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Bad positioning, bad business.

Which costs less: taking the time to teach your staff proper positioning of residents and making sure they follow through, or allowing your residents to sit in wrong-sized wheelchairs, be positioned poorly while in bed, or be allowed to lie in a reclined gerichair until they roll up into a contracted ball? These injuries -- and injuries are what they are -- occur in nursing homes all over the country, and they are expensive -- not only financially, but in needless pain and suffering.

Consider a typical nursing home resident who is admitted because he/she can no longer live at home alone: Upon admission, the resident begins to lose a sense of independence and spirit as he or she is told they will be sharing a small room and bathroom with a complete stranger (who may or may not be confused), will receive a schedule for getting up and going to bed, eating their meals, attending activities, and taking showers (they get to ride down the hallway in a commode-on-wheels!), that they will have their clothes removed and be exposed in front of other human beings (and some of these people have never even allowed their own spouse to see them nude), that water that is hopefully the correct temperature will be hosed over their bodies, and they will be dried and dressed as they desperately try to maintain their body temperature.

Oh, yes, and some well-meaning individual will look at their diagnoses and determine that they should receive a certain diet that does not include the foods or the spices and seasonings that they have enjoyed over the past 70 or 80 years. Also, because they are a bit unsteady on their feet and had fallen at home before they were admitted, another well-meaning person will tell them not to walk unless a staff member assists them -- but no one is ever available to help, so before long this person loses the ability to walk, and a wheelchair is provided for their mobility. They will sit in this wheelchair most of the time they are out of bed, will not be helped to ambulate nor encouraged to stand and bear weight at recurring intervals to preserve bone integrity.

Of course, this person has a small frame and is too small for the assigned wheelchair. Therefore, another well-meaning person will put a spongy foam pad in the seat to pad their buttocks, raising their feet several inches off the floor and, since this wheelchairs foot pedals have been lost for months, their feet will hang down and not rest flat on a surface, so they will develop a plantar flexion contracture (foot drop). The seat of the chair is stretched out so it cradles this person's hips with a sling effect, rotating them inward, which soon becomes a hip adduction contracture. There is nothing on either side of their body to support the torso, so it starts to lean to one side, starting a spinal curve, and then, as their head tries to return to midline, they develop a cervical spinal curve in the opposite direction, which before long becomes a contracture.

Their arms will have remained in the same position for so long that their shoulders have developed adduction contractures, the elbows themselves have contractured at 90 degrees and progressing, and their hands have not been fully extended routinely so the fingers are in a closed palm position and they have developed wrist drop contractures. Because of these contractures, a well-meaning person decides that this resident would be more comfortable in a reclining gerichair in which they continue to draw up into a ball.

Since most of their time in the gerichair is spent staring at the ceiling in their room (and then at their own knee caps because of their fetal position), they became disoriented. And, somewhere along the way, this individual becomes incontinent of bowel and bladder and stops feeding him or herself.

Sound familiar? If so, don't waste precious time feeling guilty because, along with all your other duties, you didn't stop to realize this was happening. We were not taught restorative care in nursing school. Nevertheless, we must change, and look at residents in a different light. Teach everyone who works in the facility to adopt a restorative mentality, to be attuned to each person's positioning and range-of-motion needs.

There is a very special "nurse" named Mother Teresa who, though surrounded by some of the direst poverty imaginable, makes sure that no one in her care dies alone or unloved. How can she do this and still exude the sense of tremendous peace that she is known for? Says Mother Teresa, "I never take care of crowds, only of a person. If I stopped to look at the crowds I would never begin."
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Copyright 1996, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:nursing home ergonomics
Author:Bonn, Karen L.
Publication:Nursing Homes
Date:Oct 1, 1996
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