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Fluids & Electrolytes
"Are You 'Too Posh to Wash'?" (Issues in Nursing, November 2004) struck a chord with me. As a retired nursing instructor who taught for 30 years, I'm appalled by the lack of personal care patients receive in a hospital. Even the patients who receive a bath are likely to get a very poor one.
Providing personal care lets the nurse communicate intimately with the patient. This is where the art of nursing is practiced. I've never understood why nurses want to give that part of their practice away!! Soon we'll be needed only to run the machines and monitor the monitors.
Be careful, ladies and gentlemen. Don't give away the parts of nursing that let you connect with your patients. Caring comes through in your touch. A clean body and bed are important to the ill person in ways that you won't fully comprehend until the day when you're a patient receiving a caring nurse's ministrations.
-SHAROLYN B. HEATWOLE, RN (Ret.), MSN
I've been an RN since 1969. I usually have seven or more patients. If I did what Ms. Olesen outlined in the article for all of them, that's all I'd have time to do. My duties include administering medications and enteral feedings, performing treatments, giving wound care, assisting with procedures, monitoring telemetry, starting I.V. lines, and transcribing, clarifying, verifying, and carrying out orders[horizontal ellipsis]ad infinitum. If I had only three or four patients to care for, it might be different. I help the nursing assistants with washing when I'm needed, but I'm sorry, Ms. Olesen, it's just different now.
-PATRICIA GAIL BATSON, RN, BSN
The intimacy of a bath and touching not only provides the chance to talk with your patient, but also lets you assess his condition, which is the foundation of nursing practice. The patient's pain and skin integrity, temperature, texture, and abnormalities are but a few findings a nurse can glean from those moments while we provide comfort. This opportunity should never have been given away.
-BADER PETERS REYNOLDS, RN, MSN
I had to respond to "Are You 'Too Posh to Wash'?" There are two sides to this issue. On one hand, the RN who's "too posh to wash" loses an excellent opportunity to do a thorough skin and body assessment and may yield the opportunity for patient teaching because "teachable moments" often arise while we're assisting with hygiene. Nursing students should give baths because they're learning to provide holistic care and to perform patient assessments and other nursing functions.
On the other hand, a nurse with a double-digit patient load can't provide total care for every patient. Delegating basic care to nursing assistants frees her to "see the whole picture" and focus on assessment, care planning, and other activities only an RN can perform.
No nurse should ever think that she's above providing basic care. But she shouldn't be afraid to delegate that care to make the most efficient use of a very limited resource-the RN. Thank you for letting me share my (strong) feelings about this topic!!
-KIM DOBSON, RN, MSN
All too often, nurses delegate jobs to nursing assistants because the nurses feel they shouldn't have to do them. I've seen a nurse who isn't busy look for a nursing assistant to wash a patient when it would've taken her just 5 minutes to do it herself. We were all taught how to do patient care, so why not do what we were taught?
-TAMARA FARRAR, LPN
No task is "beneath" a true nurse. If we choose to parcel off those elements of nursing care that we think are distasteful or beneath us, we'll be left with a fragmented outlook on patient care.
The other issue is that if we say we're "too posh" to perform certain tasks, we demean those who assist with these tasks. Teamwork, anyone? Whether you practice nursing at the bedside or elsewhere, making time to provide high-touch (not just high-tech) nursing is critical. Thank you for addressing this very controversial issue.
-FRIEDA JEANNE PULKOWSKI, RN, NHA, BSN
Taking the time to do bed baths for every patient is unreasonable due to the patient load we have now, compared with that of 20 years ago. Also, in many cases, patients shouldn't be washed by others; they need to do their own care. We need to help them maintain their abilities and increase mobility as much as possible. Keeping them in bed isn't the standard anymore.
-DEB BLANCHET, RN
I'd like to share the excellent example of my first head nurse, Mary. Whenever we had an exceptionally challenging patient in our busy medical/surgical unit, Mary would take a patient assignment and ask the assistant head nurse to manage the unit that day. In taking a hands-on role, Mary demonstrated the value she placed on good patient care. She wasn't "too posh to wash," and she led by example.
One of the best-known acts of Jesus was His washing the feet of His disciples. He wasn't "too posh to wash" either!!
-DEBBIE WEIN, RN, BSN
Nurses who think they're "too posh to wash" need to remember that the entire staff is there for the betterment of the patient. It's teamwork that gets the job done.
Nursing assistants are valuable assets in today's fast-paced health care system. If each nurse were required to perform total care for six patients, the quality of the nurse's work might be jeopardized. The problem isn't the delegation of the task, but the attitude with which the task is delegated.
-JESSICA KRATZER, NURSING STUDENT
When I was a nurse in the ICU, I provided total care to each patient. So many positive things came out of this. Now I'm a nursing instructor, and I see from a distance how little time nurses actually spend with their patients. How can you assess your patient, let alone show caring, without spending time with him? I teach my students that a bath is not just a bath, and I stress the opportunities for assessment, caring, and teaching that this time with the patient provides.
We lost a great deal (and so did our patients) when we lost the art of the bed bath.
-JUTTA BRAUN, RN, MS
After 28 years as a nurse, I'll still do whatever it takes to make the patient feel better. But I see nursing continuing to move away from the bedside because of the countless regulations and unending demand for documentation imposed by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The nursing shortage has also contributed to our increasing reliance on unlicensed assistive personnel to do the "caring" side of nursing.
Gone are the days when a nurse worked side by side with her nursing assistant to care for challenging patients. In those days, the staff and the patients were happier-and I believe that there were fewer lawsuits then as a result.
-NANCY GOMEZ, RN, C
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