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Understanding Toileting Programs Cheat Sheet by

Understanding Toileting Programs
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Unders­tanding Toileting Programs

Type
Key Elements
Cons­ide­rat­ions
Unders­tanding Toileting Programs


Habit training
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.
Bladder Training
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.
Adapted from Newman DK. Managing and Treating Urinary Incont­inence. Baltimore, Md: Health Profes­sions Press; 2002 and Newman DK. Urinary incont­inence. Adv Nursing 2004;6­(3)­:19–24.

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