[greenfaery]

Ok, I'm into my 4th week of nursing school and we are currently doing clinicals at a LTC facility. On my second clinical day I had to assist a man with toileting. That is perfectly fine with me, I have no "icky" feelings about any such thing, but the problem is I was not trained to do this. I was basically just thrown into the bathroom with this man and told to assist him and change his briefs by the CNA who was supposed to be showing me around, and she just literally ran off to do something else and just left me there before I could say 1 word. This man had a very difficult time standing up and sitting down, and on top of it I had no idea exactly what he could to independently or what exactly he needed help with. ARGhhhhhh... I was freaking out. So I clumsily made it through the whole ordeal, just winged it... But the problem is I can't find any information about toileting in my fundamentals textbook, OR on the internet at all!!!! I would think that such a basic ADL would have more guidance but I can't seem to find ANYTHING. I would really appreciate any advice or any websites any of you might have to offer on the subject of toileting assistance. Why is this not considered a "skill" for which there are standards of practice and rationales for??? If they have one for bed making you would think they would have one for this!

[Daytonite]

And, I think you'll be hard pressed to find this in any manual. It might be in a CNA manual. This kind of falls under the category of practical experience. Actually, the toileting involved doing an assisted transfer from a standing to a sitting position, including pivoting. As for putting on the diaper, that's something you learn with experience (and reading the directions on the package, if you can find them). Sorry I don't have a better explanation for you. I think we all learned the same way--trial and error.

[Toey]

Im headed into my 6th week of nursing school and we hit the nursing homes next week to do the same thing you are doing. Was the patient able to walk at all and communicate? Im worried about this sort of thing too. I've heard stories from past nursing students who had these trials by fire.

Here is what I would have done and hopefully someone will pipe in and outline a more efficient way if there is one.

I would have strapped on the gait belt and helped him the bathroom. I would ask him what he can and let him do what he is able to do to of course encourage independence, plus bathroom time is a private matter and im sure he wants to do everything he can himself in that situation.

When he finished, I would make sure he was cleaned up, draped a gown on him so he isn't walking around his room naked ( especially double occupancy rooms) helped him into bed and put a new brief on and redressed him.

anyone else have any ideas for us that are wet behind the ears?

[emy912]

The CNAs at one of my clinical site and during our second rotation, treated student nurses like slaves. The minute we showed up on the floor, they would ask us if we had any of their patients. If we were assigned to one of the patients, we found ourselves doing everything they should be doing while they hide in the nurses' lounge.

If you are not assigned to the patient and if you do not know the patient, please speak up and tell her to give you more information on what the patient can do, i.e. is he steady on his feet, 1 person assist, etc. The worst thing that can happen is if the patient you were helping started to fall while in the bathroom and hurts himself or if you get hurt. I would hate for you to ruin your nursing career just as you're getting started. Be safe and if you don't know how to do things, ask. Keep in mind that you are training to be a nurse so try to be assertive.

Good luck in school and at the end, it will all be worth it.

[greenfaery]

Originally Posted by emy912

The CNAs at one of my clinical site and during our second rotation, treated student nurses like slaves. The minute we showed up on the floor, they would ask us if we had any of their patients. If we were assigned to one of the patients, we found ourselves doing everything they should be doing while they hide in the nurses' lounge.

If you are not assigned to the patient and if you do not know the patient, please speak up and tell her to give you more information on what the patient can do, i.e. is he steady on his feet, 1 person assist, etc. The worst thing that can happen is if the patient you were helping started to fall while in the bathroom and hurts himself or if you get hurt. I would hate for you to ruin your nursing career just as you're getting started. Be safe and if you don't know how to do things, ask. Keep in mind that you are training to be a nurse so try to be assertive.

Good luck in school and at the end, it will all be worth it.

That is exactly what the CNA's at our clinical site have been doing! They are all really unnaproachable and have huge attitude problems on top of it. I have been really assertive though, I find I have to be! But I was mostly concerned about the safety of my client and having had no experience in that sort of thing I was pretty nervous to say the least!

[nightmare]

OK I'll have a go,don't know if it's the same in US though.

If you are assigned a patient ,check their care plan.Are they ambulant?do they use a walking aid? Can they adjust clothing independently?Can they perform own personal hygiene?
When you enter a room, is the area between the toilet and the patient clear of obstructions? Is there everything you require in the tiolet,wipes,disposal bags,fresh pads etc?
Speak to patient!explain what you are doing.Stand them up,do they seem stable?Start moving,is their gait stable?do they shuffle,watch for tripping,is there a raised area at toilet door? If they have Parkinson's they will "Dance"at the door because of change in flooring(our rooms are carpeted but the toilets are washable vinyl)encourage them slowly across this.Is there enough room for you and them to enter door together?Again our doors are double so that they can be fully opened giving you more space.
Once in toilet assist with clothing if required.A lot of elderly men try and stand to pee but they don't quite have the pressure to hit the toilet!Encourage them to sit if possible and make sure penis is actually in the toilet!
You should have on your gloves and apron etc and get a bag ready for the soiled pad if there is one.
If it is safe to do so leave them to perform,evacuating is not really a spectator sport!
Once they have finished either they clean or you do!Assist with clothing,replacing pads etc and then wash their hands.Finally get them back to their seat.I think it takes longer to write this than actually do it!but I hope you get the general idea!

[natrgrrl]

This is what I would try:

If he can sit on the toilet by himself, without falling, go get the brief. After you clean him, have him sit back down and pull the brief on like underwear. If you have the kind that attach like diapers, put it on around the ankles and guess how loose you should attach the tape. Then pull it up when he stands up.
That way he won't be exposed when he walks out of the bathroom.

I would have a difficult time if I was put in your position. I start my LTC clinicals in a few days. I hope I'm not put in the position to do something that I don't know anything about. Good luck with the rest of your clinicals.