Has anyone heard of this shortcut?

  1. Hi all, I just finished my LPN geriatric clinical. I was curious to know if anyone who has done clinicals has seen this "shortcut", what it does and why. I was finishing a bed bath on a resident and had a time changing out a disposable diaper. After placing the diaper in the proper position to roll resident back onto the diaper, the CNA assisting me placed a generous amount of skin lotion in a verticle line in the center of the diaper and said it was a shortcut. There was no explaination why this was done or what it does for an incontinent resident. Ease of removal for next change? Easier clean up? Skin protection? I absolutely do not know what could have been the reason for the lotion on the diaper. Anyone seen this done or know a reason why?
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    About newtress

    Joined: Dec '06; Posts: 461; Likes: 310
    LPN; from US
    Specialty: 3 year(s) of experience in med surg ltc psych

    14 Comments

  3. by   kukukajoo
    Laziness is more like it. It sounds like she was doing that instead of applying generously to the skin to aviod skin breakdown. Sorry but that won't cut it for skin protection!!
  4. by   suzy253
    Quote from kukukajoo
    Laziness is more like it. It sounds like she was doing that instead of applying generously to the skin to aviod skin breakdown. Sorry but that won't cut it for skin protection!!
    Yep....I agree
  5. by   drmorton2b
    Imagine sitting in that glob of lotion. Point taken on the laziness part.
  6. by   jmgrn65
    Quote from kukukajoo
    Laziness is more like it. It sounds like she was doing that instead of applying generously to the skin to aviod skin breakdown. Sorry but that won't cut it for skin protection!!
    My thought excatly!!:trout:
  7. by   newtress
    I dont know why this still sticks out in my mind. All I could think of at the time I saw this was having a huge amount of lotion front to back on the perineal area may create a mixture of urine and fecal matter plastered in other areas instead of it being concentrated in the usual areas. How could this be good for an elderly person let alone a healthy young female? I'm thinking that membranes in that area need to "breathe" somewhat and the excessive amount of lotion preventing the liquids from soaking into the diaper away from the skin. I know my instructor would have railed me a good one if I had done that.
  8. by   kukukajoo
    If I were you, I would pick another person to learn the ropes from!!!
  9. by   locolorenzo22
    We put the lotion on the skin, so when they squirt from the hose again,
    skin does not break, it does not tear,
    urine does not collect in the underwear!
    The laziness one sees and allows,
    reflects the lessons taught at home.
  10. by   Daytonite
    i agree with the others that this was just laziness. it was probably peppered with a little one-upmanship as well as i'm sure the cna got a kick out of showing a student something. i worked as a nursing assistant in a nursing home while i was in nursing school years ago and, believe me, there are plenty of "shortcuts" that i've seen. the lotion should have been applied directly to the patient's skin with some massage. that serves two purposes. it stimulates the patient's circulation in that area and it creates a bit of a protective barrier on the skin for any future incontinence.

    you have to realize that you are dealing with workers who are not necessarily learning the "why's" behind what they do. lpn and rn training is different. the way to handle a situation like this is to get as blank a look on your face as possible (in other words, try not to look shocked when you see these kinds of things!) and ask what that accomplishes in as friendly a tone as possible. if they can even give an answer i would then say something like, "i think it's much better to just take the time to do a little massage so i get all the areas back here covered," and smile. or, you can always do the "pass the buck" thing: "we have to do it this way or we'll get in trouble with our instructor." that way, you're being a good role model. when you get a license and you're in charge you can be a bit more assertive and give more specific direction if you are supervising this person.

