PREPARING & MAINTAINING BEDS: A BED-MAKING Review for PN Students

Glenda Jacinta L. Loyola, RN

GLENDA JACINTA L. LOYOLA, RN

GUIDELINES IN BED MAKING

Wash hands thoroughly after handling a clients bed linen. Linens & equipment that have been soiled with secretions and excretions harbor microorganisms that can be transmitted to others directly or by the nurses hands or uniforms. Hold soiled linen away from uniform. Linen for one client is never placed on another clients bed.

Place soiled linen directly in a portable hamper or tucked in a pillow case at the end of the bed before it is gathered for disposal. Do not shake soiled linen in the air because shaking can dessiminate secretions and excretions and the microorganisms they contain.

When stripping and making a bed, conserve time & energy by stripping & making up one side as much as possible before working on the other side. To avoid unnecessary trips to the linen supply area, gather all linen before starting to strip the bed. Do not use a torn piece of linen. It may tear even more & could become dangerous.

Never use a pin on any item of linen. The bottom sheet must be firm, smooth & wrinkle-free. This is very important for the clients comfort. By fanfolding the top of the bed, you make it easy for the client to get in & out of the bed. The plastic draw sheet & disposable bed protectors, should never touch a clients skin. Cover it entirely with cloth draw sheet

A client who does not use his bed a great deal may not have to be changed everyday. Always use good body mechanics, no matter what kind of bed your client is using. Side rails are used to prevent the client from falling.

THREE BASIC BEDS

UNOCCUPIED BED - Open bed/ Fan-folded bed - CLOSED BED OCCUPIED BED

UNOCCUPIED BED
OPEN BED the top covers are folded back to make it easier for a client to get in. used when it will be occupied within a short period of time. CLOSED BED Made the same way, except that the top sheet, blanket & bedspread are drawn up to the bed & under the pillows. Usually made when it will remain empty for a while.

OCCUPIED BED
This bed is made with the client in the bed. Made when the client is not able or not permitted to get out of the bed. The most important part is to get the sheets smooth and tight under the client so there will be no wrinkles to rub against the skin.

RELATED TERMINOLOGIES
Top of the bed refers to the top sheet, the blanket & the bedspread. Bottom of the bed refers to the mattress pad, if used; the bottom sheet & the draw sheets. Draw sheet small sheet made of plastic, rubber, or cotton placed across the middle of the bed to cover & protect the bottom sheet & assist in moving the client.

Mitered corner folding the bedding at the corners when making a bed so that the sheet is tightly stretched with no wrinkles. Decubitus ulcer (bedsore) open wound which occurs from lack of blood supply to an area usually located on a bony prominence.

Seam a line where 2 pieces of cloth have been sewn together. Seamless done or made so well that you do not notice where one part ends & another part begins.

PURPOSES OF CHANGING AN UNOCCUPIED BED

To promote the clients comfort. To provide a clean neat environment for the client. To provide a smooth wrinkle-free bed foundation, thus minimizing sources of skin irritation.

ASSESSMENT
Assess the clients health status to determine that the person can safely get out of the bed. Assess the clients pulse & respiration if indicated. Note all the tubes & equipment connected to the client because this may influence the need for additional linens or waterproof pads.

MAKING THE CLOSED BED

1. Explain to the client what you are going to do, why is it necessary & how he or she can cooperate. 2. Assemble your equipments. - mattress cover; if used - Bottom sheet - Cotton & plastic draw sheet (or disposable bed protectors)

Contd.
Top sheet Blanket Bedspread Pillowcase Pillow Pillow protector, if used Chair

3. Wash hands & observe other appropriate infection control measures. 4. Place a chair near the bed. 5. Put the pillow on the bed. 6. Stack the bed-making items on the chair in the order in which you will use them. First things to be used on top, last things to be used on the bottom.

7. Adjust the bed to the highest horizontal position and lock the bed in place. 8. Pull the mattress to the head of the bed until it touches the headboard. 9. Place the mattress pad on the mattress even with the head of the mattress. a. Place the center fold of the sheet at the center of the mattress from head to foot.

b. Put the small hem at the foot of the bed even with the edge of the mattress. c. Place the large hem at the head of the bed with about 18 inches left to tuck in. Always do this while practicing good body mechanics. Bend your legs not your back. 10. Open the sheet. It should now hang evenly over each side of the bed.

