Lazy patient

Published

Am I obligated to clean up a patient when they are perfectly capable of doing it themselves but are just lazy/want someone else to do it for them?

(Physical therapy has determined he is capable of doing it himself)

1 hour ago, beachbabe86 said:

Your patients are to be taken care of. They are not scored individuals to be analyzed if they can "do it or not".

What has happened to human compassion?

Feel free to flame away.

What has happened is that nurses are expected to care for too many patients.

There is no reason that a patient shouldn't take care of himself if he is capable of doing that. If he is exhausted and needs some help after PT, fine. Help him.

But if he is getting sexual or otherwise weird, I would not encourage this that. He can wash his/her own privates. I will help with back, feet, but no privates. I will get towels, water, etc., but he can do his own scrubbing if not SOB, in serious or moderate pain, or there is some other medical reason, like being in tongs, that he can't wash himself. Most people want to bathe themselves.

The royals used to (still do?) have a servant who literally wiped their tushies. Not just emptied their waste but actually wiped their bums. Maybe being royal isn't so great.

BTW, I think Harry will live to regret what he and Meghan are doing by giving up their titles. He is still a prince, by birth, but is no longer a duke, earl, or whatever.

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2 hours ago, beachbabe86 said:

Your patients are to be taken care of. They are not scored individuals to be analyzed if they can "do it or not".

What has happened to human compassion?

Feel free to flame away.

There's taking care of, there's enabling, there's learned helplessness. Takes common sense, book learning and street smarts to figure out what you're dealing with.

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Specializes in Hospice.
4 hours ago, beachbabe86 said:

Your patients are to be taken care of. They are not scored individuals to be analyzed if they can "do it or not".

What has happened to human compassion?

Feel free to flame away.

Wrong. If this is a rehab unit, then assessing capabilities and working towards maximum function is exactly what needs to be done. That’s what rehabilitation means. Failure to do so fails the patient, exposes the organization to fraud charges and is the opposite of compassionate.

Enabling unnecessary dependence is not good nursing, regardless of what the compassion police have to say about it.

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If the patient is able to clean up and chooses not to, then It's up to you to clean it up or not really. If you don't clean it, then your CNA, another RN, or the house keeper will have to in the end. All you can do is educate and reinforce the education, but in the end it's still up to the patient. There's only so much an RN can do in a given shift. So just prioritize your tasks ?

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Specializes in Psych, Addictions, SOL (Student of Life).
11 hours ago, beachbabe86 said:

Your patients are to be taken care of. They are not scored individuals to be analyzed if they can "do it or not".

What has happened to human compassion?

Feel free to flame away.

I'm not saying I agree with it I am only stating what Medicare will pay for. Medicare and CMS does not care if your loved one or patient can't/wont do ADLS! that is considered custodial care which Medicare does not pay for. IF the patient needs custodial care it's up to them and their families to arrange for it/pay for it. This actually happened to my mother who had early Alzheimer's when she broke her hip. as soon as her Rug scores dropped to the point that it was clear she could not be rehabbed the facility gave us 3 weeks to either start paying the 10 grand a month her care cost or move her home.

That being said - I would never leave a patient in their own waste or unattended to and I don't think OP is suggesting that. Still patients need to be encouraged to rise to their highest level of functionality.

I had a patient in the facility who family insisted could not do anything for her self. She was a bright, funny, lively lady who had had a stroke. When I showed her how to put in her eye drops and later to flush her super-pubic catheter she could not wait to show her family what she could do. They of course were angry because it served their purpose to keep her an invalid.

Hppy

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6 hours ago, ppham said:

If the patient is able to clean up and chooses not to, then It's up to you to clean it up or not really. If you don't clean it, then your CNA, another RN, or the house keeper will have to in the end. All you can do is educate and reinforce the education, but in the end it's still up to the patient. There's only so much an RN can do in a given shift. So just prioritize your tasks ?

While I agree others that we need to encourage the patient to be independent-I do not encourage anyone to become THAT nurse...the one that delegates every mess to a CNA, or constantly leaves their patients (or the SAME patient) in a mess at shift change for the next nurse to clean up. Leaving a patient in their own urine/feces is neglect. If they can do it on their own, guidance and help (which may take more time than just doing it for them) is essential.

