It Never Occurred To Me.

If there’s one thing I hate, it’s being told something negative about a patient in Report, even before I’ve seen them. It’s not that the off-going nurse’s observation aren’t valid, but I want to see and meet this person for myself before anticipating a rough shift that I might regret.

It Never Occurred To Me.

We'll call him John. John was 7 feet 2 inches tall. At 65 years of age, he had long brownish-gray hair, that he wore in a clumsy ponytail. He suffered from morbid obesity which made it difficult to ambulate as evidenced by his shortness of breath.

A Viet Nam veteran, homeless, was found wandering the streets with a very high blood glucose level. He claimed he didn't know he had diabetes, which was possible. John hadn't seen a doctor in years. He was polite and cooperative, up independently and ambulating in the halls when we met.

He had a distinct strong body odor. His day nurse informed me earlier that "He won't take a shower." I wondered why. Remembering that there is a reason for every kind of behavior, I decided to mull it around a bit before broaching the subject. He shared with me stories of his military service, how he got to be homeless and how he found himself in the hospital.

"I was married once," he began. "It lasted 20 years....but then...she got sick and I couldn't keep up with the bills. We lost our house, she died....and suddenly it was all gone." He was sitting on his bed. I had pulled up a chair. It wouldn't be long before I had to do rounds again for vitals and meds, but I sensed a wounded spirit in him. A burden not just on his body, but in his heart as well. The elevator doors down the hall opened. The smell of hot food wafted down the halls.

"John, " I asked gently, "Is there anyone I can call for you? A friend? Anyone?" He shook his head sadly.

"Supper trays are arriving. Will you eat?" I was worried that his blood sugar would take a dive if he didn't. He nodded. I smiled at him and retrieved the tray.

I still hadn't asked him about his refusal to take a shower. He allowed the staff to change his towels and linens. As John ate his supper, I reviewed his chart again and noticed how many times the previous shifts had offered him hygiene assistance but he would politely refuse. I also noticed that no one had charted on asking him why.

Looking at the Allergies section of the chart, I noted no issues with soap or laundry products. Was he afraid of water? How long had it been since he had a decent shower or bath? Our homeless communities have access to showers and facilities so I was coming up empty on this one. Since he was a veteran, I knew he could handle it if I was direct with him, but it would need to be tempered with respect. Off I went down the hall. I walked into his bathroom, turned on the shower, set up supplies and towels and brought in a clean fresh oversized gown and fresh robe. He glanced up in surprise. I smiled at him and pulled up the chair again.

His eyes still had that hint of sadness, so I reached for his hand and said:

"John, part of my duties as your nurse is to not only keep you safe and help you get better, but I owe you the honor of being truthful and to offer possible solutions when at all possible.

The staff, as well as myself, have noticed that you have not been able to get a shower in during your stay. You are beginning to give off a very strong odor and I am concerned that along with your medical condition, that you may be setting yourself up unknowingly for infection. The odor comes from bacteria, which loves to grow in dark, moist areas." I took a breath.

"There are places on your skin that you need to get clean." I wasn't prepared for his response.

"Well, " he began slowly, "I want to take a shower. But I didn't want to embarrass the young ladies taking care of me.....I'm so big and I can't reach where I need to, and I didn't want to make those young girls uncomfortable." This man was a true gentleman.

"John," I asked, " I would not be uncomfortable with assisting you. Will you allow me?"

He nodded with relief. I smiled. "After you, Sir."

Yep, there's a reason for every kind of behavior. And sometimes, it's just plain courtesy.

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Have Nurse

About Have Nurse, ADN, RN

Cynthia has 27 + years in Nursing, is a grandmother, Military Veteran of 9 years, Christian, and a lover of nature, the Edwardian Era and dark chocolate.

3 Articles   719 Posts

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Great article! Thank you for sharing. I agree it is very hard to come on shift and get told in report that the patient is awful/demanding/rude, etc. I like to talk to the patient and make up my own mind. I have found listening goes a long way!

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Specializes in Travel, Home Health, Med-Surg.

