Recovering patients need more than a bed to lie. The perks of getting out of bed

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1 : EFFECTIVE, IN-ROOM PATIENT SEATING HELPS EXPEDITE THE RECOVERY PROCESS The perks of getting out of bed Offering numerous health-promoting benefits over traditional bed rest, sitting speeds the healing process by improving a patient s oxygen intake, blood pressure, heart rate and more. Sitting upright provides very important cardiovascular, cardiopulmonary and muscular benefits, says Mergle. When seated, patients experience better profusion in the lungs and better oxygenation to the blood. Sitting upright also works trunk, leg and arm muscles to build up stability and reverse atrophy. Furthermore, sitting up in a chair shifts pressure on the body, encouraging bowel activity and reducing skin issues like bruising and bedsores. Recovering patients need more than a bed to lie in. Once considered the best position for healing, studies now show that lying flat in a bed negatively affects nearly every system in the body. From pneumonia to muscle waste to bedsores, too much bed rest causes a patient to deteriorate both physically and mentally. A patient loses twenty percent of their muscle mass every week spent on bed rest, says Jane Mergle, RN, BSN, certified safe patient handling professional and injury prevention and management coordinator at UC Health North. Early mobilization, such as sitting in a chair, preserves muscle mass and prevents pneumonia because a patient can breathe more deeply while sitting up versus lying in bed. A patient s trunk is often scrunched together when in bed, which does not allow for complete expansion during breathing. Sitting sends a critical message to the brain that it s time to activate the body once again. I think it s great to get a patient out of bed and into a chair whenever possible, says Jill Jansen, obstetrics nurse, Waukesha, Wis. Our goal as nurses is to help people recover so they can go home. Sitting in a chair instead of a bed feels a bit more normal to an individual. It s that first step in assimilating a patient into real-world living situations. The option to sit is proving beneficial for all kinds of patients. For example, many medical professionals believe that sitting in a chair is the best position for a conscious stroke patient, and patients with myocardial infarctions have shown promising developments from the early use of a bedside chair. Sitting is a transition point for a patient as he or she starts working towards standing and walking. Patient seating helps people get up and move sooner and more often providing important advantages to a patient s physical and mental recovery. Patients feel more in control. If a patient moves around rather than stays in bed, it helps them see they re getting better and provides hope for going home sooner, says Jenny Nielsen, RN, BSN at Columbia St. Mary s, Milwaukee, Wis. The ability to sit successfully in a chair is frequently an indicator that a patient can be discharged safely. Page 1

2 Oftentimes, patients don t want to get out of bed, admits Mergle. But it s just as necessary as any medicine they might be taking. It s important for patients to understand the positive impact sitting has on their lungs, skin, joint mobility and digestion. Effective patient seating is comfortable, functional, durable A properly designed patient chair addresses critical benefits like comfort, ergonomics, safety, functionality, durability and cleanability, while also taking care to serve both patient and caregiver equally well. Comfort is key; a serious safety issue could arise if a patient were to fall in their attempt to flee an uncomfortable chair. If a chair looks inviting, it s easier to persuade a patient to get out of bed and give it a try, says Nielsen. The ideal patient seat promotes independence and safety while offering healing comfort and support. Patients should find movement within the chair easy and natural. Chairs should provide padding to protect the skin, not just the patient s hips but also elbows, limbs, and any area that would be coming in contact with the chair, recommends Mergle. Cervical spine support, casters for easy movement, brakes on all four casters, removable arms, multi-position capability, adjustable foot rests for leg elevation and overall stability are important features to consider in a patient chair. When making patient seating product decisions, one must take into account the application. What type of patient(s) will be using the chair? What type of facility is it? Chairs for maternity, knee/hip surgery, gastric surgery and other special needs will differ. Make sure your chair can accommodate various body types. Does it serve needs that are representative of the general population? You must consider the scale of the piece some seating options are too large for a small, frail person and would not work well in a geriatric setting. A petite person in a big chair would have difficulty standing up, says healthcare designer, Michelle Gearhart. The chair must fit the patient in order to function properly and be comfy yet firm so he or she can move from a sitting to a standing position safely and effectively. Hip Chair The ease at which a patient can rise from a chair is often dictated by armrest design, foot space underneath the chair and seat height. The height and depth of the chair can also affect the ease of transferring the patient from chair to bed to wheelchair, etc., says Jansen. Arm rests should extend far enough to assist the patient in standing, while wide armrests provide patients with a comfortable spot for their arms. Armrests made of soft materials also enable better gripping to assist patients with ingress and egress. Due to the number of patients a healthcare facility sees each year, durability and cleanliness rank high on patient seating check lists. Thorough and easy cleaning of a patient chair is critical from an infection control standpoint. Anti-microbial and anti-bacterial vinyl is made specifically for health care settings, and chairs upholstered in these materials are easy to wipe off, making cleaning and disinfecting a breeze. Chairs with minimal cracks that feature one-inch-wide cleanout spaces between the seat and its sides are best as they resist gathering dust, crumbs and other various objects. Characteristics such as removable/replaceable cushions enable a deep cleaning of the chair, and materials that can tolerate strong disinfectants help reduce the spread of germs and infection. Moisture resistance is another important trait as it prevents the infiltration of blood and other bodily fluids. When working on a burn unit where patients often have wound drainage, Nielsen appreciates easy-to-clean vinyl. Page 2

