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. :-)
almost every semester (since I do not teach 101, which is full of hygiene experiences), I get one student who is brave enough to utter the question "Do we still have to do AM care" (as if it's a rite of passage qwhile crossing over to the next course). .
Get a copy of the hospitals patient rights policy (don't they all have one?) and slip it under her door.
Am I the only one that finds it a bit sad that students would behave as if they can't be bothered and feel like they should be promoted from doing AM care??
Excellent suggestion to slip the hospital's patient rights policy under the instructor's door !!
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...
Please encourage your instructor to go with you to the pt's room tomorrow and and have HER explain to THEM "How it's going to be", and let HER catch the flak from the pt. and family. GEEZ!
OTOH, yes, sometimes pt.s are simply not willing, and sometimes an approach of "This is what needs to happen BECAUSE.... can work wonders, but I would only get into this for IS, walking and commode/BR use, and not a bath. Pick your battles.
If you know you have not been passive, done your interventions and determined the pt.s ability to choose, well; they HAVE that right.
Your instructor is wrong in this instance. A bath isn't a requirement for a patient, although desired. It's one thing if a confused pt says they don't want a bath and you give them one anyway b/c they're not in their right mind to know what's best for them. It's another thing to give a bath to an AOX3 patient who refuses. If you touch the patient for a bath after they've refused...it's assault...whether you were listening to a clinical instructor or not. So beware. Do what's best for your patient. Try telling the patient's nurse or the head of your program if it continues. You don't want a patient reporting you b/c believe your instructor will deny she ever told you anything. Good luck.
I have a supervisor kind of like this. I had a patient refusing a treatment on night shift because it was uncomfortable and she couldn't sleep. I educated patient on risks and she fully understood.
My supervisor on the other hand threw a fit. The patient NEEDED this minor treatment and shouldn't be able to refuse her. I explained patient is A&Ox3 and understand the risks but still refuses.... and she went on about how terrible it was for her to miss this treatment. Finally I looked at my supervisor and said "Supervisor, this patient had been a nurse longer than I have been alive she knows the risks and does not want the treatment tonight. She has that right to refuse."
With baths there are ways to get the patient to clean up. Giving them a washcloth and asking them to wash up and all that stuff the people above me have said. One thing we can't forget is it can be embarassing to need assistance with bathing so a lot of patients may refuse rather than accept the help.
She is probably caught in the middle between the students and the facility's expectations and frustrated.
This is a big issue. There are opposing theories on the need for students to consistantly do AM care as part of their clinical experience (is it really helping them to become better nurses and critical thinkers?). The problem is the facilities; this is what has been expected from the students for ages. I've heard of some wonderful "out of the box" ways to run clinicals, but the perception on the floor would be "these students are not doing anything, none of the patients were washed".
We had this situation many times at my school...1 instructor told us to blame her in your encouragement of getting them to bathe, by stating you would get in trouble if they didn't...we were told at least try to get them to do "pits and pubs", I have seen many patients who will refuse in early am...i have also put the bathe stuff out for an A,Ox3 and told them when you are ready it is here, and then you must always document when you speak with the patient and their response. THat may be what the instructor was looking at because there are many students who will say oh they refused as a way of getting out of something and may sudents will use that as a way of getting around something they forgot to do. Good Luck, just always cover your back with a plan and documentation
I had a somewhat similar situation when I was in nursing school. I was taking care of an A&Ox3 older gentleman. While I was doing vital signs, I told/explained to the gentleman that the physical therapist would be in shortly (he had was on an ortho floor) and if he wanted to clean up before they got there, I would be more than happy to help him. His wife was at the bedside and he said he would be more comfortable with her helping him instead of me. I then asked her if she had helped him with AM care and she stated she had and only needed the supplies (ie towels, washcloths, etc). I set everything up for them and told them I'd be back to check on them in a certain period of time, something like 30 minutes and if they needed anything before I got back to call the nurses station.
I then proceeded to help a fellow student with AM care on her patient. After helping her, I went back to my patient and took out all the dirty linen and cleaned up the room. While the patient was working with PT, I changed the bed myself.
During the med pass, my instructor asked me if I had done my AM care yet and I explained the situation to her. She proceeded to tell me that I was responsible for AM care myself and I shouldn't have "put off" the care on the significant other. I tried to explain to her what had happened but she didn't want to hear it, so I just brushed it off and went about my business. I knew I didn't do anything wrong, I respected my A&O patients wishes.
It's a hospital not a prison, you can't demand a patient to do anything and your instructor is foolish in their belief. Let the instructor go in and force the patient to bath that way when the police come and arrest her for assault (and could argue sexual assault if she exposed the patient). NO means NO even in a hospital lol.
In all seriousness, if a patient refuses something just chart the refusal and reinforce the need for care to the patient. Let them know that if they change their mind to let you know. Chart pt refused and any teaching/encouragement you did as well as check later with the patient to see if they changed their mind. As far as the instructor goes, she is wrong and this type of behavior on her part is dangerous. I would take this up with your faculty adviser or dean of students. To me she has no business at the clinical site if she does not understand the patient rights. Maybe you could give her that brochure pts get when admitted that states they have the right to refuse care at anytime.
my ci was just as dictatorial, and wouldn't allow any "excuses" for refusal.
while she acknowledged pt rights, she also told us to think of a way to get cooperation, and proceed accordingly.
i was nervous as all get out, fearing the pt would accuse me of harrassment.
i am also, the least aggressive person you'll ever meet, and allow people their space (to a fault, sometimes.)
so finally as a last resort (with a very unhappy pt), i told this lady that until she demonstrates her ability to clean herself, she'll have one heck of a time getting discharged to home.
pt finally consented.
i pulled the curtains, set her up, and told her i'd be right outside for when she was ready for me to wash areas she couldn't reach.
as it turns out, she was having her period and was too embarrassed to alert anyone.
her and i turned out to be fast friends (professionally) and she requested me to be the one to assist her.
i found that if you can find out why they refuse, it gives you something to work with.
I have learned as a nurse how to convince people to do things that they initially say no to. I think it's something that comes with experience. With that said, sometimes patients DO refuse and as a nurse it is our duty to let them know the risk of refusing, but allow them to do so and chart it.
Old.Timer
338 Posts
Am I the only one that finds it a bit sad that students would behave as if they can't be bothered and feel like they should be promoted from doing AM care??
Excellent suggestion to slip the hospital's patient rights policy under the instructor's door !!