Nursing Measures Related to Comfort of the Patient

Introduction

A condition of wellbeing has been described as being comfortable. It is a condition that is devoid of suffering, discomfort, stress, and worry. Any activity made to help a patient feel more at ease, such as giving them a back rub, shifting their position, or giving them medicine, is referred to as a comfort measure. Rest, sleep, and exercise are all part of it. They are necessary for a person to function normally. Rooms should be cozy and secure to increase the comfort of patients.

Factors Inhibiting Comfort

• Pain and restricted movements due to illness.
• Hard, wet or untidy/wrinkled bed.
• Improper arrangement of pillow (e.g. hard, large).
• Part of body as an arm or legs being not well supported.
• Lack of exercise.
• Insecurity feeling.
• Lack of sleep.
• Delayed or inadequate attention to the personal needs such as cleanliness, elimination, etc.
• Some positions for a prolonged period.
• Fear and anxiety due to illness.
• Worry about family job and business.
• Interruption of daily routine.
• Noisy and dirty environment.

Rest

The term rest means the feeling of peace, relief and relaxation or relief from anything like tiredness and disturbance or worries. A person at rest feels mentally relaxed, free from anxiety and physically calm.

Sleep

A condition of near unconsciousness is sleep. Physical activity declines, physiological processes alter, and a person is less receptive to outside stimuli during sleeping than when awake. It lessens stress on a number of bodily systems, including the neurological, pulmonary, and cardiovascular systems. Additionally, it reduces anxiety, improves coping skills, and makes it easier to focus on everyday tasks, preventing the physical and psychological effects of sleep deprivation. During sleep, the activity of the endocrine and digestive systems is boosted, particularly the release of growth hormone.

Sleep Requirements

1 month                        - 21-22 hrs.

2-3 month                     - 18-20 hrs.

4-5 month                     - 18-19 hrs.

6 month                        - 18 hrs.

8 month                        - 16 hrs.

10 month                      - 15-16 hrs.

11-12 month                 - 14-15 hrs.

Adult                             - 7-9 hrs.

Old Age                        - 5-9 hrs.  

Exercise

Exercise is a physical activity for conditioning the body, improving health, maintaining fitness or providing therapy for correcting a deformity or restoring the overall body to a maximal state of health.

Factors Affecting Rest and Sleep

Physiological, psychological and environmental factors affect the quality and quantity of rest and sleep. The amount of sleep we obtain generally decreases and become more fragmented throughout our lifespan. Here are some of the common factors that influence rest and sleep:

Drugs and Substances: Sleepiness, insomnia and fatigue often result as a direct effect of commonly prescribed medications.

Lifestyle: A person's daily routine influences sleep patterns.

Environment: Mostly, a quiet environment for rest and sleep is preferred.

Exercise: Regular exercise is known to be good for helping people sleep properly, but vigorous exercise during the evening can prevent sleep. This is because exercise raises the metabolism and encourages the production of adrenalin and other stimulant hormones.

Usual Sleep Pattern: Sleep patterns can also be affected due to demanding work schedules. Chronic lack of sleep is much more serious and causes serious alteration in the ability to perform daily functions.

Pain, Anxiety, and Other Medical Conditions: A wide range of medical and psychological conditions can have an impact on the structure and distribution of sleep and rest. These conditions include chronic pain from arthritis and other medical conditions, discomfort caused by gastro esophageal reflux disease, pre-menstrual syndrome and many others.

Environment: The bedroom environment can have a significant influence on sleep quality and quantity. Several variables combine to make up the sleep environment, including light, noise, and temperature.

Psychological Stress: Worry over personal problems or situation frequently disrupts sleep.

Diet: Eating a large, heavy and spicy meal at night often result in digestion that interfere rest and sleep. Caffeine, alcohol, tea and nicotine consumed in evening produce insomnia.

Nurse's Roles to Promote Rest and Sleep in the Patient

• Establishing a connection of assistance with the sufferer.
• Learn what triggers stress, anxiety, and discomfort.
• Determine the reassuring techniques that aid the patient in getting some rest and sleep.
• establishing a rest and sleep period.
• Provide suitable relief for any pain or discomfort.
• Find out his typical bedtime, sleeping and waking hours, daily exercise routine, etc.
• Aid in keeping up personal hygiene.
• Give a comforting apparatus.
• If at all feasible, tailor the hospital schedule, rest times, and sleep schedule to the patient's normal schedule at home.
• By swiftly responding to his questions and outlining the disease, you may help him cope with the stress of being unwell and in the hospital.
• Place the patient in a relaxed posture, such as lateral or prone.
• Create a clean, calm, and darker space that is conducive to relaxation.

