St.

Paul College of Ilocos Sur

(A Member, St. Paul University System)
St. Paul Avenue, Bantay, 2727 Ilocos Sur
College of Nursing

SCHOOL YEAR 2022-2023

NCM 107
Supporting A Hygienic Environment
1st Skill Rotation: Bed Making
LEARNING COMPETENCIES:
In this lesson you will be able to do the following:
 Define bed making
 Describe different types of bed making.
 State the purposes of bed making in health care facilities.
 Develop understanding about general instruction of bed making
 Develop a skill to make different types of bed.
 Explain the purposes of side rails.
 List necessary equipment for bed making.
 Arrange bed-making equipment in order of their use.
Introduction
Because people are usually confined to bed when ill, often for long periods, the bed becomes
an important element in the client’s life. A place that is clean, safe, and comfortable contributes
to the client’s ability to rest and sleep and to a sense of well being. From a holistic perspective,
bed- making can be viewed as the preparation of a healing space. When performed with caring
intention for benefit of the clients occupying the space during their healing journey, the
environment will be affected in positive ways.
 Basic furniture in a health care facility includes bed, bedside table, over bed table, one or
more chairs, and a storage space for clothing. Most bed units have a call light, light
fixtures, electric outlets, and hygienic equipment in the bedside table.
Environment
 In Florence Nightingales book, Notes on Nursing, she discussed many concepts
including ventilation and warming, light, cleanliness of rooms, noise, and beds and
bedding. When providing a comfortable environment, it is important to consider the
client’s age, severity of illness, and level of activity.
Room temperature
 People who are very young, very old, or acutely ill frequently need a room temperature
higher than normal. A room temperature between 20 0C (68 0F and 74 0F) is comfortable
for most clients.
Ventilation
 Good ventilation is important to remove unpleasant odors and stale air. Odors caused by
urine, draining wounds, or vomitus, for example, can be offensive to people. Room
deodorizers can help eliminate odors. However, good hygienic practices are the best
way to prevent offensive body and breath odors. Hospitals prohibit smoking in client
rooms, and many prohibit smoking throughout the entire hospital.
Noise
 Hospital environments can be
quite noisy, and special care
needs to be taken to reduce
noise in the hallways and
nursing care units.
Environmental distractions
such as environmental noises
and staff communication noise
are particularly troublesome for
hospitalized clients.
 For example, increased noise
has been linked to stress
reaction, sleep disturbance,
and increased perception of pain, and also has been demonstrated to delay wound
healing (Mazer, 2012). Environmental noises include the sound of paging systems,
telephones, and call lights; doors closing; elevator chimes; industrial floor cleaners; and
carts being wheeled through corridors.

 Staff communication is a major source of noise, particularly at staff change of shift in the
morning when staff conversations and many of the environment noises occur
simultaneously. It is important for nurses to raise their awareness of noise on their units
and intervene to find solutions.

 Some hospitals have instituted “quiet times” in the afternoon on nursing units where
“quiet” signs are placed around the unit, the lights lowered, and activity and noise
purposefully decreased so clients can rest or nap. The “quiet times” are in the afternoon
because many of the required activities for client care take place in the morning.

Footboard or Foot boot

These are used to support the immobilized client’s foot in a normal right angle to the legs to
prevent plantar flexion contractures.

Mattresses
 Mattresses are usually covered with a water- repellant material that resists soiling and
can be cleaned easily. Most mattresses have handles on the sides called lugs by which
the mattress can be moved.
 Many special mattresses are also used in hospitals to relieve pressure on the body’s
bony prominences, such as the heels. They are particularly helpful for clients confined to
bed for a long time.
Side Rails
 Side rails, also referred to as bed rails, are used on
both hospital beds and stretchers. They are of
various shapes and sizes and are usually made of
metal. A bed can have two full- length side rails or
four half- or quarter- length side rails (also called split
rails). Some side rails have two positions: up and
own. Others have three: high, intermediate, and low.
Devices to raise and lower side rails differ. Often one
or two knobs are pulled to release the side and permit it to be moved. When side rails
are being used, it is important that the nurse never leave the bedside while the rail is
lowered.

