Night shift: let residents sleep?

[RGuadagna]

I am currently filling in for our regular night RN who is on vacation (read: new to the night shift). Our facility is really focussing on patient-centered care etc, and I was just curious what the routine is out there in other ltc homes with regard to nighttime incontinence care?

My question is this: should we be padding the beds really well and letting them sleep OR should we continue to wake them up several times/night to change linens? If it were me, I'd say let me sleep. However, I could totally understand others not wanting to sleep in urine. So for those who can't speak for themselves, which is the more resident-centered approach?

[caliotter3]

As long as I worked in LTC, whether as a CNA or nurse, we were required to do rounds each two hours. Some lazy CNAs would try to get away with not changing residents for the entire night, but that was individual behavior of the CNA, not established policy.

[neutrophil]

When I was a CNA, I found out real quick that if patients did not get changed as soon as possible after a void or BM, they would get a rash. Hopefully they did not have a decubitus. When on noc shift and low on CNA's, and you had over 20 residents per CNA, it was always, two things. Peri care and turn 2qh, those that could not turn themselves, nothing else was expected.

Padding the mattress extra, why? To protect the mattress? It is still on their skin. If you are short staffed, make sure CNA's put bearier cream heavily at HS, for their first pericare in case they get over loaded.

[pebbles, BSN, RN]

If it were me, I'd say let me sleep.

How many nights have you slept in a bed soaked with your own urine lately?

It's not only bad for their skin, but if they have any cognition at all, it's embarrasing and humiliating and misery-provoking. Better to do proper care and change them. Most people will sleep better quality if they are warm and dry, if you have a hard time getting them to sleep after a turn or change, that's a different problem to address.

[morte, LPN, LVN]

there are "overnight" briefs designed to wick away moisture......to give the client/patient at least 4-6 hours of sleep.....hence the best of both worlds.

[pielęgniarka, RN]

If some patients request to not be woken or disturbed and they are not at high risk for skin breakdown we accommodate & care plan that. I would still peek my head through the door and make sure they were breathing then move on. If they needed vitals done I would get them right away at the beginning of the shift. We do have a couple alzheimer's folks that have the overnight briefs on good for about 6 hours or urine due to being combative at night (dark, tired, confused) then couldn't get back to sleep, agitated during the day (vicious cycle). You could contact the manufacturer of the briefs your LTC uses to see what's available. Of course if it's BM they get changed. Otherwise NOC rounds are done q 2 hours. I grouped my cares and treatments into the NOC nursing assistant rounds so no one has to be woken up more often than they need to. Most of the time the folks sleep right through repositioning or changing.

[bubblymom373]

We do resident centered care where I work. We do two rounds one at the beginning of the shift and one at the end. Most of the residents wear the night briefs that wick away the moisture. Those with skin issues are turned and changed more frequently during the shift. I have not really noticed an increase in skin issues since we started this over a year ago.

[healthstar, BSN, RN]

You don't want to interrupt the patient's sleep for unessential things, however if you see soiled linens it is better to wake them because you want to protect their skin.

[RaeRae1997]

Really great question, your trying to think of what's best for the patient so that's always good. I think everything needs to be individualized. It's important to find out what the patient and family wishes to be done, taking into account skin integrity risk or known issues. Use the braden score to guide you with the last part. If you took care of someone a week and noticed that every time you checked their bed they were dry till 4 am, wouldn't just make more sense at that point to just do a visual check and move on until 4 am. Since you know there is a set pattern of wetting at that hour. I also think it's a good idea before bed to offer to assist folks with any bathroom needs. I work in ICU, we don't have a choice, people are woke up frequently due to multiple needs. However in any setting I know it's important for people to get rest. You function a lot better, heal better and enjoy life more with adequate sleep. We try to do our care in lumps, when the NA goes in to do 2 hour turn, measure urine, check chucks and do mouth care on vent patients, I go in, do assessment and give meds. That way we can minimize our disruptions to sleep. I worked nights for 11 years, it sucks to wake people up, but if people can't move on their own it's important that they are turned and check for wetness q2. Q2 seems like a lot of waking up but it's better than getting a horrible infected bed sore. I hate being woke up myself but it's just one of those necessary evils. Good luck. Know what would be the coolest idea. It would be great if they had pads or diapers resonably priced that would wick moisture away and put off a bright glow sort of like glow lights when wet. Oh yea, moisture barrier is my best friend. Everybody makes fun of me and tells me I keep the moisture barrier ointment companies in business.

[SuesquatchRN, BSN, RN]

You gotta change them if they're wet. You will find that most falls out of boed can be traced back to someone wet trying to get out of the wetness even if they can't because it's in their briefs.

[PedsAtHeart, LPN]

If a patient is incontinent I would say they need to have rounds done on them every 2 hours. They also need to be turned if they are unable to do so themselves. When I worked LTC we did not have those diapers some people have mentioned, but we left everything off of that area at night so that their skin could have some time to breath. They wear those things all day long (some, not all) so we would just let them be free at night.... but of course, all we had were the cloth ones unless that certain resident had their own disposable diapers, but I still would not leave a patient in one of those all night.

[CoffeemateCNA]

The concept of green briefs and checking the resident less frequently throughout the night sounds great in theory, but in practice doesn't work so well.

Sure, the briefs show you if the resident is wet, but they don't confirm/negate the presence of BM. For that, you have to turn the resident over and open their brief to check. Plus, you have to turn everyone every two hours anyways. If you are having to check them like this and possibly wake them up, why spend the extra money on green briefs? It makes more sense just to use regular ones since you still have to check and turn them, and just change the brief while you're already there.