Patients care and comfort

measures. Admission, Transfer

and Discharge. Bed making,
bathing of patients, General
comfort measures

TJIKONGO MARGALETTA SELMA
3nd YEAR 2end SEMESTER
GENERAL SURGERY DEPARTMENT




YEAR 2014




ADMISSIONS


An admission is the official entry of a person into health care setting. A person
who needs health care must be formally admitted to the health care facility that
will be providing the care, whether the length of the stay is short or life long.
Aim of admission process
In the case of a home health care agency, the health care setting is the clients
home, but there may still be an admissions process. This is because admission is a
time of orientation, for new patient, resident, or client and the health care team.
During the admissions process, the patient, resident, or client is informed of her
rights and the policies of the facility or agency, and introduced to the people who
will be caring for her. At the same time, the members of the health care team are
introduced to the person and her family, and the process of gathering the
information that the health care team needs to care for the person properly begin
Duration of admission
A few hours (for example, a person entering an outpatient surgical unit for
same-day surgery)
A few days or weeks (for example, a person entering a hospital to receive
treatment for a complication of diabetes)
A few months
The rest of the persons life (for example, a person entering a long-term care
facility)

The Admissions Process
Because the admissions process is an emotional time for the patient or resident
and his family members, you must focus on the person and his needs, as well as
on the process and the paper-work. Most admissions follow a process established
by the health care facility:
1. The admissions process usually begins in a doctors office, unless the
admission is caused by an emergency. In the case of an emergency, the
person may arrive at the health care facility without seeing his doctor first.
Normally, however, the admissions process begins when a doctor writes
orders regarding the specific needs of the person. These orders usually
include:
the doctors diagnosis of the persons condition
specify dietary orders
activity status
medications
diagnostic tests
the type of room required by the person.

2. On arrival at the health care facility, the person first goes to the admissions
office, where he meets with an admissions clerk or a nurse who is
responsible for admissions. The health care team member who is handling
the admission will help the person to complete an admission sheet, which
gathers standard information about the person, such as his name, address,
date of birth and age, social security number, gender, insurance and
employment information, emergency notification information, and advance
directive information.
The admissions clerk or nurse will also have the person sign a consent form
giving the facility permission to treat the persons medical condition. When
the admissions paperwork is completed, the admissions clerk or nurse will
provide the patient or resident with a way of being identified. In a hospital,
an identification bracelet will be issued. In a long-term care facility, a
photograph of the person will be taken for identification purposes.
3. After completing the admissions paperwork, the person will be escorted to
his room by the admissions clerk or nurse, a volunteer, or a nursing
assistant. Depending on the situation, the person may be able to walk to his
room, or he may be taken there in a wheelchair or on a stretcher.
4. A nursing assistant is usually responsible for helping the person to unpack
and for taking and recording the persons vital signs, height, and weight. If
you work in a hospital, you may need to help the person change into a
hospital gown or pajamas. Make sure that the person is comfortable by
helping him into bed or a chair. Next, a nurse will come to the patients or
residents room to complete the nursing history.
A typical admissions pack would contain a basin, a water pitcher, a drinking cup, a
package of tissues, and assorted personal care items (such as toothpaste, soap,
and shampoo). Preparing the room in a thoughtful manner indicates to the new
patient or resident that his arrival was anticipated and planned for.
This video will guide you on how to do admission.
http://www.youtube.com/watch?v=XtsDRKGV9xg







Bed making
For someone who is tired or ill, nothing is quite as comforting as clean, crisp
linens on the bed. Clean linens are essential not only for your patients or
residents comfort, but also for infection control and the prevention of skin
breakdown and pressure ulcers. A neat, well-made bed is a sign that the facility
provides capable, competent care to its patients or residents.


Supplies of bed making
Draw sheet
Lift sheet
Bed protector
Linens
Bath blanket
Mattress pad
Bed protectors
Blankets
Pillows and pillow cases
Bed spreads
Draw sheet
Top and bottom sheets


STANDARD BEDMAKING TECHNIQUES
Routine bed making is usually done in the morning, before visiting hours, while
your patients or residents are bathing or dressing. How often the linens on a
persons bed are changed will vary according to the type of health care facility
and the persons needs. For example, in a hospital, the policy may be to change
each persons linens completely on a daily basis. In a long-term care setting, the
policy may call for less frequent linen changes.
However, a persons bed must be remade each time any of the linens become
soiled or excessively wrinkled, regardless of the time of day. Soiling of the sheets
can occur as a result of spilled food or drink or as a result of excessive sweating,
vomit, urine, feces, wound drainage, or leakage from a feeding tube. In each of
these instances, a linen change would be required. Change as many of the bed
linens as necessary to ensure a clean, dry, wrinkle-free bed for your patient or
resident.