 For decades, the use of side rails has been routine practice with the rationale that the
side rails serve as a safe and effective means of preventing clients from falling out of
bed.
 In addition to falls because of raised side rails, side rail entrapment can occur. Client
entrapment occurs when a client gets caught or entangled in the openings or gaps
around the hospital bed- this usually involves a side rail. Clients at high risk for
entrapment include older or frail adults and clients who are agitated, delirious, confused,
and hypoxic.

 Intravenous Rods
 Intravenous rods (poles, stands,
standards), usually made of metal, support
IV infusion containers while fluid is being
administered to a client. These rods were
traditionally freestanding on the floor
beside the bed. Now, IV rods are often
attached to the hospital beds. Some
hospital units have overhead hanging rods
on a track for IVs.

Hospital Beds
A hospital bed is the piece of equipment most frequently used by the hospitalized patient.
Hospital beds are also found in long- term care facilities, as well as patient’s homes. The ideal
hospital bed should be selected for its impact on patient’s comfort, safety, medical condition and
ability to change positions.

Definition:
o The technique of preparing different types of patient’s comfortable bed in his/ her
suitable position for a particular condition.
o It is the process of making neat and clean bed for the client in hospital.
o Stripping the bed: removal of used linen and the airing of the mattress.

Purpose:
1. To provide clean, safe and comfortable rest and sleep.
2. To reduce the risk of infection by maintaining a clean environment.
3. To prevent bed sores by ensuring there are no wrinkles to cause pressure points.
4. To economize time, material and energy.
5. To observe patient and to prevent complications.
Principles:
1. Barrier nursing to prevent cross infection
Microorganisms are found everywhere on the skin, on the articles used by the patient
and in the environment. The nurses take care to prevent the transference of
microorganisms from the source to the new host by direct or indirect contact or prevent
the multiplications of microorganisms.
2. A safe and comfortable bed will ensure rest, sleep and prevent several complications in
bed ridden patients. E.g., bed sore, foot drop, etc.
3. Good body mechanics maintains the body alignment and prevent fatigue.
4. Systemic ways of functioning save time, energy, and material.
5. Make all beds in a nursing unit alike for uniformity of appearance.
Principles of Body Mechanics
1. Maintain good body alignment.
2. Use the large muscles of the body rather than the small muscles.
3. Work smooth and rhythmically.
4. Push or pull rather than lift because it requires less effort.
5. Using your own weight to counteract the weight of an object decreases the effort and
strain.
Universal Guidelines for Bed Making:

 Wash hand thoroughly before and after handling clients bed linen which helps to control
nosocomial infection.
 Gather all the required linen and accessories before making the bed.
 Avoid shaking the linen to prevent the spread of microorganisms and dust particles.
  Avoid placing linens clean or dirty on another patient’s bed.
 Don’t place dirty linen on floor instead put in linen bag.
 Do not hold linen against your uniform.
 Always use good body mechanics.
 Stay on one side of the bed until it is completely made.
 Observe the patient and document any nursing observations made.
 Move any furniture away from the bed to provide ample working space.
General Principles
 The patient’s privacy, comfort, and safety are all important when making a bed.
 Using side rails to aid positioning and turning, keeping call lights within the patient’s
reach and maintaining the proper bed position help promote comfort and safety.
 After making a bed, return it to the lowest horizontal position and verify that the wheels
are locked to prevent accidental falls when the patient gets in and out alone.
 When possible, make the bed while it is un occupied. Use judgment to determine the
best time for the patient to sit up in a chair so you can make the bed, follow the same
basic principles as for occupied bed making.

Kinds of linens:
a. Blanket- a large piece of cloth often soft, woolen and is used for warmth as a bed cover.
b. Top sheet: used to cover the patient to provide warmth, made of thick cotton, thermal
material.
c. Cotton draw sheet- a piece of cloth spread over the rubber sheet and is used to absorb
moisture.
d. Bottom sheet- used to cover the bed after mattress cover.
e. Rubber sheet/ Mackintosh- used to protect the bottom sheet from soiling due to patient
secretions and prevent the patients from getting bedsore. It usually placed over the
center of the bottom sheet.
Common types of bed:
a. Occupied Bed- Is made when
the patient is not able or not
permitted to get out of the bed.
Or when patient is already
occupied in the bed.
Purposes:
-To make a bed with least
possible discomfort to the
patient.
-To handle the bed clothes
skillfully while the patient is on
bed, giving least disturbance to
the occupant.
-to provide a neat, clean and tidy appearance.
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:

1. Open bed: the top covers are folded back so the patient can easily get back into bed
and is prepared for ambulatory patients.

