RETURN DEMONSTRATION EVALUATION TOOL FOR:

UNOCCUPIED BED

Name: _____________________________________ Grade: _____________

Time started:____________ Time ended:________Date of RD:________________________

RATING COMMENTS
AREA FOR EVALUATION
5 4 3 2 1 0
SKILLS (35%)
ASSESSMENT
1. Check to see whether the linen
(including the mattress pad, blanket,
and bedspread) needs to be changed.
2. Determine what linens are needed.
PLANNING
3. Gather all linens and other items
needed.
4. Use effective body mechanics and
efficient movement in completing the
procedure.
5. Obtain a laundry bag or hamper.

IMPEMENTATION
A. OPEN BED
6. Be certain the wheels are locked.
7. All garbage should be wrapped in a
newspaper and place in a waste
container.
8. Removes rugs for drapes for
cleaning. Report all evidences of torn
mattresses, bed springs, broken
furniture, tear in sheets, etc. for
repair.
9. Dampens cloth with 1 % Lysol
solution to cleanse mattress and bed
springs.
10. Cleans all furniture well
11. Lines dresser and table drawers with
clean paper.
12. Arranges furniture in order. Replace
all necessary equipment in order.
13. Checks shades for blinds screen,
 cover for cleanliness.
14. Places linens on a clean, dry surface
in reverse order of usage at the bed
side.
15. Positions the bed flat, raise to
appropriate working height, and
lower siderails.
16. Airs the mattress.
17. Working from the foot of the bed.
Places the clean bottom sheet folded
into four layers on the bed and
spreads it fully.
18. Tucks excess sheet under the
mattress at the near side of the head
of the bed.
19. Miters the upper portion of the
bottom sheet at the corner near side
of the nurse.
20. Lays the rolled plastic sheets/ rubber
sheets on the center line of the bed
and spread toward both sides of the
bed. Tucks in or the near side.
21. Lay the cotton draw sheet on the bed
with the vertical center folded into
four layers on the bed.
22. Places the top sheet folded into four
layers on the bed, so that the vertical
centerfold is at the centerline of the
bed and the top edge should be even
with the top edge of the mattress and
spread it fully.
23. Makes a horizontal toe pleat in the
sheet.
24. Tucks excess top sheet under the
mattress. Miters the corners of the
top sheet at the side near you.
25. Moves to the opposite side of the
bed. Starting at the head of the bed,
unfold the bottom sheet.
26. Pulls the sheet firmly, miter the side
corner at the head of the bed.
27. Tucks the side of the bottom sheet
working toward the foot of the bed,
pull the sheet firmly so that there are
no wrinkle in it.
28. Straightens by unfolding the rubber
 sheet, draw sheet and the top sheet,
and finish tucking in.
29. Fanfolds the top portion of the top
sheet about 18 inches from the head
part of the bed.
30. Changes pillowcases
31. Places the pillow at the head of the
bed in the center, with the open end
of the pillowcase facing away from
the door of the room.
32. Washes your hands.
B. CLOSED BED
33. Put up all sides of the top sheet
above the bed in an “envelop” style.
34. Cover the top sheet with the bed
spread to include the pillow.
35. Going to the foot part of the bed,
tuck the excess bottom edge and
miter the corners.
C. SURGICAL BED
36. Add blanket over the top sheet.
37. Fanfold the top covers to the far side
or bottom of the bed so that the
bottom sheet is exposed.
38. Leave the side rails down and the
bed in the highest position from the
floor.
39. Place under pads at the head of the
bed and at the level where there is
likely to be wound drainage.
40. Drop the pillow upright at the bottom
of the bed.
41. Place an intravenous pole at the head
of the bed, suction machine, kidney
basin, small towel or tissue and
oxygen tank.
42. Put hot water bag under the blanket.
D. STRIPPING
43. Starting on one side of the bed,
loosen all the linens
44. Remove the pillowcase
45. Using both hands, grasp the top edge
of the top sheet, one hand at the
center, the other at the mattress edge.
Fold it in half by bringing the top
edge over with the bottom edge. If it
 is soiled, roll the linen and place it in
the linen hamper. If the linen is
clean, fold it and place in the chair.
Do the same with the cotton draw
sheet, rubber sheet and bottom sheet.
46. Move the mattress up to the head of
the bed by grasping the mattress edge
and using good body mechanics, turn
the mattress upside down to air the
other side of the mattress.
47. Wipe the chair and out-bed table.
48. Wash your hands.
EVALUATION
49. Make the bed with clean linens.
50. Ensure that there are no wrinkles.
51. Work efficiently and safely.
52. Furniture and equipment are properly
arranged.
53. Uses good body mechanics
KNOWLEDGE (15%)
1. Gives rationale of the procedure.
2. Explains the elements and mechanics
of the procedure.
3. Knows the elements of nursing
process as applied
4. States Principles applied in the
procedure.
ATTITUDE: (10%)
1. Is well groomed.
2. Wears prescribed, neat, and clean
uniform.
3. Arrives on time for the RD.
4. Speaks to CI and client tactfully.
5. Minimizes use of energy, time, and
effort
6. Utilizes supplies efficiently.
7. Considers client’s safety, privacy, and
comfort.
8. Is well organized.
9. Keeps working area clean at all times.
10. Gives high value for aesthetics.

