This assignment aims to discuss and identify a nursing skill whilst on placement. The nursing skill I will be discussing is bed bathing a male patient. A bed bath in this incident was necessary as the patient was unable to mobilize himself to the bathroom due to suffering from a recent stroke which had caused greatly reduced mobility. To adhere to the Nursing and Midwifery Code of professional conduct (NMC 2008), I will maintain my patient’s autonomy to respect his right to confidentiality. Therefore no names will be used. However, clear verbal consent was gained from my patient, as the NMC states (NMC 2008a), to enable me to reflect on this experience.
I am going to use Driscoll’s (2000) model of reflection, What? So what? What next? To reflect upon this experience and gain knowledge and understanding of how the skill has to be adapted between males and females. It is also to enhance my personal and professional learning, which will assist in developing my nursing knowledge. What? As a female student, going out for the first time onto a ward with mixed-sex patients was very nerve-racking for me. I was comfortable with bed bathing females, but the thought of having to bed bath male patients really worried me. Firstly, it was an exposure I had never had previously, and secondly, I simply felt somewhat uncomfortable washing male gentiles.
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But I knew I had to overcome this situation sooner rather than later because on a busy ward; there was not going to be any shying away accepted. So I spoke to my associate mentor, who is also male, about my worries. He reassured me and said that he would assist me with a male bed bath and let me take the lead, and he would then guide me where he felt I needed to do things differently. We approached a male patient who needed assistance with washing and explained to the patient the situation; he was more than happy for me to bed bath him with my associate’s guidance. So What?
I gathered all the essential equipment needed on a trolley and brought along a skip to collect all the dirty linen. I placed these items by the patient’s bed and then prepared myself for the bed bath. I put on an apron and washed my hands as hand washing is essential for reducing bacterial and viral infections from patient to patient (Department of Health 2006). My associate mentor followed in the same manner as I carried a bowl of warm water over to my patient. To maintain my patient’s privacy and dignity (NMC 2008b), I closed the curtains around the bed area, ensuring that there were no gaps through which other people could see, and to stop other people, visitors from entering while we were attending to our patient’s hygiene needs.
I asked the patient if he had any of his own toiletries that he would like me to use; he said yes and told me they were in his bedside cabinet. I then explained to my patient that I was going to flatten the bed to make it easier for us to roll him while we removed his clothes and washed him; I then raised the bed to my level to avoid any back injury while we carried out the task (Manual Handling Operations regulations 1992). I felt very nervous but continued to wash the patient’s face. With consent, we then removed his clothes, ensuring at all times he was covered using towels to maintain his privacy and dignity (NMC 2008b, C). I could see he had his own body wash, so I placed some in the water. I commented to my patient about how nice the wash smelt and how nice he would smell all day; he laughed and joked with me, which helped break the ice and relax.
Once I had washed and dried the upper half, I covered him with clean towels and moved onto change his pad. I made the patient aware of what I was about to do. Before I began, I applied a pair of disposable gloves to come into contact with bodily fluids (WHO 2009). I removed the pad and started to clean around the genitals; my associate could see I was hesitant and supported a confused face, unsure of what and how to clean the penis. So he promptly stepped in and guided me on how to clean the foreskin to maintain cleanliness. We then continued to communicate with the patient as we rolled him to remove the pad and replace it with a clean one. At the same time, I removed the old sheets off half of the bed and replaced them with fresh ones. We rolled him back onto his other side and pulled the dirty and clean sheets through.
Once on his back, I ensured his genital area was completely dry before fastening the pad. I then removed my gloves, washed my hands and changed the water to reduce the risk of infection and maintain a safe environment (Pengram et al. 2007). After I had finished his lower half, I asked the patient if he had his own clothes to wear, to which he replied he had, so we took them from his cabinet and carefully dressed him. I then set him up in bed and made sure he was comfortable. He commented on what a good job I had done, which made me feel appreciated. Now what? After completing this skill, I feel the most important thing for me was communication. This is an important nursing attribute, and creating that environment for conversation is equally as important (Peate 2009). As I communicated more with my patient, the more at ease I felt with completing my task, I knew we were starting to build a rapport, and my nerves were disappearing.
At all times, I remained courteous and ensured my body language didn’t give my nerves away (Essence of care 2010). To help further build my confidence, I aim to do more male bed baths as possible. Having my associate mentor guide me really helped, I listened effectively to the information he gave me, and I intend to put it into practice in the future. Teamwork was also an essential aspect that ensured we delivered safe & high-quality care (Leonard, M. et al.2004). It would be of advantage to reflect again on this clinical skill in the future, to see how different I am from now and what I have learnt from my experiences (Boyd EM, 1983)
- Boyd, E. M. & Fales, A. W. (1983) Reflective learning: the key to learning from experience. Journal of Humanistic Psychology, 23, 99–117. cited in Reflective Practice, Vol. 5, No. 3, October 2004 Reflective learning journals: from concept to practice Karran Thorpe
- Dh.gov.uk (2006) The importance of hand hygiene: Department of Health – Publications. [online] Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_063673 [Accessed: 18 Apr 2012].
- Dh.gov.uk (2010) Essence of Care 2010: Department of Health – Publications. [online] Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_119969 [Accessed: 21 Apr 2012].
- Driscoll, J. (2000) Practicing Clinical Supervision: A Reflective Approach. London: Elsevier Health Sciences.
- Legislation.gov.uk (1992) The Manual Handling Operations Regulations 1992. [online] Available at: http://www.legislation.gov.uk/uksi/1992/2793/regulation/4/made [Accessed: 19 Apr 2012].
- Leonard, M. et al. (2004) The human factor: the critical importance of effective teamwork and communication in providing safe care. The international journal of healthcare improvement, 13 (1), p.85-90.
- Nursing and Midwifery Council, (2008) The NMC code of professional conduct: standards for conduct, performance and ethics. London: Nursing and Midwifery Council.
- Peate, I. and Lawson, L. (2009) Essential Nursing Care: A Workbook for Clinical Practice. West Sussex: John Wiley and Sons, p.229-231.
- Pegram, A. et al. (2007) Clinical skills: bed bathing and personal hygiene needs of patients. British Journal of Nursing, 16 (6), p.356-358
- World Health Organization (2012) Patient Safety; Save Lives, Clean Your Hands. [online] Available at: http://www.who.int/gpsc/5may/Glove_Use_Information_Leaflet.pdf [Accessed: 19 April 2012].