Patient hygiene

[Wondersnevercease]

Hello everyone. Any advice on how to get capable and competent adult inpatients to Bathe? When all reasoning behind is considered and ruled out (pain, mobility, cultural, phobia) and a patient refuses to bathe, what options are left?

Scenario at hand: Adult obese pleasant competent female multiple commode trips to BR. Very foul odor coming from the peri region which is like an elephant in the room. Nurses suggest a shower via commode, bed bath or basin even and but she refuses. Of course the MDs don't say anything to the patient. How can we get the patient to wash while still maintaining her dignity and the therapeutic relationship? Any advice appreciated. Thanks :-)

[brownbook]

No great ideas here. All I can think of is get her to talk. Use open ended questions and try to find out what she thinks about the situation. Ask her ideas, suggestions. Ask her what she would do if she were the nurse and her patient "stank," their skin was blistering and breaking down into open wounds?

Have her come up with ideas?

Yeah, I know, probably won't work!

[Purple_roses]

I had a client like this. She sat in urine for literally hours. I would come in every 20 minutes trying to get her to come around. Sometimes patients just won't budge. Do you know why she's reluctant to bathe? Sometimes I'll explain UTIs, especially to female clients, and just let them know that I'm trying to prevent them from getting sick, and sometimes they'll come around to that. One client I had a long time ago thought we were just bathing him to check it off of our to-do lists, so I explained poor-hygiene-gone-wrong to him as well, and he came around.

[Biscuits&Cheese]

How would it be if you brought all the bath stuff in, ready to go. And said, "I thought we'd give you a bath this evening, ok?" Sometimes patients seem to not want to bother anyone (but don't take the initiative to do anything on their own either.) If you brought it all in, she may acquiesce, but still have the opportunity to say no.

[SnowShoeRN]

Sometimes I'll explain UTIs, especially to female clients, and just let them know that I'm trying to prevent them from getting sick, and sometimes they'll come around to that. One client I had a long time ago thought we were just bathing him to check it off of our to-do lists, so I explained poor-hygiene-gone-wrong to him as well, and he came around.

Yep. I'll even kick it up a notch and explain how UTI's can turn into kidney infections which are life threatening yadda yadda etc and sometimes I'll resort to showing them pictures of horrible yeast infections or talk about skin breakdown that results from improper hygiene. If you're gentle enough with these discussions they can be pretty effective.

In the end, however, she is an adult and whether or not she wants to take care of her body is her perogative. :/

Best of luck.

[Lev, MSN, RN, NP]

Why don't you ask patient as part of daily assessment if she is having any lady partsl burning or abnormal discharge or any urinary complaints? Explain that you are concerned because you noticed that she has a foul odor and you want to make sure it isn't anything serious...

[cayenne06, MSN, CNM]

What does she say, when you ask her why she doesn't want to bathe? Is there any staff member she is particularly amenable to, who could help her verbalize her rationale for not wanting to clean up? Where was she before she came to your facility? Did she decline hygiene care at her previous residence?

Sometimes patients have very clear reasons for declining personal care, and addressing those issues is often relatively straightforward.