Chapter 15 The Resident’s Unit All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

A Resident Unit A resident unit is the personal space, furniture, and equipment provided for the person by the nursing center. The person’s room or area of the room is private. It is treated like the person’s home. The intent is to have resident units as personal and home-like as possible. Nursing centers are designed to provide comfort, safety, and privacy. Some residents have private rooms. Others share a room with another person. A resident unit is the personal space, furniture, and equipment provided for the person by the nursing center. Residents bring some furniture and personal items from home. As space allows, the person chooses where to place personal items. This promotes dignity and self-esteem. A resident cannot take or use another person’s space. Doing so violates the other person’s rights. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 2

Comfort Temperature and ventilation Most healthy people are comfortable when the temperature is 68 to 74 F. Older and chronically ill persons may need higher temperatures. OBRA requires that nursing centers maintain a temperature range of 71 to 81 F. Age, illness, and activity affect comfort. Temperature, ventilation, noise, odors, and lighting are also factors. They are controlled to meet the person’s needs. Heating and air conditioning systems maintain a comfortable temperature. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 3

Comfort (Cont’d) To protect persons from drafts: Make sure they wear the correct clothing. Make sure they 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. Good nursing care, ventilation, and housekeeping practices help prevent odors. Smoke odors present special problems. Persons who are less active usually do not like cool areas. Nor do those who need help moving about. Stale room air and lingering odors affect comfort and rest. Ventilation systems provide fresh air and move room air. Drafts occur as air moves. Older persons and those who are ill are sensitive to drafts. Review the actions for reducing odors listed on p. 238. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 4

Smoking If you smoke: Follow the center’s policy. Practice hand washing after handling smoking materials and before giving care. Give careful attention to your uniforms, hair, and breath. Residents, visitors, and staff smoke only in the areas allowed. The center is the person’s home. Keep it free of unpleasant odors. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 5

Noise Control The Centers for Medicaid Services (CMS) requires comfortable sound levels. A comfortable sound level: Does not interfere with a person’s hearing Promotes privacy when privacy is desired Allows the person to take part in social activities To decrease noise: Control your voice. Handle equipment carefully. Keep equipment in good working order. Answer phones, call lights, and intercoms promptly. Many older and ill persons are sensitive to noises and sounds. Common health care sounds may disturb them. People want to know the cause and meaning of new sounds. This relates to safety and security needs. Residents may find sounds dangerous, frightening, or irritating. They may become upset, anxious, and uncomfortable. Nursing centers are designed to reduce noise. Window coverings, carpets, and acoustical tiles absorb noise. Review Residents With Dementia: Noise on p. 239. Review Focus on Communication: Noise on p. 239. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 6

Lighting The CMS requires comfortable lighting. Comfortable lighting: Lessens glare. Allows the resident to control the intensity, location, and direction of light. Allows persons who are visually impaired to maintain or increase independent functioning. Good lighting is needed for safety and comfort. Adjust lighting to meet the person’s changing needs. Always keep light controls within the person’s reach. Good lighting is needed for safety and comfort. Glares, shadows, and dull lighting can cause falls, headaches, and eyestrain. A bright room is cheerful. Dim light is better for relaxing and rest. Review Residents With Dementia: Lighting on p. 239. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 7

Room Furniture and Equipment Rooms are furnished and equipped to meet basic needs. The room has furniture and equipment for comfort, sleep, elimination, nutrition, hygiene, and activity. Equipment to communicate with staff, family, and friends is included. The bed Beds have electrical or manual controls. Beds are raised horizontally to give care. The lowest horizontal position lets the person get out of bed with ease. The head of the bed is flat or raised varying degrees. Electric beds are common. Controls are on a side panel, a bed rail, or the foot-board. Some controls are hand-held devices Manual beds have cranks at the foot of the bed (Fig. 15-4 on p. 240). The cranks are pulled up for use and kept down at all other times. Cranks in the “up” position are safety hazards. The lowest position lets the patient get out of bed with ease. Review Promoting Safety and Comfort: The Bed on p. 239. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 8

Bed Positions The six basic bed positions are: Flat Fowler’s position (a semi-sitting position) High-Fowler’s position Semi-Fowler’s position Trendelenburg’s position A doctor orders this position. Reverse Trendelenburg’s position This position requires a doctor’s order. Flat is the usual sleeping position. The position is used after spinal cord injury or surgery and for cervical traction. Fowler’s position is a semi-sitting position. The head of the bed is raised between 45 and 60 degrees (Fig. 15-5 on p. 240; see Chapter 14). High-Fowler’s position is a semi-sitting position. The head of the bed is raised 60 to 90 degrees (Fig. 15-6 on p. 240). In semi-Fowler’s position, the head of the bed is raised 30 degrees (Fig. 15-7 on p. 241). In Trendelenburg’s position, the head of the bed is lowered and the foot of the bed is raised (Fig. 15-8 on p. 241). A doctor orders the position. In reverse Trendelenburg’s position, the head of the bed is raised and the foot of the bed is lowered (Fig. 15-9 on p. 241). This position requires a doctor’s order. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 9

Bed Safety The FDA defines the hospital bed system as the bed frame and its parts. The mattress Bed rails Head- and foot-boards Bed attachments The person can get caught, trapped, or entangled in spaces created by: The bed frame The head-boards and foot-boards Bed safety involves the hospital bed system. The Food and Drug Administration (FDA) defines the hospital bed system as the bed frame and its parts. The parts include the mattress, bed rails, head- and foot-boards, and bed attachments. Entrapment within parts of the hospital bed system is a risk. Serious injuries and deaths have occurred from head, neck, and chest entrapment. Arm and leg entrapment also can occur. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 10

