Night Aides keeping me late

duskyjewel · Mar 28, 2014

Jeez, some people.....do they not have lives?

Gabby-RN · Mar 28, 2014

please explain I'm thinking of the benefit of letting air get to the peri area but a wet sheet keeps a much larger area wet and cold and then there's the loss of dignity and i doubt the mattress gets wiped before placing fresh sheets unless it's just a matter of the pad not being placed properly rather than a pad capacity issue, which of course is and should be easily fixed by far most of my LTC experience is from working in CCRC's (non profit) and there are differences in approach and availability of supplies for instance, at some of the for profit places i've worked, we were supposed to use towels in the peri area of male pt.s to keep the bed from getting soaked that would be unthinkable at the CCRCs i've worked[/quote'] Briefs hold moisture close to the patients body and increase skin breakdown. When I worked LTC and even on the floor in the hospital, we had a no brief policy. Even if patients requested them we had to tell them no and have the wound nurse talk to them if they were persistent.
http://www.northshorecare.com/pdf/WOCN_2page_Study_Results_Handout_5.27.10.pdf

JDZ344 · Mar 29, 2014

Briefs hold moisture close to the patients body and increase skin breakdown. When I worked LTC and even on the floor in the hospital, we had a no brief policy. Even if patients requested them we had to tell them no and have the wound nurse talk to them if they were persistent.
http://www.northshorecare.com/pdf/WOCN_2page_Study_Results_Handout_5.27.10.pdf

What if they bring their own? Do you take them away?

duskyjewel · Mar 30, 2014

Gabby-RN, whatever happened to residents' rights at your facility? The policy at KatieP86's facility would seem to be more in line with respecting them.

Gabby-RN · Mar 30, 2014

Gabby-RN whatever happened to residents' rights at your facility? The policy at KatieP86's facility would seem to be more in line with respecting them.[/quote']
Not saying I disagree but usually with the wound care nurses education the patients end up being ok with the no brief policy which I should clarify is no briefs in bed. An incontinent patient can wear briefs during the day while active. The facility just believes the risks outweigh the benefits regarding skin breakdown.

Penholder · Mar 31, 2014

It is not that CNAs job to inspect your work. Yes, it is her job to do rounds on her patients, but that typically does not include an incontinence check due to patient dignity. (Would you want someone looking up your pants to make sure a job was done?)

Some CNAs like to single out other CNAs. Discuss what is happening with your shift supervisor.

Also, if she is clocking in 10 minutes early she may also be stacking time.

systoly · Mar 31, 2014

"Briefs hold moisture close to the patients body and increase skin breakdown. When I worked LTC and even on the floor in the hospital, we had a no brief policy. Even if patients requested them we had to tell them no and have the wound nurse talk to them if they were persistent."

relevance?

the resident(s) in question is lying in urine soiled bed linen

sometimes the "one size fits all" policy isn't the best

Gabby-RN · Mar 31, 2014

"Briefs hold moisture close to the patients body and increase skin breakdown. When I worked LTC and even on the floor in the hospital we had a no brief policy. Even if patients requested them we had to tell them no and have the wound nurse talk to them if they were persistent." relevance? the resident(s) in question is lying in urine soiled bed linen sometimes the "one size fits all" policy isn't the best[/quote']
If the resident was wearing a brief, they would be sitting in a urine soaked brief. That brief would be retaining heat as well as holding the urine close to their body. The relevance is that many studies have shown briefs in the incontinent patient versus just bed linens increase skin break down and lead to increased expenses and hospital stays. The sheet allows the skin to breathe. I didn't write any of the studies or the hospital policies. I was simply stating the rules at my facility and the explanation we were given based on evidence based practice.
I do believe that any person who wishes to wear a brief while out of bed should be allowed to BUT based on the studies I have read and information I have been provided I do not believe it is in any person's best interest to wear a brief in bed or have a towel placed between their legs. It makes it easier for the person (me) cleaning them up to not have to do a complete bed change every time they are incontinent but in the long run it would make my job harder too because if they get skin breakdown I now have to chart a change in condition for the new open area, complete an incident report, notify the doctor, get wound care orders, update care plans, and do wound care.
Easier for me to just change the sheets and better for the patient.

systoly · Mar 31, 2014

i believe the info you have is absolutely correct and true for most pt.s

but most facilities i've worked at prefer an individual approach

and continue to update the care plan should changes be indicated, but

as i said, my experience is based on CCRCs

hookyarnandblanket · Mar 31, 2014

Not saying I disagree but usually with the wound care nurses education the patients end up being ok with the no brief policy which I should clarify is no briefs in bed. An incontinent patient can wear briefs during the day while active. The facility just believes the risks outweigh the benefits regarding skin breakdown.

Hypothetically speaking, because not every shift is perfect, the hospital where I work allows patients to wear briefs in bed and out of bed. We have four levels of care: Observation/out patient, acute, swing bed/skilled, and swing bed/intermediate. We are required to turn or reposition everyone Q2. Would a no briefs policy still be effective if you were able to turn, check, and change every 2 hours? We have a g-tube patient who often has massive BM blowouts and I would be concerned about the amount of bedding and cleanup we would have to go through with a no briefs in bed policy even with disposable chux in place. I find this a very interesting topic since I am a complete OCD freak about breakdown on patients.

caliotter3 · Mar 31, 2014

Thanks again for the advice guys. I just now have the face the hurtle of telling the aide NO. Because she is the type to show up 10min early to inspect my work and then demand for me to help her.

At ten minutes before the end of shift we were no longer responsible unless it was a call light. Your nursing supervisor should be backing you up on this. Talk to her about it. When my shift CNAs were having this problem, I told the offender to leave my shift alone unless she planned on clocking in and working, then I would be supervising her work. She did not like this but started going to the break room or coming later.

likwit · Apr 1, 2014

Yeah I spoke to the unit manager and she told me that if she has a problem she can call her