Patient refusal to shower-neglect?

[MissxPriss]

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.

[ellemae93]

I would document every instance of refusal and quote what was said by the pt. For example: "Pt refusing daily shower, states she 'feels too tired and sick'. Will offer again later." And of course, offer pt a shower again and document that you offered multiple times. That's kinda all you can do.

[DeeAngel]

No, it's not neglect. Document the refusal yourself, pass it on in report to the next CNA and report it to the nurse working with you. The patient has every right to refuse no matter how stinky they get.

[TheCommuter, BSN, RN]

Patients have the right to refuse. This right to refuse is based upon the ethical principle of autonomy: the patient is exercising his/her autonomy when refusing to participate in a certain type of care activity.

You should be fine as long as you document the refusals and notify the nurse in a timely manner.

[catsmeow1972, BSN, RN]

This is more of a response geared towards acute care, but I think the premise is the same. If a patient is able to clean themselves, be it "bird bath" or otherwise, that ought to be sufficient. If a patient is refusing bathing week after week, etc and BO or other self neglect habits occur, it needs to be looked into because there is likely a reason that needs to be documented as to why the patient refuses to care for themselves. In my opinion,as OP said above, merely documenting refusal for weeks/months is more neglect than worrying about the fact the they didn't get showered.

Personally, I've spent a significant amount in hospitals on the receiving end of care. Prior to my nursing career, i had been in ICU for a good week or so. When I got back to the Surgery floor, I was of course quite weak. I wanted a sponge bath. The CNA put a chair in the bathroom, gave me a bath basin of warm soapy water and some washcloths and towels. She said you are going to bathe yourself. Ring for me when you are where you can't reach and i will come help you. That my friends, was the best thing she could have done. The small bit that I needed to do was a great start to gaining some strength. That was some 15 years ago and i will always remember that.

[missourinurse2b, BSN, RN]

At my facility, we document the refusal of care, the charge nurse also attempts to get the resident in the shower or whirlpool, if he or she still refuses, the family is notified as well. I would never force one of my residents to take a shower but I also let the family know we are attempting and not neglecting the resident.

[djh123]

I think you're right. We have some 'chronic refusers' in my facility.

[BSNGrad1]

Document, document, document! Educate and encourage, that's all you can do- assuming the pt has the capacity to make his/her own decisions.

[AlwaysLearning247, BSN]

You can't force someone to take a shower if they don't want to. I just document everything. I try to compromise too and say something like "Mrs. Jones, you haven't taken a shower in a few days. It is really important to keep your skin clean to avoid skin breakdown, etc. Can I come back at a certain time?" If they refuse that I would say "okay how about a bed bath?" If they're still refusing tell the nurse and they will document what happened, along with the interventions used.

[RegularNurse]

Gotta love these nursing issues. Hypothetical documentation: "Pt offered assistance with personal hygiene. Pt refused."

[GLORIAmunchkin72]

Maybe so, but what about the rights of the other residents who share the same dining room?

This is a reply to a resident's right to be 'as stinky as he or she wants'

[missourinurse2b, BSN, RN]

I worked at a facility that actually gave family members notice to find another facility for a resident who chronically refused a shower due to the fact that all of the other resident's had to deal with the smell AND it opened the facility up to the liability of the resident's skin issues due to refusing not only showers but also incontinent care. It is a SHARED home and they shouldn't have to dine with someone who chronically refuses a shower. This is exactly why I notify family members....also some residents will ( untruthfully) tell family members that staff refuses to shower them.....I cover all the bases and ask for family members to assist. Sometimes a resident's loved one can talk them into a shower. It's always worth a try.

[m1ghtymurs3]

You can never force a patient to take a shower. However, to simply document refusal and move on is careless.

First, I would ask why the patient does not want the shower. Pain? Tired? Wants it at a different time/day? Doesn't like how the shower is performed? Doesn't want to shower as often? Doesn't like you? Doesn't like somebody else involved in the care during the shower? Etc. This is important first question to quickly assess the problem and offer a solution.

Second, if they don't give a specific problem(which often happens in these cases), offer the patient other options. Bed bath, quick wipe down of sensitive areas etc. There are multiple ways to give basic hygiene without a shower. If having problems coming up with options speak to the Charge Nurse. If they're still not accepting, then you should document: that you offered, attempted to find reason for refusal and offered other means/times of cleaning but was still refused and that the nurse was notified.

Third, if like in your scenario the patient IS bathing at least once per week, then the patient's care plan should have already been re-evaluated and family notified to discuss options to keep the patient hygienic.

This is kind of a pet peeve of mine as I believe basic cleanliness and safety is an essential priority in Nursing care and I see it neglected too often due to difficult patients. But the fact is, everyone is different and has different needs/wants. You just HAVE to figure those out. This process might take a little more time at first but, in my experience will save you loads in the future.

Good Luck.