Adult Depends/Underwear

Ruas61, BSN, RN · Jul 19, 2014

So, she should use incontinence products and urinate/defecate into these to save the staff from injury?

Really, would you want that implemented for one of your loved ones in a care setting?

It is unethical and would fall under abuse to require someone to eliminate into incontinence products for staff convenience.

Perhaps a physical or occupational therapy consult would help with her strengthening, endurance and mobility tasks.

Has she had a decline in her mentation or other ADL skills?

Is she acutely ill or experiencing a progressive, expected decline of a disease process?

Is this a staffing problem or your own physical ability problem and not her issue other than being bariatric?

I am sorry you are hurting and understand wanting to keep yourself healthy and safe.

I suggest looking at staffing, examining the expectations of staff and implementing processes so everyone is not going MIA and one person is overloaded on heavy tasks along with following parameters in place that address a client's changing status.

People's abilities change over the years and the level of care does too. She may need to move on but it needs to be assessed.

Good luck.

Esme12, ASN, BSN, RN · Jul 19, 2014

While this patient may need to be re-evaluated for her appropriateness for your facility. To make her wear, dedicate and urinate on herself because it hurts your back is degrading to the patient. Just because she would be wearing depends doesn't mean she shouldn't be taken to the bathroom.

Place yourself in her position in 60 years. Alert. Functional. No longer in your won "home" with your own things and someone wants you to wear a diaper because it bothers the staff's back.

Not a pleasant thought at all.

I wish you the best.

ClearBlueOctoberSky · Jul 20, 2014

Is it ethical or even legal for me to kindly suggest to a client that she start using adult diaper-underwear (aka Depends, Poise, etc.)?
I hold the belt and touch her skin, so she thinks, I'm helping her stand, but, I've never lifted her. Still, I do have to push the chair. I had lower back pain before I took this job, and now this isn't helping. My back is throbbing as I write this! I'm laying on my side because it hurts to lay on my back.

No. It is not ethically, nor morally correct to suggest depends because you don't want to push a wheelchair 200 feet to the bathroom.

By your own admission, you aren't doing any physically heavy lifting, just pushing her wheelchair. While she might not be appropriate for your facility, as she is no longer independent, she would most likely benefit from PT/OT for strength and balance.

I am not giving medical advice, but merely making the observation that to avoid injury to yourself, YOU might benefit from seeing YOUR doctor and receiving PT/OT due to your severe back pain.

LadyFree28, BSN, LPN, RN · Jul 20, 2014

No. It is not ethically, nor morally correct to suggest depends because you don't want to push a wheelchair 200 feet to the bathroom.
By your own admission, you aren't doing any physically heavy lifting, just pushing her wheelchair. While she might not be appropriate for your facility, as she is no longer independent, she would most likely benefit from PT/OT for strength and balance.
I am not giving medical advice, but merely making the observation that to avoid injury to yourself, YOU might benefit from seeing YOUR doctor and receiving PT/OT due to your severe back pain.

THIS.

I'm also wondering what are your facility's policy in terms of lifting...do they have other devices to help with lifting that can be better utilized?

Wheels28 · Jul 20, 2014

As someone who is disabled (CP) and uses a wheelchair to get around I would feel degraded if someone put a brief on me because I needed help getting there because it was easier for them. A wise nurse once told me "It's not what's easiest for me to do, but what's but what's the easiest and best for you" I have always been lucky and never had a nurse make much of a fuss about such things. Think about it WOULD YOU want your nurse or CNA to put a BRIEF on you because their back hurt and they did not want to push you to the bathroom? I don't think you would.

calivianya, BSN, RN · Jul 22, 2014

I am obviously interpreting this a different way from the other posters because I don't see your question as being horrible.

Your facility does not sound like a good fit for her if she is required to be independent to be there. If she is unstable enough on her feet to need help transferring from the chair to the commode, she is not independent. If she cannot push her own wheelchair, she is not independent. What exactly are the criteria for admission to your facility? Was she more independent when she first arrived, or is this how she's always been? If your staffing really reflects that your patients are supposed to be independent, your facility is not adequately staffed to take care of patients like her successfully, period. However, removing her from your facility would likely be emotionally devastating as she has in fact formed relationships. Do you have an ethics committee? I would probably give them a call if you do.

