permitting a patient to urinate in bed versus holding it in

Anisettes, BSN, RN · Jul 2, 2011

Just a question - but why is it every time somebody poses a question, it's automatically assumed the poster is fishing for answers to school questions? I've got to say, it's been awhile since I was in school (coming up on 30 years), but half the time they don't sound like any questions I was ever asked to answer. Why not just answer the posters question or remain silent? I don't 'get it'.

wooh, BSN, RN · Jul 2, 2011

If your only question on the board is a "What do you think of this situation?" then 9 times out of 10 it's either a student who's asking us to do their homework or a patient that thought a nurses' forum is a good place to complain about the nurses who cared for them last night/week/month.

Flare, ASN, BSN · Jul 2, 2011

well, i don't think i'd tell a patient that it is okay to wet the bed - i'd just continue to coach her on that she needs to wait for the bed pan and needs to hold it for a few more seconds. (I mean where is the bedpan kept? There should be something in the department as i am sure this is not the first time they've encountered this.)

Then if the patient could not hold it and wets the linens clean her up and reassure her that it's no big deal.

leslie :-D · Jul 2, 2011

i don't think this is a matter of giving permission.

if the pt can't hold it, s/he's going to void...permission or not.

however it the pt has an accident, the biggie here, is to downplay the incident, w/reassurance and preservation of dignity.

**** happens....as does pee.

leslie

Ashkins529 · Jul 2, 2011

My thinking is why didn't someone toilet the patient before transporting them? Prevention is preferable.

When I worked patient transport in a hospital there was a timeline we had to follow. At the same time the department called for transport they were also to call the unit the patient was on so the nurse would be aware. Rarely was it ever done. I wish there was time to make sure the patient had the time to void, clean up, ect.

cherrybreeze, ADN, RN · Jul 2, 2011

Eek! I can't imagine telling a patient to wet him or herself.

There is a BIG difference between telling a patient TO wet themselves, vs. telling them that if they can't hold it any longer, it's OK to (that you won't "be mad," etc....patients are afraid of this, not to mention being embarrassed by it). It's trying to comfort them if wetting the bed is inevitable.

My thinking is why didn't someone toilet the patient before transporting them? Prevention is preferable.

Of course it is. I ask patients all the time if they have to go before being transported off the unit for a test. People don't have to go at that particular moment all the time; it doesn't mean they won't have to when they get there.

Just a question - but why is it every time somebody poses a question, it's automatically assumed the poster is fishing for answers to school questions? I've got to say, it's been awhile since I was in school (coming up on 30 years), but half the time they don't sound like any questions I was ever asked to answer. Why not just answer the posters question or remain silent? I don't 'get it'.

When someone asks for articles and references when they ask a question, it generally means that they are needing to cite it for a reason. If it was a question asked just out of curiosity, they wouldn't need that.

JSlovex2 · Jul 2, 2011

Here is my insight, for what it's worth:
A bedridden pt should always have a bedpan within reach. Why was a bedpan not in the room to begin with?
It is unnatural to urinate in the bed. We were trained early in our lives NOT to do this. There is a stigma of shame and embarrassment associated with bedwetting, no matter the circumstance. The lab tech was only trying to comfort the pt by telling her that she should pee in the bed if she couldn't wait. However, the pt is no doubt completely humiliated at the thought of having to pee in the bed. The pt is already feeling helpless simply from being bed bound. Can you imagine how completely defeating it must have been for her to pee in the bed? She LIVES in that bed.
I doubt there are any nursing articles or references that you can look up regarding this situation. It is simply common sense to have a bedpan in the room for a bedridden pt.

i disagree. i see your point, but going by that same philosophy, should every bedridden patient have an emesis basin within reach? not every bedridden patient is nauseous just like not every bedridden patient can't control their bladder or bowels. there have been several occassions when someone has called out for an emesis basin, and unfortunately they've already started getting sick or it's just not physically possible to get it to them in time. what DO you say? you say what the person in this case said, "it's okay." there have been numerous times when patients who have showed no signs of incontinence (but were on bedrest) have had an 'accident.' it doesn't make logical sense to have things such as a bedpan, emesis basin, etc. in patient's rooms who are showing no signs of incontinence, nausea, etc. this is funny bc a bedridden patient today actually had their foley dc'd and we weren't sure if she'd be able to call out for the bedpan in time or not (and getting on it alone wasn't an option). we placed pads under her and the PATIENT said, "well, i hope i'll make it in time, but if not, we'll just have to change the bed won't we!" she was exactly right. i would never encourage a patient to pee or vomit on themselves, but if they were just NOT able to hold it any longer (which obviously they aren't if it comes out) i would reassure them that it's OKAY. like you said, no pt wants to pee in their bed bc they "live there" so if they DO then it's obviously bc they absolutely couldn't control it any longer. it's not as simple as, "every pt should have a bedpan within reach."

