seen nerve roots so compressed in a 44 year old before). Before I get into the care issues, I should preface this story by saying that this is occuring in a "world-class" hospital and that I was on the unit I formerly managed during my post-op stay.
The doc and his nurse were terrific--no complaints there--everything went smoothly and I was prepared well for the surgery. Of course, as often happens, my period started with a VENGEANCE the morning of surgery. Post-op, I had a 6 hour stay in the recovery room due to no beds on the unit. The nurse kept me well-medicated, got me an inspirometer, and helped me change my peripad when I asked. When I got to the unit, I was still feeling pretty good from the Marcaine they inject into the operative area before they close, so I got up and voided, changed my pad and walked the length of the hall and back. Well......all that changed when the local anesthetic wore off several hours later and I began having the most unimaginable nerve pain and spasm in my right hip (due to retraction of the nerve root) and down the leg, as well as in my left leg. I couldn't get into or out of bed using good body mechanics and was absolutely miserable. My IV was also phlebotic and extremely painful. It took 8 hours to get the IV site changed and the resident "wouldn't order anything for the spasm because I had been under anesthesia that day". What a bunch of BUNK! I asked to see the resident, but he never came in. Through that horrible night and into the next day, I couldn't even turn myself over despite q4 hour Percocet. My urine hat was full, and no one ever emptied it--I just would struggle to get into the bathroom (it took WAY too long for anyone to respond to a call light) and sit down in the puddle of urine and let it overflow into the toilet. I asked 3 aides and a RN to help me with pericare since my pad hadn't been changed since the recovery room and I had bled all over and had clots everywhere. Everyone said--"oh, OK, sure, be right back." Of course no one ever bothered to show up. I never received a water pitcher, bath basin, but was finally given a pack of OB pads after asking for help with changing my pad. The day shift RN walked in as I was getting out of bed the morning after surgery and just looked at me like I was a bug and said, "Oh my God....you are a neuro nurse and your body mechanics are just terrible. You know better than that." I promptly growled at her, "RIGHT NOW I AM NOT A NEURO NURSE--I AM THE PATIENT IN SEVERE PAIN, AND I SUGGEST YOU SHOW ME WHAT TO DO!" She jumped back about 5 feet and coached me through getting up and down out of bed. She ran in hurriedly about 2 hours later, gave me some Percocet and had me sign the D/C orders. I never saw her again. When my surgeon showed up the morning after surgery, I simply said, "Fred, when I am not in so much pain and can put a little distance between me and this situation, you and I will talk. Please discharge me--I will get better care at home." He obliged, ordered me Valium, Vicodin, and Flexeril (use whatever works) and put me on a Medrol dosepak when none of the above decreased the pain. The first time I got any care was when I got home and my husband and parents saw the excruciating pain I was in and met my needs. I was so embarrassed that my 70 year old mother was cleaning my perineum and putting a clean pad on me, that I just cried like a big old baby. My family members were awesome in providing me with everything I needed once I got home, and as soon as I started the dosepak, I had relief of the extreme pain within 12 hours so I was able to provide most of my own care.
Now for the best part......some statistics that may blow your mind as much as it blew mine......
The unit was at 22 patients when I was there (23 is max census). Neuromedical, neurosurgical and complex ENT (there were no ENT pts. during my stay). I used to run the unit with the following:
7-3: 4 RNs/3 NAs
3-11: 4 RNs/2 NAs
11-7: 4 RNs
I had to fight for that staffing and went to all the upper management with statistics supporting the addition of RN staff and NAs on nights, but could never get anything for my floor. I left after 2 years because I couldn't take the headbashing anymore. The killer is, this was and is the current staffing on the unit while I was there:
7-3: 6 RNs/3 NAsplus a unit based Case Manager and Social Worker
3-11: 5 RNs/3 NAs
11-7: 4 RNs/2 NAs
My point in all of this is that staffing doesn't always have direct bearing on the care that will be given. Just like the patient who needs their hair washed to feel better (I spent three weeks in a hospital on bedrest while pregnant without washing my hair, so I have some knowledge of how atrocious this feels), controlling pain and making the patient feel cared for is an enormously critical part of what we do. I have worked many shifts "short-staffed", but tried never to let a patient or family member with questions feel as though I didn't have time for them or couldn't meet their basic needs at least. I assure you, the staffing on my former unit allowed for very reasonable ratios, but I felt like I was alone and on my own to meet my own needs. All I know is that we never did that with our patients on that unit when I managed it.
Thanks for those of you who have been patient enough to allow me my rant. It feels good to get it off my chest, and I hope it will make us all a little more sensitive to the needs of our patients.
