help - 1:1 home health position resident won't let me change brief!

[IHeartPeds87]

Hi! so I work home health. It is a 1:1 position at night.

This client won't get up to go to the bathroom (too tired). The client urinates in bed (wearing a brief). When I try to change the brief, the client won't let me. Meaning, when I tried to turn the client the client resisted. The client is 250+ pounds, so it's not the easiest person to move. What can I do? I can get the soiled brief off but it's too hard to get the clean brief on. I don't want to leave the resident in a soiled brief, but if I can't get a clean brief on and I can't leave the resident without a brief on! It's a 1:1 position. When I asked my supervisor what to do, she goes "i don't know, the residents always cooperate with me." How helpful.

I want to provide the best care I can...what am I supposed to do in this situation?

[caliotter3]

Is there a family member that could assist you? I know it is the middle of the night but they might want to wait til near the end of the shift or may be willing to have their sleep interrupted so that their family member is clean and dry. Or, better yet, maybe they can assist to ambulate the patient to the restroom. Doesn't hurt to ask. If no assistance is offered, then put some kind of pad or chucks under the patient as a last resort.

[Starletta, CNA]

Are you new to him? Perhaps he doesn't feel comfortable with you cleaning his genital area yet?

[tomc5555]

Give him a urinal to use, or a bedside commode. Would a different type of brief be easier to change?

[fuzzywuzzy, CNA]

I'm guessing this client has dementia because if not... wow. Not that I haven't run into people like that, but still.

Do you wash him up at night or is he already in bed when you get there? You could put a ton of barrier cream on him and then lay down several chux. Then when he wets, tuck one side of the chux as deep as you can (should be easier to slide around if there's another chux underneath), and then pull it out the other side. It's not ideal, but if he won't let you do anything it's probably the best you're gonna do. Someone that big would give TWO aides who tried to change him trouble.

[fuzzywuzzy, CNA]

OR if he stays fairly still you could prop a urinal up between his legs. Then at least the urine isn't sitting there eating away at his skin. A texas cath would be even better.

[IHeartPeds87]

Thanks for all the responses.

[yousoldtheworld]

I've had these residents before. I've even had the snot beat out of me by a 300 pound woman in her right mind who resisted being changed every time, on a near daily basis. It's frustrating.

I agree with what fuzzy said, you could try to prop a urinal, but pads/chux underneath...and just do what you can. Sometimes you have to be a little "forceful" (that's a bad way to phrase it...firm?) with difficult residents. Is he in his right mind? If so, try to reason with him. If he's pushing against when you try to roll him, ask him to put his arms at his sides first, and when he does, quickly roll him. It can be easier, to me, to roll heavy people toward me, if they are resisting.

At any rate, ALWAYS make sure you document and report any refusals and difficulties to the nurse in charge/the managers, both verbally and in writing. Every single time. ANd if you don't get support/advice from your managers and supervisors where you're working, I'd seek employment at another agency...because it is their responsibility to monitor and manage these things.