Caring for Loved Ones at Home

An Illustrated, Easy-to-Follow Guide to Short or Long-term Care 4th Edition.

5. Basic Care

The Mutual Gift of Caring

Caring for someone can be quite time consuming. Just reading the previous instructions may be enough to make you ask if you have what it takes to do this well. When I was caring for my parents, I was a recent university graduate in the fields of history and political science. I had no experience caring for anyone (including myself if the truth be told). Using some of these basic care skills that I learned from nurses, or through trial and error, I was amazed at how calming and enjoyable they were to use for my parents. These were intimate moments of real caring. Physical care of people we love is one of the greatest gifts we give to them and to ourselves. I would not have believed that if I had not experienced it. These are life-defining moments that make us better children, spouses, parents, friends and neighbours.

The people we care for may not remember what we said. They will remember how we make them feel and physical care is one of the most intimate forms of communication we ever experience.

In the days and weeks ahead you may be involved in a wide range of activities. You may be able to give another family member or friend some of the activities that you are less comfortable with while concentrating on your own strengths. However, you will likely have to do things you have never done before or do not feel comfortable doing at first. Give it a little time and you will be amazed at how quickly you learn.

Preventing Further Illness/Infection Control

We were always told to wash our hands before meals for good reason. When caring for someone it is wise to wash your hands before touching them or their food in any way. This helps prevent infections from spreading from you to them and vice-versa.

Wash your hands before and after physical contact with someone who is ill. Ask your visiting home nurse what kind of hand soap and lotion are best.

Wet your hands under running warm water.

Add soap to work up a good lather, washing your whole hand vigorously, including the wrists, back of hands, between your fingers and under your fingernails.

Rinse thoroughly and let drip dry in the sink for a moment.

Dry your hands using your own towel or a paper towel.

Turn the faucet off with your used towel (not your bare hands).

You may want to use a hand lotion to prevent dryness or chapping.

It may be wise to use disposable latex or vinyl gloves and a disposable apron if you are likely to touch blood or other body fluids. Dispose of the gloves, dirty dressings, apron, etc., in two plastic bags for extra safety to prevent the spread of infection or disease. Needles should not be thrown into the trash. Put them in a plastic or metal container (e.g., empty bleach bottle) and tape lid shut once the container is full to prevent needles from falling out accidentally. Check with your nurse about how best to dispose of the needle container.

It is likely in North America that someone will have a cold or flu in your home during the year. Use a mask to cover their mouths if they are coughing and wear one yourself if you need to be near them. Children and pets also spread germs. Remind children about hand washing. Have pets checked by a veterinarian to make sure they are healthy with up-to-date shots. Be especially careful to wash your hands after cleaning up after your pet, cleaning out the litter box or bottom of the cage.

Helping People Get Around

A good deal of your time may be spent helping the person get in or out of bed, walk around their home or helping them to the bathroom. You have seen relatively short nurses help people around the hospital so you know that you do not need to be very tall or physically strong. You do need to be smart about what you do so that you do not hurt yourself. Ask your home care coordinator/case manager to bring in an occupational therapist or physiotherapist for an in-house assessment. They are experts at helping you decide what assistive devices might be helpful and what types of support and care you can provide that would be most helpful to the person who needs it. Also ask your visiting home nurse for further tips.

Note: The tips in this section apply best to people who are weak and need some extra support. They do not necessarily apply to people who have muscular or neurologic conditions or those who have had a stroke. Always check with a physiotherapist or occupational therapist or visiting home nurse before trying something new.

Here are some specific tips that might help as well:

If movement causes extra pain, check with the physician or visiting home nurse about giving a pain relieving medication about 30 minutes before the movements happen (e.g., before daily baths, regular trips to the dining room).

Keep your feet and toes pointed straight ahead with your weight evenly divided on both feet.

You need to stand as straight as you can, keep your head up, shoulders down and knees slightly bent.

When lifting someone, you should have your head, shoulders and hips form a straight line. You need to bend your knees and

keep your back as straight as possible when lifting. Have your feet about 30 cm (one foot) apart for the best stability.

Learn a few stretching exercises for your legs, arms, back and stomach muscles and practice them before you do any lifting or assisting.

The closer you are to the person or object you are lifting, the less strain on your muscles.

Make sure the area you will be lifting or walking in does not have anything in the way (e.g., toys and throw rugs) and that it is not slippery.

Wear comfortable, low heel shoes and loose fitting clothes.

Always use wheelchair breaks to prevent people from losing their balance and falling.

Remove the foot pedals on wheelchairs or move them to the side to give extra room.

