Dignity, and what it means when you are a patient
Having spent a lot of hours, every day, at my husbands bedside in July, I learned a lot about how “things are done these days”. One horrifying thing is that routine hygiene is a thing of the past in nursing care. When I trained as a nurse, the daily bathing, oral and skin care were all fundamentals in nursing. It was the basis of what everything else built on. Every patient got a bath every day, doing whatever they could for themselves and the nurse or CNA doing the rest. Bathing someone is a very personal and intimate thing, but it is necessary for a number of reasons. While bathing a patient, nurses not only clean them, they assess the condition of the skin, particularly in skin folds and areas that have constant pressure like over the coccyx and on the heels. Bedsores tend to form on those two spots. Fungal and other infections can grow in skin folds. Beyond morning bathing, patients got PM care, which was a “wash up” and turning to the side and getting a back rub with lotion…AKA, skin care.
I was astounded at how little attention was given to hygiene or skin care for Mike. Nobody bathed him, and most of the time he was there, he was too weak to get up to the bathroom and shower or stand at a sink to wash. He was mostly bed bound, rarely even sitting up in a chair. He was so very sick.
I did what I could for him with whatever was in the room. At one point when he scheduled for a surgical procedure in interventional radiology, I asked the assistant department head nurse about Chlorhexidine bathing prior to surgical procedures. The nurse I spoke to said “Oh yes, we bath with warmed Chlorhexidine wipes every day for patients!” I knew for a fact that was untrue. I told her that I would bath him myself if they got me the wipes to do it with. And so I did..and he did what he could himself. Another time, I used unscented bum wipes to bath him, because it was all that was available in the room, and apparently washcloths and towels are a thing of the past in at Northern Light Eastern Maine Medical Center. Eventually, during his second stay, I brought in my own washcloth and towel to help clean him.
Oral care is another basic need in the hygiene of patients. Good oral care is essential to good health, and it helps to prevent pneumonia and mouth infections. An unopened toothbrush sat on his over bed table for days with a tiny tube of toothpaste. When it finally hit me to ask him…”have you brushed your teeth?” He said “no”. Nobody got him what he needed to do that. All he needed was two cups of water and an emesis basin. I helped him many times to do that…nobody else did as far as I know.
Shaving became a thing of the past. At one point, I set him up with a basin of hot water and his razor. That was the last time he had a proper shave. Then I got him a new electric razor, but it didn’t work well on his beard growth. I was too timid to shave him, because I worried I would nick him and set him up for an infection. I regret that I didn’t hire a barber to come in and do proper shaves for my sweet husband. When he died, he had a scruffy growth of facial hair, not unlike a homeless person. He was always so clean and well groomed. He took pride in that.Being clean brings a sense of dignity and pride. It is essential for the prevention of unwanted infections and for the nurse to check the skin for infections or break down. And most of all, it give a sense of normalcy and well being. When did nurses stop learning and doing this basic step in the care of human beings. It is disgraceful. Nursing has gone downhill and it is now mostly about passing medicines and clicking away at a keyboard. If you have a loved one in the hospital, do not assume that anyone is helping him to bathe. One day, when I expressed my concern about his hygiene, a CNA actually lied to me, saying that my husband refused to be bathed. He was listening and did not contradict her, but he said later that he did not refuse. Actual hands on hygiene, and patient positioning is gone. ….until there is a bedsore. And that is a subject for another blog.
