How do you get a very combative patient to take a shower - page 2

by esunada 6,291 Views | 19 Comments

I have a client who refuses showers. He comprehends most things but seems withdrawn and has alzheimers. When asked if he will let us give him a shower he gets agitated. If we explain that it is important that he is clean for... Read More


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    Most facilities require each resident be washed at least once a week. I work in a LTC facility & have some residents that fight like crazy against it. When I get a resident for a shower, I don't tell them where we are going, & sing on the way there. This usually puts them in a good mood. If this doesn't work, give them a bed bath.
    canoehead likes this.
  2. 0
    try a different time of day ,perhaps Never bribe a resident!
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    This is NOT a suggestion. (see how I said that first?)...Nor justification, but..... in the old days (when Posey vests and Geri-chairs were the norm) the aides and I (five of us) would guide the victim to the shower and who ever didn't have an arm or leg (usually me) would wash pits and peri from the posterior side and hose the patient (and partially the aides). towel off what I could (of the patient only) and call clear, then we would release the patient and duck. Sometimes we got away with out being hit, slapped or punched, sometimes not.
    I anticipate an avalanche of negative responses but back then was just that....back then.
  4. 1
    This is NOT a negative response. We did all sorts of not so wonderful things to patients back then. Remember syringe feeding? Thank goodness we've learned from those mistakes.I once had a 93 year old resident ask me if I took a bath twice a day. Before I could answer she said "they want me to have a bed bath twice a day, and I don't like it. How dirty do you all think one little old lady gets??" Her wishes from then on were honored and everyone was happier.
    VivaLasViejas likes this.
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    Oh God Syringe feeding....I almost forgot! My staff was freaking out when they did away with this practice (torture) so I had each staff member feed each other this way with water and applesauce mixed. We all immediately agreed this was a BAD way to feed someone, and a very good way to choke .
    VivaLasViejas likes this.
  6. 1
    You can read all of the responses you want, but eventually you're just going to have to find the way that works for you and that resident.

    For one lady, it's "Let's go get your medicine!" She agrees, and then I wheel her past my cart, "Goodness, must have left it at the desk.." Past the desk, "Oh wow, let's go see if this nurse has your medication, " and zip, right into the shower room. After that, we both eventually agree that while we're IN here looking for these dang pills, we might as well put on a clean shirt- don't want to be a mess for dinner, that'd be terrible. While we're putting on a clean shirt, maybe just clean under her arms 'real quick', and so on and so on until she's had a full bath, and is wearing all clean clothes. It takes a while, but no one is getting beaten with a cane with this method.


    Another one I tell that Im going to get in a terrible amount of trouble if I can't get the room cleaned up. She feels bad, and I offer to let her go get cleaned up in the shower while I mop, to make sure 'everything' in the room smells nice.

    The aides and I have also purchased a respectable amount of powders and perfumes and lotions- for men and women, but the women especially like getting fussed over and trying on 'new products'.

    I was filling in for one nurse on a different hall one day, and discovered that one gentlemans room smelled HORRIBLE, it was stinking up the whole hall. When I asked the aides when the last time he'd had a shower.... "Oh, he always refuses."

    ALWAYS.

    They had let him go without a shower or bedbath for SEVERAL MONTHS.

    Not only did he let me give him a bedbath, then boot him from his room so it could be deepcleaned (yay bleach), he stated that the aides never did ask him anymore if he'd like to have a shower, and that his requests for bedbaths were ignored.

    Ugh. People.
    Last edit by Lynx25 on Jul 14, '12 : Reason: I might be illiterate
    zieglarf likes this.
  7. 0
    Quote from CapeCodMermaid
    Geodon is an antipsychotic. PRN use is not allowed unless there is a scheduled dose as well. Unless the man reeks of urine or has horrible skin issues, let him be.
    Maybe that's true at your facility, but we get orders for PRN geodon on residents who don't have it scheduled all the time on the locked units. To be fair, though, everyone on these floors IS on scheduled haldol or clozaril or something, just not always geodon. But geodon IS what the doc always orders PRN IM for everyone. It always works. These are some very unstable, violent residents. Ativan doesn't touch some of them. They need a antipsychotic or major sedative.
  8. 0
    It's not just MY facility. It's a regulation. CMS is targeting the overuse and misabuse of antipsychotics in the elderly. In Massachusetts, we'd get cited for using a PRN without a standing order for the SAME drug.
  9. 0
    Hmm, there must be a different set of rules for state ran facilities. For example, here we preset all our medications before we even begin med pass. I know that's frowned upon out in the rest of LTC land. It's sort of ironic that actual state ran LTCs seem to have more lax regulations when "the State" over regulates you guys to death...
  10. 0
    We also have residents who need bathing desperately and are so difficult...we usually end up using a PRN, being very creative, and sometimes involving family. We have one resident in particular who will have dried BM in his pants and still refuse to shower. At this point it becomes a health issue and we cannot just leave him.

    Poor guy


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