Bedpan use in today's society is not that different from use in the 18th century. Bedpans are a way of addressing elimination concerns when the traditional toilet is not an option due to high risk of injury or debilitating illness in sick, bed-confined individuals.
There are 2 types of bedpans: regular or fracture. The regular bedpan is larger than its fracture counterpart. The fracture pan has one flat end for ease of use with specific patient populations: i.e., hip fractures, hip replacements, or lower extremity fractures. Bariatric bedpans are available up to a 1200-pound (544-kg) capacity.
Medical necessity may warrant the use of a bedpan, for example as with immobile patients with the following concerns:
Bedpans come in regular size or a smaller, fracture pan. Bedpans are chosen based on diagnosis, patient comfort or preference and if any contraindications exist for using the regular size such as a fracture. Gather all supplies before you start the procedure.
Placing a patient on a bedpan requires a special technique and is reserved for those that are on bed rest per a health care provider order or discretion. Follow any preset institutional policies on the use of a bedpan in a clinical setting.
A patient that can assist with care by raising their hips is approached differently than a patient that cannot lift their hips due to surgical considerations, fractures, or other contraindications. In both cases, ensure the patient is pulled up as high as they can be on the stretcher or bed. If they can assist with raising their hips, then raise the head of the bed at least thirty degrees. Positioning in this Semi-Fowler's position allows for anatomical support and facilitates ease of defecation or urination by assuming a natural position for these bodily functions. According to a 2003 study, body positioning has a significant influence on intestinal gas propulsion and transit times with gastric flow being faster in the upright position than when supine [Dainese, Serra, Azpiroz & Malagelada, 2003].
Complications surrounding bedpan use may include constipation, embarrassment, discomfort, and loss of dignity due to inadequate patient privacy.
Privacy and Dignity
An audit conducted in 2010 addressed "Toilet Privacy in the Hospital" [Logan, 2012]. Comments from patients and staff highlighted certain critical areas of concern in regards to toileting, privacy, and confidentiality.
Areas of interest amongst patients while toileting consisted of specific vital points, for example, call light out of reach or cord too short, slow response to call light, lack of hand hygiene after toilet use for the patient, curtains that would not close properly and lack of privacy while toileting. Suggestions were made to improve patient privacy while defecating or urinating such as better signage [Logan, 2012].
Another complication of bedpan use can be constipation. An environment that lacks appropriate privacy may force a patient to feel that it is inconvenient to use the toilet, thus resisting the urge to defecate. If defecation is discommoding, the desire to defecate prompts voluntary contraction of the external sphincter and puborectalis muscle. This urge dissipates, and the rectum accommodates to hold more stool (as cited in Sun, Read & Miner, 1990)[Rao et al., 2016].
A study conducted between 2003 and 2004 on stroke patients found that (55.2%) developed new-onset constipation within a month after the first stroke [Su et al.,2009]. The study went on to conclude that patients with moderate severity of stroke (NIHSS 4 -11) on arrival had a higher incidence of bedpan use, thus poor outcomes at 3 months post-stroke as a result of the added complication of constipation. The study recommended a suitable environment for defecation for stroke patients to curb new-onset constipation and improve patient outcomes [Su et al., 2009].
A study sponsored by the Italian Space Agency analyzed ten healthy men for the effects extended bedrest had on the body as it related to new onset constipation. The men were studied for 35 days in a controlled environment on strict bedrest with bedpan use for defecation in a lying, head down position. At the end of the study, 60% had new onset functional constipation [Iovino et al., 2013].
Patients in need of toileting with the use of a bedpan can impose specific inherent risks, thus should be used with the knowledge of the emotional and physical implications in a clinical setting. This task should not be used for provider convenience, but with certain criteria for client selection to meet the standard of care. Staffing challenges may lead to delays in answering call lights and providing toileting assistance. These delays of care may place a patient at risk for falls and incontinence, thus contributing to emotional and physical duress. Missed care opportunities lead to a decrease in patient satisfaction and overall perception of care. Therefore reimbursement of care may be affected by a trickle-down effect with negative patient satisfaction scores.
The bedpan is a useful medical equipment that is used frequently in hospitals. The nurses are primarily involved in the management of the bedpan with assistance from the therapists. The important features of bedpan are not only to provide a functional use for the patient, but comfort and privacy. If a bed pan is to be used, it should be for a short duration. there are countless cases of pressure sores, ulcers and neuropathy from patients being left too long on the bed pan. Unfortunately, managing the bed pan is not easy for the nurse when patients are obese and have limitations in movement; plus spillage of the contents is a major problem.
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