Tips for a neat bed?

[change07]

Hi,

This may seem random, but I have been a NICU RN for awhile and still can't seem to get my bed to look as neat and rolls as tight as my coworkers.

Any tips?

Thanks!

[palesarah]

double post, sorry

[Imafloat, BSN, RN]

We use snuggle ups and bendy bumpers. If a baby is in a bassinet or crib they can't use those anymore, we usually swaddle them in a receiving blanket, tuck a folded blanket into the end and cover them with it.

My pet peeve is tangled lines and wires, that drives me nuts, as well as a messy bedside.

[bubbly]

The neatest beds I have seen are not always the most comfortable for the patients. Sometimes I see "hammock" beds where the patient is just hanging out with there legs and feet out over the rolls. The best beds keep the patient in a developmentally appropriate position and mimic being in the uterus (blanket rolls containing them snugly). There are a lot of ways to make a good bed for the patient's needs (always need to assess the patient's age and how many wires and tubes that need to be worked around). And, of course, make sure there are no wrappers, syringes, and other needless items in the bed (I hate that). Use blankets efficiently (less is more)! Sometimes I will tape the rolls so that they stay in good rolls during patient repositioning. Oh, and babies hate sleeping on wrinkles so make sure the blanket underneath them is tightly pulled out. Utilize sheep skin, which my unit places under the babies' blankets, to help minimize pressure points. Ok, so my point is mostly make sure the bed is comfortable and appropriate for the patient then just being neat and pretty looking. :)

[elizabells, BSN, RN]

Both things are possible, IMO. And our PT/OT people don't seem to mind when the hips and knees are flexed with the legs up over the end of a snuggly/hammock bed. As long as the baby is repositioned frequently and doesn't spend all its time in flexion it's not a terrible position. It can really help prevent frogleg and lordotic spine problems.

[bubbly]

My post about positioning was more aimed to the premies since full term babies can handle positioning a lot better. During my internship, I had a class with a nurse teaching developmentally appropriate positioning and she was very strong in her position against the "hammock" style beds and the nesting that doesn't give adequate boundaries around the patient. She said premies do best in the flexed position and all the "wrong" images she showed us about premie positioning showed the premies outstretched. After all, the uterus where they should be is a pretty tight space. Premies do not have the strength to get in the more comfortable flexed position themselves. I guess if you had the time in NICU to be meticulous in your bed making, then it's up to you. I couldn't imagine moving the sick little premies around too much or disturbing their sleep just to tuck blanket corners in or making the pattern in the blanket look better. I think it's nice to look neat, but more important is what is best for the baby (who doesn't give a hoot about looks anyways :) LOL) What do you all think?

[RainDreamer, BSN, RN]

I think that a nice, good looking bed is important because when parents come in, this is their baby's "home". It needs to look nice, presentable, and comfortable.

I agree with Eliza in that both are possible. Obviously if you have an unstable, sick kiddo .... you're not going to be spending time making their bed look pretty, but once things calm down a bit, you can do it. But I think it's very important to give these babies beds that look nice. You're right, the baby doesn't give a hoot, but the parents would appreciate it :)

[elizabells, BSN, RN]

I think we may not disagree as much as it appears, bubbly. The snugglies we use have very high boundaries, so when the kids are in the position I'm thinking of, their hips and knees are both at 90 degrees. Again, not for a long time, and obviously not with the sick ones, but so many nurses just leave the kids flopping and they get those froggy legs and hyperextended spines. When you have a kid who can't be placed prone or swaddled, it's something, at the very least.

And one more group of people who appreciate pretty beds: the next shift. Yes, obviously not as important as what's good for the babies, but a shabby bed goes a long way toward making you unliked by your peers. I maintain that it is more than possible to have at least a clean, neat bed, even on the sickest kids, while maintaining proper positioning and good care. If nothing else, layer chux over stains and spots. I always have a passable bed, even when a kid is on ECMO.

[Imafloat, BSN, RN]

I think the bed should look neat, clean, and orderly as possible. I think these things are very important to parents. If we can't keep their baby and his bed clean, how are we going to take care of them properly on the medical side. I think that if a baby's bed is a mess, it sends up a red flag to the parents. Parent's perception is their reality. We always say in our unit, when you are sick, you don't want to lay in dirty wrinkled sheets. I always keep my sheets wrinkle free, I always thought wrinkles would lead to skin breakdown.

I have noticed that if I take my time on my first round, clean the baby really well, fix their lips (another pet peeve of mine, crusty gross lips), ensure that they are in an appropriate position with clean linen that they will have a better day. I can't tell you the number of times the previous shift has told me that baby was up and down all shift. I go in and look and the baby will be untucked, with dirty linens, arms and legs everywhere. Keeping a baby comfortable will go a long way in their recovery.

I admit, I wasn't always this anal about positioning and linen. The first few months of my career I was more concerned about learning everything I needed to know. When I learned the importance of appropriate positioning it became a priority to me.

I also know that there are some wild ones who, no matter how hard you try to tuck them in the right way insist on laying how they want.

[bubbly]

I do think neatness is important, especially for the parents. I just wanted to let people know that I have seen some really pretty beds, but the rolls are inappropriate for the babies (i.e., too small or not secure enough). I do get anal about a clean patient area and always take time out of my shift to wash down the isolettes, monitors, and cart, and throw or put away unnecessary supplies or equipment. It's just most of my parent conversations are more about "how is my baby doing?", "will my baby survive?", "will my baby be normal?" types of questions than not happy with a few untucked blanket corners, that's all. I didn't mean to sound like neatness should not be considered, just keeping in mind the baby positioning too! :) Thanks for the replies too by the way. I wish we had pictures to see what other NICU beds and nesting looked like! I love it when parents bring in cute matching blankets for us to use. LOL it also helps the nurses and doctors call the babies the right gender :)

[change07]

Thanks for the advice you guys! I've never had a problem with my beds; I have even had oncoming shift nurses thank me for them; I think I let the "competitivess" of some coworkers get to me. Plus, it's always good to learn!

I will try to try out tips from everyone. I think that what bubbly says does happen in some situations--the method for keeping the bed neat overtakes what is more developmentally appropriate-not always, but sometimes. The day I first posted this I had two different parents of my patients comment on how peaceful their babies looked; and that works for me :).

:)

Thanks!