During my previous employment as a healthcare assistant, and now as a student nurse at London South Bank University, I have noticed a fundamental difference in the standards and expectations gap between adult nursing and mental health nursing with regards to bed linen - more specifically, how frequently bed sheets are changed.
Although mental health service users are encouraged to change their own sheets, I have realised that it is somehow permissible and tolerated that bed sheets are not changed for long periods. This may be down to several factors - the service users’ symptoms, their lack of interest in hygienic standards. However, it does raise the question: why do some wards - and nurses - allow this to happen?
During my four-week long general placement I changed bed sheets everyday. This was an integral part of the routine for nurses and healthcare assistants. It is widely understood and accepted that bed linen needs to remain clean to reduce infection, keep patients comfortable and maintain the delivery of a dignified approach to patient care. I am not suggesting that mental health wards need to have a daily bed linen routine, but at least a weekly or bi-weekly routine of ensuring that bedrooms are cleaned and bed sheets are changed should be carried out. Doing so would afford service users the same hygiene standards that are set in general hospitals.
The benefits of good sleep hygiene are widely reported and - particularly within mental health - sleep is often severely affected. As we know, sleep is a valuable circadian function: not only does it restore cellular activity, it can also be a source of relief from many of the mind affecting disorders - depression, stress and paranoia. Creating a pleasant environment that aids sleep is essential to promoting regular restorative sleep patterns. Simply having a day of the week on the wards where all the bedrooms are tidied and bed sheets changed with the support of healthcare professionals will help to improve the current standards significantly.
I respect and understand that some service users may not see clean sheets as a priority in their care and that we all must value and respect their autonomy and decisions. However, should more be done for service users who are less willing to have support and do not wish to have their bed linen changed? Should the reasons for their stance not be explored, discussed and debated more carefully? Is their reluctance to sleep in clean sheets an indicator of lifestyle choice, or a reflection of their mental state or volition? In any case, can healthcare professionals learn and do something about it? If the service users’ unwillingness is due to their mental health state, can this not be a barometer that indicates improvement to - or deterioration of - health? As is known, personal hygiene, or lack of - can often be used as an indicator of mental health. Unkempt appearance and poor hygiene standards can reflect a deterioration in one’s mental state. However, if a service user is fundamentally not interested in their own hygiene, can this be an opportunity to educate them about the importance of clean practices? As nurses, are we not supposed to deliver a holistic approach to care?
So why can’t mental health wards establish an intrinsic value towards personal and sleep hygiene? If changing bed sheets on a weekly basis was the minimum, and all wards and nurses implemented this, levels of bedroom hygiene would increase, and would, in turn, promote healthier sleep patterns, a more dignified approach to care and a potentially reduced need for sleep inducing medications.
In the knowledge that we, today’s students, are the future of nursing, let’s be the future that breaks from the norms and starts new trends. Let’s be bold enough to challenge those who ignore basic nursing common sense and show those who matter - service users - that we really do have their best interests at heart.
Ian Markin is a second-year Mental Health nursing student at London South Bank University.