The Power of the Bedside Commode
At work I have a unique power. On the stroke unit I get to decide who can have a bedside commode (BSC) and in turn, who uses a bed pan. This isn't something unique to my situation. Because PTs are frequently the first to mobilize a patient they frequently make recommendations about safe transfers. Being involved in making this decision has made me aware of something. Patients will say and do almost anything to be able to use a BSC. Last weekend it extended to a family member.
I have no problem clearing patients for the BSC or bathroom if they're safe. To me, safe includes being able to do it with the family member who will be home with them. One of the criteria I use is the amount of difficulty for me. If I have trouble with the transfer I know nursing will. No BSC for that patient. Sometimes I can't do the transfer at all. That would seem to be a no-brainer but there are times when family members disagree. I agree no one wants to use the bed pan but the BSC isn't worth the risk of a fall in many cases.
My favorite disagreements come from sons who think they are big and strong and therefore able to lift mom, dad, grandma or grandpa to the BSC. Sometimes there is no reasoning with them. Pointing out the fall risk only makes them stress how strong they are. Telling them they can hurt themselves doesn't work either. Yes, I can do it. What those big, strong sons don't realize is how much technique goes into what I do. There is no way on this Earth I could life people all day. Another argument I hear is the "I'll always be here to help" one.
I always wonder how much help that person will really be. Completely lifting someone doesn't help me or the patient. All it does is completely remove any hope of a functional or therapeutic transfer. Last weekend one son demanded I put his mother on a BSC. I did because I had to assess transfers. I quickly learned that she was dead weight. I didn't want to have to transfer her back to bed. The son wouldn't accept that the nurses couldn't do the transfers. I had to lock the one in the room (no idea how it got there but I can guess) in the bathroom to prevent him from doing it and putting his mother at risk.
On the positive side the BSC is a great motivational tool. I have bribed many patients into getting out of bed with the promise of going to the bathroom or BSC. Sometimes I take them even though I know they'll need my help just to prove a point. This is great for patients who need rehab but don't want to admit it. All I have to do is put them on the commode and let them try to get up by themselves. I then point out that it will difficult to go home alone if they can't even get up off the commode. I'm sure I'm not the only one who has done this.
I've also done the reverse. I've made patients walk to and use the commode to prove they can. Sometimes patients get so wrapped up in what they aren't able to do they lose focus on what they can do. The commode is a good example of a positive. It's also a great way to begin family training. I start them off going to the commode with a family member to prepare for discharge home. Once the commode is conquered we can progress to other things.
Another use for BSCs is to see how willing a family member is to care for the patient. If the family member isn't willing to help clean and/or transfer the patient in the hospital with help readily available, what is that person going to do at home? This can be a real eye opener. My facility has multicultural patients. Sometimes the only way to get this point home is to actually try the transfer. Helping with commode transfers also gives the family member a reality check prior to discharge. If a family member realizes he can't take care of the patient after all, I'd rather find out sooner than later.