All methods of making beds for the sick are based upon a few underlying principles. The aim in every case is to obtain the following results with the least expenditure of time and labor: first, to secure comfort for the patient, and to eliminate all causes of friction, irritation, or pressure upon his skin; next to keep the covers firmly in place, so that the bed will not easily become disarranged; then to protect the mattress, and last, to secure as good an appearance as possible.

[Ill.u.s.tration: FIG. 12.--THE DRAW SHEET IN PLACE. (_From "Elementary Nursing Procedures," California State Board of Health._)]

TO MAKE AN UNOCCUPIED BED, proceed as follows: remove the pillows and covers one at a time, and place them on chairs, near an open window if possible. Brush the mattress and then set it up on its ends to air, or turn it back over the foot board. Wipe the bedstead with a damp cloth.

Replace the mattress after it has aired, turning it from side to side and from end to end on alternate days. Cover the mattress, unless it is enclosed in a slip cover, with a white quilted pad or an old blanket, and then spread the lower sheet over the mattress, so that the middle fold of the sheet lies upon the center of the mattress in a straight line from the head of the bed to the foot. Tuck the sheet under, first at the top and then at the bottom, drawing it so that it is firm and tight. If the sheet is of proper length tuck fourteen or sixteen inches under at the top, but take care to cover the mattress at the foot also.

Next tuck the sheet under at the side, folding its corners to make a neat finish like an envelope. Place the rubber sheet, if it must be used, across the bed, with its upper edge where the lower edge of the pillows will come. A draw sheet somewhat wider than the rubber sheet is needed next; an ordinary sheet, folded once the long way of the sheet, may be used, with the fold toward the head of the bed. Tuck both rubber and draw sheet securely under the mattress at the side. In some cases the rubber sheet may be placed next to the mattress, and covered by the mattress pad and lower sheet. Place the draw sheet as directed, whether the rubber is used or not. After the lower, rubber, and draw sheets have been adjusted on one side of the bed, go to the opposite side, draw them over smoothly, and tuck them under the mattress as tightly as possible.

Next spread the upper sheet over the bed so that its upper edge reaches to the upper edge of the mattress, and its middle crease lies over the middle line of the mattress, and place it right side down, so that the smooth side of the hem will be uppermost when the sheet is turned over the blankets. Place the blankets so that their upper edges lie a little higher than the place where the lower edge of the pillow will come, and tuck them in firmly at the bottom and sides. If the blankets are not long enough to tuck in at the foot, place the lower blanket as directed and the upper blanket five or six inches lower than the first. When tucked in, the upper blanket holds the lower one in place fairly well.

Place the counterpane evenly and smoothly, tuck it under at the foot, turn its corners neatly, turn its upper edge under the upper edge of the blankets and fold the upper sheet down over the whole. Last of all, shake the pillows and place them neatly on the bed.

[Ill.u.s.tration: FIG. 13.--THE CLOSED BED. (_From "Elementary Nursing Procedures," California State Board of Health._)]

Practice is necessary before it is possible to make a bed quickly and well, and a certain amount of proficiency in making an unoccupied bed should be acquired before undertaking to make a bed with a patient in it. One should learn to work in an orderly way, without confusion, unnecessary motion, or jarring of the bed.

TO CHANGE A PATIENT'S PILLOWS.--Stand preferably on the right side of the bed and slip the left arm under the patient's shoulders, supporting his head in the hollow of the arm. Raise him slightly and remove the pillows one at a time with the right hand, drawing them outward on the left side of the bed. Place a small pillow under his head. Shake the pillows, change the cases if necessary, and replace them on the left side of the bed, ready to be drawn back into position. Raise the patient as before, remove the small pillow and draw the others into place. It is sometimes better to hold the patient on the upper pillow while removing and replacing the under one.

