BED MAKING

Christian I. Echipare, RN
Clinical Instructor
 Making an Unoccupied Bed

 Ifthe patient can get out of bed, the bed

should be made while it is unoccupied to
decrease stress on the patient and the nurse.

 2 types of unoccupied bed

1. Open
2. closed
 Purpose

 To promote clients comfort

 To provide a neat environment for the client.
 To provide a smooth, wrinkle free bed
foundation, thus minimizing sources of skin
irritation.
MAKING AN OCCUPIED BED
 Assessment

 The client’s health status, to determine that

the person safely can get out of bed.
 The client’s pulse and respirations, if
indicated.
 Note all the tubes and equipment connected
to the client.
 Before beginning to change linens, inspect
the bed for evidence of any body secretions
or fluids on the linens. If present, don
disposable gloves before changing linens.

 Alsocheck for any patient belongings that

may have accidentally been placed in bed,
such as eyeglasses or prayer cloths.
 Assemble equipment:
 Two flat sheets, or one fitted and one flat sheet
 Cloth drawsheet (optional)
 One blanket
 One bedspread
 Pillowcase(s) for the head pillow(s)
 Plastic laundry bag or portable linen hamper, if
available
 Procedure

1. Introduce yourself and verify the client’s

identity. Explain to the client what you are
going to do, why it is necessary, and how the
client can cooperate.
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 over
bed table; do not use another client’s bed. This
prevents cross-contamination 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. Having the bed in the high position
and the side rails down reduces strain on the
nurse while working.
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. Disconnecting the devices prevents damage
to the devices and injury to the patient.
 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. Loosening the
linen helps prevent tugging and tearing on linen.
Loosening the linen and moving around the bed
systematically reduce strain caused by reaching across
the bed.
 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, then grasp it at the center of the middle fold
and bottom edges. Folding saves time and energy
when reusable linen is replaced on the bed. Folding
linens while they are on the bed reduces strain on
the nurse’s arms. Some agencies change linens only
when soiled
 Remove the waterproof pad 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. These actions are
essential to prevent the transmission of
microorganisms to the nurse and others. The floor is
heavily contaminated; soiled linen will further
contaminate furniture.
 Grasp the mattress securely, using the lugs, if
present, and move the mattress up to the head of
the bed. This allows more foot room for the patient.
8. Apply the bottom sheet and drawsheet.
 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. Place the sheet along the edge of the
mattress at the foot of the bed, and do not tuck it in
unless it is a contoured or fitted sheet. The top of the
sheet needs to be well tucked under to remain
securely in place, especially when bed is elevated.
 Miterthe 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.
 If a waterproof drawsheet is used, place it
over the bottom sheet so that the center fold
is at the center line of the bed and the top
and bottom edges extend from the middle of
the client’s back to the area of the mid-thigh
or knee. Fanfold the uppermost half of the
folded drawsheet at the center or far edge of
the bed, and tuck in the near edge.
 Lay the cloth drawsheet over the waterproof
sheet 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. 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. This rids bottom linens of
wrinkles, which can cause patient discomfort and
promote skin breakdown.
 Complete this same process for the drawsheet(s).
10. Apply or complete the top sheet, blanket, and spread.
 Place the top sheet, hem-side up, on the bed so that its center fold is
at the center of the bed and the top edge is even with the top edge of
the mattress. Opening linens by shaking them spreads organisms
into the air. Holding linens overhead to open them causes strain on
the nurse’s arms.
 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.
▪ Vertical toe pleat: Make a fold in the sheet 5–10 cm (2–4 inches) perpendicular
to the foot of the bed.
▪ Horizontal toe pleat: Make a fold in the sheet 5–10 cm (2–4 inches) across the
bed near the foot.
▪ Loosening the top covers around the feet of the client 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 inches) 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. This saves time
and energy and keeps the top linen in place.
 Fold the top of the top sheet down over the
spread, providing a cuff. This makes it easier
for the patient to get into bed and pull the
covers up.
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.
 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 use it conveniently.
The patient will be able to call for assistance as necessary.
 If the bed currently is being used by a client, either fold back the
top covers at one side or fanfold them down to the center of the
bed. This makes it easier for the patient to get into 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. Having the bed in the low position makes it
easier and safer for the patient to get into bed.
 Dispose of soiled linen according to agency
policy. Perform hand hygiene. This deters the
spread of microorganisms.
13. Document and report pertinent data.
 Unexpected Situations and
Associated Interventions
 Drawsheet is not available: A flat sheet can be
folded in half to substitute for a drawsheet, but
extra care must be taken to avoid wrinkles in the
bed.
 Patient is frequently incontinent of stool or
urine: More than one protective pad can be
placed under the patient to protect the bed, but
care must be taken to ensure that the patient is
not lying on wrinkles from linens.
 Changing an occupied bed

 If the patient cannot get out of bed, the linens

may need to be changed with the patient still
in the bed. This is termed an “occupied” bed.
 Purposes
 To conserve clients energy
 To promote client comfort
 To provide a clean, neat environment for the client.
 To provide a smooth wrinkle-free bed foundations,
thus minimizing sources of skin infection.
 Before beginning to change linens, check for
evidence of any body secretions or fluids on
the linens. If present, don disposable gloves
before changing linens.

