2 Patient Bathing Refusal Scenarios

[valliloves]

#1 Total dependent patient refuses a bed bath but is heavily soiled. Obviously, the CNA would be required to do it anyway. This is what I was taught at the facility. It is how I would've handled it as well.

#2 Total dependent patient refuses a shower. Patient cannot speak English but shakes head "no" when you try to put the water on her in the shower. You adjust the water many many times and realize that it's just that the patient doesn't want a shower. From what I've learned about client rights, I would take the patient back to their room because they have the right to refuse. I would then attempt to give a bed bath and see if the patient still shakes her head "no" in response to it, however I was taught at the facility during clinicals to give the shower anyway. I refused to so the CNA did it instead saying, "She always does this. You have to give her a shower anyway!" The patient was noticeably upset when the CNA brought her back to her room and transferred her to the bed. All I could do was hold her hand and apologize to her which eventually, she did smile at me.

What is the correct thing to do for scenario 1 and 2?

[gizm0]

I've just completed my CNA training and haven't actually been employed yet, but my thoughts are that the patient has the right to refuse, just like you said. However, my instructor encouraged us to try to get them to consent without hassling them or upsetting them, then come back in 15-30 minutes to ask them again if you have time and aren't sacrificing your time with other patients, and repeating this until they agree to bathe. If they have soiled themselves, you can't leave them like that even if they are refusing because to me, that's like neglect. I think you definitely did the right thing because her smiling at you is a sign you earned her trust, at least in my opinion... My instructor told us to keep your promises and let the patient learn to trust you, I hope it gets better for you the next time you have this patient! Then again, CNA certification presents a perfect-world scenario and I'm sure it's very different once you're on the job, as I also experienced in clinicals. If you really aren't sure what the ethical thing to do is, why not check with your supervisor? That way, you'll know for sure what is expected of you when this situation happens again best of luck!

[LoveMyBugs, BSN, CNA, RN]

Find out why they are refusing.

Elderly tend to refuse showers or baths because they get cold, uncomfortable, it hurts, they are scared.

Find out why and try to make it easier for them.

The soiled pt needs to be cleaned, but why are they refusing? Do they need to be medicated for pain before turning, are they anxious?....

The one with the language barrier, you need to find someone who speaks her language and talk to her

They have rights, try talking to them elevate their fears. Team problem solve

[valliloves]

Nobody at the facility speaks German. I know. It's crazy. I can't believe it myself. She definitely didn't want a shower. The reason I know is because she has allowed me to do it before, but the staff wouldn't listen to me. The male CNA just came in and took over. She was clearly upset afterward.

As far as the soiled patient, I was in training. It was my instructor who just came in and said you have to do it anyway and she just started and had me take over. I felt really bad because he was yelling "no" the entire time He has Huntington's disease so it could've been any number of things. It could've been anxiety or pain, but when I went to the charge nurse before to report that the patient was telling me that he was scared (it takes him a very long time to say what he needs to say), the nurse just told me he has anxiety and didn't even go to see the patient. All I could think of to do was to sit with the patient, hold his hand and comfort him.

[valliloves]

Recently, I used an online translator to write the German patient a letter. The next time I gave her a shower, I told her in German that I do not speak German, only English and then I apologized to her. Right in the middle of beginning to wash her private area, she said clear as day, in English, "Can we speed this up a bit?!" I about died laughing!! I smiled and replied, "Absolutely!" I gave her the wash cloth (which by the way, she is considered total dependent) and she started washing herself so I turned around to give her privacy. I stood there and then she said, "Okay" to let me know she was done!

I was so excited that she spoke to me. Some of the CNAs there speak poorly of her while she is in their presence. That same day, they fed her apple sauce very quickly and she was noticeably upset as the sauce was falling down her chin and they weren't wiping it for her. I gave her a look as if to say, "I know this is not right". Then they transferred her to the wheelchair and she said "Owww!" very loudly. They didn't even apologize to her. I crouched down, held her hand and comforted her. She smiled at me and said, right in front of them, "Can you please hand me my glasses?" They just stood there one of the CNAs said, "What did she just say?" I started to repeat and she was like, "I know but..." I replied, "Yeah, it seems she speaks some English to me." They were shocked! I don't think anyone knows she speaks some English because last time I asked at the nurse's station, they said she only speaks in German.

[Missingyou, CNA]

You will be an awesome CNA and a fantastic example to your peers, both new CNA's and the ones that have been doing this for years.

Don't ever loose your compassion and respect for the people you care for!

Be brave and step up for what is right even when others around you "know" how it is because "they do this all the time".

It's amazing what a little respect and dignity can do.

[hookyarnandblanket]

If I have a patient who is absolutely stalwart about bathing, I explain that everyone in the hospital has to have some kind of bath, whether it is a shower, a tub bath, a complete bed bath, or a partial. It usually works for me.