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Comfort

• Comfort is affected by age, illness, activity, temperature, ventilation, noise, odors, and lighting.

• Healthy comfort range: 68^\circ F to 74^\circ F; older and ill persons may need higher temperatures.

• Protect infants, older persons, and the ill from drafts.

• Use appropriate clothing and enough layers; offer lap robes; provide blankets; bath blankets during care; move away from drafts as needed.

Odors

• Odors occur in health care settings and home care (bowel movements, urine, draining wounds, vomitus).

• Check residents often to manage odors; body, breath, and smoking odors can offend others.

• Smoke odors require designated areas; follow agency policy; wash hands after smoking and before care; care for uniforms, hair, and breath.

• Good nursing care, ventilation, and housekeeping help prevent odors.

Noise

• CMS defines a "comfortable" sound level as not interfering with hearing, promoting privacy, and allowing social participation.

• Common sounds (loud talking/laughter) may disturb patients; they may think staff are talking about them.

• Health care facilities reduce noise by: window coverings, carpets, acoustical tiles; control voice; handle equipment carefully; keep equipment in good order; answer phones, call lights, and intercoms promptly.

Lighting

• CMS defines comfortable lighting as: less glare; enabling residents to control light intensity, location, and direction; aiding visually impaired individuals to maintain independence; safety and comfort.

• Adjust lighting to changing needs; light controls should be within the person’s reach to protect personal choice.

• Bright rooms are cheerful; dim lighting is better for rest; people with poor vision need bright light.

Room Furniture and Equipment

• Rooms are furnished to meet basic needs; privacy is considered.

• Beds have electrical or manual controls; raised horizontally for care; the lowest horizontal position helps the person get out of bed; head-of-bed position varies (flat to raised).

Bed Types and Safety

• Beds may be electric or manual:

  • Electric beds: controls on a side panel, bed rail, or foot-board; users should be taught to use controls safely.

  • Manual beds: cranks at the foot; cranks are up for use and kept down otherwise.

• The hospital bed system includes: the bed frame and parts, the mattress, bed rails, head- and footboards, and bed attachments.

• Entrapment risks exist in head/neck/chest, arms, and legs; at-risk persons include older, frail, confused, restless, with poor muscle control, small, or restrained.

Six Basic Bed Positions

• Flat

• Fowler’s position

• High-Fowler’s position

• Semi-Fowler’s position

• Trendelenburg’s position (needs doctor’s order)

• Reverse Trendelenburg’s position (needs doctor’s order)

Bariatric Beds

• Features: wide frame; chair position; front and side egress positions; power transport to move the bed; pressure-relief surface to prevent ulcers; trapeze; built-in scale.

Over-Bed Table and Bedside Stand

• Over-bed table moves over the bed by sliding the base; raised/lowered for meals, writing, reading, and activities; place only clean and sterile items on the table.

• Bedside stand next to the bed; stores personal items and personal care equipment; place only clean and sterile items on top.

Privacy and Personal Care Items

• The person’s unit has a chair for personal and visitor use; residents may bring chairs from home.

• Privacy curtain around the bed; pull the curtain completely around before care; curtains do not block sound.

• Personal care items are used for hygiene and elimination; agency provides: bedpan and urinal kept in bottom drawer or lower shelf; some residents bring their own products.

• A portable screen can provide privacy in the home.

Call System

• The call system lets the person signal for help; confidentiality with intercoms.

• People with limited hand mobility may need a call light that can be activated by tapping with hand or fist.

• Keep the call light within reach; place it on the person’s strong side; remind the person to signal when help is needed.

• Answer call lights promptly; bathroom/shower/tub room lights must be answered immediately; some people cannot use call lights.

• Check the care plan for special communication measures; check residents often.

Bathroom

• Standard equipment: toilet, sink, call system, and mirror; grab bars by the toilet; some bathrooms have higher or raised toilets.

• Towel racks, toilet paper, soap, paper towel dispenser, and a wastebasket should be within easy reach.

• Bathrooms have call lights; respond at once when help is needed in a bathroom.

• The sound at the nurses’ station is different from room call lights.

Closet and Drawer Space

• OBRA and CMS require each person to have closet space with shelves and a clothes rack; free access to the closet and 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.

• Always have the person present when inspecting.

• The person’s unit must be kept clean, neat, safe, and comfortable.

• Read Box 21-2 CMS requirements for rooms.