To Brief or not to brief????

VioletKaliLPN, LPN · May 24, 2011

I have seen that used for comfort care situations, and a few other situations, but not routinely. I am a Nursing student, about to graduate in August, and I have had clinicals in quite a few facilities, and so far that has been my experience.

Starletta, CNA · May 25, 2011

I have seen that used for comfort care situations, and a few other situations, but not routinely. I am a Nursing student, about to graduate in August, and I have had clinicals in quite a few facilities, and so far that has been my experience.

Thanks VioletKali,

Do you think it is easier to clean the Residents when they are not wearing briefs? Just curious...

fuzzywuzzy, CNA · May 25, 2011

I don't see how a maxi pad is necessarily better than a brief. Either way the person is going to be sitting in a mess and it will still be hard to clean if they're obese or hairy. At least a brief protects their clothing better. I only use pads on the people that dribble when they stand up- not the ones that are actually incontinent. The pads could be a little more comfortable... maybe. I had to use an incontinence pad one day at work when I forgot my tampons, and it was terrible, but at least it wasn't crinkly like a brief.

MedChica · May 25, 2011

^^^I agree.

However, I can't see a pad doing anything but creating an even greater mess.

"My new Instructor said it is much more sanitary and easier to clean NOT using briefs, but only the pads underneath a Resident. Reasoning - Resident is not spending time with Urine and Fecal matter pressed into the genital area. i.e. UTI."

I've only been a CNA 8 months...so, bear with me.

*laugh*

Sanitary...? I see no real difference.

But, 'easier to clean'?

I don't think so. Pee is pee and BM is...well, BM. At least in a diaper the poo and pee are confined to certain areas.

*laugh*

A urinating woman will just flow below and around. A urinating man? Unless you're going to put a border o pads around him it depends on the direction in which that member is pointing.

I could totally see the nearby wall being 'sprayed' (along with his chest).

Sure, those pullups and diapers aren't comfortable. Taking them off would be more comfortable.

...but letting the residents hang out like that is an idea that's only good in theory, I think.

Resident not spending time with urine/fecal matter pressed to genital area?'

No, instead it's all over their thighs and stomach, lady partss...and the bedsheets...(and possibly their fingers and hair).

If you'd just used the diaper, you could've just changed that, done some pericare and been done with it. Now...you gotta strip the bed, wait for the mattress to dry (because those pads can only hold so much urine) and take them into the shower.

Now, you've not done CNA work, yet. But, lemme tell you: You will NOT have the kind of time required to shower, strip the beds of and dress 3-6 people every 20-45 minutes. Most definitely not, if you're on morning shift (6-2)...because you have am showers and 2 meals to get though.

Not to mention the fact that STATE will rip you a new one for letting the residents hang out on soiled linen sans diapers/pullup.

'Easier to clean'? Somehow, I doubt that.

Honestly, here's a better answer: This could only be attempted on a slim minority of my residents.

...and much of that would depend on the amount of bowel/bladder control they have and, how far along they are in their 'retraining'.

- If they have better control and are mobile/can make it to the bathroom with help? Pull-up.

- Straight up 'incontinence' and can't inform? No, they should be in a diaper.

At night, with the residents undergoing 're-training', we take a few of them out of their pullups and diaper them up...especially if they'd have lots of liquids tonight.

They can't move as fast at night. Some can't get to the urinal fast enough. With one little guy (immobile but able to notify), he says, "I gotta go..." By the time I get his diaper off...he's peeing.

...and I have one little man who will lie in bed, go all over himself and not even hit the call-light. He's continent but has difficulty getting around sometimes.

I did a round. Poke my head in and he's laying there, staring at me, like, "S---, Can you help me..."

*laugh*

I said, "Mr. V ---, why didn't you use the call light? It's nothing to be embarrassed about...that's what we're here for..."

I will gladly take my residents to the bathroom. It's a Win-Win for everyone.

The more folks who successfully reclaim control of their bladders and bowels? The less folks I have to change...and the easier it is for them to get a good night's sleep (b/c, at night, you go in there every 2-3 hours waking them up and checking for wetness/poo).

LaterAlligator · May 25, 2011

I assume you mean a reusable incontinent pad on the bed and no brief of any kind? Not easy to clean. You end up with the resident way more coated in urine than she would have been with a brief, and since those cloth pads aren't absorbent, if the person peed very much, there may well be a puddle to deal with. I have a few residents who sometimes have to be open to air that way and I don't like it. I worry about their skin and end up trying to coat a lot more of them in barrier cream just in case, because it's less predictable where the waste will end up.

yousoldtheworld · May 25, 2011

I worked at a facility where the residents did not wear briefs in bed, instead had only the incontinence pads under them. It worked fine, to be honest, and DID cut down on bedsores...and it was quicker when it came to rounds. But I didn't necessarily prefer it to briefs.

yousoldtheworld · May 25, 2011

I don't see how a maxi pad is necessarily better than a brief. Either way the person is going to be sitting in a mess and it will still be hard to clean if they're obese or hairy. At least a brief protects their clothing better. I only use pads on the people that dribble when they stand up- not the ones that are actually incontinent. The pads could be a little more comfortable... maybe. I had to use an incontinence pad one day at work when I forgot my tampons, and it was terrible, but at least it wasn't crinkly like a brief.

I think the OP is talking about residents using only a bed pad for incontinence underneath them at night, not a maxi pad/the kind that go in the underwear when they're up. I agree that the maxi pad type pads just make a mess with incontinent people.

Bbo.W · May 25, 2011

If incontinence is a possibility, use a brief. Doing a full bed change every few hours on residents that are 500± lbs will break your back and spirit...If someone is not "present" enough to make it to the bathroom in time, use a brief at night to protect their dignity and your spine! Also, two chux pads underneath an incontinent resident is a lifesaver, sometimes residents will "hold it" and then unexpectedly flood the bed. It allows them to keep their dignity if a full bed change is not required!

Starletta, CNA · May 25, 2011

Thanks everyone... I wasn't sure what to think about that one.

I would think that a Resident with Dementia/Alzheimer's would also have a better chance of putting their hands down there, making a further unsanitary mess. Or if they tried to stand up, etc., it would get spread over everything.

fuzzywuzzy, CNA · May 25, 2011

I think the OP is talking about residents using only a bed pad for incontinence underneath them at night, not a maxi pad/the kind that go in the underwear when they're up. I agree that the maxi pad type pads just make a mess with incontinent people.

ohhhhh... we're not allowed to brief people in bed. I think it's good for people to be open to air when they're lying down.

kool-aide, RN · May 26, 2011

My hospital says that incont pts are not to wear briefs while in bed, instead, they are only to have an absorbent pad underneath their perineum. I completely agree with this and I do adhere to this rule with a couple of exceptions:

#1- If the pt can get OOB either w assistance or ad lib, and they have stress incontinence and they may soil themselves on the way to the BR, I have them wear briefs (and they usually prefer to wear them, too.)

#2- if the pt is a "heavy wetter" and the absorbent pads to cut it, I will use a combo of the pads and briefs to control the flow of urine from completely soaking the bed EVERY TIME!

I think those are reasonable exceptions.