 Check the bed for any patient belongings

that may have accidentally been placed or
fallen there, such as eyeglasses or prayer
cloths.
 Nursing Diagnosis
 Determine the related factors for the nursing diagnosis
based on the patient’s current status. Many nursing
diagnoses may require the use of this skill.
 Possible nursing diagnoses may include:
 Risk for Impaired Skin Integrity
 Risk for Activity Intolerance
 Impaired Physical Mobility
 Impaired Bed Mobility
 Impaired Transfer Ability

 Many other nursing diagnoses may require the use of this skill.
Outcome Identification and Planning

 The expected outcome to achieve when

making an occupied bed is that the bed linens
are applied without injury to the patient or
nurse.
 Other possible outcomes may include:
patient participates in moving from side to
side, and patient verbalizes feelings of
increased comfort.
 Preparation

 Assess:
 Note specific orders or precautions for moving
and positioning the client.
 Presence of incontinence or excessive drainage
from other sources indicating the need for
protective waterproof pad.
 Skin condition and need for special mattress,
footboard, or heel protectors.
 Assemble equipment:
 Two flat sheets, or one fitted and one flat sheet
 Cloth drawsheet (optional)
 One blanket
 One bedspread
 Waterproof drawsheet or waterproof pads
(optional)
 Pillowcase(s) for the head pillow(s)
 Plastic laundry bag or portable linen hamper, if
available
 Implementation

1. Introduce yourself and verify the client’s

identity. Explain to the client what you are
going to do, why it is necessary, and how
the client can cooperate.
2. Perform hand hygiene and observe other
appropriate infection control procedures.
Put on disposable gloves, if linen is soiled
with bodily fluids.
3. Provide for client privacy.
4. Remove the top bedding.
 Remove any equipment attached to the bed linen, such as a signal
light.
 Loosen all the top linen at the foot of the bed, and remove the
spread and the blanket.
 Leave the top sheet over the client, or replace it with a bath
blanket as follows:
 Spread the bath blanket over the top sheet.
▪ Ask the client to hold the top edge of the blanket.
▪ 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.
▪ Remove the sheet from the bed and place it in the soiled linen hamper.
 This provides warmth and privacy.
5. Change the bottom sheet and drawsheet.
 Assist the client to turn on to side facing
away from the side where the clean linen is.
This allows the bed to be made on the vacant
side.
 Raise the side rail nearest the client. If there is
no side rail, have another nurse support the
client at the edge of the bed. This protects
the client from falling. If there is no side rail,
have another nurse support the client at the
 Loosen the foundation of the linen on the
side of the bed near the linen supply. This
facilitates removal of linens.
 Fanfold the drawsheet and the bottom sheet
at the center of the bed, as close to the client
as possible. Doing this leaves the near half of
the bed free to be changed and makes it
easier to remove linens when the patient
turns to the other side.
 Place the new bottom sheet on the bed
 Verticallyfanfold 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 if a contour sheet is not
being used.
 Place the clean drawsheet 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.
Opening linens on the bed reduces strain on
the nurse’s arms and diminishes the spread of
microorganisms. Centering the sheet ensures
sufficient coverage for both sides of the mattress.
Positioning under the old linens makes it easier to
remove linens.
 Assist the client to roll over toward you onto
the clean side of the bed. Have the client roll
over the fanfolded linen at the center of the
bed. The movement allows the bed to be
made on the other side.
 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 the other side of the bed, and lower the
side rail.
 Remove the used linen and place it in the
portable hamper. Placing linens directly into the
hamper helps prevent the spread of
microorganisms. The floor is heavily
contaminated; soiled linen will further
contaminate furniture. Soiled linen
contaminates the nurse’s uniform, and this may
spread organisms to another patient.
 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 drawsheet fanfolded 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.
 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 ( change pillowcase before
replacing), 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 the 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. Dispose of soiled linens according to agency policy.
Perform hand hygiene. This prevents the spread of
microorganisms.

10. Bed making is not normally recorded.

 Unexpected Situations and
Associated Interventions
 Dirtylinens are grossly contaminated with
fecal drainage: Obtain an extra towel or
protective pad. Place the pad under and over
the soiled linens so that new linens will not be
in contact with soiled linens.
 Older Adult Considerations

 Using a synthetic sheepskin, a soft bath blanket,

or a flannelette blanket as a bottom sheet may
solve the problem of “coldness” for elderly
patients with vascular problems or arthritis.