Bed Making

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BED MAKING
Introduction:
Nurses need to be able to prepare hospital beds in different ways for specific purposes. Bed making is an art. Skillful bed making contributes materially to the patient's comfort. Clean and comfortable bed includes the patient's unit in the hospital, Usually bed is made in the morning after the client's bath.
Definition of terms:
Bed Making: The technique of preparing different types of bed for the patients to provide comfort in his/ her suitable position for a particular condition.
Fanfold: Specifically folding the edge of the sheet used in the bed 6-8 inches outward.
Mitered corner: A mitered corner is a special folding technique that secures the linen under the mattress. Purpose is to hold linen firmly in place on beds and stretchers
 
Toe pleat: a fold made in the top bed clothes to provide additional space for patients toes.
 
Foot drop: plantar flexion of the foot with permanent contracture of the gastronomies (calf) muscle and tendon.
Disposable: designed to be thrown away after one use.
Incontinence: the inability to control the bladder or bowels, which leads to an involuntary loss of urine or feces.
Insomnia: the inability to fall asleep or remain asleep.
Bed making Purposes:
·         Provide safety & comfort
·         Promote rest & sleep
·         To give ward an appearance of neatness
·         To adapt to the needs of the client
·         To economize time, material & effort
·         To prevent bedsores
·         To observe the client
·         To promote cleanliness
·         To establish effective nurse —patient relationship
·         To provide active & passive exercises
·         To teach relatives to take care of the sick at home
Principles of bed making:
1.       Microorganisms are found everywhere on the skin, on the articles used by the client & in the environment. The nurse takes care to prevent the transfer of microorganisms from source to the new host by direct or indirect contact or prevent the multiplication of organisms.

·         Prevention of cross-infection:
o   Wash hands or use alcohol hand rub before and after making each bed.
o   If linen is very soiled, wear gloves for removal.
o   Dirty linen is put immediately into soiled linen bag (white or brown bag) or as per organisation never onto floor!!
o   Don't shake or flick linen excessively o Linen shouldn't touch floor, or be held up against carer's clothing
o   Linen should only be put onto a clean surface prior to bed making
o   NO interchange of linen between clients

2.       A safe & comfortable bed will ensure rest & sleep & prevent several complications in bed ridden patients.
      e.g.: bed sores, foot drop etc.

3.       Client safety and comfort
·         Ensure that bed brakes are on, and that bed is returned to its original position (usually to a height the resident can easily access), after bed making is complete
·         Promote comfort, by having sheets free of rough areas, wrinkles or creases, food crumbs and foreign bodies
·         Avoid areas of potential pressure, i.e. hems of sheets away from direct contact with client's skin 
·         If waterproofing layer is used, must not come into contact with client's skin
·         Need to particularly consider safety and comfort, if client occupies bed whilst it is being made

4.       Good body mechanisms maintain the body alignment & prevent fatigue.
·         Maintain good body alignment when bed making - avoid bending, stretching and twisting
·         Use large leg muscles (bend knees), rather than back muscles
·         Work smoothly and rhythmically - 2 people to make beds together is optimal
·         If able, raise bed to a comfortable working height (usually waist high) - to avoid bending and back strain
·         Prepare well - gather all equipment initially, and avoid legwork

