need help with bedside care

Posted

hi, i'm often assigned to heavy care geriatric floors w/ my agency. i find i'm still struggling with heavy care residents/stiff/total care especially when they are very messy (ie., loose BM's, soiled catheters, etc.). when other nurses help me (when i'm lucky enough to get help) they seem to do it so eloquently--wheras i use tons of supplies, towels, blah blah, and take forever. if i could only develop a system this would really cut down on my time with am/hs care and allow me to do more/get my breaks/help others etc.

can anyone give me some basic pointers that will help me? or point me where i can go for help. i'm so discouraged that my care of these heavy patients taking me forever, and because of inefficient leaves me very tired and worn out...and still so many other things to do.

thank you...you can pm me too.

vamedic4, EMT-P

Specializes in Peds Cardiology, Peds Neuro, PICU, IV Jedi. Has 23 years experience. 1,060 Posts

Regarding your post about other nurses eloquence when delivering care to their patients...it really just takes practice and experience..the more you do it, the better you'll get.

But you can help yourself out in a number of ways.

If you know or suspect a patient hasn't been changed/bathed in awhile, bring all the stuff you need with you, or make a time in every night to do that. It's a good idea to check to see if some of the "basics" need to be done..weights/baths/feeds/ whatever...and employ help if you have it (aide/tech).

Anticipation is key...keep saline and heparin in your pocket if you are able to...never know when the IV was last checked. And the last thing you want is to have to start another one.

Try to develop a plan or routine and stick to it. I know it's hard when you're patients are sick or busy, you just do the best you can.

Get a full report from the night nurse about what exactly was done..and what needs to be done. Some agencies do certain things on a schedule.

Just remember, the more you do it..the easier it will get. I used to be scatterbrained like crazy until I finally figured out how to prioritize.

Best of luck to you!

vamedic4

John ;)

bargainhound

bargainhound, RN

536 Posts

Sometimes the best teacher in these situations is a good nursing assistant.

Find one whose work you admire and ask her for pointers....watch her/him

and follow thier technique.....and/or tailor it to be more comfortable to

your usual style of working.

It also helps to watch more than one person's techniques and then pick

one or take something from each person's way of working.

DG5

DG5

Specializes in Med/Surg, LTC. Has 11 years experience. 120 Posts

Use every minute you have with something useful to do or observe. When you get a patient up say, onto the commode in the am, use that time to make an assessment, make a bed, wash her face/neck/back/underarms, etc, place a pull-up pad or pad with refastenable tape on her before she stands up, as you do that, check her feet, slippers may be too tight, etc etc. I find that even though I may be a bit slower than someone else, I am always observing and doing an assessment of some sort which brings me out on top at the end of the day. Don't get discouraged! Its just practice and focusing on improving only on one thing at a time.

elthia

554 Posts

If it's a really messy liquid bm in a total care, I make a "dam" to prevent stool from flowing everywhere. With the pt laying on his/her back, I clean the top portion of the periarea from the top and "push" the stool to the back, and then put a clean towel between the legs, creating a dam to prevent the liquid stool from flowing everywhere when the pt is rolled to the side. Also, heck if you got to change the incontinence pad anyways, go ahead and use it to wipe away the majority of the stool, then you just use a clean washcloth to get the remainder off the pt. While changing out the linens, the "dam" gets pulled out with the dirty incontinence pad. This seems to work very well with geriatric males, just remember to clean the scrotum and penis before rolling the pt, and place the clean towel under the scrotum, seems to make incontinence care go faster. I've also found this is a great time to do a good assessment of the skin, I've found a lot of breakdown on the scrotum/penis that was missed by others.

dayshiftnurse

dayshiftnurse

116 Posts

to everyone...thanks for swift, helpful replies. and special thanks to you, elthia for giving that practical advice. i think i really need more of that sort of feedback. and as was pointed out, i need to shadow more cna's. they really know their stuff.

i am v. good at prioritizing...what's happening is that i'm so slowed down with the length of time it's taking to get my bedcare done, im always behind. but youre right, my organization is at least allowing me most of the time to get out on time. it's just stressful to do that, wheras other more experienced nurses seem to ALWAYS get out on time without all the stress and frustration i feel inside.

hopefullpn07

hopefullpn07

Specializes in Long Term Care. 18 Posts

Nothing wrong with shadowing a CNA to get quick pointers. Also don't think of yourself as taking alot of time helping your patient, think of yourself as being thorough in caring for that patient.

milky

milky

41 Posts

May I ask are you an LPN, RN or CNA? Not that means anything, just curious.

elthia

554 Posts

It just takes practice...watch what others do and take what you like about their methods and incorporate it into your own. Also, don't beat yourself up about taking what seems to be a long time to do bedside care, that can be a great time to do a psychosocial assessment along with a comprehensive head to toe physical assessment. A lot of pt's appreciate having someone to converse with during that bath.

chadash

Specializes in Nursing assistant. 1 Article; 1,429 Posts

One thing about turning patients alone. Always use a turning pad. You can flip two tons with practice :). First pull the pt towards you and align the body, then us the pad to gently roll them on their side. I slightly bend the top leg as I do this, and make sure the bottom arm is not under the pt first. Don't forget to bend your knees as you do this. I like to brace them against the bed. I am short, and find that this is somewhat of an advantage, my arms are alot closer to my knees than some and I can get a good center of gravity.

Always do every thing on one side of the bed you can before going over to the other side. For instance, when you have your pt on their side, strip sheets, place newones, do every thing you can after you wash them before you flip them, and then do every thing you can on the other side. Never do twice what you can do once. Use your weight as muscle, dont use your lower back. I always figure I had all my weight as a counter balance.

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