About the PhD thesis

Introduction and background

Bed baths are offered to hospital-admitted patients if they cannot get out of bed during admission. Besides ensuring the patients’ personal hygiene, bed baths have many advantages and can be crucial to patients’ quality of life. Soap and water (SAW) have gradually been replaced by a more widespread use of disposable wet wipes (DWW).
In Denmark, the two methods are both recommended. Still, the evidence for the use of both methods is sparsely elucidated.
Knowledge and evidence about SAW and DWW are important elements in nursing staff’s clinical decision-making regarding choice of washing method for a bed bath.
In particular, three factors are relevant in the choice of washing method for bed baths: evidence for the effectiveness of SAW and DWW to remove microorganisms (MOs) on the skin, the patients’ perspective on the use of SAW and DWW for bed baths, and knowledge about cost.
This PhD aimed to address these factors by investigating the use of SAW and DWW for bed baths, using both qualitative and quantitative methods.

Methods

The PhD study was based on a mixed methods research design that included three individual studies. The mixed methods findings and results were integrated through narrative weaving.

Results

The themes of integrated findings were: “Shared clinical decision-making regarding choice of washing method for bed bath”, “Freshening up or feeling really clean” and “Cleanliness in social relations”.

Conclusion

Effectiveness of washing methods, the individual patients’ preferences and costs are important perspectives to consider in the shared clinical decision of washing methods for bed baths. Overall, the patients would like to have the opportunity to be involved in the clinical decision regarding choice of washing method for bed baths. However, the most important thing, in their opinion, was to be washed. SAW was preferred for bed baths and handwashing and DWW was preferred in specific situations. The patients distinguished between “freshening up” and being “really washed” and cleanliness was essential in social relationships. There was no difference in the effectiveness of the two washing methods to remove MOs and it is unclear if there is a difference in the cost between SAW and DWW. Although the use of DWW seem to require less time than the use of SAW.

Supervisors

Supervisor:

Professor Jette Primdahl, Danish Hospital for Rheumatic Diseases, Sønderborg, University Hospital of Southern Denmark; Sygehus Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.

Co-supervisers:

Professor Jan Sørensen, Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.

Special Consultant Christian Stab Jensen, National Center for Infection Control, Infectious Disease Epidemiology & Prevention Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark.

Clinical Associate Professor Ming Chen, Clinical Microbiological Department, University Hospital of Southern Denmark, Sønderborg Denmark, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.

Assessment Committee

Associate Professor Lone Jørgensen (chair), Aalborg University, Aalborg, Denmark.

Professor Grethe Eilertsen, University of South-Eastern Norway, Norway.

Clinical Associate Professor, Mette Damkjær Bartels, University of Copenhagen, Copenhagen, Denmark.