11. Tuck the sheet in tightly at the head of the bed. Lift the mattress with the hand closest to the foot of the bed & tuck with the other hand. This is good body mechanics. 12. To make a mitered corner: a. Pick up the edge of the sheet at the side of the bed 12 inches from the head of the mattress.

b. Place the triangle (the folded corner) on top of the mattress. c. Tuck the hanging portion of the sheet under the mattress. d. While you hold the fold at the edge of the mattress , bring the triangle down over the side of the mattress. e. Tuck the sheet under the mattress from head to foot.

13. Stand and work entirely on one side of the bed until that side is finished. 14. Place the plastic draw sheet 14 inches (2 open handspans) down from the head of the bed. Tuck it in. 15. Cover the plastic draw sheet with the cotton draw sheet & tuck it in. 16. Fold the top sheet lengthwise & place it on the bed:

a. Place the center fold on the center of the bed from the head to the foot. b. Place the large hem at the head of the bed, even with the top edge of the mattress. c. Open the sheet, with the rough edge of the hem up. d. Tightly tuck the sheet under the foot of the bed.

e. Make a mitered corner at the foot of the bed. f. Do not tuck the sheet in at the side of the bed. 17. Fold the blanket lengthwise and place on the bed. a. Place the center fold on the blanket on the center of the bed from head to foot.

b. Place the upper hem 6 inches from the top edge of the mattress. c. Open the blanket. d. Tuck it under the foot of the bed tightly. e. Make a mitered corner at the foot of the bed f. Do not tuck in at the side of the bed. 18. Fold the bedspread lengthwise & place it on the bed.

19. Now move to the other side of the bed. Start with the bottom sheet. a. Straighten the sheet to get rid of all wrinkles. This should be done 3 times, 1st near the head, the middle & at the foot of the bed. b. Miter the top corner. c. Pull the sheet tight so it is wrinkle-free.

20. To make the cuff: a. Fold the top hem of the spread under the top hem of the blanket. b. Fold the top hem of the sheet back over the edge of the spread & the blanket to make a cuff. The hemmed side of the sheet must be on the underside so that it does not come in contact with the client.

To put the pillowcase on a pillow: a. Hold the pillowcase at the center of the end seam. b. With your hand outside the case, turn the case back over your hand. c. Grasp the pillow through the case at the center of the end of the pillow. d. Bring the case down over the pillow.

e. Fit the corner of the pillow into the seamless corner of the case. f. Fold the extra material from the side seam under the pillow. g. Place the pillow on the bed with the open end away from the door. 22. Adjust the bed to its lowest horizontal position.

MAKING THE OPEN, FANFOLDED EMPTY BED

1. Make a closed bed. 2. Grasp the cuff of the bedding in both hands. 3. Pull it to the foot of the bed. 4. Fold the bedding back on itself toward the hear of the bed. The edge of the cuff must meet the fold. 5. Smooth the sheets on each side neatly into the folds you have made. 6. Wash your hands.

CHANGING AN OCCUPIED BED

PURPOSES: To conserve the clients energy & maintain current health status. To promote client comfort. To provide a clean, neat environment for the client. To provide a smooth, wrinkle-free bed foundation, thus minimizing sources of skin irritation.

ASSESSMENT
Note specific orders or precautions for moving & positioning the client. Determine presence of incontinence or excessive drainage from other sources indicating the need for protective waterproof pads. Assess skin condition & need for special mattress, footboards, or heel protectors.

1. Explain to the client what you are going to do, why is it necessary & how he or she can cooperate. 2. Assemble your equipments, near the bed, in the order in which you will use them.

Materials Needed: A chair is useful for this purpose 2 large sheets 1 plastic draw sheet, if used 1 cotton draw sheet, if used Disposable bed protectors, if used One bath blanket, if available Pillowcases

1 blanket 1 bedspread Container for dirty laundry. 2. Wash hands & observe proper infection control measures. 3. Ask any visitors to step out of the room, if appropriate. 4. Observe privacy.

5. If you are working on a hospital bed, lower the backrest & knee rest until the bed is flat, if that is allowed. Raise the bed to its highest horizontal position & lock in place. 6. Loosen all the sheets around the entire bed. 7. Take the bedspread & blanket off the bed & fold them over the back of the chair. Leave the client covered only with the top sheet.

8. If using the bath blanket, cover the client with this by placing it over the top sheet. Ask the client to hold the bath blanket. If he is unable to do this, tuck the top edges of the bath blanket under the clients shoulders. Without exposing him, remove the top sheet from under the bath blanket. Fold the top sheet & place over the back of the chair.

