Understanding Best Practices When Assisting a Client Who Is Using the Commode?

Studies show that falls in the bathroom are a leading cause of injury for seniors. Proper technique is critical when assisting a client who is using the commode to ensure their safety, comfort, and dignity throughout this vulnerable process.

Quick Summary

Assisting a client using a commode involves careful preparation, maintaining privacy, using safe transfer techniques, and ensuring thorough hygiene, all while preserving the client's dignity and promoting as much independence as possible.

Key Points

• Safety First: Always lock commode wheels, use a gait belt if needed, and ensure clear paths to prevent falls.

• Preserve Dignity: Provide privacy and communicate respectfully, treating the client with empathy and patience.

• Maintain Hygiene: Use disposable gloves, wipe thoroughly from front to back for females, and empty/clean the commode immediately after use.

• Encourage Independence: Allow the client to participate in the process as much as their abilities allow, respecting their autonomy.

• Prepare Thoroughly: Gather all supplies beforehand to avoid leaving the client unattended or rushing the process.

Preparing for Commode Assistance

Before beginning, proper preparation ensures both the client's safety and comfort, and your own. This includes gathering all necessary supplies and creating a safe, clutter-free environment.

Gather Necessary Supplies

Ensure all items are within arm's reach to minimize the time the client is left unattended or in an awkward position.

• Protective Gear: Disposable gloves are essential for maintaining hygiene and preventing the spread of germs.
• Hygiene Items: Toilet paper, moist wipes, and a basin with warm water and soap should be readily available.
• Commode Equipment: Confirm the commode bucket is in place and the commode's wheels (if applicable) are locked securely. A small amount of water in the bucket can also help with odor control and cleaning.
• Client Clothing: Have clean undergarments and clothing ready for after the commode use.
• Linens: Keep a towel or blanket handy for warmth and privacy.

Create a Safe Environment

• Clear the Path: Remove any tripping hazards such as rugs, electrical cords, or clutter from the route to and from the commode.
• Adjust Lighting: Ensure the room is well-lit, especially for nighttime use, to help the client see clearly and prevent disorientation.
• Ensure Stability: Verify that the commode is on a flat, non-slip surface and is stable before the client begins to transfer.

Safe and Respectful Transfer Techniques

Open and respectful communication is key throughout the transfer process. Always explain each step clearly to the client and move at a pace they are comfortable with.

Step-by-Step Transfer Procedure

1. Communicate and Position: Begin by telling the client what you are doing. Position the commode close to the bed or chair and parallel to it. Ensure the commode's armrests are accessible.
2. Assist to Standing: Help the client lean forward slightly before standing. Use a gait belt for extra support if needed. Guide them to a standing position, with their feet flat on the floor and slightly apart.
3. Pivot and Lower: With a stable grip on the gait belt or around their waist, help the client pivot slowly so their back is to the commode. Instruct them to reach back for the commode's armrests as they begin to sit. Bend your knees to help lower them gently onto the seat, ensuring they are stable before releasing support.
4. Provide Privacy: Once seated, ensure the client is comfortable and provide as much privacy as is safe. If you must leave the room, ensure a call bell is within easy reach and they are stable. Use a blanket to cover them if they desire.

Maintaining Dignity and Hygiene

Respecting the client's privacy and dignity is paramount. This can be a sensitive time, and a compassionate, matter-of-fact approach is crucial.

Assisting with Post-Commode Care

• Wear Gloves: Always put on a fresh pair of disposable gloves before assisting with hygiene.
• Gentle and Thorough Wiping: For female clients, wipe from front to back to prevent urinary tract infections. Use gentle, firm strokes and change toilet paper or wipes as needed until the client is clean and dry. Avoid any rough or irritating motions.
• Proper Disposal: Dispose of soiled wipes or tissue in a lined trash can, not in the commode bucket, to simplify cleaning.
• Hand Hygiene: After assisting, help the client to wash their hands thoroughly with soap and water.

Handling and Cleaning the Commode

• Wear Gloves: Put on a fresh pair of gloves for this task.
• Empty and Rinse: Carefully remove the commode bucket and empty its contents into a toilet. Rinse the bucket with water and disinfectant, then empty the rinse water into the toilet as well.
• Disinfect and Dry: Wipe down all surfaces of the commode with a germ-killing cleaner. Allow it to air dry or wipe it completely dry before replacing the bucket.

Safe vs. Unsafe Practices: A Comparison

Aspect	Safe Practice	Unsafe Practice
Preparation	Gather all supplies and check commode stability beforehand.	Rushing the process or forgetting essential items.
Transfer	Use a gait belt and clear communication. Guide the client's feet and pivot slowly.	Lifting the client under the arms or pulling forcefully, which can cause injury.
Dignity	Provide privacy and speak with a respectful, calm tone.	Rushing the client or discussing their needs with others in their presence.
Hygiene	Wipe front to back for females. Ensure thorough cleaning and handwashing.	Improper wiping technique or neglecting proper hand hygiene.
Cleaning	Empty and disinfect the commode bucket promptly.	Allowing the commode to sit soiled, which can lead to odors and infection risk.

A Final Word on Empathy

Assisting with commode use is a routine task in caregiving, but for the client, it can be a significant challenge to their independence and self-esteem. Your approach can make all the difference. Maintain a supportive and empathetic demeanor throughout the process. Encouraging independence by letting the client do what they can for themselves, even if it takes longer, is a powerful way to preserve their dignity.

For additional information on healthy aging and safety in the home, the National Institute on Aging offers valuable resources and tips for caregivers and seniors alike.

Frequently Asked Questions

What is the most important thing to remember when assisting a client who is using the commode?

The most important thing is to prioritize both safety and dignity. This involves using proper transfer techniques to prevent falls and ensuring the client's privacy and comfort at all times.

How can I make the commode transfer safer for both of us?

Ensure the commode is stable and on a non-slip surface. Use a gait belt for secure transfers and practice a smooth, slow pivot. Always bend your knees and use your legs to support, not your back, and communicate each step clearly to the client.

What should I do if the client resists assistance with the commode?

Resistance often comes from feelings of embarrassment or loss of control. Approach the situation with patience and a calm, reassuring tone. You can offer choices, such as 'Would you like help now or in a few minutes?' to give them a sense of control. Never force assistance.

How should I clean the commode after each use?

After each use, wear gloves to empty the contents into a toilet. Rinse the bucket with water and disinfectant, then empty again. Use a germ-killing wipe to clean all surfaces of the commode before allowing it to dry.

Is it better to use a commode or a bedpan?

The commode is often a better choice if the client can get out of bed, as it promotes a more natural toileting position and preserves more dignity than a bedpan. However, the best method depends on the client's specific mobility and health needs.

How can I maintain privacy when a commode must be used in a shared living space?

Use a screen, partition, or blanket to create a private area around the commode. Ensure the room's main door is closed and, if possible, wait outside within earshot while the client is using the commode to give them space.

What are some signs that a client needs help with the commode, even if they don't ask?

Look for non-verbal cues such as restlessness, fidgeting, holding their stomach, or tugging at their clothing. Establishing a regular toileting schedule can also help reduce urgency and accidents.