Keeping my patient's dignity intact? Please help me!! (long but urgent)

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I am nurse and caretaker to a partially mute male, 14 years old. He has failure throughout his body, including problems with digestive and nervous and vital systems, and I must tend to him.

He has good skills and intelligent and mentally independent. He can do and enjoys doing puzzles or hand activities, but can only do so much due to low coordination. He understands language and he can make noises that resemble words, however does not speak much. He prefers to make sounds or be silent.

I massage his belly to bring about eructation (burps) and flatulence and to improve digestion. I also massage him daily to help with digestion and circulation and to soothe him.

I handle hygiene and intimacy. I give him physicals or check ups once a week. I bathe and groom him regularly and take good care of his skin. I diaper him since he dislikes bed pans or catheters. Not to mention he does have sexual insecurity, even with puberty, so it is even worse on that part. I occasionally administer enemas or laxatives also.

We've agreed that it is acceptable for me to spoonfeed him, since he has poor coordination. Often he can feed himself but requires assistanxe. Although I do respect him and I assure meals are satisfying.

I do talk to him kindly and considerably. I communicate with him and make sure I know what he needs or what he wants me to know, even though he has difficulty replying or talking. He cannot communicate easily but he is very intelligent and he has a very active mind. Even though his body cannot function correctly, his mind and feelings are still working fully. So I am concerned. He does enjoy the care. He likes massages and such. He knows he can trust me and that I can help and comfort him. He knows I will respect him and do what he needs.

However, things can be too overwhelming, like my "full control" or his overdependence. I feel as if I invade or put too much pressure on his will.

Please help me. How can I keep his dignity intact? How can I help him yet allow him to not feel like he nothing?

Are you a nurse? RN? LPN? personal care worker?

By the way, why do you ask?

Also guys, please:

How can bath time or diapering be less "drastic?

We are adjusting however no matter how close we get, the intimacy will never be 100% okay. But how can I make things a bit easier for him?

Specializes in HH, Peds, Rehab, Clinical.
By the way, why do you ask?

Just the way you've phrased certain things and the very nature of the questions you've posed. Whether or not to use certain equipment and such

Specializes in HH, Peds, Rehab, Clinical.

Intimacy is usually a word reserved for a relationship of a HIGHLY personal nature. At least in the area I am from

Intimacy is usually a word reserved for a relationship of a HIGHLY personal nature. At least in the area I am from

I mean by the diapering and bathing please.

Specializes in Complex pedi to LTC/SA & now a manager.
Intimacy is usually a word reserved for a relationship of a HIGHLY personal nature. At least in the area I am from

Exactly. Intimacy is used for care or a relationship of a romantic or sexual nature and does not belong in nursing or caretaker vocabulary unless caring for a spouse (or other intimate partner). You are referring to a minor child

Peri-care or personal care is the term for assisting a client with toileting or bathing needs.

You are constantly being your level of licensing as all of your questions are covered in nursing fundamental clinical and theory whether a graduate of a 1 year practical nursing/LPN program, 2 year associate degree/RN program, 3 year diploma in nursing/RN program or 4 year BSN RN program.

Your queries are more consistent with an unlicensed caregiver who completed a CNA or HHA class of 6-8 weeks they focuses on skills rather than theory and rationale.

You keep saying that you are a licensed nurse nurse for 2 years working with this 14 year old multiply disabled client with neurological, communication, gastrointestinal, dysphagia, and elimination abnormalities for 7 months. You should have been oriented how to safely assist or feed the client, appropriate communication, proper hygiene and bathing techniques and the indications and use of medical monitors and equipment.

Nurses don't perform physical exams but clinical nursing assessments. Nurses do not get intimate with pediatric patients but use discretion when performing personal hygiene care with respect and ensuring modesty is maintained.

Your choice of vocabulary is not typical for a professional nurse yet you state English is your first language yet seem confused when members use professional terminology when responding to your queries.

Are you in fact a licensed registered professional nurse in your country? Or are you doing "nursing" care as an unlicensed caretaker/ home health aide working under the direction of a licensed nurse.

Specializes in Complex pedi to LTC/SA & now a manager.
Also guys, please:

How can bath time or diapering be less "drastic?

We are adjusting however no matter how close we get, the intimacy will never be 100% okay. But how can I make things a bit easier for him?

What do you mean by "drastic"? I think you mean personal care that requires modesty and respect rather than intimacy.

