Bladder training debate

[ShortFuse_LPN, LPN]

We are having somewhat of a debate at work. Tell me your opinions, please.

One nurse who I work with thinks that anyone having a foley d/c'd should have bladder training first.(and will throw a fit if doc doesn't order it) Then there are those of us who think that if the res was incontinent before the foley, that bladder training isn't necessary. And unless ordered isn't pursued.

So, what do ya think?

[gwenith, BSN, RN]

Belinda - there have been several threads posted here on this topic. I tried to do a search but got distracted as the search engine threw up threads such as "You've got a what stuck in your what" 2 hours later I remembered that I wanted to reply to your post. It HAS been discussed before and it seems to be one of those contoversial areas of nursing where some do and some don't. Please do check out the topic on with the search button as there are some really great replies - including whole policies.

[O'Rose]

In order to make any decision regarding bladder training, the resident needs to be assessed as to why the foley was inserted in the first place. If the resident is returning from the hospital, the foley may have been put in for convenience. In long term care, there are only several reasons why the foley should remain and they are outlined (REFER TO CDC GUIDELINES). Once you determine that the resident no longer requires a catheter, the nurse must assess what was the resident's prior state of continence (is there incontinence due to neurogenic bladder/dementia/infection). If the resident has long-standing incontinece and previous documented attempts at bladder training have been unsuccessful, and the resident has not had a significant improvement, then it is reasonable not to trial bladder training after removing the foley.

However, it is often hard to find documented attempts at bladder training, along with the results. So, does it hurt to attempt bladder training in those situations?

The idealistic nurse you speak of, may be naive, but she may also be hopeful. Maybe she will find a lucky resident who will respond to a new initiative. Good luck.

[Talino]

You do not need an MD order for a bladder training. This is a nursing judgment through proper nursing assessment.

Considering the elimination hx of the resident is unknown, he should be given a minimum 72 hour trial period to determine bladder and bowel control.

If he is previously known to be incontinent and not a candidate for bladder training, there is no reason to pursue it (unless a significant improvement in status occured).

Unless this nurse actually meant bladder "retraining" (retraining a bladder to empty w/o the aid of an indwelling catheter). Urinary retention is the most common consequence of catheter removal. And getting an MD order is simply to compel the staff to observe the resident if there is spontaneous and sufficient bladder output?