I just had to know what all nurses think about this order. Long story short. I work in long term care and as you know, there will always be offensive odors whether in the halls or patient rooms. Anyway, one of our physicians go into a patient room to assess or examine and noticed a foul urine smell. This particular patient urinates on herself inspite of nursing staff assisting her to the toilet; she is ambulatory with some dementia and she is not incontinent so she can urinate at anytime with out us even knowing. So, I am checking physician orders and the physician writes an order stating: "make sure patient room is cleaned twice a week, there is a foul odor and increase her baths. First of all, as a healthcare professional, this order was insulting to me as a nurse who is use to seeing medications, PT or etc written on legitimate physician order sheets, not this mess. The doctor could have mentioned the odor to nurse manager or supervisor but why write it as an order. Also, the rooms are carpeted which harbors foul smells, this was not a good choice to make so far as the floors. My final thought is that if you can not take the foul odors as a doctor, then maybe you need to find another career.
Maybe this is a case of "CYB" for the Doc? If it's something he knows is difficult to change (lets face it, the facility probably isn't ripping out carpets on Dr's orders!), and relatives could be asking about quality of care, maybe it's his way of showing he is attempting to address the issue.... JMHO
I see your point, but let me remind you that this resident is ambulatory, she fights the nursing staff when they try to help her change her underware. We can't put in a urinary catheter, she would pull it out and besides this fact, she is alert. This resident moved her bedside commode out of her room. How about over night, no one can watch her every minute. I believe that she waits too late to go to the bathroom and urinates on herself which in turn goes right into the carpet and her bed. So, what can be done to keep her from urinating on herself, the toileting program that she is currently on, is not successful. Any ideas?
The docs order is bogus. I'm very glad the doc is concerned but writing an order isn't going to change things. If the doc was that concerned why didn't he take it up with the nurses or manager? Writing the order made him come off as a smart a#@.
He didn't include the time, route, and dx for in order so its' really not legit.
i am having a surley day and that part of me would like to tell the "doctor" if he is so concerned he/she/it can clean the room and bathe the patient himself since it is their nose that is offended. that being said, the reality is that the assistants are far outnumbered by the amount of patients assigned to them and are as low on the pay scale as it comes most of the time.
being a cna assistant in any nursing home is the hardest most thankless job i have ever seen anyone have. they work hard, they deal with being cussed, bit, spat on, and then there is the family members that do the same or worse. i respect and hold in awe any nurse or aide in a nursing home.
if a facility would hire enough staff at a decent wage and give them respect and not allow the staff to be talked down to or abused by families or patients i am sure that all nursing home residents would not only "smell" better but do better.
off my soap box now and slinking away smh (shaking my head).
as for the doctor and his order, i would love to tell him to stuff it.
Specializes in Trauma Surgery, Nursing Management.
Believe me, there are two rooms that i go into that definitely requires febreeze and I do not hesitate to use it. The carpet is the culprit in this situation.
Oh. My. Gawd. There is CARPET?!?!? Excuse me while I shudder. Wait...wait...just a second, please. OK. The nausea has passed. Oh no, it just came back. Be right back.
Whew! OK, focusing now. The mere thought of what could be growing in the carpet sorta made me ill. Can you imagine what would show if you actually took a culture swab of the carpet? Hang on, the nausea emerged again.
Please, I b-b-be-g-g-g you (sorry, s-s-s-still shaking from the image of what the agar plate would show) to not only request, but DEMAND that carpeted areas in resident rooms be REMOVED....STAT! Good Lord! Carpets harbor the worst kinds of bacteria. Granted, I am OCD to the nth degree...I vacuum my carpets daily and steam clean them every weekend. And I STILL don't think they are clean. OK. I know. I am a crazy woman. Got me there!
Resident rooms should definitely mimic some of the comforts of home, which makes me think that this is what the administrators of your LTC facility were aiming for. However, throw rugs (of course with adhesive backing) should be allowed and encouraged for rooms that house ambulatory and oriented patients.
But um...carpeted floors in every room? Yeah, I bet the farm that it stinks to high heaven!
I encourage you to take your concerns/ideas/solutions to your NM. Your thoughts would likely be well received. I wish you the best!
Specializes in Nurse Educator, Culturally Sensitive Nsg.
