Bedpan? Why not a Poise pad?

[TryVeganToday]

I work on a med/surge unit and all day long, men can lay in perfect comfort to urinate in a convenient urinal. But WOMEN with horrible injuries have to be rolled to the side in extreme pain then have to sit on a bedpan and basically pee all over themselves anyway. We even put paper chucks on TOP of the bed pans because the bedpan just sticks to their skin and we cant get it out especially with heavy women. For a women to pee, we easily will use 2 full chucks and if a drop of urine makes it way on to the sheets, we have to do a bed change too.

Please tell me why we just dont hand them a Poise pad or even a toddler's pampers diaper to urinate easily, cleanly and comfortably? I have used both in emergency situations and they work AMAZING!!! Why O why are we still using bedpans for women?!?!?!

[blondy2061h, MSN, RN]

OK - you're telling me you think it's all right for an adult woman to voluntarily (or involuntarily) pee herself??? Where's DIGNITY in that?

As someone with OAB who uses POISE pads (or the other various brands on the market) they are NOT the be all - end all problem solver purported to be. The absorbency capacity does vary, most esp when lying down. (And just using a super-duper size doesn't make any difference.) Wetness against the skin must be quickly addressed else 'urine burn' and 'diaper rash' like issues can occur. Urine odor is also a problem. Pads have an elastic 'stretch' side binding that can cut & chafe. And it makes a difference if the wearer is a 'large' sized woman.

Regardless of the problems, it is desired that the pt maintain whatever urinary continency ability she has. To encourage 'just letting it go' DOES NOT maintain continency. When that pt goes home, what's she do - 'pee' the couch or bed all the time?!?!? How about she visit YOUR house and sit on your couch?

As I said, where's DIGNITY when you've reduced the adult pt to the level of an UN-toilet trained toddler?

There are no easy answers to the bedpan dilemma. Use chux, use a small 'fracture' pan and try dusting the bedpan (or pt 'tush') LIGHTLY with some powder.

I think they were suggesting placing a diaper over the urethral and perineal area when the need to void arises, vs using a bedpan or actually wearing a diaper. They do have a point. No matter how well you get a bedpan under someone, urine does often end up on legs and in crevices. I do think there could be a better way, using an alternative, flexible, disposable material, vs a hard plastic bed pan.

[futureRN721]

Right?? You would think somebody would have come up with a decent female urinal by now. I don't think this is a bad idea at all. I hate rolling patients who are in so much pain

[blondy2061h, MSN, RN]

Right?? You would think somebody would have come up with a decent female urinal by now. I don't think this is a bad idea at all. I hate rolling patients who are in so much pain

Yeah. Especially if they need lasix. At night. Men have it so much easier. Urinals or condom catheters. Females can have a foley, straight cath, or bed pan. Not exactly great options.

[Julius Seizure]

I am thinking more like this... There ARE female urinals, but when you have to be flat gravity is your enemy and the urine doesnt flow down and stay down. Like a modification of the urinal that could hold a pad or even absorbent crystals preventing it from backflowing.

This is actually kind of really smart. It can be like a she-wee with absorbent crystals at the end of it! Girl, you need to invent this and patent it....and never work another day at the bedside in your life!

[AnthonyD]

Right?? You would think somebody would have come up with a decent female urinal by now. I don't think this is a bad idea at all. I hate rolling patients who are in so much pain

There are female urinals. There are a few different styles, but they basically look like this:

[lucymalfoy]

On my floor, we mostly use fracture pans because they fit under women more easily. We put some lotion or barrier cream around the top surface of the bedpan and layer the interior of it with a few paper towels. Our hip and knee patients are usually on a bed with a trapeze, so if they cannot roll, they use their arms to pull up on the trapeze to lift their bottom. Once they are on the bedpan one way or another, we sit them up a little bit and tuck a wash cloth in the mons pubis area between their legs so that urine does not spray outward.

[anon456, BSN, RN]

I have used size 6 toddler diapers for teenagers to pee into. You tuck a disposable chux or adult diaper under them as far as you can without causing discomfort. Then you tuck the back end of the toddler diaper under their buttocks just enough to hold it in place, hold the rest of it up between their legs, and tell them to pee. It usually works with not much mess. It should be done on a schedule though, not waiting hours in-between until the bladder is too full to contain with any amount of diapers/chux. It takes time for patients to get used to urinating in diapers though. Especially the age group I work with.

Those female urinals look great. I wish we had them!

Cleaning up stool in a bedbound patient who can't turn because of injuries is another matter. I wish there was an easier way. The patient ends up being afraid to move after a BM so they hold it and get constipated. The pain meds on board don't help either.

[ComeTogether, LPN]

I HATE bedpans....fracture pans are about as good as dust pans. The larger pans work better if the pt is able.

Baby powder to prevent sticking, and reverse trendelenburg is your friend.

I have had patients where in lieu of the bed pan, when they needed to go we would set up chucks and open briefs underneath them and then take them out right away. So, basically using the brief/chucks as a bedpan. These patients had serious skin integrity issues and didn't have catheters for various reasons.

I've also had patients who would fill two fracture pans easily, whenever possible I put them on the bedside commode, even if I have to hoyer them to get them there and stay by their side the whole time, it's better than a bed pan.

Oh, and using a urinal isn't that easy for all men, a lot of the time they need to lean over the side of the bed or it will spill everywhere.

[jadelpn, LPN, EMT-B]

Thanks for the idea with the barrier cream! I will try that next time.

You can also sprinkle baby powder on the edges of the bedpan for a non-stick event. As opposed to moving side to side, you can put a "fracture pan" in from below-up. Even if the patient can raise their hips a tad.

Otherwise, I would advocate for a catheter. That doesn't answer the question of what to do when the patient needs to move their bowels, however.

Adequate pain control may be an issue that needs to be addressed. As well as mobility with PT. If we are talking about someone who is waiting for a hip surgery, that is one thing. But a non-fixable fracture that a patient has to think about movement and function and pain control is going to need to be addressed, as well as function.

The problem with urinating in a pad/brief is that it doesn't take long for a patient to lose an urge to "hold it" and use a bathroom. The incontinence factor is a real one, and that is more than likely not going to work well when they go home.

[No Stars In My Eyes]

I didn't see any "attacks", I saw strong reactions​ to the idea of telling a patient just to 'go ahead' and pee, and we'll clean you up afterwards.

Many folks are so well 'potty-trained' from a young age that is is nearly impossible to overcome that training and just 'let go' while in bed.

[RNperdiem, RN]

I work trauma, so I do know about the difficulties you face. Luckily my last patient in skeletal leg traction was a man who could use a urinal. Doctors are very aware of the risks of UTI and will be quick to want to remove the foley catheter. When I worked orthopedics, three days after a total hip replacement, the foley was removed and the docs wanted all patients ambulated to the bedside commode.

[kbrn2002, ADN, RN]

Dignity for one. Think about it this way: Would you like it if we told you you won't have time to use the bathroom while working so you may as well just wear a diaper instead of going to the toilet?