Moving Someone in Bed

The greatest invention in the world (or so it seemed to me at the time I was taking care of my parents) is a draw sheet. This is just a regular sheet folded several times and placed side-ways on the bed. The person lies on top with the sheet under their shoulders and hips. A person on either side of the bed grabs the sheet at the same time and together they lift the person up to move them closer to the head or the bottom of the bed. This is very helpful when someone is sitting up in bed and they keep sliding to the foot of the bed. If they cannot move themselves, the draw sheet is perfect to move them without a lot of pulling or pushing on their skin. You can also use the draw sheet to help turn someone onto their side by placing one end of the draw sheet over the person and pulling it towards you.

Helping Turn Someone in Bed

Other than the draw sheet, you can also help a person turn in bed in the following way:

Have their far arm across their chest towards you.

Bend their far leg at the knee while their foot still rests on the mattress.

Bring the bent leg towards you. As you do this, their far shoulder will naturally start to move towards you through the leverage of the leg.

Reach over with your hand to guide their shoulder towards you comfortably and safely. This will put the person on their side with their bent knee giving extra security.

Place pillows to support their back and, if necessary, between their legs for added comfort.

Adjust the head pillow as needed.

Getting Someone Out of Bed and Into a Chair

Get a physiotherapist, occupational therapist or nurse to show you the proper techniques for your specific situation. Also ask them about transfer and walking belts that can give you something to hold onto when helping the person move about. Remember, what you do for someone who is weak from surgery is not the same as what you might do for someone who has partial paralysis. The following are some general tips that can help you remember what you have been shown by a professional.

1. Put a safe and solid chair with arm rests next to the bed facing you. The chair should be high enough to make it easy for the person to get into it and out again.

2. Raise the head of the bed as high as it will go. Help move the person's legs over the side of the bed. If the bed is not adjustable, have them lay on their side, move their legs over the side of the bed and slip your closest hand under their neck and shoulder to support those parts as they lift up. Give them a moment to rest, as they may be a bit dizzy after lying down so long.

3. Help put the person's slippers or shoes on (or do it when they are still lying down if they cannot help).

4. If the bed is too high put a strong footrest by the bed to help the person step down comfortably.

5. Help the person slide forward to the edge of the bed so their feet are touching the floor or footstool.

6. Face the person with your foot that is nearest the chair one step behind the other. This will allow you to turn easily in the direction of the chair. Have the person put their hands on their knees to help them push up with their legs. Guide them with your hands around and under their buttocks and assist the person to stand on their own feet. If they need extra support, hold them under their elbows as they hold your upper arms and lift together. If necessary, use two people to provide the support needed to lift the person and transfer them to a chair safely.

7. Have the person brace themselves with their hands around your elbows while you hold them under their elbows for leverage.

8. Help the person slide off the bed.

9. Bend your knees and press your forward knee against the person's opposite knee. Let them catch their breath and balance themselves as they stand.

10. Let the person shuffle backward towards the chair if they can and help them lower themselves. If they need help, pivot them using the pressure on their knee, and then lower them into the chair.

From a Chair into Bed

Reverse the instructions from above making sure the person helps with as much of the moving as possible. As well, make sure the chair, footstool and bed won't move while you are helping the person. using their right leg to pivot on, use your left hand to help them turn. Once in the chair, let them sit down for a more comfortable rest. If they cannot get up, wait for help to bring them back to bed or try to slide the chair to the bed. At all times, remember to safeguard your own back since you cannot be helpful if you injure yourself.

If the person is too weak to use both hands to push themselves up from the ground, have them use one hand on the chair and you use your strongest forearm under their remaining bent forearm. As they lift up from the ground using their bent pivot leg, you lift with your arm at the same time with your other arm providing support at their belt or around their waist.

Personal Care

Using a Bedpan or Urinal

None of us enjoy having to use a bedpan or urinal. No matter how hard we try, it is an unnatural feeling and not all that comfortable. However, it is necessary sometimes. After you have helped the person with the equipment, give them some privacy and wait for them to call you for help again. Leave a clean bedpan or urinal and toilet paper close to the bed so that people who are able can use it themselves and just call you when they are done.

Specific Tips

Find out if they can use a commode beside the bed. A commode is a portable toilet that looks like a chair. It allows someone to go to the toilet without having to go to the bathroom. There are various types including ones on wheels and ones with removable armrests. Your visiting home nurse, home care case manager or family doctor can help you decide which is best.

Note: People who are receiving narcotic pain medication may have difficulty with bowel functions (e.g., constipation). Talk to your family doctor or visiting home nurse right away to prevent the problem from getting worse. People need to continue using the right dose of pain medication so that they can remain relatively pain free and alert but they also need help controlling any side effects of that medication.

