Vol. 8 •Issue 6 • Page 18
Bed Baths: A Patient’s Perspective
This DON’s story illustrates the importance of providing comfort, privacy and dignity to patients.
In nursing school, I learned that bath temperature and patient privacy are two of the most important considerations when bathing patients. I have also stressed these two areas when teaching staff at my facility. But, from my experience as a patient, I can tell these are the two areas that are the most ignored.
I’d been giving bed baths for 30 years, but a catastrophic illness reversed my role from director of nursing to patient. This illness left me on the receiving end of bed baths over a two-year period of time spent in the ICU, a step-down unit, a rehab center, and eventually, at home. This experience taught me a lot about bathing that I’ll never forget.
I had just awoken from what I refer to as my “long winter’s nap,” an 18-day coma. I could only move my head, and with a vent tube down my throat, I couldn’t speak.
During this time, the first bath I remember receiving was from two RNs who stripped me naked and filled a basin with water, all while talking to one another about their evening activities. They had shut my room door to give me privacy, but while I was lying there naked, someone opened the door every few minutes to ask one of the nurses a question.
These nurses rolled me, turned me and washed me with freezing cold water, without drying me as they went along. I can remember feeling intensely cold as they finished talking about their plans. Not once did they speak to me. They laughed, spoke to everyone who opened the door, and took all of their overhead pages from my phone—all while I was still naked. I tried to get their attention by looking into their eyes, but it didn’t work. I felt like a piece of meat in a locker, being turned, wet, dried and hung on a hook to sell. It was devastating.
Bed baths of this sort continued day after day. One morning, I was set up for a bath at 10 a.m. After the nurses stripped me, they gathered their supplies, and I was cold again because one of the nurses had adjusted the temperature of my room to accommodate her hot flashes. I lay there until 11:15 a.m., completely naked, with no blankets covering me and no call bell (but I couldn’t have used it anyway, due to my paralysis). The nurse came back into my room, never said a word, and began to wash me with the basin of water that had been sitting out for over an hour. As I was getting wiped down with freezing cold water, I could tell she was mad because she was behind on her duties.
Just then, at least six to eight nurses came into my room, carrying a birthday cake for the nurse who was washing me. They sang happy birthday to her, lit candles (that they weren’t supposed to light), talked happily to each other and left the room, telling her they would all be waiting for a piece of cake when she was done.
There had to have been a look of sheer devastation on my face, but none of them looked at me the entire time. Needless to say, my bath was finished. It never really started with warm water anyway, so I was relieved to get some covers on and get warmer.
After the vent and tube were removed from my throat, I complained about these awful baths. Once I could talk, I was able to ask for warmer water, a warmer room and I offered to do some of my own bathing. I was rarely allowed to do my own bathing because it took too long for me to wash myself. The nurses said they would wash me much faster and get out of my room quicker if they did the washing. I had a huge abdominal wound, both feet wrapped, a Foley catheter and an ileostomy, so there wasn’t much left that they could get wet. It should have been a fast bath no matter what.
I received the best bed baths from my home health aide and from the nurse’s aides at the facility where I used to work (where I spent nine months in rehab). I’m not sure if this was because I taught my CNAs correctly, they’d received great aide training from someone else or if they were afraid to give their DON a bad bath. Whatever it was, it worked.
They tested the water with a bath thermometer and their elbows. They always covered me during the bath, except for the part of my body they were working on. They actually looked at me and talked to me during the process. They let me help where and when I could. If I couldn’t help, they didn’t consider it a problem.
Now that I’m at home, I have a new piece of equipment for bathing. It’s a body vacuum device that contains liquid soap on the inside and has a holding tank for clean and dirty water. It heats the water to the temperature setting I have chosen. I use the machine to spray on the soap and water and then vacuum it off, almost leaving me totally dry as I go along. I love this machine because I can even wash my own hair quite simply with a special nozzle adaptor. It keeps all of my dressings dry, because I only apply the water where I want it.
This type of machine is perfect for bed baths because it gives you the correct water temperature, and eliminates basins (which can spill) and bars of slimy soap (which should never be used on more than one resident because they can cause cross contamination). It would also be great for bariatric residents who have a difficult time getting out of bed, or residents that have large surgical wounds that should not get wet. It is such a pleasure to take my bath when I want it, and not have to rely on someone else’s schedule.
BATHING THE RIGHT WAY
While this machine has made bathing easier for me, there are always ways to make manual bed baths easier for patients. If you are teaching staff how to give a bed bath or giving one yourself, remember a few key points.
Preserve dignity. Make eye contact and talk to patients, even if they can’t respond. Show them that you respect them as human beings. Treat people how you’d like to be treated.
Check water temperature. Test the bath water with a thermometer and your elbow to make sure it isn’t too hot or cold. To determine the correct temperatures, check your facility’s policies and your state regulations as temperatures may vary among states and facilities. Encourage patients to tell you what temperature they prefer, if they can.
Maintain a private environment. Just shutting patients’ room doors doesn’t give them privacy. When you’re giving a bath, it isn’t appropriate to conduct other activities or to socialize with co-workers. If other co-workers interrupt you while you’re bathing someone, remind them about the importance of privacy.
If your facility has privacy curtains in individual resident rooms, use them. This will avoid exposing your resident if someone does come in during your bathing time.
Keep patients comfortable. Cover patients and keep them warm at all times, even if you have to raise the room temperature beyond what is comfortable for you.
Let patients help. If patients are able and want to help, let them. While this might take more time, it helps them feel like they are regaining some of their independence, which ultimately enhances quality of life.
Beyond these recommendations, provide the best quality of care that you can. Take it from me, when you’re on the receiving end of care, you experience it on a whole new level.
Sherrie Dornberger is president of the National Association of Directors of Nursing Administration in Long-Term Care, Cincinnati, Ohio.