Refuses bath all week, complains to family hasn't been given a bath in a week?

[nURse_dEZi]

So I recently saw a meme with this title that got my attention. I reviewed the comments and it got me thinking... (because I don't work in long term care and have never felt with this).

How is this handled?

One person said the would suggest the family try and make an attempt but someone pointed out the family may get mad and complain that because the care agency isn doing it, they have to.

Another person said the family will get mad and state "so you let them refuse all week?"

I keep wondering what others actually do when dealing with these issues.

[NuGuyNurse2b]

Wash the patient, and inform the family member of patient's right to refusal. I had this happen countless times in clinical - offer bed bath, patient says no, I respect their wish - I inform instructor, instructor comes in, asks if wants a bed bath, patient says yes...

[kummerspeck]

We have a few patients that do this. They have every right to refuse care, and we can't force them to do anything. If we touch them without consent, that's battery. So here, we are very proactive. If we get someone who refuses, they get their way, and we document on it, and will inform the family as soon as they come to visit. Then, if they refuse again, we document again, and we inform the family right away. That way, they become part of the solution instead of the reverse.

In my LTC facility, baths/showers are scheduled twice a week for our patients, so if they skip one it's usually no big deal....but two...yeah....we are quick to talk to family first.

[Erythropoiesis]

Document document document. And let the family know what is happening. That way nobody can pull an "I had no idea this was happening!"

[TheCommuter, BSN, RN]

I concur with the previous respondents. LTC facility residents have the right to refuse baths and showers, but the refusals need to be documented. In addition, if the resident is not his/her own responsible party or decision-maker, the family must be notified of the refusals.

[LovelyLocs, ASN, BSN, RN]

Wash the patient, and inform the family member of patient's right to refusal. I had this happen countless times in clinical - offer bed bath, patient says no, I respect their wish - I inform instructor, instructor comes in, asks if wants a bed bath, patient says yes...

OMGOSH yes!!!! That drove me bananas!

[CoffeeRTC, BSN, RN]

This is right on line with the "offers you candy, reports to family that candy is stolen"

Showers/ baths are a big one. Document, careplan, document and make sure family is aware of all of it.

[vampiregirl, BSN, RN]

Agree with the previous posters.

The SNF I worked for also involved the patient in care planning when refusals became a pattern. Some factors included shower versus bath, general time of day (morning versus evening), if there were any factors that precipitated the refusal (cold shower room for example as a complaint could be addressed by offering showers later in the day after the shower room had been in use for a while and was toasty). We actually had a pretty good success rate WHEN the POC was implemented.

There is a fine line though between individualized POC and ensuring that the plan of care can be reasonably implemented d/t staffing patterns, meal times etc.

[nURse_dEZi]

And when it's like over a week or more and they are still refusing to bathe do you continue to document (especially if the family is aware of it and is getting ticked off?)

[TheCommuter, BSN, RN]

And when it's like over a week or more and they are still refusing to bathe do you continue to document (especially if the family is aware of it and is getting ticked off?)

Perhaps it is time for a psychological evaluation...depression is common in the LTC population and sometimes manifests itself as loss of interest in bathing/showering.

[CharleeFoxtrot, BSN, RN]

And when it's like over a week or more and they are still refusing to bathe do you continue to document (especially if the family is aware of it and is getting ticked off?)

Well, hopefully before it gets too far you call in help from your managers, social workers, physicians and resident's family to try and figure out why the resident is not wanting to get cleaned up. Get a psych eval scheduled if the resident will consent.

[ComeTogether, LPN]

If the pt is A&O, they don't get a shower and it's documented. When family addresses it, they are advised their loved one refused, but if they think they can talk them into it, we'd be happy to do it.

If they are confused, they really don't get to refuse, but we find gentle ways of persuading them to get showered. On one hand people will complain that they have the right to refuse, but leaving a confused patient filthy is also neglect. Sometimes it can be a struggle.