If they cannot use a commode, follow these tips:

1. Make sure you get the right kind of bedpan or urinal. There are different models for different purposes and you should get the kind that is most comfortable for your specific purpose. Plastic bedpans, vomit trays and the like are not as cold as metal ones.

2. Make sure the bedpan or urinal is clean, warm (you can rinse it with hot water), and dry.

3. Wash your hands thoroughly and dry them with a clean towel.

4. You may want to put some talcum powder on the top of the bedpan so it does not stick to the skin.

5. Once they are using the bedpan or urinal, you can raise the head of the bed to help them feel more comfortable. Make sure the foot of the bed is down so that urine will run into the urinal and not pour out by mistake.

6. Make sure the person is wiped clean and dry.

7. Cover the bedpan or urinal before removing it to prevent spilling. Empty in the toilet and clean. If you rinse with cold water and baking soda it helps keep the equipment odour free.

8. Wash your hands and help the person to wash theirs.

Urinating and having bowel movements in such a public way can be a major source of embarrassment and frustration for people. They should not have to wait to use the equipment or to have it taken away when they are done. Anything you can do to help people maintain their sense of control at this time will be an invaluable gift.

People do not have to have a bowel movement everyday to be healthy. It varies from person to person. They will know if the frequency of their bowel movements is normal or abnormal.

Menstruating women should have all the supplies and assistance they need. Again ask them what they need and what kind of help would be appreciated and who they prefer to help them.

Helping Someone Onto a Bedpan

If they can help, have them lay on their back, bend their knees so their feet are flat on the mattress and ask them to lift their buttocks while you put the bedpan under them.

If they prefer, they can roll onto the bedpan. Have the person roll onto their side, place the bedpan against their buttocks and ask them to roll onto their back.

If they cannot lift themselves or roll onto a bedpan help them to roll onto their side. They will tell you how to help them. Place an incontinence pad on the mattress (if there is not one already), put the bedpan on the mattress in the correct spot (often a little dent in the mattress where the person was lying), and help them to roll onto the bedpan. You may need to adjust it a little for comfort.

If Someone is Incontinent of Urine or Feces

Incontinence means that the person cannot control their bladder or bowel movements. Odour, infections or rashes may develop if the person does not regularly change and keep dry. Their skin care becomes especially important at this point to prevent painful bedsores and other uncomfortable skin conditions.

Get specific advice from a dietitian, visiting home nurse, home care case manager or your family doctor.

Put a plastic sheet under the bottom sheet of the bed.

Use incontinent pads or a clean towel under the person in bed. Change as needed. Reusable incontinence pads or towels should be placed in a sealable container until they are washed. Wash the container with a disinfectant and air out regularly to diminish odour. Sometimes having a vinegar and water solution in the container helps minimize odour as well. Non-reusable incontinence pads should be sealed into an airtight garbage bag and kept outdoors and away from the person's room. Oranges with cloves stuck in them, and left in the room, can also reduce odours. There are also commercial products to help with odour. Ask your visiting home nurse or home care case manager about suitable products for your situation.

Make sure the person's skin remains clean and dry. Use soapy water and pat as needed. You may also want to use a water-resistant cream to protect the skin. Bedsores are extremely painful and dangerous. They are frequently the result of damp skin and poor blood circulation. Anything you do to keep the skin clean and dry helps a lot. You will also need to keep the bedclothes dry at all times.

Pajama bottoms are not very practical. Long t-shirts, pajamas tops or oversized flannel shirts are quite comfortable. Socks may also help keep someone warm.

The person may want to use adult diapers to keep dry and comfortable and to allow them to get out of bed and walk around for exercise. Check to see if your local home care program covers these and other supplies.

Helping With a Bath or Shower

When the person can go into the bath or shower you may find the following tips useful:

Before the person goes into the bathroom, have all the things they will need ready. Run the bath and check the water for the person's preferred temperature. Have the soap, washcloth, shampoo and other items (razor blade, cream, etc.) nearby. Have the towels within easy reach. If possible, put the towels in the dryer for two minutes to warm them up so the person can feel warm when they dry themselves.

Helping people to stand up or sit/lie down can be very difficult on your own body. It is important to remember all the rules of lifting and leaning over that you were taught in school. Remember to bend at the knees when you are picking up an object and keep your back as straight as possible. Remember as well, that the closer you are to the person or object you are lifting, the less strain you put on your lower back, arms and legs. Some regular squatting exercises will help strengthen your legs and lower back.

If you get quite sore by helping someone get up or down, ask your family doctor, visiting home nurse, occupational therapist or chiropractor to give you clearer instructions of how to lift someone properly so that you do not continue to hurt yourself.

