Make elders comfortable during lengthy ED waits

ED nurses must find the time

Do you treat elderly patients waiting in the ED as you would expect your own family member to be treated as if they were the only ones there?

"If you can't do this because of a more urgent patient, enlist the members of your team to help," advises Mary M. Pelton, RN, CEN, an ED nurse at Carteret General Hospital in Morehead City, NC. Here are approaches to make waiting elders comfortable:

Have patients lie on hospital beds instead of stretchers.

"This prevents skin breakdown and improves comfort," says Pelton. "Take the time to provide pressure relief with pillows."

Minimize the patient's pain.

"It is much more difficult to eliminate pain once it starts," says Nadine Holman, MSN, RN, CEN, an ED nurse at St. Anthony's Medical Center in St. Louis, MO. "The comfort level of a patient has been shown to affect their healing process."

Anticipate needs, rather than waiting for a patient to ask for something.

"Offering a warm blanket or providing a sling or ice pack are ways to keep patients physically comfortable," says Holman.

Keep emotional distress to a minimum.

Talking with patients frequently lets them know they have not been "lost in the shuffle," says Holman, and gives them a chance to ask for assistance if needed. "The biggest fear an elderly patient has is that they will be forgotten," she says. "A smile and a kind word can go a long way."

Make frequent contact with the patient.

"I believe just seeing a staff member can relieve stress-induced discomfort," says Holman. "With all the chaos going on in an ED, it's easy to think you have been forgotten. Complaining of physical pain may be the only way a patient knows to get attention." (See related story, below, on waiting room chairs.)

Sources

For more information on keeping elders comfortable during ED waits, contact:

Nadine Holman, MSN, RN, CEN, Emergency Department, St. Anthony's Medical Center, St. Louis, MO. Phone: (314) 525-7337.
E-mail: [email protected].
Rita LaReau, MSN GNP-BC, Geriatric Clinical Nurse Specialist, Bronson Methodist Hospital, Kalamazoo, MI. Phone: (269) 341-8809. Fax: (269) 341-8841.
E-mail: [email protected].
Mary M. Pelton, RN, CEN, Emergency Department, Carteret General Hospital, Morehead City, NC.
E-mail: [email protected].

Clinical Tip

Your ED's chairs may be harmful to elders

Examine the chairs used in your ED waiting areas, as these can be clinically harmful to elders, says Rita LaReau, MSN GNP-BC, geriatric clinical nurse specialist at Bronson Methodist Hospital in Kalamazoo, MI.

"Due to age-related changes, as well as the combination of acute or chronic conditions, the elderly emergency-room population is at high risk for various adverse outcomes. These include falls, pressure ulcers, functional decline, delirium, depression, and death," says LaReau. "Any discomfort related to seating can further exacerbate any of these conditions."

LaReau says that ED waiting chairs should have these characteristics:

A height of 18 to 19 inches and depth of 18 to 20 inches, with arms extended to the front chair edge;
Chair arms should be 10 inches above seat height;
Made of a non-slip fabric, with clearance under the front of the seat to allow feet under the front edge;
Provide lumbar support;
Be stable without tipping over, with minimal back recline and backward seat tilt;
Chair legs that fit with blocks to raise the seat height.¹

"Make sure that chairs have good arms and firm seats," adds LaReau. "Also, the frail will transfer easier out of chairs which are higher than standard chair height."

Reference

O'Keefe J. Creating a senior friendly physical environment in our hospitals: The Regional Geriatric Assessment Program of Ottawa. Available at http://www.rgpeo.com/documents/Senior-friendly-fulltext2.pdf.