Patients come to hospitals and other health care facilities because they need skilled clinical observation and treatment. According to the American Hospital Association, about 37 million people undergo hospitalization each year, and for most, it's a trying experience. After all, hospitalization challenges the patient's sense of privacy and control of his life. He must relinquish at least part of his normal routine. He must rely on you and your coworkers to meet his fundamental needs. Depending on the complexity of his health problem, he and his family may also require teaching, counseling, coordination of services, development of community support systems, and help in coping with health-related changes in his life.
In many facilities, staff nurses, primary nurses, clinical nurse specialists, and nurse practitioners deliver these vital services. This chapter serves as a starting point to help you understand and perform many of these tasks confidently and effectively. It thoroughly covers all the fundamentals: admission, transfer, and discharge procedures; assessment (including a section on writing a nursing care plan); ensuring patient safety and mobility (including proper use of restraints and assistive devices); practicing correct body mechanics and patient transfer techniques; and using special orthopedic beds. The chapter also includes a comprehensive review of personal hygiene and comfort measures, nutrition, elimination, surgical care, spiritual care, and postmortem care.
Before turning to these nursing care specifics, however, review the broader aims of your care such as helping the patient cope with restricted mobility; giving him a comfortable, stimulating environment; making sure his stay is free from hazards; promoting an uneventful recovery; and helping him return to his normal life.
Dealing with restricted mobility
Whenever a patient's condition impairs or prevents mobility, your nursing goals include promoting his independence by motivating him; helping him set goals, to prevent injury and the complications of immobility; teaching him needed skills; and fostering a positive body image, especially if he faces long-term or permanent immobility.
Promoting a comfortable environment
By manipulating physical factors in the patient's environment—temperature, humidity, lighting—you can affect his comfort, condition and, at times, his response to treatment. For example, a room temperature of 68° to 72° F (20° to 22.2° C) and a relative humidity of 30% to 60%, although comfortable for most patients, may be too cold for elderly patients. Also, proper artificial or natural lighting helps duplicate the day-night cycle.
Providing sensory stimulation
Sensory stimulation (such as therapeutic touch) contributes to patient well-being. Although the amount and type of required stimulation varies with each patient, you can prevent sensory overload or deprivation by accurately assessing his needs. When evaluating stimuli in the patient's environment, remember that illness is a stressor that may intensify the patient's responses, especially to noise and odors.
Promoting safety
Besides weakening the patient, illness and any accompanying treatment may impair his judgment and contribute to accidents. Be alert to hazards in the patient's environment, and teach him and his family to recognize and correct them. When caring for a patient with restricted mobility, you must help him as he's moved, lifted, and transported. By using proper body mechanics and appropriate assistive devices, you can prevent injury, fatigue, and discomfort for the patient and yourself.
Preventing complications
For the bedridden patient, immobility poses special hazards such as pressure on bony prominences; venous, pulmonary, and urinary stasis; and disuse of muscles and joints. These can lead to such complications as pressure ulcers, thrombi, phlebitis, pneumonia, urinary calculi, and contractures. To prevent complications, be sure to use correct positioning, meticulous skin care, assistive devices, and regular turning and range-of-motion exercises.
Promoting rehabilitation
The first step toward rehabilitation typically is progressive ambulation, which should begin as soon as possible—if necessary, using such assistive devices as a cane, crutches, or a walker. Effective rehabilitation may also require you to teach positioning, transfer, and mobilization techniques to the patient and his family. Give him and his family the opportunity to demonstrate the skill or technique so that problems may be corrected. Demonstrating a technique—such as transferring from a bed to a wheelchair—during hospitalization helps the patient and his family to understand it. Allowing them to practice it under your supervision gives them the confidence to perform it at home. Encourage them to provide positive reinforcement to motivate the patient to work toward his goals.