Diapering and toilet accidents

[Jocelyn Z]

Hello!I just started as a health room assistant at an elementary school. I have been assigned to special education pre-k to kindergarten students. Therefore I'm the one who needs to do the dirty and stinky task of changing poopy pull-ups and underwear. The problem is that I am not experienced in this task as I don't have a whole lot of experience with kids. Although I am looking forward to advancing in my career as a nurse no matter what I have to deal with. Another issue is that the restroom where the kids are changed do not have a changing table, as they change them standing up to help promote self confidence I guess. This does sound strange but how am I supposed to do this when they are standing? It seems really messy and unpleasant, but it has to be done I guess. Anybody else ever had to deal with this?

[Sudsy]

Never had to deal with, sorry. Can you ask WHY no diaper table?!

Advice: wear gloves and use a LOT of wipes. Wipe from front to back. Make THEM also wash their hands after having a diaper change, as it will get them into the habit when they are able to wipe themselves.....

Sorry not more ideas. Good luck!

[Flare, ASN, BSN]

why not take the initiative and start trying to toilet these kids on a schedule?

[NurseLoveJoy88, ASN, RN]

I used to be a health assistant too in ES, this was NEVER part of my job. There is something wrong with how they do things at your school.

[momnurse23]

I haven't had to do too much of this while in school nursing but from my experience during nursing school while working in the nursing home:

1) Have lots of wipes handy and already out of the container. It's difficult to get them out sometimes without having to constantly change gloves. Also, even though the wipes are technically ready to use, it sometimes helps to wet them a little more with warm water.

2)Tear pullups down each side and remove like a diaper instead of trying to pull them down like panties/underwear. Just kept things a little more "contained" rather than streaking it down their legs.

2) If there is a bar in there (like in wheelchair accessible restrooms) I'd have them hold on to that and lean over so I could see/reach the need to clean areas better. With kids who might be a little more steady on their feet, if there is not a bar ask them to put hands on knees or reach for their toes.

3) Make sure a trashcan is handy and easy to use. Sometimes it's difficult to put trash in a lidded trashcan quickly when your gloved hands are soiled.

Our school only has pre-K special ed and the teachers/parapro's generally handle all toileting with these kids. I do know they have a special changing table with little steps so the kids can climb up which helps save the backs of those working there. If you are assigned this job, I really think you should petition for some kind of changing table. I'm not familiar with older kids in this situation though, so I'm not sure what the norm is for that area.

[nightie-night nurse]

I work at a school with K - 5 students. I do have students come in with soiled clothes. Very seldomly do I cahnge them. I ask the student if they can clean themselves and if not I call home.

I do have two students with Spina Bifida who come in twice a day for catheterizations. They do need help cleaning themselves. I have a doctor's order and parent's written permission to help them. One is in a wheelchair and one uses crutches.

The one with crutches I change standing up and I have him use the toilet seat and the handicap bar to help with stability. I have a grocery sack open and ready to put the soiled wipes and diapers in. I tie it up when I am done (this helps with the smell also). I wipe front to back (this makes cleaning easier). There is no changing table or private area for cleaning while he is laying down. It would make it easier on my knees, but there is no place to put one.