Controversial Patient Odors in Nursing

Body odor is a somewhat controversial topic. More specifically, there is the persistent belief that certain groups of patients are more odorous than others. This piece will highlight several groups of patients who, rightly or wrongly, have been deemed more odorous than usual. Nurses General Nursing Article

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Controversial Patient Odors in Nursing

In fact, the mere mention of body odor can trigger a knee-jerk reaction in some persons. Moreover, any nurse who has worked on the floor or in a home care setting can attest to the reality that not all patients, clients, or their families come to the table smelling cleanly. In other words, body odor often comes with the territory during the delivery of direct patient care.

Some unpleasant stenches are certainly to be expected in the nursing profession. For example, every health care worker is cognizant that fecal matter has an unpleasant odor. Urine-stained linens, briefs and pads sometimes reek strongly of ammonia. Smelly phlegm in the intranasal area is usually associated with sinus infections, while pneumonia caused by bacterial agents such as Pseudomonas aureginosa result in sputum with a notable smell that characteristically blends sweetness with foulness. Furthermore, depending on the causative agent or microbe, infected wounds can generate lingering odor that is capable of knocking the strongest clinician to his or her knees.

In spite of the usual and customary smells commonly associated with the provision of hands-on nursing care, several types of patients are believed to be more odorous than normal. It should be highlighted that, fairly or unfairly, some nurses have expressed a visceral dislike of a few of these patient populations, which may or may not affect their perceptions of the supposed body odors. After all, a person's perception is his or her reality, and perceptions can definitely be clouded by a strong loathing of the patient in that hospital bed. Without further ado, the following types of patients and their purported aromas will be elucidated.

Patients With Renal Failure

Patients who have been afflicted with severe chronic kidney disease or end stage renal failure are often the subject of various complaints from health care staff. Many outpatient dialysis nurses gripe nonstop about the inappropriate behaviors of some of their clients while conveniently failing to mention any of the well-mannered, compliant patients they have. It is negativity bias at its finest: belligerent patients who arrive at the dialysis center late while cursing at the staff will make a more profound impression than those who are polite.

On the other hand, patients with renal failure can sometimes possess the characteristic smell of ammonia due to nitrogenous waste byproducts that leave their bodies through their skin. When the kidneys are no longer functional, they can no longer expel nitrogenous waste effectively through the genitourinary system. These waste products exit the body via the patient's skin, resulting in the unmistakable smell of ammonia.

Patients With Obesity

Unfortunately, the overweight and obese are one of the last groups of people who can experience legal discrimination in most American states. Obesity is a poorly understood phenomenon, as evidenced by legions of physicians and nurses who exclaim with disgust that their rotund patients simply need to put the fork down. Simply put, a sizable number of health care workers harbor overt or hidden biases against obese patients. Countless health care personnel also claim that their obese patients smell badly. A recent Google search of the term "obese odor" generated 464,000 hits, and a search of the phrase "obese stench" yielded a whopping 885,000 results.

Here is the deal: adipose (fat) tissue is odorless. However, since many people are disgusted by the obese, perhaps they perceive that their heavier counterparts smell worse than others. When a person with a normal body weight smells badly, poor personal hygiene or other issues are often blamed. Yet, if a heavyset person has an odor, it is almost instantly blamed on obesity. Is the double standard becoming apparent?

Homeless Patients

Homelessness and health are interconnected. Homeless patients tend to be in poorer health than their counterparts who possess stable housing. Additionally, since the vast majority of homeless patients lack health insurance coverage, they sometimes utilize hospital emergency rooms to receive care. A number of health care workers express disdain toward homeless patient populations, making statements such as, "They need to pull themselves up by the bootstraps and find jobs like the rest of us."

A growing patient population exists; they are known as the 'invisible homeless' or the 'hidden homeless.' These patients live in shelters, weekly rate motels, campers, RVs, or tents in the wilderness. They are often part of the working poor, so they never have enough money to conjure up the security deposit and first month's rent required by landlords to rent a permanent dwelling. These homeless people are usually cleanly and without body odor because they have access to shower facilities at a shelter, motel, friend's house, health club, or campground.

Likewise, the visible homeless (read: the unsheltered individuals who 'sleep rough' in parks, alleys, cars and other places unintended for human shelter) may smell offensively. Regularly unable to bathe or shower, they can sometimes possess the smell of destitution, which is the smell of pungent sweat, filth and/or urine (Kozol, 1988).

References

Kozol, J. (1988). Rachel and Her Children. New York, NY: Crown.
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TheCommuter

About TheCommuter, BSN, RN

TheCommuter, BSN, RN, CRRN is a longtime physical rehabilitation nurse who has varied experiences upon which to draw for her articles. She was an LPN/LVN for more than four years prior to becoming a Registered Nurse.

