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!!!
Jul 4, '13
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?
Jul 4, '13
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.
Jul 5, '13
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.
Jul 5, '13
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.
Jul 5, '13
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!
Jul 5, '13
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.
Jul 5, '13
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.
Jul 5, '13
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.
Jul 6, '13
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
Jul 11, '13
DO you have a whirlpool or something?? offer him to go in the whirpool for a water massage. Fill it with lots of soap and hot water. We actually have a whirlpool at our hospital, with a chair and stuff. I will offer to take patient's there if they truly do stink and are refusing baths. I don't like to offer it to just anyone because we only have one on our floor. I think it was an old OB tub or something? not really sure. It tilts back so they can walk in, sit and tilt back to cover their entire body. I'm so pushy with these people that refuse anything...I can't stand it. Is seriously feel like a drill sergeant sometimes. I just want the whistle now.
Sometimes patient's just need a firm kick in the butt. I've told patients before "Today you are going to sit in the chair for meals like a normal person and bathe before lunch. you will brush your teeth and you are going to walk the halls a minimum of 4 times. You are going to pour your own water and wipe you're own butt today." Pretty sad when I call that a "successful and great day" for someone. Dear lord. Given I will assist anyone who TRULEY needs it, but I do say this stuff to people that need a true kick in the hind end. We all know the type....the up ad lib people "Wipe my butt for me", yea no.
Get after him, annoy him with bathing if you need to. If he reports you, whatever. What is he going to say "I want to this nurse fired. she is trying to make me bathe"...yes, yes you are trying to make him bathe because you are here to get him better. He is in REHAB. he needs to participate. Tell him making sure he can bathe himself is part of his rehab. If he does not participate than insurane will not pay for this and he will be paying for his stay out of pocket. If you need to treat him like a child, make a chart for the days he will shower or bathe. Put up a calendar of days he needs to shower and clean everything. Give him SOME control though. Like if you make him shower or clean, allow him to do it himself. Or if you do the calendar, allow him to pick the days. just be like "You are gong to shower a minimum of 3 days a week, you pick the days."
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