An elderly patient entered our unit disheveled, dirty, unshaven, and unkempt. The patient looked sad, did not make much eye contact, and did not speak much. I could smell an odor from the hallway outside the room. Since my patient load was so heavy that day, another nurse offered to bathe the patient. When the nurse started washing the patient, the patient’s chin trembled and tears began to roll down his cheeks. The patient stated, “I cannot bathe myself at home, and I can only afford to have one bath per week. I wish I could keep myself cleaner.” I felt tears in my own eyes.
This broke my heart and helped me understand that our patients do not always have access to the resources they need to take care of themselves. In that moment, I remembered all the people I had passed in grocery stores throughout the years who were disheveled and who I avoided because of their smell. I realized in that moment, that many people would not choose to look this way, and that those people may need a smile from me more than anyone else.
After shaving away the stubble, washing away the dirt, and brushing the patient’s teeth, the change in affect was unbelievable. The patient began smiling and talking. Physiologically, the patient’s vital signs improved. I never fully understood the medicinal properties of a bath and a toothbrush until after I saw that patient. Experiences shape our practice as caring professionals.
The Evidence
As nurses, our time is precious with tight staffing and increasing workloads. It is easy to put off bathing a patient and brushing a patient’s teeth when the unit is busy. However, patient baths and oral “cares” cannot fall to the wayside with increasing workloads. In fact, there is increasing evidence that oral care can prevent non-ventilator healthcare acquired pneumonia in patients.
One skilled nursing facility performed a study where one group of patients’ teeth were brushed after each meal and had a weekly hygienist care, and the other group had no oral care. Pneumonia incidence was 8% higher in the group without oral cares, and mortality from pneumonia was 9% higher in the group without oral cares.1 Providing routine skin care by bathing patients routinely helps keep skin dry, removes excess sweat, exposes any incontinence, and helps nurses visualize any areas at risk for pressure ulcers early.2
Saving Lives
Bathing patients and providing routine oral care improves the quality of the nurse’s relationship with the patient, positively affects the patient’s attitude, prevents pressure ulcers, prevents pneumonias, and prevent patient deaths.
When I am bathing my patient is the time I really get to know my patient. Patients tend to share stories during patient baths and ask more questions about care. After a bath, when the air smells clean, my patient and I both feel more relaxed. As nurses, we always imagine that saving a patient’s life will occur by an overtly heroic action– shocking a patient out of ventricular fibrillation or performing CPR. Brushing teeth, patient baths, and hand washing, although simple acts, save our patients’ lives every single day, too.
References
1. Yurkofsky, Mark, and Ouslander, Joseph. (3/2019) Medical care in skilled nursing facilities (SNFs) in the United States. UpToDate. Retrieved on 4/30/2019 from https://www.uptodate.com/contents/medical-care-in-skilled-nursing-facilities-snfs-in-the-united-states?search=brushing%20teeth%20pneumonia&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2
2. Berlowitz, Dan. (3/2019)Prevention of pressure-induced skin and soft tissue injury. UpToDate. Accessed on 4/30/2019. Retrieved from https://www.uptodate.com/contents/prevention-of-pressure-induced-skin-and-soft-tissue-injury?search=skin%20care&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
3. Powers, J. and Fortney, S (2014). Bed baths: Much more than a basic nursing task. Nursing 2019. Retrieved from https://journals.lww.com/nursing/Fulltext/2014/10000/Bed_baths__Much_more_than_a_basic_nursing_task.20.aspx
4. Quinn, B. and Baker D. (2015). Using oral care to prevent non-ventilator hospital-acquired pneumonia. American Nurse Today. Accessed from https://www.americannursetoday... Blogger
Carolyn Hoy is an expert nursing content writer and cares for patients as an ICU nurse in addition to her role as Sepsis Team Leader. She received the Excellence in Nursing Award from her hospital in 2018 and earned her CCRN shortly thereafter. She is working with hospitals in Michigan and Wisconsin to improve outcomes for patients with sepsis. She is the mother of four girls, two guinea pigs, and one Cavapoo. #soccermom