hygiene

[chronicallywiserRN7878]

I have been asked to speak with several middle school students with poor hygiene. Some lack resources at home and others just do not fully understand their changing bodies and need to shower more frequently. 
Does anyone have any suggestions on how to approach these students and have this conversation? Teachers want me to call them down and talk about it, but the "your teacher said you stink" approach is not one that develops an open relationship/dialogue. 

We have set some students up to shower at school and do laundry here in the past, but not an option for those who have these resources at home. 

[k1p1ssk, BSN, RN]

If the students have the resources and are simply electing not to use them then it is not a medical problem and IMO, should not be dumped on the nurse to deal with independently. If I were you, I would involve your school's adjustment counselor/psychologist/guidance counselor/health teacher AND the teacher making the referral when speaking with the students in question. 

Hygiene is an incredibly delicate situation, and unless there is a barrier for the student to access the necessary tools (laundry options, running water, cleansing products/tools), then you cannot make them change. As they say, you can lead a horse to water, but you can't make them drink. 

It is absolutely worth investigating if the student is dealing with mental health barriers, financial/access barriers, physical barriers, but again, this should not be falling on you alone to deal with. 

[NutmeggeRN, BSN]

Over the years (and there are many of them ?) I have honed my approach to the kid, (I'm in HS). I agree it is not a medical issue, but it can have an effect on their social interactions with others.

I am direct and tell them that a concern has been brought to my attention (and I NEVER reveal my source),  about their hygiene. I am very honest and up front. I ask them, in no particular order, depending on how the conversation is going

• how often they shower?
• do they need soap and or deodorant?
• do they have access to (hot) water?
• do they have  access to do laundry?
• how old are their shoes? (esp boys, but not always)
• if its someone who menstruates, do they need  product?
• do they need to change it more often?

The answers can be very telling sometimes about what is going on. Once I learned tht a young lady was suffering with hyperhydrosis, that was exacerbated by her profound anxiety...I wa able to loop in guidance and get her some supports.

It is never a fun conversation but if done in a caring, nonjudgmental manner, it can often help. But not always. Most times I will contact the parent to let them know I had the conversation, and often the bigger picture is shared.

Good Luck

[RatherBHiking, BSN, RN]

We have tried talking to students, talking to parents, offering hygeine supplies, having meetings with the parents, having the students shower at school and/or washing their clothes, even calling CPS for bad cases when they don't have running water (which as long as they have access to water even in a jug it's not grounds for them to do anything in our state I was told), nothing helps. Many families don't care about it-this is the least of their worries. We can't force them. Bullying them or constantly "getting onto the child" (I've seen this by teachers and some have made the student sit outside the classroom which I don't agree with) isn't helping the situation at all.

I agree it's not the nurse's job but we do get asked a lot. The problem is the student is mortified the teacher has told someone else about it. Then they come to someone they don't know well and are embarrassed the whole time and they are thinking to themselves just get out of here. It's better if the counselor can talk to them and start by asking how things are going, what their home life is like, do they need any resources, and noticing they don't appear or smell very clean today so why is that? That's something that would be better for the child. Same with clothes, we aren't the dress police. I also think the health teacher should be having a lesson for every class on hygiene and if they are then it's not like the student isn't already aware. So either they don't have resources or don't care because of bigger problems, both of which the counselor can help. 

Either way, if you aren't comfortable with it, I don't think there's anything wrong with just saying that's not a medical problem, we can't force students to smell clean, it signals either a lack of education (teacher can take care of that with a class lesson) or a problem at home which the counselor can help with. 

Send an email to all the staff of how you want to deal with that now. Just explain your new "policy". I've done that and it does help. I always add if nothing helps then there's always the option of a parent meeting with the principal, counselor, teacher and nurse. It's usually a multi-faceted problem anyway. I don't run it by anyone like the principal first either. It's easier to beg for forgiveness then ask for permission. I do it and then if the principal has any comments they will let me know but it puts them in a position that they can't really argue with the logic and the teachers know how I feel and everyone knows I'm not going to allow that problem to just be dumped on me alone.