MAKING A BED FOR A CLIENT

I. DEFINITION
Bedmaking – a procedure wherein bed linens are changed to make the client comfortable during the
entire stay in the hospital or health care setting.
Unoccupied Bed – a hospital bed which is made ready for admission or wherein the client is out of bed
ambulating around. It can either be a closed or open bed.
Closed Bed – an unoccupied bed wherein the top sheet, blanket, and bedspread are drawn up to the top
of the bed.
Open Bed – an unoccupied bed wherein the top covers of the bed are folded back to make it easier for a
client to lie on.
Occupied Bed – a bed occupied by a client who cannot get out of bed for some reasons.
Surgical Bed – a bed made for a client who is undergoing a surgical or diagnostic procedure that requires
the use of an anesthetic agent.
Fracture Bed – a bed made for a client who is suffering from a fracture or other musculo - skeletal
disorders.
Stripping the Bed – is a procedure wherein used linens are removed from the bed and the bed mattress is
aired.

II. RATIONALE

1. To provide comfort and safety.

2. To provide a clean bed for the client.
3. To make a bed that is comfortable and neat while being occupied by a client.
4. To help maintain proper body alignment.
5. To help immobilize a body part.

III. EQUIPMENT

Mattress Cover Top Sheet

Bottom Sheet Blanket (if needed / optional)
Rubber Sheet Bedspread (if needed / optional)
Cotton Draw Sheet Hamper for soiled linens

Additional Equipment for Making a Surgical Bed

Emesis Basin Wash Cloth
Tissue Wipes IV Stand
Tongue Depressor Hot Water Bag (2)
Suction Machine (if needed) Bath Towel
Sphygmomanometer and Stethoscope

Additional Equipment for Making a Fracture Bed

Bedboards Footboards
Cradles

IV. PLANNING AND IMPLEMENTATION

Special Considerations:
A. Asepsis in Bedmaking
1. Handle linens carefully. Avoid shaking them. Place soiled linens inside the laundry hamper and not
on the floor. To prevent the spread of microorganisms which move through space in air currents.
The floor is the most contaminated area in the hospital.

2. Hold both soiled and clean linens away from your uniform. To prevent contamination.
Microorganisms are transferred from one surface to another whenever one object touches
another.

3. Wash hands before and after the procedure. To prevent the spread of microorganisms.

B. Body Mechanics in Bedmaking

1. Raise the bed to a comfortable height (hip level). Bend your knees and not your back. To prevent
fatigue. A person or an object is more stable if the center of gravity is close to the base of support.
 2. See to it that the entire body is facing in the direction that you are moving and avoid twisting the
body. To lessen the susceptibility of the back to injury.

3. Make the bed completely on one side before moving to the other side. Organize your work and
move with moderate speed. To save time and effort. Smooth, rhythmical movements at moderate
speed require less energy.

C. Other Considerations
1. Place client on a safe position when the linens are completely changed. To prevent accidents.

2. Be certain the wheels of the bed are locked. To keep the bed from moving.

3. Remove attached equipment (call light, waste bag, personal items) before starting the procedure.
To save time and effort. One can perform better and movements are easy when the work area is
clear.

4. Side rails should be in the down position and in the case of an occupied bed, only at the side
where you are working. To promote easy movement and at the same time to prevent accident in
cases of occupied beds.

5. When making the bed, seams should always be toward the mattress or away from the client. The
smooth surface should be in contact with the client. To prevent skin irritation. There are clients
who are hypersensitive to rough surfaces.
QUALITY OF LIFE

Remember to:
 Knock before entering the person’s room
 Address the person by name
 Introduce yourself by name and title

MAKING AN UNOCCUPIED CLOSED BED

ACTION RATIONALE

Pre-procedure

1. Bring necessary clean linens to the bedside. To save time and energy.

2. Place linens on a clean chair or on the over bed To prevent cross - contamination. Having linens in
table in the same order in which they will be order in which they will be used saves time and
placed on the bed. Do not place the linens on effort.
another client’s bed.

