Briefs at night???

ktwlpn, LPN · Feb 4, 2004

Originally posted by AlixCoastRN
OK - here's the deal - I am a RCM/MDS type RN in a long term care facility. I've been here almost 5 years. At night and for lay downs after meals we have the CNAs lay residents down without briefs. They have the typical incontinence cloth pad and sometimes a paper pad on their bed. Pants are off. Blankets on. What I need to know is how other facilities do it.

The ombudsperson (don't you love them!) says it is a dignity issue and that folks should have briefs or underwear on. We have had very few skin issues from rashes, pressure, etc. So the question here is briefs (or boxers?) or not?

Thanks for your input.

I would say that your admin needs to educate this ombudsman...with the medical directors assitance..Naps-I can see briefs there...if they lay down with their clothes still on...I have worked in homes that did this.I have also worked in an LTC were the residents were undressed in the afternoons for their naps,padded and then gotten up and fully dressed again for dinner.(a private very chi chi joint-I was an aide then) At night time NO BRIEFS....EVER (can you hear my "Joan Crawford" voice?) Gets doctors orders if you must....Your own family doc and almost every gyn will tell you we all need to air out at night---guys should too....Even with q 2 hour rounds you get a higher incidence of skin problems....The residents whom are alert and oriented and incontinent and insist on briefs should be permitted them-if you have any.......Let us know what happens...

Long Term Care Columnist / Guide · Feb 4, 2004

This was an ongoing debate in a couple LTCs where I worked as an MDS coordinator. The aides liked putting everyone in briefs at night, and the nurses didn't care one way or the other........then I came in and did the Joan Crawford thing too: NO BRIEFS AT NIGHT, EVER!! Well, the CNAs didn't like it because, they said, it made their job harder (excuse me, it seems to me that putting a Depends AND a pad on would be more work), but sure enough, our skin issues began to decrease. The residents were more comfortable too......who on earth wants to have their butt encased in plastic all the time??.....AND their beds were changed more often, which was one of the reasons for doing it in the first place.

Of course, there were always a few aides who still put their residents in briefs at night, or put a fresh pad on top of a wet sheet But overall, I think it's a good policy, and should be the standard everywhere.

oceanblue · Feb 6, 2004

In my facility, no briefs for naps or at hs, very little skin breakdown here too!:)

AlixCoastRN · Feb 7, 2004

Thanks for the great input! We figured most facilities do what we do and the ombudsman was barking up the wrong tree. As a further: We reported this whole episode to the state sr svcs folks and they came in and did their investigation. In speaking with the head of the ombudsmen in the capitol, he stated that he didn't think that sr svcs would take it seriously...Proved him wrong! Such a petty thing for them to worry about...

Marti Ann · Feb 8, 2004

What ever happened to RESIDENTS RIGHTS!!!

maybe same of the residents want the diapers off and some want it on. ask the residents. its their choice. Right?

THE OMBUDSMAN

Catsrule16, RN · Feb 9, 2004

This practice has also been known to reduce the incidence of UTIs. The wet brief may act as an incubator for the normal flora on the skin to grow in and cause an infection. Have to look at all the outcomes, good or bad from leaving briefs off while in bed. While the resident has the right to wear the briefs, if they do or can cause more harm than good, then the safety of the resident overrides his right. Just because someone wants likes to play with matches, doesn't mean they should.

AlixCoastRN · Feb 9, 2004

Marti, if a res requests to wear a brief at night, then they are care planned for that. A couple of our residents like this and they are aware of the risks of breakdown, UTI, etc. when wearing a brief all night. So we do take into consideration 'resident rights' in everything we do. The no briefs at night is just a standard of practice in our facility.

tmoorelpn · Mar 12, 2004

In my facility, I've suggested that pads be left off at night but I was vetoed by the CNAs who also think that there's more work involved in that. I don't see how it could be more work. They have the cloth incontinence pads on their beds. If it gets wet, roll them over put a new one underneath. I would think that would be easier than those darn Depends-type pads which also require those mesh underpants over them. How it's "more" work is beyond me.

We take pants off for naps and make sure they are covered. It makes check and change a little easier instead of taking pants up and down plus it gets a little more air to their bottoms. We don't really have a breakdown problem even with the Depends on all day and night because we use a Desitin type cream on everyone.

We were told about the dignity issue too but we continue to do things as we always have. If they are in bed with their pants off and they are covered with a blanket and sheet, where is there a dignity issue? They sleep at night with a gown on and there are no pants covering their bottom half so what's the difference? And i would think it would more comfortable to take a nap without pants on. Not to mention the skin irritation and potential skin tears that could occur by taking their pants up and down every two hours to check and change. There are some elderly that have paper-thin skin and that constant pulling up of pants could give them a skin-tear and it's not the easiest thing to pull up pants while someone is lying in bed.:imbar

OK - here's the deal - I am a RCM/MDS type RN in a long term care facility. I've been here almost 5 years. At night and for lay downs after meals we have the CNAs lay residents down without briefs. They have the typical incontinence cloth pad and sometimes a paper pad on their bed. Pants are off. Blankets on. What I need to know is how other facilities do it.
The ombudsperson (don't you love them!) says it is a dignity issue and that folks should have briefs or underwear on. We have had very few skin issues from rashes, pressure, etc. So the question here is briefs (or boxers?) or not?
Thanks for your input.

jyoung1950 · Mar 13, 2004

OK - here's the deal - I am a RCM/MDS type RN in a long term care facility. I've been here almost 5 years. At night and for lay downs after meals we have the CNAs lay residents down without briefs. They have the typical incontinence cloth pad and sometimes a paper pad on their bed. Pants are off. Blankets on. What I need to know is how other facilities do it.
The ombudsperson (don't you love them!) says it is a dignity issue and that folks should have briefs or underwear on. We have had very few skin issues from rashes, pressure, etc. So the question here is briefs (or boxers?) or not?
Thanks for your input.

I'm a CNA at a nursing home.

Our practice is to put quilted pads on the bed and also a "crotch" cotton pad in between their legs. On the ones I put to bed before dinner who are very heavy wetters I keep a cloth brief with a heavy duty liner on them but take them off during PM care.

My incontinents get 3 changes from me on my watch.

On the units that have 62 residents the aids put the incontinents to bed before dinner with diapers and take them off at last rounds. That's usually because they are staffed on average with only 4 aids (or less on weekends) and they are forced to do the bare minimum. Helps them avoid whole bed changes.

Weekends on 3-11 are disasters waiting to happen at this place.

renerian, BSN, RN · Mar 13, 2004

I would be really angry if I were a patient put to bed in a facility without pants or sometype of clothing on. My dignity would suffer.

We all are different,

renerian

longtermcarern · Mar 13, 2004

How many people in their own homes would lay down for a nap with their pants off? At night it should be their choice. The better quality attend type pants wick the wetness away from them. For those who don't believe me and have infants, try putting your infant down at night in a cloth diaper or just on a pad. then try a disposable diaper, feel the difference on their skin. We use a high quality 8 hour depends at night, people and beds stay dry, the residents stay comfortable, they get their sleep. Some even ask for them and are stressed if they don't have them on. We have had no increase in skin breakdown since going to these, in fact we have seen just the reverse.