On the Dying Art of the Bed Bath

Joni Watson (@joniwatson) explains why bed baths are important:

I am a fan of cleanliness, but I’d rather not bathe a complete stranger (or acquaintances for that matter). However, as a nurse, I do know that care is part of my responsibility, and I am thankful to the many great nursing assistants who understand the importance of a thorough bath, too. At times, I have rushed through bed baths, thinking of the growing to-do list and soon-to-be announced priorities. On other occasions, though, I have taken my time, even brushing my patient’s hair as though it was my only duty for the day. I know my patients felt my presence or lack thereof in all circumstances.

In nursing school, bed baths were literally the second practical skill I learned, after making the bed itself. Get the warmed bath flannels, the basin of warm water, the soap, the washclothes, towels, lotion, barrier cream; start from the top, (no soap on the face), work your way down, drying as you go, washing from the distal points up, strategically positioning the flannel to preserves modesty; rub the back with the lotion, apply barrier cream to the bony pressure points, paying particular attention to the sacrum and feet; assess the patient as you go; document.

Ta-da. Done: your patient feels like a million bucks and you get a warm fuzzy for doing a good thing.

Nurses will defend the bed bath as the most elemental nursing skill, simultaneously bringing comfort to the patient while establishing a therapeutic bond and allowing us to assess physical and mental condition. Problem is, in the emergency department, we just don’t do them. Or rather, we try, at least for the admitted patients, but are frequently unsuccessful. We get a new, complicated patient. The patient in the next bed is crashing. A code is called. It’s always something, and bed baths as a priority item of care fall off the plate, because at the end of the day, being unwashed won’t kill the patient. The majority of nurses I work with have just given up trying altogether.

It’s a bit ironic. Anecdotally, nurses will tell you of ever-increasing patient acuity taking time away from basic nursing, yet it’s these acutely ill patients who need bed baths in the worst way. When one adds the time needed for the legion of non-nursing-related activities  and documentation that crowd a nurse’s attention, it quickly becomes clear how bed baths are deemed non-essential. Except that they aren’t.

Bed baths — or the lack thereof — are symptomatic of a larger issue in nursing. The integrity of the nursing profession has been under attack for years. We are constrained from being nurses in the fullest sense by time, resources, and  ill-considered hospital policies. Or worse: attitudes. I have known more than a few nurse-managers and administrators — and if truth be told, front line nurses themselves — who think the entirety of nursing consists of a list of tasks to be performed, unthinkingly and uncritically. When nurses start thinking of bed baths as just another task, like emptying the urine drainage bag, rather than as an essential part of the therapeutic process, we’re in trouble. So bed baths illustrate rather nicely the present conflict in the profession: are we mindless drones just doing the job, or are we thinking health care professionals engaged in a holistic therapeutic process with our patients? If you want to point to a single cause of nursing malaise, it’s this dichotomy, and it starts with being unable to give bed baths properly.