Toileting, Bedpans, Urinals and Elimination Routines

Safe and Dignified Toileting Assistance

Assisting a resident with toileting requires a balance of safety, infection control, and personal dignity. Nurse aides must provide privacy by closing the door, pulling privacy curtains, or using screens during toileting. Personal modesty is vital for resident comfort, but hygiene must always be maintained. Nurse aides perform hand hygiene before and after care, and they wear clean gloves whenever contact with urine, stool, the perineal area, or contaminated items is expected.

Fall prevention is critical whenever transferring a resident to a toilet or commode. The nurse aide must ensure the resident wears non-skid footwear before transferring them to the toilet or commode. If a wheeled bedside commode is used, lock the wheels of the commode before assisting the resident onto or off it. Nurse aides assist the resident to use grab bars for toilet transfers when they are available and appropriate under the care plan. Additionally, a transfer or gait belt is applied to assist a resident to the toilet if indicated in the care plan.

Resident supervision depends entirely on safety needs. A nurse aide must never leave an unsteady or high-fall-risk resident alone while toileting. If a resident is safe to be left alone, the call light must always be placed within the resident's immediate reach before the aide leaves the bathroom. If a resident becomes dizzy, weak, or faint while toileting, the nurse aide must call for help and stay with the resident rather than leaving them unattended.

When elimination is finished, proper hygiene prevents infections and skin irritation. When a resident cannot perform perineal care after toileting, the nurse aide must assist with cleansing. When providing perineal care, wipe from front to back to avoid carrying bacteria from the anal area toward the urinary opening, and use a clean part of the cloth for each stroke. For instance, the aide cleans downward in a single stroke, turns the washcloth to expose a fresh surface, and wipes again. Finally, the nurse aide must assist or encourage the resident to wash their hands after elimination.