April 4, 2012

Tips For Bedside Care

The following are some bedside care tips provided by The Hospice Patients Alliance

Making arrangements for Assistance:

If you have even a few friends or family members who are willing to help out, you could make out a list of people willing to help out around-the-clock, when it becomes necessary. Of course, because of the intimate nature of bedside care, any person helping would have to be acceptable to your loved one. A friend or relative who is a nurse would be able to demonstrate how to provide bedside care. The RN case manager from the hospice will also show you what needs to be done. When a person is unable to get up out of bed, or even turn in bed by themselves, they are dependent on the caregiver for their needs. Hospice care is directed toward meeting the needs of the terminally ill. You will be an important part of the overall team that helps to keep your loved one comfortable and helps to meet his or her needs.

Scheduling Helpers:

Being organized in making schedules for help will help relieve you of bearing the full responsibility for care. Even with hospice services, there will be many times when you will need to be at the bedside assisting your loved one. Of course, if there is an actual crisis in symptoms out of control, then the hospice will provide additional continuous nursing care. Learning how to provide the care needed without straining your back or otherwise injuring yourself is so important.

Positioning the Bed:

Because you will be caring for your loved one when he becomes unable to move or turn on his own, the bed must be positioned so that you can walk along both sides of the bed and reach him from either side. Trying to work from only one side is not practical, may cause you to strain your back, and will make bedside care extremely difficult.

Raising or Lowering the Ends of the Bed:

It is helpful to have a hospital bed for patient care, when patients’ strength declines and they are unable to get up on their own. Hospital beds have mechanisms to raise or lower both the head or foot of the bed, which makes patient comfort easier to maintain. It is common for many patients to resist the idea of using a hospital bed, feeling that allowing a hospital bed into the home is equivalent to admitting defeat, that death is approaching. However, the reality is that death is approaching, and patient comfort is the goal now. When patients have congestive heart failure or respiratory disease, a hospital bed’s ability to raise the head of the bed up will greatly help the patient to breathe more easily.

Side rails and Safety:

Hospital beds also have side rails which can help prevent the patient from falling out of bed. They serve to physically hold the patient back in bed if they roll over the side and also remind the patient about the edge of the bed. These are extremely important to have if the patient is confused or may become confused in the future. It may be necessary to have someone sitting with your loved one 24 hours a day if he or she becomes seriously confused or agitated. When a patient is very confused, she may attempt to get up out of bed independently, even though she’s too weak to stand on her own and would fall down.

Terminal Agitation:

Many patients (although not all) may become quite restless or even agitated as they approach nearer to death. Even if your loved one is normally quite calm and peaceful, how he acts at this time may change dramatically and drastically. Some patients become quite anxious and seemingly nothing you do can help them calm down. This type of agitation is called terminal restlessness and is a major symptom which needs to be controlled for your loved one’s safety and well-being. Experienced hospice nurses know that such a patient, if left alone for even a moment, may get up out of bed and fall or injure himself. Some patients have been known to crawl right over or in between the siderails of a hospital bed, and then fall! The attending physician will order medications which will help to calm your loved one down and relieve the agitation.

Using a Regular Bed:

If your loved one refuses to use hospital bed, it is possible to place cushions (such as might be used in couches) under the mattress to raise the head of the bed up and help the patient breathe more comfortably. Placing pillows on top of the bed is not as effective or easy to use. Siderails may be purchased at some department stores which can be secured in place by placing a part under the mattress. Keep Linens Flat and Smooth: Keeping the bottom bed sheets flat and smooth will help your loved one to be comfortable. Wrinkles in the bed or any debris will irritate the skin and cause discomfort as well as injury to the skin. While it is not easy to completely straighten out the linens when the patient is in the bed, you can snug up the sheets on one side, then roll the patient on top of the smooth sheets, and then smooth out the other side. Also remember to leave the top sheet loose enough so that it does not press down on his feet or feel uncomfortable. Some patients become so sensitive that they cannot tolerate anything at all laying on top of their feet, even a sheet!

