Patient rights v. Clinical instructor?

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Last week, my clinical instructor and a fellow student got into, well, let's call it a discussion, regarding bathing our assigned patients. In this case, this student's patients was A&0x3 and completely independent. He refused, even after encouragement and rationale for hygiene was given, to bathe or have his linens changed. When the clinical instructor heard this from the student, she said she didn't care and it was a requirement of each day that we bathe our patients and change their linens. She stated that we should not ask, we should demand and state that we WILL be assisting/giving our pt their bath and changing their linens. IF the patient refuses, tell them it is our job and we have to do it and that it WILL be done. I understand the importance of hygiene and comfort and what a lack of can do to a patient's immune system and overall well being, as do my fellow students and we are NOT above assisting our pts. If the patient asks for a bath or says yes to one, we will give it in a heart beat. My question is: Is it a violation of their rights if we "force" them to bathe? Can we be found guilty of any sort of abuse as students if we are following the instruction of our clinical instructor? We are second semester (out of 5) RN students if this makes a difference and we are currently doing our clinicals on an Oncology ward in a hospital. Thanks for your opinions. :-)

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Specializes in Med/Surg, Ortho, ASC.

Oh my.

The instructor is wrong. Dead wrong. A patient has a right to refuse medications and treatments if they choose to, let alone decline a bath. A nurse/student nurse who persisted in coming at the patient with wet washcloth in hand after the patient specifically refused could conceivably be accused of patient abuse.

Seriously, what was the student to do? Inflict bodily harm in the name of hygiene? Slap restraints on the patient in order to wash his face?

I don't know what to advise you on this matter. Go above the instructor's head on this issue? You have to live with her for the rest of the semester, so that's no good. Plus, if her judgment is this faulty on this small matter, what will the rest of the semester hold?

Good luck.

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Specializes in pediatric critical care.

Your instructor needs to get over herself. You can't force someone to do something they don't want to do. Period. That's abuse. You need to take this up with whoever is in charge of your instructor.

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Specializes in Peri-op/Sub-Acute ANP.

If your patient is AAOx3 and refused to have you touch them (whether to give them a bath, or put in an IV, or whatever) if you disregard this and touch them it's legally called battery.

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The patient has the right to refuse care, medications, ect. You can highly encourage someone to bathe by explaining the rationale for good hygiene to the patient but your instructor is not correct in trying to force a patient to do something he does want to do. It is a violation of their patient rights.

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Specializes in LTC,Hospice/palliative care,acute care.

The instructor is wrong .How was the situation resolved?

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Specializes in LDRP.

wow, it sounds like you may be in my class. haha. are you from PA by chance?

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Specializes in MS, ED.

In this case, I agree that your instructor was wrong...

but I do see the rationale for 'insisting' and using specific language, (i.e., 'let's get ready to bathe' in lieu of 'would you like a bath?'). We have students on the floor who will often ask patients whether they 'would like' something and unsurprisingly, the patient often says no! Student returns with medications in hand, saying 'patient refused', or leaves patient unbathed and linens dirty because patient said no to bath after being awoken from a nap. Later, same patient's family member comes to desk screaming about missing doses of medicine or patient is angry because 'no one ever came back to bathe me'.

Some patients do need to be gently coaxed into things with teaching and encouragement. If given the choice, plenty of patients would like to stay in bed and watch tv rather than have pain getting up and walking, doing their IS, getting shots and all the other unpleasant things that come with hospital stays. Unfortunately, that's not doing right by the patient to allow their cares to slide. Fine line, but being more assertive definitely does change attitudes.

You will get the kooks who, despite all your concern, teaching and coaxing, refuse interventions. That's okay. As others have said, document your actions and don't force any oriented person to do something after they've refused. I had similar situations in nursing school and all you can do at that point is to tell your instructor, "I'm sorry, the patient has refused. I don't feel comfortable doing that." Take it as far as it needs to go.

Best of luck.

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Well I'm in my 3rd semester of a 5 program and we've been taught the patient (A&Ox3) has the right to refuse anything. Can you force them? Nope, very bad idea. Maybe wait til later in the day and ask again but if they still refuse you just accept it and move on. Next time ask the instructor to show you how that's done and maybe she'll march in and demand it...should be a great lesson learned for her (and a lesson on what not to do for you). LOL

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The instructor is wrong .How was the situation resolved?

It was at the end of the day, so it ended with the instructor stating that was how it was to be. I am somewhat weary of going to the hospital tomorrow b/c I know it's not over...

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wow, it sounds like you may be in my class. haha. are you from PA by chance?

Nope. ;-) We're in FL.

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Specializes in Acute Care Cardiac, Education, Prof Practice.

I would be totally irritated if a student nurse came into my room and said "ok time for a bath now". If I don't have dementia then you had better not be demanding I do anything as though I do. I understand the rationale for "directing" a patient who may be less than competent, even though I still don't like doing it to them either.

Your instructor is inappropriate and is setting you up for disciplinary action when that patient brings it down on the hospital. I would bring your situation to the head of your nursing department, or discuss the issue with an educational adviser for advice on how to handle the situation.

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