Told to pee in her depends

pediatriclpn · Jan 27, 2008

You need to advocate on the part of your patient, and ensure that the aides/companions either transfer her to a bedside commode, or maybe at least utilize a bedpan. You also need to talk to administration and let them know what is happening. It is not only a safety/health issue for the patient but also a safety issue for the caregiver's. If someone hurts their back it becomes a huge insurance inssue. and having dealt with worker's compensation myself, I really don't blame anyone for not wanting to lift someone who is difficult to transfer.

pagandeva2000, LPN · Jan 27, 2008

Is there a way that the companions can get together, say every two hours to assist this one client and aide to toilet safely? I certainly believe we have to think about the resident first, but I can also understand the point that an aide may present (provided that she is not a lazy person trying to get over with her job duties): she may be saying that she does not feel that she can perform this skill safely. And, if something happens to the client, and the nurse is aware that many employees have expressed difficulty, then, ultimately (and unfortunately), the nurse will be blamed.

I never worked in assisted living, so, I don't know the roles of the the companions. Are they only to be assigned to one patient and that is all, or are they able to assist each other? Is the companion always with the patient, or do they go from room to room on like an appointed time? At the moment, I would say to try and schedule a time where a few companions can go in together every two hours to assist this patient with toileting, and maybe the first bath or shower of the day, where turning and positioning may not be safe for one person to handle. Of course, this means that the companions HAVE to work together, and should be spoken to if they don't. And, I am not sure if this would be the best long term solution, because one can never tell when they actually have to go to the bathroom. If she is not feeling well at the moment, she may go more often...or what if she has diarrhea? But at least, this may be a start.

locolorenzo22, BSN, RN · Jan 27, 2008

If companions aren't trained, they need to be. This is a huge skin issue....not only for that, but how tough will it be for her to be trained at a LTC if she is just used to going in depends.....

also, staff need to be able to give APPROPRIATE nursing care, get admin involved....and good job on knowing that something just isn't "right" here.

Jolie, BSN · Jan 27, 2008

Is there a way that the companions can get together, say every two hours to assist this one client and aide to toilet safely? I certainly believe we have to think about the resident first, but I can also understand the point that an aide may present (provided that she is not a lazy person trying to get over with her job duties): she may be saying that she does not feel that she can perform this skill safely. And, if something happens to the client, and the nurse is aware that many employees have expressed difficulty, then, ultimately (and unfortunately), the nurse will be blamed.
What an excellent idea! If it is regarded as a short-term, stop-gap measure while the family locates a suitable placement in long term care. Residents in need of this much hands-on assistance for basic ADLs are just not appropriate candidates for Assisted Living.

dv0806 · Jan 27, 2008

thank you everyone for the response. I have brough this to administrations attention.

I dont agree with the comment of her pee'ing in her depends because of the difficult transfer. Last weekend right after the paramedics left she said I need to go to the restroom and I was so bummed but myself and her caregiver got her up. I am going to push this issue harder and stress why it is important to not handle it this way.

oh yeah last week there was 5 of us trying to lift her prior to calling for help and some of the companions were complaing of back pain so its hard when you want to help this resident but also have to look out for the safety of your coworkers.

Thanks again.

Mulan · Jan 27, 2008

this resident is already known to be too much for assisted living and family is looking for a LTC facility.
Here is the situation she is very immobile and VERY difficult with transfers. We have called paramedics/fire dept to help get her off the floor several times. quote)
I don't blame the staff for not wanting to get her oob.
Can she use a bedpan? That sounds like a safer alternative for all.

EmmaG, RN · Jan 27, 2008

oh yeah last week there was 5 of us trying to lift her prior to calling for help and some of the companions were complaing of back pain so its hard when you want to help this resident but also have to look out for the safety of your coworkers.
Thanks again.

If this person is immobile and requires 5 people to lift her yet some staff still hurt their backs, when there have been times the fire department was called in to lift this person, when there are no mechanical lifts available ... what exactly do you propose they do?

It doesn't matter one bit if this woman is continent if she can't get to a toilet or BSC.

As I see it, she has three choices: bedpan, foley, or wet her depends. Sorry, I will not nor will I expect anyone else to harm themselves trying to lift a person as you describe.

EmmaG, RN · Jan 27, 2008

If companions aren't trained, they need to be. This is a huge skin issue....not only for that, but how tough will it be for her to be trained at a LTC if she is just used to going in depends.....
also, staff need to be able to give APPROPRIATE nursing care, get admin involved....and good job on knowing that something just isn't "right" here.

What isn't 'right' is a person requiring this level of care residing in an assisted living facility.

dv0806 · Jan 27, 2008

What isn't 'right' is a person requiring this level of care residing in an assisted living facility.

you are right and that is why the family is looking for a new place that can offer her more than what assisted living does. However, until that is resolved we still have to take care of her the best that we can.

EmmaG, RN · Jan 27, 2008

you are right and that is why the family is looking for a new place that can offer her more than what assisted living does. However, until that is resolved we still have to take care of her the best that we can.

And from what you describe, that sounds like it includes offering her a bedpan rather than risking injury to staff and this woman by attempting to get her up.

nici1978 · Jan 27, 2008

I need some feedback on this matter. I work at an assisted living facility and this resident is already known to be too much for assisted living and family is looking for a LTC facility.
Here is the situation she is very immobile and VERY difficult with transfers. We have called paramedics/fire dept to help get her off the floor several times. She has good days and bad days with transfers. She alert and oriented and she is continent of bowel and bladder. She wears depends as a back up. She does have a small area of skin breakdown starting up. Well others have told her to just pee herself and they will change her then have to get her up to the bed side commade.
In assisted living they do not have CNA's that learn about tranfers. We don't have a hoyer lift or anything like that. So the "companions" think it is easier to change her every 2 hours. I understand they are concerned about hurting themselves with transfers but I am also thinking about the resident because if she is continent then why make her pee herself?
Can you please offer some advice/feedback?
Thank You

if she is continent there is no need for her to pee herself

not even is it disgusting it is also not good for her skin, if she is already getting red...

also if i would be the patient i would be very disgusted with myself

to pee myself

nici