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the patient: if he is entirely helpless two people are necessary. Two people should proceed as follows: Let A place her left arm under the patient's head and shoulders as before, her right arm under the small of his back; let B place her right arm also under the small of his back and her left arm under his thighs, and at a signal let them lift together. In this way the weight is so evenly distributed that a heavy person can be lifted without great difficulty.
To Turn a Patient in Bed.

—A patient may be turned toward or away from you. In turning a patient toward you, place one hand over his farther shoulder and the other over his hip, and turn him toward you. Then flex his knees slightly. To turn a patient from you, pass one hand as far as possible under the shoulders, and the other as far as possible under the thighs. Then raising the patient slightly, draw him back toward you, turning him at the same time, and then flex the knees. Lastly place a pillow firmly against his back to support it.

To change the sheets while the patient is in bed  

proceed as follows: First collect the fresh linen and place it conveniently near the bed. Then draw the bedclothes from beneath the mattress, raising the mattress meanwhile with one hand to prevent jarring the bed. Remove first the spread and then the upper blanket if there are two, fold each once and place it on a chair. Hold the remaining blanket in place with one hand, while with the other you draw the upper sheet out from under it; then fold the edges of the blanket up over the patient to keep them out of the way. The upper sheet, unless soiled, may be folded once and used again as a draw sheet. Next remove all the pillows, unless the patient prefers to keep one. Then move the patient toward one side of the bed and turn him on his side so that he faces the edge nearest him. Roll the draw sheet and rubber sheet together if both are to be removed, or separately if the rubber sheet is to remain on the bed; then roll the bottom sheet throughout its entire length, and bring the three sheets, all rolled as flat and as tightly as possible, close to the patient's back. Pleat about half of the fresh lower sheet lengthwise and place the pleated portion as close as possible to the rolled soiled sheets. Tuck in the other half of the fresh sheet at the top, bottom and side, draw the rubber sheet if it is to be replaced back over the fresh lower sheet, arrange the fresh draw sheet in place, tuck it in at the side, and roll its free portion close to the patient's back. The fresh side of the bed is then ready for the patient. Lift his feet back over the rolled sheets keeping his knees flexed, then turn him back over the rolled sheets on to the fresh smooth part, remove the soiled sheets and arrange the fresh ones in place on the side where the patient has just been lying. Be careful to keep him well covered with the blanket. After the lower sheets are in place and firmly tucked in, spread above the blanket the fresh upper sheet, and over the sheet spread the second blanket. Hold the sheet and blanket in place with one hand while using the other hand to draw out the first blanket from beneath the sheet. In this way the patient is constantly covered by a blanket. Place the blanket just removed above the other and finish the bed according to the directions given for an unoccupied bed, using special care, however not to draw the covers too tightly over the patient's feet.

Fig. 14.—Changing the Draw Sheet. (From Pope "Home Care of the Sick," American School of Home Economics, Chicago.)
To Move a Patient from One Bed to Another.

—On the fresh bed have the lower sheets in place but not the upper covers. Place the two beds close together side by side, and draw one mattress a little over the place where the two sides meet. Loosen the draw sheet under the patient, roll it on both sides close to the body and draw him gently over by means of this sheet, moving his shoulders at the same time. If the beds are unequal in height, use firm pillows or folded blankets to make an inclined plane.

Fig. 15.—Changing a Patient from One Bed to Another. (From Pope "Home Care of the Sick," American School of Home Economics, Chicago.)

If the beds differ greatly in height and indeed in most cases, it is better to carry the patient from one bed to the other. At least two people are needed; one alone should never attempt to carry anyone heavier than a small child. One method for lifting is as follows: Let two bearers, A and B stand on the same side of the bed. If the patient is to be moved into the right side of the fresh bed let both bearers stand on the right side of the occupied bed; if he is to go into the left side of the fresh bed, let them both stand on the left side of the occupied bed. Let A place one arm under the patient's shoulders and her other under the small of his back, while B places one arm under his hips and the other just below his knees. Draw the patient to the edge of the bed, instruct him to place his arms about the shoulders of A and to hold the body rigid, and then lift together at a given signal, keeping his weight well up on the chests of the bearers.

