How to change a resident's brief in bed? A comprehensive guide for caregivers

According to the National Institute on Aging, proper hygiene and incontinence care are crucial for preventing common skin issues and infections in bedridden individuals.

Knowing how to change a resident's brief in bed safely and with dignity is a fundamental skill that every caregiver must master to ensure the resident's health and comfort.

Quick Summary

Safely changing a resident's brief in bed involves methodical preparation, positioning the resident using a log-roll technique to maintain spine alignment, and meticulously cleaning the skin before securing a new brief, all while prioritizing the individual's dignity and physical comfort.

Key Points

• Log-Roll for Safety: Always use the log-roll technique to turn the resident, which protects their spine and prevents back strain for the caregiver.

• Communicate Constantly: Explain each step to the resident, even if they seem unaware, to maintain dignity and build trust.

• Gather Supplies First: Preparation is key; have all necessary items like briefs, wipes, and protective cream within arm's reach before starting.

• Front-to-Back Cleaning: Always clean from front to back to prevent the spread of bacteria and reduce the risk of infection.

• Prioritize Skin Health: Regularly inspect the skin for redness or irritation and use a barrier cream to protect against moisture-related skin breakdown.

• Ensure a Snug Fit: Make sure the new brief is snug but not too tight to prevent leaks and ensure the resident's comfort.

Preparing for the Brief Change

Proper preparation is key to a smooth and respectful brief change. By having all your supplies ready, you can minimize the time the resident is exposed and vulnerable. This organized approach also makes the process more efficient for the caregiver.

Essential Supplies Checklist

Before you begin, gather the following items and place them within arm's reach on a bedside table or rolling cart:

• A new, appropriately sized brief
• Disposable gloves (2-3 pairs, in case of contamination)
• Wet wipes or a washcloth with warm, soapy water
• Incontinence pads or a waterproof bed protector
• Skin cleanser and a protective skin barrier cream
• Disposable trash bags
• Clean towels or paper towels
• Fresh linens, if needed

The Step-by-Step Brief Changing Process

Follow these steps carefully to ensure the resident's safety and comfort throughout the process.

1. Communicate and Explain: Always explain what you are about to do, even if the resident is non-responsive. This promotes dignity and trust. Speak in a calm, reassuring tone.
2. Ensure Privacy: Close the door and pull the curtain to create a private environment for the resident.
3. Position the Resident: Have the resident lie on their back. If possible, gently bend their knees and have their feet flat on the bed. Put on your first pair of gloves.
4. Prepare the Bed: Loosen the old brief and slide an incontinence pad or waterproof protector underneath the resident's hips to catch any spills and keep the bed clean.
5. The Log-Roll: Gently turn the resident onto their side, away from you. The log-roll technique is crucial for preventing injury and keeping the spine aligned. Support their back with a pillow or your forearm if necessary. Tuck the dirty brief in on itself as you roll them to minimize contact with their skin.
6. Clean and Inspect the Skin: While the resident is on their side, clean the perineal area thoroughly from front to back using wet wipes or a washcloth. Pay close attention to skin folds. Use a different section of the wipe or washcloth for each pass. Inspect the skin for any signs of redness, rash, or pressure sores. Apply a protective barrier cream as needed. Remove the dirty brief and dispose of it in a sealed trash bag.
7. Position the New Brief: While the resident is still on their side, fold the new brief lengthwise and slide it into place from front to back, tucking the back half firmly under the resident's hips. Ensure the top of the brief is centered on their waist.
8. Complete the Change: Gently roll the resident back onto their back. Pull the front of the brief up and secure the tabs. Ensure a snug but not overly tight fit. Smooth out any wrinkles in the brief and bed protector.
9. Final Touches: Remove your soiled gloves, dispose of them, and put on a fresh pair. Reposition the resident to a comfortable, safe position. If linens are wet, change them now. Ensure the resident's personal belongings, like the call button, are within reach. Clean and sanitize any equipment used and wash your hands.

