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Third, you don't need to be there. Patients are actually more cooperative with the RN's than they are with relatives.
And once she was up, I'd keep up my banter as well as my guided push towards the bathroom. Agree with her, empathetically, and in a moment, just make next suggestion, as if it was not connected to her earlier refusal, as if that had been part of a process which was understandable and we are now moving on.
And it's like moving a car on a snowy road, once moving, focus steady movement with no stops - minimize the length of those, in positive but focused way. Be sure ahead of time, that bathroom is set up safely. Have towels and underwear handy for later. Step by step. I didn't worry about time, and I might emerge from shower helping, wetter than she was. Having a MD order is a good idea, even for twice a week.
Some aides are good at this, make sure it's happening. When I left that job with that woman, the next aide kept writing in her notes, "pt refused to shower. Non-compliant." And no showers were done, only sponge baths, where it is hard to see what's being cleaned with a large person. Two months later she developed a red rash so large and so bad she had to be sent to a pain management center for several weeks. So make sure they are tracking each time she actually HAS a shower, and there is a process in place for effective care.
I said OK, and sat with her at the table and we talked. After a while, she wanted to know why she was supposed to have a shower today. I explained that she had missed two shower opportunities recently. She said "oh". I didn't try to persuade her. I agreed, she would not want to get cold. Finally, she said, well, what time would this shower be? I said 10 AM (it was then 9) - and said nothing more about it. By 9:40, she asked what needed to be done before the shower - and she helped me get her glasses case for her glasses, and I could say thanks, and tell her I want to have her clothes and everything ready so that she won't get cold - she helped me set it up, and I made sure the water was right temp and all went smoothly, I let her clean her privates, but did all the rest, gently, steadily..
It helps a lot to have time, be calm and to go with the person's choices and at their pace. I was taught by a superb worker in a program for cognitively disabled, to say "Yes, and", not "No" or "But". Focus on new clean clothes and beauty, not criticize filthy clothes. I don't mean to criticize others - there are times it doesn't always work. But agreeing with the positive works, just laughing at life together, pausing taking time - better to get closer with permission, than trying to explain or persuade or rush, if the person is set against it. Not at all easy for any family member to do, and also not for busy staff in facilities - but it does work better over time sometimes.
You don't ask if they want a bath, of course they don't. But you know they need one and are calm and respectful, but gently firm. Our trainer likes to say, "As gently as possible, as firmly as necessary." You have all your supplies ready and everything in place to make the experience as pleasant and comfortable as possible. You start bathing in the areas they are most comfortable with, taking your time and talking soothingly all the while. Then move on gently to a surrounding area. If any resistance is encountered, you move back to where it was comfortable for them for awhile and move on again until you are done. If it's chilly a rubdown with several nice heated towels is a good way to end and make sure it is always a positive experience for them. Then tell them how good they were and don't they feel and look and smell nice? The most important aspects are calmness on your part (becoming angry about an irrational fear never helps) and not seeming to rush through it (while at the same time not taking any longer than is necessary and dragging it out). When they have a negative experience it only makes it harder the next time, for the both of you.
This may sound patronizing, and I know people are not animals, but if you are dealing with someone who has unwarranted fear or irrational reluctance and cannot be logically reasoned with, it may help someone.
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