Whenever a patient must be turned, lifted, carried, or moved in any way, let him know beforehand just what you intend to do so that he may not be startled, and also that he may coöperate if possible. Grasp him firmly but gently, avoid pinching the skin, and move him steadily and smoothly, avoiding jerks and false starts. Do not attempt alone more than your strength is amply sufficient to accomplish, and endeavor at all times to handle the sick with the utmost gentleness and consideration.

EXERCISES Describe a bedstead and mattress suitable for a sick person's use, and tell why they are to be preferred. How should the bedstead be cared for? the mattress? the pillows? How should a mattress and pillows be protected? Describe in detail the bed covers that are desirable for use in sickness. Name the results that a good method of bedmaking aims to secure. Describe the method of making an unoccupied bed. How should one change the pillows of a helpless patient? Describe the way in which you would lift and turn a patient in bed. Describe the method of changing sheets and remaking a bed while the patient is in it. Why are beds and bedmaking considered so important in the care of the sick? FOR FURTHER READING Notes on Nursing—Florence Nightingale, Pages 79-84.

CHAPTER VII

BATHS AND BATHING

Bathing is necessary in sickness no less than in health. It stimulates and equalizes the circulation, is soothing in feverish conditions, is refreshing to most people, and by affording a certain amount of exercise it lessens the fatigue of lying in bed. Moreover, without frequent bathing it is impossible to keep the skin in good condition, since scales of dead skin, oily matter, and solid substances left by perspiration collect on the surface of the body when a person is lying still in bed as well as when he is leading an active life. The common belief that sick people are likely to catch cold from bathing is quite unfounded; every patient, unless his condition is such that the doctor orders otherwise, should have one complete cleansing bath each day. In addition to the regular cleansing bath other kinds are often prescribed as medical treatment.

CLEANSING BATHS

A tub bath if allowed by a patient's condition, is the most satisfactory kind, but special precautions must be taken to guard her from fatigue and chill. The bath room and everything to be used should be made ready before she leaves her bed. Necessary clothing and toilet articles should be collected and arranged conveniently, a chair covered with a blanket and also a bath mat should be placed beside the tub, and the temperature of the bath room should be regulated so that it is about 70° F., or a little lower if the room is likely to become overheated as the bath proceeds. The bath water should be drawn last. Its temperature, tested by a thermometer, should be between 96° and 100° at the beginning, and may be increased if desirable.

If the patient is weak, wash and dry her face, neck, and ears, and if necessary cut the finger and toe nails before she leaves the bed, in any case before she enters the tub. As soon as the patient has left the bed, strip it and leave it to air; then assist her into the bath room and help her carefully into the tub. Do not allow her to stay in the water more than ten minutes at most, and stop the bath at once if she shows the slightest sign of faintness, dizziness, exhaustion, difficult breathing, marked change of color, or other unusual symptom. Indeed, if the patient is weak or her reaction to the bath uncertain, as when she takes her first tub bath after an illness, someone should always be within call to help the attendant in case of need. A faint, heavy patient in a bath tub is an impossible load for one person to handle.

While the patient is in the tub, soap her well, brush her finger and toe nails, rinse, and rub her to stimulate the circulation. Then help her from the tub, seat her in the chair, draw the blanket closely about her from neck to feet, dry her with warm towels, exposing the body as little as possible, and, if she is to return to bed, put on a fresh night gown, and wrapper and slippers. Next place the lower sheet, the draw sheet, and one pillow on the bed as quickly as possible, help the patient into bed, keeping her well covered with a blanket, and finish making the bed. If she seems chilly, give a hot water bag and hot drink and leave the blanket next her in place. After the patient has been made comfortable, clean the tub and put the bath room in order.

Even patients supposedly able to take tub baths without assistance should not lock the bath room door nor be left alone a long time.

Bed Bath.

—Practice is essential in order to give a bed bath skillfully. The aim is to make the patient thoroughly clean and thoroughly dry, without chilling, fatiguing, or exposing her, without making the bed damp, and without unnecessary haste or delay. One method of giving a bed bath follows, but any method that accomplishes these aims is likely to be satisfactory.

First see that the room is about 70° F. and likely to remain so, and exclude draughts. Collect everything to be used, including a blanket to cover the patient, an old blanket or large bath towel to protect the bed, at least two other towels, one a bath towel and the other a face towel, two wash cloths, soap, nail brush, powder, alcohol, comb and

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