Non-diapering nursing home patients

[ASSEDO]

My Mom was transferred from an inpatient rehab facility to a nursing home with skilled rehab. She has incontinence, but I was very shocked the nursing home facility has a non-diapering policy, so Mom urinates on a cotton pad on the bed. The nurse said it cut down on diaper rashes, fungus, and skin breakdown. I realize that some air exposure is good. They put on adult diapers only when the patient get up in a wheel chair. The nurse explained that policy was in place at another local nursing home. Is this a quality of care issue? Where is the research? I failed to find it. Thanks

[noc4senuf]

I hate that anyone would use the term "diaper" when speaking about our elderly. They are not babies or children!

[CapeCodMermaid, RN]

A Granny Cam? That's insulting and would be an invasion of privacy.

[Here.I.Stand, BSN, RN]

Hmm I thought I posted a reply on this thread the other day. I guess not.

When I was a CNA in LTC, in general we did put briefs on at all times for those who needed them, although there was one RN who had us just put them pantless on a cloth bed pad for naps. She "liked her people to air." FWIW the only resident who had skin breakdown in the 3.5 yrs I worked there had several strikes against him--he was a quad from severe CP, he was very obese, he stayed in his w/c all day long (his choice; he was in his 40s and totally A&O), and didn't have a LAL or other specialty mattress. Just an eggcrate topper. But we religiously changed and repositioned everyone, and used the eggcrate mattress toppers and chair pads for everyone at risk. I remember just being dumbfounded when I saw pictures of stage III and IV ulcers, thinking "HOW does that happen??"

If your mom is A&O and is most comfortable wearing a brief at all times though, I would think they could just explain to her the rationale for their policy and then make her preference part of her care plan. That way they've covered themselves AND honored her preferences.

[BadAszFannyPak]

the reason you were given for not applying briefs while in bed has validity, and it is

backed by research (which you can find on this board) $

please direct me to this.

[IndigoFlame90]

Exactly (though possibly the facility call it "non-diapering" to help make their case?)

The only time I've ever referred to them as "diapers" in this setting is with a resident who uses the term to refer to his incontinence supplies (I referred to them as 'briefs' exactly once. Will not be doing so again). He's in his nineties, it's urine-only and he manages them independently. If he asks if the RCC ordered his diapers from the VA, I'm just telling him I'll ask. His rants are a solid 15 minutes and ain't nobody got time for that. Well, besides him.

[Daisy Joyce]

I personally use the term "brief" , or sometimes " underwear", but most of my residents say "diaper"--it doesn't bother them...

[jdub6]

I personally use the term "brief" , or sometimes " underwear", but most of my residents say "diaper"--it doesn't bother them...

I realize this thread is old but had to comment cause i have a strong feeling on this...no the elderly/other incontinent adults are not "babies" as another PP said. However adult diapers ARE just that...diapers that are larger than those for children. If an adult prefers to call them briefs/depends then fine. However in my experience just as many are confused by those terms or prefer to just say diaper. I actually feel its condescending, stigmatizing and actually treating them like children to act like using a euphemism will make them feel like they aren't incontinent.

What we should do IMHO is follow individual preference while using the term diaper as just what it is-an accurate term-and use it with respect/dignity. Much like using the diagnostic terminology "moderate mental retardation" instead of "slow" etc. It's a legitimate term that can be used in inappropriate/insulting ways.. but we can use it as intended without malice. avoiding its appropriate use just gives credibility to those trying to turn it into an insult IMO.

[jdub6]

My hospital including ED is diaperless for adults. If bed bound its fine. It's a nightmare for those who are w/c bound or ambulatory and incontinent. These folks often come in, need to be changed at some point (home diaper comes off and we don't have anything but bed pads). Fine...while they're in bed. When discharged a few hours later I've had more than one person literally in tears over the thought of wetting/soiling their clothing for all to see.

Also although we give extra pads for the car seat that's also a worry, especially when they are having friends/family who may not know about their incontinence coming in their own cars. Who wants to pee in someone else's car? Or leave a urine trail behind them when leaving or during a PT eval for example? Or feel the stares as they put down a pad before sitting in a bus/cab/train, knowing all will be able to see and smell when the pad is soiled, and carrying the wet/soiled pad who knows how far when they get out? It's cruel in my opinion to put people in that situation in the name of skin integrity-especially ER/Same Day Surgery patients who are likely discharged within hours of arrival. Or the wheelchair bound person who otherwise would get a friend to drive them in with w/c and transfer board in the back, who now has incentive to call an ambulance-at everyone's expense-instead.

