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).
