Changing a patient's diaper while they are standing ?

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I am a Future RN student (one more semester of academics WOO HOO) and I am currently completing my clinicals for my CNA. I just started my rotation at a local LTC and OMG it is awful. Not the job I am doing, but the care the residents are recieving. Residents are divided among the CNA's 19 per CNA and if a call light goes off each cna only takes care of her own. I see them spending most of their time sitting down together. But every patient I walk in to help has a dirty diaper, dried secretions on their eyes or under their nose. (care seems awful) but what really freaked me out and the reason for this post was the fact that a veteran CNA was making a man stand up lean over and hold himself in a standing position while I cleaned his bm. I could not clean it fast enough and told her i was laying him down to clean him properly as his face was turning red (i was scared he was going to fall over and wanted to clean him well) Has anyone ever heard of changing a w/c using patient in this manner. It seems soo wrong :angryfire???

Donald

Specializes in LTC/SNF, Psychiatric, Pharmaceutical.
Oh gosh, now I just have to comment......I don't know how in the world "much of the LTC in this country" would EVER get away with care like that!! I work in LTC and in PA we have more regs than a nuclear power plant!! (and no, i'm NOT kidding....we looked at the manuals!!) The state looks us over with a fine tooth comb! Residents or families call their ombudsman anytime they have a complaint (one of ours was "the ice cream melts...."). We always get cited for something, but it almost never is poor patient care....it may be something that has potential for harming a pt, but even that is pretty rare. It's usually physician notes not on the chart quick enough, or a care plan that wasn't updated appropriately-important, yes, but certainly nothing like the conditions noted above. Any LTC facility in PA that gets Medicare or Medicaid funds has to be inspected at least yearly, and often at other times. Perhaps it's different elsewhere, but, darnit, we give good care!

Most nursing home staff does its best to give good care, but they are not given the resources necessary to give good care. I agree that LTC is more heavily regulated than nuclear power, but nuclear power has gotten away with some pretty big screwups too. It does not translate into better patient care by any stretch, it just means State surveyors tramping through a facility picking the staff to pieces. . The regulations for nursing homes are generally completely arbitrary too, subject to what kind of mood the surveyor is in.

Oh, by the way, sometimes it's better to change someone while standing...just "depends" on the situation.

And, 19 pts to one CNA is only acceptable on 11-7 shift. Even then, we try to keep the ratio lower.

Facilities play fast and loose with staffing requirements. Here, it's generally accepted that the staffing ratios include ALL nursing staff - from the CNAs on the frontlines, to the charge nurses who have multiple halls, to the administrative nurses. The staffing ratios in Oklahoma only specify "nursing staff". So the administrative nursing staff is counted into staffing, with the result that the CNAs can end up, legally, with 19-20 patients at a time. For the charge nurses, it's even worse, since the nurses have 2 or more halls under their wing.

Thanks for letting me vent!! :devil:

There are few nursing venues that create a need for venting in the way that LTC does.:angryfire

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Specializes in Critical Care, Capacity/Bed Management.

As a CNA we cut many corners and standing a patient is something I do if the patient is getting out of bed and their diaper is soiled.... I also use the shaving cream technique along with the mouthwash technique and the Peri-Wash technique. Being a CNA truly is an artform..cleaning 24 patients under 3 hours requires alot of corner cutting

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we use the term pads and i find it wrong to use the term nappy the common uk term for what a baby would use. we sometime use the term diaper for all in one pad as opposed to pads and net knickers.

standing up either prior to being on the toliet or afters is apprioate for those pt who an stand and you can do good care.

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This facilty sounds awful and how in the world do they get away with such care! But to the issue of a resident standing while be cleaned this is sometimes the residents preference and might be care planned that way because the resident requested it be done. But in general it all boils down to dignity and if this was witnessed by a state inspector and done in the way you have discribed the state would make a beeline for the care plan you can bank on that. There are standing lifts that enable you to change a resident who can bear weight on their legs but cant walk and are wheelchair bound and incontinent that you change in a standing type position but I have always thought it should be up to the resident. I worked in a veterans home once for 7 years and you wouldnt believe some of the ways those old guys wanted to be assisted with changes. If I could write a book on those methods of theirs it would make for some strange reading!