Guidelines on how to handle linens
Always wash your hands before collecting clean linens.
Do not hold linens, clean or dirty, against your uniform.
When collecting linens, collect only those that you will need for that
persons bed. For example, if a draw sheet is not needed, do not collect
one.
Collect linens in the order that they will be used.
Once you have collected your stack of linens, flip the stack over so that the
item you will need first is on the top of the stack.
Place clean linens on a clean surface in the room, such as the over-bed
table or a chair.
Do not place clean linens on the floor.
Wear gloves when removing used linens from a bed.
Roll the linens toward the center of the bed to confine the soiled area
inside.
If body fluids or substances leak through the linens to the mattress or bed
frame, the mattress or bed frame should be wiped with an appropriate
cleaning solution before placing clean linens on the bed
Remove your gloves and wash your hands before handling the clean linens.
After removing the dirty linens from the bed, place them in the linen
hamper immediately.
Your facility may require you to place dirty linens in a plastic bag or
pillowcase before placing them in the linen hamper.
Do not place dirty linens on the floor or on any other surface.

Guidelines for Bed making
1. Always place linens on the bed so that the seams of the sheets face away
from the persons skin because sheets can rub the persons skin, causing
irritation and leading to skin breakdown. Linens must be pulled tightly to
avoid wrinkling.
2. Layering should be kept to a minimum. Because the wrinkles and extra
layers of linens can cause skin breakdown and contribute to the formation
of pressure ulcers.
3. Linens should be changed whenever they become soiled or wet, regardless
of the time of day. Besides causing discomfort, soiled or wet sheets can
cause skin breakdown and contribute to the formation of pressure ulcers.
4. Do not shake linens when placing them on the bed. Because Dust is a
transport mechanism for microbes. Shaking linens stirs up dust from the
floor. The dust then settles on surfaces in the room and can be easily
transferred onto eating utensils or into a wound, causing an infection.
5. When you need to change the linens on a persons bed with the person still
in the bed, always be sure to explain what you are doing throughout the
procedure. Talk reassuringly to the person, even if the person is
unconscious and you think that the person cannot hear you. Close the door,
pull the privacy curtain, and keep the person covered at all times. since
Having the bed linens changed while still in the bed can be a frightening
experience for a bedridden person, particularly if the person is
unconscious. Even if the person is conscious, movement may cause pain,
and incontinence (the involuntary loss of urine or feces) can be
embarrassing if it occurs. If the person is mentally impaired, he or she may
become combative. Explaining what you are doing and taking care to
preserve the persons modesty during the procedure will make the
procedure more pleasant for the person.
6. Check the bed linens for personal items before removing the linens from
the bed. Personal items, such as dentures, eyeglasses, or jewelry, may
become lost in the bed linens. If these linens are removed from the bed,
bundled up, and sent to the laundry, the mislaid personal items may not be
discovered and they could be damaged in the wash cycle, or they may be
lost altogether. Personal items may be expensive and inconvenient to
replace. If they hold sentimental value, they may be irreplaceable.

Closed (Unoccupied) Beds
A closed bed is an empty bed is the bed that is unoccupied because the previous
patient or resident has been discharged from the facility and a new patient or
resident has yet to arrive is considered a closed bed. Similarly, a bed that is
unoccupied because the patient or resident is simply not in it at the moment (and
is not expected back any time soon) is also considered a closed bed. For example,
many long-term care facilities make closed beds each day for residents who are
not bedridden.
Procedure how to make a closed bed.
When the top sheet, blanket, and bedspread of a closed bed are
turned back, or fan folded, the closed bed becomes an open bed, or a
bed ready to receive a patient or resident. For example, you would
open a bed in preparation for a new admission, or after you have
changed the linens while a patient or resident is bathing or out of the
room for a diagnostic test. Because the patient or resident would be
expected to return to the bed shortly, you would fanfold the linens
back in anticipation of his return. Similarly, in some long-term care
facilities, the linens on the beds of residents who are not bedridden
are folded back in the evening, before the residents return to their
rooms.

To open a closed bed, you first grasp the bedspread, blanket and top sheet and
fold them back to the foot of the bed, creating a fanfold . Finish by making sure
that the bed is in the lowest position and the bed wheels are locked. Place the call
light control near the head of the bed, clipping it to the bottom sheet.

A surgical bed
Is a closed bed that has been opened to receive a patient or resident who will be
arriving by stretcher. A surgical bed may be prepared for a patient who is
returning to the room following surgery or a diagnostic procedure, or for one who
is being transferred from another unit (such as the emergency room). When
preparing a surgical bed, instead of folding the top sheet, blanket, and bedspread
to the foot of the bed, you loosen these linens from the foot of the bed and fold
them toward the side of the bed, leaving one side open and ready to receive the
person


The following videos will guide you on how to do bed marking.
http://www.youtube.com/watch?v=XBQcHc9vKvc
http://www.youtube.com/watch?v=rf5qELHsUoU
TRANSFERS
A transfer occurs whenever a patient or resident is moved within or between
health care settings. A transfer can be:
From one room to another (for example, from a semi-private to a
private room)
From one unit to another [for example, from the intensive care unit
(ICU) to a standard care floor]
From one health care facility to another (for example, from a long-
term care facility to a hospital for the treatment of an acute illness)
Transfers can occur when a persons medical condition improves, or
when it worsens.
Transfers can also occur when a preferred room becomes available
for a person on a waiting list, or when it is necessary to move people
to resolve conflicts between roommates.


