Preparation is Key: Gather Supplies and Set the Scene
Before you begin, gathering all the necessary supplies and preparing the environment is crucial for a smooth and dignified process. This saves time, reduces patient discomfort, and prevents leaving the patient unattended.
Essential Supplies Checklist
- Disposable Gloves: Always use new gloves for each task to prevent infection.
- New Brief: Ensure you have the correct size and type of incontinence product.
- Absorbent Underpad: Also known as a 'chux,' this protects the bed linens.
- Moistened Wipes or Washcloths: Use gentle, non-irritating wipes for cleaning.
- Barrier Cream/Ointment: Protects the skin from moisture and irritation.
- Laundry Bag: For soiled linens, if any.
- Trash Receptacle: A covered container for disposing of the old brief and wipes.
Preparing the Environment
- Ensure Privacy: Close the door and pull the curtain. Inform the patient of what you are doing, even if they have cognitive impairment.
- Adjust the Bed: Raise the bed to a comfortable working height to protect your back. Lower the head of the bed to a flat position if tolerated by the patient.
Step-by-Step Diaper Changing Procedure
1. Position the Patient and Remove the Old Brief
- Gently help the patient turn onto their side, facing away from you. You can use their hip and shoulder as guidance. For very frail patients, it may be beneficial to have a second CNA assist.
- Unfasten the tabs of the old brief. If the brief contains solid waste, fold the front panel inward to trap the mess and tuck it between the patient's legs.
- Clean the front and inner thigh area with a wipe, moving from front to back. Place the soiled wipes inside the folded brief.
- Finish rolling the patient completely onto their side, over the soiled brief. This allows you to access the back area.
2. Thoroughly Cleanse the Skin
- With the patient on their side, begin cleaning the back and buttocks. Always wipe from front to back to prevent infection. Use fresh wipes as needed.
- For heavily soiled briefs, it may be necessary to perform a partial bed bath using a no-rinse perineal wash and washcloths. Be gentle, as an older person's skin is often fragile.
- Once clean, pat the skin dry completely. Moisture can lead to skin breakdown and rashes.
3. Inspect the Skin and Apply Barrier Cream
- Carefully inspect the patient's skin for any redness, irritation, or signs of pressure sores, especially on the coccyx (tailbone) and hips. Report any concerns to the charge nurse.
- Apply a thin, even layer of barrier cream to the buttocks, perineum, and any other areas prone to irritation. Do not apply too much, as it can reduce the brief's absorbency.
4. Apply the New Brief
- Roll the clean brief lengthwise (like a hot dog bun). Tuck it between the patient's legs and up against their side, ensuring the tabs are facing the back.
- Roll the patient back onto their back, over the new brief. Pull the brief through their legs.
- Smooth out any wrinkles in the back of the brief and secure the front panel. Fasten the bottom tabs first, angling them upward, then fasten the top tabs, angling them downward. This provides a snug, leak-proof fit.
Briefs vs. Pull-Ups: A Comparison
| Feature | Tab-Style Briefs | Pull-Up Style Underwear |
|---|---|---|
| Best For | Bedridden or less mobile patients; heavy incontinence. | Mobile or semi-mobile patients; moderate incontinence. |
| Application | Patient remains lying down. Easier for changing heavily soiled briefs without lifting. | Patient must stand or be able to roll sufficiently to pull up. |
| Fit | Highly adjustable via tabs for a custom, snug fit. | Pre-sized like underwear; less adjustable. |
| Removal | Can be unfastened at the tabs. | Must be torn at the sides or pulled down like underwear. |
| Discreetness | Bulkier and less discreet under clothing. | More discreet and resembles regular underwear. |
Ensuring Patient Dignity and Safety
- Communication: Talk to the patient throughout the process, explaining each step. This provides reassurance and maintains their sense of control.
- Gentle Handling: Use proper body mechanics to avoid hurting yourself or the patient. Always use a gentle touch, as skin can be sensitive.
- Respect Privacy: Only expose what is necessary. Covering the patient with a blanket or sheet during the process helps them feel more comfortable and less exposed.
- Skin Integrity: Consistent and proper skin care is paramount. Regular inspection and use of barrier cream prevent painful and dangerous pressure ulcers.
- Reporting: Promptly report any skin issues, new rashes, or changes in the patient's condition to the nurse.
For additional training and best practices, CNAs should consult authoritative resources like the National Association of Health Care Assistants (NAHCA). NAHCA provides valuable resources for CNAs.
Aftercare and Cleanup
- Remove your gloves and dispose of the soiled items in the designated trash. Wash your hands thoroughly.
- Ensure the patient is comfortable and repositioned to their liking. Straighten bed linens and check for wrinkles.
- Return the bed to its lowest position and raise side rails as per facility policy.
- Provide the patient with their call light and ensure they are within reach of personal items before leaving the room.
Conclusion
Mastering how you change a diaper as a CNA involves more than a list of steps; it requires a compassionate and respectful approach. By focusing on preparation, proper technique, and maintaining the patient's dignity, you can provide the highest quality of care. This essential skill not only ensures hygiene and comfort but also strengthens the trust between caregiver and patient, an invaluable part of the caregiving process.