9. If the mattress had slipped out of place, move it to its proper position touching the headboard. Remember to use proper body mechanics. If you cannot move the mattress, get assistance. 10. Raise the side rail on the opposite side from you will be working, and lock in place.

11. Ask the client to turn onto his side toward the side rail. Help the client to turn if necessary. If the client cannot turn, have him stay in his back but move as far as possible toward the side rail. Be careful as to the placing of the clients hands. Adjust the pillow to suit the clients needs. Check for items such as dentures & eyeglasses.

12. Fold the cotton draw sheet toward the client & tuck it against his back. Protect him from any soiled matter on the bedding. 13. Raise the plastic draw sheet (if it is clean) over the bath blanket & client. 14. Roll the bottom sheet towards the client & tuck it against his back. This strips your side of the bed down to the mattress.

15. Take the large clean sheet & fold it in half lengthwise. Do not permit the sheet to touch the floor or your uniform. 16. Place it on the bed, still folded, with the fold running along the middle of the mattress. The small hem end of the sheet should be even with the foot edge of the mattress. Fold the top half of the sheet toward the client. (this is for the other side of the bed. Tuck the folds against his back, below the plastic draw sheet.

17. Tuck the sheet around the head of the mattress by gently raising the mattress with the other hand closest to the foot of the bed & tucking with the other hand. 18. Miter the corner at the head of the mattress. Tuck in the clean bottom sheet on your side from head to foot of the mattress. 19. Pull the plastic draw sheet toward you, over the clean bottom sheet and tuck it in.

20. Place the clean cotton draw sheet over the plastic sheet, folded in half. Keep the fold near the client. Fold the top half toward the client, tucking the folds under his back, as you did with the bottom sheet. Tuck the free edge of the draw sheet under the mattress. 21. Ask the client, or help him, to roll over the hump onto the clean sheets toward you. 22. Raise the side rail on your side of the bed and lock into place.

23. Go to the opposite side of the bed and lower the side rail. 24. Remove the old bottom sheet & cotton draw sheet from the bed. Put them into the container for soiled linen. Pull the fresh bottom sheet toward the edge of the bed. Tuck it under the mattress at the head of the bed and make a mitered corner. Then pull the bottom sheet under the mattress from head to the foot. Do this by rolling the sheet up in your hand toward the mattress & pull it as you tuck it under.

25. One at a time, pull & tuck each draw sheet under the mattress. 26. Have the client turn on his back. 27. Change the pillowcase, & place the pillow under the clients head. If necessary, assist the client to place the pillow under his head. 28. To put the pillowcase on a pillow; same with unoccupied bed.

29. Spread the clean top sheet over the bath blanket with the wide hem at the top. The middle of the sheet should run along the middle of the bed. The wide hem should be even with the head edge of the mattress. Ask the client to hold the hem of the clean sheet, if he can, while you remove the bath blanket, moving toward the foot of the bed. Do not expose the client.

30. Tuck the clean top sheet under the mattress at the foot of the bed. Make sure you leave enough room for the client to move his feet freely. Miter the corner of the sheet if the client likes this. 31. Spread the blanket over the top sheet. Be sure the middle of the blanket runs along the middle of the bed. The blanket should be high enough to cover the clients shoulders.

32. Tuck the blanket in at the foot of the bed if the client likes this. Make a mitered corner with the blanket. 33. Place the spread on the bed as the client prefers. Pull up the side rails. 34. Go to the other side of the bed. Put down the side rails, turn the top covers back & miter the top sheet, then miter the blanket. Be sure the top covers are loose enough that the client is able to move his feet.

35. To make the cuff: a. Fold the top hem of the spread under the top hem of the blanket. b. Fold the top hem of the sheet back over the edge of the spread & the blanket to make a cuff. The hemmed side of the sheet must be on the underside so that it does not come in contact with the client.

36. Raise the backrest & knee rest to suit the client if this is allowed. 37. Lower the entire bed to its lowest horizontal position. 38. Put the side rails in place. 39. Make sure the client is comfortable. 40. Put all used linen in the proper place. 41. Wash your hands. 42. Chart any observations you made during this procedure.

REFERENCES 1. The Caregivers Resourcebook by Elana Zucker pp 138-147 2. Fundamentals of Nursing 7th Ed, by Kozier & Erb

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