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Please help - diaper issues

Posted

Has 12 years experience.

Sorry, long post/rant. I have a student that due to medical issues wears diapers. This is a regular elementary school. Student does not qualify for a full-time aid. I agreed last year to change students diapers (somewhat under pressure). A teachers assistant would bring the student up at a designated time and PRN, and I'd change the diaper. There was always copious amts of stool that took time to clean up. This quickly became a problem in that my office is very busy, and 9 times out of 10 there were other students that had to wait to get meds or be seen while I did the change. I realized early on this was going to be a problem and spoke to Admin about it several times. Please note that diaper changes ARR in the teachers assistants job description, but they basically refuse because of the potential liability issues. The Admin person said, well, I don't blame them. I fought this issue up until school was out. I wanted a resolution before school started up. I had to chase the Admins around because they were never available and would not make a decision. I might add that the policy on diapering does not indicate a nurse must do it but does always require a second person to witness. It burns my butt to have to stop what I'm doing when I'm really busy and the Teachers Aide, whose job does include diaper changes, just sits there and watches! Meanwhile the other kids are having a great time not being in class and are goofing around waiting for me. This student will again this year have to have an Aide accompany them to my office and the problem will start over again. Let me also add that every other school in the district has the Aides change the diapers. As I said Ive talked to my Admin and even written them an email stating my points.Nobody will give me a direct answer.

Can any of you think of what I could do from here, or how to handle it when I bring it up when school starts? I'm thinking of just gently reminding the Aide they really should be doing this and I'll witness, at least I'd be able to keep an eye on the other kids. I did this towards the end, and they got upset with me. This has been really bothering me, so much so that I'm thinking of changing schools if I get the chance.. Don't really want to do that, either...Sorry for the long post :(

mc3

Sorry about your situation… (been there, done that and it is not pleasant). If the child has an aid, I am assuming he also has an IEP and should be changed by the aid and it should ideally be done in a bathroom near the classroom. Your office is high traffic so there is certainly not much chance for keeping confidentially about the child's incontinence (a social barrier if it gets around)…

If aids in your district's other schools do changes, then a standard has been established. I would recommend getting your nursing supervisor involved. Sometimes admins only listen to other admins.

You certainly should not feel compelled to change schools over this issue. Special Ed supervisor might also be consulted.

Best wishes for a sensible outcome!

wearingmanyhats, RN

Has 23 years experience.

Maybe you can hand the aide te supplies and say "I need to look at little Johnny's sore throat, I will check on you as soon as I can" -- I worked as a classroom nurse/Paraprofessional, and we (and the teacher) were expected to just take care of it. This is not a nurse issue, and the other students are getting short changed.

mc3, ASN, RN

Has 12 years experience.

Yes, this is probably what I need to do. I started this at the end of last year and it didn't go over too well..

mc3

I'm facing this now with a new student. The student also self-caths. He has to do it at lunchtime, when I am also dealing with diabetic students/dosage calculations. When I finished with him yesterday (first day) there were three kids waiting for their meds, a mom waiting to talk to me, and a diabetic student waiting for me to figure and administer his insulin dose. Talked to admin yesterday, and they have not faced this issue before (except for kids in special ed) and didn't really have any answers so I guess it's mine to figure out.

Flare, ASN, BSN

Specializes in school nursing, ortho, trauma.

how old is this student? Can this student be taught to do their own changes? I have a similar situation with a student with spina bifida that came to me as a kindergartener and didn't qualify for an aide. Despite my writing that recommendation into IHP, 504 and any other idea i could think of, the best i could get was the classroom aide to come down to assist. Fortunately for me, given enough time and a little coaching, this student started to catch on part way through the year. Not to say that she didn't need help from time to time, but it sure beat spending 10 minutes in the cramped bathroom with her AND it gave her a sense of independence. The hardest part (which i know will come as a shock) was getting consistency at home.

mc3, ASN, RN

Has 12 years experience.

Student will be in kindergarten. Can I ask how you approached the training issue with the parents? They are very touchy...student does have a "medical" 504 but it does not specify who changes the student, but does state times. Problem is, school personnel believe this is a medical issue that should fall under the nurse no matter how I disagree.

Flare, ASN, BSN

Specializes in school nursing, ortho, trauma.

What is this student like? Is this an issue the student will have to wear diapers for a medical reason? The parents in my case knew that this is a lifelong issue for this student. And while other ideas are on the table (bowel training and such) it's just not enough follow through at home. So when I started having the student do more and more for herself, there was no push back from the parent.

If this student is going to need diapers long term or until some sort of larger medical intervention is done, then the parents need to be a bit realistic and start giving their child a bit of responsibility in their own care if they are developmentally able. I get that a kindergartener may not be able to do this on the first day of school, but Rome wasn't built in a day.

As far as the medical issue vs. aide care - if changing diapers is written into the aide job description then they should be the ones doing that care. Simple as that. I'd imagine you are one person for an entire school. It's not fair to the rest of the school body that medical issues wait and medication dispensaries run late because you are tied up changing diapers while a person without a nursing license sits there and does nothing while you do the task listed in their job description.

I had a similar complaint with my situation as they wanted to make me the responsible party to ensure that my student came to my office for her needed pull up changes - i told them that my office can be the change location. There is an extra key available, but that there is no way I can be counted on to be able to break 4 times a day to leave my office to go and get her from whereever she is. I am tied up with students, giving meds, called out of the office with emergencies, occasionally in meetings. This is the exact reason why I suggested the shared aide for her. Not that it went heeded.

mc3, ASN, RN

Has 12 years experience.

Flare, please see my PM to you.

I work in a special ed preschool and all the TA's change diapers, but my nephew had this "problem" when he started school (eventually he transferred to a special school in because of other issues)...he just finished kindergarten and still in diapers bc of severe GI issues after Hirschsprung's surgery at birth... When he first started school at 3 1/2 he needed to be changed, but the past year or 2 they've been working with him to change himself (with help/supervision)....I feel like, especially if there are no other limitations for this child, that should be the goal....Let the assistant supervise in a location NEAR your office in case of a "problem" if they want? But even when they WANTED a "medical para" for my nephew (when he first started school) to change him that was ONLY bc he used to get bleeding diaper rashes that needed 3 types of skin barrier creams....which teachers probably can't do. It makes no sense to make you, the nurse, change a 6-yr-old's diaper.

mc3, ASN, RN

Has 12 years experience.

Just wanted to update everyone. Met with new management team who agreed 100% the child should be changed by the TA. Arrangements were made today so there is no longer a problem!!!

Hurrah!!! I'm feeling pretty darn good now about my upcoming year!

mc3

:yes: