The Shower Refusal Before a Family Visit
Mrs. Alcott, 84, has moderate dementia and type 2 diabetes. She has refused her scheduled shower three mornings in a row, saying the bathroom is 'full of strangers.' At 9:40 a.m. the nurse hands you the assignment sheet and says, 'Her daughter visits at 2:00, so just get the shower done this morning - she'll be fine once you start.' Mrs. Alcott is awake, calm, and dry. Her care plan calls for a shower twice weekly with 'offer choices; two-person assist' and notes a healed skin tear on her right forearm. You have 25 minutes before breakfast rounds for four other residents begin.
1. The nurse has told you to 'just get it done.' What do you actually do in the next 25 minutes, and what do you say to Mrs. Alcott?
Read the worked answer
A calm refusal from an alert, calm resident is a refusal, and the CNA does not override it - not for a family visit and not because a coworker said to.
- Go in without equipment. Sit at eye level, introduce yourself, and ask what she would like to do about 'getting fresh' this morning.
- Offer real choices: shower, basin bath at the sink, or a partial wash of face, hands, underarms, and peri area now with a full shower later in the week.
- Keep the two-person assist from the care plan if she accepts any water-based bath.
- No deception and no bargaining with threats. Do not say 'we're only checking your arm' and then start a shower, and do not tell her the doctor ordered it.
- Report, don't force. Tell the nurse the shower was declined and what was offered so it can be rescheduled.
- Do not blame the daughter. 'Your daughter will be upset' is pressure, not persuasion; a clean face and hands is a legitimate outcome.
2. Mrs. Alcott agrees to a basin bath at the sink. What specific precautions does her diabetes and the forearm skin tear require?
Read the worked answer
Diabetes and fragile skin change how the bath is done, not whether it is done.
- Water: warm, not hot; test it before it touches her, since neuropathy reduces her ability to feel heat.
- Skin check head to toe, with extra attention to the healed tear on the right forearm and to both feet - look for redness, blanching, breaks, or swelling and report anything new.
- Wash gently with mild soap, no scrubbing over the old tear, and do not soak the arm.
- Pat dry thoroughly, especially between the toes; moisture there feeds infection.
- Lotion on dry skin, but not between the toes, and never massage reddened bony areas.
- Dignity: keep her covered except the part being washed, close the door and curtain, and use the two-person assist the care plan requires.
- Stop and report any new opening, drainage, or area that looks infected.
3. What do you document and report at the end of this morning, and to whom?
Read the worked answer
Document facts, not opinions, and report anything that changes the plan.
Document:
- That the shower was offered and declined, in her own words if possible.
- What alternatives were offered and which was accepted.
- The basin bath given, areas washed, and the two-person assist used.
- Skin findings, including the condition of the right forearm and feet.
- Who was notified and when.
Report verbally to the nurse:
- The refusal, so the shower can be rescheduled inside the twice-weekly plan.
- Any skin change, since a new break in a diabetic resident is a plan-of-care issue.
- If refusal is now a pattern across four days, because the nurse may need to problem-solve the 'strangers' concern - consistent assignment, a quieter time, or a bath aide she recognizes.
Never write 'refused care' alone with no context; that phrasing gets read as noncompliance instead of as a preference.