Nursing Notes

October 30, 2009

Student nurses should not underestimate the value of delivering hands-on, personal care | Practice | Nursing Times

Here is another article from the UK but one that addresses a basic and undervalued skill for nurses.  After reading this, I was able to articulate why I like to do personal care when my patients need help.

I have many times sat in the bathroom helping my patient to bathe or shower.  As I work with psychiatric patients, I rarely give bed baths, but I have done a few for medically compromised psychiatric patients in my time.  It has been during these times that I have received pertinent information that directly affected the care given.  Once a patient relaxes and let’s down those barriers, you can explore just about any topic with them. 

During bathing, I have been told “secrets” that these patients had been carrying around for years.  In one case, the secret dealt with sexual abuse and ended with prosecution.  Another time, the secret was revealed by the presence of new wounds on breasts and abdomen.

I agree that this is a wonderful time to do a full head-to-toe assessment.  Your patient is relaxed and comfortable.  You are there to help and support them.
For me in psych, it is a wonderful time to observe for side effects of psychotropic medications or to assess for over-medication.  Since our patients are all encouraged to be independent and ambulatory, this is a perfect time to assess the patients ability to fulfill these functions.

Never, ever, miss an opportunity to provide personal, professional care for a patient.  If you do, you and your patient lose out on an opportunity for growth and sharing.

30 October, 2009

Even though HCAs now deliver most bedside care, student nurses must realise the value of developing skills in essential care, says Ben Bowers Recently a very experienced community colleague retold a student nurse’s disappointment that she had spent a six-month placement working in a residential home. This experience was particularly unsatisfactory for the student because she felt she had not learnt anything from washing people which will aid her practice when she qualifies.

Being a holistic practitioner, my colleague challenged this view. However, as we come to increasingly rely on healthcare assistants to deliver personal care, are tomorrow’s nurses perceiving washing patients as a role separate from being a qualified nurse?

The harsh reality of modern healthcare is that there are relatively few qualified nurses while there are increasingly more patients. As practitioners we often manage this by overseeing HCAs who deliver the bulk of hands-on, personal care.

But like any delegated task, we need to know what care we are asking others to deliver and the outcomes of such interventions. For qualified practitioners, this means being willing to help patients with their personal hygiene and advocating the high standards of respect and dignity we expect of the whole team. For example, my colleagues and I are busy community nurses but when the opportunity arises we welcome the chance to help a patient wash.

Helping patients with personal hygiene gives nurses the opportunity to use all their assessment, observational and communication skills. You discover how well they can coordinate their actions, mentally process what is being said and express themselves. It is a great opportunity to learn how to assess patients’ skin integrity, bodily functions and their variations in physical stamina. Most importantly, it is the best way to learn the telltale signs of clinical problems and when someone is not coping physically.

Nurses often have to assess patient needs quickly and efficiently. Other members of the team may deliver much of the personal care for patients but nurses need the knowledge and skills to oversee that the care meets each patient’s needs. This is particularly important for patients at a higher risk of conditions such as pressure ulcers, skin infections or fluid retention.

Without the hands-on experience of delivering personal care and seeing how situations present, nurses are ill equipped to prevent potential problems. Developing such nursing skills can be compared to learning to read. Before we learn to read, all the pages in a book appear just as important. Once you have experience of reading you develop the knowledge to cut straight to the main text, avoiding the publisher’s information and uninteresting forewords.

Student nurses often hear all these reasonings in college lectures and from their clinical mentors. I remember sitting through just such a lecture thinking, “Well, this may be true but the qualified nurses I see in practice hardly wash patients.”

In reality, no matter how busy things get, most nurses will make time to help patients wash when they believe they have complex needs, or if they need extra support or end-of-life care. The reason for this is simple: helping people to wash shows them you have time for them. It helps build up trust and aids the nurse-patient therapeutic relationship far more than countless drug rounds or other clinical interventions.

Helping patients with personal hygiene is one of the most fundamental and crucial relationship-building skills available to nurses, regardless of their seniority and clinical experience. My advice to student nurses is to embrace these opportunities while you do not have other time pressures and reflect on your experiences. These skills will prove invaluable in delivering, overseeing and evaluating meaningful, holistic care.

BEN BOWERS is community charge nurse, Cambridge Community Services and Queen’s Nurse, Cambridge

Student nurses should not underestimate the value of delivering hands-on, personal care | Practice | Nursing Times

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