14.1 Toileting, Bedpan, and Privacy (Skill 4)

14.1 Toileting, Bedpan, and Privacy (Skill 4)

Quick Answer: Colorado Skill 4 — Assists With Use of Bedpan is a 17-step sequence. Explain. Privacy. Lower the head of the bed before placing the pan. Clean gloves before the pan goes under the client. Place it correctly under the buttocks. Remove gloves without contaminating yourself, wash hands, then raise the head of the bed. Put toilet tissue in reach. Put a hand wipe in reach and instruct the client to clean the hands when finished. Put the signaling device in reach and ask the client to signal when finished. Clean gloves before removing. Lower the head of the bed before the pan comes out. Keep the client covered except when placing or removing the pan. Empty and rinse the pan and pour the rinse into the toilet. Send the pan to the designated dirty supply area. Gloves off, wash, call light in reach, bed low. Privacy is a right. Offer toileting on a schedule to prevent incontinence and falls. Know a standard pan from a fracture pan. Do not leave a client on a bedpan for a long time — sacral skin and dignity both suffer.

Why this section is on the exam

On the 2024 National Nurse Aide Assessment Program (NNAAP) outline Colorado uses, Elimination is leaf I.A.3 inside Activities of Daily Living (I.A). ADLs are 22% of the 60 scored written items — about 13 questions that also cover hygiene, nutrition, and rest. Elimination stems ask privacy, the head-of-bed sequence, glove timing, and what you do with a used pan.

The Skills Evaluation may assign Skill 4 as one of the four random skills (plus the always-assigned Hand Hygiene skill). You have 30 minutes for five skills and must pass all five. The current Colorado Credentia card does not print a bold critical-element step on Skill 4, but every listed step still counts toward a satisfactory skill. Miss enough remaining steps and the skill fails — which fails the skills exam.

/practice/co-cnaPractice questions with detailed explanations

Skill 4 — handbook steps in order

Memorize the official Colorado sequence. The head-of-bed and glove switches are where candidates lose the card.

The head-of-bed trap — lower, place, then raise

This is the sequence written items and evaluators both watch.

Lower the head of the bed before the pan goes under the client. A high Fowler's angle jams the pan against the sacrum, tilts urine toward the bed, and makes a correct seat under the buttocks almost impossible. Flatten enough to slide or roll the person onto the pan. Then, after the pan is seated and your gloves are off and hands are washed, raise the head of the bed so the person can sit in a more natural voiding position. Sitting up on a pan is physiology and dignity. Sitting up while you still have the pan in your hands is the wrong order.

Lower the head of the bed again before the pan comes out. Pulling a pan out of a sitting person scrapes the sacrum, spills, and exposes more than the card allows. Flat enough to remove. Then you finish covering, clean up, and leave the bed low — low is the safety close, not the placement angle.

Why gloves come off before you raise the bed

You glove to place the pan because you are handling a device that will collect urine or stool. You then remove those gloves without contaminating yourself and wash before you touch the head-of-bed control, the tissue, the wipe packet, and the call light. Dirty gloves on the bed control and the call light turn the whole room into a contaminated surface. That is why step 6 is not optional busywork. New clean gloves go on before you remove the used pan. Two glove cycles, not one pair worn from start to finish.

Place it correctly, then cover

Correctly under the buttocks means the open bowl is actually under the perineum, not parked under the thighs or the lumbar spine. If the client can bend the knees and lift the hips, support the small of the back and slide the pan in. If the client cannot lift, turn the person toward you or the rail, seat the pan against the buttocks, and roll the person back onto it. Check the seat before you leave. A pan that is only half under the sacrum will spill and will fail step 5.

Keep the client covered except when placing and removing the bedpan. Privacy is not only the curtain. The sheet or bath blanket stays over the legs and abdomen while the person uses the pan. You uncover just enough to place and just enough to remove. Walking away with the person naked on a pan is a rights miss and a listed miss.

Tissue, wipe, and the signal — then you leave

After the person is sitting on the pan:

• Toilet tissue must be in reach, not on the windowsill or in your pocket.
• A hand wipe must be in reach, and you must tell the client to clean the hands when finished. Handing tissue without a wipe, or leaving a wipe without the instruction, is an incomplete step 9.
• The signaling device (call light) is in reach, and you ask the client to signal when finished. Do not say you will just come back in a bit and skip the ask.

Then you give the person privacy. Hovering at the bedside while someone tries to void is a dignity failure. Leaving without a call light is a safety failure.

After-care is still the skill

When the light goes on, gloves on, head of bed down, pan out, client covered. Take the pan to the toilet. Empty it. Rinse it. Pour the rinse into the toilet — not into a clean sink, not into a drinking-water pitcher, not onto a towel on the overbed table. The pan goes to the designated dirty supply area, not onto the floor and not onto a clean bedside table. Gloves off without contaminating yourself. Wash. Call light in reach. Bed low.