3 Tall-Back Chair Another factor to consider is the chair s portability. How easy is it to move? Is it a one- or two-person job? A chair that can be transferred with little effort enables a more thorough cleaning of the patient room. Chairs with swivel casters are ideal, as they make it simple to move patient seats to wherever desired. Some chairs are also equipped with push bars that make it easy to transport a seated patient. Nielsen s unit has a recliner in each room and a regular tallback chair that opens up into a bed for use by a patient or guest. She likes the ease at which the chairs can be moved because, It helps people feel more secure in knowing they can make it back to their bed once they re in the chair. Also, it s easy to shift the chairs around so patients can enjoy views of the lake. Recliners a comfortable and supportive alternative to the bed Many healthcare professionals agree that a recliner is one of the most desirable patient seating options. Sitting upright may not be ideal for every patient; therefore the ability to recline is crucial. Sitting in a recliner alleviates back pressure and opens up airways. A recliner is ideal for a patient on prolonged bed rest or for a patient whose capacity to stand up is questionable because of blood pressure issues, says Mergle. Medical recliners enable patients to elevate their feet to decrease swelling and offer a progressive reclining tolerance to relieve pressure points commonly found in conventional seating. Useful for patients on dialysis and those needing different types of therapy, recliners are also typically more comfortable for patients with sleep apnea. In addition, recliners can handle higher weight capacities than the average chair. Since no single sitting position is comfortable for a lengthy time, it s a good idea to change postures while seated. Rocking and reclining features help a patient vary their posture and be more active while sitting. The seat-to-back angle directly affects comfort, and adjustment mechanisms should be easy for a patient to reach and operate so even weak persons can alter positions without exerting much pressure. Chairs with a contoured seat and back help provide effective pressure distribution by delivering even and constant support to the patient s body. The use of a reclining backrest has been shown to reduce disc pressure by as much as 20 percent, and recliners offering generous lumbar support make sitting an easier task for a recuperating patient. The mechanism in which the chair reclines weight, lever, pull string is an important feature to examine. Each one has pros and cons. How much control do you want to give the patient in reclining? How much control should the caregiver have? How far does it recline? Whatever mechanism is decided upon, it should be easy for both parties to use and effectively assist caregivers working in fast-paced environments. Independent operation of footrest and back recline give patients flexibility in how they wish to be positioned while seated. Breakaway foot rests on recliners offer overload protection, releasing rather than bending when subjected to extensive weight, and three-tier footrest systems accommodate a wide range of patient heights. Weight-activated recliners have no breaking parts, but a frail patient or someone who just had surgery might not have the strength or ability to adjust the reclining position without pain and would likely require help from the caregiver. A lever mechanism doesn t require Recliner with Casters Page 3

