How should a nursing assistant place a standard bed pan?

According to the World Health Organization, proper hygiene is crucial for preventing infection and ensuring patient dignity. Knowing how should a nursing assistant place a standard bed pan is a fundamental skill that directly impacts patient comfort and safety, and following the correct procedure is essential for maintaining a high standard of care.

Quick Summary

A nursing assistant should place a standard bedpan by first ensuring patient privacy and gathering supplies, then assisting the patient to roll onto their side or lift their hips to slide the wider end of the pan under the buttocks, and finally raising the head of the bed to a comfortable position for use.

Key Points

• Pre-Procedure Steps: Gather all supplies, including gloves, bedpan, and a protective pad, and ensure patient privacy before beginning.

• Two Placement Methods: Use the hip-lift method for assisting patients or the side-roll method for total care patients with limited mobility.

• Standard Bedpan Alignment: Position the standard bedpan so the wider, high-rimmed end is aligned with the patient's hips.

• Post-Placement Positioning: Raise the head of the bed to a semi-Fowler's position (30-60 degrees) to make elimination easier and more comfortable for the patient.

• Prioritize Privacy: Offer the patient privacy during use by leaving the room, but remain nearby and provide the call light.

• Safe Removal and Cleaning: When finished, carefully remove the bedpan, provide perineal care, and properly clean and dispose of the equipment to prevent infection.

• Check Bed and Call Light: After the procedure, ensure the patient is comfortable, the bed is low and locked, and the call light is within reach.

Preparing for the Procedure

Before you begin, gathering all necessary supplies and preparing the patient is key to a smooth and respectful process. Preparation minimizes the patient's time in an uncomfortable position and upholds their dignity.

Required Supplies

• Standard Bedpan: Ensure it is clean and the correct size.
• Protective Underpad: Also known as a 'chux' pad, this barrier protects bed linens from spills.
• Disposable Gloves: Always wear gloves when handling bodily fluids to follow universal precautions.
• Toilet Tissue and/or Wipes: For post-procedure cleansing.
• Warm Water and Soap: For proper hand hygiene and perineal care.
• Privacy Blanket or Sheet: A bath blanket can be used to maintain patient dignity.
• Bedside Table: A clean surface to place supplies temporarily.

Patient Preparation

1. Introduce Yourself: Greet the patient by name, introduce yourself, and explain the procedure in a clear and calm manner. Explain what is about to happen to alleviate anxiety and gain their cooperation.
2. Ensure Privacy: Close the door and pull the privacy curtain. This is a critical step to maintain the patient's dignity and comfort.
3. Perform Hand Hygiene: Wash your hands thoroughly and don clean, disposable gloves.
4. Position the Bed: Raise the bed to a comfortable working height for your back to prevent injury. Ensure the wheels are locked to prevent movement.

The Bedpan Placement Technique

There are two primary methods for placing a standard bedpan, depending on the patient's ability to assist. Choose the appropriate technique for the patient's condition and mobility level.

Method 1: For Patients Who Can Lift Their Hips

This method is used for cooperative patients who have sufficient upper body strength to assist with the lift.

1. Lower the Head of the Bed: Position the patient flat on their back.
2. Assist with Hip Lift: Ask the patient to bend their knees, place their feet flat on the mattress, and push with their legs to lift their hips.
3. Place the Bedpan: With one hand supporting the patient's lower back, slide the protective underpad and the standard bedpan underneath the patient's buttocks with the wider, high-rimmed end aligned with their hips and the narrow end towards their feet. The patient's buttocks should be centered firmly on the pan.
4. Confirm Comfort: Ask the patient if the pan is positioned comfortably.
5. Return to Position: Instruct the patient to lower their hips gently back onto the bedpan.

Method 2: For Patients Who Cannot Lift Their Hips (Full Assistance)

This technique is used for patients with limited mobility or those who cannot assist in their movement, such as post-surgery patients.

1. Lower the Head of the Bed: Place the bed flat.
2. Raise a Side Rail: Raise the side rail on the side the patient will turn away from for safety.
3. Turn the Patient: Go to the opposite side of the bed. Gently roll the patient onto their side, positioning them away from you. A lift sheet or turning sheet can be used for this.
4. Place the Bedpan: Once the patient is on their side, place the protective underpad under their buttocks. Then, position the standard bedpan against their buttocks, ensuring the wider end is aligned with their hips.
5. Roll Back onto the Bedpan: While holding the bedpan firmly with one hand, use your other arm to help the patient roll back onto their back, carefully centering them on the pan.

Post-Placement Care

After successfully placing the bedpan, there are several steps to ensure patient comfort and safety.