Specializes in Complex pedi to LTC/SA & now a manager.
I am an educated nurse, a year's experience as well.

I have gotten traning in basic caretaking, training in medical aid, training in social and personal care, and training in medical equipment.

This is not typical of the clinical and theoretical education of a licensed nurse in North America. What you describe sounds like the training offered to a unlicensed nursing assistant, personal support worker, personal care assistant or home health aide.

Nursing education in most of the world requires education in anatomy & physiology, pharmacology, psychology, sociology, nutrition, statistics, microbiology, and more. In addition clinical, theory ( including rationale), and laboratory practice in nursing fundamentals (which includes clinical skills, assessment, charting, basic equipment, etc), adult medical-surgical nursing, psychiatric nursing, pediatrics, maternity/obstetrics, and geriatric nursing. This is pretty standard education in countries that train nurses as generalists such as the US, Canada, Australia, New Zealand, Philippines.

Exactly. Intimacy is used for care or a relationship of a romantic or sexual nature and does not belong in nursing or caretaker vocabulary unless caring for a spouse (or other intimate partner). You are referring to a minor child

Peri-care or personal care is the term for assisting a client with toileting or bathing needs.

You are constantly being your level of licensing as all of your questions are covered in nursing fundamental clinical and theory whether a graduate of a 1 year practical nursing/LPN program, 2 year associate degree/RN program, 3 year diploma in nursing/RN program or 4 year BSN RN program.

Your queries are more consistent with an unlicensed caregiver who completed a CNA or HHA class of 6-8 weeks they focuses on skills rather than theory and rationale.

You keep saying that you are a licensed nurse nurse for 2 years working with this 14 year old multiply disabled client with neurological, communication, gastrointestinal, dysphagia, and elimination abnormalities for 7 months. You should have been oriented how to safely assist or feed the client, appropriate communication, proper hygiene and bathing techniques and the indications and use of medical monitors and equipment.

Nurses don't perform physical exams but clinical nursing assessments. Nurses do not get intimate with pediatric patients but use discretion when performing personal hygiene care with respect and ensuring modesty is maintained.

Your choice of vocabulary is not typical for a professional nurse yet you state English is your first language yet seem confused when members use professional terminology when responding to your queries.

Are you in fact a licensed registered professional nurse in your country? Or are you doing "nursing" care as an unlicensed caretaker/ home health aide working under the direction of a licensed nurse.

Answering to this and all.

It is difficult to understand half of what you are saying but I am trying.

I like in a confidential and closed in nation. It is west from the US state of Haiwaii (however you spell it, dear) It is not specified in a continent. We have our own training and care units.

I have degrees but it's hard to communicate and tell you about my own self.

We say diplomas or passes oe education. Here we don't use the term degree but I found it somewhere on this site and searched it and it means the same thing, just about.

I am sorry for the inconvenience.

Anyway, I got a degree for housing patients and caretaking. I have done nursing but it aide here. We dont have the best medical, at least compared to the US (your residence, right?).

We don't know much. Due to low population, we dont deal with many cases. We only have 10 recorded incidents of serious syndromes and we have 164 patients with mental or physical illness in our medical field. My boy is actually our second case with very severe issues. We are still studying. Also due to location and separation, it is hard to contact any bigger medical centers out of the nation who are smarter.

And intimate here means private or inside care, dealing with the more confidential body areas. These areas to us include the two organs, the bottom, the bare soles of feet (unless it is for sports or water activities), and your lower back if you're a woman and the back of your thighs if you're a guy.

That is for your understanding.

Specializes in Complex pedi to LTC/SA & now a manager.

The syntax/language barrier is causing much confusion here.

So are you trying to ask when it comes to bathing and diapering how can you make him more comfortable and maintain respect and modesty as well as professionalism?

Keep the patient covered (with towels during a bed bath not only for modesty to prevent chilling him by exposing excess skin to the environment/air; for tub bath use a small towel or wash cloth). There are many videos on you tube for basic bathing as far as CNA or HHA skills or nursing fundamentals. I will try and find a link.

Specializes in Complex pedi to LTC/SA & now a manager.

Does this help, it even includes recommended temperatures (in Fahrenheit as it's a US resource) ?

http://www.nursingassistanteducation.com/site/courses/eng/nae-pc2-eng.php

Does this help, it even includes recommended temperatures (in Fahrenheit as it's a US resource) ?

Nursing Assistant Education

Thanks for cooperating.

And I will see that and get back to you.

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