2. 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. Also called admission bed.
Purposes:
-To welcome a patient.
-to keep the bed ready for occupancy.
-To provide a neat and tidy appearance to the unit.

3. Post- operative bed: known as recovery bed or anaesthetic or surgical bed, and
used for patient with large cast or other
circumstance that would make it difficult for
him to transfer and make it easy to receive
patient into bed from OT.
Purposes:
-To receive the pt. conveniently.
-To provide warmth and comfort.
-To prevent shock.
-To prevent injury.
-To prevent soiling of the bed.
-To meet any emergency.

4. Amputation or Divided bed: This is a bed that is prepared for a patient having
amputated limb.
 Purposes:
-To watch the stump for hemorrhage and
apply tourniquet instantly.
-To take the weight of the bed clothes off
the patient.
-To keep the stump in position.

5. Fracture bed: This is a hard firm bed designed for patient with fracture particularly of
spine, pelvis or femur, bone diseases and
deformity.
Purposes:
-To prevent undue sagging of
mattress
-To immobilize the fractured part.
-To restrict sudden jerky
movements
-To keep the traction in position.

6. Cardiac bed: this is prepared for patient with

breathing difficult and make use of cardiac table to
relive their dyspnea.

7. Therapeutic bed: are used to treat clients with severe

joint contractures, prolonged immobility, or skin wounds
such as pressure ulcers or severe burns. These bed
reduce or relieve the effects of pressure against the skin
through various mechanisms. Few examples are blanket
bed or rheumatic/renal bed, burn bed and also it is used to
induced sweating.

Commonly Used Bed Positions

Flat Mattress is completely horizontal. Client sleeping in a variety of bed positions,

such as back- lying, side- lying, and prone
(face down)
To maintain spinal alignment for clients with
spinal injuries
To assist clients to move and turn in bed
Bed- making by nurse
Fowler’s position Semi- sitting position in which head of Convenient for eating, reading, visiting,
bed is raised to an angle between 450 watching TV
and 600, typically at 450. Knees may Relief from lying positions
be flexed or horizontal. To promote lung expansion for client with
 respiratory problem
To assist a client to a sitting position on the
edge of the bed
Semi- Fowler’s position Head of bed is raised between 150 Relief from lying position
and 450 typically at 300. To promote lung expansion
Trendelenburg’s position Head of bed is lowered and the foot To promote venous circulation in certain
raised in straight incline. clients
To provide postural drainage of basal lung
lobes
Reverse Trendelenburg’s Head of bed raised and the foot To promote stomach emptying and prevent
position lowered. esophageal reflux in client with hiatal hernia
Straight tilt in direction opposite to
Trendelenburg’s position.

Making Beds
Nurses need to be able to prepare hospital beds in different ways for specific purposes. In most
instances, beds are made after the client receives hygienic care and when beds are
unoccupied. At times, however, nurses need to make an occupied bed or prepare a bed for a
client who is having surgery (an anesthetic, postoperative, or surgical bed). Regardless of what
type of bed equipment is available, whether the bed is occupied or unoccupied, or the purpose
for which the bed is being prepared, certain practice guidelines pertain to all bed- making.

