Diapers or incopad for incontinence???

DLS_PMHNP, MSN, RN, NP · May 27, 2009

I don't have much knowledge in this subject matter, but using the term "brief" instead of "diaper" conveys much more respect to your elderly patients.

Long Term Care Columnist / Guide · May 27, 2009

I work in long-term care, and I disagree with keeping residents in briefs (I hate the use of the word 'diaper' for an adult---it's demeaning IMHO) at night. I see far too much skin breakdown to believe that it's good for people to wear plastic garments 24/7, without ever having the chance to let some air circulate to their most sensitive areas.

I prefer to lay residents down on the absorbent cloth incontinence pads and change them every 2 hours; in fact, I refuse to even put briefs on them at night except when they or their families request it for modesty or other personal reasons. It's also too easy to ignore the need for a change---we have all known aides who let people lie there for hours, marinating in their own waste, since the brief absorbs a fair amount of urine and feces before overflowing. With the pads, you HAVE to be on top of things or you end up having to do an entire bed change.

I think of all this in terms of the kind of care I'd want for my parents, and I'd be LIVID if they were kept in plastic underwear all of the time.

CABG patch kid, BSN, RN · May 27, 2009

I agree with Viva. The pads are better than the briefs for three reasons I can think of. First, the pad allows a bit of air to circulate around the person's skin, rather than the constant covering of a plastic brief, which will encourage sweating in addition to whatever waste may accumulate. Second, the pad allows for much easier visualization of waste, so people will be cleaned faster. Third, I've noticed especially in females, when the person has a soft or loose BM, well, the briefs push it up into places that can be very hard to clean if you catch my drift. That doesn't seem to happen as much with pads. In our CCU, we don't even use briefs. Please, stick with the pads. I wish there were studies to back this up. (Don't feel like looking right now, lol).

FLArn · May 27, 2009

We use incontinence briefs in only specific instances; when pt is up out of bed, is confused and "plays" in his/her BM, or when pt will not keep self covered for personal dignity. Otherwise it is incontinence pads only, and everyone regardless of whether we are using briefs or pads is checked for incontinence q 2 hrs. :twocents: :smilecoffeeIlovecof

RNperdiem, RN · May 27, 2009

My hospital required all staff to attend a meeting on the new skin care protocols.

We were taught to only use diapers/briefs when transporting an incontinent patient. Otherwise all patients are on pads.

Pads fit everyone unlike the diapers.

I'm not sure how using pads would work in places like long term care where patients spend more time out of bed.

lblondie1128 · Jun 25, 2009

Diapers are actually a pet peeve of mine. I am a nursing instructor and my students know my no diaper policy. This is a policy that took me a while to accept. I started out, like everyone else, using diapers, and the first time i went to work at a "diaper free" facility, i was irritated. I was very skeptical and during orientation was already thinking of ways to circumvent. Once I thought about the idea of a diaper and was educated by the WOCN nurses, I was appalled that I had ever used them. They are practical for incontinent patients who are getting up, but otherwise increase skin breakdown, for a couple of reasons: 1st, it traps moisture to the skin- even if it is not from incontinence. Often, we have pts who are sweating b/c of fever or they are weepy secondary to a disease process. Its like a green house - or as I tell my students, imagine being in a poncho on a humid day at 98 degrees - not good for skin or for pt feeling. 2nd is definitely nursing care. Out of sight, out of mind. We are less likely to notice incontinence when diapers are used.

Anyways, that's my two cents. Of the 4 facilities that I have worked at, the last two were diaper free, and I agree - even though it may mean more linen changes.

(also, I prefer paper or cloth chucks as opposed to the plastic ones for pts who are not pouring out the liquids)

Batman24 · Jun 25, 2009

I agree with those saying they should be referred to as briefs with patients and their families. Diapers can be degrading. I also agree why pads should be used instead due to all the reasons listed so eloquently above.

evilolive, BSN, RN · Jun 25, 2009

I really have enjoyed reading the pros of the pads! I work in LTC right now and agree that it's a great idea to leave people's bottoms free to the air for periods of time. Often times if someones groins or abdominal fold is getting red I'll leave their brief open on the sides to allow air in.

There would also be a lot less waste from all of the dirty briefs and wipes we go through. I've heard so much BS from my SDC about my CNAs mixing trash with linen on my shift, that this might be a good solution to the problem.

A few of our residents wear pull-ups at night, and wouldn't go without them. These are people who are generally incontinent on a regular basis, not the occasional accident. BUT, if we even tried using briefs on them at night, the families would go nutty.

I've seen so many red bottoms and irritated/rashy groins, UTIs in the ladies, and now yeast infections, that I might bring this up to my DON as a 'food for thought' issue. This would at least be good for night shift, IMO. Since most people are up and down throughout the day, at least they could get a solid 8-12 hours with air to their bottoms.

Zookeeper3 · Jun 25, 2009

For long term care standards, I don't know. Hospital standards, where I am, denies all diapers unless children and the all encompasing and terminal care where the patient has refused a foley. We are NOT allow to use any diapers or hike up or "fix" anythin g that can be construdeded as. We use condom caths and for females uses pads and must use barrier cream every two hours with the flip and turn. To use diapers, allow the urine to sit on the skin, I need an MD order, nursing is NOT allowed to use them.

For some might sound foreign, but this has helped prevent fungal infections and breakdown. Know that in the ICU, this is rare, no foley, but we track it and the no diapers has saved us from breakdown.