Chapter 21

BEDS AND BEDMAKING

The common saying that the best bed for an invalid is his own bed contains an element of truth. Taking from a patient his own accustomed bed, even when a better is substituted, sometimes disturbs him greatly and makes him feel that he is indeed very ill. Nevertheless, a suitable bed is essential to the proper care of a helpless person, and no patient should continue to use an unsuitable one, unless his illness is slight and also likely to be of very short duration.

Besides being comfortable, a bed suitable for the sick must be clean and easy to keep in a sanitary condition. The springs should be firm, and the mattress should be elastic and should give an even support without lumps and hollows. The bed covers should be clean, light, and warm; the pillows should be sufficient in number not only to make the head and shoulders comfortable, but also any other part of the body in need of support. Moreover, the bed should be so placed and of such a kind that the work of caring for the patient may be rendered as easy for the attendant as possible. In every household at least one bed suitable for a sick person should be available in case of need.

BEDSTEADS.--Beds of white enameled iron, brass, or brass and iron combined are most easily kept clean, and are the best in every way. The frame should be strong enough to stand firmly, yet not so heavy that it is hard to move. It should have as few angles as possible, and all its joints should be smooth and well finished. The springs should be made of wire stretched tightly on a metal frame that fits smoothly into the head and foot pieces. Large castors should be used; they may be removed from the foot if the bed moves too easily.

A bed to be used in sickness should have the following dimensions--length, 6 ft. 6 in., height 24 to 26 inches, width, 36 inches. If a bed is either too high or too low the labor of lifting and moving the patient is greatly increased. If the bed is too narrow the patient is insecure. If the bed is too wide, its center is difficult or impossible to reach without leaning or kneeling upon it; and if too short, it will prove uncomfortable for a tall person. A bed that is too low may be raised on four heavy boxes of the same height; or still better, upon heavy wooden blocks which any carpenter can easily make, and which are well worth a little trouble to obtain. In the top of each block a hollow should be made into which the leg of the bed will fit after the castor has been removed. A broad firm stool or a low chair may be provided for a patient who has difficulty in getting in and out of a high bed.

Beds with complicated attachments for moving patients are not recommended for family use. They are expensive, likely to get out of order, seldom needed, and generally unsatisfactory. In some surgical cases a bed with a firm, flat surface is necessary. Such a surface may be secured by placing between the mattress and springs two boards slightly separated, or one wide board with holes bored in it to afford ventilation.

Wooden beds are undesirable: they are difficult to keep clean, they readily absorb moisture and odors, they cannot well be disinfected, and their solid frames prevent a free circulation of air. Moreover, it is almost impossible to render fit for use again a wooden bed into which vermin have once made their way. Folding beds and lounges even of the best type are unhygienic, usually too low for the patient's comfort, and often insecure.

A bedstead should be wiped frequently with a damp cloth; if it is of enameled iron it may be washed with soap and water. The springs may be cleansed with a stiff brush dipped in kerosene oil. Excessive use of water upon the springs is likely to make them rust.

MATTRESSES.--Various substances are used in the manufacture of mattresses, but nothing has yet been found that is as satisfactory as curled hair. It is light and clean and elastic, it does not readily absorb odors, and it is easily renovated. Although hair is more costly than other materials, a hair mattress may be used almost indefinitely if it is occasionally made over.

Felt or cotton mattresses are firm, but heavy, difficult to keep clean, and likely to absorb odors. A useful mattress made from straw is sometimes found in country districts. Such a bed is thoroughly hygienic, for the worn straw may be burned and the tick washed and refilled with clean straw; but straw beds are generally hard and lumpy. The least desirable of all mattresses is the old fashioned feather bed, and it should never be used if a better can by any possibility be obtained; but a feather bed should not be arbitrarily taken away from an old person accustomed to its use, unless his welfare is really at stake.

A mattress made in two sections is unnecessary for a single bed; indeed, a mattress made in one piece is more easily kept in place if the patient is restless. A good quality of blue and white ticking makes a serviceable cover for both mattress and pillows since its color is not likely to run.

CARE OF THE MATTRESS.--A mattress should be brushed frequently with a whisk broom, especially around the tufts and edges. If a patient is long confined to bed, a fresh one should occasionally be substituted so that the regular mattress may be removed, well brushed, beaten with a carpet beater, and left exposed to the sun and air for a day or two. A mattress that is badly soiled should be sent to a cleaner and made over; it cannot be cleaned properly at home. It is generally possible to remove blood stains, if they have not soaked through the ticking, by applying a thick cream made from raw starch and cold water. When the starch becomes dry it should be brushed away, and the application should be repeated until the stain has disappeared. For the best results the starch should be applied before the stain is dry.