    when i worked in a nursing home i used to try to periodically take time to work side by side with the cnas making rounds. this is one of the best ways to find out just what kind of care they give, as well as what kind of bad habits they might have.
  11. by   newtress
    Daytonite you are so right on this. Matter of fact, I did do the blank look on my face thing. I did that because the entire morning was spent around various different CNA's telling me NOT to do certain things and those things were clearly against all my standard/ universal precautions, protocols and knew I would not have passed all my skills for the day by my intructor if I repeated any of their "shortcuts." They all got blank looks on their faces when I told them I had to follow procedures per my instructor. Unfortunately for me, it was not accepted as a role model statement. The look resembled resentment. I even got (pardon the pun) railed for putting up a residents bed rail after I had secured her in bed for her afternoon nap. The CNA looked at the rail placed in full upright position and snapped at me "no no nooo, don't leave her bed rail up. She's gonna fidgit and fuss laying there and will eventually get out and wander around." Does this sound like contradicting rationale to you? Once again I think it generates back to the laziness issue. If you put a bed rail up, there would have to be someone to lower it back down and that requires a little WORK ETHIC. This was one of those everything opposit days. What's good for the resident is bad, and what's bad is good. I won't even go into the cross contamination issue. Glad this round of clinicals is over!
  12. by   midcom
    "no no nooo, don't leave her bed rail up. She's gonna fidgit and fuss laying there and will eventually get out and wander around"

    Although I wouldn't have said it that way, many of the residents in LTC do not have the side rails up because they often try to climb over them & fall. As a matter of fact, I don't think I ever was supposed to raise the rails in the 2 terms that I was in clinicals in a LTC facility. Many of the beds were really close to the floor & an extra mattress was laid next to the bed in case thye fell out. My teacher said that they are more likely to fall & get hurt climbing over the bed rails than not using them.

    Dixie
  13. by   newtress
    Point taken. In some instances I could see how this could be more of a benefit to the resident. But not knowing the history of the particular resident, I had to go with standard precaution. I realize that some care of geriatric clients/patients, need to be fine tuned or modified and is not standard for all. I'm certain that I will see many diversions from hard text teaching in all my phases of clinical experiences. But for now as a nursing student, my clinical eval from my instructor was graded as excellent for patient safety, and in this phase of the program I keep hearing those instructors mantras about patient safety being formost and primary. I must say that our intructors are doing a good job at grooming us to be safe and competent. Perhaps I'll have to be more flexible to those who are more experienced in what is more beneficial for a patient/client. But for now.... cross my t's and dot my i's.
  14. by   Daytonite
    this is part of the challenge of working in ltc with cnas. don't ever apologize for doing what is for the safety of a patient you don't know as well as these cnas. believe me, if a patient fell out of the bed, there would be some explaining to do. a patient climbing over the side rails and breaking a hip compared to a nurse failing to raise a side rail and the patient falling out of bed and breaking a hip is interpreted a whole lot differently by the safety committee that reviews the incident report. how in the blazes is an unfamiliar nurse going to be blamed for a patient climbing over the side rails of a bed? she's sure gonna take heat for not raising the side rails though. just keep doing what your instructor has taught you. if the facility has problems with student nurses raising the side rails of the patient beds, they will pass it along to your instructor. however, i'm betting that she's not going to hear diddley squat on this. i've worked in ltc off and on over my career and i am very familiar with the rules on restraining patients and strategies to prevent falls. and, if you choose to work in ltc after you graduate and get your license you will learn them too. until you are the one in charge and can make a decision about siderails being up or down on the patients under your charge, you always stick with basics.

    fyi. . .years ago i had a patient in the acute hospital who managed to scoot to the foot of her hospital bed and get the bottom end of her side rail down, climb out of the bed, and promptly fall on the floor and break not one but both hips. she never called out for help, never said a word. we found her like this when we made rounds coming out of change of shift report. worried about the legal problems that might come up, i wrote a page and a half on her chart. i also drew a picture of the scene in the nurses notes that showed the position of the side rails as i found them and a stick figure of the patient as i found her positioned on the floor by the bed. i never got so much as a call from anyone in administration or nursing on the incident. i was sure there was going to be a lawsuit with two broken hips. if there was any kind of legal action, i never knew about it. after that incident i started including notations about the position of the side rails in all my charting from then on. i worked with one lpn who had to give a deposition on a case of a fall from the bed where a patient broke his hip. the whole problem the hospital was having in defending itself was that no one had charted that the side rails had been pulled up. nurse after nurse claimed they had pulled his side rails up, but no one had charted it--and that was part of the hospital's problem with the lawsuit. my whole career i've spent a lot of extra time charting things like that which some people might think were a waste of time. i assess everything i can think of and chart on it all. i'm always thinking about the "what ifs".

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