Comfort And Mobility: Helping the patient to move and maintain a comfortable position
Comfort And Mobility
One of your most important tasks as a volunteer is to attend to the patient’s comfort. Since much of the ill person’s day is spent in and around the bed, you will need to make the bed neatly and regularly – whether or not he is allowed up.
If the patient is unable to move or if his movements are restricted, it is up to you to choose the most suitable position in bed for him: you should know how to lift and move him without causing him any pain and without straining your back.
Prolonged bed rest is known to be harmful: a bedridden patient is likely to develop pressure sores, and there is a risk of blood clotting in his leg veins (thrombosis). Because of this risk, you should turn the patient regularly and help him to take gentle exercise. The district nursing sister will guide you in all these matters.
The patient who can get up and move around should be encouraged to do so, but do not forget that even the relatively mobile patient may need help.
The Patient in Bed
Most homes have low beds. These make nursing difficult, mainly because the risk of back strain for the helper is greater. Bed blocks may be used to increase the height: these are blocks of wood placed under all four legs of the bed, but you should check frequently that they are stable.
If the patient is being nursed in a double bed it is more difficult to care for him, especially if he cannot get out of bed. If there is a single bed available, it might be worth trying to persuade him to move to it. However, if someone is sharing the bed, any nursing disadvantage will probably be outweighed by the advantage of having another person at hand during the night.
There are also adjustable beds, which can be raised or lowered by a winding handle or hydraulic foot pedal, but usually, these are found only in hospitals. You lower the bed when the patient is getting in or out and raise it when bedmaking.
There are many different ways of making a bed, but certain rules apply at all times:
- Strip the bed neatly.
- Mitre corners.
- Make sure that there are enough bedclothes at the top of the bed to cover the patient when he lies down.
- Loosen the bedclothes over the patient’s feet so that he can move his toes freely.
To Make a bed, you will need
- Two bedsheets.
- An under blanket.
- Two top blankets.
- An eiderdown in cold weather.
- As many pillows as the patient wants or his condition dictates.
- Two chairs back to back.
You may also be using a drawsheet. If you need to protect the mattress, place a piece of plastic sheeting under the drawsheet and, if necessary, another piece under the bottom sheet.
Making a cot
Making a cot is very similar to making a bed. Often it is easier: normally only one person makes a cot, stripping the bed linen onto a chair first. It is also usually possible to lift the baby from the cot before you make it, making sure that he is comfortably wrapped in a blanket beforehand.
A pillow is unnecessary and even dangerous for a baby under one year old.
Making Empty Bed
- Make sure the bed linen is readily folded on the chairs at the bottom of the bed in the order required. Where possible, you should work in pairs to make the bed.
- Cover the mattress with the under blanket. Place the bottom sheet right side up with the crease centered down the middle of the bed.
- Tuck in the sheet along the head, then the foot of the bed. Make mitered corners, pulling the sheet taut before you tuck in the sides.
- Put two pillows on the bed. Place the top sheet in position wrong side up, with the crease centered down the middle. Allow about a 45cm turnover and cover half the pillow.
- Tuck in the sheet at the foot of the bed. Make mitered corners and tuck in the sides. Repeat with each blanket. With the counterpane leave the sides hanging loose.
- Loosen the bedclothes at the bottom end of the bed, and turn the excess sheet on the pillows down over the blankets and counterpane.
Making Mitred Corners
- Pick up the edge of the sheet about 45cm from the corner of the bed.
- Tuck in the sheet hanging down between your hand and the corner.
- Allow the remaining fold of sheet to hang down and then tuck in.
Bedmaking when the patient is in bed
Two people must make the bed together. See that the room is warm and tell the patient, what you are doing to do before you start. Place any clean linen on a chair near the bed. Prepare a linen bag or bucket for any soiled linen. Put two more chairs at the foot of the bed.
- Loosen the bedclothes all around the mattress. Remove the counterpane by folding it in three and place it on a chair. Remove the top blanket in the same way.
- Slide the top sheet from under the second blanket, fold it, and put on a chair. Keep the patient well covered with the blanket and remove all but one pillow.
- Roll the patient to one side of the bed. Support him while your helper brushes out any crumbs, and roll all the layers of bedlinen up to the patient’s back.
- Straighten each layer in turn, unroll it, pull it taut and tuck it in again. Roll the patient to the other side of the bed and repeat the process.
- Tuck in all bedclothes, sit the patient forwards and replace the pillow. Unfold the top sheet over the patient.
- Remove the blanket from underneath the sheet, allowing 45cm to turn over at the top.
- Replace each blanket in turn over the patient, and tuck them in. Replace the counterpane and turn down the sheet over it.
Using a Drawsheet
If the patient is in bed for more than a few days or is sweating a great deal, you may find a drawsheet useful. A rectangular piece of material about one meter wide and two meters long, a drawsheet can be made then placed on top of the bottom sheet under the patient’s buttocks and allows a clean cool area to be moved under the patient without there being any need to change the bottom sheet.
When the patient is uncomfortable and you want to adjust the drawsheet, untuck it at both ends. Pull a fresh area under the patient’s buttocks and tuck in both sides again. The length of the drawsheet allows three or four fresh areas to be pulled through before the sheet needs changing.
