Understanding Toileting Programs
Independent voiding or a program provided by the caregiver where toileting occurs on a fixed schedule at regular times
Based on a pattern observed in the bladder and bowel record, toileting interval is established, usually every 2–4 hours. In institutions like nursing homes, a typical toileting schedule may be determined around daily events.The following is an example of a toileting program that can be used by institutions or caregivers. Toileting occurs 8 times in a 24-hour period, or every 3 hours:
• Day: Upon awakening, after breakfast, mid-morning, before lunch, and following an afternoon nap (mid-afternoon)
• Evening: Before dinner and at bedtime
• Night: Determine if the person wants to be awakened at night to void and identify times.
Other publications and most nursing home staff often report toileting schedules of every 2 hours. This frequent toileting schedule is unrealistic in most nursing homes because it requires high numbers of staff and consistent intensive efforts. It cannot be maintained over time. A more reasonable schedule would be timing voiding with activities.
Prompted voiding (usually used in nursing homes)
Prompted voiding is used with habit training and promotes active participation by the person in his or her toileting behavior. Prompted voiding is most successful in individuals who can ask for assistance or respond when prompted to void. The individual may have decreased cognitive ability to participate in a bladder retraining program. The major elements of prompted voiding are as follows:
• Monitoring: Caregiver checks on a regular basis (use toileting schedule described in habit training), and person is asked to report verbally if wet or dry
• Prompted: Person is asked if he or she needs to void, and staff assists with voiding
• Praising: If the person has maintained the goal of dryness, he or she is praised.
• Ensure privacy during toileting
• Toilet tissue and the call signal should be placed in easy reach
• Helping the person to relax by offering a magazine to read is important to elimination
• Do not rush the person; allow him or her to sit on the toilet, commode, or bedpan for about 15 minutes. A shorter time is too rushed, and more time defeats the purpose: getting the person to void at expanding intervals when placed on the proper receptacle.
This promotes restoration of normal bladder function through education of urge inhibition techniques and requires person to be able and willing to participate in active rehabilitation and education techniques. The 3 primary components are as follows:
1. Education program that usually combines written, visual, and verbal instruction that addresses the physiology and pathophysiology of the lower urinary tract
2. Scheduled voiding with systematic delay of voiding that requires the ability to resist or inhibit the sensation of urgency to postpone voiding and to urinate according to a timetable rather than according to the urinary urge
3. Reinforcement through consistent encouragement and positive feedback.
• Teach patients to relax when the urge to void occurs by taking several slow, deep breaths until the bladder relaxes and urge sensation lessens
• If the urge sensation diminishes and there is less urgency and pressure as the person attempts to go from sitting/lying to standing, a bladder contraction with subsequent leakage will not occur
• Always have the person walk unhurriedly to the bathroom.