PILLOWS.--One patient can use an almost unlimited number of feather pillows. Some should be soft and others firm, some large and some small; but pillows that are very large and thick are less useful than a greater number of smaller ones. It is well to have several small pillows of varying size and thickness to support different parts of the body.

Hair pillows are often acceptable in warm weather, and they are also desirable for patients with high fever or excessive perspiration. Rubber air pillows are a convenience in traveling and add much to the comfort of a patient when he first goes out in a carriage or motor car, but air pillows are not sufficiently durable for general use.

If a pillow tick becomes soiled, the feathers may be transferred to a clean tick by making an opening about six inches long in the end of each pillow, sewing the ticks together, and then shaking the feathers from one tick to the other. The soiled tick can then be washed. If the feathers themselves have become soiled they should be renovated by a cleaner. Pillows, like mattresses, should be frequently brushed, sunned, and aired. They should not be held in the mouth while a clean pillow-case is adjusted.

PROTECTION OF THE MATTRESS AND PILLOWS.--In all cases of sickness the mattress must be adequately protected. Neglect is inexcusable and may cause expense and trouble as well as discomfort to the patient.

The following may be used to protect the mattress or pillows: large quilted pads, small pads of cotton batting covered with old muslin or cheese cloth, slip covers for the mattress, rubber sheets and pillow-cases, old blankets and quilts that may be washed easily. Heavy wrapping paper, builders' paper, and newspapers serve well in emergencies, or for a short time.

RUBBER SHEETS AND PILLOW-CASES.--Soft rubber cloth, single or double faced, is most frequently used when it is necessary to protect the bed from discharges. It may be purchased by the yard. Rubber sheets should not be used unless they are really necessary. They are hot and uncomfortable, and increase the tendency to perspire. When used, a rubber sheet should be 1 yard wide or wide enough to reach from the lower edge of the pillows down to the patient's knees, and long enough so that it can be tucked in securely on both sides of the bed. Rubber sheets may be cleaned by laying them on a flat surface and washing on both sides with soap and water, using a small brush if necessary. After rinsing they should be wiped, and when thoroughly dry they should be rolled rather than folded, to prevent the rubber from breaking.

Rubber pillow-cases are used for a patient who perspires profusely, or who has a discharge of any kind from the head or neck, and also when substances which may wet or stain the pillow are applied to the head. They should be put on next to the pillow, securely fastened with tapes, snap hooks, or buttons, and covered with the regular pillow slip.

Rubber sheets and pillow-cases are not durable. They should be used carefully, and frequently examined for holes or worn places by holding them up to the light. Even a pin hole near the center may render a rubber sheet or pillow-case as useless as a sieve.

SHEETS.--Sheets of ample proportions are necessary for comfort, and important for sanitary reasons as well. For a bed of the dimensions mentioned in this lesson sheets should be three yards long, and two yards wide. A safe rule for any bed is to have the sheets one yard longer and one yard wider than the mattress. A sheet of these dimensions is large enough to be tucked under the sides and foot of the mattress, while at least twelve inches are left to fold over the blankets at the top. Cotton sheets are as good as linen for general use, or even better, and are far less expensive.

DRAW SHEETS are used to cover rubber sheets, and to protect beds when the rubbers are not used. In hospitals special draw sheets are usually provided, but an ordinary sheet folded answers every purpose. New and expensive sheets should not be used for draw sheets, since they are more likely than other sheets to become stained. Draw sheets should be wide enough to extend about four inches beyond the rubber sheet at the top and bottom.

PILLOW COVERS.--Pillow covers are generally made of cotton, but persons who can afford the cost frequently prefer linen, especially in hot weather. Unless fastened with buttons or tapes, a pillow case should be several inches longer than its pillow. It should be wide enough to slip on easily, but not so wide that it wrinkles or allows the pillow to turn. If it is too small the pillow will become hard and uncomfortable. These small things, unimportant as they are to the well, may cause much discomfort to a restless or nervous patient.

BLANKETS.--All wool blankets are both light and warm, and are consequently the most comfortable bed covering. But unless they can be dry cleaned frequently, it is better to select blankets made from one part wool and two parts cotton. Blankets containing equal parts of wool and cotton are warmer, but are more injured by washing. Very light blankets of wool or outing flannel are useful in summer. Double blankets should always be cut in two and bound at the ends, since single blankets are easier than double blankets to handle and wash. Patients are frequently too warmly covered by day. Too much warmth is enervating, it causes the patient to perspire, and makes him restless and more susceptible to draughts and to changes of temperature. Two light blankets are warmer and more comfortable than one heavy blanket.

COMFORTERS AND QUILTS.--Heavy cotton comforters are burdensome without being correspondingly warm. Eiderdown quilts or those padded with wool are good for a patient who sleeps out of doors, or whose room is kept at a low temperature. Bed covers that cannot be laundered readily should be protected by basting on both sides of the top a wide piece of muslin or linen, which can be removed and washed.

