Showering Kids

SentimentalGeek, ADN, RN · Jan 7, 2012

I don't work in Peds or know the answer, but my gut tells me you can't "force" a patient (even a child) to do something. What do the parents say? They're the ones with the authority to make decisions for a child.

yousoldtheworld · Jan 7, 2012

I don't know about California, but I know that here, any alert and oriented patient has the right to refuse care. But it's tricky with kids. On one hand, I don't really agree with forcing anyone to do anything. On the other hand, if you only did things that a child wants to do, odds are very little, if any care is going to be given.

I would talk to your boss, first of all, and ask them what they would like you to do about refusals. I work with mostly MR/DD kids, but we do get alert and oriented kids in for rehab/therapy and it's an issue, often.

AJ_427 · Jan 7, 2012

I am not entirely clear what you mean by "forcing." Is it physically forcing them to take a shower? Or is it verbally trying to get them to shower? I know that at my facility, if an aide tries to physically force a resident to take a shower then she/he can get fired. I am not sure if this fits the category of abuse so I can't write about any laws.

At my facility every resident is to be showered unless parents/family or the nurse gives an order to not give a shower. Then on the shower sheet I write "No shower given per parent's request. My name."

When a resident refuses a shower (we have few residents who do that quite often) then we have to try to verbally get them to the shower room. If you feel like you can't convince them to take a shower then you have to tell the nurse and she/he has to talk to the resident. If they refuse the shower with nurse, the shower is not given and on the shower sheet I write "Refused. My Name."

In my opinion, if an alert resident/patient refuses to take a shower after you try to convince them for a while then the shower should not be given. Nurses, case managers, and upper management should be aware of which kids refuse to take shower, but then again, other staff members force them so you may be seen as a person who just can't get them to shower.

I used to have a resident who would refuse a shower after he ate dinner. One time he refused a shower and I told the nurse. He became very aggressive. The nurse yelled at me and said that when I work with him, I always create problems, other aides always shower him, and I can't deal with residents (she couldn't even get him to the shower room!). I yelled back saying that other aides don't even shower him (they write on the shower sheet that he's been showered but everyone knew that he was not showered for days sometimes). She couldn't believe me. With some people you just can't argue since it's like talking to a wall.

Chesh · Jan 10, 2012

It's unclear whether you work in longterm care or a hospital and I'm sure that will make a difference to the answers you're given. Assuming you mean hospital I'd have to answer with 'you can't force a pt to recieve treatment or care against their will' regarless of their age. It would be up to their parent to make the decision for them if necessary.

As a CNA I wouldn't force anyone to do anything. Leave it to the nurse to do that. As a parent I'd be worried as to what harm might come from someone forcing my child to get naked and be touched by a stranger, (if you know what I mean) Better to be safe than sorry and in court.

rosey2012 · Jan 11, 2012

It's unclear whether you work in longterm care or a hospital and I'm sure that will make a difference to the answers you're given. Assuming you mean hospital I'd have to answer with 'you can't force a pt to recieve treatment or care against their will' regarless of their age. It would be up to their parent to make the decision for them if necessary.
As a CNA I wouldn't force anyone to do anything. Leave it to the nurse to do that. As a parent I'd be worried as to what harm might come from someone forcing my child to get naked and be touched by a stranger, (if you know what I mean) Better to be safe than sorry and in court.

I agree. I was also thinking that it might be wise to wait until the parent shows up for the shower. That way they can be with you when you shower them, or maybe the parent can help the child to shower.

yousoldtheworld · Jan 12, 2012

I agree that if you are in a hospital/acute care, leaving it to the parents is likely best. Also, the showering is less important in this setting, as most aren't going to be there for an extended period of time. When I worked at the hospital, I very rarely did a shower on the peds floor, as many of the patients had picc lines or other issues that made showering difficult.

In a long term care situation, that tends to be a different story, as the parents are generally less involved, and many have no family at all. That is when the same principles need to be involved as in any other long term care...encouragement, encouragement, encouragement. And if they refuse, it falls to the nurse to talk to them and then follow whatever protocol is in your facility.

yousoldtheworld · Jan 12, 2012

...Except for the time a month or so ago when an alert and oriented 17 year old rehab resident refused his shower because he felt sick to his stomach and just wanted to lie down...and after the nurse hounded both of us for 3 hours and he still refused, she WROTE ME UP. :flamesonb

But that's a different story.

joonil.choe · Jan 18, 2012

What everyone else said.

jjic3982 · Jan 18, 2012

"Nurses, case managers, and upper management should be aware of which kids refuse to take shower, but then again, other staff members force them so you may be seen as a person who just can't get them to shower."

"Except for the time a month or so ago when an alert and oriented 17 year old rehab resident refused his shower because he felt sick to his stomach and just wanted to lie down...and after the nurse hounded both of us for 3 hours and he still refused, she WROTE ME UP."

Thank you for the responses everyone, and the quotes above helps explain things much better. Yes, one reason I was confused since few nurses at my facility would respond the same way and tell me to just do my job. Then I am thinking, I can't force them, what do I do.

I've talked to my DON with a similar issue (changing clothes and diaper refusal) and she has told me to keep trying to influence and I do have the right to hold the patient. I am in a subacute so it is more like LTC here. Parents do come in and some has been fired for "forcing" the kids (which I know isn't right).

AJ_427 Thanks for the detailed info. I am sure that the protocol you explained is how it is everywhere, and I will just let the nurse know she/he will have to help me if all my convincing fails. It seems like hospitals are very organized and orients you well.

Again thanks for the advice everyone!

P.S. One more question, yousoldtheworld, when she wrote you up what happened? I am lucky to have few nurses that are like this. I try my best to let the nurse know that I am there to help her as much as I can, but sometimes they just are grumpy in personality.

yousoldtheworld · Jan 21, 2012

Again thanks for the advice everyone!
P.S. One more question, yousoldtheworld, when she wrote you up what happened? I am lucky to have few nurses that are like this. I try my best to let the nurse know that I am there to help her as much as I can, but sometimes they just are grumpy in personality.

Well, it was a "coaching", which normally serves as a written warning, and it is supposed to stay in your file - but at my next evaluation, it read that I had zero disciplinary actions, so I think the DON threw it out - probably realized how ridiculous it was.