Nursing Care – The Patient’s Surroundings: Easy Guide
Nursing Care Guide: Healthy people are usually able to choose their environment. If anything makes it uncomfortable or dangerous, they are free to make adjustments or move away. The patient, however, is dependent upon those nursing him to see that his surroundings are safe.
As a volunteer, you may be asked to provide a safe environment for the patient. When people are ill their movement is usually restricted. They may be confined to bed in their own home or hospital.
Their physical surroundings matter greatly and the bedroom and furniture should be selected with care. The general atmosphere in the room is also crucial. Family, friends, doctors, and nurses all help to create it and their attitude largely determines whatever or not the patient feels a burden.
Always try and create a pleasant and cheerful atmosphere. Let the patient feel you have time to meet his every need. Be conscious of the privilege you have in serving the sick. Your forethought will give comfort to the patient as well as support to his family.
Nursing Care: Planning the Patient’s Room
The room in which the patient is nursed should be clean. The air can carry germs from one person to another and any dust stirred up can settle on food or a wound and so infect the patient. The room should also be free from unpleasant smells.
Use an aerosol to disperse the smells of food, bedpans, and any other unpleasant odors. Even flower-water smells if it is not fresh. The sense of smell is intensified in sickness, so this is important.
The room should be comfortably warm and well ventilated. If it is too hot, the patient may sweat and become uncomfortable; if it is too cold, he may chill. In winter additional heating will probably be necessary. Beware of draughts.
An open fire increases ventilation, but it should be well guarded so that when the patient is out of bed there is no danger of his dressing-gown catching fire.
Smoking in bed is also dangerous, particularly if the patient is elderly or drowsy. Always provide a large ashtray that will not spill easily and try and stay with the patient until he has finished smoking.
Most people prefer to stay in their own bedroom when they are ill. It may be more convenient for you to move a sick person downstairs or to a room nearer the bathroom but do this only for his real wellbeing, not merely for your convenience.
Whenever possible nurse the patient in a single bed with a firm but comfortable mattress. Try and leave plenty of space around the bed for ease of movement and the placement of any essential equipment.
If there is a pleasant garden or an interesting view, place the bed so that the patient can see out of the window.
On the other hand, if the room can be overlooked, there must be blinds or curtains that can be closed for privacy. These are also useful for controlling the light.
It is a good idea to leave everything the patient may need within easy reach of the bed, otherwise he may overbalance and fall when stretching for something or when getting out of bed to reach something.
If a small handbell is available, this is an added safety measure. A good bedside light is necessary for both patient and nurse, over and above the main lighting.
Take care of what is left on the bedside table of a confused patient. For instance, if you leave disinfectant in a sputum cup he may drink from it by mistake.
Remove medicines, especially bottles of tablets, as he may repeat the dose, forgetting what he has already taken. Remove cigarettes and matches in case he sets the bed alight.
If the patient can use the bathroom you should ensure that the passageways are clear and that nothing has been left on the floor for him to trip over.
Check also that the bathwater is not too hot and that there is a chair or stool in the bathroom and tablecloths on the bedside table and work surfaces will help to reduce noise and at the same time protect the furniture.
Be sensitive to noise: to an ill person, every sound seems magnified. Noise can cause headaches and make the patient irritable. You may need to turn down the radio and television or remove a ticking clock if it is disturbing him.
Warn visitors to talk in a normal voice and not to shout: people often seem to think that because someone is ill he cannot hear.
Visitors, however welcome, can be exceedingly tiring. Try and restrict their number and the length of time they stay. This needs tact and may tax your ingenuity if you are to control visitors without giving offense.
Nursing Care: Selecting Furniture
If you are re-organizing a bedroom to make nursing easier, try and preserve the patient’s feeling that it is still his room at home. Individual needs will vary, but certain minimum requirements usually apply to all sickrooms:
You Should Have:
- A firm table or locker for the patient within reach of the bed.
- An armchair for the patient to sit in when he is allowed out of bed.
- Two chairs for bedmaking and the use of visitors.
- A commode if one is necessary and available.
- A working surface for you: this should be protected by newspaper or plastic sheeting and covered with a clean paper towel.
- Cupboard space, useful if there are any dressings or equipment that the district nursing sister or midwife might use.
