Feeding and toileting

fluffwad · Oct 30, 2005

I can't see something like that surviving the next state survey. When ya gotta go, or when your patient is sitting there soaked you just can't leave them. But they probably did that because someone wasn't helping out the others whose people still needed to be fed.

DusktilDawn · Oct 30, 2005

The facility I just left recently implemented a policy that under no circumstances was a resident to be toileted when there were still trays to be passed out or residents needing to be fed. How are things done at your facility?

I'm shaking my head in disbelief here. Is there even a sane rationale behind this?

SouthernLPN2RN, MSN, RN, APRN, NP · Oct 30, 2005

To tell the truth, I never heard the rationale. I was only part-time, so I missed a lot of the new rules and their reasons. At one time, CNA's were doing cath care, and one day I was doing a dsg change with a CNA's help, and I asked her if she would mind making sure the cath care got done, and I was informed that they didn't do it any more. For some strange reason, I also hadn't seen any wipes in about 2 months. At first, all inc. pts had wipes, then just the cath pts. Then all the sudden there were none anywhere, and no announcement was put up about it.

L&Dnurse2Be · Oct 30, 2005

If that is actually a rule that is upheld, there will be a lot of messes to clean up if you know what I mean!:chuckle As was said before, I don't think the state will like that.

Bird2 · Oct 31, 2005

We have one CNA at each meal that just answers lights and toliets residents. Who ever implemented the new rule will regret it. What a dining experience for the poor resident that was incontinent! Plus it's a dignity issue.

txspadequeenRN, BSN, RN · Oct 31, 2005

This has been the policy at every nursing home I have ever worked at and I am almost 100 % sure it is a nursing home regulation. Meaning that if the state were to see you leaving while feeding to toilet someone it would be a violation. The rational behind this is you are mixing feeding and passing clean trays of food with possible body fluids. Now before you start flaming me to death , I dont agree with this. I think we work hard to keep our residents on a toileting schedual and making them wait just causes a increase in incon. We take everyone to the restroom just prior to meals but everyone knows that you have to tinkle after you eat. Plus if you have ever attended a micro class or nursing school you will know that you can scrub your hands all day long and never remove all the germs. So there is no way to be germ free while you are passing trays , feeding or anything else... Just leave it to the state to develop orifice backwards rules.

student4ever · Oct 31, 2005

This has been the policy at every nursing home I have ever worked at and I am almost 100 % sure it is a nursing home regulation. Meaning that if the state were to see you leaving while feeding to toilet someone it would be a violation. The rational behind this is you are mixing feeding and passing clean trays of food with possible body fluids. Now before you start flaming me to death , I dont agree with this. I think we work hard to keep our residents on a toileting schedual and making them wait just causes a increase in incon. We take everyone to the restroom just prior to meals but everyone knows that you have to tinkle after you eat. Plus if you have ever attended a micro class or nursing school you will know that you can scrub your hands all day long and never remove all the germs. So there is no way to be germ free while you are passing trays , feeding or anything else... Just leave it to the state to develop orifice backwards rules.

Forgive me if this is a stupid question....

Why is it "contaminating" clean trays to LEAVE to toilet someone? I can understand going straight from toiletting to mixing food without washing hands. DUH!! Or for example, hand feeding someone who is at risk for aspiration and leaving them there with a full mouth in order to toilet someone. Again, DUH!! However, I would think that leaving to toilet a pt. and then full hand/arm scrubbing, then returning to passing out trays should be acceptable.

achot chavi · Oct 31, 2005

[. Plus if you have ever attended a micro class or nursing school you will know that you can scrub your hands all day long and never remove all the germs. So there is no way to be germ free while you are passing trays , feeding or anything else...

Germ-free? We all have 'good ' bacteria that are beneficial to us found in all parts of our body. It works on a symbiotic relationship and helps us prevent other fungal infections etc. However if what you're implying were to be correct, we should never change diapers even before a meal as we will never be able to properly clean our hands. I personally disagree as I feel a vigorous scrub of the hands with soap and warm water for 1 and a half minutes should be enough to prepare your hands between activities. In our facility it is required to wash and wear gloves and a clean apron when feeding patients. Thank G-d we have a good record!!