Help the person into the bath or shower making sure you bend your knees slightly and keep your back as straight as you can. You may want to put a long towel under their arms to help lower them into the bath.

If the person is able to help themselves more, you can help them sit on the side of the tub (on a warm, non-slip towel or mat), swing their legs over and help them to ease into the tub. Reverse the procedure when they want to get out.

Make sure the bath or shower has a non-slip bath mat.

If the person needs help for weeks or months, it may be wise to adapt your bath or shower with handles and other safety aids. Check with an occupational therapist or physiotherapist through your home care program.

If the person prefers a shower, rent or borrow a bath chair or use a water-resistant chair so they can sit down comfortably. Your home care program may be able to arrange this.

The person may feel more comfortable if their genital area is covered. You can use a short apron or modified towel with Velcro tabs so the person has the privacy they want.

Giving a Bed Bath

Bed baths may be a little (or a lot) embarrassing for someone. However, they are necessary for people who cannot take a bath or shower. The person must stay clean and dry throughout the day and night. Bed baths can be quite comforting because they allow a little exercise, improve blood circulation and also provide an opportunity for gentle massage and a chat if the person enjoys that. They also give you a chance to check for bedsores, bruises, rashes and other skin conditions. Bed baths are an intimate experience and must be done with respect and compassion. They should not be rushed. You may even want some music playing in the background for mutual enjoyment.

My father and I were very shy the first time we helped wash my mother in bed. We didn't know what we were doing so my father and I washed her from top to bottom, all at once. Then we dried her from top to bottom, all at once. She froze. We learned to wash and dry one part at a time and keep the rest covered for warmth. She was so patient with us.

What You Need

  1. A large bowl or basin filled with hot water (hot enough to be warming).

  2. Mild soap.

  3. Skin lotion, cream and/or powder.

  4. Washcloths (for washing and rinsing) and towels.

  5. Personal toiletries: comb, brush, toothbrush and paste, nail file and clippers, make-up, deodorant, shaving items, perfume/cologne (whatever the person needs).

  6. A suitable change of clothing.

What You Do

Wash your hands thoroughly and try to make the room temperature comfortably warm or cool depending on the season.

Let the person do as much as possible for themselves.

Wash one body part at a time starting at the face and working down or in the reverse direction; whichever the person prefers. The rest of the body should be covered with the top bed sheet or a large warm towel.

During a bed bath, you may also put a basin of water on a towel at the foot of the bed so the person can soak one foot at a time in the basin. It is very comforting. Dry the feet when they are finished.

Wash carefully under the skin folds since these are the most likely spots for rashes or other skin problems. This is especially true under the arm, in the groin area, buttocks, stomach skin folds, and under a woman's breasts. In sensitive areas, the person may be able to help with the washing more than in other areas.

Cleaning the back is the perfect opportunity to give someone a back rub whether they are on their stomach or on their side. Once you have cleaned them you can use skin lotion to evenly massage the upper and lower back and buttocks. Ask the person how they like their backs rubbed best and follow their lead. Use soft pressure and move your hands in circular motions. Do it several times, always keeping your hands on the person's skin and using enough lotion so that your hands move smoothly. You can also do this while a person is sitting at a table leaning over and resting their head on a pillow. This may be very helpful for people who cannot lay on their stomach or sides for very

long e.g., elders or people who have had recent surgery or who have breathing problems.

People often enjoy having their face, temples, neck, hands, elbows, feet and heels massaged as well. Again follow their wishes.

Once you have completely washed and dried the person, help them with their personal hygiene. For example, they may want to use deodorant, put on some makeup, have their hair combed, etc.

Help them put on their clothes in whatever way they ask.

General Care of Hair

People need their hair cleaned, combed/brushed (at least twice a day), cut and set. The condition of one's hair often tells visitors and the person themselves how well they are doing. Clean and groomed hair is important for good health and feeling good about yourself.

Dry Shampoo

You can wash someone's hair using 'dry' shampoo like a commercial dry shampoo, cornstarch or natural (unscented) talcum powder. This method was all the rage in the late 1960s and early 1970s for teenagersI remember it well!

For someone who needs their hair washed in bed, dry shampoo can sometimes be a quick alternative to a normal wash. Do the following:

Place a towel under the person's head.

Sprinkle powder on the scalp and massage the hair and scalp gently.

Brush the powder out of the hair with slow, even strokes. If hair is tangled, hold the hair near the scalp before brushing through to the end.

Wash the hairbrush after each dry shampooing.

Wet Shampoo

If the person needs a normal hair wash but cannot use the bath or shower you can wash their hair in bed. You will need:

  1. A plastic sheet to protect the bed.

  2. A waterproof cape (like in a hair salon) or a plastic garbage bag with a hole for the head and cut along the sides to make a cape.

