Advice

[leksie]

Hi.. I just first want to say that I am only a student in a nurse-assisting class. At this point in the class we are going to our local nursing home 2 times a week for 4 hours a day. We help CNAs do things sometimes, but mostly we are taking residents to the shower, giving bed baths, changing linens, giving bedpans, filling up their ice cups, etc. Which I like, actually. Anyway, today something occurred that I'm confused about. I would have asked my instructor about it but she actually had to leave early today because of an emergency, so I didn't get the chance and I am wary of talking about it to any other classmates or the nursing staff at this LTC facility.

This morning another class mate and I were told to give a resident (I'll call her Mary) a bed bath. We gathered our supplies and everything, went inside and introduced ourselves, began talking with her and telling her what we needed to do. She first said she did not want to take a bath today. I then told her if she doesn't feel well then she can rest for a little longer before we start to bathe her. At this time a nurse enters the room to tend to the patient sharing the room with Mary. The nurse (or nursing student in the RN program, I'm not sure) informed us that Mary never wants to take baths and to just go ahead and begin bathing her. Then she walked over and got Mary out of her bed and walked her into the bathroom that was in her room. Mary complained about not being moved in her wheelchair and that she didn't want to walk. The nurse sat Mary on the toilet and pulled her pajama pants down and Mary started to have a bowel movement. The nurse then went back to tend to the resident on the other side of the room, while telling us to just wash her off while she was using the toilet. I was hesitant at first, because Mary was in a lot of distress as she was using the toilet, the overbed table wouldn't fit near the bathroom so we would have to be walking back and forth carrying our wash cloths and towels and getting soap&water everywhere, and the nurse was shouting at us to hurry and clean her and then pull her pants back up. We began washing her face and chest with her shirt unbuttoned, and Mary said it was okay to take it off so we did. All the while we were cleaning her upper extremities, she kept wiping herself with toilet tissue and trying to throw the tissue away insider her brief. She was getting feces on herself as we were trying to clean her. I told the nurse that if we could let her finish using the bathroom, and clean her appropriately so we could at least get her back in bed and comfortable (she also kept asking and pleading to be put back in her bed) and then we could give her a bed bath, but the nurse said, "I know they have their rights and everything but sometimes you just have to do what's the simplest, go ahead and put her clothes back on her, she has to go to therapy," At which we began cleaning her as we were told to do before putting her clothes back on her. I got a moist cloth and tried helping her wipe herself, and when I looked at the cloth I suspected she had an impaction. I reported this to the nurse who then lubed up her fingers and tried to remove the impaction, but unsuccessfully. She then wiped Mary, pulled her pants back up, put her shirt back on, put her in her wheelchair and took her downstairs to therapy, without another word except for "I bet that really makes you want to be a nurse," (referring to the impaction).

First, I know I'm only a nurse-assisting student and I am not trying to criticize anyone here but I just want a little insight on this from some of you nurses. I was confused and unfamiliar with the situation and I feel bad for the resident because she was in pain and distress the entire process. I want to talk to my instructor about this as well but I would feel kind of dumb if I was worried about nothing. Thanks for reading!

[BrandonLPN, LPN]

I wouldn't have washed her while sitting on the toilet. But, yes, some residents protest getting washed up every time. It still has to be done. For many demented old people getting washed up or dressed is *always* a distressing experience. Probably more so cause she didn't know you. I'm sure her regular aides know all the "tricks" to calming her down. Also, LTC residents have scheduled bath days. They do not get a bed bath every day. There's no time for that.

[leksie]

Thank you for your reply. I understand some residents can be difficult especially if affected by dementia. But this woman was speaking very clearly and was totally oriented. Her chart in the CNA care plan indicated she was totally oriented as well. The part where I was unsure of how to proceed was when she was on the toilet struggling to have a BM and the nurse was rushing us to just "wipe her off", and with Mary telling us that she was not finished yet when the nurse was urging us to go ahead and put her clean pajamas on her so she could be taken to therapy. I remember now the color of the woman's scrubs and looking at her ID tag, she was a nursing student in the RN program at my college. I am not doubting or criticizing her, but I was just sort of freezing at some points, unsure of what to do, with Mary still having a really messy bowel movement when the nurse put her in her wheelchair and took her out of the room. I may be just over analyzing everything, because the only place I ever bathed a resident was in the shower rooms and their bed.