Having a hard time with less hygienic patients

  1. I know I am going to get scolded from everyone about this, but I have to share my issue. I've only been a nurse for a short time & the hospital I work for is in a rather poor suburb of Chicago.

    My issue is patients who are admitted who are either homeless and haven't bathed in months or patients who come from home and haven't bathed in months. In the last week, I admitted 2 men who came to the ED & then to my unit covered in feces. Another was a homeless man who I had to fight with all night long to take a shower so that he could have a colon resection done the next day.

    Last month I had an elderly female patient who smelled of urine so badly when she came to the unit that her roommates family complained. Thankfully, she was ambulatory so I assisted her with a shower before I ever even did her admission paperwork.

    Scold me if you must, but really I'm looking to find out if every nurse expiriences patients like this or is it because I work in a low income area?
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    About Manatee111

    Joined: May '08; Posts: 49; Likes: 24
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    13 Comments

  3. by   wildlaurel
    Well...I am a CNA in a hospital in a medium sized community and will finish nursing school in May (yay!). We have our share of homeless people and sometimes elderly people just aren't physically able to shower everyday. I know it is sometimes really hard to handle the smells and appearance of some people - but I try to remember that a) if these people had a choice, they probably wouldn't look that way and b) under the dirt, there is a person and while his/her hygiene standards may not be my own, we are all more than the way we smell or look. I know this doesn't help...I will tell you that a nurse I work with puts eucalyptus oil or mint oil under her nose if we have someone who is really smelly! It helps when you go into the room.
  4. by   Ruthiegal
    It can happen anywhere, sometimes people just can't manage a shower alone, and are too embarrassed to ask a family member to help. Sad. I know. but you can only do so much at the sink. It could be related to a decrease in mobility or ability to do ADL's. It won't stop so just keep doing what you do, and encourage better hygiene while in your care and maybe find out if family is checking in and know that Mom, Aunt, Uncle etc is having a problem and could they help our or do they need a referral to a community agency for a Home Health Care Aide.
    If they are homeless they probably don't have a place to go where someone will help them or they won't go... Our world unfortunately isn't perfect. I remember a man who lived under a bridge in a town I lived in a decade ago, I worked across from the bridge. He had an elaborate cardboard box "house" and spent time gathering lettuce for "his rats", he had a military pension but chose to live under the bridge and have his mail and money sent to a sisters home. The police finally came and "rescued" him... I never did hear how he did. So some people just make choices we could never live with... It is tough either way. Some Vick's under your nose can help with the smells.
    Last edit by Ruthiegal on Apr 17, '09 : Reason: added content
  5. by   loriangel14
    Quote from wildlaurel
    Well...I am a CNA in a hospital in a medium sized community and will finish nursing school in May (yay!). We have our share of homeless people and sometimes elderly people just aren't physically able to shower everyday. I know it is sometimes really hard to handle the smells and appearance of some people - but I try to remember that a) if these people had a choice, they probably wouldn't look that way and b) under the dirt, there is a person and while his/her hygiene standards may not be my own, we are all more than the way we smell or look. I know this doesn't help...I will tell you that a nurse I work with puts eucalyptus oil or mint oil under her nose if we have someone who is really smelly! It helps when you go into the room.

    You are going to be a wonderful nurse.
  6. by   Dalzac
    If they are able I usually don't give them an option. I worked in a downtown hospital and we got them all the time. I think the worst was an admit that had not bathed in over a year.. I got an armload of towels and a bucket filled with very soapy water and another bucket with clean water Bathed and rinsed him twice. the towels were for the floor to soak up all the water I poured all over him. I also used 5 soapy scrub brushes they use in surgery. It took me over an hour and a half to get him clean. I also washed his hair and shaved him. He had been admitted for gangrene of his foot after I got thru with him the "gangrene" of his foot had been washed off. and they discharged him the next day. His Doc brought me a basket of fruit.
  7. by   Kunzieo
    Li'l dab of Vicks under the nose. Empty out a Carmex jar and stick some Vicks in there. Easy to carry around, easy to put on without looking offensive.

    Believe it or not, you do sort of get used to some smells after a while
    I worked on a unit where we always had a few people with c-dif. I went from practically gagging in my mouth when we changed them to just noticing "oh, c-dif!" after a while.
  8. by   CoffeeRTC
    I'm not sure I see the problem. These people are poor and on the street. Some may or may not be suffering from mental illness, so it is not like they have a shower in their house. When they come to the hospital.....give them a bath, help them out. Most will be very glad to be able to have that type of help and care.
    I work LTC and see this alot with our admits from home. Nope...not a poor area. Some might be neglected, but others might have mental health or dementia issues while others might not be able to do for themselves.
  9. by   WoofyMutt80
    Keep a small bottle of scented lotion in your pocket, rub it in your hands and lightly on the shoulders of your uniform.

    BTW when a pt is admitted from a LTC facility find out if they have been getting the proper hygenic care. Another thing I learned as a CNA, if the urine is pungent smelling, and they are able to have liquids, get some cranberry juice since they might have a UTI, and see if you can get a urine test. Also check for bedsores.
    Another thing, these people might be mentally ill, and might live in group homes, where they are not getting the proper treatment.
  10. by   flightnurse2b
    i work in a very large inner city hospital and we have patients like this come through quite often. most of the time, if they are alert and oriented and able to bathe themselves, i don't give them much choice but to bathe. i give them the option of setting them up to do it themselves or i tell them that i will be more than happy to assist them with getting clean. gown up, glove up, bring in two buckets like another PP said, and get scrubbin. sometimes if you put a little bit of shaving cream in with the soap it also helps with the smell.

    alot of elderly patients like a PP said are not physically able to wash appropriately because they are too weak, have no access to family members, etc, and i take special care with making sure that they get a nice bath since their skin is usually extra fragile and they are more likely to get infection and breakdown quicker.

