Changing a patient's diaper while they are standing ?

[EmBeMap]

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

[casi, ASN, RN]

dl it sounds like the CNA you were paired up with was a nasty peice of work.

Keep doing what you are doing and treating the residents with the dignity and respect they deserve.

On the briefs note I've always differentiated between them by calling them tape briefs and pull-up briefs

[Nrs_angie, BSN, RN]

I dont work in LTC, but I work in a hospital...

I guess it all depends on the situation...

Once a very confused and weak patient was told not to get out of bed with help. The bed check was alarming all night. Once, I went in and she was attempting to get out of bed and already had one foot on the floor. She had a bad diarrhea episode. It was running all over the place, looked like a **** explosion. Me and the tech asked her to get back in bed several times so we could clean her. But with her being confused, she didn't understand and insisted on walking to the BR.

The **** just kept coming and coming and we had no choice but to let her walk in the BR and stand while we cleaned her up... fortunately, she wasn't as weak as I thought she was... she stood there the whole time... I was afraid she'd fall but she was fine.

Now that situation aside... I dont recommend this as a standard practice... if the BM were to drip or fall on the floor and the patient stepped in it.. they would slip, fall, and break a hip. Not good!

It's just that much easier to have them lay in bed, and roll side to side as they are cleaned and the old brief is taken out and a new one put on.

[pagandeva2000, LPN]

When I was a CNA, I had patients stand up if they could to change them. In fact, many of them wanted it that way. I would take them to the bathroom, get a basin with warm water and soap as well as washcloths and towels. I was able to see where they needed cleaning and did so.

It may be easier for some to lay in bed, it depends. But, also, there were always so many patients to one CNA, that the job was very brutal and physically demanding. It is hard to do things by the books, and to tell the truth, it is still hard as a nurse.

If I discovered that a patient was weak by the knees or unable to stand, I would lay them down, or if they asked me to.

[avery157]

If a resident can stand (use his walker if he has one to hold onto) then changing them

standing up is OK but this residents sounds like he was struggling and there is no need

for that. It is easy to change someone in bed by just rolling them from side to side (gently). Unfortunately there are still many nursing homes that take Medicare, etc. that

are over booked and understaffed. You can call the Ombudsman and report the facility. The name and number MUST be displayed in a common area in the facility. They will ask your name on the phone but WILL NOT use it in the facility. Each facility is inspected by the state every 12-15 months. Sounds like they need a suprise inspection today. Your careing is why we so desperatly need good CNA's out there working. Thank you for all you are doing!!!

[Lovely_RN, MSN]

I'm not making excuses for the poor attitudes of the CNAs but their behavior likely has a lot to do with the crappy work environment.

19 patients per CNA is an absolutely ridiculous load!!!

Even if only 10 of those 19 wear briefs it's still too much for one person. At those staffing levels there is no way on Earth to do things the right way. Think about it...the CNA you are criticizing has a point no matter how crudely she stated her opinion.

To properly change a resident...take them to their room...lay them down in bed, gather all the supplies, use the peri-wash, rinse them, pat them dry, apply Vitamin D, diaper them, re-position or re-ambulate, you are talking at least 15-20 minutes...multiply that by 10, 15, or 19 residents.

2.5 hours...for 10

3.75 hours for 15

4.75 hours for all 19

That's if you can get it done in 15 minutes and what about repeats...the resident with diarrhea or the ones who go and then go again as soon as you get the "brief" on them?

If that was all a CNA had to do in a 8 hour shift it might be possible but they do have other duties. Not to mention that bending over the bed to change all of those patients is back breaking labor. At the end of the day your entire body feels like it's been beaten to a pulp.

I hated nursing home work as a CNA...got out of it as soon as I could. The expectations are totally unrealistic and unsafe.

Instead of reporting these CNAs you should report the facility to the state.

There is no way that in heck that the residents can be cared for in the manner that they should be with those ratios.

[bethin]

Depends - if the resident can hold himself up I will put the depends on then, but usually only if he/she is going to a chair. Just extra work for me and the resident to get them back in bed and roll around. I've noticed that the elderly don't roll as well as the rest of us. I'm sure that's attributed to degeneration of bones.

Eye crusties: I hate them!! It screams poor care if someone can't get a washcloth and wipe the crusties away. I do med surg now, but when I did LTC we had to have an order for baby shampoo if it was going to be used for eye crusties. A few did have the order and it worked wonders. Just takes a little extra work with a warm washcloth.

The poor residents at that facility. I don't think I could work in a place where I was responsible for bathing, turning, changing, getting up, ROM, feeding, etc on 19 people.

