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Toileting Programs CNA Training Advisor October 2015 TOILETING PROGRAMS This document contains privileged, copyrighted informa- tion. If you have not purchased it or are not otherwise entitled to it by agreement with HCPro, any use, disclo- CMS requires nursing homes to develop individualized toileting sure, forwarding, copying, or other communication of the programs to help residents with incontinence relieve themselves safely contents is prohibited without permission. and hygienically. These programs implicate the entire frontline care team, including CNAs, who are often responsible for facilitating intimate personal care tasks. Quality toileting programs usually encompass a breadth of care-related activities, including: EDITORIAL ADVISORY BOARD • Identifying the presence—or potential—of incontinence and deter- Adrienne Trivers Delaney Rebernik Product Director Associate Editor mining the speci¿c type [email protected] [email protected] • Flagging any factor(s) that predispose a resident to incontinence • Tracking elimination habits (e.g., time of day, frequency, volume) STAY CONNECTED in a bladder or bowel record Interact with us and the rest of the HCPro • Establishing a customized program for elimination based on a res- community at HCPro.com ident’s needs and personal patterns Become a fan at facebook.com/HCProInc • Regularly reviewing the contents of this program, particularly in terms of its effectiveness and need for re¿nement based on chang- Follow us at twitter.com/HCPro_Inc es in a resident’s condition or ability to go to the bathroom Email us at [email protected] Depending on the speci¿c circumstances surrounding a resident’s incontinence, interventions in a toileting program that a CNA would Questions? Comments? Ideas? Contact Associate Editor Delaney Rebernik at play a fundamental part in performing may include: [email protected] or 781-639-1872, Ext. 3726. • Helping a resident ambulate to the toilet Don’t miss your next issue • Scheduling regular bathroom trips to facilitate bowel and bladder If it’s been more than six months since you purchased or renewed your subscription to training and to avoid accidents CNA Training Advisor, be sure to check • Changing bed linens in the event of an accident your envelope for your renewal notice or call customer service at 800-650-6787. Renew your • Changing incontinence pads or adult diapers subscription early to lock in the current price. • Emptying bedpans Relocating? Taking a new job? • Helping residents use assistive devices for improving continence If you’re relocating or taking a new job and would like to continue receiving CNA Training • Monitoring continence patterns, and reporting any major changes Advisor, you are eligible for a free trial identi¿ed to facilitate timely clinical action subscription. Contact customer serv ice with your moving information at 800-650-6787. At • Preventing and caring for complications from ineffective elimina- the time of your call, please share with us the tion (e.g., skin breakdown, body odor, emotional distress) name of your replacement. CNA Training Advisor (ISSN: 1545-7028 [print]; 1937-7487 [online]) is published monthly by HCPro, a division of BLR®. Subscription rate: The remainder of this in-service explores the implications of inconti- $159/year; back issues are available at $15 each. • CNA Training Advisor, 100 Winners Circle, Suite 300, Brentwood, TN 37027. nence in greater depth, as well as the speci¿c roles CNAs play in related • Copyright © 2015 HCPro, a division of BLR. All rights reserved. Printed in the USA. Except where specifically encouraged, no part toileting activities. of this publication may be reproduced, in any form or by any means, without prior written consent of HCPro, a division or BLR, or the Copy- right Clearance Center at 978-750-8400. Please notify us immediately if you have received an unauthorized copy. • For editorial comments Understanding urinary incontinence or questions, call 781-639-1872 or fax 781-639-7857. For renewal or subscription information, call customer service at 800-650-6787, UI can affect all types of individuals but is particularly common fax 800-639-8511, or email [email protected]. • Visit our website at www.hcpro.com. • Occasionally, we make our subscriber among elders. Despite its prevalence among this major nursing home list available to selected companies/vendors. If you do not wish to be included on this mailing list, please write to the marketing department population, UI is not a part of the natural aging process and can be at the address above. • Opinions expressed are not necessarily those of CTA. Mention of products and serv ices does not constitute en dorse- improved or even cured through resident education and quality care. ment. Advice given is general, and readers should consult professional counsel for specific legal, ethical, or clinical questions. Managing and treating UI hinges on staffs’ ability to recognize its spe- 2 HCPRO.COM © 2015 HCPro, a division of BLR. