Tips for bed baths with combative patients.

Give me some background. What's the Hx? Recent Dx? Is the pt A&O? Anything that normally soothes the pt? Could the pt be in pain? Is the pt only combative when betting a bath? If so, it could be the bath causing the problems… Would a warm blanket help? Is the pt demented? Any family available to help? My first suggestion is to have a nice fluffy pillow available to absorb some punches! LOL! :) If all else fails and the pt is too dangerous, you may need to speak to your HH agency and ask to have an aide with you at visits.

give me some background. what's the hx? recent dx? is the pt a&o? anything that normally soothes the pt? could the pt be in pain? is the pt only combative when betting a bath? if so, it could be the bath causing the problems... would a warm blanket help? is the pt demented? any family available to help? my first suggestion is to have a nice fluffy pillow available to absorb some punches! lol! :) if all else fails and the pt is too dangerous, you may need to speak to your hh agency and ask to have an aide with you at visits.

hx: c/p, severe dd, non-verbal, vent dependent, gt feeding.

it is not a visit situation, it is a 12-hour shift in the pt's house. i don't think my agency even hires hha or cna's its all nursing care (lvn/rn).

Vented at home? Wow... didn't even realize that was a possibility...but I suppose that's why you're there for a 12 hour shift, huh? lol That's a really difficult situation... Is there anything about the bath that can be causing the pt pain or discomfort? Too cold maybe? If the pt only becomes combative at bath time that would be my first thought... Maybe use lots of warm blankets? If all else fails.. does the pt have any PRN meds for relaxation that can be given near bath as to be most therapeutic during an unpleasant time for them?

the only med's i can use is ibn. i can try to pre-med him next time see if that makes it better. yeah around here a ton of vent-dependant, patients live in their homes. almost all of them require 24 hours nursing care. it provides a ton of nursing hours and employees a lot of nurses.

There may not be much you can do, but there may be something! Here's what I would try:

Protect privacy and comfort of course...no one wants to lay there naked! You can warm a blanket in the dryer and cover the client with it, then only lift enough of it to wash one part of him at a time (if you're washing the right arm, expose only the right arm and then re-cover it when you're finished with it). If you have access to his old music, of if the family can tell you what music he used to enjoy, play some of that during the bath. If not, play some soothing music. Aromatherapy can be nice too, candles or oil burners or those scented eye pillows. I would also verbalize everything I was doing; even if you think he can't understand there's always the chance that he may!

Good luck :)

Since the pt is nonverbal it is especially important to watch for nonverbal signs of pain, anxiety and stress. I have one pt in a LTC setting that I give a complete bed bath to in stages. Depending on how cooperative she's feeling on any given day I will do it in 2-4 sessions, stopping whenever she gets upset before it escalates to combative. Once they're too far into combative mode it's hard to get them settled down. I will leave her, covered and warm, of course, and return in 20 minutes and continue. Most of the time there's a specific trigger within the task itself - maybe a certain body part that they don't want touched or is painful or they could be cold, overtired, etc. The most important thing is to identify whatever the trigger is, alleviate the problem if you can and if you can't avoid it all together maybe save that part for last so you get everything else done adequately before getting the pt upset.

Good luck, and kudos to you for being patient and trying to solve the problem by all means accessible to you!

hx: c/p, severe dd, non-verbal, vent dependent, gt feeding.

it is not a visit situation, it is a 12-hour shift in the pt's house. i don't think my agency even hires hha or cna's its all nursing care (lvn/rn).

can you ask your agency to overlap the shifts, so that for the first half hour of every visit there are 2 nurses to bath/change the patient as needed?

yeah that's not going to happen.

my agency refuses to pay overtime and has several questionable policies about breaks and work shift options. i also know for a fact that at least one rn they hired was accepting lvn pay for doing shifts. so no way are they paying two nurses for any amount of time.

peri-care on the patient doesn't seem to have the same problems that the bed bath does. a couple of wipes and a clean diaper and chuck pad under takes less than 5 minutes total and the patient doesn't get so combative.