LIFTING A PATIENT IN BED.--Patients tend to slip down toward the foot of the bed, and they should be raised if unable to help themselves. To raise the patient, instruct him to flex his knees and to press his feet firmly upon the bed; place one arm under his shoulders, as when changing pillows, the other arm under the thighs, and lift him upward without jerking. The lifting can be done more easily by two people, and with less discomfort to the patient: if he is entirely helpless two people are necessary. Two people should proceed as follows: Let _A_ place her left arm under the patient's head and shoulders as before, her right arm under the small of his back; let _B_ place her right arm also under the small of his back and her left arm under his thighs, and at a signal let them lift together. In this way the weight is so evenly distributed that a heavy person can be lifted without great difficulty.

TO TURN A PATIENT IN BED.--A patient may be turned toward or away from you. In turning a patient toward you, place one hand over his farther shoulder and the other over his hip, and turn him toward you. Then flex his knees slightly. To turn a patient from you, pa.s.s one hand as far as possible under the shoulders, and the other as far as possible under the thighs. Then raising the patient slightly, draw him back toward you, turning him at the same time, and then flex the knees. Lastly place a pillow firmly against his back to support it.

TO CHANGE THE SHEETS WHILE THE PATIENT IS IN BED proceed as follows: First collect the fresh linen and place it conveniently near the bed.

Then draw the bedclothes from beneath the mattress, raising the mattress meanwhile with one hand to prevent jarring the bed. Remove first the spread and then the upper blanket if there are two, fold each once and place it on a chair. Hold the remaining blanket in place with one hand, while with the other you draw the upper sheet out from under it; then fold the edges of the blanket up over the patient to keep them out of the way. The upper sheet, unless soiled, may be folded once and used again as a draw sheet. Next remove all the pillows, unless the patient prefers to keep one. Then move the patient toward one side of the bed and turn him on his side so that he faces the edge nearest him. Roll the draw sheet and rubber sheet together if both are to be removed, or separately if the rubber sheet is to remain on the bed; then roll the bottom sheet throughout its entire length, and bring the three sheets, all rolled as flat and as tightly as possible, close to the patient's back. Pleat about half of the fresh lower sheet lengthwise and place the pleated portion as close as possible to the rolled soiled sheets. Tuck in the other half of the fresh sheet at the top, bottom and side, draw the rubber sheet if it is to be replaced back over the fresh lower sheet, arrange the fresh draw sheet in place, tuck it in at the side, and roll its free portion close to the patient's back. The fresh side of the bed is then ready for the patient. Lift his feet back over the rolled sheets keeping his knees flexed, then turn him back over the rolled sheets on to the fresh smooth part, remove the soiled sheets and arrange the fresh ones in place on the side where the patient has just been lying. Be careful to keep him well covered with the blanket. After the lower sheets are in place and firmly tucked in, spread above the blanket the fresh upper sheet, and over the sheet spread the second blanket. Hold the sheet and blanket in place with one hand while using the other hand to draw out the first blanket from beneath the sheet. In this way the patient is constantly covered by a blanket. Place the blanket just removed above the other and finish the bed according to the directions given for an unoccupied bed, using special care, however not to draw the covers too tightly over the patient's feet.

[Ill.u.s.tration: FIG. 14.--CHANGING THE DRAW SHEET. (_From Pope "Home Care of the Sick," American School of Home Economics, Chicago._)]

TO MOVE A PATIENT FROM ONE BED TO ANOTHER.--On the fresh bed have the lower sheets in place but not the upper covers. Place the two beds close together side by side, and draw one mattress a little over the place where the two sides meet. Loosen the draw sheet under the patient, roll it on both sides close to the body and draw him gently over by means of this sheet, moving his shoulders at the same time. If the beds are unequal in height, use firm pillows or folded blankets to make an inclined plane.

[Ill.u.s.tration: FIG. 15.--CHANGING A PATIENT FROM ONE BED TO ANOTHER.

