Need serious advice- dealing with smell

JZ_RN · Apr 16, 2013

Keep in mind that one is a man I have to deal with almost weekly. The other patient is a rare occasional visit. The man especially makes me almost physically ill with his smell. I once asked him if he would wash his hands before we completed some wound care and the water ran mud-brown for a minute. And did I mention that he literally always wears the same dirty clothes. Same ones. Always. I feel bad for them but the smell of urine-soaked clothing is too much for me anymore. I can't even breathe near them. I don't want to be rude and hurt their feelings because I feel like they are either confused (poor management of their conditions, like incontinence and wounds) but it's not fair for me to have to smell the stench all the time either. They don't even notice that they smell, I don't think.

LTCNS, LPN · Apr 16, 2013

We had a patient when I worked in a wound care clinic, God love him, who came in for wound care weekly with the most horrendous, putrid smelling wound I had ever smelled in my life. He was a nice, nice man and knew how bad the smell was. We had to have really good poker faces and never let on how the smell made us feel. We did everything in our power not to embarrass him but other patients would complain about the smell. We couldn't let him sit in the waiting room for even 30 seconds.

Anyway, we never took our laptops in the room when doing his wound care and put Vick's Vapo-Rub in our noses before going into the room. We could still smell the wound some, but the Vick's helped a lot. Wonder if you could try that? Seems you've all tried everything you can. I hope you can find a solution.

katielea · Apr 17, 2013

Maybe a dumb question, but I work with homeless people, so my first question is do your patients have access to things like showers, washrooms and clean clothes? It's easy to just assume they don't care or don't notice, but if you don't have a home, or your home is inadequate, it can be really hard to get your basic hygiene needs met.

Assuming that they do, and are capable of taking care of their hygiene needs, it might be time for a chat about how we can best take care of ourselves. If you frame it as one of the ways we can keep ourselves healthy (especially in the context of wound care) instead of "I'm so upset I have to smell you all the time because you stink" it might go over a bit better.

sharpeimom · Apr 17, 2013

When I did a year of community nursing, I became much more tolerant and accepting of people who weren't as clean as I was. I carried a can of Lysol with me so I could spray my car and me if the stench got too bad.

I also reminded myself frequently that most people don't smell bad because they don't care or because they want to, but because they either don't have laundry facilities, running warm/hot water, couldn't pay their utility bill, food stamps don't pay for soap, shampoo, detergent, toothpaste, deodorant, etc.

It's only a few that no longer have the emotional oomph to be clean, who are homeless, or simply don't care. Some just have to be prodded or gently reminded about being clean. It's hard to care when you have to wear the same outfit or two day after day after day.

JZ_RN · Apr 17, 2013

The one patient I feel is homeless but the other I know lives in a home with running water and all of the associated facilities. I feel like she just has lost the drive to maintain hygiene. I understand the homeless patient. I've set him up with social services and shelters and numerous resources in the past, and I can sympathize with him, but the other patient literally just doesn't bathe or wash her clothes. I tried to discuss the importance of washing for infection control to her and she said she understood that. And she tells us that she bathes and changes her clothes and wound dressings daily but we simply know that it's not true.

eCCU · Apr 21, 2013

How do I deal with patients who absolutely stink in a professional manner? As in complete stench of feces, urine, draining wounds full of mrsa infection, just pure filth. I have several patients with poor hygiene who have been the subject of complaints to APS, but I still need to provide care to them when they come in. The smell makes me literally feel like I might vomit, and I can't close doors in rooms with them. I don't want to touch them because I'm afraid of what's on their clothes and personal items, and the smell lingers for hours after they are gone. Any serious advice on how to deal with this situation? Have tried to get them into a situation with a caregiver or aide but they don't see that there's a problem. While I wait and hope that APS places them in some kind of protective custody (they are not competent in my opinion, but what do I know? I can't imagine thinking it was normal to smell like this!) Thanks in advance for any help.[/quote']
Hello, just wondering whether your facility has case manager or social worker and perhaps they can assist in finding the patient a place to live in or home health care where they can have their hygiene issues addressed....

tewdles, RN · Apr 22, 2013

Ongoing education is obviously needed provided in a compassionate, nonjudgmental, and sensitive manner.

A social worker would be extremely helpful in providing the support that these patients need. In these situations it is really important to develop a strong professional relationship with the patient so that they will value your teaching.

You have received good tips for the smell.

I use a good amount of febreze, kept some in my car when I did home care, kept it in my exam room when in community health...before that was invented I used Lysol.

Good luck. Continue to advocate for these patients.

amoLucia · Apr 23, 2013

Severe clinical depression will contribute to a lack of hygienic care. This in addition to all the other possible reasons brought up, so I question if they've been assessed for the disorder and are being treated?? Maybe???

P_RN, ADN, RN · Apr 23, 2013

A NP at my doctor's office would tell them they had some skin problem...for example an area near their buttocks, neck whatever and she would give them a "treatment kit" (wash cloth, large bottle of water, soap, shampoo). They also kept a free clothes closet from Goodwill, with easy stuff-T Shirt, boxers/panties and directions to the nearest shelter. She also had connections with a laundromat company to salvage what clothes they could and return them. She would also ask them if they had a problem with not feeling "fresh."

No as far as YOU vs.the odor: Vicks vaporub just under your nares, oil of wintergreen with a 4x4 as a wick. Try not to open your mouth unless you are speaking...hand signals and inquiring facies can help not intake the nasty.

JZ_RN · Apr 25, 2013

Thank you guys for all of your advice. Honestly, in our area, our resources are stretched as thin as they can possibly be. I've had pregnant patients and those with newborns turned away from the shelters for lack of space. We do the best we can, but I can only smell so much before I begin to feel ill. I appreciate all of you guys! I'll continue to try to help these people.

Georgia peach RN · Apr 25, 2013

Medline makes a biological odor eliminator that we use during our wound care clinic. It works fairly well.

We have used oil of wintergreen and the vicks trick also but the odor eliminator is the best expecially after the patient has left.

We have been know to give our really aromatic patients a bath. The one that comes to mind is a younger patient who is a paraplegic and has elderly parents, no home health care coming out, not sure why??? We did try to set them up but there was a problem with the insurance??? The patient was very receptive and was thankful for the help. He brings with him clean clothes every time he comes now just incase we (us and Him) feel that there is a need to bathe. makes me really sad for him.