5.       Systematic ways of functioning saves time, energy& material.
·         Keep linen arranged in order of use.
·         Make bed completely on one side before doing other side to limit unnecessary movement from one side of bed to the opposite side
Review Principles of bed making:
1.       Microorganisms are found everywhere on the skin and the articles used by the patient and in the environment.
2.       A safe and comfortable bed will ensure rest, sleep and prevent several complications in bedridden patients (bed sores, foot drop etc.)
3.       Good body mechanisms maintain the body alignment and prevent fatigue.
4.       Systematic ways of functioning saves time, energy and material.
Practice Guidelines for Bed-Making:
·         Wash hands thoroughly after handling a client's bed linen.
·         Linens and equipment that have been soiled with secretions and excretions harbor microorganisms that can be transmit-ted to others directly or by the nurse's hands or uniform.
·         Hold soiled linen away from uniform.
·         Linen for one client is never (even momentarily) placed on another client's bed.
·         Place soiled linen directly in a portable linen hamper or tucked into a pillow case at the end of the bed before it is gathered up for disposal.
·         Do not shake soiled linen in the air because shaking can disseminate secretions and excretions and the microorganisms they contain.
·         When stripping and making a bed, conserve time and energy by stripping and making up one side as much as possible be-fore working on the other side.
·         To avoid unnecessary trips to the linen supply area, gather all linen before starting to strip a bed.
Common types of bed:
A.      Occupied Bed: Is made when the patient is not able or not permitted to get out of the bed.
B.      Unoccupied Bed: Is made when there is no patient confined in bed, while a patient in the shower or sitting up in a chair.
Types of unoccupied Bed:
·         Open bed: the top covers are folded back so the patient can easily get back in to bed.
It is done when patient is about to be occupied into bed.              
It is made either for a new or ambulatory patient.
When the patient is transferred from trolley to bed, the top linen is fan folded at foot end.
·         Closed bed: the top sheet blankets and bedspreads are drawn up to the head of the mattress and under the pillow; this is prepared in a hospital room before a new client is admitted to the room.
Closed bed is an empty bed, in which top linens are so arranged that all linen beneath the spread is fully protected from dust and dirt while waiting for the patient.
On admission closed bed is converted into open bed.
Post-operative bed: known as Surgical, recovery bed or anesthetic bed is modified version of open bed, and used for a patient with large cast or other circumstance that would make it difficult for him to transfer easily into bed.
Nurse's responsibility
Assessment:
1.       Check the activity orders, and assess the client's ability to get out of bed.
Rationale: This determines whether an unoccupied or occupied bed should be made.
2.       Assess the client's self-toileting ability; note the presence of any wounds, drainage tubes.
Rationale: This determines if placement of waterproof pads should be on the bed.
Planning:
Expected outcomes focus on the client's safety and comfort.
Expected Outcomes
1.       Client has a clean, safe environment throughout hospitalization.
2.       Client verbalizes a sense of comfort while in bed.
3.       Client’s skin remains free of irritation throughout hospitalization.
Unoccupied Bed Making:
Purpose:
·         To be ready for the next occupant
·         Prepare the bed for the client's return
·         To provide a clean environment
·         To provides a good appearance
·         To minimize source of infection
Equipments/ articles:
·         Linen bag,
·         Mattress (change only when soiled ),
·         Bottom sheet,
·         Draw sheet,
·         Top sheet,
·         Blanket,
·         Bed spread,
·         Mackintosh,
·         Pillow-cases,
·         Bedside chair or table,
·         Disposable gloves (if linen is soiled),
·         Washcloth, and
·         Antiseptic cleanser.
Implementation:
Preparation
Determine what linens the client may already have in the room to avoid stockpiling of unnecessary extra linens.
Performance/ steps
1.       Prior to performing the procedure, introduce self and verify the client's identity using agency protocol. Explain to the client what you are going to do.
2.       Perform hand hygiene and observe other appropriate infection control procedures
3.       Provide for client privacy.
4.       Place the fresh linen on the client's chair or overbed table; do not use another client's bed.
           Rationale: This prevents cross contamination (the movement of microorganisms from one client to another) via soiled linen.
5.        Assess and assist the client out of bed.
·         Make sure that this is an appropriate and convenient time for the client to be out of bed.
·         Assist the client to a comfortable chair.
6.       Raise the bed to a comfortable working height.
7.       Strip the bed.
·         Check bed linens for any items belonging to the client, and detach the call bell' or any drainage tubes from the bed linen.
·         Loosen all bedding systematically, starting at the head of the bed on the far side and moving around the bed up to the head of the bed on the near side.
           Rationale: Moving around the bed systematically prevents stretching and reaching and possible muscle strain.