• Raise the Head of the Bed: Elevate the head of the bed to a semi-Fowler's position (30-60 degrees) to simulate a sitting position. This angle makes urination and defecation easier and more natural. Place a pillow for lumbar support if needed.
• Provide Privacy: Give the patient toilet paper, the call light, and a personal wipe for their hands. Leave the room to offer privacy but remain nearby.
• Respond Promptly: Return to the patient's room when they use the call light to signal they are finished.

Removing the Bedpan and Final Steps

Removing the bedpan requires care to prevent spills and maintain patient hygiene.

1. Perform Hand Hygiene: Wash your hands and put on fresh gloves.
2. Lower the Head of the Bed: Gently lower the patient back to a flat position.
3. Remove the Bedpan: Assist the patient in lifting their hips or rolling to the side to carefully remove the bedpan. Cover the pan and place it on the bedside chair, not the floor.
4. Provide Perineal Care: Help the patient with cleaning if they are unable to do so themselves. Always wipe from front to back to prevent infection. Dry the area thoroughly.
5. Measure and Dispose: Empty the contents of the bedpan into the toilet or a graduated cylinder for measurement if required. Document output as per facility policy. Disinfect the equipment properly after use.
6. Ensure Comfort: Help the patient return to a comfortable position, replace the linens, and put the bed in the lowest, locked position.
7. Final Steps: Ensure the call light is within reach and perform hand hygiene before leaving the room.

Standard vs. Fracture Bedpans: A Comparison

To highlight the nuances of bedpan types, consider this table comparing standard and fracture bedpans.

Feature	Standard Bedpan	Fracture Bedpan
Shape	Resembles a regular toilet seat, with a wider, high-rimmed end for support.	Smaller and flatter, with a tapered front that slides easily under the body.
Placement	Requires the patient to lift their hips or be rolled significantly to position.	Slides under the patient with minimal lifting, suitable for limited mobility.
Primary Use	Ambulatory or partially immobile patients who can sit up or lift their hips.	Patients with hip fractures, spinal injuries, or very limited mobility.
Comfort	More natural sitting position for many, providing a secure feel.	Less comfortable for extended use due to lower profile, but safer for certain conditions.
Capacity	Larger capacity due to its higher walls and overall size.	Smaller capacity, increasing the risk of spills if not monitored.

Conclusion

Placing a standard bedpan is a fundamental procedure in nursing care that requires a precise, step-by-step approach. By prioritizing patient dignity, ensuring proper positioning, and maintaining scrupulous hygiene, nursing assistants can perform this task efficiently and with respect. Following the protocol outlined above not only ensures a safe and comfortable experience for the patient but also reinforces the standard of professional care. The key is clear communication, thoughtful preparation, and careful execution throughout the entire process.

For more resources on certified nursing assistant training and patient care techniques, visit the WisTech Open website: WisTech Open Pressbooks.

Frequently Asked Questions

What is the correct way to position a standard bedpan for a patient who can lift their hips?

For a patient who can lift their hips, have them bend their knees with feet flat on the bed. Ask them to lift their hips, and then slide the bedpan under their buttocks, ensuring the wider, high-rimmed end is correctly aligned with their hips.

How do you place a bedpan on a total care patient who cannot assist?

For a patient who cannot assist, roll them onto their side away from you. Place the bedpan firmly against their buttocks, and then gently roll them back onto their back, centering them on the pan.

What is the proper bedpan orientation?

When placing a standard bedpan, the wider, high-rimmed end should be positioned under the patient's buttocks and aligned with their hips. The narrower end points towards the patient's feet.

Should a bedpan be heated before placing it?

Warming a cold bedpan with warm water before use is recommended to increase patient comfort, especially for metal bedpans. Always ensure it's not too hot before placing it.

What is the difference between a standard bedpan and a fracture pan?

A standard bedpan is larger and taller, requiring more hip movement for placement, while a fracture pan is smaller and flatter, with a tapered front that slides under the patient with minimal lifting. Fracture pans are ideal for patients with hip or spinal injuries.

What is the semi-Fowler's position and why is it used for bedpan use?

Semi-Fowler's position is when the head of the bed is raised to a 30-60 degree angle. This position is used to provide a more natural, seated posture for the patient, which facilitates easier urination and defecation.

How do you prevent a bedpan from spilling during removal?

To prevent spills, lower the head of the bed to a flat position before removing the bedpan. Hold the bedpan firmly in place while assisting the patient to roll off of it or lift their hips.

Is perineal care always necessary after bedpan use?

Yes, perineal care is always necessary after bedpan use to ensure hygiene and prevent infection. If the patient is unable to perform this themselves, the nursing assistant should assist, wiping from front to back.