Creating Comfortable Resident Units: Tips for Nursing Centers

1. Chapter 18 The Resident’s Unit

2. A resident unit is the personal space, furniture, and equipment provided for the person by the nursing center. • The person’s room or area of the room is private. • It is treated like the person’s home. • The intent is to have resident units as personal and home-like as possible.

3. Comfort • Temperature and ventilation • Most healthy people are comfortable when the temperature is 68 F to 74 F. • Older and chronically ill persons may need higher temperatures. • OBRA requires that nursing centers maintain a temperature range of 71 F to 81 F.

4. To protect persons from drafts: • Make sure they wear the correct clothing. • Make sure they 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. • Good nursing care, ventilation, and housekeeping practices help prevent odors. • Smoke odors present special problems.

5. If you smoke: • Follow the center’s policy. • Practice hand washing after handling smoking materials and before giving care. • Give careful attention to your uniforms, hair, and breath.

6. The Center for Medicare Services (CMS) requires comfortable sound levels. • 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 • To decrease noise: • Control your voice. • Handle equipment carefully. • Keep equipment in good working order. • Answer phones, signal lights, and intercoms promptly.

7. The CMS requires comfortable lighting. • Comfortable lighting: • Lessens glare. • Allows the resident to control the intensity, location, and direction of light. • Allows persons who are visually impaired to 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.

8. Room Furniture and Equipment • Rooms are furnished and equipped to meet basic needs. • The room has furniture and equipment for comfort, sleep, elimination, nutrition, hygiene, and activity. • Equipment to communicate with staff, family, and friends is included. • The bed • Beds have electrical or manual controls. • Beds are raised horizontally to give care. • The lowest horizontal position lets the person get out of bed with ease. • The head of the bed is flat or raised varying degrees.

9. The six basic bed positions are: • Flat • Fowler’s position (a semi-sitting position) • High-Fowler’s position • Semi-Fowler’s position • Trendelenburg’s position • A doctor orders this position. • Reverse Trendelenburg’s position • This position requires a doctor’s order.

10. The FDAdefines 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: • Bed rails • The mattress • The bed frame • The head- and foot-boards

11. Persons at greatest risk of entrapment include persons who: • Are older • Are frail • Are confused or disoriented • Are restless • Have uncontrolled body movements • Have poor muscle control • Are small in size • Are restrained

12. Hospital bed systems have seven 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 head-board or foot-board • Zone 7: Between the head-board or foot-board and the end of the mattress

13. The overbed table is: • Placed over the bed by sliding the base under the bed • Raised or lowered for the person in bed or in a chair • Used for meals, writing, reading, and other activities • The bedside stand is used to store personal items and personal care equipment. • The resident’s unit has at least one chair for personal and visitor use. • It must be comfortable and sturdy. • It must not move or tip during transfers. • The person should be able to get in and out of the chair with ease.

14. Each person has the right to full visual privacy. • Full visual privacy means that a person has a means to be completely free from public view while in bed. • Always pull the privacy curtain completely around the bed before giving care. • The bathroom • A toilet, sink, call system, and mirror are standard equipment. • Grab bars are by the toilet for the person’s safety. • Some bathrooms have raised toilet seats. • Towel racks, toilet paper, soap, paper towel dispenser, and the wastebasket are placed within easy reach of the person.

15. The call system lets the person signal for help. • When using an intercom, remember confidentiality. • Some people cannot use signal lights. • Check the care plan for special communication measures. • Check these persons often. • To promote safety, 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.

16. Closet and drawer space • Each person is provided with closet and drawer space. • The closet space must have shelves and a clothes rack. • The person must have free access to the closet and its contents. • Other equipment • Nursing centers may allow residents to bring furniture and other items from home. TVs, radios, clocks, photos, and other small items help residents feel “at home” in their units.

17. Quality of Life • The center is the person’s home. A home-like setting is important. • Personal choice is always allowed in arranging items. • The health team must help the person feel safe, secure, and comfortable. • Everyone involved in the person’s care must keep the unit clean, neat, safe, and comfortable. • OBRA and the CMS serve to promote quality of life.