3. Strip the bed, in case the bed is not stripped.

Raise the bed for proper body mechanics. (Refer
to procedure in Stripping the Bed)

Procedure

4. From the foot of the bed, place the folded bottom To allow the top of the sheet to remain securely in
sheet along the edge of the mattress with its place especially if the head of the bed is elevated.
center fold on the center of the mattress and the
seam toward the mattress. The smooth surface
should be in contact with the client. Unfold the
sheet over the bed and allow a sufficient amount
of sheet at the top to tuck under the mattress.
5. Move to the head of the bed on the same side To anchor the sheet firmly.
and tuck the sheet under the head part of the
mattress and miter the top corner (refer to
procedure on how to make a mitered comer).
Tuck the remaining sheet under the side of the
mattress all the way to the foot of the bed.
6. Working from the same side, place the rubber To protect the bottom sheet from soiling. Draw
draw sheet on the center third of the bed over sheets can also be used in moving and lifting the
 the bottom sheet. The centerfold is at the center client.
line of the bed. Place the cotton draw sheet (seam
in contact with the rubber sheet) in the same
manner over the rubber sheet. Unfold the sheets
over the bed and tuck them under the mattress.

7. From the same side, place the top sheet at the To avoid unnecessary moving about the bed. To
top edge of the mattress, centerfold of the sheet save time and effort.
at the center line of the bed and seam side up.
Unfold the entire sheet and tuck under the foot
end of the bed. Miter the bottom corner of the
top linen at the foot of the bed but do not tuck
the sides. Allow it to hang freely unless toe pleats
are provided.
To provide additional room for the client’s feet.
Optional: Make a vertical or horizontal toe pleat
on the sheet.
Vertical Toe Pleat: Make a fold on the sheet 5 to
10 cm (2 to 4 in) perpendicular to the foot of the
bed.
Horizontal Toe Pleat: Make a fold on the sheet 5
to 10 cm (2 to 4 in) across the bed near the foot.

8. If using a blanket and a bedspread, follow the To provide warmth when the weather is cold.
same procedure as the top sheet, but place the
top edges about 15 cm (6 in) from the head of the
bed. Tuck at the foot of the bed and miter the
corner together with the top sheet.

9. Move to the other side of the bed to tuck the To save time and effort.
linens on that side in the same manner as the
other side. Pull the sheets firmly so that there are To prevent discomfort.
no wrinkles.

10. If using a blanket and a bedspread, fold the top of To make it easier for the client to pull the covers up.
the sheet down over the spread, providing a cuff
of about 15 cm (6 in).

11. Put a clean pillowcase on the pillow. To promote comfort. A smoothly fitting pillowcase is
more comfortable than a wrinkled one.
- Grasp the closed end of the pillowcase at the
center with one hand.
- Gather the case from top to bottom with the
second hand.
- 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.

12. Align and place the pillows at the head of the bed To provide a neat appearance.
in the center, with the open ends of the pillow
case facing away from the door of the room.

Post-procedure

13. Replace all attached equipment (call light, waste To provide easy access for the client in case needed.
paper bag)

14. Leave bed in high position until admission comes To provide an easy access in case the client comes in
or until the client comes back. by stretcher.

15. Do after care. To prevent the spread of microorganisms.

MAKING AN UNOCCUPIED OPEN BED

- Follow the procedure in Making Unoccupied

Closed Bed.
- To make the bed an Open Bed, either fold back To make it easier for the client to get into the bed.
the top covers at one side or fanfold them down
to the center of the bed.

MAKING A SURGICAL OR ETHER BED

1. Follow steps 1 -6, and 9 of the procedure in

Making Unoccupied Closed Bed.

2. Spread the bath towel over the head part of the To protect the linens.
bed.

3. Spread the top covers of the bed. Do not tuck To facilitate easy transfer of the client from
them in, miter the corners, or make a toe pleat. stretcher to bed with minimum motion and
discomfort.
4. Fold the hanging edges of the top covers up over To promote ease in transferring the client into the
the top of the bed so that the folds are at the bed.
mattress edge (fold the sides first, then the top
and bottom). Fanfold them lengthwise at one side
of the bed or cross - wise at the bottom of the
bed.

5. Place hot water bag in between folds of the top To warm the bed.
linen.

6. Follow step 11 of the procedure in Making an

Unoccupied Closed Bed.

7. Place pillow(s) on a table or chair, or on top of the To protect the client from injury.
fan - folded linen or against the head rails of the
bed.

