Changing a patient's diaper while they are standing ?

[EmBeMap]

I am a Future RN student (one more semester of academics WOO HOO) and I am currently completing my clinicals for my CNA. I just started my rotation at a local LTC and OMG it is awful. Not the job I am doing, but the care the residents are recieving. Residents are divided among the CNA's 19 per CNA and if a call light goes off each cna only takes care of her own. I see them spending most of their time sitting down together. But every patient I walk in to help has a dirty diaper, dried secretions on their eyes or under their nose. (care seems awful) but what really freaked me out and the reason for this post was the fact that a veteran CNA was making a man stand up lean over and hold himself in a standing position while I cleaned his bm. I could not clean it fast enough and told her i was laying him down to clean him properly as his face was turning red (i was scared he was going to fall over and wanted to clean him well) Has anyone ever heard of changing a w/c using patient in this manner. It seems soo wrong :angryfire???

Donald

[Spidey's mom, ADN, BSN, RN]

If a patient is strong enough - yes. We call them briefs though - diaper is too degrading.

The rest of the care sounds terrible - I'm sorry you have to witness that. Can you talk to your instructor?

Thank you for caring.

steph

[casi, ASN, RN]

I'll definately stand a person if they are strong enough and it's appropriate to do so. I've found that standing people is faster and quite a bit cleaner than putting them in bed. I'm always afraid of missing a spot when I clean someone in bed.

What happened with this shouldn't have happened. Someone should have been supporting this man. Whether it be a second aide or you if the patient is small enough.

[Hellllllo Nurse, BSN, RN]

Oh, I just hate in when nursinghome residents have eye crusties.

A warm washcloth with a bit of no-tears baby shampoo works great to get rid of this. When I worked LTC, I would give my residents each a warm cloth w/ baby shampoo to hold over their eyes for a few mins before I got them up. Not only does this clean their eyes and face well, but it helps them wake up.

A warm cloth with shaving cream helps clean off dried BM, and it helps the smell, too.

Sorry you are having to see what much of the LTC in this country is really like.

[Shooting4RN]

I think changing a brief and doing peri care while the resident is standing is inappropriate. I have seen two cnas with a res's arm draped around the shoulders while one wipes...... It's sad. They need their dignity, most of of them have lost so much already.

[Hellllllo Nurse, BSN, RN]

I think changing a brief and doing peri care while the resident is standing is inappropriate. I have seen two cnas with a res's arm draped around the shoulders while one wipes...... It's sad. They need their dignity, most of of them have lost so much already.

When you are cleaning up a pt in the bathroom, you don't have any choice. You can't lay them down in the bathroom.

[Spidey's mom, ADN, BSN, RN]

When you are cleaning up a pt in the bathroom, you don't have any choice. You can't lay them down in the bathroom.

I agree . . or a bedside commode.

Getting them up and moving is a good thing . . .and the truth is, it is more effective to wipe when they are standing.

So, there isn't anything inherently wrong with standing someone up.

As long as they are supported.

Having someone clean you up is difficult . . . no matter where you are.

steph

[Shooting4RN]

I can understand if they are in the actual bathroom. I was commenting on residents who are incontinent. You wouldn't want to walk someone to their bed with feces dropping off of their bottom. I agree with that. However if the resident is incontinent and is using a brief and bed pad I would change them in bed and change the linens, It is pretty uncomfortable I imagine to hunker over two cna's with your legs dangling while being wiped.

[CT Pixie, BSN, RN]

Changing the brief while standing is appropriate in some circumstances and not in others.

When toileting a pt (back in the day that I was a CNA), if pt had been incontinet of BM prior to us toileting them, we'd clean the pt while the pt stood, then we'd sit the pt to allow them the opportunity to relieve themselves. And then wipe the pt and use pericare solution, warm water and a bit of soap or whatever cleaning product was the norm for the facility, apply a new brief and then sit the pt in their chair. We put almost ALL patients on the toilet when doing rounds, even the ones who were always wet or soiled when we doing rounds. Even those people deserve the right to SIT on a toilet and try to go. That was eons ago when I worked in the best LTC facility anyone could imagine. I really miss that place...

I personally would have much more dignity, if I needed my bottom cleaned, to have it done while standing in the room that under normal circumstances would be the room to do such things..the bathroom. And its better to be in the room where the toilet paper is, the toilet to fluch the paper, the warm water from the sink etc..its all in the bathroom.

Now if the pt is not steady enough to stand with assistance no, its not a good idea, then to have them safely in bed is the better option.

[TiggerBelly]

First of all I agree that calling them diapers is somewhat degrading. We always call them briefs. Second if it is safe to clean the person and put on a new brief while they are standing then go ahead. If I know someone has already soiled themselves and can walk with assistance, I will take them to the bathroom and let them sit a while to 1- make them feel as tho they still have some control over their bodies and where they can relieve themselves and 2- I would rather be cleaned up in a bathroom then laying on my bed. Now if the person can not be toileted like that, then yes the alternative is to clean them up in bed. As far as the other care goes, I would maybe speak to someone about that. All it takes is a warm washcloth to get rid of eye crusties and it makes the person feel so much better.

[Xbox Live Addict]

If they are able to, stand them up, much easier. However, that should be done in the bathroom, with grab rails and the toilet to sit them on, not in the resident's room. ("Briefs" is the legally accepted term for adult disposable undergarments in my state, calling them "diapers" to the residents wearing them will get you a dignity deficiency write-up). As an aside, Oklahoma regulations forbid the use of shaving cream for incontinence care, although I've seen it done anyway - just not when State is there.

That aside, I see so much else wrong with this picture. 19 patients to 1 CNA is pretty bad staffing, there's no way one CNA could do it even if all the CNAs were hustling their butts, which it doesn't look like is happening. This operation looks poorly managed all around.

[EmBeMap]

First of thanks for everyone's replies.. all good info to know.. I didn't know you called these type of garments briefs. There are a second type of depends there that are more like briefs in that they are more like pull ups. This gentlemen had the other type that literally were adult sized diapers. I didn't know it was a ding to the resident as they asked me to change their "diapers". (I will desist in calling them that though) He was approximately 180lbs on top but very weak legs. It made me nervous as he had almost no more muscle tone in upper body or legs so I was cleaning between multiple folds of skin and did not feel I was doing it fast enough. One of the thing that I keep trying to do because it seems to calm the resident is talking to them during the procedures. The veteran cna I was working with kept telling me that I was wasting my time as the resident wouldn't remember. I feel like even if you have to re-explain 1 million times it's better for the resident so that they don't remember the trauma. Some of the ladies we did peri-care on were screaming about it until I held their hands and explained what we were doing and assured them that we would hurry up. They calmed right down and said thank you so many times it seemed the first time someone had been nice about it. Yes I am getting the negative side of LTC, but when I am and RN and decide to give up ER I can do LTC helping each of my CNA's dealing with residents in a nice way. I guess i might be too idealistic but it breaks my heart to see these people mistreated.