I. Changing an Unoccupied Bed

An Unoccupied bed is one that is made for an ambulatory patient. The open bed has the linens
folded down, making it easier for the client to get into bed. Open a bed for a new client or leave
it open when the client is out of bed for a short period of time.
Beds are often changed after baths. The replacement clean linen can be collected before the
bath. The linen is not usually changed unless it is soiled. Check the policy at each clinical
agency. Unfitted sheets, blankets, and bedsheets are mitered at the corners of the bed.
Purpose of mitering is to secure the bedclothes while the bed is occupied.
Purposes

 To promote the client’s comfort

 To provide a clean, neat environment for the client
 To provide a smooth, wrinkle- free bed foundation, thus minimizing sources of skin
irritation
Equipment
Clean gloves, if needed Two flat sheets or one fitted and one flat sheet
Cloth drawsheet (optional) One blanket
One bedspread Incontinent pads (optional)
Pillow case/s for the head pillow/s
Plastic laundry bag or portable linen hamper, if available
Assessment

 Client’s health status to determine that the person can safely get out of bed. In some
hospitals it is necessary to have a written order to get out of bed if the client has been in
bed continuously.
 Client’s bp, pulse and respirations if indicated. Rationale: Client may experience postural
hypotension when moved from a lying position to standing to sitting, particularly if it is
the first time out of bed for awhile.
 Client’s mobility status. Rationale: This may influence the need for additional assistance
with transferring the client from the bed to a chair.
 Tubes and equipment connected to the client. Rationale: This may influence the need for
additional linens or waterproof pads.

Preparation
Determine what linens the client may already have in the room. Rationale: This avoids
stockpiling of unnecessary extra linens.
Mitering of bed linen
- is a practice made popular in hosp. settings for neatness, for the comfort of patients.
- It is a technique that creates a sharp, smooth corner on the bed, where normally wrinkles
would be left by non- fitted sheets.
 CHECKLIST FOR MAKING UNOCCUPIED BED

Steps Rationale

1. Silently recite the prayer for the success of the

procedure.
2. Bring a laundry hamper and clean chair to the bedside.
3. Place the bed in the high position and drop the bedside
rails.
4. Remove equipment attached to bed lines, and check for
personal items the patient may have dropped in the bed
such as watch or dentures.
5. Starting at the head of the far side of the bed, loosen all
linen while moving around the bed and to the head on
the near side.
6. Remove pillow cases by slipping them off while the
pillows lie on the bed.
7. Fold reusable linens, such as blankets, in place on the
bed in fourths, and hang them over a clean chair.
8. Snugly roll all of the soiled linen inside of the bottom
sheet and place them directly into the laundry humper.
Do not place them on the floor or on the furniture.
9. Bring necessary clean linens to the bedside.
10. Place linens on clean chair or on the over bed table in
the same order in which they were placed on bed.
11. Place the mattress pad on the bed in position so that it is
unfolded, it will be in proper place.
12. Place the bottom sheet with its center fold in the center of
the bed and high enough to have a sufficient amount of
the sheet to tuck under the head of the mattress.
13. Place the water proof sheet over the bottom sheet so that
it will be under the client’s chest to knee area. Place the
cotton draw sheet in the same manner over the water
 proof draw sheet.
14. Tuck the bottom sheet securely under the head of the
mattress on one side of the bed. Create a mitered corner.
Tuck the remaining bottom linens securely on the same
side. Move to the other side of the bed to tuck in the
bottom linens on that side.
15. When pulling bottom sheets tightly, hold the hands with
the palms downward so that pull is produced by the arms
and shoulder muscles, spread feet as though to walk
backward, and rock back so that the weight of your body
helps produce the force needed. Do the same for
securing the draw sheets.
16. Place the top sheet on the bed with its centerfold in the
center of the bed and with the top of the sheet placed so
that the hem is even with the head of the mattress.
Unfold the top sheet in place.
17. Make a foe pleat by making a small diagonal or vertical
fold in the top sheet near the bottom of the bed.
18. Tuck top linens securely at the foot of the mattress.
19. Turn the spread down from the top, and fold it under the
top edge of the blanket. Turn the top sheet down over the
spread.
20. Place the pillow on the bed. Open each pillow case and
slip the case over the pillow.
21. Place pillows in place at the head of the bed.
22. Fan- fold or pre-fold top lines.
23. Adjust the bed to the low position.
24. Discard dirty linen in linen hamper.
25. Wash hands.

Evaluation

 Make sure the call light is accessible to the client.

 Relate client parameters of activity (e.g., pulse and respirations) to previous assessment
data particularly if the client has been on bed rest for an extended period of time or if it is
the first time that the client is getting out of bed after surgery.
 Observe client’s linens for cleanliness and tightness.

