Help!!

flashpoint · Aug 12, 2006

Did you go into nursing because it was trendy? You were taught nursing theory to help you deal with these issues. You also use your creativity to solve these problems that nurses have had to deal with for years. Not all places have the financial means to stock all the newest new-fangled supplies. What do you think the nurses in the third world countries and even poorer areas have to contend with? Wake up! Nursing is not a fashion show.

Wow...a lot of yours posts seem to have a "bite" to them...pretty unfair to someone who is just expressing a concern!

I've worked places that use all disposable peri care supplies and places that use all cloth peri care supplies and I honestly don't see a big difference in either one. The best thing I have found to prevent skin breakdown is good old fashioned care...toilet people often, frequent repositioning, good peri care, use of moisture barriers, etc. Our night shift does the facility's laundry and with the chemicals and hot water temperatures that are used, I doubt there is much risk for contamination there.

banditrn · Aug 12, 2006

Did you go into nursing because it was trendy? You were taught nursing theory to help you deal with these issues. You also use your creativity to solve these problems that nurses have had to deal with for years. Not all places have the financial means to stock all the newest new-fangled supplies. What do you think the nurses in the third world countries and even poorer areas have to contend with? Wake up! Nursing is not a fashion show.

Daytonite - give me a break!! Disposable pads new fangled?!! They've been around as long as I have. And what does my stating my opinion have to do with 3rd world countries?? This isn't a 3rd world country!!

It is my opinion, from my experience, that those cloth pads our facility uses are lumpy, bumpy, cause pressure areas - and don't wick moisture away!! They stink, and it's my opinion that we have too many butt sores!

Another facility that my son worked in did a cost study, and found that they were actually spending MORE money using the non-disposables, when they factored in the expense of paying someone to keep the laundry washed up, and the time it took the CNA's to stand at a hopper and wash all the BM outof the pads and wash cloths!!

I've also observed the CNA's and their turning schedules - they all seem to be conscienscious, but they still only have time to check them every two hours.

So my concerns have nothing to do with 'a fashion show'! :uhoh3: :uhoh3:

flashpoint · Aug 12, 2006

Another facility that my son worked in did a cost study, and found that they were actually spending MORE money using the non-disposables, when they factored in the expense of paying someone to keep the laundry washed up, and the time it took the CNA's to stand at a hopper and wash all the BM outof the pads and wash cloths!!

That's one of the big reasons they started making the night shift do laundry! LOL...We toss laundry in before we make rounds, get it in the dryer after rounds, and get it folded before we make rounds again. I guess they thought we didn't have enough to do...

banditrn · Aug 13, 2006

That's one of the big reasons they started making the night shift do laundry! LOL...We toss laundry in before we make rounds, get it in the dryer after rounds, and get it folded before we make rounds again. I guess they thought we didn't have enough to do...

We simply would not have time. There are only two of us at nite! I won't be surprised, tho, when they decide to do that.

catlady, BSN, RN · Aug 13, 2006

When I became a unit manager, I instructed the staff to stop putting diapers on the residents when they were in bed; skin was to be open to air and only cloth soakers on the bed. The DNS immediately overruled me and the nasty plastic things came back, complete with decubiti and rashes.

dragonflyRN · Aug 13, 2006

My heart is in LTC...but I work in 2 large hospitals. In my position, I rarely use a brief on a patient. I feel cloth pads underneath the incontinent pt. will suffice.

banditrn · Aug 13, 2006

When I became a unit manager, I instructed the staff to stop putting diapers on the residents when they were in bed; skin was to be open to air and only cloth soakers on the bed. The DNS immediately overruled me and the nasty plastic things came back, complete with decubiti and rashes.

We do that at noc with many patients - leave them 'open to air' I mean - the aide and I talked about it, and felt like keeping them in the attends 24/7 was not a healthy thing.

Maybe it's just the kind of cloth pads they use - like I said, they're lumpy, won't lay flat.