·         Remove the pillowcases, if soiled, and place the pillows on the bedside chair near the foot of the bed.
·         Fold reusable linens, such as the bedspread and top sheet on the bed, into fourths. First, fold the linen in half by bringing the top edge even with the bottom edge, and then grasp it at the center of the middle fold and bottom edges.
            Rationale: Folding linens saves time and energy when reapplying the linens on the bed and keeps them clean.
·         Remove the waterproof pad/mackintosh and discard it if soiled.
·         Roll all soiled linen inside the bottom sheet, hold it away from your uniform, and place it directly in the linen hamper, not on the floor.
            Rationale: These actions are essential to prevent the transmission of microorganisms to the nurse and others.
·         Grasp the mattress securely, using the lugs if present, and move the mattress up to the head of the bed
8.       Apply the bottom sheet and draw sheet.
·         Place the folded bottom sheet with its center fold on the center of the bed. Make sure the sheet is hem side down for a smooth foundation. Spread the sheet out over the mattress, and allow a sufficient amount of sheet at the top to tuck under the mattress.
·         Miter the sheet at the top corner on the near side and tuck the sheet under the mattress, working from the head of the bed to the foot.
·         Lay the cloth draw sheet over the mackintosh in the same manner.
     Optional: Before moving to the other side of the bed, place the top linens on the bed hem side up, unfold them, tuck them in, and miter the bottom corners.
           Rationale: Completing one entire side of the bed at a time saves time and energy.
9.       Move to the other side and secure the bottom linens.
·         Tuck in the bottom sheet under the head of the mattress, pull the sheet firmly, and miter the corner of the sheet.
·         Pull the remainder of the sheet firmly so that there are no wrinkles. Rationale: Wrinkles can cause discomfort for the client and breakdown of skin. Tuck the sheet in at the side.
·         Complete this same process for the draw sheet.
10.     Apply or complete the top sheet, blanket, and spread.
·         Place the top sheet, hemside up, on the bed so that its centerfold is at the center of the bed and the top edge is even with the top edge of the mattress.
·         Unfold the sheet over the bed.
            Optional: Make a vertical or a horizontal toe pleat in the sheet to provide additional room for the client's feet.
a)       Vertical toe pleat: Make a fold in the sheet 5 to 10 cm (2 to 4 in.) perpendicular to the foot of the bed.
b)      Horizontal toe pleat: Make a fold in the sheet 5 to 10 cm (2 to 4 in.) across the bed near the foot.
·         Loosening the top covers around the feet after the client is in bed is another way to provide additional space.
·         Follow the same procedure for the blanket and the spread, but place the top edges about 15 cm (6 in.) from the head of the bed to allow a cuff of sheet to be folded over them.
·         Tuck in the sheet, blanket, and spread at the foot of the bed, and miter the corner, using all three layers of linen. Leave the sides of the top sheet, blanket, and spread hanging freely unless toe pleats were provided.
·         Fold the top of the top sheet down over the spread, providing a cuff.
          Rationale: The cuff of sheet makes it easier for the client to pull the covers up.
·         Move to the other side of the bed and secure the top bedding in the same manner.
11.     Put clean pillowcases on the pillows as required.
·         Grasp the closed end of the pillowcase at the center with one hand.
·         Gather up the sides of the pillowcase and place them over the hand grasping the case.  Then grasp the center of one short side of the pillow through the pillowcase.
·         With the free hand, pull the pillowcase over the pillow.
·         Adjust the pillowcase so that the pillow fits into the corners of the case and the seams are straight.
         Rationale: A smoothly fitting pillowcase is more comfortable than a wrinkled one.
·         Place the pillows appropriately at the head of the bed.
12.     Provide for client comfort and safety.
·         Attach the signal cord so that the client can conveniently reach it. Some cords have clamps that attach to the sheet or pillowcase. Others are attached by a safety pin.
·         If the bed is currently being used by a client, either fold back the top covers at one side or fanfold them down to the center of the bed.
            Rationale: This makes it easier for the client to get into the bed.
·         Place the bedside table and the overbed table so that they are available to the client.
·         Leave the bed in the high position if the client is returning by stretcher, or place in the low position if the client is returning to bed after being up.
13.     Document and report pertinent data.
·         Bed-making is not normally recorded.
·         Record any nursing assessments, such as the client's physical status and pulse and respiratory rates before and after being out of bed, as indicated.
Bed making- Occupied bed:
Is made when the patient is not able or not permitted to get out of the bed
Purpose of Occupied Bed Making:
·         To conserve the client's energy
·         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:
·         Check for specific orders and precautions for moving and positioning the patient.
·         Assess skin condition and need for special mattress, footboard
Equipments:
·         Bottom sheet
