Tips for those in care

If you have someone in care here are some hard-learned tips for making their experience better.

1. Those famous, crisp, tight hospital corners on beds are great in theory, but can do long term harm if the patient is recovering from a stroke, in frail condition or in bed for long periods. Tightly made beds, which look sharp and can feel nice and secure for those of us who are well, can do harm to the patient. Tightly tucked in sheets force the foot down causing a condition known as “foot drop”. In simple terms, foot drop occurs when the ankle becomes weak or locked into place. You need to keep sheets from being too tightly tucked in, as well as gently moving the patient’s feet up and down and rotating them. This is part of the range-of-motion movements and exercises which will help keep the patient limber for life after hospital. Linked to foot drop can be sores on the heels, like a localized bed sore. So watch for this. Keep feet lubricated with lotion and from staying in one position for any length of time. If the sores persist, the facility will have thick wool-lined boots for the patient to wear. If they don’t suggest them, ask for them. And do it at the first sign of redness. It will save a lot of pain, discomfort and treatments later.

2. If you are visiting someone make sure your hands are clean. This is the greatest and easiest way to prevent infection. If you don’t have a cold or flu touch them. It makes then feel better. Hold hands, stroke cheeks, squeeze (gently) an arm or shoulder or knee. In care patients are touched all day by strangers, but having a friend or family member do it is a whole different experience. I believe touch helps de-sterilize the experience and keeps the person connected to their real world life. And it lets them know they’re not forgotten. And even if they are not conscious, they will still have the experience of your touch.

3. If the patient is in a wheelchair and on a catheter know that the catheter bag can be discretely hung under the chair so the world is not party to their business. I also noticed in a nursing home that they had bag covers to further disguise the situation. It’s a small thing but does contribute to privacy and dignity.

4. If the patient is in a wheelchair and you want to take them outside for some fresh air, make sure they’re warm. The usual mistake staff and visitors make is to cover the patient’s front. But that often leaves the backside open to breezes. Think of all those jokes about bare asses hanging out of Johnny shirts. Make sure a blanket is used for the patient to sit on and fold over in front on them. If they get too hot, they can throw it back, uncovering their front, but spares them the discomfort of a cool breeze where it isn’t welcome.

5. If the patient is slumped over in the wheelchair, or their feet are too far out for the foot pedals, then they are improperly positioned in the chair. Get the professionals to reposition them so they sit upright.

6. Watch where staff leave the nurse’s call button on the bed. Often these can fall to a place where a bedridden patient can’t reach. Sometimes the button is moved while staff – either nurses, doctors or therapists – attend to the patient. They get called away and forget to put the button where the patient can reach it. This is a serious problem. Another problem is if the patient is weaker on one side – maybe from a stroke or injury – make sure the call button is placed on their good/stronger side.

7. Watch where tray tables are left. This makes the difference between whether a patient eats or nor. For some reason food services staff are not allowed to move the tables so that they are within reach of the patient. Only nurses seem authorized to move them when food is present and they may not be there when food is. It’s not unusual for tables to be moved out of reach by cleaners, visitors, nurses, doctors or porters. A meal arrives and the patient can’t reach it, so they don’t eat. Food services staff return an hour later and take it away without checking with the nurses if the patient refused the food or was too sick to eat. It’s one of those obvious things that gets forgotten.

8. Hospital beds are covered in a plastic or moisture-resistant barrier. This makes for fast cleaning, but is mighty uncomfortable for the patient. This type of covering causes patients to sweat, which adds to their discomfort. (I also wonder if it doesn’t affect temperature readings.) Insist that beds have double sheets on the bottom. This provides some layering so air can flow between the body and bed, and reduce sweating. Pillows are the same, so double pillow-case. And make sure Johnny shirts are fully secured. Often, for their convenience, staff just sort of position the Johnny shirt over the patient’s front, leaving it open in back. This puts the skin in closer touch with plastic, non-breathable surfaces causing the patient to sweat.

9. Talk to the patient about anticipation of needs. In other words, tell them not to wait until the last minute to request going to the washroom. The hospital is not like home. You can’t get up and go when you want. If you need assistance ask before you really need to go. Often nurses and other staff are attending to other patients and can’t just run when you buzz. I’ve seen desperate people wait 30-60 minutes for a nurse to answer their patient call buzzer. Patients don’t need this extra grief. As I write this in the ER I hear a man calling out, “bathroom please!” He’s been yelling that for 12 minutes and no one has gone to his aid. Its not like this ER is busy. People are calmly walking back and forth, two young clerks are giggling. I hope he gets help. But for some reason no one is paying attention to him.

10. Question any meds being administered. I have witnessed a young nurse trying to get an older woman to take a drug she had already had. The patient questioned the nurse and told her not only had she already had this drug, the dosage was many times greater than her prescription. The nurse, who was young and perhaps less experienced, treated the patient as if she didn’t know what she was talking about. However, this patient’s son is a pharmacist, so she was better informed or more aware than many who would blindly accept anything handed to them. Only when the patient insisted the nurse call the doctor did the nurse realize she was in wrong room, trying to give medication to the wrong patient! I worry about ageism in the system. Early on in our family member’s hospitalization we had a situation where the patient was not acting normally. The nurse said, “I’ll get a doctor’s permission to sedate (the patient).” I thought the hell you will, that will only give you a quiet shift, I want to know what’s causing this. Fortunately the doctor on call came in and realized the problem before she even reached the patient’s bedside. It was a matter of stopping what they were doing, letting the patient recover and reattempting this at a slower rate.

11. Ask when personal care is done. And how. When someone is getting a bedbath, their modesty should be preserved at all times. Find out how staff do this because different schools  teach different ways. Only parts of the body should be uncovered at any one time, the patient shouldn’t have to lay fully naked in front of strangers. Also check view plains. Curtains should be closed, so people in other parts of building or workmen on the roof don’t become unexpected voyeurs.

12. Ask when staff take breaks and when shift changes happen. This will save you aggravation wondering where people are or why it takes so long to get assistance.

13. Patients in hospital for a long period will want to have their hair washed. The hospital staff happily provide a “cap”, like a glorified shower cap, with some type of shampoo that they put on the patient’s head. It’s okay, but not great. We found it left an itchy residue not unlike a baby’s cradle cap. So we provided shampoo (just grab those miniatures you get in hotels) and asked the nurses if they would shampoo our family member’s hair. They will do it. It’s best to ask a day ahead so they can accommodate this in their schedule. Hospitals have a special bed tray they put under the patient’s head so it’s a simple thing for them to do, but makes the patient feel so much fresher and comfortable. It’s a small kindness that goes a long way.

14. If the patient seems listless, out-of-sorts, or more lethargic than you think is right, check to make sure they are getting their proper medications. It is astonishing how often facilities focus on a new problem to the exclusion of a pre-existing condition. It is not that unusual for regular medications to be accidentally withheld or withheld longer than was meant.

1 Response to Tips for those in care

  1. barb says:

    Actually some great tips.
    We take so much for granted it is hard to re-think when in hospital.
    I would like to add, this is a hospital and the public comes and goes, please do not have any purses, wallets, jewelery.

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