Persons at Risk for Entrapment Persons at greatest risk of entrapment include persons who: Are older Are frail Are confused or disoriented Are restless Have uncontrolled body movements Have poor muscle control Are small in size Are restrained You may feel that a person is at risk for entrapment. Report your concerns to the nurse at once. Also, always check the person for entrapment. If a person is caught, trapped, or entangled in the bed or any of its parts, try to release the person. Also call for the nurse at once. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 11

The Seven Entrapment Zones Hospital bed systems have seven entrapment zones. Zone 1: Within the bed rail Zone 2: Between the top of the compressed mattress and the bottom of the bed rail and between the rail supports Zone 3: Between the bed rail and the mattress Zone 4: Between the top of the compressed mattress and the bottom of the bed rail and at the end of the bed rail Zone 5: Between the split bed rails Zone 6: Between the end of the bed rail and the side edge of the head-board or foot-board Zone 7: Between the head-board or foot-board and the end of the mattress Review Figure 15-10 on p. 242. Review Figure 15-11 on p. 243. If a person is caught, trapped, or entangled in the bed or any of its parts, try to release the person. Also call for the nurse at once. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 12

Unit Furniture The overbed table is: Placed over the bed by sliding the base under the bed Raised or lowered for the person in bed or in a chair Used for meals, writing, reading, and other activities The bedside stand is used to store personal items and personal care equipment. The resident’s unit has at least one chair for personal and visitor use. It must be comfortable and sturdy. It must not move or tip during transfers. The person should be able to get in and out of the chair with ease. The nursing team uses the over-bed table as a work area. Only clean and sterile items are placed on the table. Never place bedpans, urinals, or soiled linen on the over-bed table. Clean the table after using it for a work surface and before serving meal trays. The top of the stand is often used for tissues and other personal items Often residents bring their own oral hygiene equipment, hair care supplies, and deodorant. Respect the person’s choices in personal care products. The chair is usually upholstered, with armrests. Nursing center residents may bring chairs from home. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 13

Unit Equipment Each person has the right to full visual privacy. Full visual privacy means that a person has a means to be completely free from public view while in bed. Always pull the privacy curtain completely around the bed before giving care. The bathroom A toilet, sink, call system, and mirror are standard equipment. Grab bars are by the toilet for the person’s safety. Some bathrooms have raised toilet seats. Towel racks, toilet paper, soap, paper towel dispenser, and the wastebasket are placed within easy reach of the person. OBRA and the CMS require that rooms are equipped and designed for full visual privacy. Rooms with more than one bed have a privacy curtain between the units. Many centers have a bathroom in each room. Some have a bathroom between two rooms. The person uses grab bars for support when lowering to or raising from the toilet. Higher toilets make wheelchair transfers easier. They also are helpful for persons with joint problems. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 14

Call System The call system lets the person signal for help. When using an intercom, remember confidentiality. Some people cannot use call lights. Check the care plan for special communication measures. Check these persons often. To promote safety, you must: Keep the call light within the person’s reach. Place the call light on the person’s strong side. Remind the person to signal when help is needed. Answer call lights promptly. Answer bathroom and shower or tub room call lights at once. The CMS requires a resident call system. When in their rooms, using the toilet, or in a bathing area, residents must be able to contact the staff at the nurses’ station. An intercom system lets the staff talk with the person from the nurses’ station. The person tells what is needed. The call light is at the end of a long cord (Fig. 15-14 on p. 244). It connects to a light panel or intercom system at the nurses’ station (Fig. 15-15 on p. 245). Some call lights are turned on by tapping with a hand or fist (Fig. 15-16 on p. 245). They are useful for persons with limited hand mobility. The person is taught how to use the call system when admitted to the center. Some people cannot use call lights. Examples are person who are confused or in a coma. The care plan lists special communication measures. Check these persons often. Review Teamwork and Time Management: The Call System on p. 245. Review Focus on Communication: The Call System on p. 245. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 15

Closets, Drawers, and Other Equipment Closet and drawer space Each person is provided with closet and drawer space. The closet space must have shelves and a clothes rack. The person must have free access to the closet and its contents. Other equipment Nursing centers may allow residents to bring furniture and other items from home. TVs, radios, clocks, photos, and other small items help residents feel “at home” in their units. OBRA and the CMS require that nursing centers provide each person with closet space. Items in closets and drawers are the person’s private property. You need to have the person’s permission to open or search closets or drawers. Review Promoting Safety and Comfort: Closet and Drawer Space on p. 246. Review Promoting Comfort and Safety: Other Equipment on p. 246. Review Focus on Rehabilitation: Other Equipment on p. 247. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 16

Quality of Life The center is the person’s home. A home-like setting is important. Personal choice is always allowed in arranging items. The health team must help the person feel safe, secure, and comfortable. Everyone involved in the person’s care must keep the unit clean, neat, safe, and comfortable. OBRA and the CMS serve to promote quality of life. Review the actions for maintaining the person’s unit listed in Box 15-1 on p. 247. The health team must make sure that the person’s choices: Are safe Will not cause falls or other accidents Do not interfere with the rights of others Review the OBRA and CMS Requirements for Resident Rooms listed in Box 15-2 on p. 248. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 17