·         Mackintosh
·         Draw sheet
·         Blanket (depending on patient preference)
·         Top sheet
·         Pillow case
·         Clean gloves (if there is risk for contact with body secretions)
·         Laundry bag
·         Disinfectant
PROCEDURE- occupied bed:
1)      Explain the procedure to the patient
       Rationale: Minimizes anxiety and promotes patient's co-operation
2)      Perform hand hygiene & Apply the gloves
       Rationale: Reduces the transmission of microorganisms
3)      Provide privacy
        Rationale: Maintains comfort of the patient
4)      Remove the top bedding.
·         Remove any equipment attached to the bed linen
·         Loosen all the top linen, at the foot of the bed, and remove the bed spread and the blanket. Rationale: Allows easy removal of the sheets.
·         Leave the top sheet over the client (if it is being changed) or replace it with a bath blanket.
        Rationale: Maintains privacy of the patient
·         Spread the bath blanket over the top sheet. Ask the client to hold the top edge of the blanket. If patient is unable to help, tuck top of bath blanket under shoulders.
·         Reaching under the blanket from the side, grasp the top edge of the sheet and draw it down to the foot of the bed, leaving the blanket in place.
       Rationale: Maintains privacy and warmth of the patient
·         Remove the sheet and place it in the soiled linen hamper.
       Rationale: Reduces spread of organisms.
5)      Change the bottom sheet and drawsheet.
·         Assist the client to turn on the side facing away from the side where the clean linen is.
       Rationale: Makes linen easier to remove
·         Raise the side rails nearest the patient
       Rationale: Protects the patient from fall
·         Loosen the linen on the near side of the bed
·         Fanfold the drawsheet and the bottom sheet at the center of the bed, as close to and under the client as possible.
       Rationale: Doing this leaves the near half of the bed free to be changed
·         Wipe off any moisture on exposed mattress with appropriate disinfectant. Make sure that mattress surface is dry before applying linens.
       Rationale: Reduces transmission of microorganisms.
·         Place the new bottom sheet on the bed, and vertically fanfold the half to be used on the far side of the bed as close to the client as possible. Tuck the sheet under the near half of the bed and miter the corner.
·         Place the clean draw sheet on the bed with the center fold at the center of the bed. Fanfold the uppermost half vertically at the center of the bed and tuck the near side edge under the side of the mattress.
·         Assist the client to roll over toward you onto the clean side of the bed. The client rolls over the fanfolded linen at the center of the bed
·         Move the pillows to the clean side for the client's use. Raise the side rail before leaving the side of the  bed
·         Move to other side and lower the side rails.
·         Remove the used linen and place it in the portable hamper
·         Unfold the fanfolded bottom sheet from the center of the bed.
·         Facing the side of the bed, use both hands to pull the bottom sheet so that it is smooth and tuck the excess under the side of the mattress.
·         Unfold the draw sheet fan folded at the center of the bed and pull it tightly with both hands. Pull the sheet in three sections:
·         Face the side of the bed to pull the middle section, Face the far top corner to pull the bottom section, and
·         Face the far bottom corner to pull the top section.
·         Tuck the excess drawsheet under the side of the mattress.
6)      Reposition the client in the center of the bed.
·         Reposition the pillows at the center of the bed.
·         Assist the client to the center of the bed. Determine what position the client requires or prefers and assist the client to that position.
7)      Apply or complete the top bedding.
·         Spread the top sheet over the client and either ask the client to hold the top edge of the sheet or tuck it under the shoulders.
·         The sheet should remain over the client when the bath blanket or used sheet is removed.
·         Complete the top of the bed.
8)      Ensure continued safety of the client.
·         Raise the side rails. Place the bed in the low position before leaving the bedside.
·         Attach the signal cord to the bed linen within the client's reach.
·         Put items used by the client within easy reach.
9)      Bed-making is not normally recorded.
Special Beds:
Meaning:
These are beds which are adapted to meet the special needs of the patient which in turn helps the patient to rest and sleep properly.
Post- operative Bed:
Meaning:
The bed which is prepared for a patient who is recovering from the effects of anesthesia following a surgical operation.
Also called as surgical bed, anesthetic bed or recovery bed
Purposes:
To provide a safe, clean, comfortable bed and unit for a post-operative patients
To be prepared to meet any emergencies
To provide warmth
For a quick transfer of patients from trolley to bed & care for the client without loss of time
Articles required:
·         Same Articles as for unoccupied bed
·         One small mackintosh & towel-to protect head end of the bed
·         According to the type of operation, the number required of mackintosh and draw sheet is different.
·         Hot water bag with hot water (104- 140 O F) if needed (1): to keep the bed warm
Procedure:
1)      Apply the bottom sheet as for an unoccupied bed.