What this tells me is that if/when I ever have to be a patient in the hospital for any reason - under occupation and employer, I will respond PRIVATE. It's none of their business anyway - it doesn't affect their reimbursement or the diagnosis. No way will I ever again tell anyone taking care of me that I am a nurse. People apparently figure you know how and are able to take care of yourself and that you will understand if they don't help you. I have seen many posts here about how nurses (and even student nurses) are treated when they are patients (being told "you should know better than to put the light on and bother us, we have real patients, blah, blah, blah") CRAP - we pay as much as if not more than everyone else for our medical care - we should, at the very least, get the same care. This is just one more example of nursing's failure to take care of their own.
Suzanne: thanks for telling your story - it was a real eye opener!
It reminded me of the time I was in the hospital on bedrest while preg with my twins. It was extremely difficult for me to move at all, much less clean myself properly. With all the mag I was on I was on, and the 75 plus pounds extra I was carrying I really was sweaty and boy did I need a bath! I found it hard to believe that no one else noticed my dire need of a bath and was stunned that no one ever offered to help me wash up. No one set up my basin for me. It was like the staff feared that asking me if I needed help might open up a flood gate of requests for other things I might need! I washed as I could with a washcloth, but that hardly made me feel clean.
After going to the critical side with a 1:1 nurse/patient ratio I asked my nurse if she could please help me wash. I truly feel that nurse was an angel, she gave me a complete bed bath and washed my hair. I will never forget her kindness, and it made me realize how something as simple as a bath can give a patient their dignity back and that does wonders for their morale and outlook. I took from that experience the importance of seeing things from the patient's point of view. There should be a place to document empathy on every patients flowsheet.
Yeah I have hit that "not without a doctor's order" with head trauma too. But there are ways and ways of washing hair that is not traumatic. Personally my fav is the old plastic bin liner tucked uner the neck with a hole cut in the bottom of the bin liner and tuck it into a bucket. I can give a quick hair wash in about 10 minutes.
As for mouth care - why can't someone invent a combination toothbrush/squirter and sucker???? I have a picture in my mind of a bulb of water on a yanhauer sucker that has bristles on the end. Squeeze teh bulb and it sqirts water in the mouth or place your finger over a hole to suction.
I worked in a facility that had suction toothbrushes. Hooked right up to the suction machine tubing. Our residents had traches and g-tubes and needed really good oral care and they had these great toothbrushes with a hole in the middle to suck out the fluids as you did oral care. Just dont forget to empty the jar afterwards cause it gets really gross if sits a while.
Thanks for those of you who have been patient enough to allow me my rant. It feels good to get it off my chest, and I hope it will make us all a little more sensitive to the needs of our patients.
Suzanne
Thank you.
Hygeine, comfort, and pain relief are so basic. I HAVE experienced nursing staff just not caring. Fortunately it was not my unit. I was registry when observing it and i reported the staff in writing by mail, to the VP of nursing and the unit manager.
We often wash hair. Patients on ventilators get their hair washed weekly unless they refuse. We used to have a "Bedfast Rinser", plastic device with a place for the neck and a trough for the water to run down.
Now we use new trash bags rolled around the exterior and taped under the patients head. With the patient near one side of the bed other trash bags are taped to drain the water into an empty trash can. LOTs of warm water and the no rince liquid shampoo. I pour just enough to dampen the hair, then suds it up. If the patient can help great. Sometimes I can turn the head. Other times one of our care partners helps. Then pouring warm water to rinse. Pushing down on the bed to drain. Over and over until the soap is all out. Then make sure all water is in the trash can. Get LOTs of towels under the head as you remove the plastic. We need help unless the patient can lift her/his head.
If the patient has cream rinse it takes twice as long.
Last do the rest of the bath. Change the sheets (some water nearly always spills) give a back rub, and comb or brush the clean hair.
We have an electric razor for men on anticoagulants. I do sometimes use the razors from the cart. Once a nurse accidentally shaved the "tail" to the ET tube cuff. RT used a syringe to temporarily fix it.
If there are too many admissions, discharges, and transfers, the patient is unstable, or other patients are too unstable we explain and wash hair ASAP. Often if the patient is awake at 3:00 am that is a good time. Oh yes, we tell the patient and family hair is NOT washed every night. (A comatose patients daughter once reported a nurse for not washing her mothers hair. That same nurse had washed it less than 24 hours before!
LaNorteBellaRN
16 Posts
I suppose I should just be happy that she survived her MI, pulmonary edema (twice) two rounds on the BiPap, quadruple bypass and a pacemaker insertion due to 3rd degree HB, and I am, I'm eternally greatful for the nurses and doctors who have worked so hard where my grandmother is concerned. But I personally think it's more unbelievable that no on has had time in three weeks to wash her hair, than if someone actually did take the time to do it.
I don't know, is that unreasonable?