8. Leave the bed in high position to receive the To facilitate easy transfer of the client from the
client. stretcher to the bed.

9. Place emesis basin, tissues, IV stand, and other To provide easy access when needed.
necessary items appropriately at the bedside.

10. Do after-care. To prevent the spread of microorganisms.

MAKING A FRACTURE BED

1. If bed board is used, place directly under the To promote good body alignment and comfort.
mattress.

2. Make an unoccupied bed.

3. Place a footboard at the foot of the bed. To prevent the client from sliding to the foot of the
bed. To provide a firm surface for foot exercise. To
prevent foot drop.

4. If a cradle is used, arrange the top linen over the To keep the linen off the client’s feet and lower legs
device and pin it in place or simply tuck as as in cases of edema, leg ulcers, and burns.
securely as possible around the frame.

5. Do after-care. To prevent the spread of microorganisms.

MAKING AN OCCUPIED BED

1. Bring all materials to the bedside. Place on a chair or
on the over bed table. Arrange the linens in the
same order in which they will be placed on the bed.
2. Explain the procedure to the client. Use a screen
if the client is in the ward.
To avoid the transfer of microorganisms.
To save time and energy.
To gain the client’s cooperation and to provide
privacy.

3. Adjust the bed to a comfortable working height To prevent unnecessary strain on the nurse’s back.
and place in a flat position if the client's health
permits. Remove the pillow(s), if permissible.

4. Loosen all the top linen at the foot part of the To promote ease and comfort during the procedure.
bed. Remove the spread and blanket, if used by To provide warmth and privacy for the client.
the client. Leave the top sheet over the client.

5. Assist the client to turn on the far side of the bed To give the nurse more room to make one side of
facing away from the side where the clean linen the bed first.
is. Reposition the client in a side-lying position. Be
sure the side rail is up in the far side of the bed. To prevent accidental fail.

6. Loosen the bottom sheet, draw sheet, and cotton To save time and effort.
draw sheet on the side where you are working.

7. Fanfold the draw sheet, rubber sheet, and bottom
sheet towards the center of the bed and tuck
them under the client's back and buttocks.
8. Lay the clean bottom sheet lengthwise on the
bed, unfold it so that its centerfold is at the center
of the bed, the bottom hem is in line with the
bottom edge of the mattress. Fanfold half of the
sheet lengthwise to the center of the bed.
To limit the transfer of microorganisms from the
soiled linen to the clean one.
To make it easier to pull the linen at the other side
of the bed.
To make sure that the linens are placed and tucked
equally on the bed.

9. Tuck the sheet under the mattress at the head To anchor the linen securely.
part of the bed and miter the top comer on that
side.

10. Place the rubber sheet and cotton draw sheet on To conserve time and effort.
the bed in similar fashion as you did with the
bottom sheet. Together with the bottom sheet,
tuck them snugly and smoothly under the side of
the mattress.

11. Assist the client to roll over toward you onto the To facilitate making the other side of the bed.
clean side of the bed. The client rolls over the fan-
folded linen at the center of the bed.

12. Move the pillow to the clean side for client’s use, To provide comfort.
if not removed from bed. Raise the side rail To prevent the client from having an accidental fall.
before leaving the side of the bed.

13. Move to the other side of the bed and lower the To promote ease and comfort during the procedure.
side rail.

14. Loosen and remove the soiled linen and place it in To limit the spread of microorganisms.
the hamper.
15. Pull the fan-folded linen, rubber sheet, and cotton To provide comfort and protect the client from skin
draw sheet from the center of the bed. Beginning irritation.
with the head part of the bottom sheet, smooth
out the sheet, tuck it at the top of the mattress,
miter the top corner of that side and tuck under
the side of the mattress together with the rubber
sheet and cotton draw sheet.

16. Assist the client to the center of the bed. To promote client’s comfort.
 Determine what position the client requires or
prefers and assist the client to that position.

17. Spread the fan-folded top sheet over the client’s To provide privacy while removing the soiled linen.
chest. Remove the soiled top sheet by asking the
client to hold the top edge of the clean sheet or
tuck it under the shoulders, if the client is unable
to hold it, as you pull it together with the soiled
top sheet from the top to the bottom. Place the
soiled linen in the hamper.