Need to Avoid Dragging:

When your loved one experiences difficulty turning himself or pulling himself up in bed, pulling or pushing him without lifting will result in dragging his body across the bed. Dragging him from side to side or up in bed can cause injury to the skin, so it should be avoided. Any time you wish to turn or move him, the bed should be flat, if this is possible. If you have a hospital bed, the electric or manual controls will allow you to lower the head of bed briefly while this task is performed.

Drawsheets used to lift or turn your loved one:

When moving a patient in bed, it is quite useful to place folded sheets across the bed linens with your loved one on top. Then when it becomes necessary to help move your loved one, you and another person can pull and lift this draw sheet to turn or move him in bed. This helps to avoid dragging him across the bed. Pulling on the patient’s arms to position him should be avoided. The sheet should be folded so that the distance from the shoulders to the knees is lifted when using the draw sheet. How to use a draw sheet is something your nurse can demonstrate for you.

Turning from Side to Side:

In hospitals, it is the standard to turn or roll a patient in bed every two hours, so that skin breakdown and bedsores do not occur. If your loved one is unable to move on his own, you will need to turn him on a regular basis. Using a drawsheet is helpful for turning as well as pulling your loved one up in bed. Your RN case manager will be able to advise you as to how often turning is necessary in your situation.

When you assist your loved one to lay on his side in bed, you can use a rolled blanket or a pillow tucked against his back to help keep him on his side, otherwise he may roll back over onto his back. Placing a pillow between the knees and ankles can help make your loved one more comfortable as well.

In some cases, at the very end, it will not be appropriate to turn your loved one in bed, because this could be more disturbing or painful at this time. There is no need to be concerned about bedsores if the patient is actively dying at the very end. Maintaining comfort is most important. Whatever is done should be based upon your loved one’s comfort.

Changing the Sheets:

When your loved one becomes bedbound and can’t reposition himself, it will be more difficult to change the sheets. But changing the sheets on a regular basis is important and can help him to be more comfortable; keeping clean and dry are part of patient comfort. The way to change sheets with the patient in bed is to get the patient over toward one half of the bed, then pull the sheets out on one side and tuck them under the patient, place clean sheets on the unoccupied side of the bed with the excess tucked against the patient, roll the patient back onto the clean sheets and pull out the old sheets and pull the clean sheets all the way out and make the bed, tucking the ends under the mattress. With a little patience and nursing technique, the job can be done without too much difficulty!

After death care:

For many family members, even thinking about death or after death issues is virtually impossible, …something to be avoided at any cost. However, your loved one may have definite wishes about the funeral, after death care and other arrangements. Different religions have certain restrictions about after death care which must be respected. It is important to find out if your loved one has specific requests about after death care and arrangements.

After death occurs, the hospice nurse will either assist you with after death care or perform this care by herself. Your loved one’s body may need cleansing due to urinary and bowel incontinence. Clothing may need to be changed if soiled. The body should be placed in a suitable position for viewing, with legs straight and head of bed lowered down flat. If rings or other jewelry are to be given to others after death occurs, they should be removed after family and close friends have an opportunity to say goodbye.

Depending on the religious beliefs and wishes of your loved one, the minister, priest, or rabbi may be called to perform prayers with the family present. In other religious traditions, no special prayer is performed after death, but is to be performed before death occurs. All of these issues need to be addressed long before death occurs.

It is quite common for families and close friends to wish to visit at the scene of death right after death occurs. It is a very intimate time for final goodbyes to be said. This is one reason why it is so important to allow all family members and close friends an opportunity to say goodbye.

The hospice nurse, chaplain or social worker may assist you in calling the funeral home. When the representative from the funeral home comes out to the home, he will ask for the exact time of death, name of the attending physician, date of birth, and other information. It is helpful to make decisions about funeral arrangements prior to the time of death if at all possible, because after death it is an extremely emotional time, and making such decisions at that time can cause even more emotional upset. It is also helpful to make decisions prior to death, because your loved one would have an opportunity to express his wishes.