[nitewarrior]

Oh, I just hate in when nursinghome residents have eye crusties.

A warm washcloth with a bit of no-tears baby shampoo works great to get rid of this. When I worked LTC, I would give my residents each a warm cloth w/ baby shampoo to hold over their eyes for a few mins before I got them up. Not only does this clean their eyes and face well, but it helps them wake up.

A warm cloth with shaving cream helps clean off dried BM, and it helps the smell, too.

Sorry you are having to see what much of the LTC in this country is really like.

WOOHOO! Shaving cream is the best thing ever not only does it get rid of the smell but it is really moisturizing too. But as far a changing someones brief while standing. If they can stand do it. Its cleaner, faster and has them doing something instead of laying in bed.

[avery157]

Yes! That is my advice, report the facility to the state. If we don't do

that then those horrible facilities will continue to opperate. Thankfully

there are less and less of them but it is up to us as CNA's to get the

word out about the bad ones. An employee can only be as good as

the employer gives them the tools and support to be.

[Virgo_RN, BSN, RN]

I worked in LTC briefly early in my CNA career. We were each assigned a hall. I typically had 19 residents, 15 of whom were incontinent. Each incontinent resident had to be changed every two hours. Well, if you take 15 minutes and multiply that by 15 residents, it takes 3.75 hours to change all 15 residents once. Plus, I had four other residents that needed toileting during the night, and had to do four "get ups", meaning I had to get four residents up and ready for the day by the time day shift arrived. That meant that in order to get four residents up by seven am, I had to start at five am. If you do the math, it's plain to see that there is no way one CNA can change briefs on 15 residents every two hours, plus get four residents out of bed, all in the span of an eight hour shift. Plus two of the residents I had to get up really needed two CNAs to dress them due to contractures and/or being immobile and too heavy for one person to turn side to side. But I could never find anyone to help me. The other CNAs were too busy doing the same thing in their hall.

There was a fall one night. The care plan for the resident said they were a one person assist, and she was insisting on getting out of bed to sit for a while. So, I got her up, only to find out when she hit the floor that the one person who could assist her was the giant male CNA on day shift. The resident had to go to the emergency room to get the gash in her head stitched up. I hadn't screwed up. The care plan specifically said she was a one person assist, and it was drilled into us to "follow the care plan". That's exactly what I did. I still felt horrible for the patient, and will never forget it. Anyway, after all the commotion died down and the resident had been taken away by the paramedics, the resident's room mate said to me "Can you get me out of here too?".

[Lovely_RN, MSN]

What is really sad about this post is that I have found this to be the norm rather than the exception in most LTCs.

I worked in LTC briefly early in my CNA career. We were each assigned a hall. I typically had 19 residents, 15 of whom were incontinent. Each incontinent resident had to be changed every two hours. Well, if you take 15 minutes and multiply that by 15 residents, it takes 3.75 hours to change all 15 residents once. Plus, I had four other residents that needed toileting during the night, and had to do four "get ups", meaning I had to get four residents up and ready for the day by the time day shift arrived. That meant that in order to get four residents up by seven am, I had to start at five am. If you do the math, it's plain to see that there is no way one CNA can change briefs on 15 residents every two hours, plus get four residents out of bed, all in the span of an eight hour shift. Plus two of the residents I had to get up really needed two CNAs to dress them due to contractures and/or being immobile and too heavy for one person to turn side to side. But I could never find anyone to help me. The other CNAs were too busy doing the same thing in their hall.

There was a fall one night. The care plan for the resident said they were a one person assist, and she was insisting on getting out of bed to sit for a while. So, I got her up, only to find out when she hit the floor that the one person who could assist her was the giant male CNA on day shift. The resident had to go to the emergency room to get the gash in her head stitched up. I hadn't screwed up. The care plan specifically said she was a one person assist, and it was drilled into us to "follow the care plan". That's exactly what I did. I still felt horrible for the patient, and will never forget it. Anyway, after all the commotion died down and the resident had been taken away by the paramedics, the resident's room mate said to me "Can you get me out of here too?".

[Virgo_RN, BSN, RN]

My brother spent some time in a rehab facility following a near fatal car accident, and some of the things he told me were very disturbing. We do need reform desperately. With all the aging baby boomers, I'm afraid it's going to get worse before it gets better, if we don't do something about it now.

[Rexie68]

[quote name=

Sorry you are having to see what much of the LTC in this country is really like.[/quote]

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!

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.

Thanks for letting me vent!!