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. :-)
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.
I have to say that I completely agree with you. I worked in a LTC prior to entering RN program and I know that there are pts who will "refuse" and personelle who will walk away smiling and family member who will be irate with staff later. However, we understand the need to use certain terminology with certain attitudes and assertiveness. This student tried to encourage the pt to rcv the bath and then explained to the pt that it was not conducive to his health to go without a bath. He still said no. He was capable of doing so himself either way. He may have required some assistance with obtaining supplies or ambulating to the shower, but he was in no way incapacitated. Either way, this instructor is stating that this applies to all of our patients that we will be assigned. We don't have a problem doing it, but we are weary to do it when the patient refuses after encouragement.
I had an instructor like that. But when I explained to my instructor that I educated my pt and stated it would be unlawful to force my pt, she was ok with the response. Even though still felt I should give a bath but understood that I did not just accept a "no".
Is it possible that your instructor is trying to see if you are doing the right thing by educating the pt and then respecting their rights?
Specializes in Acute Care Cardiac, Education, Prof Practice.
I had an instructor like that. But when I explained to my instructor that I educated my pt and stated it would be unlawful to force my pt, she was ok with the response. Even though still felt I should give a bath but understood that I did not just accept a "no".
Is it possible that your instructor is trying to see if you are doing the right thing by educating the pt and then respecting their rights?
If she is trying to "evaluate" her knowledge she is going about it the passive-aggressive way that I have seen used all to often in nursing school and at the bedside. A responsible instructor should just have a discussion to problem solve the situation, not badger the student.
I had an instructor like that. But when I explained to my instructor that I educated my pt and stated it would be unlawful to force my pt, she was ok with the response. Even though still felt I should give a bath but understood that I did not just accept a "no".
Is it possible that your instructor is trying to see if you are doing the right thing by educating the pt and then respecting their rights?
This pt was definitely educated and encouraged. No doubting that. And, she stated that this would be the rule for ALL patients (meaning those yet to be assigned). So, I fear it was not just aimed at this particular situation.
Your instructor is dead wrong here. If they say no and you proceed to touch them that is legal battery. They could press charges. You educate, document refusal, and move on.
On a side note you don't bathe a patient that can bathe themselves. You can give them supplies, etc. but you let the patient do as much for themselves as they are able to do. You seem to understand this and it's sad your instructor doesn't. She sounds like she has no respect for patients and/or their privacy let alone their legal right to refuse.
Let the director of your school in on this. There is a way to inform her, which will both save face for the instructor and leave no harm to any student. This absolutely must be done. Lawsuits and the board are sure to follow if this is not rectified and soon. Peace!
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
I agree with all of the posts here that say the patient has the right to refuse and he exercised his right. He's A+Ox3 and has every right to decide what is done concerning his body. I also agree that to touch him afterward and force a bath would be considered battery. Even if it doesn't go that far and someone tells him he WILL have a bath and tells him he WILL move so his linens can be changed.. this would be considered a threat and seen as assault. I would tread very lightly whenever a patient refuses anything after being educated. I would tell the director of your nursing program, this is wrong and this instructor needs to be set straight.
Instructor is being passive aggressive about her instruction.
Please talk to the course coordinator or dean of your college. If you're in an accredited program, they should be talking all about the ethical dilemmas of nursing, and this is one where the patient's right to refuse wins out. She could educate on coaxing techniques without being such a witch about it.
Specializes in Medsurg/ICU, Mental Health, Home Health.
When that happened with any of our patients in clinical, we usually were asked to help another student with a complete bath or assist one of the staff nurses or techs, something like that.
Also, as a staff nurse, I can see the fallout for that coming to ME as a nurse on the floor rather than the student or the school.
I agree with everyone else... patient can refuse anything... just document that they did and what teaching you did. Maybe the teacher was just trying to get your friend to be more assertive? I've learned that if I walk into the room and say something like "hey, why don't you hop in the shower while I change your sheets" or "Let's go ahead and get you cleaned up" and then if they still refuse let them, it works better than walking in and asking if they would like a bath. If the teacher is actually insisting that you force something on a patient then they are wrong. That said, when I was in nursing school I did what I had to to pass... Maybe try talking to another teacher who you trust about the issue and get some advice? Good luck!
studentnurse0383
6 Posts
I have to say that I completely agree with you. I worked in a LTC prior to entering RN program and I know that there are pts who will "refuse" and personelle who will walk away smiling and family member who will be irate with staff later. However, we understand the need to use certain terminology with certain attitudes and assertiveness. This student tried to encourage the pt to rcv the bath and then explained to the pt that it was not conducive to his health to go without a bath. He still said no. He was capable of doing so himself either way. He may have required some assistance with obtaining supplies or ambulating to the shower, but he was in no way incapacitated. Either way, this instructor is stating that this applies to all of our patients that we will be assigned. We don't have a problem doing it, but we are weary to do it when the patient refuses after encouragement.