Patient's Room Environment

Patient's room should make comfortable as home. It needs to be safe and large enough to allow the patient and visitors to move about freely. Nurse's important responsibility is providing a comfortable bedside. This includes attention to ventilation, odors, room temperature, lighting and noise. All patients require a sleeping environment with a comfortable room temperature, proper ventilation, and minimal sources of noise, a comfortable bed and proper lighting. Keeping the room neat and orderly also contributes to the patient's sense of well-being. Comfortable environment depends on a patient's age, severity of illness, and level of normal daily activity. Patient preferences for room temperature often vary widely. Depending on age and physical condition, maintain the room temperature between 20 degree and 23 degree centigrade. Room should be well ventilated. The circulation of fresh air in the patient's room provides comfort to the patient. Care should be taken to reduce harsh lighting and noise whenever possible, although adequate lighting is necessary for all nursing procedures. Adjust room lightning by closing or opening drapes, regulating over bed and floor lights and closing or opening room doors and avoid crying on conversations immediately outside the patient's room.

Room Equipment

Although there are variations across health care setting, a typical hospital room contains the basic pieces of furniture such as bed, bedside stand, chairs, and over bed table, etc. Standard equipment in the healthcare environment includes the call light, oxygen, suction, bath basin, bedpan or urinal, water jug/glass and bed linen. Nurses should arrange necessary equipment and items in their proper place. Nurses are responsible for ensuring the equipment functioning properly and safety of bedside unit.

Beds

A bed is the piece of equipment used mostly by a client. It is the place where the patient spends most of his time in the hospital and most of the nursing care is given in bed. Seriously ill patients often remain in bed for a long time. It is an important part of the patient's environment so it should be designed for comfort, safety and adaptability for changing positions. Different bed positions promote patient comfort, minimize symptoms, promote lung expansion and improve access during certain procedure. Historically, hospital beds have been generally 66 cm from the floor. This is higher than normal bed, thus enabling the caregiver to reach the patient without undue musculoskeletal strain. However many manufactures are making low height beds  available to healthcare facilities. These beds have a minimum height of 7 to 15 inches from the floor. To promote bed safety, ensure the following before leaving the patients bed side:

• The bed is in its lowest position.
• The bed position is safe for the patient.
• The bed controls are functioning.
• Side rails are raised if indicated.
• The wheels or casters are locked.

Types of Bed

Manual: This is made of metal, and is normally operated which requires more energy to use but it is economical and is the most common type of bed in Nepalese hospital.

Hydraulic: These are light beds so they can be moved easily. Some hydraulic beds have a free metallic structure. It is safe to use electric equipment on hydraulic beds but these are expensive. They are not available in Nepal.

Electric: These beds require the least amount of energy. Most electric beds have a control panel that the patient can operate to move the bed into the desired position easily.

Mattress

Hospital mattress is firm and generally covered with a water-repellent material that can be easily wiped with a bactericidal solution. They are used with the beds and variety of therapeutic beds and mattress are available to reduce the effects of pressure on the skin and to give support to the patient. The size of the mattress is varying according to the size and type of the bed.

Types

• Cotton mattress.
• Foam mattress.
• Air mattress.
• Water mattress.
• Woolen mattress.

Sheets

Sheets are usually made up of cotton materials. They are used to protect the mattress from soiling, to cover the patient and to protect the patient from irritation due to woolen blanket.

Types

• Bottom sheet
• Rubber sheet
•  Draw sheet
• Blanket cover
• Top sheet
• Pillow cover.

Bed Making

Bed making is a systematic way of preparing the appropriate bed based on the condition of the patient, which adopts scientific principles of nursing. It is the process of keeping the bed clean, neat and tidy. It is an important measure in promoting a patients comfort as well as health by increasing the cleanliness of their environment.