Also, your coworkers will grow to dislike working with/following you.

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Specializes in Psychiatry, Community, Nurse Manager, hospice.

You are obligated to intervene as necessary. That might be patient education. It might be a psych consult.

I'm not concerned with whether or not you bathe this patient. I'm concerned with your ability to properly assess the situation. Laziness is not a nursing diagnosis. You have to do better.

Identify the patient's barriers to self care. Amotivation is sometimes a barrier. It's not laziness.

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3 hours ago, NurseSpeedy said:

While I agree others that we need to encourage the patient to be independent-I do not encourage anyone to become THAT nurse...the one that delegates every mess to a CNA, or constantly leaves their patients (or the SAME patient) in a mess at shift change for the next nurse to clean up. Leaving a patient in their own urine/feces is neglect. If they can do it on their own, guidance and help (which may take more time than just doing it for them) is essential.

Also, your coworkers will grow to dislike working with/following you.

Oh shoot, I misread the OP post. I was reading it as cleaning up the mess they make, like trashes and stuff. I guess I was too tired haha. But yes, in this case... educate, reinforce education, then clean the patient up. You are obligated to clean them up ?

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Absolutely not. If they demonstrate the physical and cognitive ability you are only obligated to set them up, ensure that they are safe and leave the call light within reach. By allowing them to perform self-care is taking care of him/her. Bending to their whim can lead to deconditioning and loss of ADLs. That being said you should thoroughly assess if they can perform their own ADLs prior. Coaching them through their ADLs may be a way to meet them in the middle and see if they lack the ability.

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2 minutes ago, Okayestdad78 said:

Absolutely not. If they demonstrate the physical and cognitive ability you are only obligated to set them up, ensure that they are safe and leave the call light within reach. By allowing them to perform self-care is taking care of him/her. Bending to their whim can lead to deconditioning and loss of ADLs. That being said you should thoroughly assess if they can perform their own ADLs prior. Coaching them through their ADLs may be a way to meet them in the middle and see if they lack the ability. 

What if they're physically and cognitively capable of cleaning themselves up but decided to not to? You did all the things you could like educate, coach, set them up, compromise, etc. Let's assume the patient is ready for discharge, but as we all know the discharge process can take a while sometimes. So in this case, the patient still won't clean themselves up, then what? You are just going to leave the patient sitting in stools/urine until then? Something to think about, perhaps...

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2 minutes ago, ppham said:

What if they're physically and cognitively capable of cleaning themselves up but decided to not to? You did all the things you could like educate, coach, set them up, compromise, etc. Let's assume the patient is ready for discharge, but as we all know the discharge process can take a while sometimes. So in this case, the patient still won't clean themselves up, then what? You are just going to leave the patient sitting in stools/urine until then? Something to think about, perhaps...

If the patient is 100% able to provide the care themselves you document that they refused and yes leave them. It is unfortunate, yes but the patient is making the choice and patients are free to make poor choices. The patient is choosing to sit in their own filth. Obligating the nurse to bathe a patient that can otherwise do so themself 1.) takes time away from patients that need care 2.) is providing a service to a patient that they do not require. Nurse are medical professionals and are not obligated to wait on fully functioning adults that treat them like servants. Just my opinion that I clearly feel strongly about.

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2 minutes ago, Okayestdad78 said:

If the patient is 100% able to provide the care themselves you document that they refused and yes leave them. It is unfortunate, yes but the patient is making the choice and patients are free to make poor choices. The patient is choosing to sit in their own filth. Obligating the nurse to bathe a patient that can otherwise do so themself 1.) takes time away from patients that need care 2.) is providing a service to a patient that they do not require. Nurse are medical professionals and are not obligated to wait on fully functioning adults that treat them like servants. Just my opinion that I clearly feel strongly about. 

This is good! : ) I guess I haven't encountered a situation like this. I was only imagining it in my head and I guess just can't stand seeing patients soiled. But now that you mention it, I will probably do exactly what you said. It's the right way : )

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