Tuesday, April 9, 2013

Bed Baths: A Necessary (and Embarrassing) Evil

Bed Baths: A Necessary (and Embarrassing) Evil

Laurie Scudder, DNP, NP
Apr 01, 2013

Bed and Shower Baths: Comparing the Perceptions of Patients With Acute Myocardial Infarction

Lopes JL, Nogueira-Martins LA, de Barros AL

J Clin Nurs. 2013;22:733-740

Patients' Perceptions of Bed Baths

Hospitalization, particularly in intensive care, invariably involves a loss of personal space and privacy. Patients experience many invasive and unpleasant procedures. Bed baths may not be the worst of these procedures, but previous studies show that patients view them to be anxiety-provoking.
The purpose of the current study was to compare perceptions of bed and shower baths among patients hospitalized for acute myocardial infarction. The researchers also examined the impact of variables such as patient age, sex, sex of nursing personnel, and previous hospitalizations.

Study Summary

Methods. The study, conducted in Brazil, used a crossover design in which all patients received both treatments, allowing patients to serve as their own controls. Patients who were severely ill, experiencing arrhythmias or ischemic pain, or undergoing invasive procedures at the time of data collection were excluded. Patient perceptions were asked to evaluate both bathing experiences using scales that included responses such as "hygienic/antihygienic," "restful/tiresome," "pleasant/unpleasant," "good/bad," "relaxing/stressful," "necessary/unnecessary," and "independent/dependent." The evaluations occurred at the time of each patient's second bath and again at the time of the second shower bath, typically on the fourth or fifth day of hospitalization. A shower chair was provided and the shower bath occurred without direct assistance, although patients were supervised.
Findings. The sample included 71 patients with an average age of 58.8 years. Patients were more positive about shower baths than bed baths across all variables, and even those who reported negative experiences during bed baths considered the procedure to be necessary and hygienic. Patients who had experienced a previous hospitalization reported more negative perceptions of both bathing experiences. Although sex of the patient did not affect the overall evaluation of bathing, differences in individual scales were found between men and women. Half of the patients in the study indicated that they did not have a preference as to the sex of the person who performed their bath, but those who did have a preference and whose preference was met reported less embarrassment during bathing.


That bed baths are uncomfortable and embarrassing for patients is certainly not news to nurses. What this study adds, however, is a quantitative description of just how unpleasant and anxiety-provoking the experience is for virtually all patients. All nursing personnel can benefit from the reminder that an everyday and routine part of nursing care is anything but ordinary for our patients. Furthermore, the researchers emphasize that bathing is often done without asking permission, putting nurses in a position of power over the patient.
This study has lessons that should affect practice. First, when possible, patients should be asked whether they have a preference about the sex of the person administering their bath and, if they do express a preference, that preference should be honored. Second, patients commented that the experience of receiving a bed bath engendered feelings of dependency. Lessening that dependency by allowing and encouraging patients to participate in the process may make this necessary procedure somewhat less unpleasant.

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