Incontinent ON PURPOSE

CoffeeRTC, BSN, RN · Jun 25, 2012

I see this in LTC/ rehab too. What about a bedside comode? Or I ask them...what were you like at home? Do you use pull ups etc? If they say they don't have "accidents", ask them why they think they are having them in the hospital? I know they might not need to be told to use the call bell, but remind them or ask them to use the call bell for help before it gets to the point that they need to go so bad and then have an accident.

student forever · Jun 25, 2012

It is disappointing to have an ambulatory resident tell you staright out he prefers to be changed in bed rather than get up on the commode when he is perfectly able. It makes my stomach kind of turn.

JZ_RN · Jun 25, 2012

I saw this in LTC in people who just never want to get up. But then again we also had the LOLs and LOM that wanted to get up and ambulate to the BR and were always falling to do so... You can't win.

caliotter3 · Jul 10, 2012

I saw a new admit in an LTC facility that came in continent rapidly deteriorate to wetting the bed due to the nursing assistants refusing to help him ambulate safely to the bathroom, and more than likely due to their repeated belittling of him. Do not care to state why he was made fun of, but it was not a laughing matter. The man seemed to realize his predicament, so he just let all ties to reality go. Technically, he was abused by the staff. I felt very sorry for him.

nurse nosa · Jul 10, 2012

It sound like they just need that attention ......

Seas · Jul 23, 2012

It frustrates me too. Some people seem to purposely regress, and act like a baby.

I understand things may change while you are sick; I empathize with those. But some people do it purposely.

Aniroc · Oct 17, 2012

WHen I have patients that act like this...and I'm talking about those that have the mental and physical capabilities to toilet themselves and mobilize to the washroom or can ask for help etc... I first tell them how unacceptable their actions are and that I have more critical things to do then clean up someone who should know better. They're wasting my time when I can be helping Mrs. Smith over there use her new knee replacement. They wouldn't do this at home in their own bed so I insist that they do what they'd have to do at home.

First I get them to the washroom and make them wash themselves or shower if possible. An attends is put on if one wasn't previously. As they're doing that...I pull out new sheets and have them waiting. I make the patient assist me in making their bed. I specifically have them take off the wet sheets and put them in the hamper. I make them cavi-wipe the mattress and I do the same on the other side. I have them help me make the bed. I actively involve them in dealing with the consequence of relieving themselves on purpose - i.e. getting out of bed, actively cleaning themselves and being hygienic, making the bed and reminding them every hour on the hour while i am on shift that they must use the washroom to prevent an accident as it is their responsibility to keep them and their environment clean for their safety and others. I never threaten the use of a foley (cause some of them want that as a reason to stay in bed), and I talk candidly about real urinary incontinence, the health consequences of incontinence as well as social shame and isolation that goes along with real incontinence that such actions often result in people going to nursing homes which isn't always the best choice.

Give clear expectations, define consequences and more so follow through and document in the nursing notes and in the care plan.

Surfin USA · Dec 14, 2017

WHen I have patients that act like this...and I'm talking about those that have the mental and physical capabilities to toilet themselves and mobilize to the washroom or can ask for help etc... I first tell them how unacceptable their actions are and that I have more critical things to do then clean up someone who should know better. They're wasting my time when I can be helping Mrs. Smith over there use her new knee replacement. They wouldn't do this at home in their own bed so I insist that they do what they'd have to do at home.
First I get them to the washroom and make them wash themselves or shower if possible. An attends is put on if one wasn't previously. As they're doing that...I pull out new sheets and have them waiting. I make the patient assist me in making their bed. I specifically have them take off the wet sheets and put them in the hamper. I make them cavi-wipe the mattress and I do the same on the other side. I have them help me make the bed. I actively involve them in dealing with the consequence of relieving themselves on purpose - i.e. getting out of bed, actively cleaning themselves and being hygienic, making the bed and reminding them every hour on the hour while i am on shift that they must use the washroom to prevent an accident as it is their responsibility to keep them and their environment clean for their safety and others. I never threaten the use of a foley (cause some of them want that as a reason to stay in bed), and I talk candidly about real urinary incontinence, the health consequences of incontinence as well as social shame and isolation that goes along with real incontinence that such actions often result in people going to nursing homes which isn't always the best choice.
Give clear expectations, define consequences and more so follow through and document in the nursing notes and in the care plan.

