How do you get a very combative patient to take a shower

[esunada]

I have a client who refuses showers. He comprehends most things but seems withdrawn and has alzheimers. When asked if he will let us give him a shower he gets agitated. If we explain that it is important that he is clean for hygeine and health reason he gets more agitated. if we say his family really wants him to have a shower because they care about him, he gets even more agitated.

Distracting him doesn't work because he knows that we want to give him a shower. He starts yelling, slaps, punches, kicks and squeezes my arm if we come anywhere near him in an attempt to give him a shower. He is a two person assist so for him to be that agitated makes it really hard to give him a shower when he is trying to hit us. Its amazing how strong people get when they are angry even if they are elderly - it really hurt when he held on to my wrist with all his might. One of us tries to hold their hands to prevent the punching but its still not easy.

The nurse is going to see if a agitation med will work right before the shower. Anyone experience this and how do you manage it?

[Diamond Nurse]

This is NOT a suggestion. (see how I said that first?)...Nor justification, but..... in the old days (when Posey vests and Geri-chairs were the norm) the aides and I (five of us) would guide the victim to the shower and who ever didn't have an arm or leg (usually me) would wash pits and peri from the posterior side and hose the patient (and partially the aides). towel off what I could (of the patient only) and call clear, then we would release the patient and duck. Sometimes we got away with out being hit, slapped or punched, sometimes not.

I anticipate an avalanche of negative responses but back then was just that....back then.

[CapeCodMermaid, RN]

This is NOT a negative response. We did all sorts of not so wonderful things to patients back then. Remember syringe feeding? Thank goodness we've learned from those mistakes.I once had a 93 year old resident ask me if I took a bath twice a day. Before I could answer she said "they want me to have a bed bath twice a day, and I don't like it. How dirty do you all think one little old lady gets??" Her wishes from then on were honored and everyone was happier.

[Diamond Nurse]

Oh God Syringe feeding....I almost forgot! My staff was freaking out when they did away with this practice (torture) so I had each staff member feed each other this way with water and applesauce mixed. We all immediately agreed this was a BAD way to feed someone, and a very good way to choke .

[Lynx25, LPN]

You can read all of the responses you want, but eventually you're just going to have to find the way that works for you and that resident.

For one lady, it's "Let's go get your medicine!" She agrees, and then I wheel her past my cart, "Goodness, must have left it at the desk.." Past the desk, "Oh wow, let's go see if this nurse has your medication, " and zip, right into the shower room. After that, we both eventually agree that while we're IN here looking for these dang pills, we might as well put on a clean shirt- don't want to be a mess for dinner, that'd be terrible. While we're putting on a clean shirt, maybe just clean under her arms 'real quick', and so on and so on until she's had a full bath, and is wearing all clean clothes. It takes a while, but no one is getting beaten with a cane with this method.

Another one I tell that Im going to get in a terrible amount of trouble if I can't get the room cleaned up. She feels bad, and I offer to let her go get cleaned up in the shower while I mop, to make sure 'everything' in the room smells nice.

The aides and I have also purchased a respectable amount of powders and perfumes and lotions- for men and women, but the women especially like getting fussed over and trying on 'new products'.

I was filling in for one nurse on a different hall one day, and discovered that one gentlemans room smelled HORRIBLE, it was stinking up the whole hall. When I asked the aides when the last time he'd had a shower.... "Oh, he always refuses."

ALWAYS.

They had let him go without a shower or bedbath for SEVERAL MONTHS.

Not only did he let me give him a bedbath, then boot him from his room so it could be deepcleaned (yay bleach), he stated that the aides never did ask him anymore if he'd like to have a shower, and that his requests for bedbaths were ignored.

Ugh. People.

[BrandonLPN, LPN]

Geodon is an antipsychotic. PRN use is not allowed unless there is a scheduled dose as well. Unless the man reeks of urine or has horrible skin issues, let him be.

Maybe that's true at your facility, but we get orders for PRN geodon on residents who don't have it scheduled all the time on the locked units. To be fair, though, everyone on these floors IS on scheduled haldol or clozaril or something, just not always geodon. But geodon IS what the doc always orders PRN IM for everyone. It always works. These are some very unstable, violent residents. Ativan doesn't touch some of them. They need a antipsychotic or major sedative.

[CapeCodMermaid, RN]

It's not just MY facility. It's a regulation. CMS is targeting the overuse and misabuse of antipsychotics in the elderly. In Massachusetts, we'd get cited for using a PRN without a standing order for the SAME drug.

[BrandonLPN, LPN]

Hmm, there must be a different set of rules for state ran facilities. For example, here we preset all our medications before we even begin med pass. I know that's frowned upon out in the rest of LTC land. It's sort of ironic that actual state ran LTCs seem to have more lax regulations when "the State" over regulates you guys to death...

[CookiePB]

We also have residents who need bathing desperately and are so difficult...we usually end up using a PRN, being very creative, and sometimes involving family. We have one resident in particular who will have dried BM in his pants and still refuse to shower. At this point it becomes a health issue and we cannot just leave him.

Poor guy

[Lisa Ferrell]

I Ben a care tech a very long time what do you do when a resident whom has advanced dementia no matter how hard you try beats you up every time you shower her and she says the water burns her skin even though we have the temperature at a comfortable temp she tries to bite hit slap punch no one should have to be abused it takes 2 ppl to bathe her 

[dianah, ASN]

Lisa Ferrell said:

I Ben a care tech a very long time what do you do when a resident whom has advanced dementia no matter how hard you try beats you up every time you shower her and she says the water burns her skin even though we have the temperature at a comfortable temp she tries to bite hit slap punch no one should have to be abused it takes 2 ppl to bathe her 

What a challenge, eh?  My advice is to read through the other responses in this thread, some of whom report dealing with exactly what you are facing.  Perhaps resident would do better with a sponge bath rather than a shower (maybe she reacts poorly to the feeling of the shower water pummeling her)?  Yes, dementia, as mentioned, can present quite a challenge!  I hope you and your staff can come up with a plan of action to keep resident clean and yourselves safe from blows.

[ComeTogether, LPN]

Let him refuse. A good bed bath is just a good.