Measuring the urine is Skill 13 (Chapter 10), not a hidden extra on Skill 4. If you are assigned output, you still follow Skill 4's empty-and-rinse-into-the-toilet idea and then use a graduate. Do not mash the two cards together on test day unless both are assigned.

Privacy is a right, not a courtesy

Pulling the curtain, closing the door, or using the screen is step 2 and an OBRA / client-rights duty. Elimination is the most exposing everyday care many people receive. Knock. Explain. Cover. Do not discuss the result in the hallway. Do not leave the door open because the assignment is running late. A person who can use a bathroom still gets a closed door and time. A person on a pan still gets a curtain that actually closes.

Offer toileting on a schedule

Scheduled toileting means you offer the toilet, commode, urinal, or bedpan at regular times — on waking, before and after meals, at bedtime, and at the interval on the care plan — instead of waiting for a desperate call or a wet brief. A schedule prevents two problems the written exam loves:

1. Incontinence that did not have to happen, with the skin and dignity damage that follows.
2. Falls, because people who need to void and cannot find help will climb over a rail or walk in socks.

Briefs are not a toileting plan. If the person can toilet with help, you offer the toilet. Section 14.2 covers incontinence in more depth; the bedpan card is where you prove you still treat voiding as an activity of daily living.

Standard pan versus fracture pan

Do not grab whichever pan is on the shelf. A standard pan forced under a new hip can injure the joint and will not seat. A fracture pan used on a person who can lift is legal, but the card still requires correct placement under the buttocks. Powder is not on the Colorado Skill 4 list — do not invent a powder step.

Do not leave a client on a bedpan for a long time

A bedpan is hard plastic under the sacrum. A long sit causes pressure, pain, and skin blanching on the same bony prominence you protect during turning. It is also humiliating. Check back promptly. Typical training treats about ten minutes as a long time to sit on a pan if the person is finished or cannot void — that is a skin-and-dignity limit, not a number printed in the Colorado handbook. If the person has not finished, offer a brief pause off the pan, inspect the sacrum, and try again. Never park someone on a pan and go to lunch.

A urinal (male or, when assigned, a female urinal) and a bedside commode are other toileting tools on written items. A commode still needs privacy, non-skid footwear if the person stands, a locked device, and a call light. Empty commode and urinal contents into the toilet the same way you empty a pan. Skill 4 itself is the bedpan card.

Colorado scenario

You draw Skill 4 at a Credentia site in Aurora, then you work days at a Parker skilled-nursing facility. On the skills card you leave Ms. Alvarez's head of bed at high Fowler's, slide a standard pan under her with bare hands, stay gloved while you mash the call light onto the overbed table, and forget tissue and a wipe. You walk to the door and chat with the next candidate while she sits uncovered. When she is done you yank the pan out with the head of the bed still up, dump it in a clean utility sink, and set the wet pan on the floor.

That sequence misses the placement angle, both glove cycles, coverage, the wipe-and-instruct step, the ask-to-signal step, the lower-to-remove step, the toilet rinse, the dirty-supply destination, and the bed-low close.

Do this instead: explain, curtain, lower the head of the bed, gloves on, seat the pan under the buttocks, gloves off and wash, raise the head of the bed, tissue in reach, wipe in reach plus the instruction to clean the hands, call light in reach plus the ask to signal, give privacy, return when she signals, gloves on, lower the head of the bed, remove the pan, keep her covered except during place and remove, empty and rinse into the toilet, pan to dirty supply, gloves off, wash, call light, bed low.

That afternoon on the unit you see a coworker leave Mr. Chen on a fracture pan from 11:40 until after the 12:30 trays because he is always slow. His sacrum is red when the pan finally comes out. You do not copy that habit. You offer the pan or commode on his toileting schedule, you do not leave him on hard plastic through a meal, you cover him, and you report the reddened sacrum to the licensed nurse. You also offer toileting before he tries to climb out of bed — scheduled offers prevent the fall that looks like a toileting accident.

Exam traps

• Placing the pan with the head of the bed still raised, or removing it with the head of the bed still raised.
• Raising the head of the bed while still wearing the placement gloves.
• Forgetting the second glove cycle before removal.
• No toilet tissue, no hand wipe, or a wipe with no instruction to clean the hands.
• Call light out of reach, or no request to signal when finished.
• Uncovering the person for the whole procedure, or skipping the curtain.
• Leaving the person on the pan for a long time.
• Emptying the pan into a clean sink or parking it on the floor.
• Using a standard pan on a client who cannot lift after a hip fracture, or seating any pan only under the thighs.
• Treating briefs as a substitute for a toileting offer.