First printed July 4, 1997, this piece was a favourite of the third Facts & Arguments editor Katherine Ashenburg: "I think I've thought back to this one and quoted it more often than any other Facts & Arguments essay I published. Vicki Niblett's lament for the humble bed bath - an apparently simple procedure that permits the skilled nurse to assess her patient, and the frightened patient to ask the questions that preoccupy him - is a little classic about the art of healing."
My boss came back from a meeting the other day with a sad piece of news. Apparently, the movers and shakers in the "New Order Health Care" have decreed that registered nurses will no longer be giving bed baths to their patients. Instead, multiservice workers with a couple of weeks training will be ensuring that patients who need help are clean.
That would work well if what is being done means only cleaning the patient. But the humble bed bath serves a much broader role in the overall healing process. In the 30 years I have been nursing, I've done thousands of bed baths, and I've always found that this is the time I can carry out all of the elements of nursing.
A bed bath is the ideal time to carry out a complete assessment of my patient. A postoperative bath lets me check the incision, look for blood that may be oozing down under my patient, monitor his pain and identify potential problem areas. I can assess the functioning of the woman who had a stroke. Is she able to move her paralyzed hand a little more, or has she lost more function in her leg? Is the skin on her coccyx breaking down into a bed sore? Postpartum moms can be checked for bleeding and bladder distention which may interfere with healing. Bathing her baby lets me check for a wide variety of problems and reassure her that the child is normal and healthy. Ideally, I like to do a baby bath with the mother so that I can combine it with the health teaching she will need to care for him at home. This is particularly important now that postpartum hospital stays are so short and many new moms have little or no support at home.
A thorough assessment lets me plan the best care for my patients. A bed bath is the ideal time to make sure that my goals for the patient and his own goals are the same. All the nursing and medical care in the world won't help the patient if we are headed in different directions.
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A lot of other elements of nursing intervention can be incorporated into a bed bath. Many of the important things that nurses do are preventive. (This makes nursing hard to measure -- how do you count the number of bed sores that didn't happen?) While I'm giving a bed bath, I do the skin care that prevents bed sores, the "range of motion" exercises that prevent contractures, the moving and coughing that prevent pneumonia and the leg exercises that decrease the risk of deep-vein thrombosis.
Giving a bed bath also creates an excellent setting for my patient to discuss his fears and hopes and concerns. The closed curtains give a feeling of privacy, the repetitive and ritualized movements of the bath provide a reason for closeness. In that environment of privacy and closeness, my patient can let down the barriers and ask the questions he really wants answered. "Will I walk again?" "Can I have sex again?" And most important: "Am I going to die?"
Almost all patients are frightened. They are frightened of the hospital setting, they are frightened of the consequences of their diagnoses, and they are frightened of possibly losing control. The impersonal closeness of a bed bath allows patients to discuss and examine these fears. I don't always have answers for them; indeed, they often don't want answers. They do want a chance to talk about things. Supportive listening gives them a chance to confront the demons and manage them a little better.
Bed baths also make patients feel more comfortable physically. It is hard to deal with difficult situations if you are sweaty and sticky and wrapped in crumpled, smelly sheets. The person who is clean and combed and shaved, positioned comfortably in a smooth bed, feels better and is able to cope much better. And I get a feeling of personal satisfaction from looking at this comfortable person and knowing that I brought it about. It is immensely rewarding.
Finally, it is during a bed bath that I can evaluate how well the present plan of care is working. Is the skin more or less red? Is the urine clearer or cloudier? Do we need to change our approach or continue with what we are doing?
I like giving bed baths. It is a time when I can use all my skills to nurse the whole patient, and I will be sorry to lose that. Multiservice workers can probably get my patients as clean as I can, but who will do the rest?
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