Stubborn CNA in ICU

Nurses General Nursing

Published

You are reading page 3 of Stubborn CNA in ICU

Career Columnist / Author

Nurse Beth, MSN

146 Articles; 3,468 Posts

Specializes in Tele, ICU, Staff Development.
I want to thank everyone for their input. The last thing I want is for this to CNA to be terminated. She's a hard worker , a better worker than most CNA's I've worked with. However, my priority is my patients. I've already had multiple discussions with the CNA about this so my next step will be to discuss the policy with the educator and the clinical coordinator. Thanks for all your input and helping me realise that my initial nursing judgement was correct!

Kudos to you for taking steps towards standardizing nursing practice based on clinical evidence. Your CNA has to make her own decision whether to meet performance expectations or not, once they are clarified.

BadAszFannyPak

26 Posts

I still really want to see the clinical evidence. Not trying to say it's wrong, but it does go against my understanding of skin care.

Mulan

2,228 Posts

Wow, aren't they called Adult Diapers?

Adult Diapers and Adult Pullups at Magic Medical

Career Columnist / Author

Nurse Beth, MSN

146 Articles; 3,468 Posts

Specializes in Tele, ICU, Staff Development.
I still really want to see the clinical evidence. Not trying to say it's wrong, but it does go against my understanding of skin care.

So many changes are happening in practice, and we all have to re-think what we learned.

Coincidence- I am right now working on some education modules on pressure injuries (new term- "ulcer" is out :) and support surfaces).

It's not recommended to use absorbent pads with pressure redistribution surface- pads have long been known to have an adverse effect on mattress pressure redistribution properties.

Here's the link to an abstract titled "The effect of multiple layers of linens on surface interface pressure: results of a laboratory study" in the Ostomy Wound Management Journal, 2013.The effect of multiple layers of linens on surface interface pressure: results of a laboratory study. - PubMed - NCBI

MunoRN, RN

8,058 Posts

Specializes in Critical Care.
Please do not call them diapers. I'm assuming that you don't have all infants in the ICU. Call them briefs or something else that would not be demeaning to an adult who has to use them.

I think it's more demeaning to suggest that "diapers" are only for infants, "diaper" is the correct term, a "brief" is not something intended for incontinence and "incontinence briefs" are different from diapers in that they are non-disposable but include a disposable or washable absorbent component.

In my experience patients find our discomfort and outright refusal to call diapers what they are far more demeaning that using the correct verbiage.

MunoRN, RN

8,058 Posts

Specializes in Critical Care.
So many changes are happening in practice, and we all have to re-think what we learned.

Coincidence- I am right now working on some education modules on pressure injuries (new term- "ulcer" is out :) and support surfaces).

It's not recommended to use absorbent pads with pressure redistribution surface- pads have long been known to have an adverse effect on mattress pressure redistribution properties.

Here's the link to an abstract titled "The effect of multiple layers of linens on surface interface pressure: results of a laboratory study" in the Ostomy Wound Management Journal, 2013.The effect of multiple layers of linens on surface interface pressure: results of a laboratory study. - PubMed - NCBI

I don't think there is any recommendation to not use absorbent pads, moving moisture away from the skin is actually a commonly recommended intervention for skin protection.

The study you've sited looked at sacral pressure (not overall effect on skin integrity due to the combination of pressure, moisture, and shear) and found that "excessive" layers of linen should be avoided, the study defined "heavy use" of linens as 9 layers. A single layer of polymer absorbent pad (ie Dri-Flo) pad is what is recommended by low-airloss mattress manufacturers and the main wound care practice organization. This optimizes the balance between pressure redistribution at the coccyx/sacrum and moisture management and shear reduction.

MunoRN, RN

8,058 Posts

Specializes in Critical Care.

As far as the diaper-free concept goes, it's not accurately broadly described as being best practice. The end-goal is to keep the skin as dry and clean as possible, which is sometimes better achieved with either a strategically placed absorbent pad or by using the absorbent portion of a diaper to sequester moisture away from the skin. When these items can't be changed as frequently as they probably should be, then patients are probably better off just relying on gravity to eventually move moisture away from the skin. In an ICU environment, it's reasonable to expect that either of these can be changed regularly, in which case it's better practice to use interventions that move moisture away from the skin.

BadAszFannyPak

26 Posts

Thank you so much for the link. It is not exactly what I was looking for but it helps. I do not fully accept the fact that quality and highly absorbing diapers / briefs are more hygienic and provide for a better experience for the patient, family and staff. Notice I am not saying they are better for skin integrity. I do not know but am starting to entertain the notion that the practice of letting the patient just soil the bed and assume the CNA (or dare I suggest a RN) is standing by and waiting to clean it up is originating from something other than "best practice." It might have been invented by the "Disturbed Energy Field" person?

Anyway. Point being that I contest that this practice is actually better for the patient and for understaffed floors is really impractical.

However, I am VERY open to quality research based evidence and beg someone who is better at research to help me find the smoking gun.

Does this practice have a commonly used title? Open to Air Nether Regions or Free Flowing Code Browns? That would help my crusade.

+ Add a Comment