A client's bed should be kept as clean and comfortable as possible. A clean, dry, smooth bed enhances the client's feeling of wellbeing. Usually, make a bed in the morning after the client's morning care or while the client is bathing in a shower, sitting in a chair or out of the room for procedures or tests. Throughout the day, straighten the linen that becomes loose or wrinkled. The client's privacy, comfort and safety are all important when making a bed. Using side rails promote to aid positioning and turning, keeping call lights within the client's reach, and maintaining the proper r bed position helps promote comfort and safety. In some settings, making the bed is not a nurse's responsibility, but ensuring patient comfort is always a priority in nursing. To bed comfort, ensure the following before leaving a patient:

• Linens are clean and free of crumbs and wrinkles.
• The patient feels comfortably warm.
• Pressure areas are protected from rough sheets, border edges, and water-repellent material. 

Purposes of Bed Making

• To provide a clean and comfortable bed for the patient.
• To provide and rest to the patient.
• To provide physical and psychological comfort and security.
• To provide active and passive exercise to the patient.
• To maintain a clean environment and neat appearance to the unit.
• To observe, identify and prevent patient's complications.
• To ambulate the patient.
• To provide smooth wrinkle free bed thus minimizing sources of skin irritation and bedsore.
• To establish a good nurse-patient relationship and teaching the relatives.
• To dispose soiled and dirty linen properly.
• To reduce risk of infection by maintaining clean environment.
• To receive new patient.

Principles of Bed Making

Using Correct Body Mechanics

Body mechanics refer to the use of correct body posture while making bed, lifting patients or carrying out any other procedures so the nurse must use proper body mechanics during bed making. Nurses can apply the following principles of body mechanics to all bed making procedures:

• During bed-making, use good body movement and make each step purposeful.
• Raising the bed to a working level to avoid bending down or stretching over the mattress.
• Twisting of body should be avoided during bed making. When you bend, bend your knees not your back.
• Point your toes and face in the direction that you are moving, avoid twisting. w * Point

Preventing Cross Infection

• Hold clean and soiled linen away from uniform which may have germs.
• Handle linens carefully without shaking them to prevent germs spread around room.
• Put soiled linens immediately in special linen container before discarding it in hamper or plastic bag. Do not put soiled linens on the floor to prevent transmitting microorganisms.
• If clean linen touches the flower, discard it immediately.
• Do not mix soiled and clean linen during bed-making.
• Avoid fan linen because air currents can spread organisms.
• Wash hands before and after bed making and use gloves during bed-making.
• Avoid touching your clothing and wash your hands before and after making bed of each patient to prevent cross infection.
• Wash hands thoroughly before and after making bed of each patient.

Making the Bed Smooth for the Safety of the Patient

• The bed should be free from crumbs and creases and should give a maximum comfort to the patient.
• Pillows and other bed accessories should be well arranged to give support as necessary.
• The rough surface of the bottom sheet and draw sheet should be turned downward so that they do not hurt the patient's skin.
• Similarly, a soft cotton sheet should be placed under the blanket.

Making the Bed Just Sufficiently Tight

• Enough tight bed does not cause foot drop and it is comfortable and lasts longer to prevent wrinkles, pull linen tight as they are tucked but top clothes over the patient must be loose enough to allow the movement of feet.
• To make bed tight and free from wrinkles, place all linen straight line on the bed.

Preparing Bed with Less Effort and Time

• It is important to learn that how to make a bed in such a way where least amount of energy and time is required.
• To conserve time and energy, pick up all the necessary linens from the linen supply before beginning.
• Arrange the linen in the reverse order of use.
• Stay on one side of the bed until it is completely made; then move to the other side and finish the bed.
• During the procedure, the nurse should study her movements so as to avoid waste of time and energy.

Others

• Prepare the bed neatly.
• Change bed linen frequently to assure cleanliness.
• Keep everything ready on bed side before starting bed-making.
• Always fold bed linen from top to bottom.
• During occupied bed making, confirm patient safety and comfort.
• Always arrange bed linen in correct order with closed side away from you before making the bed.
• While tucking bedding under the mattress the palm of the hand should face down in order to protect your nails.
• Keep the open end of the pillow away from the entrance of the ward.
• After completing bed-making see that the locker and chair are in place and that all the beds are in line.
• Provide privacy by screening and draping. Do not expose the patient unnecessarily.
• Always get extra help to make a bed for helpless patients and prevent from falling.
• Do not cover the patient's face while placing the linen.
• Check for the areas of redness.
• Note tolerance of activity level while out of bed.
• Note observations about the physical and emotional status of the patient.
• Note any patient teaching or reinforced teaching given and the patient's response.
• Check for drainage, wetness or other body fluids and record observations.