Regarding your claim: "We take everyone to the restroom just prior to meals but everyone knows that you have to tinkle after you eat."

That may be true with healthy individuals, but our patients often have to go in middle of a meal and I personally feel it would be cruel to make them wait and risk complications or an 'accident' (which can cause the patient much embarassment!),Therefore I always send a CNA to toilet my patients when they request, and they just don a new pair of gloves and apron after washing their hands after helping that human being to the bathroom!

For future reference, just provide the care for the patients that you would have wanted for yourself!

By the way I once did an inservice to teach my CNA's empathy for the patient who wants the bathroom. I restrained them and made them drink a bottle of coke before a lecture Halfway through they were begging for the toilet and i answered them with a half hearted "later,dear" and "not now I am busy", Try it and seee how you feel!!

txspadequeenRN, BSN, RN · Oct 31, 2005

Now wait a minute here. I knew by mentioning these few things was going to get hung without the jury. I am implying nothing here . What I said was you can rub and scrub all day long and you will have bad and ok good bacteria that remains on your hands. My point was that the state dosent want people taken to the restroom during meal times because of contamination between body fluids and food ; I was merly pointing out that you can scrub all day long and the bacteria remains, so what difference does it make when it comes to when the patients go to the restroom.Just take them. You are picking apart this post and reading into it. I have been a geri nurse a long time and am well aware of the toileting needs of my residents. I never said I agreed with any of the rules and regs the state has. You need to go back and re-read my post and then give the lecture to someone else, because you have totaly missed the point here.....

[. Plus if you have ever attended a micro class or nursing school you will know that you can scrub your hands all day long and never remove all the germs. So there is no way to be germ free while you are passing trays , feeding or anything else...
Germ-free? We all have 'good ' bacteria that are beneficial to us found in all parts of our body. It works on a symbiotic relationship and helps us prevent other fungal infections etc. However if what you're implying were to be correct, we should never change diapers even before a meal as we will never be able to properly clean our hands. I personally disagree as I feel a vigorous scrub of the hands with soap and warm water for 1 and a half minutes should be enough to prepare your hands between activities. In our facility it is required to wash and wear gloves and a clean apron when feeding patients. Thank G-d we have a good record!!
Regarding your claim: "We take everyone to the restroom just prior to meals but everyone knows that you have to tinkle after you eat."
That may be true with healthy individuals, but our patients often have to go in middle of a meal and I personally feel it would be cruel to make them wait and risk complications or an 'accident' (which can cause the patient much embarassment!),Therefore I always send a CNA to toilet my patients when they request, and they just don a new pair of gloves and apron after washing their hands after helping that human being to the bathroom!
For future reference, just provide the care for the patients that you would have wanted for yourself!
By the way I once did an inservice to teach my CNA's empathy for the patient who wants the bathroom. I restrained them and made them drink a bottle of coke before a lecture Halfway through they were begging for the toilet and i answered them with a half hearted "later,dear" and "not now I am busy", Try it and seee how you feel!!

MS._Jen_RN, ASN, RN · Oct 31, 2005

When I am in a state of aged grace, God help anyone who says to me and my 80 yo bladder, "I'm sorry you'll have to hold it, Mrs Jones hasn't had her dinner yet." We'd have words.

~Jen

Purple Princess · Oct 31, 2005

we had this problem too at places i've worked at. The one home I was at about 6 or 7 residents all in wheelchairs basically got in line and demanded i take them all to the toilet. i did but i could only help one at a time!! this was when i just came on shift and was hall person, of course no one could or would help cause they were after all my residents and everyone else was in report and i was the hall person but these residents were from my assignment. anyway, the second place had the same rule about toileting and eating. we spend a good two hours before meals doing rounds toileting everyone, changing them etc. yet one night i was in the middle of feeding a resident was told to stop and go change someone and also put someone else on the toilet and of course wait to get them off before i could resume feeding my resident. if a resident needs attention i give it but this was crazy the place we were at. we had almost 68 residents, all skilled care, incontinent, some with psych problems, and only 4 people to take care of them and that's if everyone showed up on time.