Need your opinions for personal care

[solanim]

Guys I need your advice

today I had a big argument with senior nurse regarding patient's personal care.

This is about one female patient who presents mild chorea movement involving both arms, independent mobility with unsteady gait. She is a voluntary admission under guardianship.*

Obviously due to her chorea movements and unsteady gait,* I believe she needs a standby assist during shower although she insists she can do it by herself. Also I noticed when I assisted this patient to get change to pajama , she didn't wear bra and underpants.* When she was asked, she laughed and said she forgot to wear. Then she asked me to put her underpants on.*

After that when I gave handover to night staff I* asked her to try to help patient's shower. If she refuses assist, let her do by herself with set up assist otherwise she will get agitated . But wait for her outside until she finishes. Then night staff told me she tried early am when patient asked for shower but patient strongly insisted to have shower herself so she let her do it by herself after setting up for shower.*

So i told the night staff that I saw the patient without wearing proper underwear when patient got change to pajama. And i asked staff to remind her to wear underwear after shower if patient refused help again for dressing. The reason why I asked to the staff she is sharing common areas with male patients (this is 4 beds sub acute unit) and sometimes she didn't pull up her pants after toilet use. So she might expose her body to male patients without noticing . Also her husband who is her guardian is really sensitive about this matter.

*I cannot remember how many time he asked staff to ensure the patient wears proper clothing . Also he asked us please to help her shower. He also know she does not do proper shower herself . Just let water flow in front while standing . Again she has mild involuntary arms movement with unsteady gait. I know patient does not like help for shower and wearing bra but willing to wear underpants with prompting. Night staff was also informed of husband's request and complaints of letting patient have shower by herself . To be honest, his request is fair enough.* But night staff misunderstood me and persuaded patient to have shower assist when she asked for shower around 0600. Then the staff ensured she had a proper dressing. Then Patient was not happy at all by being assisted for shower and got agitated after shower.

What i was told patient approached to nursing station to say something when am handover occurred around 0700. there were 3 RN. One rn tried to open *the station door to listen what she wanted but the other senior RN who was sitting in chair asked her to wait for them by telling her they are busy for meeting and waving his hand to her . Then she suddenly outburst and became physically aggressive. So she hit one rn's chin who tried to approach the patient.

One of am staff who was the senior nurse complained to me and night staff that we provoked her behavior.* And asked us what' s wrong with not wearing underpants?* Told us He doesn't wear underpants neither at home. Oh my god. I dont want to know what he wears at home. And told me I do too much care of what her guardian, husband, asked. And asked me not to just listen to husband and have my own idea. Just let her shower herself then let her wear whatever she wants.* Oh my god. I just told the senior nurse that i don't think this is the same case. Then i think night nurse misunderstood me. I didn't ask her to force to shower the patient. (Oh my god . He was sitting next to me when I gave the handover to the night staff. But how come he said that to me.) I also told him i don't just listen to the husband, I just try to respect patient's dignity . She just needs prompting or remind othewise she forgets. If she doesn't like to wear underpants that's fine. I don't bother.* If she is reminded of underpants she will wear. *

*Then i told him i am not really certain whether she wears clean clothes by herself after shower.* So i asked him whats wrong with giving her gentle remind for wearing proper clothes and offering shower assist. Anyway he still believes just let her wear whatever she likes and let her shower herself as long as patient requested.* And he insisted us to follow his opinion. But I don't think it's a proper management for the patient. She has lack of insight that's why she's a voluntary patient under guardianship. *I belive I can respect her dignity by gentle remind and prompting rather than neglecting . How do you think?? What would you do in this situation???

Now I feel really silly myself. I feel like I argue with senior nurse whether to put patient's underpants on or not.

Sent on the go with Vodafone

[toomuchbaloney]

Has there been a care conference?

What does the POC say relative to the patient's independence and ability to self determine, especially as related to what clothing is REQUIRED?

[Been there,done that, ASN, RN]

Far from "silly".

You are advocating for the patient and her husband. You are absolutely correct that she needs at least stand by assistance in the shower and firm direction in her choice of dress.

This is why she is in your facility!

The nurse is blowing you off. toomuchbaloney had the best advice.

You have the right to call a patient care conference. Please do so and let us know how it went.

Good job... please see it through.

[Here.I.Stand, BSN, RN]

Yes, she needs a care conference. Also, where is PT/OT in this?