COUNTERPANES.--White dimity counterpanes are desirable, since they are light in weight, easily laundered, and inexpensive. A heavy counterpane is uncomfortable at any time, and still more uncomfortable in sickness. If a light spread is not available, a sheet makes a good substitute. A counterpane should be wide enough to cover the sheets and blankets at the sides when the bed is open, and long enough to protect the bedding at the top and bottom.

BED MAKING

All methods of making beds for the sick are based upon a few underlying principles. The aim in every case is to obtain the following results with the least expenditure of time and labor: first, to secure comfort for the patient, and to eliminate all causes of friction, irritation, or pressure upon his skin; next to keep the covers firmly in place, so that the bed will not easily become disarranged; then to protect the mattress, and last, to secure as good an appearance as possible.

TO MAKE AN UNOCCUPIED BED, proceed as follows: remove the pillows and covers one at a time, and place them on chairs, near an open window if possible. Brush the mattress and then set it up on its ends to air, or turn it back over the foot board. Wipe the bedstead with a damp cloth. Replace the mattress after it has aired, turning it from side to side and from end to end on alternate days. Cover the mattress, unless it is enclosed in a slip cover, with a white quilted pad or an old blanket, and then spread the lower sheet over the mattress, so that the middle fold of the sheet lies upon the center of the mattress in a straight line from the head of the bed to the foot. Tuck the sheet under, first at the top and then at the bottom, drawing it so that it is firm and tight. If the sheet is of proper length tuck fourteen or sixteen inches under at the top, but take care to cover the mattress at the foot also. Next tuck the sheet under at the side, folding its corners to make a neat finish like an envelope. Place the rubber sheet, if it must be used, across the bed, with its upper edge where the lower edge of the pillows will come. A draw sheet somewhat wider than the rubber sheet is needed next; an ordinary sheet, folded once the long way of the sheet, may be used, with the fold toward the head of the bed. Tuck both rubber and draw sheet securely under the mattress at the side. In some cases the rubber sheet may be placed next to the mattress, and covered by the mattress pad and lower sheet. Place the draw sheet as directed, whether the rubber is used or not. After the lower, rubber, and draw sheets have been adjusted on one side of the bed, go to the opposite side, draw them over smoothly, and tuck them under the mattress as tightly as possible.

Next spread the upper sheet over the bed so that its upper edge reaches to the upper edge of the mattress, and its middle crease lies over the middle line of the mattress, and place it right side down, so that the smooth side of the hem will be uppermost when the sheet is turned over the blankets. Place the blankets so that their upper edges lie a little higher than the place where the lower edge of the pillow will come, and tuck them in firmly at the bottom and sides. If the blankets are not long enough to tuck in at the foot, place the lower blanket as directed and the upper blanket five or six inches lower than the first. When tucked in, the upper blanket holds the lower one in place fairly well. Place the counterpane evenly and smoothly, tuck it under at the foot, turn its corners neatly, turn its upper edge under the upper edge of the blankets and fold the upper sheet down over the whole. Last of all, shake the pillows and place them neatly on the bed.

Practice is necessary before it is possible to make a bed quickly and well, and a certain amount of proficiency in making an unoccupied bed should be acquired before undertaking to make a bed with a patient in it. One should learn to work in an orderly way, without confusion, unnecessary motion, or jarring of the bed.

TO CHANGE A PATIENT'S PILLOWS.--Stand preferably on the right side of the bed and slip the left arm under the patient's shoulders, supporting his head in the hollow of the arm. Raise him slightly and remove the pillows one at a time with the right hand, drawing them outward on the left side of the bed. Place a small pillow under his head. Shake the pillows, change the cases if necessary, and replace them on the left side of the bed, ready to be drawn back into position. Raise the patient as before, remove the small pillow and draw the others into place. It is sometimes better to hold the patient on the upper pillow while removing and replacing the under one.

LIFTING A PATIENT IN BED.--Patients tend to slip down toward the foot of the bed, and they should be raised if unable to help themselves. To raise the patient, instruct him to flex his knees and to press his feet firmly upon the bed; place one arm under his shoulders, as when changing pillows, the other arm under the thighs, and lift him upward without jerking. The lifting can be done more easily by two people, and with less discomfort to the patient: if he is entirely helpless two people are necessary. Two people should proceed as follows: Let _A_ place her left arm under the patient's head and shoulders as before, her right arm under the small of his back; let _B_ place her right arm also under the small of his back and her left arm under his thighs, and at a signal let them lift together. In this way the weight is so evenly distributed that a heavy person can be lifted without great difficulty.