  3. A jug or pitcher of warm-to-hot water (several if the person has long hair).

  4. A bucket or large basin to collect water, (there are also special shampoo trays available through some drug stores).

  5. A washcloth or small towel, plus two larger towels for drying.

  6. Pillow(s).

  7. Shampoo.

  8. Comb or brush.

  9. A hair dryer (if needed).

To Help the Person Wash Their Hair if They Cannot Do it Themselves

1. You may want to put a towel or plastic sheet on the floor under the bucket to catch any spilled water.

2. Have the person lie on their back with their head over the side of the bed (adjust pillows, covers, etc. so they are comfortable). Put the bucket or basin on a small table under the person's hair.

3. Cover the area with the plastic sheet and have the person wear their cape with the back side covering their pillow rather than tucked under them.

4. Pour warm water from the jug over their hair so that the water falls in the bucket or basin below.

5. Put the shampoo into the hair and gently massage it in to lather the hair and scalp.

6. Rinse the hair with the remaining water.

7. Dry the hair with a towel and then with the dryer if necessary.

8. Empty the bucket and tidy up the bed. Remove the cape and plastic sheet. Place the other dry towel on the pillow to soak up any moisture still in the hair.

9. Other tasks like setting or colouring the hair can be done in bed using the same common sense approach to comfort and cleaning as described here.

Taking Care of Someone's Back

Many people like a back rub whether they get a bed bath or not. If the person agrees, you can give them a back rub while they lie on their stomach or on their side just as in the diagram earlier. Use a good skin lotion or experiment with natural oils such as rose or almond oil. Check with the visiting home nurse or family doctor for suggestions.

If the person cannot turn in bed themselves, they need to be turned every two hours or so. Otherwise there is too much pressure on just one part of their skin and they may get painful bedsores. Use pillows to provide the back support they need when they are on their side. Earlier in the book there are illustrations that show proper back support in different lying positions.

Other Areas Needing Care

Most people can brush their own teeth (or soak them), clean their mouths, ears and nose. Some people may need a little bit of help; let them tell you how you can best help. They may need extra help especially with their fingernails. For example, you might brighten up a woman's day by helping them use their favourite nail polish.

Feet and toenails may require a good footbath (with the person sitting in a chair or lying in bed with the basin on the mattress). It is important to clean and dry between the toes as well as the rest of the foot. They may need a cream to help prevent skin dryness. This is a good time to check their toenails. They should be trimmed in the same shape as their toes without sharp edges to prevent damage to other toes and ingrown nails.

Adaptive Clothing

If someone must stay in bed for a long time or if they must stay around the home for long periods they may wish to adapt some of their clothes to make care easier on themselves and for others.

For example, rather than long pants or pajamas bottoms, they may wear oversized shirts or pajamas tops that are buttoned in front to keep their upper and lower body warm while also making it easier to get dressed and undressed. Sometimes, the back part of a shirt or pajamas top can get wrinkled and be quite uncomfortable for someone in bed for a long time. It may be worth taking some older shirts/pajamas tops and cutting up the back and sewing a seam on each side (much like those wonderful hospital gowns everyone loves to wear). Use a strip of extra cloth to make a tie at the top and middle if you like. You can also use oversized shirts/pajamas tops and put them on backwards for a similar effect although it may not fit as nicely and may need a little cutting and sewing to fit better around the neck.

Scarves (light or heavy) may be very useful to make sure that someone remains warm if there is a draft. Also, scarves can be used to keep one's head warm if the person has lost their hair during treatments. The book Changes, Choices and Challenges (in the reference section) gives examples of the creative uses of scarves. Socks or good slippers will also help keep feet warm.

Bed Care

Supported Lying Positions

People need to rest in different lying positions so that they do not put too much pressure on any single body part or skin area. People can sit up, lay down or lay on their sides as they normally do for sleeping.

Sitting Up

The head should be raised about 45 to 60° with small pillows under their head, lower back and under their knees (or raise the foot portion of the bed). This position is helpful for eating, using a bedpan or urinal and helps improve how the person's heart and lungs work. If the person likes a large pillow, place it lengthwise to support their upper back, shoulders and head. It may help to have a footboard at the bottom of their feet to allow them to push up a little as they will naturally slide down in bed over time.

Lying Down

With the person in the centre of the bed, put a pillow under their shoulders, neck and head. Another pillow can go under their lower back for extra support and a rolled up towel or smaller pillow under their ankles and knees. The person may also enjoy pillows under the upper arms and hands. Follow the person's wishes and change pillow positions as requested.

