Difficult Conversation re need for bathing

JDZ344 · May 16, 2012

When this comes up at work (I am a CNA, BTW) all we can do is offer and offer again.

Maybe you could try something like "I'm going to change your bed linen now- why don't you go into the shower with (staff member) and she'll help you get washed up while I change it, so it's all fresh when you get back"

Do you have a bath at your facility? Sometimes they may prefer a bath over a shower. You could try running a bath and telling them you ran a bath for them, come on, lets get you there... making it more like a given thing that she will get in, rather than a suggestion?

No other ideas, hopefully someone else can help you more :/

Home Health Columnist / Guide · May 16, 2012

I had homecare patients like this. I came up with the idea of a "Day of Beauty" pampering with toenail and fingernail polish.

I made up a sign "Day of Beauty" and aide would post sign in their bathroom. We started out slow. They agreed to sit on the side of the tub, allowed their urine soaked stockings (which they denied were dirty) to be rolled down so they could soak their feet in water which we had added Dr Johnson lavendar scented epson salts, have cream rubbed in and toe nails painted and fresh stockings applied Next week we added washing legs. Hand soak in sink and hand cream progressed to washing arms.

By week 3-4, aide prepared bathroom and we had her sponge bathing herself when we placed our sign up as she so enjoyed trying on new polish and hand cream.

CT Pixie, BSN, RN · May 16, 2012

Good Morning All,
I have had a conversation with a resident in assisted living who is alert, confused and keeps refusing to shower. She thinks she is clean however she has a strong body odor, family is upset as she will not even allow them to help her shower. All employees have tried to explain the health issues regarding this, we have even asked if we could just wash and set her hair to get her in the shower but with no success. Resident is "highly insulted" by our request and PCP's only suggestion is nursing home. Has anyone had this experience and what would you suggest?

As a LTC LPN I can tell you that placing this resident from assisted living into a nursing home will not change this resident, not one bit. If she's refusing to be bathed/showered in the assisted living she will continue resisting and refusing in the nursing home.

jadelpn, LPN, EMT-B · May 17, 2012

If someone is assisting this resident in getting dressed every day, and to get into her pajamas at night, that would be the time that I would have a basin of warm water, soap and face cloths--hand her one to wash her face, and then you start with her back and under her arms. , etc etc and start and end each day with washing as we are dressing/undressing. Perhaps a "new fangled" shampoo cap. Often people who are confused are also demented, and a classic alzeihmer's sign is the terror of water.....Another choice would be a rolling shower chair with the explination that they merely have to sit in the chair, you will wheel it into the shower and she doesn't have to move off the chair. Another huge fear is slipping in the watery soapy shower. Also I LOVE powder, nice smelling lotion......

allnurses Guide · May 17, 2012

This can also be a sign of depression....sometimes the ONLY sign. How is the patient coping with being hospitalized/ill?

allnurses Guide · May 17, 2012

I have (when all other strategies have failed) actually taken the patient aside. I leaned closely into my patient and, in a very sincere and concerned tone, with a very pained and distressed look on my face and with measured hesitation, said:

"Ma'am, I don't know how to say this without hurting your feelings, but... but I do smell an odor and I know... I know I would be mortified and I just want to help you because I don't want other people to notice it. You are too nice and I just want to spare you that. I will help you. We can make it as quick or as long as you like and I will make sure you are kept warm and safe."

Or some variation of that.

This has been successful for me with several difficult patients (especially women) in the past.

This I-wish-to-spare-you-embarrassment tactic also works with visibly wet pants.

Some people will be hesitant to try such a straight-forward technique, but when all else has failed, you would be surprised how well it works.

backtowork · May 17, 2012

Being raised by depression era, rural farming, parents, I can also add that this is a cultural thing. For his entire life, my father associated taking a bath with only 2 things..he was visibly dirty from working the farm, or he was getting dressed up to go out. Since one or both of these things happened on a daily basis, no problems..until he became old..then, I would tell him it was time to bathe and he would answer.."but I have not worked today and I am not going out??" When I was growing up on the farm, my mother would have us bathe every night, but only washed our hair once a week. She would put Breck creme rinse in our wet hair, put it up in two pig tail wet braids and that is where it stayed all week. Being raised in the far north, the common thought was that if you washed your hair too often, you would take a cold. People who caught colds during the depression sometimes died of pneumonia. Also, a woman who had just given birth was not supposed to wash "down there" for a month.

This all sounds crazy today in our super hygienic world, but in those days, in that culture, this was the norm. All these things come into play when dealing with our elderly patients. Culture may play as large of a role as dementia.

canned_bread · May 18, 2012

I had homecare patients like this. I came up with the idea of a "Day of Beauty" pampering with toenail and fingernail polish.
I made up a sign "Day of Beauty" and aide would post sign in their bathroom. We started out slow. They agreed to sit on the side of the tub, allowed their urine soaked stockings (which they denied were dirty) to be rolled down so they could soak their feet in water which we had added Dr Johnson lavendar scented epson salts, have cream rubbed in and toe nails painted and fresh stockings applied Next week we added washing legs. Hand soak in sink and hand cream progressed to washing arms.
By week 3-4, aide prepared bathroom and we had her sponge bathing herself when we placed our sign up as she so enjoyed trying on new polish and hand cream.

That is honestly brilliant. I just finished off working in a nursing home where we had some challenging behaviours about showering, and sometimes I felt so frustrated spending 10 minutes trying to convince, and them crying it was horrible. That is such a lovely idea, I wish I had thought of it!!

LaterAlligator · May 21, 2012

I second what's been said here; most confused people are afraid of showering, I don't know why that is but it's definitely a hallmark of Alzheimer's.

With really, really difficult patients, I've resorted to "accidentally" spilling water on them, apologizing profusely (sometimes I'll say it was coffee or juice to increase the incentive to get it cleaned off) and then while apologizing, shepherded them into the bathroom to change their clothes and whipped out at least a partial sponge bath while they're in-between clothing changes.

If they're combative and likely to be really mad at you for "accidentally" spilling on them, coordinate with someone else to be the one who gets them fixed up afterwards. But do it right then and there while it's still in their head what happened.

The other thing that works wonderfully is getting an order for PRN xanax or ativan to premedicate them for bathing.

I'm not saying that for your run-of-the-mill resistive patients, just the ones who really refuse or fly off the handle.

knighton201 · May 22, 2012

not sure if this is the best technique, but one i observed very early in my student clinicals at a nursing home in the alzheimer ward, is the cna would weekly (as it was the policy every resident showers at least once a week there), would trick this lady into getting a shower, each week i understood she would use a different tactic.

the week i observed it, is as the lady was going to use the restroom, the cna ran across the room, and shouted, "don't use that toliet its broken!", then proceeded to guide the lady to the shower room saying, "here the toliet in here works, let's use this one." then while the lady was doing her buisiness (they had an arangement with the shower chair rolling directly over the toliet which the cna placed her on) the cna helped her undress and then said, "we'll since we're here in the shower room, and all ready to shower, lets shower!"

after a quick shower the lady emerged smelling much nicer, however did little to improve her mood as i believe the comment was as follows, "i'm going to shove my foot up your ......" probably well deserved, but as i understood it, that particular cna and that resident had a unique relation of being each others arch nemesis. dunno, hope this helps.

zoey3270 · May 28, 2012

Thank you!!! It worked!