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GOWN FOR INCONTINENT PATIENTS
1206
Preliminary
GOWN FOR INCONTINENT PATIENTS A. ARNOTT N. H. NISBET M.B.
S.R.N. From Foresthall
Glasg.
Hospital, Glasgow
enlightened hospitals aim at keeping their elderly patients active as far as possible, but a few who are too weak or apathetic even to sit up in a chair must spend their days lying motionless in bed, doubly incontinent and having to be fed. Each of these irremediably bedridden patients constitutes a serious nursing problem ; some of them develop the habit of contaminating their ALL
hands with their excreta, and this may necessitate a change of bed-linen several times a day. complete A simple modification of the ordinary hospital nightgown has been devised to prevent these patients’ hands becoming soiled. The gown is easy to make and to fix; it can be laundered with the rest of the bedlinen ; it keeps the patient warmer than the short gown that incontinent people usually wear in hospital ; and it does not alter the appearance of the bed. It allows the patient to move the arms freely and to be propped up in bed when necessary. The object is not to restrain movement but to prevent access of the patient’s hands to the perineum. The gown is put forward as a useful development in nursing management and not as a substitute for full collaboration between nurse, doctor, and physiotherapist in the task of rehabilitation, which is the best approach to the problem of incontinence.
bodily
Communication
THE BACTERIOLOGY OF CHRONIC
BRONCHITIS PERHAPS the most striking feature of the published reports on the bacteriology of chronic bronchitis is the great variety of organisms that can be isolated from the
sputum in this disease, as described, for example, by Marshall1 and Southwell.2 In fact it seems true to say that all the organisms commonly found in the upper respiratory tract are frequent inhabitants of the bronchi in chronic bronchitis. In addition to noting this variety of organisms, Howell s pointed out that the predominant organism in any given case of chronic bronchitis may show considerable variations over comparatively short intervals of time. For example, Neisseria catarrhalis might pre. dominate in the sputum of a patient on one occasion, while a week or two later the predominant organism might have changed to, say, Friedlander’s bacillus, which in turn might be superseded later by the original N. catarrhalis or even by some other organism. The purpose of this communication is to draw attention to a phenomenon which has come to light as a result of an investigation into the variations described by Howell. It seemed possible that the apparent variations in the predominant organisms might in fact be due to irregular distribution of the organisms throughout the sputum, so that if single cultures only were made the predominant organism might well be determined largely by chance VARIATION SINGLE
IN THE DISTRIBUTION OF ORGANISMS WITHIN A SPECIMEN OF SPUTUM IN CHRONIC BRONCHITIS
DESCRIPTION
Fig. I-Modified gown, showing position ot
A very large and strong long gown, with long sleeves, is opened completely down the front and its edges hemmed. Tapes are attached to tie at the neck 11/2 in. below the usual neck-line and at three points on each side of this new opening (fig. 1). The gown is put on back to front, over the usual short gown. The top tapes are then tied behind the neck, but the rest of the gown is spread out over the patient, and the other three pairs of tapes are tied to the bedstead on each side, the first of these being high enough to prevent the patient inserting an arm below the gown (fig. 2). The lower edge of -
tapes.
according to the portion of sputum cultured. Preliminary investigations showed that in many cases the distribution of organisms in the sputum was in fact far from regular, and a more detailed study. has indicated that the organisms that are distributed most irregularly are those which often seem to be responsible for the infective element of the disease. DIFFERENTIAL COLONY COUNTING
Fig.
2-How the gown is
worn
in bed.
the gown should extend well below the knees. Finally, the is covered with sheet and blankets in the usual way.
patient
No difficulties have been encountered in the use of this gown. It makes the patient feel much warmer as well It is also an exceedingly as keeping the hands clean. useful adjunct to the Brocklehurst bed (Brocklehurst 1951), designed for the same type of patient. We are grateful for the encouragement and advice of Prof. Stanley Alstead. REFERENCE
Brocklehurst, J. C. (1951) Incontinence
in Old
People. Edinburgh.
In order to determine the amount of variation in the distribution of organisms within a specimen of sputum, a system of " differential colony counting " has been developed. This is applied to cultures made from several different parts of the sputum, the parts being selected by a random sampling method. The relative numbers of the colonies of each type of bacterium present are determined by counting a total of 300 to 500 colonies The counting is simplified by on each culture plate. using a modification of an electric counter devised by Dr. W. D. Linsell. This counter and full details of the counting technique will be described elsewhere. Initially cultures were made from some thirty parts of each sputum specimen, but it has been shown that, with the random sampling technique employed, this number may be reduced to five. Findings for a single specimen of sputum in which extreme variations are 1. Marshall, G. Practitioner, 1931, 126, 59. 2. Southwell, N. Brit. J. industr. Med. 1946, 3, 75. Chronic Bronchitis. London, 1951; p. 61. 3. Howell, T. H.