Kudos to you for going the extra mile. And I only say extra mile because sometimes time does not permit sitting down and talking with our patients. Reminds us all that we need to look at each and every patient as a human being and treat them with the kindness and respect they deserve. Thank-you for sharing, and for that reminder!!

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Specializes in Primary Care, LTC, Private Duty.

I had a patient like this: he had a complicated medical history, including morbid obesity, and anyone who looked at his chart without knowing him cringed. They immediately thought, like his medical history, he would be complicated and difficult. But no! He was the most wonderful, considerate gentleman there is, and it truly opened my eyes to the saying "don't judge a book by its cover". Whenever I was having a bad shift, especially, it was wonderful to have him as one of my patients because he was always SO polite and SO grateful for anything we could do for him, even if we had to wheedle it out of him because he was too embarrassed or saw how busy we were and didn't want to bother us. He was a good guy!

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That is such a sweet story.

As a nurse who was a CNA and has pretty much seen everything, that was a very kind consideration for him to take.

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I've had patients who were reluctant to receive care because they're very modest.

No matter how matter-of-fact we were, care is still an embarrassing ordeal for them.

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^^^This. Yes, this^^^

Have Nurse, this is truly a touching, beautiful illustration of what so many caregivers & patients experience, but is often hard to convey the feelings & emotions coupled with professionalism & idk having the knack I guess to put the patient at ease? I'm having a difficult time trying to put into words THAT FEELING. THAT SECOND SENSE we are truly blessed with. You have done a fantastic job of putting those feelings into words & getting the point across.

This article definitely struck a chord with me. I have had several co-workers/supervisors tell me that this is one of the strong skills I possess. Though I absolutely appreciate hearing this, It is only validated because I have THAT FEELING in my heart.

Though I admittedly love the adrenaline rush of a code etc., this is the part of nursing that idk, makes me smile, I guess???

We are all part of a team. We all bring a different skill set to the table. As a team, we are one.

Thank you for sharing. Rock on :)

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Specializes in Med/Surg/Infection Control/Geriatrics.
^^^This. Yes, this^^^

Have Nurse, this is truly a touching, beautiful illustration of what so many caregivers & patients experience, but is often hard to convey the feelings & emotions coupled with professionalism & idk having the knack I guess to put the patient at ease? I'm having a difficult time trying to put into words THAT FEELING. THAT SECOND SENSE we are truly blessed with. You have done a fantastic job of putting those feelings into words & getting the point across.

This article definitely struck a chord with me. I have had several co-workers/supervisors tell me that this is one of the strong skills I possess. Though I absolutely appreciate hearing this, It is only validated because I have THAT FEELING in my heart.

Though I admittedly love the adrenaline rush of a code etc., this is the part of nursing that idk, makes me smile, I guess???

We are all part of a team. We all bring a different skill set to the table. As a team, we are one.

Thank you for sharing. Rock on :)

You are kind. Thank you for your words and encouragement.

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Specializes in EMS, LTC, Sub-acute Rehab.

I take all reports with a grain of salt. Sometimes it reflects more on the nurse than the patient. A psycho-social approach seems outside the skill of some people. Every patient has their own story.

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Specializes in LTC, assisted living, med-surg, psych.

I had a strict policy of visiting the "difficult" patients first (assuming the rest of the team was not coding or otherwise had no immediate needs). I found that investing 10 minutes or so at the start of the shift usually saved me a lot of time later on. I liked to establish trust and rapport early, and that very often meant less anxiety for the patient and less running up and down the hall for me. Going into a shift with a reputedly needy or angry patient was something I never looked forward to, but I did my best not to let it prejudice me toward that patient. I was proud of my ability to make these folks a little more comfortable and leave the day-shift nurse with a calmer patient than she'd had yesterday.

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Specializes in Practice educator.

A great story that really hits home on two things, getting to know your patients and how a country's philosophy on health care causes hard working people to lose their home because they can't afford the bills to keep healthy. A sad indictment.

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Specializes in ED.

Thank you for your kind service to one of our own.

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