Since staff have raised these issues repeatedly only to be ignored/told the "benefits outweigh the negatives", I strongly encourage these folks to complete their patient satisfaction surveys, ignoring the questions about whether the housekeeper gave their name when emptying the trash or if the pillows were fluffy enough and writing wherever they please exactly how this made them feel and what they had to do upon discharge or while walking in-house. Including any negative feedback they endured from strangers or friends/family. I also give them the info for the patient advocates office to discuss reimbursement for the cost of cleaning/replacing soiled clothing, car seats or the floors/carpets between the door and the diapers at home.

I understand the theory behind it, but as others have said this one size for all solution is not the answer.

[ComeTogether, LPN]

I know this is an older post but I recently ran into this.

For residents with air mattresses we don't use briefs as it causes pressure.

[amoLucia]

Just re-reading this resurrected .and I HAVE to comment from my personal perspective.

Early this year, I was in a NH/skilled rehab facility. It was a hellish situation that I would never wish on anyone.

I have pre-existing Overactive Bladder. And yes, I would leak at times but I was always AWARE of the urge and tried to make it to the BR as fast as I could. I did wear incont pads and my bed had some protection. It was manageable.

But while in that NH, I became incont by default. Pt care was horrific. The POOR response to pt needs was shameful. I, and other pts, could request assist, but it would all be for nothing. No assistance. So I had to learn how to 'pee myself'. Yes, you're reading that right! I had to force myself to be incont - I kind of had to bear down (like for a BM) and then I would squish some urine amount and then I'd have to do it again, and then again, etc until I felt 'empty' and relieved.

I was on major diuretics so I did void quantities. Eventually (and in a very short time) I could just pee unconsciously during the night. When I started getting up out of bed for Therapy, I preferred to wear a pull-up. But once back in bed for most of my time, I would prefer to wear the 'tabbed' briefs.

Prior to my NH stay, I didn't like to call 'tabbed' briefs 'DIAPERS'. Now that I was demoted to having to wear them, I felt HUMILIATED. They will forever be called 'tabbed' briefs and 'pull-up' briefs.

And just to complicate the issue, I am a 'BIG' girl. I am overweight, so I need the larger sizes. Even when someone would bring in a new bag and put them in my closet, they'd DISAPPEAR by morning. (Which cracked me up because I wondered for WHOM were the staff using them? It sure wasn't me!) Many a night, I'd awaken to some person in my closet taking my large size briefs. Now I do know that getting those larger briefs are like trying to squeeze blood from a turnip, esp on 3-11 & 11-7.

Now home, I continue to have bladder problems WORSE now than when BEORE I entered the facility. Through trial & error, I've had to try multiple products to control my leakage and incont.

I still prefer pull-ups; 'tabbed' briefs require being able to attach the sticky tabs and they're difficult to make a snug fit when you're doing it by yourself. And then they're a mess to pull down and worse to pull up. Then it's oops, too late!

Sorry for this long rant, but this post hit such a raw nerve. If your pt has any level of cognition to be aware, find out the preference. And be sensitive about calling them DIAPERS.

'Tabbed' briefs or 'pull-up' briefs.

[CapeCodMermaid, RN]

I’m sorry about your experience in the SNF-horrible to say the least. We do the best we can. We have 5 CNAs for 41 residents so our staffing is better than the region’s average, but even with that, not everyone can be toileted exactly when they want to be.

It’s not just SNFs. Last time I was in the hospital (as a patient) the nurses told me I couldn’t get up without help. OK but after 40mg of IV push ladies.... my call light was on for more than 25 minutes. I got up and took myself to the bathroom. 15 more minutes later a nurse finally showed up and yelled at me for getting out of bed alone.

[amoLucia]

CCM - TY for your understanding. I still have such ANGER at that facility.

This post hit me so hard and all the old feelings just boiled up & out.

Without digressing much more on this post, I think I'll open a new thread.