18. Tuck the top sheet at the foot part and make a To ensure that the linen is anchored securely.
square corner.

19. If blanket and spread are used, follow the same To provide warmth.
procedure as the top sheet and tuck them
together at the foot part with the top sheet.

20. Remove the pillow(s) and change the pillow

case(s) (follow step 11 of the procedure in Making
an Unoccupied Closed Bed). Position the pillow(s)
appropriately for client’s use.

21. Place the bed in low position and adjust the side To prevent injury.
rails.

22. Do after-care. To prevent the spread of microorganisms.

STRIPPING THE BED

1. Wash hands. To prevent the spread of microorganisms.

2. Obtain a laundry or hamper bag. To be used for the soiled linens.

3. Place a chair at the foot part of the bed. To be used for the pillow(s) after removing the
pillow case(s).

4. Remove the pillow case(s) from the pillow(s). To limit the transfer of microorganisms.
Place the pillow(s) on the chair and the soiled
pillow case(s) on the low bar of the bed or in the
laundry / hamper bag.

5. Check bed linens for any of the client’s misplaced To prevent losses of client’s personal items and to
personal items, and detach the call bell or any promote ease and comfort in doing the procedure.
drainage tubes from the bed linen.

6. Loosen the top and the bottom linen from the To prevent stretching and reaching and possible
mattress, moving around the bed from head to muscle strain.
foot on one side and foot to head on the opposite
side.

7. Remove the rubber draw sheet and discard if it is To prevent the spread of microorganisms.
soiled.

8. Roll all soiled linen inside the bottom sheet, hold To prevent the transfer of microorganisms.
it away from your uniform, and place it directly in
the linen hamper.

9. Remove the mattress cover, discard it into the To allow the mattress to be exposed to sunlight and
linen hamper and turn the mattress over. air.

10. Do after - care and wash your hands. To prevent the spread of microorganisms.

TO MAKE A MITERED CORNER

1. Pick up the side edge of the sheet approximately
12 inches from the comer of the mattress. Hold it
straight up and down, parallel to the side of the
mattress.

2. Lay the upper part of the sheet on the bed.

3. Tuck the part of the sheet that is hanging below

the mattress smoothly under the mattress.

4. Holding the sheet in place against the mattress

with one hand, use your other hand to lift the
folded part of the sheet lying on the bed and
bring it down. Tuck it under the mattress.

TO MAKE A SQUARED CORNER

1. Pick up the sheet to form a 45 - degree angle

(step 1 of how to make a mitered comer).

2. Lay the upper part of the sheet on the bed. See to

it that when the folded edge is placed on the top
of the mattress before tucking, it is even with the
bottom edge of the mattress.

3. Tuck the part of the sheet that is hanging below

the mattress smoothly under the mattress.

4. Bring the folded edge at the top of the mattress

down and let the sides of the top sheet hang
freely.

V. EVALUATION AND DOCUMENTATION

Evaluation is done using the following criteria:

Unoccupied Bed
1. smooth, wrinkle - free surface
2. tight corners
3. correct position (high or low) for the client’s needs
4. necessary equipment (call light, waste paper bag) attached in appropriate place
Post - op or Surgical Bed
1. smooth, wrinkle - free surface
2. top covers folded back out of the way
3. necessary items at the bedside
4. bed in high position

Fracture Bed
1. smooth, wrinkle - free surface
2. client’s comfort
3. proper placement of devices

Occupied Bed
1. client’s comfort
2. smooth, wrinkle - free surface
3. tight comers
4. bed and side rails in correct position
5. bed in low position
6. call light and other personal items within client’s reach

Documentation on the ff:

1. Tolerance of the client’s being out of bed, in case of unoccupied bed
2. Any assessment data or change in the client’s clinical status
VI. ILLUSTRATION

Mitering the Corner of a Bed A Horizontal Toe Pleat

Body mechanics – movement of the body in a coordinated & efficient way so that proper balance, alignment, &
conservation of energy is maintained.
Principles
 A person maintains balance as long as the line of gravity passes through the center of the
body & the base supports.
 The wider the base of support & the lower the center of gravity, the greater the stability.
 Objects that are close to the center of gravity are moved with the list effort.

