No patient should ever feel embarrassed.
I’m such a dork now that I think about it but I love my job. The evening started off well.. We were full and within 10 minutes of coming into work, we were cardioverting someone. Then we got a medevac for a post arrest… It was a fun night.
One patient sticks out tonight… I felt really bad for this older gentleman I took care of today. He came in 79 year old male with new onset shortness of breath. You could tell he was in CHF. He had edema all over his body, rales, and all that good stuff.
What stuck out though was his hygiene. He looked like he hadn't showered in three weeks.. He had this build up in his hair.. he had pus in both eyes which made them red.. His glasses were filthy… One of my coworkers actually cleaned them and he remarked “I can see now.”
He was a stubborn old man, even though he would get really short of breath and desaturate to the 70’s he didn't want help. He had these urine soaked socks on.
The ambulance gave him Lasix, a loop diuretic that will make you pee. So he wet himself...I went to go help clean him up and like I said he was stubborn. I asked him if he lived at home and he said he did, alone. One could see that he wasn't able to take care of himself. I went to go take his socks off so that we could put new ones on and he said no… I asked him why.
I said, "Your socks are soaked with urine. I don’t want you to sit there with them on like that."
He said that he was embarrassed because his feet looked “horrible”. I reassured him that I've seen it all and nothing would bother me. He insisted on not taking them off. So it led me to wonder, man this guy really has a bad case of Self Care Deficit.
Ha, there goes nursing process…
Anyway so I told him if he was my family member I would not want him to sit there in his urine soaked socks and that I was going to clean him up and make him feel better. We got him cleaned up and I switched his socks...his feet were bad.
There was crusting in between the toes and his nails did not look like they were cut in years. Now yes, it was gross and I’m sure everyone reading it is thinking it. And I’m sure we all as health care providers joke about things like that or the “worst things weave seen”. What struck me tonight though was the embarrassment of the older gentleman.
I felt bad for him.
It must be frustrating to lose your ADL’s and your dignity getting older. We all have weakness and something so simple like not wanting to show his feet meant so much more.
No patient should ever feel embarrassed.
Like I said, I’m someone in healthcare that I've been doing for so long and have joked about the sometimes dirty patients or the silly stuff that comes in. But in another perspective these people have other stories. That man was losing his ability to deal with everyday things.
I felt bad for him and it truly gave me a new perspective to bring to my practice. In nursing school they taught us to be non judgmental when it comes to our patients. I hope the patients know that. I want my patients to know that they can ask me anything because if I were in their shoes, I’d want the same care. His feet and the want to cover them represented his vulnerability.
I hope that man gets better and finds the appropriate care for him. I asked him if he had family and he told me his daughter was a LPN at another local hospital… I was appalled. And I was kinda upset… but then again, just like my patient who had a reason why he didn't want to take his socks off, I’m sure the daughter had a reason not to take care of her father.Last edit by Joe V on Jan 14, '15
Jun 5, '08Nice article! I shadowed in an ER when I was 15. I was overwhelmed by compassion and saw such a need in healthcare to help care for others in our society. I have been working in healthcare for 3 years now and sometimes it scares me how cold and detached I feel. Your article brings to mind a very important lesson nurses need to remind eachother of!Jun 23, '08"What the world needs now, is love sweet love". Thank you for being compassionate and caring. I am an LPN and my now ex-husband (was 59 y/o at the time) was hospitalized for HPTN, diabetes, gout. and more; made sure the nurses knew that I was a nurse and claimed that I didn't care. What he didn't tell was that I was caring for my 86 y/o mother who was dying and a full time student, did I leave out that he was verbally and physically abusive? I am an advocate for children, the elderly, and others not capable of caring for themselves. The lesson that I learned is those who are the most difficult to love, are indeed the ones who need it the most.Jun 24, '08i agree! they're just not feet. that's why everytime i take a shower and i clean my healthy looking feet with abundant blood circulation, i thank God remembering my patient's cold, dark, ready to retire feet.Jun 24, '08It's sad that this pt was in such bad shape, esp when he had a qualified family member to care for him. The thing to remember is that you don't know what it may have been like for the daughter growing up. There may have been a valid reason for her not caring for him in his time of need. I know that with the things that I have gone through with my father, healthcare professionals will probably think that I am a horrible daughter for not caring for him when he becomes elderly. All I can say is that people definitely reap what they sow. If you haven't led a good life, don't think that people will go out of their way to help you just because you are old and feeble.Jan 14, '15I like that you could give unconditional positive regard to the patient while you eventually were able to give some benefit of the doubt to the daughter. As several have pointed out, we really don't know the whole story. It could be something as simple as a father's refusal to let "his girl" take care of him as though he were a child (though everyone in the situation can see that he needs help). Could be he was self possessed before his health was in decline, and this has not changed even though now it would be age-appropriate for him to accept help with ADLs.Jan 14, '15that's awesome that you save that poor mans life and I am hoping some one can do the same for my mother she lives in Plattsburgh and the doctors diagnose she with temporal seizersJan 15, '15What a great reminder of why we do what we do!
Hopefully, this man will get some home health in to help him with his ADLs. Sometimes, the stubborn older man does NOT want his daughter (nurse or not) anywhere NEAR his ADLs.
While he is there, though, can the podiatrist come and see him? Can a CNA sweet talk him into a shower and shave? Will a family member bring some clean clothes?
Make sure he goes home with his urinal. Makes all the difference in him adhering to his Lasix, and not having to "get up and pee" every "two seconds".
Hopefully, you can get him feeling better, cleaned up, and on his way with some support at home.Jul 9, '16I'm glad you felt bad for him, and your compassion is intact after time in this career, but what did you do about the situation? He clearly is unable to care for himself, that makes him an elder in danger. In NYS, this obligates us nurses to call APS and report it. Did you? Maybe he needs assisted living or visiting nurses. Perhaps more, you didn't state other comorbidities.Jul 10, '16I did 6 1/2 years in rural home health, and I've seen the other side of this story. It's very likely that the man was extremely independent and stubborn and didn't want his daughter looking after him, especially his personal needs. The people I cared for were intensely private to the point of prudishness and would not want a child of the opposite sex caring for their personal needs. If he had a son helping him, it might be different, but even then, he'd have to be about totally incapacitated. If he could be set up with a home care agency, it would be ideal, but at least a podiatry consult while he was in the hospital would be helpful, and as one person suggested, be sure he is sent home with his urinal. Also a social work consult might be helpful, to see if homemaking services or a change in living situation might be needed. He might or might not accept these, but it's a thought.Jul 23, '16Just before my father died, he was hospitalized with liver failure. He had a brief because he was on lactulose and very weak. I would ask the nurses or techs to come change him, and I know what they were thinking. There I was, in my nursing school uniform, waiting to start my shift in the same hospital one floor down. Here I was, an able bodied capable family member.
Here's what they didn't know. Yes, my father and I had a complicated relationship. That, however, didn't matter much in his last few days. It wasn't as much about what I didn't want to do, but how it was not within our dynamic for me to see my dad like that. HE did not want that kind of help from his daughter. And I respected that. Im glad I did. He died 3 days later in hospice.
Im an NP now, of Women's Health. Maybe that experience shaped my choices some. Its hard to deal with death/dying/aging, and male-female dynamics. I applaud those of you working hard to help these men maintain dignity, and a relationship with their daughters that does not cross their own personally set boundaries.
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