Anyone have a hose?

kadokin, ASN, RN · May 20, 2005

I've finally started laying the foundation for my career in psych, even if it is as a CNA II for the summer (one more semester = RN!).
One thing I need help with is - How Do I Get These People To Bathe? I'm telling you, the stench from some of them is unbelievable!
I'm open to suggestions. I can't wear Vicks under my nose all summer long :chuckle
Thanks

Too Funny!! And yet, serious. I have worked in psych for over 10 years now and I have almost been doing it too long to be able to explain how it's done, if you know what I mean. My style of interacting w/these folks is more of a habit than it is a deliberate process these days. A few tips:

#Be respectful, don't tell them they need a shower in front of a crowd.

#Without being overly coercive, try to offer it as a reward, when they come to ask you for say, gum, a smoke, an extra blanket, help making a phone call, etc. tell them you would be happy to help them, but, first, how about a shower.

#Offer choices, would you like a bath or a shower?, would you prefer to bathe before or after your meal?

#Get every thing ready in the shower room-clean clothes, soap, towels, etc. then take your pt by the hand and gently lead them down the hall. Don't tell them where you are going, necessarily, and they won't have as much time to consider all the reasons they don't want to do this.

#Tell them what you are doing every step of the way if they need help getting undressed, etc. This is especially helpful w/the confused elderly. Offer reassurance throughout the process, I am your nurse. I am helping you to get clean. I'm not trying to hurt you. You will feel so much better when we are done. Some people require 2 people to assist w/a shower/bed bath for safety's sake

#BEWARE-Some elderly pt's w/dementia can be incredibly fearful of the bathroom environment in general and water coming out of a showerhead especially. These people tend to be desperate, powerful fighters. You might want to consider a bed bath instead and even then, see previous statement.

#For the profoundly psychotic or depressed, you may have to give specific step by step instructions i.e. unbutton your blouse now, now step out of your pants, take the washrag in your hand, get the washrag wet, put soap on it, scrub under your arms, etc.

#Offer a reward that is hygeine related-afterwards, I'll help you shave, put on makeup, style your hair, once you are clean you can wear your pretty blue sweater

#While you are leading them to the shower(mum's the word), distract them w/conversation that is not shower related and continue to do so during the bathing process

#Try to catch them when their medication is at it's peak

#Above all, remember, these folks want to be treated w/the same respect, dignity and freedom to choose that all people should have. No one method will work all the time w/every pt. If you can spend some time getting to know them, you are half way there. If all else fails, tell them you are not going to make them do any thing that they don't want to do, but you are available to assist them when they do feel like they want to get clean. I"m amazed at how frequently this particular approach seems to work, then again, even this last doesn't work w/everyone. In most cases, the gentle, low key approach is best.

Good luck! Keep learning.

NCINDASUN · May 20, 2005

Thanks for the tips. I managed to get one to shower in exactly the way you suggested - "I'll let you go outside to smoke IF you take a shower." Another one took the good cop, bad cop approach. One of the nurses ticked her off by telling her to take a shower, but then the "nice" one asked and she did it just to spite the first nurse!

My friends think I'm absolutely crazy (poor choice of words, I know) to work in psych, but I love it. So far, every day offers something new and I love trying to find a way to be creative to get them to do what I need them to do, but yet help them retain their dignity. Kinda like having kids all over again, except I can't use "Because I said so!"

Hope you don't mind if I pick your brain every so often. It's nice to have someone on the outside to turn to.

kadokin, ASN, RN · May 22, 2005

Thanks for the tips. I managed to get one to shower in exactly the way you suggested - "I'll let you go outside to smoke IF you take a shower." Another one took the good cop, bad cop approach. One of the nurses ticked her off by telling her to take a shower, but then the "nice" one asked and she did it just to spite the first nurse!
My friends think I'm absolutely crazy (poor choice of words, I know) to work in psych, but I love it. So far, every day offers something new and I love trying to find a way to be creative to get them to do what I need them to do, but yet help them retain their dignity. Kinda like having kids all over again, except I can't use "Because I said so!"
Hope you don't mind if I pick your brain every so often. It's nice to have someone on the outside to turn to.
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Pick away. I enjoy sharing my experiences. Just promise me I can use you as a job reference when I get old and "expensive". LOL.