Lying on the Side

When you look at a person lying on their side you should see the same body position as if they were standing with one leg bent up. The back is in line with the straight leg with pillows under the head, top arm and bent leg. Pillows can also be rolled along the person's back for extra support to prevent them from rolling onto their back when they are sleeping.

Making a Bed

People may spend a lot of time in bed. It is important that the bed stay clean, dry and comfortable.

Making an Unoccupied Bed

It seems silly to have a section on making a bed. Add to that that my mother would be amazed that I am offering advise on this subject at all and you get the idea that you should accept or reject any of the following advice based on your own expertise. However, many of us have never had to make a bed for someone who will spend days there. How you make the bed will decide how comfortable the person may be.

Try to use fitted bottom sheets so that the sheet has few wrinkles in it. Wrinkles add extra pressure to the person's skin and may cause bedsores. If you can, try to make the bed when the person is normally out of bed (e.g., taking a bath, sitting in a chair). Try to avoid extra efforts to get the person out of bed so that you can change it. The more natural the effort, the less trouble for everyone.

Making an Occupied Bed

Sometimes the person cannot get out of bed while you change the

sheets. This takes a little more planning but is quite simple after a few tries. The idea is to make one side of the bed at a time. It is harder to explain what you need to do than to actually do it. After you have done this once or twice you will master the steps and fill in the little details that are most important to you and your loved ones.

1. Make sure you have all the clean sheets, pillowcases, etc., that you need on a chair beside the bed.

2. If possible, have the bed lying flat (if it is adjustable) and the person using only one pillow.

3. Place another chair on the opposite side of the bed you are working on. If you are using a hospital bed, you can raise the side rail on the far side. Either way will allow the person in bed to hold onto something as they roll onto their side closest to the chair. Their back should face you and they should be covered with a top sheet, blanket or cover so they can stay warm.

4. Loosen the bottom sheet at the head and foot end of the bed, as well as any top sheets and blankets. Roll the bottom sheet as close to the person's back as possible. They will have to roll over this old sheet and the new one when you are ready.

5. Smooth out the mattress cover.

6. Lay down the clean fitted bottom sheet, folded lengthwise, from head to foot ends of the bed. Tuck in the head and foot ends and smooth out the sheet as much as possible.

7. Roll the remaining bottom sheet, lengthwise, as close to the person's back as possible. It will be right beside the old bottom sheet.

8. Ask (or help) the person roll toward you, over the sheets. If they need extra support, have them roll onto their back first, lift their far leg towards you gently, and help them roll onto their side facing you. Bring the chair from the other side to put where you were standing or lift the hospital bed's side rail so that the person has something to hold onto and help them from falling out of bed.

9. Move to the other side of the bed. Loosen the old bottom sheet and pull it completely off the bed as well as pulling the new sheet from under the person. Some of the sheets might get caught under the body weight of the person in bed but just pull gently until they are loose. If necessary, gently push the bottom part of the person's back to release some of the body weight on the sheets. Smooth the mattress cover.

10. Tuck in the new bottom sheet at the head and foot of the bed and make sure there are few, if any, wrinkles.

11. Have the person lie on their back and position the bed comfortably for them. Replace old pillowcases.

12. If the person uses a duvet, replace the outside cover as needed.

13. If the person uses sheets and blankets they will already be untucked from replacing the bottom sheets. Place a clean sheet on top of the blanket. Have the person hold onto the blanket and clean sheet as you pull out the old top sheet from the foot of the bed. If they cannot help you, you will have to do this yourself and take a little more time.

14. Turn the sheet and blanket around so that the blanket is on top, tuck in the top sheet, blankets, and bedspread (if they like).

Extra Tips: Sometimes there may be other things on the bottom sheet that will need to be changed or at least kept there. For example, draw sheets, sheepskin pads and incontinence pads are often used for someone who is in bed. The same principles apply as in the instructions above. You do one side of the bed at a time and the person rolls over the old and new items you are changing. The more things there are, the higher the 'bump' the person has to roll over.

Pain and Symptom Control

Describing Pain and Symptoms

Pain is a very subjective sensation. One person's headache may force him to bed while another person's headache may allow her to continue to work. The following checklist will allow you to describe your pain and other symptoms as clearly as possible. If you or a family member/friend can, write down the answers for your doctor.

Where in the body did the pain/symptom begin?

When did it start (date and time)?

On a scale of 1-10, with 10 equalling the worst pain you have ever had (e.g., broken arm, back pain, severe toothache), how do you rate your pain?

Describe any other symptoms you have had.

What were you doing at the time of the pain/symptom?

To what degree does your pain/symptom limit your normal activities?

How long does the pain/symptom last (an hour, all day)?