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I think standing is preferable- if the resident is able. Standing up more often does them some good. Also, it lets things "air out" a bit more than in-bed incontinence care.

After thinking about it for a minute, it seems to me that in standing, the resident is participating in their care, rather than just being completely passive while the care is done "on" them. Maybe in standing, the care is being done "with" them.

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I think standing is preferable- if the resident is able. Standing up more often does them some good. Also, it lets things "air out" a bit more than in-bed incontinence care.

After thinking about it for a minute, it seems to me that in standing, the resident is participating in their care, rather than just being completely passive while the care is done "on" them. Maybe in standing, the care is being done "with" them.

Excellent point. I work med surg but we will keep pts that should be transferred to LTC for months. One such pt has been on the floor for a several weeks. Dx was failure to thrive. She'd lay in bed, staring at the ceiling. Blatantly refused all care. She'd try to get out of bed if she had to go the br but she didn't walk without assistance. Instead of throwing her back in bed and changing her there, I'd stand her up, clean her and then say "as long as you're up, why don't you sit in the chair?" Worked everytime. I figured she's half out of bed she might as well be all the way out.

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Specializes in pedi, pedi psych,dd, school ,home health.

standing a pt to care for them also increases cirulation to the legs and feet; helps with venous return ; and muscle tone which helps decrease contractures!

another technique for cleaning is a good body or baby lotion; softens dried matter and doesnt irritate the skin.

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Specializes in NICU.

I wonder if shaving cream would work on sticky meconium... not that we keep any on our unit (NICU, so not much call for it), but we nurses sometimes bring in lotion and such things we don't routinely stock.

And in re the diapers/briefs question: when I was doing my medsurg clinical in nursing school, we had one RN who called them Pampers. On an adult unit. None of the patients ever said anything to me about it, but I cringed every time she said it in front of a patient.

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And in re the diapers/briefs question: when I was doing my medsurg clinical in nursing school, we had one RN who called them Pampers. On an adult unit. None of the patients ever said anything to me about it, but I cringed every time she said it in front of a patient.

Oh my gosh I have a fellow CNA student that keeps calling them pampers as well! I cringe everytime I hear her say it and have even said something to her about it (which is out of line and not my place, but geez have a little more tact!) :trout:

I actually wasn't sure what to call them so I was just calling them undergarments! I refuse to call them diapers (even though the residents do.) But now I know briefs is a better term!

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Excellent point. I work med surg but we will keep pts that should be transferred to LTC for months. One such pt has been on the floor for a several weeks. Dx was failure to thrive. She'd lay in bed, staring at the ceiling. Blatantly refused all care. She'd try to get out of bed if she had to go the br but she didn't walk without assistance. Instead of throwing her back in bed and changing her there, I'd stand her up, clean her and then say "as long as you're up, why don't you sit in the chair?" Worked everytime. I figured she's half out of bed she might as well be all the way out.

Good thinking!

Good nurses and CNAs know that learning how to gently manipulate pts into doing what we want them to do is a valuable skill!

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I wonder if shaving cream would work on sticky meconium... not that we keep any on our unit (NICU, so not much call for it), but we nurses sometimes bring in lotion and such things we don't routinely stock.

And in re the diapers/briefs question: when I was doing my medsurg clinical in nursing school, we had one RN who called them Pampers. On an adult unit. None of the patients ever said anything to me about it, but I cringed every time she said it in front of a patient.

For shaving cream to work well on BM with adults, I find it's best to remove as much as I can with a dry cloth or paper towel first, then use a warm, damp wash cloth with shaving cream.

I've seen a couple of people start with the shaving cream, before removing the loose BM first. They ended up with a brown, foamy mess.

I thnk it works better than lotion- maybe this is because of the shaving lubricants which help a razor glide over skin.

By the way, I think that referring to briefs as "Pampers" with adults is just awful.

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Oh my gosh I have a fellow CNA student that keeps calling them pampers as well! I cringe everytime I hear her say it and have even said something to her about it (which is out of line and not my place, but geez have a little more tact!) :trout:

I actually wasn't sure what to call them so I was just calling them undergarments! I refuse to call them diapers (even though the residents do.) But now I know briefs is a better term!

That is demeaning. We were taught in class, first day to never ever call them pampers or diapers. They're depends or briefs.

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