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'There's a huge difference in the standards of sheets between adult and mental health nursing'


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.


Readers' comments (3)

  • sharon down

    Thank you for this article, I never knew there was a difference between mental health and general nursing standards in regards to clean sheets. I do agree that having clean sheets can make a difference to a good nights sleep, and this is just myself although patients have said this.

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  • I am a mental health nursing student and in every placement I have been in so far has had a weekly rotational bed sheet changing policy.

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  • Thanks so much for this article, I agree with everything you say, I have worked in general wards and I just started working as mental health support worker even though I'm studying Adult Nursing. I have noticed the difference and have mentioned a few things but I have been told that the patient doesn't want bed linen changed or their room being cleaned. It's a shame to see how mental health units are run and I think if Adult nurses can keep wards and their patients clean so can mental health nurses. I have seen mental health nurses with false nails, big ear rings and I was shocked to see what l was looking at. Not all Mental health nurses behave the same but some you ask yourself why are they in this profession. CQC should not tell mental health units that they will visit, because the place is thoroughly cleaned only because the CQC will visit. They should just turn up then thy will know exactly how dirty some of this places are.
    And you are right we are the nurses of the future and should be proud of what we do but do it in a way that dignifies the care that we give to our patients.

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