1. Chapter 18
The Person’s Unit

2. 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.
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.

3. 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.

4. Comfort (cont’d) Odors occur in health care settings and in home care.
Bowel movements, urine, draining wounds, and vomitus have embarrassing odors.
Body, breath, and smoking odors may offend others.
Smoke odors present special problems.
Residents, visitors, and staff smoke only in the areas allowed.
If you smoke, follow the agency’s policy. Practice hand washing after handling smoking materials and before giving care.
If you smoke, give careful attention to your uniforms, hair, and breath.
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.

5. Noise According to the CMS, 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

6. Noise (cont’d)
Common health care sounds may disturb some patients and residents.
Loud talking and laughter in hallways and at the nurses’ station are common.
People want to know the cause and meaning of new sounds.
Health care agencies are designed to reduce noise.
Window coverings, carpets, and acoustical tiles absorb noise.
To decrease noise:
Control your voice.
Handle equipment carefully.
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.

7. Lighting According to the CMS, comfortable lighting: Lessens glares
Lets the person control the intensity, location, and direction of light
Lets visually impaired persons 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.
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.

8. Room Furniture and Equipment
Rooms are furnished and equipped to meet basic needs.
The right to privacy is considered.
Beds
Beds have electrical or manual controls.
Beds are raised horizontally to give care.
The lowest horizontal position allows the person to get out of bed with ease.
The head of the bed is flat or is raised to varying degrees.
The room has equipment to communicate with staff, family, and friends.

9. Room Furniture and Equipment (cont’d)
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.
The six basic bed positions are:
Flat
Fowler’s position
High-Fowler’s position
Semi-Fowler’s position
Trendelenburg’s position
Reverse Trendelenburg’s position
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.

10. Fowler’s Position

11. High-Fowler’s Position

12. Semi-Fowler’s Position

13. Trendelenburg’s Position (Head Down, Feet Up)

14. Reverse Trendelenburg’s Position (Head Up, Feet Down)

15. Room Furniture and Equipment (cont’d)
Bed safety involves the hospital bed system.
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 headboard or footboard
Entrapment within parts of the hospital bed system is a risk.

16. Room Furniture and Equipment (cont’d)
Serious injuries and deaths have occurred from head, neck, and chest entrapment.
Arm and leg entrapment also can occur.
Persons at greatest risk:
Are older
Are frail
Are confused or disoriented
Are restless
Have uncontrolled body movements
Have poor muscle control
Are small in size
Are restrained

17. Room Furniture and Equipment (cont’d)
Hospital bed systems have 7 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 headboard or footboard
Zone 7: Between the headboard or footboard and the end of the mattress
Refer to Figure and 18-12, A through G, on pp in the Textbook.
If you feel a person is at risk for entrapment, report your concerns to the nurse at once.
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.
Call for the nurse at once.
Review the Focus on Children and Older Persons: Bed Safety Box on p. 293 in the Textbook.

18. Zone 1
Zone 2

19. Zone 3
Zone 4

20. Zone 5
Zone 6

21. Zone 7

22. Room Furniture and Equipment (cont’d)
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.
Place only clean and sterile items on the table.
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.
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.

23. Room Furniture and Equipment (cont’d)
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 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.

24. Room Furniture and Equipment (cont’d)
Personal care items
Personal care items are used for hygiene and elimination.
The agency provides:
Bedpan and urinal
Wash basin, kidney basin, water pitcher and cup, and soap and a soap dish
Some persons bring their own personal care products.
Some agencies also provide powder, lotion, toothbrush, toothpaste, mouthwash, tissues, and a comb.
Respect the person’s choices in personal care products.

25. Room Furniture and Equipment (cont’d)
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.
Some people cannot use signal lights.
Check the care plan for special communication measures.
Check these persons often.
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.

26. Room Furniture and Equipment (cont’d)
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.
Towel racks, toilet paper, soap, paper towel dispenser, and a wastebasket are placed within easy reach of the person.
Bathrooms have signal lights. They are usually next to the toilet.
The sound 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.

27. Room Furniture and Equipment (cont’d)
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.
The person’s unit must be kept clean, neat, safe, and comfortable.
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.