Is the pain/symptom constant or does it change?

Does the pain/symptom stay in one place or spread out to other parts of your body?

What makes the pain/symptom worse?

What makes the pain/symptom better?

Other information.

Pain Control Medication

Pain has different degrees of intensity. Pain control experts divide pain into: mild, moderate, severe, very severe and overwhelming. At present, experts recommend the following types of medication for each level of pain:

Mild A non-narcotic e.g., aspirin (ASA).

Moderate weak narcotic e.g., codeine.

Severe An intermediate-strength narcotic e.g., increased dose of codeine.

Very severe A potent narcotic e.g., morphine.

Overwhelming A potent narcotic and sedative e.g., diazepam.

It takes time and experimentation to arrive at the exact combination of medications that will keep a patient painfree and alert. Patients and families can shorten this process by recording any positive or negative results of new medications and talking to their doctor about these results.

Other Pain Control Techniques

There are other treatments for pain control. A few of these techniques use medications in a different way or use other forms of therapy such as:

Radiotherapy Radiation is used to shrink tumours to reduce a patient's symptoms.

Nerve blocks For localized acute cancer pains, a local anesthetic or neurolytic injection is given to block nerves from sending pain messages to the brain. Results may be temporary or longlasting.

Hypnosis A hypnotist can use oral suggestion to sometimes increase a person's pain threshold.

Acupuncture This ancient Chinese art uses sterile needles in very specific spots to neutralize pain messages going to the brain.

Neurosurgery With the proper use of medication and other techniques, the need for neurosurgery should be uncommon. If other measures do not work, neurosurgery should not be delayed.

Symptom Control Techniques

Total pain is not only the sensation or feeling of pain. Total pain is a combination of physical and psychological feelings. The primary psychological component of total pain is fear. Fear can aggravate a patient's physical pain, so fear, anxiety and other negative emotions must also be treated. Add to this list diarrhea, constipation, lack of hunger and energy, bedsores, lack of mobility, and other symptoms and you will understand the need for symptom control and relief.

Some of the symptom control and stress management techniques that home care personnel use, other than medications, include:

Diet Some foods cause constipation while others cause loose stool. Knowing which foods cause what reaction can help caregivers to alleviate a specific symptom.

Exercise Extended bed rest can lead to bedsores, constipation, back aches, general immobility and loss of muscle strength because of the decreased use of muscles. Exercises, active or passive, can be done by the patient or with someone's help in bed or they can be done when the patient is out of bed. Walking, stretching and breathing are excellent forms of exercise.

Skin care Nurses that visit patients at home will often tell you that bedsores are one of their greatest concerns. Bedsores are very painful and almost always avoidable. They occur most often when elbows, ankles, shoulders, hips, buttocks, heels and the back are in constant contact with a surface. Paralyzed or unconscious patients are most likely to get bedsores. Proper skin care includes daily washing, skin cream treatments and the use of a lamb or sheep's skin mattress covering or watercirculating mattress pad. For people unable to move themselves in bed it is important to change their body position at least every two hours to avoid bedsores.

Massage Gets the blood circulating, invigorates the skin and can be very soothing and or exhilarating depending on the type of massage. Everyone enjoys a massage so it is not a surprise that they are excellent for the physical and emotional well being of a patient as well.

Recreational therapy Physical activity like a walk in the garden or a card game with friends encourages people to make decisions and participate in things that they have always enjoyed.

Art therapy People can express feelings by doing creative work. Whatever the person decides to do may end up as a gift to a grandchild or a cherished memento for a family member or caregiver.

Music therapy People can relax and be comforted by playing,

listening, interpreting, and talking about music. Personal preferences are important to the success of music therapyjust playing favourite music can be therapeutic.

Laughter Technically it increases the production of endorphins (natural chemical pain killers in our bodies), reduces tension, distracts attention, changes expectations, and is an internal jog of organs for exercise. In another sense, laughter is contagious and lets people express their feelings in a less threatening way. It can change the mood of a place faster than any other emotion. Find a few good records or videos of comedians like Bill Cosby and sit back and enjoy yourself.

Relaxation exercises Deep breathing, visualization, hypnosis, meditation and prayer are all ways to relax. They help to relax the body physically and mentally.

Listening Perhaps no method of symptom control has a greater impact on a patient's fear, anxiety, loneliness and depression than someone who listens unconditionally and answers questions in an honest way.

The purpose of all of these techniques is to give people a sense of control over their lives. Even if they are bedridden, decisions have to be made about exercises, diets and other daily living tasks. Making decisions about their care helps to give patients a sense of control. Independence is very important to people and symptom control helps them to be as independent for as long as possible.

