Assisting with Bedside Commode Use (Nursing)

00:01 When someone needs your assistance to use a bedside commode, it's usually because they are especially weak or have extra equipment to manage.

00:09 In this video, I'm going to walk you through the necessary body mechanics, safety principles, and important communication points that are helpful when people are using a bedside commode.

00:20 Now, the steps of the transfer itself is not that different than assisting a client to transfer from bed to wheelchair.

00:27 The steps that are different are assisting the client to avoid, perform hand hygiene steps, and return to the bed-to-chair after toileting. I encourage you to review our content on transferring clients and body mechanics. Now, one of the first things to consider is your client's individual needs. And what are the supplies are already in the room? And if you're in the hospital or a care facility setting, these items are typically available.

00:53 So some of the items you're going to need include personal protective equipment.

00:57 Definitely gloves, toilet paper for the patient, maybe wet wipes, hand sanitizer, or access to running water and soap.

01:06 You're also going to need cleaning supplies, maybe a detergent spray or soap and brush and of course, the bedside commode itself.

01:14 Now, when we start. Before entering the client's room, you're going to perform hand hygiene and apply gloves.

01:20 Now, if you were not positive that your supplies were in the room, you want to make sure to gather them.

01:25 Taking time to prepare, ensure that you're not going to leave the client unattended during the procedure.

01:31 Now, if the client has any isolation precautions, you would follow facility protocol for additional PPE requirements like a gown, mask, or maybe even a face shield.

01:41 So to go ahead and talk through this skill, the first thing I want you to know is step one. You got to enter the room and introduce yourself to the client.

01:49 Explain the procedure that you'll be performing and ask for their permission to assist them. We want to make sure we close the door.

01:57 And draw any currents to ensure complete privacy, if that's possible. Now, if there's a roommate present, make sure the privacy curtain is fully closed.

02:06 We want to position the bedside commode next to the bed on the client's strongest side, and make sure if wheels are present to make sure to lock these.

02:16 Then you're going to remove or fold up the arm of the bed rail on the exit side, while keeping the opposite rail up for safety.

02:24 We also want to adjust the bed height so the client's feet are able to rest flat on the floor when they're sitting on the edge of the bed.

02:32 This proper positioning is crucial for safe transfer and also is going to help prevent falls here. Now, if the client's got any intravenous lines or oxygen equipment, make sure to bring them to the same side as the bedside commode.

02:46 Now we also want to perform assessment here.

02:48 So you want to assess the client's current level of strength and mobility.

02:52 So explain each step before you perform it.

02:55 This is going to help the client participate in their care and reduce anxiety about the process. Now using proper body mechanics, assist the client to a sitting position at the side of the bed.

03:06 Allow them to sit for a moment though, because otherwise they may have a drop in blood pressure, otherwise known as orthostatic hypotension.

03:15 We also want to take a moment to watch for signs of dizziness or any instability.

03:20 Now, if the client does appear unsteady, consider the need for a gait belt or a second staff member for the transfer.

03:27 Now remember that gait belt is an assistive device for balancing guidance, not for really fully lifting the client.

03:34 Now, if the client requires lifting, you want to use the appropriate mechanical lift equipment. Now we want to align any tubing.

03:42 So it's laying loosely along the client.

03:45 We don't want this getting caught or tangled if the client stands or pulling out their IV, for example. We're going to start by standing facing the client, positioning our feet about shoulder width apart.

03:57 We also want one foot slightly forward and placing our hands under the client's elbows, or grasp their waist, depending on their mobility level.

04:06 Now, this is an important point that we want the client to then be able to steady themselves by placing their hand on our shoulders.

04:13 Make sure they do not grab you by the neck, because this can cause you to tilt forward, and it's unsafe for both of you.

04:20 Now we want to guide the client to stand by, rocking forward from your back foot to your front, and using your leg muscles rather than your back.

04:29 We also want to instruct, to pivot together until that client can feel the camo behind their legs.

04:37 Now, while maintaining support on the client's hips, we're going to bend at the knees and help the client safely lower to the commode.

04:45 You want to ensure they're stable while sitting on this and centered on the seat.

04:50 Now you want to go ahead and provide toilet paper wet wipes that's within easy reach, and ensure they have a cool light system and place it within reach.

04:58 This is a good time to give them as much privacy as possible, but also don't go too far away because they may need you fairly quickly.

05:06 When the client signals they're finished, we want to don clean gloves and assist with perineal hygiene if needed.

05:12 This is a great time to provide wet wipes or warm washcloths based on the client's preference. And remember to always wipe from front to back to prevent infection. Also, don't forget to assist your patient with their own hand hygiene.

05:27 Now we're going to help the client stand and adjust their closing up using that same proper body mechanic techniques used during the initial transfer.

05:36 At this point, we just want to make sure their clothes aren't twisted and everything's back in place.

05:40 Also, don't forget to check any lines IV lines fully catheters to also make sure these aren't going to get caught when the patient is transferred.

05:50 Now that we've made sure everything is adjusted and we're back where it should be, we're going to move them away from the commode, assist the client back to bed using the same transfer techniques, and position them comfortably.

06:02 Ensure that that bed is in the lowest position with rails up for safety.

06:07 Now we're going to don clean gloves and remove the commode bucket carefully to prevent splashing. Observe the contents for any abnormalities that should be reported such as color, consistency, amount, maybe even the presence of blood.

06:21 We want to empty the commode bucket in the bathroom and follow your facility protocol for measuring whatever output is therefore required.

06:29 We also want to clean and disinfect the bucket and the commode thoroughly according to the facility protocol.

06:35 Now we can remove gloves and perform hand hygiene.

06:39 Now we return to the client's bedside, ensure they're comfortable.

06:43 Make sure their call lights within easy reach.

06:45 The bed rails are up and the beds in the lowest position.

06:48 We're going to perform our hand hygiene again and make sure to document the procedure based on the context and the facility policy.

06:56 For example, if the client may have orders to document the specifics of maybe how much assistance was required or the characteristics of the output, every client situation will be unique.

07:07 Some additional things to consider as you perform these steps is how important it is to always maintain a supportive and professional demeanor.

07:16 Many clients feel embarrassed about needing assistance with toileting.

07:20 Your matter of fact, respectful approach can help really normalize the situation.

07:25 It's really important to watch the client's face for signs of fatigue, dizziness, or even distress distressed during all phases of the transfer.

07:34 Be prepared to call for assistance if needed.

07:38 And most importantly, don't rush the procedure.

07:41 Moving too quickly or rushing the patient can increase anxiety and the risk for falls. Allow the client to move at their own pace and provide necessary support. Now this is a huge point.

07:54 If at any point you feel the transfer is unsafe or the client's unstable, you've got to stop and call for additional assistance.

08:01 Because client and staff safety are always top priorities.

08:05 No. In summary, this can seem like a pretty straightforward skill, but there are multiple points in which not paying attention can threaten the safety of the client or you. Failure to utilize handrails or not ensuring that commode is safely secured can really result in a fall.

08:21 And lastly, not using gloves, proper hygiene practices and not disposing of bodily fluids properly.

08:29 Getting a risky exposure to contaminants that can cause illness.

08:32 Thank you for watching.