Meeting patient's needs - Nurses' responsibilities

MEETING PATIENT'S NEEDS - NURSES' RESPONSIBILITIES.

Assisting with domestic ward management.

Every woman should learn the art of cleaning; everyone should be able to keep a home clean. Every nurse should know how to keep her ward clean, and this is best learned by practice.

A ward head nurse-in-charge is able to train her domestic staff and guide her nurses in ways of cleanliness because she understands methods of cleaning.

Germs live in dust and are a source of infection. Hence, some authorities state that dusting and cleaning should be done by domestic staff and not touched by the nurses. This also means that domestic staff, i.e., ward workers (class IV workers) should not do anything for the patients, e.g., carrying of crockery.

It is necessary that the ward is kept clean so that growth of germs is inhibited. A nurse should be able to keep her ward clean. However, too much domestic work is not advocated.

1).     Cleaning of ward

1.     Unnecessary articles such as crockery should be removed.

2.     High dusting is done, for ceilings and walls.

3.     The beds are made so that bits fall to the floor.

4.     Beds, etc., are pulled out.

5.     Sweeping is done

A tray is prepared for dusting and cleaning

1.     Two dusters, one wet, one dry.

2.     A bowl of water.

3.     A receiver of bits.

4.     Metal polish.

5.     Furniture polish and dusters.

6.     Soap in a dish.

Some method should be chosen, such as following: (The ward cleaning is usually supervised by the nurses).

1.     Begin at one end, and work round.

2.     When things are washable they should be dusted with wet and polished with dry duster.

3.     Dust is wiped into the duster and not flicked on the floor.

4.     Furniture surfaces are polished with furniture polish and tiled surfaces washed with soap and water.

5.     Dusting of the lamps depends upon their height, but they must not be forgotten. Dust must be removed from windows and doors. Usually furniture is polished once a week.

6.     The inside of the lockers are washed once a week.

7.     The floor is washed by the class IV workers.

Gusts of wind will disturb dust. It is usual to open the windows on the opposite side from which the wind is blowing whilst dusting is in progress.

Screens must be dusted.

Oiling is done periodically. Fluff must be removed from chair legs and screen wheels.

Washbasins require to be washed with vim powder.

2).   Care of kitchen

1.     Food cupboard is cleaned daily. Each article should have a definite place.

2.     Sinks must not be allowed to become blocked. Waste food should be placed in the rubbish bin and removed daily. The bin should be emptied and cleaned daily.

3.     Both bucket and rubbish bin should have tightly fitting lids which should be properly replaced.

4.     Should the sinks become blocked, simple measures may be tried to unblock it. A label should be placed on the sink with "out of use" on it.

5.     Food must not be left exposed in the kitchen. Milk must always be kept covered.

3).  Care of Linen

1.     This must be properly stamped with the ward and hospital names so that it is not lost in the laundry or in the ward.

2.     New articles should be washed before use.

3.     Torn linen should be put aside for repair.

4.     Stains should be removed at once before they become fixed.

5.     Wet articles must not be left in the dirty linen bin.

6.     Dirty linen should be sent to laundry promptly.

7.     Linen is carefully sorted, on its return from the laundry and discrepancies reported.

8.     Stock-taking must be accurate and frequent so that track is kept on lost articles.

9.     Dirty linen is sorted and account is written when sending to laundry.

4). Care of Rubber Articles

1.     All mackintoshes and rubber articles should be washed in warm soapy water, rinsed and carbolised with 1 in 20 carbolic lotion. Dry thoroughly in a cool place and french chalk powder is sprinkled and either rolled or hung up, never folded. Dry heat and hot sun destroy rubber. Sun causes it to blister. Turpentine will do this too.

2.     Two rubber surfaces should not come together but must be separated. In the case of hot water bottle, the surfaces are separated by air.

3.     Mackintoshes in the store cupboard should be examined weekly. If the air is moist, the mackintosh may become sticky.