What Prevents Adequate Pain and Symptom Control?

Errors by the Person Receiving Care

Believing the pain and symptoms are untreatable.

Not contacting the doctor for help.

Telling the doctor and family that the pain isn't strong or the symptoms aren't bad.

Failing to take medication.
Taking the medication at the wrong times or not consistently.

Fearing drug addiction or drug tolerance.

Believing pain killers are only for extreme pain.

Discontinuing medication because of severe side effects and not telling the doctor.

Doctors or Nurses' Errors

Ignoring a patient's description of pain and symptoms because it sounds extreme.

Not seeing through the patient's brave face.

Prescribing medications that are too weak.

Giving medication only when the person says her pain has returned (effective pain control prevents the return of pain).

Believing post-surgery pain killers are suitable for cancer pain (generally, surgical pain is acute but short-lasting while cancer pain is chronic and can increase over time).

Not giving enough information about the medication, its use and when it must be taken.

Not knowing enough about different types of medication and how to move from one to another as the pain increases.

To deal with pain and symptoms, we must recognize that pain and symptoms are always real and unique for each person. Proper pain control requires the right drug or treatment, in the right way, and at the right time. Proper pain control includes some experimentation to discover the right combination of medication and treatments, requiring the complete co-operation of the patient, the family and the caregivers. When the pain is under control, other symptoms can be addressed, so that the patient's suffering is reduced and he can remain alert and active for as long as possible.

Helping With Medication

The three biggest problems with taking medication (drugs) are: (1) that some people take far too many different ones without knowing how they react with each other, (2) they take the wrong kind of drugs or (3) they take too little of a drug for it to be help

ful. For drugs to work best, people must:

Use the right drug.

In the right amount.

At the right time.

Buy the right method: liquid, tablets, drops (for ears, eyes and nose), ointment, sprays, suppositories, injections.

Make sure they work well with any other drugs they are taking.

Whenever you see your doctor, go to a clinic or to an emergency department, make sure to have a current list of all your medications, how often you take them and what dose you take. This helps to spot any oversights in the amount and kind of medication you are taking. If you do not have a list, bring all your medications with you in the containers you got from the pharmacist.

Pharmacists are very knowledgeable about drugs and how they react with other medications. When you get a prescription filled, ask the pharmacist about side effects, mixing with other drugs (have a list of your drugs with you) and any tips on how you can take your drugs in the right way. Also ask if there are any foods, drinks or personal habits that might affect the usefulness of the medication. For example, ask if one should not have alcohol with this medication or should not drive after taking it. Medications do affect people mentally and physically. People may have behaviour changes, hallucinations or other mild to severe reactions. You have to be very careful to make sure the medications are more helpful than harmful.

If you forget to give a drug at the right time, check with your doctor or pharmacist about what to do. Do not double the dose at the next scheduled time without their permission, as this might be dangerous.

Note: If you are taking complementary therapies like vitamins, herbs, or are on a special diet, tell your doctor or pharmacist. For example, some Chinese herbs may be harmful when combined with certain medications.

Medication Records

You may be taking several drugs and your prescriptions may change from time to time. The following record allows you to keep track of your drugs, what dose should be taken, at what time, with what conditions (e.g., take one hour before a meal, only with milk), and how well the drugs are working. The prescription date and the doctor's name are useful in emergency situations when your regular doctor may not be available to help you.

Make up your own chart on some separate pages. The following is a sample of how it might look. Change it to meet your own needs.

Date Drug Dose Taken Doctor Results/Side Effects

Aug 1 Tylenol 3 10 mg 4 times a day Kildair Pain relieved after

5 hours but

returned three

weeks later.

Aug 23 Tylenol 3 20 mg 4 times a day Kildair Pain relieved after

6 hours.

If you are taking various drugs, a Medication Table is useful to help you remember what to take, when and with what special instructions (e.g., with milk, during a meal). Use a pencil to fill in the drugs since they may change over time and you do not want to rewrite a whole list each time.

Time Drug(s) Special Instructions

8:00 a.m. Give drug names, dose and Take yellow pills with milk

colour (e.g., yellow pills).

4:00 p.m. Give drug names, dose and Do not drive after taking pink

colour (e.g., yellow pills). liquid

10:00 p.m. Give drug names, dose and Take drugs before bedtime.

colour (e.g., yellow pills).

Make up your own schedule. Under the time column, list all the different times of the day that you need to take drugs. Some drugs you will only need to take once a day while another one might be every 4, 8 or 12 hours.

Local pharmacists often sell 'Dosettes'. These boxes have many small compartments and they can be used to prepare medication for a day or a few days at a time. They are very helpful in reminding people what to take at what time of day.


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