Assisting clients to use toileting facilities

Nurses and carers, in partnership with the client, need to assess the most appropriate vessel for the client to eliminate into based on their current situation.

Using the toilet:
Ideally, individuals prefer to use the toilet, as from a very early age we are taught that this is the most appropriate place to eliminate. Therefore if a
person can maintain this normality despite illness or disability it should be encouraged and supported, to promote psychological well-being.

This can simply involve the nurse or other health care professional helping the client to locate the whereabouts of the toilet if they are in a new environment.

Adaptations can be made to the toilet if required to enable a person to continue to use the toilet if, due to mobility problems, this is becoming difficult. Raised toilet seats and rails can help some people to get on and off the toilet and help them to continue to meet their elimination needs independently.

Using a commode:
If a person is unable to get to the toilet then a commode can be used. The nurse can either wheel the client to the toilet on the commode, or the client can use the commode at the side of their bed.

When a person is using a commode the nurse or other carer needs to ensure that the commode is cleaned before and after use. Washing with soap and water is usually perfectly adequate provided that it is subsequently dried. If the client is safe to be left alone while they are on the commode/toilet the nurse must ensure that they have easy access to the nurse call system so they can get the assistance quickly when they have finished. Numerous complaints made by clients and their relatives identify that some clients have been left for long periods of time in a toilet or on a commode before a nurse has returned to help them. This is a very frightening experience for the client, as well as uncomfortable and potentially dangerous.

Using a bedpan or urinal
If a client is unable to go to the toilet then a bedpan or urinal will be required.

When assisting a client with their elimination needs, standard precautions should be applied. You should wear a plastic apron and gloves if you are likely to come into contact with body fluids. Hand hygiene following these activities is essential to reduce the risk of cross-infection. The client’s hygiene needs should also be considered. Providing the client with time and the facilities to wash their own hands after going to the toilet is essential. The client may also require assistance to wash their perineal area.

Most bedpans and urinals in institutional settings are now disposable and can be discarded in the macerator. If caring for a client in an alternative environment, however, it may well be that you will need to dispose of the contents down the toilet and then wash the receptacle in hot soapy water before returning it to the client. Take care of course to accurately record any output if required.

In the case of disposable urinals, it is usually desirable for both the client and the carer to leave them with a replacement. This not only serves to increase the individual’s autonomy but also means that they do not get upset about having to ask, and that they do not have to wait next time should you be busy.