Adult Depends/Underwear

[grad2012RN]

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'm going to be brief because I don't want to be recognized by any coworkers, should I give all the details.

Where I work, clients are supposed to be independent. They should be able to feed themselves and several walk with the assist of a cane or walker.

This particular client, has a mobility impairment, she uses a wheelchair, that must be pushed by staff. Thus, it's not a motorized chair. When we take her to the restroom, she must be lifted into a standing position, by using a gait belt. The distance to the bathroom and back, is approximately 200 ft.

My problem is, and I truly hope, I'm not sounding mean, but, I'm petite in stature and weight, and the client weighs 325 lbs. The techs are usually MIA, so I end up taking her to the bathroom, one to three times a day. 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.

My supervisor and other RN friends have told me: "Don't take her, you can't injure yourself, for any job"! Still, I feel it would be cruel to let her soil herself.

Right now I only see two options to solve this.

1. Ask management that we begin the process of transitioning her, and her family would have to find a different facility. I can't imagine the burden this would cause to the family. The client has been there 7+years and has developed friendships with other clients. Plus, I am the first RN to question her suitability (needing to be independent) for our facility. Five other RNs held this role before me.

2. Ask her to wear adult undergarments (diapers). If she agrees to this, there would be no need for me to suggest the transfer.

I want to treat her with respect and dignity. But, could this become a legal/discriminatory issue with the ADA?

In advance, thanks for all the responses and help. :)

[imintrouble, BSN, RN]

There is no debate about the Depend question. It wasn't the best idea. I think the OP threw it out there because the alternative for this resident/client is LTC.

grad2012RN reviewed her options and attempted to come up with a solution that would not result in the client having to leave her home and her friends.

That's exactly what needs to happen, but it's a painful and sad decision for everybody involved.

[imintrouble, BSN, RN]

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!

In a boarding home, or assisted living, the client has to be able to care for themselved with minimal assist, n order to live there. Sit to stands are not compatible with this facility.

[wooh, BSN, RN]

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!

Because it is ALF, not LTC. Residents shouldn't need that type of equipment. Resident needs to be moved to a higher level of care.

[wooh, BSN, RN]

There is no debate about the Depend question. It wasn't the best idea. I think the OP threw it out there because the alternative for this resident/client is LTC.

grad2012RN reviewed her options and attempted to come up with a solution that would not result in the client having to leave her home and her friends.

That's exactly what needs to happen, but it's a painful and sad decision for everybody involved.

Which is why I think jumping to judgment of the nurse isn't appropriate here. She was trying to come up with a way to keep the resident here where she's apparently happy. Unfortunately, there's often not a good solution.

[toomuchbaloney]

Because it is ALF, not LTC. Residents shouldn't need that type of equipment. Resident needs to be moved to a higher level of care.

Here in AK there are very very few LTC beds but lots of ALF beds. Most of the ALFs have at least a few completely dependent folks living in them.

[Nurse SMS, MSN, RN]

I think it is time for re-evaluation of her living situation. It is ALWAYS hard on the family and resident to make this transition but it also always has to come, sooner or later. Avoiding it because it will be hard is not best practice. Surely your facility has a policy and procedure in place for transitioning to a higher level of care?

If the patient can have PT and perhaps a weight loss regimen to improve strength, agility and ability to care for herself, she may be able to stay where she is. She could come back after having rehab elsewhere, go to outpatient PT or she may just need to transition to skilled nursing. It sounds like avoidance of a very real issue (the patient's lack of independence) to go the route of Depends. As long as accommodations are made that are inappropriate, the family and resident will continue to see those as "normal" and "okay", much as the nurses before you kicked that can down the road. The family and the patient need to be informed of the issues at hand, the inability of the facility to provide safe care in the current situation and then to present their options to them and let them choose. Staying where she is, as is, is obviously no longer an option.