Preliminary
GOWN FOR INCONTINENT PATIENTS A. ARNOTT N. H. NISBET M.B.
S.R.N. From Foresthall
Glasg.
Hospital, Glasgow
enlightened hospitals aim at keeping their elderly patients active as far as possible, but a few who are too weak or apathetic even to sit up in a chair must spend their days lying motionless in bed, doubly incontinent and having to be fed. Each of these irremediably bedridden patients constitutes a serious nursing problem ; some of them develop the habit of contaminating their ALL
hands with their excreta, and this may necessitate a change of bed-linen several times a day. complete A simple modification of the ordinary hospital nightgown has been devised to prevent these patients’ hands becoming soiled. The gown is easy to make and to fix; it can be laundered with the rest of the bedlinen ; it keeps the patient warmer than the short gown that incontinent people usually wear in hospital ; and it does not alter the appearance of the bed. It allows the patient to move the arms freely and to be propped up in bed when necessary. The object is not to restrain movement but to prevent access of the patient’s hands to the perineum. The gown is put forward as a useful development in nursing management and not as a substitute for full collaboration between nurse, doctor, and physiotherapist in the task of rehabilitation, which is the best approach to the problem of incontinence.
bodily
Communication
THE BACTERIOLOGY OF CHRONIC
BRONCHITIS PERHAPS the most striking feature of the published reports on the bacteriology of chronic bronchitis is the great variety of organisms that can be isolated from the
sputum in this disease, as described, for example, by Marshall1 and Southwell.2 In fact it seems true to say that all the organisms commonly found in the upper respiratory tract are frequent inhabitants of the bronchi in chronic bronchitis. In addition to noting this variety of organisms, Howell s pointed out that the predominant organism in any given case of chronic bronchitis may show considerable variations over comparatively short intervals of time. For example, Neisseria catarrhalis might pre. dominate in the sputum of a patient on one occasion, while a week or two later the predominant organism might have changed to, say, Friedlander’s bacillus, which in turn might be superseded later by the original N. catarrhalis or even by some other organism. The purpose of this communication is to draw attention to a phenomenon which has come to light as a result of an investigation into the variations described by Howell. It seemed possible that the apparent variations in the predominant organisms might in fact be due to irregular distribution of the organisms throughout the sputum, so that if single cultures only were made the predominant organism might well be determined largely by chance VARIATION SINGLE
IN THE DISTRIBUTION OF ORGANISMS WITHIN A SPECIMEN OF SPUTUM IN CHRONIC BRONCHITIS
DESCRIPTION
Fig. I-Modified gown, showing position ot
A very large and strong long gown, with long sleeves, is opened completely down the front and its edges hemmed. Tapes are attached to tie at the neck 11/2 in. below the usual neck-line and at three points on each side of this new opening (fig. 1). The gown is put on back to front, over the usual short gown. The top tapes are then tied behind the neck, but the rest of the gown is spread out over the patient, and the other three pairs of tapes are tied to the bedstead on each side, the first of these being high enough to prevent the patient inserting an arm below the gown (fig. 2). The lower edge of -
tapes.
according to the portion of sputum cultured. Preliminary investigations showed that in many cases the distribution of organisms in the sputum was in fact far from regular, and a more detailed study. has indicated that the organisms that are distributed most irregularly are those which often seem to be responsible for the infective element of the disease. DIFFERENTIAL COLONY COUNTING
Fig.
2-How the gown is
worn
in bed.
the gown should extend well below the knees. Finally, the is covered with sheet and blankets in the usual way.
patient
No difficulties have been encountered in the use of this gown. It makes the patient feel much warmer as well It is also an exceedingly as keeping the hands clean. useful adjunct to the Brocklehurst bed (Brocklehurst 1951), designed for the same type of patient. We are grateful for the encouragement and advice of Prof. Stanley Alstead. REFERENCE
Brocklehurst, J. C. (1951) Incontinence
in Old
People. Edinburgh.
In order to determine the amount of variation in the distribution of organisms within a specimen of sputum, a system of " differential colony counting " has been developed. This is applied to cultures made from several different parts of the sputum, the parts being selected by a random sampling method. The relative numbers of the colonies of each type of bacterium present are determined by counting a total of 300 to 500 colonies The counting is simplified by on each culture plate. using a modification of an electric counter devised by Dr. W. D. Linsell. This counter and full details of the counting technique will be described elsewhere. Initially cultures were made from some thirty parts of each sputum specimen, but it has been shown that, with the random sampling technique employed, this number may be reduced to five. Findings for a single specimen of sputum in which extreme variations are 1. Marshall, G. Practitioner, 1931, 126, 59. 2. Southwell, N. Brit. J. industr. Med. 1946, 3, 75. Chronic Bronchitis. London, 1951; p. 61. 3. Howell, T. H.