TO TURN A PATIENT IN BED.--A patient may be turned toward or away from you. In turning a patient toward you, place one hand over his farther shoulder and the other over his hip, and turn him toward you. Then flex his knees slightly. To turn a patient from you, pass one hand as far as possible under the shoulders, and the other as far as possible under the thighs. Then raising the patient slightly, draw him back toward you, turning him at the same time, and then flex the knees. Lastly place a pillow firmly against his back to support it.

TO CHANGE THE SHEETS WHILE THE PATIENT IS IN BED proceed as follows: First collect the fresh linen and place it conveniently near the bed. Then draw the bedclothes from beneath the mattress, raising the mattress meanwhile with one hand to prevent jarring the bed. Remove first the spread and then the upper blanket if there are two, fold each once and place it on a chair. Hold the remaining blanket in place with one hand, while with the other you draw the upper sheet out from under it; then fold the edges of the blanket up over the patient to keep them out of the way. The upper sheet, unless soiled, may be folded once and used again as a draw sheet. Next remove all the pillows, unless the patient prefers to keep one. Then move the patient toward one side of the bed and turn him on his side so that he faces the edge nearest him. Roll the draw sheet and rubber sheet together if both are to be removed, or separately if the rubber sheet is to remain on the bed; then roll the bottom sheet throughout its entire length, and bring the three sheets, all rolled as flat and as tightly as possible, close to the patient's back. Pleat about half of the fresh lower sheet lengthwise and place the pleated portion as close as possible to the rolled soiled sheets. Tuck in the other half of the fresh sheet at the top, bottom and side, draw the rubber sheet if it is to be replaced back over the fresh lower sheet, arrange the fresh draw sheet in place, tuck it in at the side, and roll its free portion close to the patient's back. The fresh side of the bed is then ready for the patient. Lift his feet back over the rolled sheets keeping his knees flexed, then turn him back over the rolled sheets on to the fresh smooth part, remove the soiled sheets and arrange the fresh ones in place on the side where the patient has just been lying. Be careful to keep him well covered with the blanket. After the lower sheets are in place and firmly tucked in, spread above the blanket the fresh upper sheet, and over the sheet spread the second blanket. Hold the sheet and blanket in place with one hand while using the other hand to draw out the first blanket from beneath the sheet. In this way the patient is constantly covered by a blanket. Place the blanket just removed above the other and finish the bed according to the directions given for an unoccupied bed, using special care, however not to draw the covers too tightly over the patient's feet.

TO MOVE A PATIENT FROM ONE BED TO ANOTHER.--On the fresh bed have the lower sheets in place but not the upper covers. Place the two beds close together side by side, and draw one mattress a little over the place where the two sides meet. Loosen the draw sheet under the patient, roll it on both sides close to the body and draw him gently over by means of this sheet, moving his shoulders at the same time. If the beds are unequal in height, use firm pillows or folded blankets to make an inclined plane.

If the beds differ greatly in height and indeed in most cases, it is better to carry the patient from one bed to the other. At least two people are needed; one alone should never attempt to carry anyone heavier than a small child. One method for lifting is as follows: Let two bearers, _A_ and _B_ stand on the same side of the bed. If the patient is to be moved into the right side of the fresh bed let both bearers stand on the right side of the occupied bed; if he is to go into the left side of the fresh bed, let them both stand on the left side of the occupied bed. Let _A_ place one arm under the patient's shoulders and her other under the small of his back, while _B_ places one arm under his hips and the other just below his knees. Draw the patient to the edge of the bed, instruct him to place his arms about the shoulders of _A_ and to hold the body rigid, and then lift together at a given signal, keeping his weight well up on the chests of the bearers.

Whenever a patient must be turned, lifted, carried, or moved in any way, let him know beforehand just what you intend to do so that he may not be startled, and also that he may coöperate if possible. Grasp him firmly but gently, avoid pinching the skin, and move him steadily and smoothly, avoiding jerks and false starts. Do not attempt alone more than your strength is amply sufficient to accomplish, and endeavor at all times to handle the sick with the utmost gentleness and consideration.

EXERCISES

1. Describe a bedstead and mattress suitable for a sick person's use, and tell why they are to be preferred.

2. How should the bedstead be cared for? the mattress? the pillows?

3. How should a mattress and pillows be protected?

4. Describe in detail the bed covers that are desirable for use in sickness.

5. Name the results that a good method of bedmaking aims to secure.

6. Describe the method of making an unoccupied bed.

7. How should one change the pillows of a helpless patient?

8. Describe the way in which you would lift and turn a patient in bed.

9. Describe the method of changing sheets and remaking a bed while the patient is in it.

10. Why are beds and bedmaking considered so important in the care of the sick?

FOR FURTHER READING

Notes on Nursing--Florence Nightingale, Pages 79-84.