4.     Kinking the rubber tubing is ruinous.

5.     Excessive steam causes rubber gloves to become hard.

6.     Ointments spoil rubber.

7.     Excessive boiling makes rubber limp and overstretched.

8.     Rubber articles should be stored in the dark.

5). Disinfecting the ward equipments

Linen and bandages: Receive into a bucket at bedside containing disinfectant lotion-carbolic lotion 1:40. Keep for 4 hours.

Pus, urine, stools, vomit and sputum are disinfected before disposal in carbolic lotion1: 20 for 2 hrs.

Immerse receptacles in phenyl lotion 1:20 for 2 hours Rinse them before use.

Infected furniture and mackintoshes: Mop with carbolic lotion 1:20 before routine cleansing.

Infected blankets, pillows and mattresses: In most hospitals these are submitted to steam sterilisation e.g. 25 1bs. pressure at 260º F for ½ an hour.

Crockery and glassware when it is inconvenient to boil:

These may be immersed in carbolic lotion 1:20 for 2 hours. Wash thoroughly before use.

6). Care of the sanitary annexe:

A. Care of the sanitary annexe is considered to

important and the steps are,

This is cleaned thoroughly daily, tidied at frequent intervals and well ventilated.

Insides and outsides of the sinks are cleaned.

Bedpans and urinals are washed with hot soapy water.

Bedpans and urinals are stored in large tanks containing a suitable cheap disinfectant, which is changed daily.

Ventilated cupboards may be provided for bedpan storage.

Enamelware is washed daily and stains removed before they become fixed.

      The sanitary annex should have the following:

A.Lavatory brush and mop.

A bucket with a tightly fitting lid to receive dressings prior to their removal to the incinerator.

Soil linen box.

B. Care of the flush out

This is cleaned daily.

Frequent flushing is required.

The lavatory brush is stored in a disinfectant, which is changed daily.

C.Care of the bath room

Walls and floors of bath room should be washed daily.

7). Stock Taking

Stock taking is done periodically of all kitchen utensil, cutlery and dressing instruments.

This ensures the nurses with a sense of responsibility. Stock taking of linen and equipment is taken at definite intervals, e.g. every three months.

Certain days are allocated for reporting of repairs, losses and breakages.

8). Hospital Economy

Economy of time is too often neglected. If a nurse is undecided about the method of carrying out a duty, she should ask for guidance and not waste time in her efforts of trial and error. It is quicker in the long run to do things correctly.

A nurse should look after her health so that working hours are not lost through illness.

Daily inventories of important instruments will prevent their loss.

Dressings -Dressing should be large enough to cover the wound only. Old blankets are used for medical fomentations and not lint. A wide bandage should not be used when a small one will do. Dressing lotions should be carefully measured so that there is no waste.

During dressing, the bed-linen is protected by a dressing mackintosh and dressing towel.

Taps, lights and gas should be turned off when not in use. Faulty taps must be reported. Kettles sterilizers and saucepans must not be allowed to boil dry, or left on the gas unnecessarily. The kettle should not be filled when a small quantity of hot water is required.

Articles must be used for the purpose for which they are made.

Medicine and drugs must be accurately used as ordered. Many deteriorate from exposure or evaporation.

Soap must not be allowed to stay in water.

Disinfectants should not be wasted or used in wrong strengths.

Cleaning powders, furniture polish and metal polish should be used sparingly.

Torn linen must not be used without mending or it may be torn further and rendered useless.

Bed linen should be protected wherever necessary.

During meals patient' s wear and bed lines are protected with towels.

A small amount of diet should be given to a patient and a second help if desired and permitted. Excess food should be returned to the main kitchen.

Although patients should look as nice as possible, it must be remembered that laundering involves wear and tear and is very expensive.

Crockery must be handled carefully and not allowed to chip or crack.

Nurses should be taught the prices of articles, lotions etc.

False economy is stupid and even criminal on occasions.

Nurses must remember that hospitals are maintained with the public's money. The people can often ill afford their contributions.

Each ward is assessed separately and list of expenses sent round to the wards. They impress the nursing staff and encourage economy.