I know you all are super, incredibly busy, but just a couple q's.... You said she is on a toileting schedule, but how often? If she's waiting too long, and can't hold it, as you suggest, maybe she's not being taking often enough? And second... what about Depends? Or an incontinence pad? I know there are some reasons to not use them, but if dementia is a problem, she can't really be expected to hold it... again...JMHO...
Specializes in Trauma Surgery, Nursing Management.
i am having a surley day and that part of me would like to tell the "doctor" if he is so concerned he/she/it can clean the room and bathe the patient himself since it is their nose that is offended. that being said, the reality is that the assistants are far outnumbered by the amount of patients assigned to them and are as low on the pay scale as it comes most of the time.
being a cna assistant in any nursing home is the hardest most thankless job i have ever seen anyone have. they work hard, they deal with being cussed, bit, spat on, and then there is the family members that do the same or worse. i respect and hold in awe any nurse or aide in a nursing home.
if a facility would hire enough staff at a decent wage and give them respect and not allow the staff to be talked down to or abused by families or patients i am sure that all nursing home residents would not only "smell" better but do better.
off my soap box now and slinking away smh (shaking my head).
as for the doctor and his order, i would love to tell him to stuff it.
awww, chey! you weren't surly at all! you were just telling it like it is. that is refreshing.
i am also very respectful of cnas that work in ltc facilities. i could never do it. it is the most backbreaking work under the sun...and oftentimes thankless. i don't know how they do it day in and day out. my hat is off to every single one of them.
sadly, the all mighty dollar throws the trump card in staffing for ltcs. as long as the facility is in the black, they don't seem to care about the staff who work themselves to the very bone.
and before i get flamed, i completely understand that i just made a blanket statement...but i have yet to hear from a cna that works in a ltc facility that states without question that they love their job and have no issues. these guys have my respect, hands down!
I do LTC and the CNAs definately work really hard. On one of the floors there is a resident that for no real reason just urinates where ever he is. He's totally lucid, no reason for it, he's very surly though.
Oh and we have all tile and I must say rarely does it smell... just some transient smells at times.
Specializes in SICU, MICU, BURN ICU, Trauma, CTICU, CCU.
I have had physicians write orders for nursing care before. I'm usually first in line to tell them that they do not dictate or order nursing care. If he was upset that the patient was dirty at the moment, the linen closet is *right there*. You cannot constantly watch the patient who dibbles pee constantly. You work in LTC, you have an insane workload and there just is no way. I work in ICU and if I didn't have a foley in my patients, they absolutely would end up dirty for an hour at a time because its just not feasible. You are doing your best and he could pitch in to help. They are HIS patients too.
I don't like that it's in the permanent medical record. IF something should happen re: care issues, it looks bad. Chart like crazy re: when she pees on herself, changing clothing, etc to CYA re: it being addressed on a nursing level.
Tile grout also soaks up urine. Some places I've been in that were nightmares years ago- and got new admin who have made huge improvements had to rip out the tile to get rid of the smells of yesteryear.
be glad he mentioned it before someone turns the facility in to the health dept.
Management needs to get a grip on this. I have worked in LTC where there were NO odors. It CAN BE DONE
It can pretty much be done in common areas but if you walk into someone's room five minutes after they were taken off the bedpan or moved their bowels on the commode in their room, you're going to smell poop until it dissipates. Of course, the person is cleaned completely and the stool is flushed and the commode/bedpan is cleaned any anything soiled bagged, tied and taken out of the room but I can still tell if someone just had a BM.
Not to be too gross but even if an employee uses the restroom and someone walks in five minutes later even though everything has bee flushed etc. you can still smell it.
Air freshener...as long as everything is clean, bagged, flushed, etc. just mixes the smell of chemical flowers with the stool.
Also, when we have people empty their ostomies, at times all bets are off. The smell can make it out to the halls and up to the nurses station no matter what everyone does, and lingers long after everything is flushed, bagged, cleaned, put in dirty utility, hauled away, etc. We do use different sprays and stuff for ostomies but sometimes there is just no covering it up.
sweetnurse63, BSN, RN
202 Posts
I see your point, but let me remind you that this resident is ambulatory, she fights the nursing staff when they try to help her change her underware. We can't put in a urinary catheter, she would pull it out and besides this fact, she is alert. This resident moved her bedside commode out of her room. How about over night, no one can watch her every minute. I believe that she waits too late to go to the bathroom and urinates on herself which in turn goes right into the carpet and her bed. So, what can be done to keep her from urinating on herself, the toileting program that she is currently on, is not successful. Any ideas?