    do try and remember that the person you are washing, regardless of why they are not clean (and some mentally ill patients will fight you tooth and nail to shower), still deserve dignity and respect. i've seen too many people laugh, gag, fan themselves... just stuff that shouldn't happen.

    the smells are not pleasant, yes, but usually your hospital pharmacy carries peppermint oil, which is not abrasive to the respiratory compromised and you can dab it on some 4x4's and stick it in the room. the vicks trick under the nose works well too, i prefer burt's bees menthol lip balm in my nose... but stay away from anything scented--i can tell you myself as an asthmatic, i wheeze from certain perfumes and lotions, i can only imagine if someone has chronic bronchitis what it does to them.

    this is also a good time to get your full head to toe assessment of the patient as well as their skin assessment done at the same time. you can learn alot about a patient from their bath.

    good luck to you
  11. by   Aneroo
    Quote from michelle126
    I'm not sure I see the problem. These people are poor and on the street. Some may or may not be suffering from mental illness, so it is not like they have a shower in their house. When they come to the hospital.....give them a bath, help them out. Most will be very glad to be able to have that type of help and care.
    I work LTC and see this alot with our admits from home. Nope...not a poor area. Some might be neglected, but others might have mental health or dementia issues while others might not be able to do for themselves.
    Regardless of WHY they haven't bathed, and no matter how compassionate the nurse might be, it doesn't make the smell any less tolerable.

    Quote from flightnurse2b


    the smells are not pleasant, yes, but usually your hospital pharmacy carries peppermint oil, which is not abrasive to the respiratory compromised and you can dab it on some 4x4's and stick it in the room. the vicks trick under the nose works well too, i prefer burt's bees menthol lip balm in my nose... but stay away from anything scented--i can tell you myself as an asthmatic, i wheeze from certain perfumes and lotions, i can only imagine if someone has chronic bronchitis what it does to them.
    Agreed. We had bottles of the peppermint oil also. Tent a paper towel and stick it into the top of the bottle, let it get wet, and it acts as a great wick for the scent. I also like the idea of replacing the Carmex with Vicks or using Burts Bee's.
  12. by   Morettia2
    OMG I work in Newark, NJ and we get the worst of the worst. Low income area where my hosp. is located. The pt's that are admitted to my floor with cardiac problems are so unbearable at times. There was one pt. in particular last week. Great guy, young guy but heary transplant rejection and morbidly obese, but very friendly but had the worst aroma. YOu could smell it as soon as you walked into the back part of the unit. I would walk into his room and I had that gagging sensation from the smell. But I maintained being a professional and didn't make a face.

    He was for TEE on the following day, so Iwas determined to strongly encourage him to was himself very well before I left in the AM...well the CNA was not so professional, she kept telling me, "HE stinks so bad that the other pt's are complaining, and I askd him if he washes and he told me he does, he's a liar..." I just said" calm down this is what you do, when you start your AM care at 4:30am, offer him a hot basin of H20 with lots of soap insted of just asking him to go into the bathroom and wash up b/c he may be too SOB to stand at the sink and do it, soo and as you offer him the hot soapy H20 in a basin ,start to fill the basin up with the hot H20 and soap and give him lots of wash cloths and towls and a big boy gown and just place it at his bedside table, even if he says he can do it him self in the bathroom, fill the basin anyway and I bet he will wash...and make sure you change all of his linens that will also help and I will get you some magic spray for the room, but if the hot soapy water is in the basin right in front of him and he has enought wash cloths and towls to dry it encourages him to washup, insted of just assuming since he can walk into the bathroom he can wash himself,"

    I go into the room at 5:45am to give him his meds and what do you know he washed himself. The basin H20 was so dirty it was dark brown. The pt. said to me, "I overheard what you said earlier to the nursing assistant, I appreciate that you didn't talk about how I smell, I know I do and I apologize but it's hard for me to wash up but what you told the Nursing assistant to do this morning is the first time I have had a nurse care about me. And I thank you for the deodorant you gave me. I feel much better, and you are the only nurse that I have had since I was admitted that didn't say that I stink up the unit."

    I just said, "well, sometimes a good wash makes you feel better, and if you just have the right way to do it you can really clean your self up, but from now on, just tell them in the morning that you want a hot basin of soapy H20 with lots of wash cloths and to put it at the bedside. But as long as you feel better, I feel better."
  13. by   Virgo_RN
    Yep, I've had my share of these folks too. I once had a LOL who lived alone. When I washed her back, there was so much built up gunk that it was coming off in sheets and turning the washcloths dark grey. It was so sad, because I knew she probably just couldn't manage bathing on her own and had nobody to help her. Others are able bodied, but for whatever reason, such as homelessness, substance abuse, mental illness, or just a lack of having learned about personal hygiene from their parents, have poor personal hygiene habits and smell pretty rotten. I felt awful one time discharging a homeless alcoholic without being able to wash his clothes first. In the past, we could just run over to the rehab unit and borrow their washer and dryer, but in this case, the patient had a spot in a rehab center and needed to get there *yesterday* if he wanted his spot, so we had to send him packing in a hurry. I hope he got his clothes washed when he got there.
  14. by   CoffeeRTC
    Quote from Aneroo
    Regardless of WHY they haven't bathed, and no matter how compassionate the nurse might be, it doesn't make the smell any less tolerable.



    Agreed. We had bottles of the peppermint oil also. Tent a paper towel and stick it into the top of the bottle, let it get wet, and it acts as a great wick for the scent. I also like the idea of replacing the Carmex with Vicks or using Burts Bee's.

    I kinda thought the OP was looking for the how could someone let themselves stink that bad? or is this just because of the area she works in?

    Anyway...

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