Difficult showers

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Specializes in LTC.

I have a resident that absolutely refuses to take a shower. The other aids just take her in the shower room and do it. They usually end up getting verbally abused or worse, physically abused. I have a problem with forcing anyone to do something they don't want to do. It's their right to refuse. A few weeks ago I was working with this resident and no matter what I did or said I couldn't get her to take her shower. On Friday that week, which I have off, the resident gets a bad peri rash. Her skin was open and bleeding. I ended up getting blamed by another CNA for not being able to get this resident in the shower. It's my turn with this resident again and now I feel like I absolutely have to shower her. A lot of the problem is she scares me. I don't want to get hit. She's a hoyer lift and has contracture in her legs so I'm not sure a tub bath is a good idea. I've tried bed baths before, but she refuses that too now. Aside from taking her into the shower room and just doing it like the other aids, I'm at a loss. Never mind that the last time I tried that before we even got there she started yelling at me. What are your strategies on getting through difficult showers and talking residents into them?

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I would go for getting another CNA to assist you with either a good bed bath or shower. Give the resident the choice. We would use two CNAs for difficult showers. It is nice for them to refuse, but then they should get the bed bath. One can't go two weeks without hygiene and not end up with worse problems.

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If the patient is a full lift then I don't see why you wouldn't have 2 people showering her. As well, why not bath her? I'm having difficulties seeing showering someone in a lift? We usually put a person that is in a lift in the tub, much easier that way, the only ones to shower are those who are capable of mobility on their own who really want a shower over a bath or those who are too heavy to fit into the bath chair.

With those in a full lift we either use a bath sling or we take out the sling when the person is in the lift, we have even had the person stay in the sling (bath sling) and connected to the lift and lowered into the bath...it is so relaxing for them :)

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Try contacting the family to see if they may be able to come in and talk to her. I have found that the patients are more responsive when their kids come and talk to them. Also, I know its a long shot, but have you tried asking her "Would you mind helping me out? I really need to get this shower done, I don't want to get fired" Sometimes with difficult patients, this works because it seems more like its a team effort and they're helping you keep your job rather than you taking care of them, they feel less helpless. I had a difficult patient who refused to let me change is depends with BM in it unless I asked this way... let us know how it all turns out

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Specializes in Certified Nursing Assistant.

I know at the facility I work at...if we told a resident that we would get fired if he/she didn't take a shower...we WOULD actually get fired! It is considered to be a form of abuse, because you are playing on their emotions. We have residents that refuse showers all the time...but, it gets to the point where eventually you have to make them take one. If this person is a lift...then I agree that there should be two CNA's present giving the shower. I also agree that if you contact the resident's family and explain what is going on, then they may be able to help talk the resident into it. For some residents, they may be refusing because of a dignity issue. Maybe they would be more receptive if they were allowed to wear a hospital gown during the shower so they don't feel so "exposed." It's definitely an issue that everyone needs to be aware of...charge nurses, other CNA's, the family, etc. I, too, don't believe in forcing a resident to do something they do not want to do...but, you have to draw the line somewhere when it comes to their personal hygiene. :)

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Specializes in LTC.

I ended up asking for help and it went as well as can be expected. The resident yelled and swore at me the entire time, but that's typical for her during any type of cares. Changing her into a night gown the other day was a challenge and in her opinion warranted throwing her clothes at me and swearing at me so you can imagine how fun her showers are.

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Just out of curiousity, does the patient have dementia? The reason I ask is that I work in the dementia unit and with dementia patients and that behaviour sounds like someone with dementia. If so there are ways to control the behaviour, see if the RN or LPN can medicate the resident beforehand and use gentle but firm approach, sometimes one needs to talk to them like a 2 yr old by telling them what they will be doing instead of asking, othertimes tell them that the behaviour is not accepted and leave, then try going back and if that doesnt work have someone else as sometimes another person will get awhole different reaction. Just some thoughts :)

Oh and document!! Document, document, document...all abuse and behaviour so that the physician can see what is happening so they can put the patient on new meds or a trial med depending.

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I know at the facility I work at...if we told a resident that we would get fired if he/she didn't take a shower...we WOULD actually get fired! It is considered to be a form of abuse, because you are playing on their emotions. We have residents that refuse showers all the time...but, it gets to the point where eventually you have to make them take one. If this person is a lift...then I agree that there should be two CNA's present giving the shower. I also agree that if you contact the resident's family and explain what is going on, then they may be able to help talk the resident into it. For some residents, they may be refusing because of a dignity issue. Maybe they would be more receptive if they were allowed to wear a hospital gown during the shower so they don't feel so "exposed." It's definitely an issue that everyone needs to be aware of...charge nurses, other CNA's, the family, etc. I, too, don't believe in forcing a resident to do something they do not want to do...but, you have to draw the line somewhere when it comes to their personal hygiene. :)

In the facility that I work in, they actually encourage us to tell them that, its better than doing anything against their will. At the end of the day, my patients are clean and happy.

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Specializes in Med-Surg/urology.
Just out of curiousity, does the patient have dementia? The reason I ask is that I work in the dementia unit and with dementia patients and that behaviour sounds like someone with dementia. If so there are ways to control the behaviour, see if the RN or LPN can medicate the resident beforehand and use gentle but firm approach, sometimes one needs to talk to them like a 2 yr old by telling them what they will be doing instead of asking, othertimes tell them that the behaviour is not accepted and leave, then try going back and if that doesnt work have someone else as sometimes another person will get awhole different reaction. Just some thoughts :)

Oh and document!! Document, document, document...all abuse and behaviour so that the physician can see what is happening so they can put the patient on new meds or a trial med depending.

Yes that is a really excellent suggestion! For some residents they would get a PRN medication, usually Ativan & then we would shower them after they calmed down.

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Specializes in Certified Nursing Assistant.
In the facility that I work in, they actually encourage us to tell them that, its better than doing anything against their will. At the end of the day, my patients are clean and happy.

caitylumpkins,

I agree with everything you stated in your previous post...except the part about telling them you would get "fired" if they didn't help you. The facility I work at also encourages asking residents for their help, because if they can indeed help you, then that is a plus for the resident and also helps with their self-esteem. Every facility is different, though. When I asked my boss about this issue, I was told that telling a resident you could/would get fired if they didn't help you is (in the facility's eyes) viewed as a threat against the resident...and if you were caught doing such...you would definitely be fired on the spot. :)

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http://www.bathingwithoutabattle.unc.edu/

If you have to buy it, it is worth it. The residents whent from fighting, biting, and screaming to OOOOing and AAAHHhing and thanking the cna repeatedly throughtout the bath.

Oh, I looked at the price... it is still worth it for a facility or class or maybe several of you can split the cost. At the very least check out the towel bath.

Basically, avoid the distressing things.... almost everyone is distressed by being cold and uncovered. The dvd shows several alternatives in which the person remains warm and covered the whole time. It also covers several other commonly distressing things related to baths... how/why they are distressing and how to avoid them.

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I have many of the same problems as the OP, you just described my night!!! lol Had a bad night at work and found this thread, just feeling a little discouraged, and this does help....:) I am going to try some of these suggestions. I have also found that if you get to know your resident, you can make the experience enjoyable for them. A massaging shower head on an aching back helps, as well as a good scrubbing on an itchy one. Just small things that actually make the shower a good thing. Of course, sometimes they will be mad no matter what, so make it quick!!

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