Changing a drawsheet
Prepare a clean drawsheet by rolling it crosswise. Leave the drawsheet rolled up close to the patient’s back. Tuck in the clean drawsheet and unroll it until it meets the soiled one. Roll the patient over both drawsheets before removing the soiled sheet. Tuck in the clean drawsheet.
Changing a bottom Sheet
If you need to change a bottom sheet, proceed in the same way, Remember to roll the clean sheet lengthwise before starting and, before tucking it in, check that its center crease will come in the middle of the bed.
Changing a Fitted Sheet
- After putting the rolled sheet in the bed, place the top corner over the mattress, pull the sheet toward the bottom corner and ease it over.
- Roll the patient over both the clean and the soiled sheet. Pull the sheet diagonally towards the top and ease it over the corner.
- Pull the sheet diagonally towards the bottom, bend up the mattress and ease it over the last corner. Complete bedmaking as before.
Bedmaking when the Patient Cannot Lie Flat
If the patient cannot get up for bedmaking but cannot lie flat either – probably because he is breathless – Strip the bed, but do not remove any pillows. Two of you should then lift the patient towards the foot of the bed.
Your helper should support him while you make the top half of the bed. Remove the pillows and backrest, brush out any crumbs, remove the drawsheet and plastic sheet, and place them on the chair. Roll the bottom sheet and blanket down to the patient’s back, and change them or tuck them in again.
Replace the plastic sheet and drawsheet and tuck them in. Support the patient while your helper tucks in the bedclothes on her side. Replace the backrest and pillows.
Striping a Bed
Two people should work together to strip a bed efficiently. Fold each layer of bedlinen neatly into three before removing it from the bed. Make sure that the folded linen is placed tidily on two chairs in the order required to remake the bed.
Bedlinen can be folded into three according to the preference of the people making the bed. Two common methods of folding are illustrated here.
Using Continental quilt
Continental quilts are increasing in popularity: they are warm, light, mold themselves to the body, and do not slip off the bed like an eiderdown. They come filled with down, a mixture of leather and down, or man-made fibers, and have washable covers. Quilts come in various sizes: for maximum comfort use the largest.
If a continental quilt suits the patient, bedmaking is greatly simplified. However, it is important to make the bed for the patient as often as you would normally.
It is tempting to think that a continental quilt merely needs t be plumped up occasionally: in fact, the filling tends to collect at the bottom of the quilt, while the patient needs the pleasure of returning to a freshly made bed in the same way as any other patient.
You make the bed in the usual way. Often a fitted sheet is used, while the quilt replaces all the bedding on top of the patient. Shake the quilt so that its fitting is evenly distributed and let it fall neatly on top of the pillows and bottom sheet. Avoid using a counterpane as it flattens the quilt and reduces the warmth created by the trapped air.
Patient’s Pressure Areas
Whenever you sit or lie down you are compressing the skin and the underlying tissues between the bed or chair and your bones. But the compression is never so prolonged as to cause damage because the pressure of the nerve endings in the skin causes healthy people to move frequently, even when asleep.
However, if weakness, paralysis, or unconsciousness makes movement impossible, the pressure may be enough to cut off the blood supply to the underlying tissues. They then die and the skin ulcerates. The ulcers are known as pressure sores.
Common sites for pressure sores are the back of the head; the shoulders; the elbows; the base of the spine; the buttocks; the sides of the hip; the knees; and the heels.
Preventing Pressures Sores
There are several things you can do for a patient to help prevent pressure sores. Improve the general health and the body’s healing power with adequate protein and vitamin C. Change his position regularly – about every two hours.
Keep the skin over the vulnerable damage the skin when giving a bedpan. Make sure the bottom sheet is kept dry, do not rub the area, and always lift the patient to the bed. Relieve pressure on specific areas with pillows. Sheepskin bootees relieve pressure on the heel.
An artificial sheepskin relieves pressure under the shoulders or buttocks. Apart from the inability to move and general debility, several other factors contribute to pressure sores:
- Moisture next to the skin.
- Wrinkles or crumbs in the bed.
If the patient is paralyzed or incontinent, further measures can be taken. He may find that sitting on a Sorbo ring or water cushion relieves pressure on the buttocks. Barrier cream may be used if the is incontinent. He may be helped by a ripple bed (alternating pressure mattress).
This consists of a mattress of corrugated polythene, with electric pumps are noisy and disturb the patients; others dislike the movement. An alternative is a water bed. This is a mattress filled with water, which moves with the patient and so relieves pressure.
Treating Pressure Sores
If pressure sores occur, it becomes even more important to turn the patient regularly. Sores must be treated as surgical wounds. The doctor may remove dead tissue and pack the wound with gauze, which is either dry or soaked in a solution that aids healing.
The pack allows the wound to heal from below upwards. The wound may also be treated with ultraviolet light or other special measures. The patient’s general health must be improved; he needs to eat a balanced diet with protein and vitamin C.
Next Nursing Care Tip: Patient’s Positions for Bedrest.