While you're at it...can you clean my poop too?

If not already, you should move him into a semi-private room

I had the exact same situation w a middle-aged female pt! A&Ox3, admitted with LLE cellulitis.

She would be incont of urine in the bed (I think) just to get attention and have a staff member in the room (either myself or the nurse). She had anxiety problems and most likely a lot of other psych issues… She would ask us to stay in the room with her just until she calmed down, which was quite impossible on a BUSY med/surg floor and so she would wet the bed. She claimed it was because she was taking lasix. I asked her if she was incont at home and she said no, so I said, if you have ANY warning that you need to use the bedpan, you need to let me know IMMEDIATELY. And don't you know it, she called for the bedpan the rest of the night! Not one more occurrence of incontinence! Then I had her the next weekend and she was getting up to use the BSC and then claimed that she couldn't wipe herself because her arms were too swollen (they weren't at all)! I got some wipes for her and made her do it herself. I will absolutely NOT enable someone to be lazy and not take care of themselves to the best of their ability in the hospital!!!!

Maybe the term has gone by the wayside with the improvements in cardiac care, but we used to call patients like that "cardiac cripples."

My coworkers and I have this theory that when people are admitted to the hospital, they suddenly become invalids.

There's been plenty of times we've lectured our patients, "Who does this for you when you're home?" And that often will motivate them to do it on their own. I think the best story I have of this, I actually had a patient call me in his room to scratch his butt, where he's well capable of doing it himself! (He asked me AND my coworker to do this!).

I've also had my fair share of pts requesting to be turned in their beds, when they were just up and walking around in the hallway.

Really, I don't know what gets in people's heads when they come to the hospital. I understand you're sick and feel awful, but if you're well capable of doing things on your own, DO IT!

My coworkers and I have this theory that when people are admitted to the hospital, they suddenly become invalids.

There's been plenty of times we've lectured our patients, "Who does this for you when you're home?" And that often will motivate them to do it on their own. I think the best story I have of this, I actually had a patient call me in his room to scratch his butt, where he's well capable of doing it himself! (He asked me AND my coworker to do this!).

I've also had my fair share of pts requesting to be turned in their beds, when they were just up and walking around in the hallway.

Really, I don't know what gets in people's heads when they come to the hospital. I understand you're sick and feel awful, but if you're well capable of doing things on your own, DO IT!

I swear to everything holy, that if a patient that didnt have bil finger to shoulder arm casts on, asked me to scratch his but? i would lose my job that day.

I'll never get it. If a patient is capable of using and asking for the bedpan, I give them the speech. My biggest fear is using the bedpan. When I was in labor with my daughter and had to use the bedpan against my will, I made my exhusband give it to me and dump it. I wouldn't let the nurse even though she was a nice young woman my age. (an no, this isn't why he's my ex-husband) I could barely use the bedpan let alone poop myself knowing I am well and capable of doing in a toilet or on a bedpan.

If this patient was ambulatory, I would have brought towels & washcloths, handed them to him, and suggested he walk to the bathroom to get cleaned up while I changed the bed.

With alert, ambulatory patients I operate from a "assume the best" mindset, as in ... I will assume that you did not intend to surrender your independence and dignity when you came to the hospital ... so let's preserve it. Much of the time this works to avoid getting sucked into any kind of "I'm going to use my hospitalization to be reduced to a dependent invalid so that I can get my secondary needs met" drama.

I love how we nurse ask patients to please "try and do things themselves" and as a result we are cruel and nasty nurses to the patients.

I think there should be an inservice to incoming patients to let them know that if they can do it themselves then please do it yourself. This of course will never happen, but it is good to dream.

I use reverse psychology on patients over a certain age. I say to them, "Who is going to do these things for you when you are discharged home?" When they can't answer the question, I say to them, "We better start practicing these things now because you don't want to be discharged to a nursing home; if the treatment team finds out that you are struggling with toileting yourself, they are going to start looking at alternative discharge plans." Every time I have had this talk with someone, the game changes. I believe the problem (most of the time) is that the patient is lonely and wants someone to spend time with them. I have seen patients in the hospital for up to a month with no visitors or phone calls and during their stay I find out they have 6 kids that haven't bothered checking on them. Sad. I say whatever works. The truth is, if they are capable, then they MUST do it themselves. The goal is to keep our patients as close to their normal level of autonomy as possible; we want to maintain their quality of life as much as we can.

I had a lady once with one deformed hand/fingers. Other hand/fingers perfectly normal. She would call for help to wipe her butt after a BM. THE PROBLEM: She was a VISITOR (daughter of one of my LTC residents). She would tell some of the staff that she would "hold it" til she came to see Mama so we could help her. Umm..no, you are a 60 year old lady with the same birth defect you have had from the day you were born. Surely you have adapted to being able to wipe you own orifice. I refused to do it!

I do think that occasionally pts are not aware that they can get up and take care of themselves. Occasionally I have a pt who has an accident or asks for assistance to the bathroom because they didn't know they could get up on their own, and they couldn't wait. On my initial rounds, I always try to establish with the pt their activity level, and make getting to the bathroom/commode as independent as safely possible.

That's not who we're talking about, though. In addition to Altra's methodology, with those who persistently request nursing assistance for activities they can clearly perform independently, our conversation usually runs something like this:

Pt: "I need help wiping."

Me: "Okay. Who does this for you at home"

Pt: "Well, I do."

Me: "Why do you need assistance now? Are you feeling too weak? Are you having pain that is preventing you from having your full range of motion"

Pt: "Uh, I guess I just feel a little weak and unsteady."

Me: "That's just the information that I need to know. I'll speak to the doctor about a skilled nursing consult. We can't send you home if you're too weak to take care of yourself. We made need to consider a temporary nursing home placement with some intensive physical therapy to get your strength back up. Which do you think would suit your needs best: a nursing home, or perhaps you have a daughter or son who could move you into their home, so they can take care of you?"

Pt: "Well, I think I'm really just a little weak from being in bed all day. I really think I'll be strong enough once I get home."

Me: "Well, you'll have to prove it. From now on, one of our jobs is getting you stronger. We're going to be encouraging and expecting you to show us you can do these things on your own. Here's your toilet paper."

Sometimes, though, I'll admit the conversation just goes like this:

Pt: "I need help wiping."

Me: "No, you can wipe yourself."

Pt: "No, I need you to do it."

Me: "Don't be absurd. You can do it yourself."

With all this 'customer service' attitude these days at places, it's getting to be more the norm of if you don't do it for them, you will be reprimanded for not helping with every need (or non-need) and your job could be on the line for saying something as trivial as "who's going to do this for you at home?" In other words, been there and got it for denying services since 'the customer is always right.'