Patient refusal to shower-neglect?

Nurses Relations

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Scenario: you are a cna and you have a fully cognitive patient who multiple times a month refuses a shower, though does get them at least weekly.

Could you be charged with neglect for not giving the refused shower?

Assuming you asked they refused and you reported it to the charge nurse and charted it as system prompts- shower given-no l. why- patient refusal.

My thought here is this would not be neglect. Patient has right to refuse care.

Specializes in psych, addictions, hospice, education.

On the other side of the coin, if you force a shower, you could be charged with battery...

I say document refused. Patient has right to refuse. Forced shower would be battery. Maybe negotiate a different day or time? "How would you feel about doing it tomorrow instead of today?" Or "I can come back in an hour if that would work out better for you?" Sometimes just letting someone be in control makes them more agreeable. Is this homework? Or just a general discussion?

Specializes in LTC and Pediatrics.

They are getting one of the two scheduled showers a week. We need to remember that our elderly are not use to taking two showers a week. It was part of their culture growing up. On the other hand, the scheduled time might not be good for them Have you tried to find out what they prefer as far as shower times.

It nothing works, document the time they refused. As I said, they are getting one of the two a week.

Specializes in Med/Surg, Gyn, Pospartum & Psych.

Is there a reason why the patient needs a shower more than once a week? As the skin ages, the skin gets more delicate and frequent showering can actually be bad for the skin. Is the patient even doing anything to work up a sweat or soiling themselves? Simply provide the means to do a personal wipe down like a tub of soapy water and a washrag or a package of bed bath wipes between weekly showers and offer to assist in any way then need. Document the self care as well as the patient's refusal of a full shower.

It's a general discussion. Just trying to be clear on what to do in certain scenarios.

Is there a reason why a patient should have a shower more than once a week?

Yes, the skin gets more delicate. BUT think about all the risks to infection...

1) opportunistic bacteria can enter the slightest break in skin - all of the sudden your patient has unexplained vomiting, diarrhea, or pneumonia

2) incontinent patients face skin breakdown

3) many patients do not even wash hands before eating (ick!)

4) the stench of decay and really bad BO

I think one solution in LTC facilities especially is forget about showers and bring back bed baths. With showers, you basically have water propelling at clients like a speeding truck and have to rub and scrub to get them dry. If bed baths are used, you don't have to rub and scrub. At my nurse tech job, I asked clients who were fully capable to wash themselves in the room at the bedside if they wanted me to wash their back. When they said yes, I took four wash clothes, make sure they get wet and soapy in warm water, and cover their back with wash clothes. Then I would gently press them on the back with my hands. Patients said that felt really good, and then removed the wash clothes and draped a towel over them followed by a bath blanket and just dabbed dry the back. That prevents skin shearing from scrubbing the patient dry.

I should have specified this is about skilled nursing facilities not ltc and that this is in regards to continent patients.

Is there a reason why a patient should have a shower more than once a week?

Yes, the skin gets more delicate. BUT think about all the risks to infection...

1) opportunistic bacteria can enter the slightest break in skin - all of the sudden your patient has unexplained vomiting, diarrhea, or pneumonia

2) incontinent patients face skin breakdown

3) many patients do not even wash hands before eating (ick!)

4) the stench of decay and really bad BO

Infection issues can be resolved with proper hand-hashing--not showers. Infection risk increases with skin breakdown, so frequent showering, which can be drying and abrasive for the elderly especially, could potentially increase infection risk. Also, skin breakdown due to incontinence can be resolved by instituting toiling schedules and cleaning up the patient/resident in a timely fashion. Most residents also do get daily perineal care--you don't need a full shower for perineal care.

Specializes in Acute Care, Rehab, Palliative.

A fully competent patient can refuse anything. A shower once a week is fine.

Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.

Agree with all that has been said regarding the pts right to refuse.

However. Please make sure your documentation reflects the fact that pt refused, was given other options and still refused.

The state visited my facility once and wanted lots of explanations as to why a particular pts hygiene was below acceptable.

Please also know, this responsibility falls to the facility, and not a particular staff person.

Specializes in Early Intervention, Nsg. Education.

I would also ask the resident's family about his/her usual showering/bathing routine. I worked in a NH as a NA in the 80's. One particular resident had every single shower marked "refused" for several years. She would only allow a nightly "bird bath" and she had her hair washed and set once a week. She wore long-sleeved shirts and pants every single day, and would wear the same clothes about 3 days in a row. (She wore a nightgown to bed, and carefully folded her clothes and put them in a drawer each night.). She was alert and oriented and required very little assistance with ADL's; NA's only helped her with her feet, legs, and back and she did the rest. She spoke Polish and very little English.

Her son was able to explain everything. She was a Holocaust survivor, and bore unimaginable physical, mental, and emotional scars from her ordeal. Her care plan should have been changed to reflect her bathing and other preferences, rather than documenting shower refusals for years on end.

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