Beds and Bedding-Nightingale minisode #7

Michelle: Welcome back to the Florence Nightingale Miniseries. This is minisode number seven, Beds and Bedding. When Florence tells us what properties make a good bed, how proper bedding reduces infection, and the properties of pillows in positioning your patient, her flair for sarcasm rears its head. Again, in the form of a snarky comment. Let's get into it.  She starts by talking about the cleanliness of patients' bedding, that the sheets are not being laundered regularly. Well, what was doing laundry like in the mid-19th century? Listen to this description from the Philadelphia Library website. Washing clothes in the late 1800s was a laborious process. Most household manuals recommended soaking the clothes overnight first. The next day, clothes would be soaked, boiled, or scalded, rinsed, wrung out, mangled, dried, starched, and ironed, often with steps repeating throughout. Wow. So not easy by any means. Now, imagine doing this on a large scale for hospital beds. It would have taken forever. So I get it. It was an intensely laborious project. But what Florence is saying is, in the meantime, between washing, patients have fevers, they're sweating, they have open wounds that are draining onto these sheets, so they're laying in their filth and disease. She talks about the importance of airing your dirty sheets out. And again, this was probably time-consuming and difficult to do on a large-scale basis. But here's where her snarky comment comes in. I once told a very good nurse that how her patient's room was kept was quite enough to account for his sleeplessness. And she answered, quite humorously, that she was not at all surprised at it, as if the state of the room were, like the state of the weather, entirely out of her power. Now, and in what sense was this woman to be called a nurse? So apparently, nurses did the laundry for their patients, and I'm so glad in this day and age that is not the case because we have more than enough to do as it is. Now, at the end of episode six, I referred to nurses being very particular about their beds, and I am certainly one of them. Back in my days as a pediatric nurse, I was caring for a child of five or six who had undergone a surgical procedure. He had an open wound that was being packed daily, and he had Montgomery straps. Do you guys remember those? I had just bathed him and made his bed when the surgeon called to say he was on his way to change the dressing. Now, a dressing change of this kind on a five-year-old was not fun. It was a messy procedure requiring a sterile field, removing the old packing, which could sometimes get stuck in the wound, irrigating with normal sailing, and then repacking with sterile gauze and it also involved pain or the fear of pain for a five-year-old. So I premedicated the child with IV Morphine gathered my supplies, and the surgeon arrived in a rush. Because aren't surgeons always rushing? The last thing I did was attempt to put a Chux underneath the child since I had already changed his bed. And the surgeon, while he went, excuse me, batshit crazy, and proceeded to make an *** of himself before the staff, the child, and the child's mother. "Oh, my God. Your precious sheets can't get a drop of blood on them." Yada, yada, yada. Yes, you are. **** right, I left out the curse word. I think all my patients love clean sheets, as I'm sure you do. Are you ready for your sterile gloves, Doctor? Then he proceeded to change the dressing in silence, which I very much appreciated. Florence talks quite extensively about the best kinds of beds. She says that the bed should not be too wide, no more than three and a half feet. It should not be too high, should not have more than two mattresses, and should be positioned near a window. So the patient has a view and can get the benefits of fresh air and light, which, as you remember, are two of the essentials for health that we talked about in minisode one. Of course, in hospitals today, we have a variety of beds for a variety of different reasons. For adults, we have Stryker beds, Hill-Rom beds, and Bariatric beds for very large patients. We have pneumatic mattresses that prevent bed sores, and we have beds with built-in scales. We have beds with alarms for fall prevention, which, as you all know, falls are a huge problem and almost always part of any hospital's quality improvement projects. For the NICU, we have the amazing Giraffe isolates, the Draegers, and several different transport isolates available with every bell and whistle imaginable. One final note from Florence about pillows. She says, "every weak patient, be his illness what it may, suffers more or less from difficulty in breathing to take the weight of the body off the poor chest, which is hardly up to its work as it is, ought, therefore, to be the object of the nurse in arranging his pillows. Now, what does she do and what are the consequences? She piles the pillows one atop the other like a wall of bricks. The head is thrown upon the chest, and the shoulders are pushed forward so as not to allow the lungs room to expand. The pillows, in fact, lean upon the patient, not the patient upon the pillows. It is impossible to give a rule for this because it must vary with the figure of the patient. And tall patients suffer more than short ones because of the drag of the long limbs upon the waist. But the object is to support with the pillows the back below, the breathing apparatus to allow the shoulders room to fall back and to support the head without throwing it forward. The suffering of dying patients is immensely increased by the neglect of these points. And many an invalid, too weak to drag about his pillows himself, slips his book or anything at hand behind the lower part of his back to support it."  I love how Florence uses her knowledge of physics to show us how the body works and what the patient needs. And it seems Florence had the same issues that we as nurses have today regarding hospital pillows, that they are absolute pieces of ****. So take it easy on us, Florence. We don't have a lot to work with. Well, that's all about bedding. Join me next time for Minisode Eight when Florence discusses cleanliness. Cleanliness of hospital rooms and the nurse's personal cleanliness. Thank you and I will see you soon.