- A clear pathway between the bed and the door, so that neither you nor the patient stumbles into the furniture in the dark.
Nursing Care: Planning a Child’s Room
The day of the formal nursery is past but, where possible, the new baby should have a room to himself, which in time can double as a playroom.
The aim should be to provide a clean, airy room that is safe for its occupant. In the early months when the baby is confined to his cot there is little danger, but, once he begins to crawl, all sorts of hazards are to be found.
Parents usually decorate the room intended for the new baby: high gloss washable paint and vinyl papers are easily cleaned of grubby finger marks. A blackboard or an area of wall covered with Formica gives the small child somewhere to draw and scribble as he wishes.
The floor needs a covering as splinters from the wooden floor are dangerous when the child is crawling; linoleum or lino tiles are safe and colorful and many of the new synthetic materials are both soft and warm to the knees.
If rugs are used, they should be bright, washable, and, above all, non-slip. Curtains too should be washable and nursery prints are very attractive, but remember that pictures of witches and ogres may frighten small children.
Ventilation is important and should be achieved without draughts. As the child grows you should take care to see that he cannot fall from an open window.
Lighting should be adequate, both for baby care in the early days and for the child to play for later on. Switches should be out of reach of small fingers and trailing flexes and unprotected sockets should also be made inaccessible.
Toddlers will push things into electric sockets: it is essential to put a plug into an empty socket even if it is unconnected to any equipment.
Heating is essential, especially for the newborn who may become severely chilled if the temperature drops at night. Central heating or oil-filled electric radiators are probably the safest form of heating but unfortunately are not always available.
Gas fires dry the air and maybe dangerous if the flame blows out. Electric fires should be used with care as they account for innumerable deaths from fire each year among babies and children.
Nursing Care: Selecting Furniture
The cot is the most important piece of furniture required for a newborn baby. For the first few weeks, a carry-cot is often most convenient as it can be carried everywhere and the new baby put to sleep in it during the day as well as at night.
If it has a waterproof hood and cover you will be able to take the baby out in the rain. If it comes with a stand and wheels it can double as a pram. Alternatively, you may like to use a basket with handles.
Although lighter and easier to carry than a carry-cot, such baskets are not waterproof and therefore not very practical for outdoor use.
The baby will also feel more comfortable and secure in the first weeks of life if he is in a small cot or cradle.
Moving a baby is easier if he is in a small cot, and washing small cot-sheets and blankets is less arduous than washing full-sized ones. By the time the baby is about six months old, however, a larger cot will be needed: a drop-sided wooden one is probably the most hardwearing.
The side-lowering mechanism should be sturdy but move easily. The cot bars should be no more than 8 cm apart.
The cot mattress should be firm and preferably encased in waterproof material for easy cleaning. It should fit the cot exactly so that there is no possibility of the baby becoming wedged in a gap between mattress and cot.
It should be thick enough to keep the baby warm; if the mattress you have bought is a thin one, a folded piece of blanket between the mattress and its waterproof cover will increase both the baby’s warmth and comfort.
The sheets should be either flannelette or cotton. Flannelette sheets are warmer than cotton but take longer to dry. Two blankets should cover the baby: they should be light but warm; cellular blankets are now much used. Eiderdowns are optional but often used.
A pillow is unnecessary and even dangerous for a baby under one year old. There is a chance that a small baby could bury his head in a pillow and suffocate.
How much other furniture you choose to put in the baby’s room will depend on personal taste, but in the early days at least, you will probably keep the baby bath and bathing equipment in the bedroom.
There are two types of baby bath in common use: one is plastic and fits into a stand, the other fits over an ordinary bath. Both of these can be used until the baby is quite big.
There should also be a low chair on which you can sit to bathe the baby. A trolley or table is necessary for the bathing equipment; the former can be moved easily, while the latter can be used by the toddler later on.
Cupboards are useful for clothing and for storing toys. As the child grows, a playpen may be used: this allows freedom while restricting his environment to a safe one.
Some kind of baby chair will also be needed; a low chair is safer than a high one. The chair should have a firm, broad base, and safety straps; its tray should be large and ideally should have rounded corners for easy cleaning.
The next article on the Nursing care series will be “Comfort and Mobility: Helping the Patient to move and maintain a comfortable position”.