Hi Aniroc! You sound like the kind of person who approaches incontinence in a very educational and proactive way.

I have a question posted on here about double diapering. I truly think that it's being done at my old facility as a means of not toileting people as much as they need it, or changing them as regularly. One is an ms patient who doesn't know when she needs to go, and has slight stress incontinence, and simply needs to be toileted every 90 mins (up to two hours, tops) and has expressed distain and disgust at wearing a brief under a pull up, or two pull ups. She prefers just one. I never even heard of double briefing until one day I came on here looking for answers about chux being doubled on some beds, air bed chux etc, and saw a lot said about doubling up on briefs and pull ups being neglect and a big no no. I personally have (three times now) removed the inner wet brief and left her in her clean single pull up, and educated her of her rights. This was in the time space of a few days, and I reported it to the manager who I thought was a nurse, because she was a manager of the ALF and wore different scrubs and does medpass. I mean to the point that she touches the meds and gives some shots and all that.

I was fired apparently for explaining to this resident her rights. Before leaving, I told her where to find the ombudsman's number, in case it happened again and she was feeling like she wasn't being adequately toileted.

This is an ALF that has bed bound patients that never leave the bed. There's a memory care unit which doesn't have a nurse at night. It's confusing to me because it's not a nursing home, so I don't know entirely what's going on there. And some people on here say it's okay to double diaper. I think they're out of their minds.

I'm not on a warpath here. I just want to know if I did the right thing. I'm a newly licensed CNA so I'm really raw. Please tell me what you would do.

It really frustrates me to see someone on an air mattress with a chux pad under them. I know that's not allowed. I just don't know where to look for guidelines on incontinence care to show people what's legal vs illegal, and I wish I had some kind of guide to help with this. I'm glad I don't work there anymore, to say the least. I just want what's best for the patient. If that means I have to do more work, then that's fine by me. It just seems like there are a lot of aides out there who don't see patient care as anything more than a task. That's why I want to be an LPN. (Eventually an RN) Because someone needs to know wtf is best for the patient, and aides (myself included) don't seem to know much in terms of legal vs illegal and best practices etc.... Lol

-Frustrated and feeling lonely!

PS thanks in advance

DarcyInSATX · Sep 19, 2018

I was looking for something else about incontinence and found this thread, and it reminded me of something. "Adult babies roleplaying as a baby or small child for erotic stimulation is considered the signature expression of paraphilic infantilism. This may involve the use of adult-sized diapers and baby clothes or toys and furniture such as a crib to lend reality to the infantilist fantasy, crawling on the floor, and some individuals may urinate or defecate in their diapers." Residents of a nursing home may want erotic stimulation but probably don't want that known. Maybe some residents could be urinating in diapers or in bed as part of paraphilic infantilism. They are certainly not going to tell staff that it is for erotic stimulation!

mtmkjr, BSN · Sep 19, 2018

Urgency, frequency/overactive bladder, stress incontinence

Anxiety over the above conditions

Lack of sleep related to sleep disruption that overrides self dignity.

Pain!

Impaired cognitive functioning

Resignation to long wait time/lack of response, especially when combined with previous issues (long term problem)

Once all the above is addressed, you should be left with VERY FEW people who have no self dignity and simply 'prefer' to wet themselves. Expecting them to clean themselves up and change their own brief if they are capable (as implied in the OP) should nip that in the bud.

As for fetishes...well, that isn't too difficult to determine, but probably a whole 'nother discussion.