BEDS AND BEDMAKING
The common saying that the best bed for an invalid is his own bed
contains an element of truth. Taking from a patient his own accustomed
bed, even when a better is substituted, sometimes disturbs him greatly
and makes him feel that he is indeed very ill. Nevertheless, a suitable
bed is essential to the proper care of a helpless person, and no patient
should continue to use an unsuitable one, unless his illness is slight
and also likely to be of very short duration.
Besides being comfortable, a bed suitable for the sick must be clean and
easy to keep in a sanitary condition. The springs should be firm, and
the mattress should be elastic and should give an even support without
lumps and hollows. The bed covers should be clean, light, and warm; the
pillows should be sufficient in number not only to make the head and
shoulders comfortable, but also any other part of the body in need of
support. Moreover, the bed should be so placed and of such a kind that
the work of caring for the patient may be rendered as easy for the
attendant as possible. In every household at least one bed suitable for
a sick person should be available in case of need.
BEDSTEADS.--Beds of white enameled iron, brass, or brass and iron
combined are most easily kept clean, and are the best in every way. The
frame should be strong enough to stand firmly, yet not so heavy that it
is hard to move. It should have as few angles as possible, and all its
joints should be smooth and well finished. The springs should be made of
wire stretched tightly on a metal frame that fits smoothly into the head
and foot pieces. Large castors should be used; they may be removed from
the foot if the bed moves too easily.
A bed to be used in sickness should have the following
dimensions--length, 6 ft. 6 in., height 24 to 26 inches, width, 36
inches. If a bed is either too high or too low the labor of lifting and
moving the patient is greatly increased. If the bed is too narrow the
patient is insecure. If the bed is too wide, its center is difficult or
impossible to reach without leaning or kneeling upon it; and if too
short, it will prove uncomfortable for a tall person. A bed that is too
low may be raised on four heavy boxes of the same height; or still
better, upon heavy wooden blocks which any carpenter can easily make,
and which are well worth a little trouble to obtain. In the top of each
block a hollow should be made into which the leg of the bed will fit
after the castor has been removed. A broad firm stool or a low chair may
be provided for a patient who has difficulty in getting in and out of a
high bed.
Beds with complicated attachments for moving patients are not
recommended for family use. They are expensive, likely to get out of
order, seldom needed, and generally unsatisfactory. In some surgical
cases a bed with a firm, flat surface is necessary. Such a surface may
be secured by placing between the mattress and springs two boards
slightly separated, or one wide board with holes bored in it to afford
ventilation.
Wooden beds are undesirable: they are difficult to keep clean, they
readily absorb moisture and odors, they cannot well be disinfected, and
their solid frames prevent a free circulation of air. Moreover, it is
almost impossible to render fit for use again a wooden bed into which
vermin have once made their way. Folding beds and lounges even of the
best type are unhygienic, usually too low for the patient's comfort, and
often insecure.
A bedstead should be wiped frequently with a damp cloth; if it is of
enameled iron it may be washed with soap and water. The springs may be
cleansed with a stiff brush dipped in kerosene oil. Excessive use of
water upon the springs is likely to make them rust.
MATTRESSES.--Various substances are used in the manufacture of
mattresses, but nothing has yet been found that is as satisfactory as
curled hair. It is light and clean and elastic, it does not readily
absorb odors, and it is easily renovated. Although hair is more costly
than other materials, a hair mattress may be used almost indefinitely if
it is occasionally made over.
Felt or cotton mattresses are firm, but heavy, difficult to keep clean,
and likely to absorb odors. A useful mattress made from straw is
sometimes found in country districts. Such a bed is thoroughly hygienic,
for the worn straw may be burned and the tick washed and refilled with
clean straw; but straw beds are generally hard and lumpy. The least
desirable of all mattresses is the old fashioned feather bed, and it
should never be used if a better can by any possibility be obtained; but
a feather bed should not be arbitrarily taken away from an old person
accustomed to its use, unless his welfare is really at stake.
A mattress made in two sections is unnecessary for a single bed; indeed,
a mattress made in one piece is more easily kept in place if the
patient is restless. A good quality of blue and white ticking makes a
serviceable cover for both mattress and pillows since its color is not
likely to run.
CARE OF THE MATTRESS.--A mattress should be brushed frequently with a
whisk broom, especially around the tufts and edges. If a patient is long
confined to bed, a fresh one should occasionally be substituted so that
the regular mattress may be removed, well brushed, beaten with a carpet
beater, and left exposed to the sun and air for a day or two. A mattress
that is badly soiled should be sent to a cleaner and made over; it
cannot be cleaned properly at home. It is generally possible to remove
blood stains, if they have not soaked through the ticking, by applying a
thick cream made from raw starch and cold water. When the starch becomes
dry it should be brushed away, and the application should be repeated
until the stain has disappeared. For the best results the starch should
be applied before the stain is dry.
PILLOWS.--One patient can use an almost unlimited number of feather
pillows. Some should be soft and others firm, some large and some small;
but pillows that are very large and thick are less useful than a greater
number of smaller ones. It is well to have several small pillows of
varying size and thickness to support different parts of the body.
Hair pillows are often acceptable in warm weather, and they are also
desirable for patients with high fever or excessive perspiration. Rubber
air pillows are a convenience in traveling and add much to the comfort
of a patient when he first goes out in a carriage or motor car, but air
pillows are not sufficiently durable for general use.