JSlovex2 · Jul 2, 2011

NURSING POST
I'm wondering if any of you have any thoughts on the following situation:
A bedridden female geriatric patient, while undergoing a lab test, has an intense urge to urinate and insists she cannot wait. The lab tech, who is physically not capable of lifting the patient, calls for another tech to bring a bed pan. The nurse urges the patient to wait for the bed pan to arrive, but the patient continues to say that she cannot wait and needs to urinate at that very moment. Finally the first lab tech reassures the patient that if she absolutely cannot wait, she should not be ashamed if she needs to urinate in the bed, the staff will clean the bed. This is a lesser evil situation; what would be the best approach? Are there any nursing standards or articles that might shed some light on this question? Any insight would be greatly appreciated.

I wouldn't say, "it's okay if you urinate in the bed" because if the patient TRULY can't hold it...they're going to urinate in the bed without that reassurance. if it were ME, i'd keep encouraging them...."they're almost here. just one more second. you can do it." and more than likely if it's that intense of a situation the patient is going to say, "oh no, it's coming out." if they really CAN'T hold it at which point i'd say, "it's okay! don't worry about it. it's not your fault...we'll get you cleaned up...that's my job, etc." so, i think the BEST approach would be to encourage the patient to hold it bc ultimately no amount of encouragement in the world is going to stop a bladder that truly has no more control.

JSlovex2 · Jul 2, 2011

i disagree. i see your point, but going by that same philosophy, should every bedridden patient have an emesis basin within reach? not every bedridden patient is nauseous just like not every bedridden patient can't control their bladder or bowels. there have been several occassions when someone has called out for an emesis basin, and unfortunately they've already started getting sick or it's just not physically possible to get it to them in time. what DO you say? you say what the person in this case said, "it's okay." there have been numerous times when patients who have showed no signs of incontinence (but were on bedrest) have had an 'accident.' it doesn't make logical sense to have things such as a bedpan, emesis basin, etc. in patient's rooms who are showing no signs of incontinence, nausea, etc. this is funny bc a bedridden patient today actually had their foley dc'd and we weren't sure if she'd be able to call out for the bedpan in time or not (and getting on it alone wasn't an option). we placed pads under her and the PATIENT said, "well, i hope i'll make it in time, but if not, we'll just have to change the bed won't we!" she was exactly right. i would never encourage a patient to pee or vomit on themselves, but if they were just NOT able to hold it any longer (which obviously they aren't if it comes out) i would reassure them that it's OKAY. like you said, no pt wants to pee in their bed bc they "live there" so if they DO then it's obviously bc they absolutely couldn't control it any longer. it's not as simple as, "every pt should have a bedpan within reach."

edited to add: my real point here is that no "woulda, coulda, shoulda" matters in a circumstance such as this. mistakes are made in nursiing. not having a bedpan "within reach" of a patient who is down for a LAB TEST (and i must say - i've never sent pt's belongings with them for testing) might be considered a mistake to you. it's irrelevant because we're talking about what should happen in THAT moment...the moment where the patient didn't have a bedpan within reach. what should a transporter do/say if a pt says they can't hold it while they're being rolled down the hallway? should transporters carry gloves as they transport and stop to put patients on bedpans? what if it happens in the elevator? i don't know...i'm just thinking about real life too much i guess.

kool-aide, RN · Jul 2, 2011

Working on an ortho unit, the dayshift nurse had told one of my pts that she could just pee in her depends instead of walking to the BR. What is going through these people's heads?!?!?!?!?!

canesdukegirl, BSN, RN · Jul 2, 2011

i disagree. i see your point, but going by that same philosophy, should every bedridden patient have an emesis basin within reach? not every bedridden patient is nauseous just like not every bedridden patient can't control their bladder or bowels. there have been several occassions when someone has called out for an emesis basin, and unfortunately they've already started getting sick or it's just not physically possible to get it to them in time. what DO you say? you say what the person in this case said, "it's okay." there have been numerous times when patients who have showed no signs of incontinence (but were on bedrest) have had an 'accident.' it doesn't make logical sense to have things such as a bedpan, emesis basin, etc. in patient's rooms who are showing no signs of incontinence, nausea, etc. this is funny bc a bedridden patient today actually had their foley dc'd and we weren't sure if she'd be able to call out for the bedpan in time or not (and getting on it alone wasn't an option). we placed pads under her and the PATIENT said, "well, i hope i'll make it in time, but if not, we'll just have to change the bed won't we!" she was exactly right. i would never encourage a patient to pee or vomit on themselves, but if they were just NOT able to hold it any longer (which obviously they aren't if it comes out) i would reassure them that it's OKAY. like you said, no pt wants to pee in their bed bc they "live there" so if they DO then it's obviously bc they absolutely couldn't control it any longer. it's not as simple as, "every pt should have a bedpan within reach."

My statement was that every BEDRIDDEN pt should have a bedpan within reach.

GLORIAmunchkin72 · Jul 2, 2011

This same scenario can happen on the bus on the way to Walmart. I am talking about buses that transport nursing home residents. I am sure the bus drivers already have a solution in place (turn the bus around?)