(_From Pope "Home Care of the Sick," American School of Home Economics, Chicago._)]

If the beds differ greatly in height and indeed in most cases, it is better to carry the patient from one bed to the other. At least two people are needed; one alone should never attempt to carry anyone heavier than a small child. One method for lifting is as follows: Let two bearers, _A_ and _B_ stand on the same side of the bed. If the patient is to be moved into the right side of the fresh bed let both bearers stand on the right side of the occupied bed; if he is to go into the left side of the fresh bed, let them both stand on the left side of the occupied bed. Let _A_ place one arm under the patient's shoulders and her other under the small of his back, while _B_ places one arm under his hips and the other just below his knees. Draw the patient to the edge of the bed, instruct him to place his arms about the shoulders of _A_ and to hold the body rigid, and then lift together at a given signal, keeping his weight well up on the chests of the bearers.

Whenever a patient must be turned, lifted, carried, or moved in any way, let him know beforehand just what you intend to do so that he may not be startled, and also that he may cooperate if possible. Grasp him firmly but gently, avoid pinching the skin, and move him steadily and smoothly, avoiding jerks and false starts. Do not attempt alone more than your strength is amply sufficient to accomplish, and endeavor at all times to handle the sick with the utmost gentleness and consideration.

EXERCISES

1. Describe a bedstead and mattress suitable for a sick person's use, and tell why they are to be preferred.

2. How should the bedstead be cared for? the mattress? the pillows?

3. How should a mattress and pillows be protected?

4. Describe in detail the bed covers that are desirable for use in sickness.

5. Name the results that a good method of bedmaking aims to secure.

6. Describe the method of making an unoccupied bed.

7. How should one change the pillows of a helpless patient?

8. Describe the way in which you would lift and turn a patient in bed.

9. Describe the method of changing sheets and remaking a bed while the patient is in it.

10. Why are beds and bedmaking considered so important in the care of the sick?

FOR FURTHER READING

Notes on Nursing--Florence Nightingale, Pages 79-84.

CHAPTER VII

BATHS AND BATHING

Bathing is necessary in sickness no less than in health. It stimulates and equalizes the circulation, is soothing in feverish conditions, is refreshing to most people, and by affording a certain amount of exercise it lessens the fatigue of lying in bed. Moreover, without frequent bathing it is impossible to keep the skin in good condition, since scales of dead skin, oily matter, and solid substances left by perspiration collect on the surface of the body when a person is lying still in bed as well as when he is leading an active life. The common belief that sick people are likely to catch cold from bathing is quite unfounded; every patient, unless his condition is such that the doctor orders otherwise, should have one complete cleansing bath each day. In addition to the regular cleansing bath other kinds are often prescribed as medical treatment.

CLEANSING BATHS

A _tub bath_ if allowed by a patient's condition, is the most satisfactory kind, but special precautions must be taken to guard her from fatigue and chill. The bath room and everything to be used should be made ready before she leaves her bed. Necessary clothing and toilet articles should be collected and arranged conveniently, a chair covered with a blanket and also a bath mat should be placed beside the tub, and the temperature of the bath room should be regulated so that it is about 70 F., or a little lower if the room is likely to become overheated as the bath proceeds. The bath water should be drawn last. Its temperature, tested by a thermometer, should be between 96 and 100 at the beginning, and may be increased if desirable.

If the patient is weak, wash and dry her face, neck, and ears, and if necessary cut the finger and toe nails before she leaves the bed, in any case before she enters the tub. As soon as the patient has left the bed, strip it and leave it to air; then a.s.sist her into the bath room and help her carefully into the tub. Do not allow her to stay in the water more than ten minutes at most, and stop the bath at once if she shows the slightest sign of faintness, dizziness, exhaustion, difficult breathing, marked change of color, or other unusual symptom. Indeed, if the patient is weak or her reaction to the bath uncertain, as when she takes her first tub bath after an illness, someone should always be within call to help the attendant in case of need. A faint, heavy patient in a bath tub is an impossible load for one person to handle.

