patient who refuses to bathe. help!!

  1. 0
    I have a newly admitted patient in the rehab I work at who refuses to bathe. He is exceedingly malodorous. You can smell him from up hall, with his door closed. He is also very unpleasant to all the aides and nurses. When I go into his room to give him meds or change his dressing (rectal abscess s/p surgical intervention) I feel like I'm going to pass out from the intense smell coming off of him. He wears his shoes in bed and refuses to takes them off and he has a bka and his prosthesis is filthy. He has only been at the facility for 2 days and other patients are going to start complaining soon. I know it. I think he is mentally ill but it is not noted in his chart so may be undiagnosed. He is able to get around fine and is not very old. He doesn't have Alzheimer's. What can I do? Help!!!

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  2. 10 Comments...

  3. 2
    You can lead a patient to water but you can't make him shower.

    Provide towels, soaps, lotions. Ask if he'd like a razor, toothbrush, etc.

    Is he homeless? Live in a shelter. I've worked with patients who lived rough. They had nothing. But if the offer was made in a non-judgmental way they'd often bathe if they felt secure in the environment.

    Even try offering a basin so he can control how much gets washed.

    Can your social worker rustle up some clothes for him? Can you access a washer and dryer?
    KelRN215 and loriangel14 like this.
  4. 2
    Can't force someone to bathe, unfortunately. Do you have a social worker? We will get ours involved if a patient consistently refuses routine care.
    Fiona59 and loriangel14 like this.
  5. 0
    This is a difficult situation to address. You cannot force a person to bathe or shower, and this person may also have mental illness issue that contributes to this. If he develops a trusting relationship with a caregiver, maybe he could be persuaded to shower. Social work, psych, and management should all become involved and work out an agreement about his hygiene that benefits everyone. Good luck.
  6. 0
    I would make the responsible doctor aware, and request both the social worker and a psych consult get scheduled on this patient. This isn't just quirkiness, this is self neglect.
  7. 1
    Does he need pain medication before he can bathe comfortably? For me pain is the number one reason patients refuse adl's.

    In my experience, when working with "difficult" patients, your priority is to establish rapport. If he knows you have a vested interest in him as a person he will be more likely to believe you when you say you are trying to help him. He also might reveal why he refuses certain adls/treatments etc. Save the power struggle for things that are actually important (important meds etc). Educate and document your education and the patients response. Make sure he knows that proper hygiene will prevent infection, and maybe that BKA won't turn into an AKA.

    -pardon my typos, I think I fixed them but I am using my phone!
    GrnTea likes this.
  8. 0
    Has he given a reason why he doesn't want to shower? Like is it some sort of phobia or does he really just not want to be clean? This can't be good for his skin.
  9. 0
    Perhaps OT/PT could borrow his leg for a short time to "make sure it's safe to use and do any needed small repairs"-- and in my opinion, a scrub is a repair.

    Otherwise, I agree with the it-takes-time-to-build-trust thing.
  10. 0
    Could it be a privacy thing? If you gave him warm soapy water and washcloths and left him alone maybe he would wipe up?

    Otherwise psych consult.
  11. 0
    This reminds very much of my patients with schizophrenia. Patients with schizophrenia tend to be disorganized in thought as well as behavior. They tend to neglect/avoid proper hygiene, especially hair washing and hand washing. Also, the reason he sleeps with his shoes on May be due to paranoia that someone will take them. Watch for hoarding of paper cups, utensils, or anything really. If you suspect schizophrenia or a similar illness be firm but do not agitate. Try to build rapport by finding if he has any interest (music was one of the things that got my patients to to open up, be more cooperative and altogether more personable.) Def get that psych consult

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