Comments: _______________________________________________________________
Clinical Instructor’s signature: ____________________________________

RETURN DEMONSTRATION EVALUATION TOOL FOR:

OCCUPIED BED

Name: _____________________________________ Grade: _____________

Time started:____________ Time ended:________Date of RD:________________________

RATING COMMENTS
AREA FOR EVALUATION
5 4 3 2 1 0
SKILLS (35%)
ASSESSMENT
1. Check to see whether the linen
(including the mattress pad,
blanket, and bedspread) needs to be
changed.
2. Determine what linens are needed.
3. Determine the patient’s ability to
assist with the procedure and
whether additional help is needed.
4. Assess for drainage or incontinence
to determine whether personal
protective equipment, such as
procedure gloves and gown, is
needed.
PLANNING
5. Gathers all linens and other items
needed.
6. Uses effective body mechanics and
 efficient movement in completing
the procedure.
7. Obtains a laundry bag or hamper.

IMPEMENTATION
8. Identifies the patient and explain
the procedure.
9. Places linens on a clean, dry
surface in reverse order of usage at
the bed side.
10. Positions the bed flat if possible,
and raise it to appropriate working
height. Lower the side rails nearest
you.
11. Loosens all the bedding. Remove
the patient’s personal items from
the bed.
12. Checks that no tubes (e.g. IV,
NGT) are entangled in the bed
linens.
13. Removes the blanket but leave the
top sheet over the patient or replace
it with a bath blanket
14. Slidse the patient to the side of bed
farthest from you, and place her in
a side-lying position, facing the
side rail. Places pillow under the
patient’s head.
15. Rolls or tightly fanfold the soiled
linens toward the patient’s back.
Tuck the roll slightly under the
patient.
16. Places the clean bottom sheet, on
the near side of the mattress, with
center vertical fold at the center of
the bed.
17. Unfolds the bottom sheet
lengthwise. Fanfold the half of the
clean linen that is to be used on the
far side, folding it as close to the
patient as possible and tucking it
under the dirty linen.
18. Tucks the top edge of the sheet
under the mattress and miter top
 corner of the bottom sheet at the
head part.
19. Tucks the side edges of the bottom
sheet under the mattress moving
from the head to foot. Smooth out
all wrinkles.
20. Places the clean rubber sheet and
draw sheet.
21. Rolsl the patient over the clean and
dirty linen.
22. Raises the siderail on the clean side
of the bed.
23. Moves the pillows to the clean side.
Position the patient comfortably on
her side, near the siderail.

24. Goes to the other side of bed, and

lower the siderail. Pulls the soiled
linen from under the clean linen,
and place it in laundry bag or
hamper.
25. Pulls clean linens through, and
tucks them in. Pull taut, starting
with the middle section.
26. Assists the patient to a supine
position close to center of the
mattress.
27. Places the top sheet over the patient
and remove the bath blanket:
28. Returns the bed to the low position,
raises the siderails. Positions the
bedside table and overbed table
within patient’s reach.
29. Disposes soiled linens.
30. Washes hands.
EVALUATION
31. Maintain patient safety during the
procedure.
32. Remove soiled linens without
cross-contaminating other items in
the room.
33. Work efficiently and safety.
34. Ensure that there are no wrinkles in
the bottom sheet and draw sheet.
35. Evaluate the patient’s responses to
activity (e.g. pulse, respirations and
 blood pressure).

DOCUMENTATION
36. Report and document in the nurses
notes if something abnormal
occurred e.g. presence of a 20 cm
circular area of serosanguineous
drainage.

KNOWLEDGE (15%)
1. Gives rationale of the procedure.
2. Explains the elements and
mechanics of the procedure.
3. Knows the elements of nursing
process as applied
4. States Principles applied in the
procedure.

ATTITUDE: (10%)
1. Is well groomed.
2. Wears prescribed, neat, and clean
uniform.
3. Arrives on time for the RD.
4. Speaks to CI and client tactfully.
5. Minimizes use of energy, time, and
effort
6. Utilizes supplies efficiently.
7. Considers client’s safety, privacy, and
comfort.
8. Is well organized.
9. Keeps working area clean at all times.
10. Gives high value for aesthetics.

Comments: _______________________________________________________________

Clinical Instructor’s signature: ____________________________________