While the patient is in the tub, soap her well, brush her finger and toe nails, rinse, and rub her to stimulate the circulation. Then help her from the tub, seat her in the chair, draw the blanket closely about her from neck to feet, dry her with warm towels, exposing the body as little as possible, and, if she is to return to bed, put on a fresh night gown, and wrapper and slippers. Next place the lower sheet, the draw sheet, and one pillow on the bed as quickly as possible, help the patient into bed, keeping her well covered with a blanket, and finish making the bed.

If she seems chilly, give a hot water bag and hot drink and leave the blanket next her in place. After the patient has been made comfortable, clean the tub and put the bath room in order.

Even patients supposedly able to take tub baths without a.s.sistance should not lock the bath room door nor be left alone a long time.

BED BATH.--Practice is essential in order to give a bed bath skillfully.

The aim is to make the patient thoroughly clean and thoroughly dry, without chilling, fatiguing, or exposing her, without making the bed damp, and without unnecessary haste or delay. One method of giving a bed bath follows, but any method that accomplishes these aims is likely to be satisfactory.

First see that the room is about 70 F. and likely to remain so, and exclude draughts. Collect everything to be used, including a blanket to cover the patient, an old blanket or large bath towel to protect the bed, at least two other towels, one a bath towel and the other a face towel, two wash cloths, soap, nail brush, powder, alcohol, comb and brush, nail file, scissors, etc.; fresh bed and personal linen; a large basin containing water at 105, a jug of hotter water, and a slop jar.

Remove the upper bed clothes except one blanket, which should cover the patient constantly during the bath, and spread them where they will air; remove all the pillows but one, and place the bath blanket under the patient as the under sheet is placed in bed making. If a bath blanket is not used, keep the bath towel under the part that is being bathed by moving the towel from place to place.

Next remove the night gown in the following way: Let the patient lie on her back, with her knees flexed; draw the gown up as far as possible, then raise or get her to raise her hips so that the gown may be drawn up above the waist. Next raise her head and shoulders with one arm and draw the night gown up to the neck with the other; remove one sleeve, draw the gown over the head and then off the other arm.

[Ill.u.s.tration: FIG. 16.--WASHING A PATIENT WITHOUT EXPOSURE. (_Sanders "Modern Methods in Nursing."_)]

The patient is now ready for the bath. Wet the wash cloth thoroughly, but hold it gathered in the hand so that it will not drip. Wash the face, neck, and ears first, dry them thoroughly, and next, using the second wash cloth, wash the arms and hands, chest and abdomen, giving particular attention to the armpits and navel. Raise the blanket slightly with one hand to keep it from becoming damp, but expose the patient as little as possible; the arms and legs need not remain covered while being washed. Dry each part thoroughly before washing the next.

Next turn the patient on her side and wash the back, the b.u.t.tocks, and upper part of the thighs; give special attention to the fold between the b.u.t.tocks. Then turn the patient on her back, and wash the thighs, legs, and feet. If it is important to move the patient as little as possible, leave the back until last so that the under sheet may be changed without turning her again. Cut the toe nails if necessary before washing, and clean them carefully afterward. Unless there is a reason to the contrary, wash the hands and the feet in the basin, first protecting the bed with a towel, newspaper, or clean wrapping paper. Be sure to clean well between the toes, and to dry the feet thoroughly; they may need some friction. Throughout the bath empty and refill the basin as necessary.

Wash the genital region last. Let the patient lie upon her back with knees flexed and separated, or upon one side with the knees flexed and one slightly raised. Patients who are able may take this part of the bath themselves with whatever a.s.sistance may be necessary. The attendant, however, must either do it herself or make sure that the patient does it thoroughly. To neglect a helpless patient is always unkind, and no less unkind when the motive is a mistaken sense of modesty. If discharge from the genitals is present use absorbent cotton, or clean, soft old cloth to wash the parts, and burn it afterward. It is sometimes desirable to place the patient on a bedpan and rinse the parts by a gentle stream of warm water poured from a jug. After the attendant has completed this part of the bath she should wash her own hands thoroughly.