As is the case with admissions, transfers can be stressful for the patient or
resident, as well as her family members. The reason for the transfer may cause
anxiety, especially if the persons condition has worsened or if the person is being
transferred from a hospital to a long-term care facility. These transfers may not
be expected or desired by either the person or the persons family members.
They are usually the result of necessity. Even if the transfer is expected and
desirable (for example, a resident in a long-term care facility is moving from one
room to another because the view is better), the person being transferred may
still experience some stress as a result of the change.


Ways of transferring patients
The patient or resident may simply walk
transported in a wheelchair or on a stretcher
By bed from moved to another room or unit.
An ambulance may be used when a person is being moved from one health
care facility to another.
Your duties related to assisting with transfers will vary according to the type of
facility where you work. In a hospital or acute care setting, you will be responsible
for gathering and packing the persons belongings. It is very important that you
help to make sure that all of the persons belongings are packed and sent along
with her, so that nothing gets lost. You may also need to assist the nurse in
transporting the person to the new room or unit, or to the waiting ambulance,
car, or taxi. The nurse is usually responsible for reporting information about the
persons medical condition and medications or other treatments to the receiving
nurse. If the transfer is taking place within the hospital, you may be asked to
report information about the persons preferences and habits to the receiving
nursing assistant.
In a long-term care facility, the assistance you provide will be more personal.
Although the nurse will report medical information about the resident to the
receiving nurse, you will be responsible for reporting personal care information
about the resident to the receiving nursing assistant. This is appropriate, because
you are the caregiver who is most likely to know the most about your residents
personal preferences. For example, you would know that Mr. Vasquez does not
like overcooked vegetables, that he requires minimal assistance in the bathroom,
and that he likes to read the paper after breakfast. By providing the new nursing
assistant with this information, you are helping to ensure that the transition from
one caregiver to another is as seamless as possible for your resident.

This video will guide you on how to transfer.
http://www.youtube.com/watch?v=UIQVmySJR4Y

DISCHARGES
A discharge is the official release of a patient or resident from a health care
facility to her home. A patients or residents discharge is ordered by the
doctor. Occasionally, a person will insist on leaving a health care setting
without a doctors order, or against medical advice (AMA).
A person who is mentally competent may choose to leave a facility if she
wants to. However, that person must sign certain documents first. By signing
these documents, the person states that she understands that leaving the
facility without a doctors order releases the doctor and the health care facility
from any legal responsibility regarding her health status because she has
refused to follow the recommendations for her care. If a person tells you that
she is leaving the facility, you must report this to the nurse immediately. The
nurse will follow the facilitys policy for ensuring that a person who is leaving
AMA is aware of the consequences of her actions. Although some people
initiate their own departure from a health care facility, most people wait to be
officially discharged.
Many times, the official discharge is a happy event, but sometimes, people have
mixed emotions about leaving. Many patients are still acutely ill or need
complicated treatment and care at the time of their discharge from the hospital.
For these people and their family members, leaving behind the safe, professional
care provided by the hospital staff can be a frightening experience. To help ease
the transition from a health care facility to home for patients and residents,
preparations for discharge begin as soon as a person is admitted to the health
care facility. Discharge planning is the process used by the members of the health
care team to help prepare a patient or resident to leave the facility. Discharge
planning helps to make sure that the person continues to receive quality care,
either from a home health care agency or from family members after the
discharge.
The purpose of discharge planning is to identify the needs that a person will
have after his discharge and to make arrangements for meeting these needs
after the person goes home.
For example, as a result of discharge planning:
A patients family members may be taught how to change a wound
dressing before the patient is sent home
A resident and his family may receive help in planning a special diet
before the resident is sent home
Arrangements may be made to transfer a patient from the hospital to a
long-term care facility for a short recovery period.
The ultimate goal of discharge planning is to help the patient or resident achieve
the best health status possible after he leaves the health care facility, When a
patient or resident is discharged from a health care facility, the nurse is
responsible for making sure that the person and his family members have been
taught what they need to know about the persons condition and how to monitor
or care for it. Your responsibilities when a person is discharged are related more
to helping the person to gather and pack his belongings and say goodbye to
friends and caregivers. Ask the nurse or the person about the estimated time of
discharge so that you can have the person ready to leave on time, taking into
account the time the person needs to pack and say his goodbyes, You may need
to assist the person out of the facility or help to carry his belongings.

This video will guide you on how to discharge a patient.
http://www.youtube.com/watch?v=UIQVmySJR4Y