I am more concerned about the risk for falls based on what you've said than anything else. I would not take someone of her size that requires hands-on assistance to the bathroom without another person in there to help catch her if she goes down. If she cannot transfer by herself, she is a fall risk. If she starts to fall and you just let her fall without assisting her to the floor, you will be negligent. If she starts to fall and you attempt to assist her, you could be severely injured, especially if she pulls on you and drags you down. That is not a position I would like to be in.

As several other posters have suggested, I am putting myself in the client's shoes - and I think I would rather have a brief on than risk falling, breaking a hip, and dying of pneumonia in an ICU somewhere because the facility I was in did not have the staff to toilet me properly. Once again, I think an ethics consult might be appropriate.

I also agree that she needs some PT. If she can become a little more independent, maybe she would be a better fit for the facility.

toomuchbaloney · Jul 22, 2014

In my view adult briefs are intended for persons who are experiencing incontinence. They are not intended for patients who are experiencing staffing levels which are dangerous to staff and cause her to be in danger of falls or becoming incontinent because of long delays in toileting assistance.

It seems to me that requiring a continent and competent patient to wear briefs because there is an issue with the admission practices of the facility is not acceptable.

ClearBlueOctoberSky · Jul 23, 2014

I am obviously interpreting this a different way from the other posters because I don't see your question as being horrible.
Your facility does not sound like a good fit for her if she is required to be independent to be there. If she is unstable enough on her feet to need help transferring from the chair to the commode, she is not independent. If she cannot push her own wheelchair, she is not independent. What exactly are the criteria for admission to your facility? Was she more independent when she first arrived, or is this how she's always been? If your staffing really reflects that your patients are supposed to be independent, your facility is not adequately staffed to take care of patients like her successfully, period. However, removing her from your facility would likely be emotionally devastating as she has in fact formed relationships. Do you have an ethics committee? I would probably give them a call if you do.
I am more concerned about the risk for falls based on what you've said than anything else. I would not take someone of her size that requires hands-on assistance to the bathroom without another person in there to help catch her if she goes down. If she cannot transfer by herself, she is a fall risk. If she starts to fall and you just let her fall without assisting her to the floor, you will be negligent. If she starts to fall and you attempt to assist her, you could be severely injured, especially if she pulls on you and drags you down. That is not a position I would like to be in.
As several other posters have suggested, I am putting myself in the client's shoes - and I think I would rather have a brief on than risk falling, breaking a hip, and dying of pneumonia in an ICU somewhere because the facility I was in did not have the staff to toilet me properly. Once again, I think an ethics consult might be appropriate.
I also agree that she needs some PT. If she can become a little more independent, maybe she would be a better fit for the facility.

It is neglect and abuse to tell someone who is continent "I am not going to take you to the bathroom. You must eliminate in your diaper."

What kind of facility do you work in, OP? What is done at night? If she needs as much assistance during the day that you are indicating, what is staff doing at night to assist her?

Karou · Jul 23, 2014

I agree with other posters in that she sounds like she needs a higher level of care. I second the idea for an occupational therapy eval, if possible. In the meantime, is a bedside commode an option?

For dignity reasons already hashed out on this thread, briefs would not be a good option. If she were having urge incontinence (where she couldn't make it to the bathroom in time), I could see recommending a perineal pad or brief. It sounds like she is able to control her bowel/bladder, but has physical difficulty getting to/from the bathroom independently.

wooh, BSN, RN · Jul 23, 2014

Briefs aren't going to help with this problem. Even if she eliminates in her brief, she'll need the brief changed. Which isn't going to feel good on your back either.

brandy1017, ASN, RN · Jul 23, 2014

Why don't you have lift equipment like a sit to stand? Would be much safer for both of you than moving her by hand all by yourself! If she started to fall you would definitely injure yourself trying to brake her fall!