Refusing a Shower and a Family Request to Hand Over Pills
Mr. Halverson, 82, is on day 3 after hip replacement surgery. He has refused a shower each morning, saying the shower chair "hurts" and that he would rather wash at the sink. At 9 a.m. his daughter arrives, finds him unshowered, and tells you, "You need to make him shower - he's not leaving this room until he does." She then sets his morning pills on the bedside table and says, "Just put them in his hand, he's stubborn with the nurses." Mr. Halverson is alert, oriented to person, place, and time, and has no cognitive impairment noted in his chart. The charge nurse is at a mandatory in-service and will be off the unit for about 20 minutes. A shower chair with a padded seat was delivered yesterday.
1. How do you respond to the daughter's demand that Mr. Halverson be made to shower, and what do you do about his hygiene today?
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Mr. Halverson is cognitively intact, so bathing is his decision, not his daughter's and not mine. I would thank her for caring about him, then explain plainly that a resident with decision-making capacity can refuse care and that forcing or threatening him would violate his rights - and could also hurt him, since he says the chair causes pain.
That does not mean dropping the task. I would:
- Ask him what specifically hurts about the chair (incision? pressure on the hip? the room being cold?), because the fix may be a padded seat, a warm room, a partial bath, or turning the chair differently.
- Offer choices: sink bath now with the door closed and a towel over his lap, or a shower later with the padded chair.
- Do the sink bath today if he agrees, and document what was done.
I would not argue with the daughter, and I would tell the nurse that the family is upset and wants a care conference.
2. The daughter asks you to place the pills in her father's hand. What do you say and do, and what do you report?
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I cannot do this. In Montana, medication administration is outside the nursing assistant's scope, and that is true even when the resident is capable and even when a family member is asking. Handing pills to a resident unasked by the nurse also skips the five rights, the nurse's assessment, and any crushing or timing instructions.
What I do:
- Say it simply and without blaming: "I'm not able to give medications - that's the nurse's job. I'll let her know his pills are here."
- Leave the pills in a secure place - do not leave them loose on the table where a confused roommate or a visitor could reach them.
- Tell the nurse promptly that the medication was left out and that the dose was not given at the scheduled time. A late or missed dose is a reportable event, not something I quietly fix.
- Report the daughter's request and her pressure to give the medicines, because the nurse may need to talk with the family about roles.
The 20-minute absence of the charge nurse does not change my scope. If the delay were long, I would call the nurse or the unit supervisor rather than act outside my role.
3. What belongs in your documentation of this morning, and what does not?
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Document objectively, with times:
- 0900: resident declined shower; states shower chair "hurts"; offered sink bath - accepted; partial bath completed at sink. Skin intact, no new redness noted.
- 0915: daughter present and requesting resident be required to shower; explained resident may refuse; daughter upset.
- 0915: morning medications found on bedside table; not administered by this aide; nurse notified.
Things to leave out: labels such as "stubborn," "noncompliant," "difficult family," or guesses about why he refused. I document what he said and did, not my opinion of him. I also do not write the daughter's threats or my own frustration in the record; the nurse's note covers the care conference.
Because refusal of care and an unadministered dose both matter for the next shift, I would also give a verbal handoff so the nurse and the oncoming aide know to re-offer the bath and follow up on the medication.