Chapter 18 The Person’s Unit Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

The Person’s Unit The person’s unit is the personal space, furniture, and equipment provided for the person by the agency. The person’s unit is a private area. Patient and resident rooms are designed to provide comfort, safety, and privacy. OBRA and CMS have requirement for resident’s room that are monitored during surveys A private room is for one person. Semi-private rooms are for two people. Some agencies have rooms that are shared by four people. Review the Focus on Long-Term Care and Home Care: The Person’s Unit Box on p. 287 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Comfort Temperature and ventilation Most healthy people are comfortable when the temperature is 68 F to 74 F. Older and ill persons may need higher temperatures. Protect infants, older persons, and those who are ill from drafts. Have them wear the correct clothing. Have them wear enough clothing. Offer lap robes to those in chairs and wheelchairs. Provide enough blankets for warmth. Cover them with bath blankets when giving care. Move them from drafty areas. Age, illness, activity, temperature, ventilation, noise, odors, and lighting affect comfort. Review the Focus on Children and Older Persons: Temperature and Ventilation Box on p. 288 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Odors Odors occur in health care settings and in home care. Perfume in not allowed to be worn by staff Bowel movements, urine, draining wounds, and vomitus have embarrassing odors-use room deodorizers as needed Body, breath, and smoking odors may offend others. Smoke odors present special problems. Residents can only smoke in the areas allowed. Good nursing care, ventilation, and housekeeping practices help prevent odors. Some people are very sensitive to odors. To reduce odors, follow the guidelines on p. 289 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Noise Common health care sounds may disturb some patients and residents. Loud noises may increase anxiety or frighten some residents Loud talking and laughter in hallways and at the nurses’ station are common. To decrease noise: Control your voice. Handle equipment carefully-watch rolling carts etc Keep equipment in good working order. Answer phones, signal lights, and intercoms promptly. Patients and residents may think that the staff are talking and laughing about them. Patients and residents may become upset, anxious, and uncomfortable. What is noise to one person may not be noise to another. Review the Focus on Children and Older Persons: Noise Box on p. 289 in the Textbook. Review the Focus on Communication: Noise Box on p. 289 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Lighting Good lighting is needed for safety and comfort. Adjust lighting to meet the person’s changing needs and wishes Always keep light controls within the person’s reach. This protects the right to personal choice. Glares, shadows, and dull lighting can cause falls, headaches, and eyestrain. A bright room is cheerful. Dim light is better for relaxing and rest. Persons with poor vision need bright light. Bright lighting helps the staff perform procedures. Review the Focus on Children and Older Persons: Lighting Box on p. 290 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Room Furniture Rooms are furnished and equipped to meet basic needs. The right to privacy is considered. The patient is encouraged to bring in personal items The room is maintained according to the patient’s wishes The bed must be of proper height and size for the resident The room has equipment to communicate with staff, family, and friends. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Beds-Side rails are optional. What is the biggest risk? Electric beds Controls are on a side panel, bed rail, or the foot board. Patients and residents are taught to use controls safely. Manual beds have cranks at the foot of the bed. The cranks are up for use and kept down at all other times. Patients and residents are told of any position limits or restrictions. Staff can lock most electric beds into any position. Persons restricted to certain positions may need their beds locked, so may persons with confusion or dementia. Review the Promoting Safety and Comfort: The Bed Box on p. 291 in the Textbook. Review the Focus on Long-Term Care and Home Care: The Bed Box on p. 291 in the Textbook. A doctor’s order is needed for Trendelenburg’s position and for reverse Trendelenburg’s position. Review the Focus on Long-Term Care and Home Care: Bed Positions Box on p. 292 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Bed Positions The six basic bed positions are: Flat Fowler’s position 45-60 degrees High-Fowler’s position 60- 90 degrees Semi-Fowler’s position 30 degrees Trendelenburg’s position HOB is low and feet are high-requires a doctor’s order! Reverse Trendelenburg’s position HOB is high and feet low Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Fowlers Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Overbed Table The overbed table is moved over the bed by sliding the base under the bed. It is raised or lowered for the person in bed or in a chair. It is used for meals, writing, reading, and other activities. The nursing team uses the overbed table as a work area-but must be cleaned after Place only clean and sterile items on the table. Never place bedpans, urinals, or soiled linen on the overbed table. Clean the table after using it for a work surface. Also clean it before serving meal trays. The bedside stand has a top drawer and a lower cabinet with shelves or drawers. Never place bedpans, urinals, or soiled linen on the top of the stand. Clean the bedside stand after using it for a work surface. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Bedside Stand The bedside stand is next to the bed. It is used to store personal items and personal care equipment. Place only clean and sterile items on top of it. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Chair and Privacy Curtains The person’s unit has a chair for personal and visitor use. The chair must be comfortable and sturdy. It must not move or tip during transfers. It must not be too low or too soft. The person’s unit has a privacy curtain that extends around the bed. Always pull the curtain completely around the bed before giving care. Privacy curtains only block others from seeing the patient. They do not block sound or voices. The person should be able to get in and out of the chair with ease. Nursing center residents may bring chairs from home. Rooms with more than one bed have a privacy curtain between the units. Review the Focus on Long-Term Care and Home Care: Privacy Curtains Box on p. 296 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Personal Care Items Personal care items Personal care items are used for hygiene and elimination. Some persons bring their own personal care products. The agency provides: Bedpan and urinal Wash basin, emesis basin, water pitcher and cup, and soap and a soap dish Some agencies also provide powder, lotion, toothbrush, toothpaste, mouthwash, tissues, and a comb. Respect the person’s choices in personal care products. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Call Lights The call system lets the person signal for help. When using an intercom system, remember confidentiality. Persons with limited hand mobility may need a signal light that is turned on by tapping it with a hand or fist. You must: Keep the signal light within the person’s reach. Place the signal light on the person’s strong side. Remind the person to signal when help is needed. Answer signal lights promptly. Answer bathroom and shower or tub room signal lights at once. To get help, the person presses a button at the end of the signal light. The staff member shuts off the light at the bedside when responding to the call for help. Keep the signal light within the person’s reach even if the person cannot use the signal light. Visitors or staff may need to signal for help. Review the Focus on Communication: The Call System Box on p. 299 in the Textbook. Review the Focus on Long-Term Care and Home Care: The Call System Box on p. 299 in the Textbook. Review the Teamwork and Time Management: The Call System Box on p. 299 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Bathrooms Bathroom A toilet, sink, call system, and mirror are standard equipment. Grab bars are by the toilet for safety. Some bathrooms have higher toilets or raised toilet seats. Bathrooms have signal lights. They are usually next to the toilet. The sound of the bathroom call light at the nurses’ station is different from signal lights in rooms. Someone must respond at once when a person needs help in a bathroom. Some bathrooms have showers. The person uses grab bars for support when lowering to or rising from the toilet. Raised toilet seats make wheelchair transfers easier. They are helpful for persons with joint problems. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Closet and Drawer space OBRA and the CMS require that nursing centers provide each person with closet space. The closet space must have shelves and a clothes rack. The person must have free access to the closet and its contents. Items in closets and drawers are the person’s private property. You must have the person’s permission to open or search closets or drawers. Agency staff can inspect a person’s closet or drawers if hoarding is suspected. The person is informed of the inspection. He or she is present when the inspection takes place. Review the Promoting Safety and Comfort: Closet and Drawer Space Box on p. 300 in the Textbook. Review the rules in Box 18-2 on p. 301 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.