Unit 19
More than 50% of the nursing home’s population experience incontinence, according to the Centers for Medicare and Medicaid Services (CMS). Incontinence is not an outcome of normal aging. Contributing causes of incontinence is disease process or injury such as multiple sclerosis, paralysis, pelvic floor weakness, acute illness, or a combination of conditions. Other contributing factors could be impaired mobility or disorientation.
Examples:
The resident is not able to move independently to toilet in a timely manner.
The resident may forget how to get to the bathroom.
Reasons for promoting bladder and bowel continence is to restore the resident’s ability to control a basic function. This will help maintain or restore the resident's self-respect and dignity and prevent embarrassment for a resident and family, along with preventing other health problems.
Incontinence is associated with other problems such as falls, skin irritation or breakdown, and social withdrawal. Meet regulatory expectation that all residents will retain or be restored to as much normal function as possible. Incontinence is a functional decline and not a normal part of aging.
Toileting Assistance Programs
Assisted living communities should adapt toileting assistance programs. The goal is for all residents to be clean, dry, and free from odor. Program plans should be individual for each resident and built from information about the resident's pattern of incontinence and the resident's specific needs. The type of incontinence (urination, bowel movements or both) that the resident experiences should be identified. The plan may include mobility goals, since mobility is important in achieving continence.
Bowel incontinence management
Medication may also be used to regulate bowel elimination. Resident may experience both bowel and bladder incontinence. A toileting plan should address both needs.
Prompt voiding
The goal in these programs is to help residents relearn to recognize bladder fullness or the need to urinate and to ask for help, or to respond when prompted to urinate. Ask the resident every two hours during the day if he/she would like to use the toilet. If yes, assist resident with toileting and the record results. Make sure to give positive reinforcement. If no, and resident has not voided in te past four hours, repeat the question about needing to use the toilet. If no, tell the resident that you will return in two hours and ask him/her to try to wait to urinate until then.
Habit training program
Staff monitors and records resident’s voiding pattern to find a predictable pattern. Toileting follows the resident’s pattern in hopes to strengthen a habit.
Scheduled voiding program
The resident is taken to the toilet on a regular schedule (such as every 1-2 hours) during waking hours. The goal is to toilet at intervals that will allow the resident to stay dry.
Bladder retraining
Resident is taught to consciously delay voiding or urge to void as part of a plan to regain voiding control.
CNA’s responsibilities:
Collects information for development of plan over a period of several days. Follows facility protocol.
Checks resident for continence every 1 or 2 hours during waking hours and at longer intervals at night
Accurately records intake and output
Follows toileting assistance plan exactly and organizes care for multiple residents.
Demonstrates an attitude that reflects patience. Lack of continence is never criticized.