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.

[all.is.silent]

I've had patients who refused, and I'd come back a little after to ask again, then I'd offer then a bed bath. If they still refused I'd document it, and the next shift would be notified that they should try and do the bath, and it works. If they refuse the next shift, then the shift after that takes it on until they get it done. Some patients prefer to shower in the day or at night, and at their own pace. I usually let them know as soon as my shift starts and they set their terms, what time, if they want to wear the same clothes on because they just used them in the morning etc. then I'll let them know everything is ready and if they're good to go. I give them as much control over things like this, because I can't force them, and they appreciate being notified beforehand.

[jdub6]

As long as the pt is truly aaox4 as you stated, and reasonable alternatives have been offered, I agree that they have the right to choose. At one facility where a number of residents had chronic psych/ personality issues but were still consisted competant to refuse care and meds, a shower weekly would have been considered great! and the care plan changed to weekly rather than biweekly if the person consistently refused more. (For those who refused for weeks on end, care plan started at weekly as the goal to avoid constant conflict etc. Occasionally psych would order some sort of prn like trazodone or Ativan to be given scheduled on shower day...usually didn't help but a good way to document trying all options. )

What gets me are the demented residents who have no clue what they are refusing (aka obviously incapable of making any care decisions) but truly terrified of bathing with help regardless of when, how, with who...and can't do it themselves. In those cases some would sob or scream for their mothers through each shower or bath...they would recover quickly usually and seemed to forget all about it, but still sad and in many cases no one could find any alternative or solution to help.

[Nurse Michael MB]

Shagc1

Great post. So many times we forget we are not dealing with patients but with people.

1) Why is the patient refusing? Could it be modesty , time of day , dementia , mistrust?

2) How can we reasonably accommodate their needs?

3) have they had a bad experience?

So many times as a nurse I have been called to the shower room for a skin issue. The female patient was naked and dripping wet in a cold room with two CNA and now a male nurse in the room. As a nurse and expecially a male I expect that resident to be covered so that I may expose only what I need to see at that time. Thee resident is warm and I have respected their privacy. This is just one example that would turn me against showering if I were the patient.

Yes the resident has the right to refuse but it is our responsibility to encourage healthy practices. If the answer is still no it is still no. Document your attempt and strategies, care plan and most of all respect the patient for your safety and theirs.

[Axgrinder]

I agree with Wispera, CNS: forcing a pt to shower could land you in a whole lot of legal hot water - not to mention it is morally wrong. Pt's are not children you can force to do something against their will. Pt's do (and have the right to) refuse a lot of things: vaccinations, colonoscopies, mammograms, Rx medication, surgical procedures … the list goes on, and on. I urge you to check with your governing state board if you feel your job is in jeopardy, because not only can you not force someone to do something they have declined, but it is all kinds of wrong to do so. Plus, you will likely be disciplined by the state board and face charges against your CNA license - something you worked hard to get. Good luck, and stand strong.