Tuesday, June 24, 2008

Continence and continence pads

sorry for the late post, I had some "cookie" problem with this site :S

This happened while I was working as a physio assistant last year. I was working in a tertiary hospital rehabilitation ward. The work involved mainly supervise and assisting patients doing exercises and ambulation. One of my patients there was about 80 years old asian lady. She was able to speak and understand English however as it’s not her first language, she wasn’t too fluent and had limited vocabulary. She has no children and her closest relatives are her sister and her family.
She was in the rehab ward, however she’s waiting for available beds at a nursing home (or something similar). Therefore her daily exercise was strengthening exercise and ambulation for purpose of maintenance. She needs minimal assistance to get out of bed, standby supervision with ambulation and mostly independent with all exercises. I was able to ambulate about 40m with no rest in between. She did walk very slowly though. To me she was very shy lady and was often worried that she was causing trouble on other staff.
However, one day she was talking to me about her nights. She expressed to me that the night staff were not very friendly. She needed to go toilet a few times a night, however night staff were slow to respond to her bell. When they were unable to walk to the toilet, and instead gave her a bed pan on her bed. She was very uncomfortable with this arrangement. As a result, she could not sleep well at night. A week later, I walked in as she conversed with her doctor who suggested wearing pads at night. I was shocked to hear this. She was not urinary incontinence. She was physically able to get to toilet. I was not sure if other options had been considered such as commode in the room. As it was my last week there as a physio assistance, I did not chase this issue on. Staff on at night might have been too busy to take her to toilet, I was unable to find out why as I was not familiar with the ward and ward staff. There may well be other issues that I’m not aware of. Nontheless, wearing pads for non-incontinent patients would decrease their dignity and self esteem, and at the same time it would increase the possibilities of having urinary infections.
Now with more experience in the hospital setting, I would have to find out the reason that night staff were unable to walk this patient to toilet and encourage them to ambulate patients more frequently. If there is issue with time constraints, other options such as commodes should be considered before using bed pans or pads.
Has anyone had similar experience as a physio? What other approaches are possible apart from bed commodes that’s time efficient?

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