BackgroundFor immobile patients, a body wash in bed is sometimes the only bathing option. Traditionally, the bed bath is performed with water and soap. However, alternatives are increasingly used in health care. Washing without water is one such alternative that has been claimed to offer several advantages, such as improved hygiene and skin condition. This systematic review aims to provide a comprehensive overview of the evidence on outcomes of the washing without water concept compared to the traditional bed bath.MethodsControlled trials about washing without water outcomes published after 1994 were collected by means of a systematic literature search in CINAHL, Embase, MEDLINE, and PUBMED at the 25th of February, 2016. Additionally, references and citations were searched and experts contacted. Studies were eligible if (1) the study designs included outcomes of washing without water products developed for the full body wash compared to the traditional bed bath, and (2) they were controlled trials. Two researchers independently used a standardized quality checklist to assess the methodological quality of the eligible studies. Finally, outcomes were categorized in (1) physiological outcomes related to hygiene and skin condition, (2) stakeholder-related outcomes, and (3) organizational outcomes in the data synthesis.ResultsOut of 33 potentially relevant articles subjected to full text screening, six studies met the eligibility criteria. Only two studies (of the same research group) were considered of high quality. The results of these high quality studies show that washing without water performed better than the traditional bed bath regarding skin abnormalities and bathing completeness. No differences between washing without water and the traditional bed bath were found for outcomes related to significant skin lesions, resistance during bathing and costs in the studies of high quality.ConclusionsThere is limited moderate to high quality evidence that washing without water is not inferior to the traditional bed bath. Future research on washing without water is needed and should pay special attention to costs, hygiene, and to stakeholder-related outcomes, such as experiences and value perceptions of patients, nursing staff and family.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-017-0425-4) contains supplementary material, which is available to authorized users.

Purpose This paper aims to explore how tensions and alignments between different actors’ needs in a transformative services network affect balanced centricity, which is an indicator of well-being. Balanced centricity describes a situation in which all network actors’ interests and needs are fulfilled simultaneously. In such cases, all actors are better off, which increases both individual actors’ and overall actor-network well-being. Design/methodology/approach The empirical study takes place in nursing homes in which in-bed baths represent co-created service encounters that affect the well-being of focal actors (i.e. patients), frontline service employees (i.e. nurses) and transformative service mediators (i.e. family members), who have potentially competing needs. Using a qualitative, phenomenological approach, the study inductively explores and deductively categorizes actors’ personal experiences to gain deep, holistic insights into the service network and its complex web of actor interdependencies. Findings The resulting conceptual model of balanced centricity identifies actors’ lower-order needs as different manifestations of the psychological needs for autonomy, competence and relatedness. If actors’ needs are aligned, their psychological needs can be satisfied, which facilitates balanced centricity. If actors exhibit competing needs though, balanced centricity is impeded. Practical implications This study establishes actors’ psychological needs as the origin of tensions/alignments in multi-actor networks that impede/contribute to balanced centricity. Transformative service providers should try to address all actors’ psychological needs when co-creating services to achieve network well-being. Originality/value This study adopts a novel, multi-actor perspective and thereby presents a conceptual model that contributes to the understanding of balanced centricity. Future research could test this model in other transformative service settings.

Aims and objectives To compare the washing without water method with the water and soap method regarding comfort perceptions of the bed bath. Background Bathing affects nurses’ and care recipients’ comfort. Bedridden care recipients can be bathed in bed with water and soap or with washing without water products. Little is known about the differences between these two bed bath methods regarding comfort perceptions among care recipients and nurses. Design Crossover randomised laboratory‐controlled trial, conducted from March 2018–November 2019, according to the CONSORT guidelines. Methods Nursing students were randomly allocated roles as a patient (who received both types of bed baths) or a nurse (who provided both types of bed baths). Also, the order in which the bed baths were received/provided was randomised. A total of 97 students were included in the analysis. Student patients filled out the Patient Evaluation of Emotional Comfort Experienced (PEECE) scale to measure emotional comfort and a single‐item question on physical comfort after each bed bath. Student nurses filled out the Physical Demands scale after each bed bath to measure their physical comfort perceptions. Results No differences were found between the two bed bathing methods regarding student patients’ emotional or physical comfort levels. Among student nurses, the washing without water method was less physically demanding than the water and soap method. Conclusions Taking into account time‐efficiency and physical comfort for nurses, washing without water seems to be a valuable alternative to water and soap from a care recipient comfort perspective, which should be assessed in a clinical setting in future research. Relevance to clinical practice The washing without water method is less physically demanding for nurses and takes less time. It does not have a detrimental effect on care recipients’ emotional and physical comfort. The trial is registered at http://www.trialregister.nl (ID = NL6787).

Background The traditional bed bath with water and soap often leads to emotional and physical discomfort among bedridden patients. In addition, the traditional bed bath is physically demanding for nurses. The washing without water concept is increasingly used in healthcare to bathe bedridden patients and is likely to affect emotional and physical comfort dimensions. This protocol describes a study that will assess how washing without water performs compared to the traditional bed bath regarding emotional and physical comfort experienced by the bathed bedridden person and regarding physical demands for the provider of the bed bath.Methods This study uses a randomized cross-over design in which nursing students will simulate the bed baths of patients in a laboratory setting. Students will be randomly allocated to a patient or a nurse group and consequently will respectively receive or provide two bed baths: the traditional bed bath and a washing without water bed bath. The order of the bed baths will be randomly determined. Students will receive instructions about the steps of the bathing methods and case descriptions about their role as a patient or nurse. Questionnaires will be used before and after each bed bath to collect data for the primary outcomes of experienced emotional and physical comfort (among students receiving the bed bath) and physical demands (among students providing the bed bath); and, for secondary outcomes related to bed bathing preferences, grades given to the bathing methods and perceived importance of the bed bath. Differences between the two bathing methods will be analyzed, taking the order of the bed baths into account.Discussion This study will add to the scientific knowledge of the washing without water bed bath, for which evidence on comfort is currently lacking. If differences in comfort between washing without water and the traditional bed bath are detected among nursing students, it is likely these differences will also be present among actual patients and nurses, as generally, patients are more vulnerable and nurses spend more time bathing patients compared to students.

Bathing is one of the most performed activities among nurses. Although care recipients experience bathing as an important activity in daily living, nurses often undervalue this care task. We developed a questionnaire to measure nurses’ opinions regarding 1) the importance of the bed bath, and 2) a bathing innovation known as Washing Without Water. Construction of the questionnaire items was based on literature and interviews with nursing home residents (n=8), their family (n=5) and nurses (n=6). After items construction, nurses and nursing students (n=124) completed the questionnaire to assess the questionnaire’s internal consistency (IC) and construct validity. Cronbach’s alpha coefficients were analyzed as an indicator for IC and items were deleted if this resulted in improved IC. To analyze the construct validity, a Principal Component Analyses (PCA) with Direct Oblimin Factor rotation was performed. The final scale consists of two subscales. The first subscale measures nurses’ opinions about the importance of the bed bath and consists of 12 items. The second subscale consists of 17 items and aims to inventory nurses’ opinions about the Washing Without Water innovation. The Cronbach’s alpha coefficients are high (.81 for the first and .89 for the second subscale). The PCA results show a one factor loading for both subscales, explaining 33,20% and 37,08% of the variance for the first and second subscale respectively. Results indicate a reliable and valid questionnaire to measure nurses’ opinions related to the bed bath, which can support health care institutions in evaluating the bed bathing process.