Keeping a Bedfast Patient Comfortable

When patients must remain in bed for long periods of time, joints become stiff, skin becomes sore, and muscles ache. To prevent such occurrences and to keep the patient comfortable in bed, skill and frequent attention by the home nurse are necessary.

A frame at the foot of the bed (under the top sheet) can serve two purposes: (1) to keep the covers from pressing on the toes, and (2) to keep the feet in proper position. Feet that are allowed to slant downward for long periods of time develop a condition called “foot drop,” in which the flexor muscles of the leg are paralyzed. When the patient is on his side, a pillow against the back and one between the legs provide support and prevent pressure from knees resting against each other. Pads made from foam, cotton in soft covers, or other ready-made materials when placed under heels or elbows can prevent or reduce skin breakdown.

The patient needs to be encouraged to drink an adequate amount of fluids, unless medically restricted. Otherwise, skin may become dry and/or irritated. After baths, during the day, and especially when settling for the night, lotion with gentle massage of the back can help relax as well as lubricate the skin, reducing irritation and stimulating circulation.

When the patient is given a bath in bed, the bed linens should be changed immediately afterward; then the patient can be given a gentle back rub which will relax him, allowing him to rest without further disturbance.

Unless prohibited by the physician, the patient should be “dangled” two to three times during the day. Sit him up on the side of the bed, with assistance and support, and let the legs hang over the side of the bed for five to ten minutes. If such activity is not possible, the patient’s position in bed should be varied from flat to as near upright as possible to prevent dizziness and to improve circulation.

If the patient must eat in bed, sit him up as straight as possible, using a backrest and pillows. Serve the food on a bed table or a board or tray set on top of stacks of books or wooden blocks. If he can remain in a sitting position for some time, use a slanted foot support to brace his feet.

Home health agencies can often provide a visiting nurse to teach the family how to care for a patient who will be in bed for a prolonged period of time, so that family members can assume such responsibility in a knowledgeable and safe manner. Suzanne Dandoy, M.D., M.P.H., Director, Arizona Department of Health Services