4 much effort, although a smaller person might have trouble operating it. An inside flip lever or pull string is the easiest reclining method for most patients to use, but it is hard for the caregiver to offer assistance. Nielsen prefers recliners with a lever on the side. I care for a wide range of people at various stages of healing, and other reclining options are harder for them to use. A recliner for every situation Seating options need to safely support patients of all shapes and sizes. With an increased obese population, the ability to accommodate for a large weight capacity is vital, says Jansen. The standard weight capacity on many recliners is 350 pounds. Bariatric recliners can hold between 500 and 750 Motorized Lift Recliner pounds and typically recline to a 45 degree position to provide utmost comfort to bariatric patients. Durable, soft urethane arm rests with knobs can be used to aid weak occupants in getting out of the recliner easily. can flip up, flip out to the side or be removed entirely, giving caregivers easy access to the patient. Recliners outfitted with a breathable mesh seat and back minimize heat and pressure build-up two factors that contribute to the formation of bedsores while increasing the level of oxygen flowing around the patient. Mesh material is ideal for patients with wound care issues and is easily cleaned and disinfected with steam. In some instances, the ability to recline beyond horizontal to a Trendelenburg position is necessary; where a patient s head is approximately 10 to 20 degrees lower than their feet. This is useful for a patient with edema in the knees or ankles, as elevating the legs higher than the heart helps reduce swelling. If a patient goes into shock, the caregiver can fully recline the Trendelenburg recliner so the patient s head is below their knees, helping to preserve blood flow. In rooms where space is at a premium, wall-saver recliners provide healthy, compact patient seating, while protecting patient room walls. The wall-saving design enables the recliner to be placed as close as five inches to the wall. Recliners featuring LiquiCell technology create a comfortable place for patients to rest, regardless of their height or weight. Located between the foam and upholstery, LiquiCell is an ultra-thin liquid layer within the chair seat that is in constant motion, allowing the body to glide or float on the chair without interfering with patient positioning or stability. LiquiCell seating also improves blood flow and helps prevent skin breakdown that can lead to pressure ulcers. When patients are too weak to operate a recliner, motorized lift recliners can make the sitting much more comfortable, allowing the patient or caregiver to easily change position from sitting to full recline automatically. The recliner can also bend forward to help a patient rise from the chair with minimal effort. When repositioning a patient from bed to chair, providing a level transfer surface is the goal. Certain types of recliners make it especially safe and easy to transfer a patient in and out of a chair. Recliners featuring adjustable arms that swing open allow for an easy, gapless, lateral patient transfer to and from a wheel chair or bed. Chairs come with different options: the arm Recliner with Heavy-Duty Casters Page 4

5 Rockers/gliders provide soothing comfort Gliders and rockers are an excellent choice for getting people out of bed and on their way to recovery. A glider chair is a therapeutic and comforting option that enables a patient to sit upright, easing the nervous system to encourage relaxation, while their feet rest comfortably on the floor. Especially Glider Chair welcome in pediatric and maternity settings, the glider s smooth back and forth motion helps reduce anxiety and provides a soothing solution for children and mothers. In addition, some gliders are also designed to swivel a full 360 degrees, giving patients added freedom and mobility. Stimulate wellness through countless seating choices Patient seating selections are numerous. With something for every iteration, size and application, you ll find dozens of recliner models available in a multitude of colors and styles to fit every medical need. Get patients on the path to recovery quicker by working with a vendor who carries a wide variety of affordable, durable and comfortable seating products from reputable brands. A furniture professional well-versed in the healthcare field can help you painlessly select in-room seating options that promote a healing environment while enhancing patient care and mobility. A high-back rocking chair, featuring arms with grip extensions, helps patients feel instantly supported and aids in easy sitting and standing. Seat and back cushions featuring durable Ultracell foam provide abundant comfort, and a contoured, waterfall-design seat cushion promotes relaxed legs. A rocker with molded foam back cushion provides proper lower and upper back support, while seat and back openings make cleaning a snap. Jansen, who works in labor and delivery, says that each room on her floor has a rocking chair, a rocker/recliner and a sofa as seating options. My patients can use the rocker or rocker/recliner during or after labor if they choose. It s just another positioning option for laboring moms if the situation allows. It s also nice to have a place to sit besides the bed both before and after delivery because if you aren t sick, you certainly don t want to be in bed all of the time. Rocker Chair Begin your patient room seating transformation. Contact NBF for free office space planning and design services today: , web code References 1. Progressive Mobility: The Benefit of Getting Out of Bed. May HermanMiller Healthcare. Healthful Patient Seating: Perspectives from Caregivers and Patients Page 5