If a pillow tick becomes soiled, the feathers may be transferred to a
clean tick by making an opening about six inches long in the end of each
pillow, sewing the ticks together, and then shaking the feathers from
one tick to the other. The soiled tick can then be washed. If the
feathers themselves have become soiled they should be renovated by a
cleaner. Pillows, like mattresses, should be frequently brushed, sunned,
and aired. They should not be held in the mouth while a clean
pillow-case is adjusted.
PROTECTION OF THE MATTRESS AND PILLOWS.--In all cases of sickness the
mattress must be adequately protected. Neglect is inexcusable and may
cause expense and trouble as well as discomfort to the patient.
The following may be used to protect the mattress or pillows: large
quilted pads, small pads of cotton batting covered with old muslin or
cheese cloth, slip covers for the mattress, rubber sheets and
pillow-cases, old blankets and quilts that may be washed easily. Heavy
wrapping paper, builders' paper, and newspapers serve well in
emergencies, or for a short time.
RUBBER SHEETS AND PILLOW-CASES.--Soft rubber cloth, single or double
faced, is most frequently used when it is necessary to protect the bed
from discharges. It may be purchased by the yard. Rubber sheets should
not be used unless they are really necessary. They are hot and
uncomfortable, and increase the tendency to perspire. When used, a
rubber sheet should be 1 yard wide or wide enough to reach from the
lower edge of the pillows down to the patient's knees, and long enough
so that it can be tucked in securely on both sides of the bed. Rubber
sheets may be cleaned by laying them on a flat surface and washing on
both sides with soap and water, using a small brush if necessary. After
rinsing they should be wiped, and when thoroughly dry they should be
rolled rather than folded, to prevent the rubber from breaking.
Rubber pillow-cases are used for a patient who perspires profusely, or
who has a discharge of any kind from the head or neck, and also when
substances which may wet or stain the pillow are applied to the head.
They should be put on next to the pillow, securely fastened with tapes,
snap hooks, or buttons, and covered with the regular pillow slip.
Rubber sheets and pillow-cases are not durable. They should be used
carefully, and frequently examined for holes or worn places by holding
them up to the light. Even a pin hole near the center may render a
rubber sheet or pillow-case as useless as a sieve.
SHEETS.--Sheets of ample proportions are necessary for comfort, and
important for sanitary reasons as well. For a bed of the dimensions
mentioned in this lesson sheets should be three yards long, and two
yards wide. A safe rule for any bed is to have the sheets one yard
longer and one yard wider than the mattress. A sheet of these dimensions
is large enough to be tucked under the sides and foot of the mattress,
while at least twelve inches are left to fold over the blankets at the
top. Cotton sheets are as good as linen for general use, or even better,
and are far less expensive.
DRAW SHEETS are used to cover rubber sheets, and to protect beds when
the rubbers are not used. In hospitals special draw sheets are usually
provided, but an ordinary sheet folded answers every purpose. New and
expensive sheets should not be used for draw sheets, since they are
more likely than other sheets to become stained. Draw sheets should be
wide enough to extend about four inches beyond the rubber sheet at the
top and bottom.
PILLOW COVERS.--Pillow covers are generally made of cotton, but persons
who can afford the cost frequently prefer linen, especially in hot
weather. Unless fastened with buttons or tapes, a pillow case should be
several inches longer than its pillow. It should be wide enough to slip
on easily, but not so wide that it wrinkles or allows the pillow to
turn. If it is too small the pillow will become hard and uncomfortable.
These small things, unimportant as they are to the well, may cause much
discomfort to a restless or nervous patient.
BLANKETS.--All wool blankets are both light and warm, and are
consequently the most comfortable bed covering. But unless they can be
dry cleaned frequently, it is better to select blankets made from one
part wool and two parts cotton. Blankets containing equal parts of wool
and cotton are warmer, but are more injured by washing. Very light
blankets of wool or outing flannel are useful in summer. Double blankets
should always be cut in two and bound at the ends, since single blankets
are easier than double blankets to handle and wash. Patients are
frequently too warmly covered by day. Too much warmth is enervating, it
causes the patient to perspire, and makes him restless and more
susceptible to draughts and to changes of temperature. Two light
blankets are warmer and more comfortable than one heavy blanket.
COMFORTERS AND QUILTS.--Heavy cotton comforters are burdensome without
being correspondingly warm. Eiderdown quilts or those padded with wool
are good for a patient who sleeps out of doors, or whose room is kept at
a low temperature. Bed covers that cannot be laundered readily should be
protected by basting on both sides of the top a wide piece of muslin or
linen, which can be removed and washed.
COUNTERPANES.--White dimity counterpanes are desirable, since they are
light in weight, easily laundered, and inexpensive. A heavy counterpane
is uncomfortable at any time, and still more uncomfortable in sickness.
If a light spread is not available, a sheet makes a good substitute. A
counterpane should be wide enough to cover the sheets and blankets at
the sides when the bed is open, and long enough to protect the bedding
at the top and bottom.
BED MAKING
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.
[Illustration: 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.
[Illustration: 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, pass 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.
[Illustration: 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.
[Illustration: 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 coöperate 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.