2)      Place the top sheets (blanket is used if needed) on the bed and do not tuck them in, miter the corners, or make a toe pleat.
3)      Fold the top sheets up from the bottom to make a cuff at the top of the bed.
4)      Make a triangle in the middle of the bed by folding up the two outer corners of the top sheets.
5)      Pick up the apex of the triangle and fanfold the top sheets lengthwise to the other side of the bed .
           Rationale: Patient can be transferred to the bed easily.
6.       Use additional mackintosh and draw sheet according to the site of operation
                Rationale: Protects the bed from soiling.
7.       Leave the bed in high position with the side rails down.
           Rationale: The high position facilitates the transfer of the client
8.       Lock the wheels of the bed if the bed is not to be moved.
            Rationale: Locking the wheels keeps the bed from rolling when the client is transferred from the stretcher to the bed.
After care:
·         Ensure that the patient is comfortable.
·         If needed raise side rails. Observe for any signs of complications like bleeding, anxiety etc...
·         Replace all unused articles in proper position.
·         Record & report.
Cardiac Bed:
Meaning:
It is a bed made to help the patient to assume a sitting position which can afford greater amount of comfort with less strain.
Purposes:
·         To relieve dyspnea caused by cardiac diseases.
·         To prevent bedsore.
·         To make the patient comfortable.
Equipment:
·         Articles same as of unoccupied bed
·         Additional pillows
·         Back rest and cardiac tables
Procedure:
1)      Make the bed as in open bed, place the back rest and arrange the pillows in position.
           Rationale: Support the back of the patient.
2.       Place the knee pillow under the knees
           Rationale: Prevents slipping of the patient.
3.       Place the pillows on either side of the arm.
            Rationale: Arms can be supported well.
4.       Adjust the cardiac table with pillows in front of the patient.
           Rationale: Patient can lean forward and rest on it.
Note: Assisted devices will be provided to the patient as per the need (sand bags, fracture board, back rest)
Fracture bed:
Meaning:
It is meant for patient who have fracture of the limbs or spine so as to give a firm support
Purposes:
·         To provide firm support by the use of firm mattress that rest on the fracture board or bed board
Articles required:
·         Articles for a open bed
·         Fracture board
Procedure:
·         Arrange the fracture board on the cot to give a firm support to the fractured area
·         An open bed is made
·         If traction is required balken frame is fitted to support the pulleys and weights.
Blanket bed:
·         This type of bed is used for patients with rheumatism or renal diseases
Purpose:
·         To carry the weight of the bed cover off the painful joints & body especially in burnt patients
Articles required:
·         Articles for an open bed
·         2 woolen blankets
·         Bed cradle, sand bags & hot water bottles
·         Note: in renal bed, the cradle & sand bags are vomited.
Procedure:
·         Make the bed as in open bed
·         Cover the bed with blanket one under & other over the patient
·         Make the patient to lie down
·         Place the bed cradle
·         Cover the patient with blanket over the bed cradle to take off the weight over the painful joints
·         Immobilize painful joints using sand bags
Amputation/divided/stump bed:
Meaning:
Used after amputation of the leg to take off the weight of bed clothes off the amputation site
Purposes:
·         To take weight of bed clothes off the amputation site
·         To keep the stump in good position
·         To be able to watch the stump for hemorrhage & apply tourniquet immediately
·         To avoid unnecessary disturbance to the client during observations or repeated procedures
Articles required:
·         Articles for a open bed
·         An extra set of top linen-top sheet ,blanket & counter pane
·         Bed cradle
·         Pillow with waterproof cover
·         Hot water bags
·         Sand bags/towels/draw sheets-to keep stump in good alignment & prevent jerking
·         Tourniquet & dressing tray in case of emergency haemorrhage
Procedure:
·         Foundation & head end is made as in open bed
·         The other end does not reach the foot end but is folded back toward the head end at the level of the stump
·         The other set of top linen starts at the level of the stump but overlapping at least 20-25cm & the excess is tucked under the mattress at the foot end.
·         The two sets of top linen is fan-folded till patient occupies the bed
·         Elevate the stump with a small pillow protected with a water proof cover.
·         Place sand bags at either side & use bed cradle to take weight off the stump.
·         Cover client & keep him/her warm
 Summery:
Unoccupied bed : A bed made without patient in the bed.
Occupied bed :      A bed made with patient in the bed.
Open bed:              A bed which is about to be occupied.
Closed bed:            A bed which will remain empty until the admission.
Cardiac bed:          A bed for patient with cardiac condition.
Fracture bed:        A bed for patient with fracture.
Amputation/ Divided bed: For patient with amputation.
Operation bed/ Recovery bed/ Post-anesthetic bed: For patient who underwent surgery.

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notes.nursium.com: Bed Making
Bed Making
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