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at copyright.com or 978-750-8400. October 2015 CNA Training Advisor TOILETING PROGRAMS ci¿c causes and signs. Potential causes include urinary While medicine and surgery are largely in the hands tract infections, confusion and forgetfulness, muscle of the resident’s nurse and/or doctor, CNAs often con- weakness, vaginal or prostate problems, medication re- tribute to behavioral treatments. These interventions actions, and problems with clothing. Patients who suf- help residents control their urine and use the toilet at fer from UI may wet the bed, leak urine, and/or require the right time. There are three types of behavioral UI protective pads or padded briefs. If you notice a patient’s treatments with which a CNA can assist: clothing or bed has urine stains or odors, he or she will 1. Scheduled toileting, which can help residents most likely require your help dealing with the condition. who are unable to get out of bed or reach the bath- room alone. Help the resident ambulate to the Types bathroom every three to four hours, or according to UI can take a number of forms, and residents may the individualized program. experience more than one variety at a time. Although it 2. Prompted voiding, which can help residents who may not be initially clear which kind(s) of UI a patient know they have a full bladder but do not ask to go has, CNAs can often learn this information by keeping to the bathroom. Check these residents often for track of urinary habits in a bladder record. wetness, asking whether they want to use the toilet, Below are some of the most common types of UI: and assist them on their trip to the bathroom. • Functional incontinence refers to loss of urine 3. Habit training, which can help residents who in residents whose urinary tract function is normal. tend to urinate around the same time every day. Affected individuals are unable to maintain conti- Monitor an individual to determine the times he or nence because of external factors, such as an inabil- she urinates, recording observations in the bladder ity to reach the toilet in time. record. Take the resident to the bathroom at those • OverÀow incontinence refers to the leakage of times every day. small amounts of urine when the bladder reaches its maximum capacity and becomes distended. In addition to service categories that target the actual • Stress incontinence refers to the leakage of act of elimination, there are certain interventions facili- small amounts of urine when intra-abdominal tated in part by CNAs that are more proactive in focus. pressure on the bladder increases from movements such as sneezing, laughing, or climbing stairs. Dietary management • Transient incontinence refers to temporary epi- Although there is no dietary treatment for UI, some sodes of UI that are reversible once the cause of the foods and drinks can irritate the bladder, such as sugar, episodes is identi¿ed. chocolate, citrus fruits, alcohol, grape juice, and caffein- • Urge incontinence (overactive bladder) involves ated drinks. CNAs may be asked to encourage residents a sudden, strong urge to expel moderate to large with UI to try eliminating these foods and beverages from amounts of urine before the bladder is full. their diets and see whether their condition improves. • Mixed incontinence is the combination of stress incontinence and urge incontinence. Assistive devices Bedbound residents who are experiencing UI may Specific UI treatments need to use a bedpan, urinal, or bedside commode. Depending on the speci¿c circumstances surround- If this is the case, CNAs can ensure these articles are ing a resident’s UI, a care plan can be developed that always accessible. In addition, always keep the path to will include at least one of the following service catego- the bathroom—and the room itself—clear and well-lit. ries: behavioral treatment, medicine, or surgery. © 2015 HCPro, a division of BLR. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at copyright.com or 978-750-8400. HCPRO.COM 3 CNA Training Advisor October 2015 TOILETING PROGRAMS Understanding bowel incontinence can maintain a record of a resident’s bowel habits and Like UI, treatment and care for BI depends on the schedule a daily movement by any identi¿ed patterns. speci¿c cause. Some of the most common instigators include incorrect diet or Àuid intake, confusion and General toileting interventions forgetfulness, injury or weakness of the anal muscles, In addition to the interventions speci¿c to UI and BI, nerve injury, medication reactions or laxative abuse, there are several general toileting strategies CNAs can diarrhea, paralysis, constipation, and fecal impaction. apply when caring for residents with elimination issues.
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