Basic hygiene for CMO patient who refuses it?

[vintagestudent]

Should basic hygiene be given if the CMO pt refuses it continuously? Pt Stage 4 cancer & given a couple of days to live by physician. No foul odors, no visible bodily fluids other than a small amount of weeping on leg & abdomen due to anasarca. Pt wouldn't answer any of my assessment questions. Wouldn't talk at all, in fact...until her son came later in the afternoon and repeatedly asked her questions to solicit a response. As the student nurse, I just tried to respect pt's wishes. I did my head-to-toe assessment (as required), took VS, tidied up the room, & every hour checked on pt (on morphine) who was verbally asked about pain level but never replied either way (pt had no pain based on facial expressions/body language I observed and this was confirmed when adult son arrived to visit & asked him. The son informed me that father told him he had no pain).

I'm a newbie, so after getting sorely reprimanded and told that I would bathe this patient even if it meant I lost my lunchtime, I'm left wondering if I even belong in nursing. According to my instructor, I was negligent in my care of this patient. Ouch!

Some background on me: My first & very recent evaluation had some NIs, but on many things we haven't yet been able to do on the floor. I was told I ask good questions and do well with making my patients feel comfortable. Have I made bonehead mistakes? Yes, but none that are out of the ordinary for a newbie student nurse with no previous experience in healthcare. (Been home all these years raising 4 children for the past 20+ years, so it's been a huge adjustment being in nursing school.)

Will you seasoned nurses clue me in...I've never considered myself negligent in my care of pts but, well, maybe you can help me understand where I grossly erred, so it doesn't happen again. I'm very teachable; it can only help me. Thanks.:)

[missjennmb]

I'm just a student as well, but what a rough situation.

You said the patient is dying, so I'm assuming hospice type protocols? I was taught, just recently of course so I have no experience, that when someone is dying your goal is only to make them comfortable, right?

I'm sorry but if I only have DAYS to live, I do not want some nursing student messing with me. Particularly if I have not yet processed and reached the phase of acceptance.

[mume2mykidz]

I would ask the head nurse not instructor what you should do,I am a new graduate but I know with my cousin we made sure that she was comfortable,we did bed baths as much as we could and made sure that peri care was done and she never sat in a wet depend but this was at home.

like the previous poster said she probably does not want to be bothered or just can't because the morphine is suppresing her/him

[missjennmb]

I asked my teacher about this exact thread yesterday. She basically said that you just keep bugging them. You cant do it against their will, but you ask repeatedly, and if that doesnt work, get another student to ask, and if THAT doesnt work, get your CI to ask.

[vintagestudent]

I asked my teacher about this exact thread yesterday. She basically said that you just keep bugging them. You cant do it against their will, but you ask repeatedly, and if that doesnt work, get another student to ask, and if THAT doesnt work, get your CI to ask.

Hmmm, good point. I'll do that next time. Thanks for asking your instructor...mine still doesn't want to talk about it...preferred to send me to the counselor for this incident. Good thing the counselor was reasonable and while she couldn't agree with me, she understood my perspective and reasons.

Curious, can you ask your instructor if not giving a CMO pt basic care because the patient repeatedly refuses it is "respecting the dying patient's wishes?" I would like clarification on this.

Thanks!

[iluvivt, BSN, RN]

I can not believe what i just read!!!! If a patient of sound mind refuses care of any kind than not only should those wishes be respected,it is illegal to do so. For example,if I insert an IV against a pts wishes it is considered battery. This pt was just refusing very basic nursing care and their wishes should have been respected. Does a pt that only has a few days to live really need to "bugged" into doing something. I would explain to the patient that it might make them feel more relaxed or comfortable and let them know that I was available at anytime if they changed their mind. I totally disagree with your instructor and think you did the right and kind thing,

[missjennmb]

Just a slight perspective on this from my day at clinical this week. I cared for a patient who had extensive/extreme contractures of her upper and lower extremities, who could not eat/swallow/speak/move but was off and on awake and would look at us as we cared for her. She was in obvious pain as we took care of her ADLs, and I hesitated to bother her because I knew she was not happy about it, just from her muscle tensing and the slight bit of emotion and gesture she was able to portray. However, we continued to do her ADL (we gave her a bed bath and spoke to her, changed her clothing and her bed linens - we were unable to provide mouth care because she was completely NPO and her mouth was clenched and immovable). If I had to guess, I would assume she did not want us caring for her. She even had a tear run down her cheek when we had to manuever her gown around her extremely contractured and entwined arms. But ya know what? For all of her fighting and fussing, when it was said and done, she was so peaceful and so relaxed and you could just TELL that she felt so much better for it. Even our CI came in and said as much, completely without prompting. Now I'm not saying that we should ever do anything against anyone's will ever, but I can understand why it would be encouraged to do ADLs even with an end stage illness, just because I think that sometimes patients (and all of us!) forget the value of feeling clean and refreshed when we're not feeling well. Ever felt like crap and dragged yourself up to shower and suddenly felt better?

Anyways, I would hope that if the patient put their foot down it would be respected, but simultaneously, I would hope that if I was the patient, someone would ask me again later, when perhaps the moment of refusal had passed.