Line of gravity – an imaginary vertical line drawn through an object’s center of gravity.
 The point at which all of the mass of an object is centered.
 Base of support: the foundation on which an object rests.
Purpose of proper body mechanics
 Prevents injuries to clients
 Prevents injuries to all health care providers
 Reduces the energy required to move & maintain balance
 Facilitates safe & efficient use of appropriate groups of muscle

Lifting a patient in bed

Lifting a patient – to raise patient, to move patient from one position to another, higher position.
Moving a patient – to change previous location/ position.

Guidelines / principles of patient lifting/ body mechanics

 Assume a proper stance before moving or tuning clients
 Distribute work load evenly before moving or tuning clients
 Establish a comfortable height.
 Push and pull objects when moving them to conserve energy.
 Use large muscles for lifting and moving, not the muscle.
 Avoid leaning and stretching
 Request assistance from others when working with heavy clients.
 Avoid twisting your body.

Purpose of lifting & moving

  To assist patient who is unable to move
 To prevent fatigue &injury
 To maintain good body alignment
 To stimulate circulation

Precautions on patient lifting & moving

 Asses client’s condition
 Use good body mechanics when moving & turning clients.
 Avoid leaning & stretching.
 Request assistance when working with heavy clients.

Moving a patient from bed to stretcher & from stretcher to bed.

Purpose
 To transfer patient to other department
 To take patient to surgery or examination
Steps for moving a patient from bed to stretcher
Requires helper
Method - 1
- Fold top bedding to the foot while covering the patient with a bath blanket.
- Place stretcher at a right angle to the bed with the head of stretcher to foot of bed.
- All stand on same side of bed. Place hands well under patient to support head &entire body.
- All helpers should lift together in unison, swing half way round, bring head to foot of bed &
place patient on stretcher.
- Cover the patient with sheet or bath blanket.
Method – 2
- Place stretcher parallel to the bed.
- Four nurses or helpers are required, one stands on the opposite sides of the bed. Three will
have to reach across the stretcher. The nurses at the head & the foot of the stretcher may find
it easier to step around the end of the stretcher.
- Grasp sheet beneath patient & support shoulders & legs separately.
- Co-ordinate lifting, & swing patient to stretcher by pulling the sheet & patient towards
stretcher quickly & gently.
- The sheet can be removed at this time by turning patient from side to side. Or wait until he
has been transferred from the stretcher to the bed or table again.
- The opposite method is used when moving a patient from the stretcher to the bed.

Precaution on moving a patient from bed to stretcher

- Lock the wheels of the bed & stretcher.
- Fasten safety straps across the client on a stretcher, &raise the side rails.
- Never leave a client unattended on a stretcher.
- Always push a stretcher from the end where the client’s head is positioned

Moving a patient from bed to chair & from chair to bed

Purpose of moving a patient from bed to chair
- To simulate circulation
- To prevent fatigue
Equipment
- Chair
- Bath blanket
- Slipper
Steps/ procedure
- Identify the patient.
- Wash your hand.
- Explain procedure.
- Lock the bed in place.
- Place the chair at the head of the bed. Be sure to lock chair wheals or have someone hold the chair
as you move the patient.
- Dangle the client until she or he is stable.
- Give the client nonslip shoes or slipper.
- Have the client reach across the chair or grasp the chair arm, if possible. (Helps stabilize client to
prevent falls during transfer of chair).
 - Place your hands under the client’s axilla or around clients back.
- Place your feet slightly to the side and infront of the client.
- Rock the client and, on the count of three, pivot (rotate) the client in to the chair.
- Position the client in the chair to prevent pressure area. If the client has circulatory impairment,
elevate legs while out of bed. (This promotes venous return).

Precautions on moving a patient from bed to chair

- Lock the bed & chair wheals.
- Prevent trauma e.g. pulling joints
- Keep movements smooth & rhythmic.
- To avoid injury to the care giver when a patient starts to fall, gently guide person to the floor, rather
than attempting to hold the patient up.

