Med-Surg to Rehab help.

[DesiDani]

I transfered to Rehab and I love it. After only 3 days I noticed that Rehab has it's own challenges. One is convincing people to get up during night shift to toilet. I'm use to bedpans and urinal, but now that is a no go. I go in, I'm supportive. I tell them we will take it slow, I'm not going to let you fall yada.  I get a NO! One person fired me. A seasoned coworker told me not to even ask if they have to toilet, just tell them that they ARE getting up. Another said even if they are sleeping wake them up to toilet.

Oh boy?!?! So any tips on what I can say and manage Rehab?

 

[amoLucia]

I used to tell them it made their therapy stronger to get up 'so they wouldn't pee their bed' when they went home.' Or I asked them how their daughter would 'feel about a peed-on couch'.

And 'how would they manage at home?', esp since discharge was about 2 weeks away. That used to get a wide-eyed response and some improved compliance since all staff used that approach.

(I picked that up from a NOC CNA who made her pts walk to the BR.)

[DesiDani]

Should I still have them get up even if they already urinated in the bed or just change them anyway? One person told me to have them sit in the chair while I change their pad. I suspect some are incontinent by choice. How do I work with those patients?

[amoLucia]

Rounds were made q2h, so freq someone would already be wet. Regardless the staff would still walk the pt to the BR just 'to try even a little bit to keep the feeling there'. And they'd be emptier next time when rounds made. That little urge to void will still likely be there even if they only void a little. Even the guys would sit on the toilet to try & pee.

While in the BR, we'd fix the bed. But it was a dual purpose - they exercised by walking a little, and the hopefully maintained that urge sensation.

Now time for me to explain that 2 yrs ago, I was a pt in a skilled/rehab/NH post serious hospitalization. It was a 'NH from Hades' and I had  to learn how to 'pee myself' because NOBODY would assist. I was having bladder spasms and would be crying. While stuck  in bed, I learned to palpate my bladder and/or to crede myself. I was 68 yo and experiencing 'INCONTINENCE BY DEFAULT'. All shifts were responsible.

Two years later, I have problems. I don't know when I void while sleeping. Or I wake up just as I'm actually 'leaking'. Just to say, I don't find it easy to deliberately incontinently void. It just leaks on its own. But if I do get to the BR in time, I do have better luck (not always perfect).

Some people will just give you a hard time. The more A/O pts will be easier to convince. But take my word for it, it doesn't take long to lose function. Make sure you all approach active voiding for your pts and it's care-planned. And it helps if the family has been clued in and can help to coach.

[DesiDani]

Thanks a bunch.