young adults and diapers

[ally6]

First of all I agree wth previous posts, NEVER call them diapers. I dont like the word briefs so I generally use underwear or pad.

My question is that I had a paitent who was a 20 year old female who was a major trauma patient due to a car accident. She is currently incontinent as her injuries make it very difficult for her to use the bathroom. However she is mortified at the fact she was put in incontinence underwear. From experience how do you tell them that it is nothing to be ashamed of and that we (staff) do not judge or make fun of them in any way what so ever?

[evolvingrn, BSN, RN]

some people would have a foley than be incontinent, others want to work towards continence so we try scheduled tolieting ect.... I just try to advocate for the pt and to treat them with the upmost respect when were changing them. Like you i usually call it underwear.

[utadahikaru]

I think its great that you are in touch with your patients feelings and are searching for ways to help, but I don't think its as simple as any one thing you can tell them. Reassure your patient that the underwear are in place to both protect her skin and to mitigate the potentially even more embarrassing problem she would be facing without them. I don't know if this is a permanent or temporary measure for the patient, but I do know that patients will often overlook the big picture, in this case "having lived through the accident", and instead they may focus on a single issue related to their condition. Its not uncommon for women undergoing chemo to sometimes be more upset about losing their hair than anything else. This perception probably seems odd to everyone except the patient, but in the patients view, it may be extremely disturbing and even worse, she may feel that no one understands her view. Give her time to adjust and let her know you are there for her to talk or just listen. Chances are she will have a more healthy perspective later on, but for now dealing with incontinence is probably more than she feels capable of readily accepting. Emotional support is the key to a good prognosis here. She might even benefit from you sharing a story with her like the one I mentioned regarding some chemo patients feeling more distress over losing their hair than the fact that they have cancer. (I read a very interesting article last month r/t breast cancer awareness over this very topic)

[Davey Do]

ally6:

Ditto to utadahikaru for your sensitivity to your patient's feelings. And your term, incotinency wear, is more benign, also.

Patients who need to utilize such items seem to respond more favorably to their use if the apparatus is treated in the same regard as any other type of medical device.

Thanks for bringing up this sensitive subject for open discussion.

Dave

[tyvin, BSN, RN]

When I was in the hospital after my back surgery the doctor took out my Foley but I had to be helped to the bathroom and people were busy. BSC was out as it took staff just as much time as helping me to the BSC and the bedpan was a complete disaster. This story is for nurses who have patients that are continent but have complications getting to the bathroom.

There was no way I was going to wear a diaper so I made a deal with the nurses to give me a supply of chucks, diapers, gloves and wipes so when I had to go I put it on myself and went and then could remove it so I wouldn't have to stay in a wet diaper.

Being a nurse this was easy for me because I knew how to put the chuck under me and then the diaper when I had to go. It worked out really well and saved me the humiliation of wearing diapers. If I ever end up taking care of someone in this situation I will offer them the same option with the option to call for assist as well.

[nurse2033, MSN, RN]

You just have to be matter-of-fact that this is one of changes in her life that she will have to deal with. It will take time for her to adjust. Her attitude towards those changes will be instumental in her moving on with her life. Some patients will adapt beautifully and others may never. Best of luck.

[ally6]

this is a good suggestion thankyou! However at times this wouldnt work so well work because the patient is completely dependent when it comes to doing anything. Just a touchy subject I guess, especially of someone of that age.

And by the way, dont get me wrong by most post, she is extremely grateful that she survived the accident and is a wondeful patient!

[Sally Lou]

Alot has to do with how you react to whatever is in the brief also, remember actions speak louder then words.

[RNCEN]

Is she a candidate to use a fracture pan? If she is considered to be incontinent d/t immobility, but recognizes urge and can control herself, perhaps she could ring her bell for assistance with using a fracture pan. This would retain her privacy, dignity, and the outcome would be met for both the patient and the nursing staff. Her skin would not be at increased risk for breakdown r/t incontinence as well.

This is indeed a good topic to get us all thinking. I am merely a student, so I do not have a lot of real world experience to draw from.

[ally6]

she can usually recognize the urge (sometimes not so well at night), but being groggy and out of it from the meds often waits till its too late.

[dishes, BSN, RN]

She may benefit from a bowel managment program, as it would allow for scheduled emptying and prevent the following problems; constipation, incontinence, social embaressment and skin breakdown. Ask the doctor if they think a bowel routine is approipriate for her situation. For more information on establishing a bowel managment routine see link http://www.pva.org/site/DocServer/BWLC.pdf?docID=621

In regards to the difficulty assisting onto the toilet, can she be transferred onto a commode using a mechanical lift?

She may also benefit from a bladder managment routine such as scheduled voiding or intermittent catheterization, as it may prevent problems such as; skin breakdown, bladder stones, hydronephrosis, renal failure. However before establishing a bladder managment routine, the doctor needs to determine which type of incontience the patient has first. She may have functional, overflow or over active incontinence and each of these types of incontinence require a different treatment plan. Ask the doctor if she has been assessed by urology, if the type of incontience is established an approipriate treatment plan can be made. If the type of incontience has not been determined maybe she can be referred urology.

dishes

[ally6]

just wanted to say this question is not just directly based at this one patient. Its really a general question about how to stop the stereotyping of this awkward situation and helping patients to not be ashamed of something they cannot control!