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Teeth!! Rotting teeth and the breath that goes along with them is one of the hardest odors for me to deal with.

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Oh hygiene. So frustrating! I can't stand when fully independent patients refuse to wash up. On my floor our we rarely get to use the shower room and when we do it's usually because someone has been around for a week or so and a bed bath can only do so much. I offered a shower to an independent patient today because there was actually time if he needed help he admittedly smelled. Of course he refused. I sincerely don't know how people allow themselves to smell the way they do. I understand not feeling well, but come onnnnn. Would you not take a shower for a week at home? I might be afraid of that answer.

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Specializes in Private Duty Pediatrics.
Xlorgguss said:
Oh hygiene. So frustrating! I can't stand when fully independent patients refuse to wash up. On my floor our we rarely get to use the shower room and when we do it's usually because someone has been around for a week or so and a bed bath can only do so much. I offered a shower to an independent patient today because there was actually time if he needed help he admittedly smelled. Of course he refused. I sincerely don't know how people allow themselves to smell the way they do. I understand not feeling well, but come onnnnn. Would you not take a shower for a week at home? I might be afraid of that answer.

A person becomes accustomed to their own smell. That patient who refuses to shower may actually think it isn't needed. He doesn't smell bad. "That nurse is just too fussy."

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Not as often but another group critisized are the elderly.

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Specializes in school nursing, ortho, trauma.

We encounter this a lot in school health for a multitude of reasons. Kids come in with dirty clothing often because they either don't have the means to wash their clothing / bathe - to which we can do something about or because they choose not to bathe and change their clothing and have been wearing the same hoodie for weeks. That kid, we can do less about. I can speak till i'm blue in the face to a child about bathing regularly, offer them deodorants and soaps but if a child has no desire to shower and change their clothing i can't force them into a shower. And the teachers ALWAYS saddle the school nurse with this task. On the other end of the spectrum, i have the tweens that bathe themselves in colognes which can be overpowering too.

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I second Flare's comment! I have a few that I swear bathe in essential oils, to the point that it has caused problems with classmates' asthma. Then there's the kid who never really learned how to wipe his butt properly, then the animal smells. Just today, I have a kid who has been wearing the same pants-that are too big and fall off of his rear-and boxers for the last 4 days!

In the hospital setting, I was never really bothered too much by personal odors. The one smell that always struck me as the strangest was that of the severe jaundiced patient. Untreated, tunneling, infected, stage 4 decub was the worse smell I've ever smelled!

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Libby1987 said:
Not as often but another group critisized are the elderly.

Once they land in LTC, the norm is bathing once a week. If they smell bad, perhaps it's not their own fault.

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Specializes in "Wound care - geriatric care.

Hardly anything grosses me out, not even the stinkiest of wounds (which can be easily fixed by applying crushed flagyl) from cachectic patients. I used to be grossed out by the smell pt exude when they are on vanco...not sure it that still bother me. Everybody has their own smell gross scale.

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Specializes in LTC, assisted living, med-surg, psych.

Another group that may face criticism is the mentally ill, many of whom neglect to shower for days or even weeks at a time. This is very common in depression, when it seems like too much bother to run the water, get in the shower, wash hair, rinse, dry off, and then dress in clean clothes. Needless to say, this practice makes a person smell bad, and I've seen nurses wrinkle their noses and say unflattering things behind the patient's back. "Why doesn't ____ just take a bath? He REEKS!" they'll say with distaste. They don't know that failure to maintain physical hygiene is a complex issue that has no easy solution.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Ruby Vee said:
Once they land in LTC, the norm is bathing once a week. If they smell bad, perhaps it's not their own fault.

All of the LTC facilities where I've ever worked typically had residents' showers scheduled for three times per week, or sometimes twice weekly.

I once asked my former DON (director of nursing services) why the residents were not bathed daily. She mentioned the lack of staff. She also added, "Elderly people do not need daily showers anyway. Their skin is already dry. Daily bathing would dry out their skin further."

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
TheCommuter said:
All of the LTC facilities where I've ever worked typically had residents' showers scheduled for three times per week, or sometimes twice weekly.

I once asked my former DON (director of nursing services) why the residents were not bathed daily. She mentioned the lack of staff. She also added, "Elderly people do not need daily showers anyway. Their skin is already dry. Daily bathing would dry out their skin further."

I want to know where you work! My mother (in Wisconsin) and mother-in-law (in Massachusetts) get weekly showers unless we wish to pay extra for a second shower every week. Or unless they make a really big mess.

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