Positioning a patient
Position – any one of many postures of the body, as the anatomic position, semi-fowlers position …..
Therapeutic positioning is used to prevent complications when mobility is reduced.
Purpose of positioning a patient
- To stimulate circulation
- To prevent some potential problems of immobility
- To prevent bed sore

Types of positions
The patient may be placed in specific positions to facilitate diagnostic testes or surgical intervention.
Common positioning postures includes
- Prone (face down )
- Supine (lying on back)
- High-fowler’s (head of the bed elevated 80-90 degrees)
- Semi-fowler’s (head of the bed elevated 30-45 degrees)
- Low-fowler’s (head of the bed elevated 15 degrees)
- Dorsal recumbent (supine with legs flexed in an elevated position )
- Knee-chest position (prone with buttocks elevated and knees drawn to the chest).
- Trendelenburg (supine with head lowered than feet )
- Lateral or side-lying position
- Sims’ (semi prone between a prone & side-lying position )


~I

Dorsal recumbent: The client lies supine with legs flexed and rotated outward. This position is used
extensively for vaainal examination but no; for abdomina! assessmen1 be;ause it promotes
contraction of abdominal muscles.

Knee-ehest: The client lies prone with buttocks elevated and knees drawn to the chest to
accommodate a rectal procedure or examination A client with arthritis or other joint deformity may
be unable to lie in this position.

Lithotomy: The client lies supine with hips flexed and calves and heels parallel to the floor. This
uncomfortable and ernLF.HfJSSii19 position req'J:l r:~-. df 2ping tile client for privacy. 11 is used for vaginal
and rectal examination and may pose great difficulty for clients with immobilizing arthritis or a joint
deformity.

Trendelenburg's: The client lies supine with head 30°-40° lower than feet. The position may be used for
postural drainage and to promote venous return. Hypotension may be an after effect of this position.
1------

 


Prone: The client lies face down. Arms may
cushion the head or may be flexed An
alternative position for an immobilized client,
the prone position is contraindicated after
abdominal surgery and in clients with
resDiratory or spinal problems.
Side-lying: The client lies on the side with
weight on hip and shoulder. Pillows support
and stabilize uppermost leg. arm, head, and
back. A choice position for clients with
pressure on bony prominences of the back and
sacral pressure sores, side-lying is not used
after hip replace'Ti(;nt and other orthopedic
surgery.
\
\

Supine: The client lies flat on back. Pillows may Sims': In this semiprone position the client lies \
be used under the head. knees and calves to on the side with weight distributed toward the
raise heels off the mattress. An alternative anterior ileum, humerus, and clavicle. Pillows
position for a client on bed rest, the prone support the flexed arms and legs. The position
position is used after spine surgery and some is contraindicated by many spine or orthopedic
spinal anesthesia. It is not used for clients "\llth conditions.
dyspnea or at risk for aspiration. I
I
I ~I
._----~

Fowler's: This sitting position raises the client's Semi-Fowler's: In this semi-sitting position
head 8oO-90c Pillows can be used under the the client's head is elevated 30°-45°. This
head and arms and a footboard may also be position has the same advantages and
used. The position improves cardi:::c output. contralnc!lcations as Fowler's position.
promotes ventliation and eases eating, talking.
and watching TV. It is not used after spine or
brain surgery.
(((lllliilU,_'di
I ______
L_ •. ___~ __ . ____•• ______________. ___________________________________________. --..------J
_______-
Figure 33-5 • Common client posit ions. Among selected body positions, 1I1e prone,
supine, Fowler's, semi-Fowler's, side-lying, and Sims' positions are typically chosen for
clients in heoll11core facilities, whereos the dorsal recumbent, lithotomy, knee-chest,
and Trendelenburg POSitiOns are typically used durinl) certain tests and surgical ,()
((>(edures
Ambulating a patient
- Is to move from place to place by walking.
- Is the act of walking.
- Early ambulation significantly reduces complications of immobility. Waking exercises almost all body
muscles & promotes joint flexibility. Most surgical clients are permitted & encouraged to get out of bed &
walk on their first postoperative day.
Purpose
 To increase muscle strength & joint mobility.
 To prevent some potential problems of immobility.
 To increase the client’s sense of independence & self esteem.
Precaution of patient ambulation
 Check vital signs for base line data before walking, especially if this is the client’s first time up.
 Remain physically close to the client in case assistance is needed at any point.
 Use a transfer or walking belt if the client is slightly weak & unable.