Daytonite, BSN, RN · Aug 14, 2006

banditrn. . .in your original post you said

i'm thinking that these cloth pads hold the wetness and are harder on the people's skin. they seem to have a lot of bedsores, and the aides do seem to be turning them as they should. . .give me your wisdom on the subject, please.

my wisdom is that you should use your creativity to solve the problem. i brought up the 3rd world countries because they have the same problems with bedsores and use cloth pads as well. they don't have the luxury of using disposables. i came into nursing at a time when there were no disposables and all we had were sheets and bed blankets--no washable underpads. we made do with what we had.

it is my opinion, from my experience, that those cloth pads our facility uses are lumpy, bumpy, cause pressure areas - and don't wick moisture away!! they stink, and it's my opinion that we have too many butt sores!

it is my opinion that nurses allowing patients to remain on unsmoothed linens of any kind cause pressure areas. showing aides how to straighten out the lumps and bumps in these pads when they are placed under patients (and it can be done) should be a priority of the nurses in charge.

to my way of thinking, this is just another case of someone trying to pass the buck instead of acting like a charge nurse, blaming their problems on the equipment they have to work with, and failing to, not wanting to or not knowing how to educate the aides working with them on the proper way to use the equipment that they have and give the best care possible with it. :twocents:

buddy5630 · Aug 20, 2006

I am an RN and have been in LTC for 20 years. Not long ago I "helped out" at a tiny out of the way place where the residents did NOT wear briefs and the pads were all cloth, no chux allowed; in addition to the great turning done by the CNA's (or nurses), I never saw such beautiful skin! It was surreal and I never forgot that.

banditrn · Aug 20, 2006

I am an RN and have been in LTC for 20 years. Not long ago I "helped out" at a tiny out of the way place where the residents did NOT wear briefs and the pads were all cloth, no chux allowed; in addition to the great turning done by the CNA's (or nurses), I never saw such beautiful skin! It was surreal and I never forgot that.

I have to agree with you about the briefs, if you mean Depends - it is my feeling that they need some 'air' to their peri-areas, at least at night.

I do know that at night, there are only two of us, and the aide I work with is very good - maybe it is a staffing issue, the place seems to be understaffed from what I can tell looking at others in the area.

At the hospital, we routinely used a barrier cream - they don't use anything like that where I work now. It seems like it would be much easier to prevent these things before they happen, than to try to heal them once they've started. It doesn't seem to make any difference when we report the ones who we feel need more watching. On my shift, at least, we try to turn them at LEAST every two hours.

Maybe I am blaming it all on the wrong thing, but I'm only dealing with the experience I have, and I never saw such bottom breakdown at the hospital.

lovingtheunloved, ASN, RN · Aug 22, 2006

Chux are the devil. I HATE those things. You might as well sit the resident's bare bottom on a tarp. They absorb about as much. Hosing BM off of pads never hurt me before!

As far as barrier cream is concerned, if it is applied improperly, I'd prefer it not be used at all. When it is liberally slathered on the skin, it takes some SCRUBBING to get it off again, which makes the skin glowing red. I've seen aides put it on when they haven't given peri care, which just seals all that stuff in. And it gets applied to freshly washed, but not dry skin. Moisture=bad. Apply it correctly or not at all.

CapeCodMermaid, RN · Aug 22, 2006

Zowie...everyone certainly is getting their knickers in a twist over this debate! As with many things in nursing, it isn't the product, it's the skill of the person using it. We have to use Allevyn's on stage 2 pressure ulcers...think Duoderm...comfeel...all depends on the company who makes the product. The point is, if you take the time and apply it properly, it stays on the wound for at least 3 days and healing takes place. If you slap it on and walk away before the edges are attached, it'll roll off in 4 hours.

We've recently outlawed briefs at night (unless the resident has horrid diarrhea) and have gone to all cloth soakers. They are brand new...soft...lump free, and our #'s of pressure sores has already decreased. And I agree with Daytonite...get rid of those blasted wrinkles in the sheets! It takes a moment or two longer to have a wrinkle free bed but those moments mean less skin breakdown and less cranky residents.