Comparison of Briefs: Tab-Style vs. Pull-Up

Feature	Tab-Style Briefs	Pull-Up Style Briefs
Best For	Bedridden or less mobile residents who require assistance	More mobile residents who need assistance and can stand or help pull them up
Changing Method	Can be changed in bed using the log-roll technique without requiring the resident to stand	Often requires the resident to stand or have more mobility for removal and application
Ease of Use	Tabs allow for easier adjustment and a customized fit for comfort and security	Can be more difficult to pull up and down if the resident has limited mobility
Protection Level	Often comes in higher absorbency levels and is more secure for heavy incontinence	Can be more comfortable for active wear but may offer less secure protection for heavy, nighttime incontinence
Resident Dignity	Can feel more like a medical device, but changing method is discreet for bedridden	Can feel more like regular underwear, promoting independence for more mobile residents

Tips for Minimizing Discomfort and Promoting Dignity

• Maintain Dignity: Always cover the resident with a blanket or towel to prevent exposure and maintain their modesty. Communicate every step clearly.
• Preventing Injury: Always use good body mechanics. Bend at your knees, not your waist, and use the log-roll technique to prevent back strain for yourself and the resident.
• Routine: Establish a regular schedule for brief changes to prevent over-saturation and prolonged skin contact with moisture.
• Gentle Touch: Be gentle with the resident's skin, especially in areas prone to pressure sores. Avoid rubbing or scrubbing aggressively.
• Address Skin Issues Promptly: If you notice any redness, irritation, or breakdown, notify a healthcare professional immediately. Early intervention is key.

Advanced Considerations and Troubleshooting

Sometimes, caregivers face additional challenges. It's important to know how to handle these with care and compassion.

If the Resident is Uncooperative

If the resident is agitated or resists the brief change, try the following:

• Use Distraction: Offer a favorite object or play calming music.
• Try Later: If possible, give the resident some time and try again later. Sometimes a change in mood or a brief rest is all that is needed.
• Seek Assistance: If resistance continues, enlist a second person to help. Two caregivers can work together to make the process quicker and safer.

Dealing with Pressure Sores or Skin Breakdown

• Do Not Rub: Never rub directly on a reddened area or pressure sore. Use a gentle, dabbing motion.
• Specialized Products: Use products specifically designed for delicate skin. A skin barrier cream is essential for protecting the area from further damage.
• Reduce Friction: When repositioning the resident, use a lift sheet or incontinence pad to minimize friction on the skin. Avoid pulling the resident's bare skin across the sheets.

For more information on proper incontinence care and managing skin integrity, the Family Caregiver Alliance offers valuable resources on caregiver.org.

Conclusion

Learning how to change a resident's brief in bed is a core aspect of compassionate and effective caregiving. By following a clear, step-by-step process, gathering the necessary supplies in advance, and always prioritizing the resident's dignity and comfort, caregivers can provide excellent care while ensuring safety for everyone involved. Regular communication, proper technique, and attention to skin health are the foundations of successful incontinence management for bedridden individuals.

Frequently Asked Questions

How often should a resident's brief be changed?

Briefs should be changed as soon as they are wet or soiled to prevent skin irritation and infection. For many residents, this means a routine check every two to four hours, with an immediate change if incontinence occurs.

What is the best way to prevent skin irritation from a brief?

To prevent skin irritation, ensure the resident's skin is clean and completely dry before applying a new brief. Using a protective skin barrier cream can also create a protective layer against moisture and chafing.

Can I use baby powder when changing a brief?

Most care professionals advise against using baby powder. The fine particles can be inhaled, posing a respiratory risk, and when mixed with urine, can form clumps that harbor bacteria and cause skin irritation. Use a specialized barrier cream instead.

How do I deal with a brief that has a solid bowel movement?

Use wet wipes or a damp washcloth to gently and thoroughly clean the area. Roll the resident onto their side, then fold the soiled brief inward to contain the waste. Ensure all waste is removed and the skin is clean and dry before applying the new brief.

What should I do if the resident is very heavy and I can't lift them alone?

Never attempt to lift or roll a resident who is too heavy for you to manage alone. Always seek assistance from another person to prevent injury to both yourself and the resident. You can also use specialized equipment like a lift sheet or a mechanical lift.

How can I make the brief change more comfortable for the resident?

You can make the brief change more comfortable by communicating clearly, maintaining privacy, and using warm water and cloths for cleaning. Working efficiently and gently also minimizes the resident's discomfort and exposure.

What if the resident has a Foley catheter? Do I need to do anything differently?

If the resident has a Foley catheter, be careful not to pull or snag the tube. When cleaning, wipe away from the catheter insertion site and always ensure the tubing is not kinked. Pay close attention to skin around the catheter entry point for any signs of irritation or infection.