II. Changing an Occupied Bed

Some clients may be too weak to get out of bed. Either the nature of their illness may
contraindicate their sitting out of bed, or they may be restricted in bed by the presence of
traction or other therapies. When changing an occupied bed, the nurse works quickly and
disturbs the client as little as possible to conserve the client’s energy, using the following
guidelines:

 Maintain the client in good body alignment. Never move or position a client in a manner
that is contraindicated by the client’s health. Obtain help if necessary to ensure safety.
  Move the client gently and smoothly. Rough handling can cause the client discomfort
and abrade skin.
 Explain what you plan to do throughout the procedure before you do it. Use terms that
the client can understand. Encourage client participation when appropriate.
 Use the bed- making time, like the bed bath time, to assess and meet the client’s needs.
Purposes:

 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

 Assess skin condition and need for special mattress (e.g., an egg- crate mattress),
footboard, or heel protectors.
 Assess client’s ability to reposition self. Rationale: This will determine if additional
assistance is needed.
 Determine presence of incontinence or excessive drainage from other sources indicating
the need for protective waterproof pads.
 Note specific orders or precautions for moving and positioning the client.
 CHECKLIST FOR MAKING AN OCCUPIED BED

Steps Rationale

1. Silently recite the prayer for the success of the procedure.

2. Determine if client is incontinent or has excess drainage on
bed linen.
3. Check chart for orders or specific precautions for
movement and positioning of client.
4. Explain procedure to client.
5. Prepare needed equipment and supplies.
6. Wash hands.
7. Assemble and arrange equipment on bedside chair or
table.
8. Provide privacy.
9. Lower side rail on near side of bed. Remove call light.
10. Adjust bed height to comfortable working position.
11. Loosen top linen sheet at foot of bed.
12. Remove bedspread and blanket separately by folding them
into squares and placing them in linen bag (if not to be
reused). Do not allow linen to contact uniform. Do not fan
or shake linen.
13. Fold blanket and spread if they will be reused. Fold them
into neat squares and place them over back of chair.
14. Cover client with bath blanket in following manner. Unfold
bath blanket over top sheet. Ask client to hold top edge of
bath blanket, or tuck top of bath blanket at client’s
shoulders. Grasp top sheet under bath blanket at client’s
shoulders, and bring sheet down to foot of bed. Remove
sheet and discard it in linen bag.
15. With assistance, slide mattress toward head of bed.
16. Position client on his or her side on the far side of the bed,
facing away. Adjust pillow under client’s head, and raise
farthest side rail.
17. Loosen bottom bed linens, moving from head to foot of
bed.
18. Fanfold first drawsheet and then bottom sheet toward
client. Tuck edges of linen just under client’s buttocks,
back, and shoulders.
19. Wipe off moisture on mattress with towel and appropriate
disinfectant.
20. Apply clean linen to exposed half of bed: Place clean
mattress pad on bed by folding it lengthwise with center
crease in middle of bed. Fanfold top layer over mattress.
21. Unfold bottom sheet lengthwise so center crease is
situated lengthwise along center of bed. Fanfold sheet’s
top layer toward center of bed alongside client. Smooth
bottom layer of sheet over mattress, near side. Allow
sheet’s edge to hang about 25 cm over mattress edge.
Lower hem of bottom sheet should lie seam down and
 even with bottom edge of mattress.
22. Miter bottom sheet of bed: face head of bed diagonally.
Place hand away from head of bed under top cover of
mattress, near mattress edge, and lift.
23. Tuck top edge of bottom sheet smoothly under mattress.
24. Face side of bed and pick up top edge of sheet at
approximately 45 cm down from top of mattress.
25. Lift sheet and lay it on top of mattress to form neat
triangular fold, with lower base of triangle even with
mattress side edge.
26. Tuck lower edge of sheet, which is hanging free below
mattress, under mattress. Tuck with palms down without
pulling triangular fold.
27. Hold portion of sheet covering side edge of mattress in
place with one hand. Pick up top of triangular linen fold and
bring it down over side of mattress. Tuck this portion of
sheet under mattress.
28. Tuck remaining portion of sheet under mattress, moving
toward foot of bed. Keep linen smooth.
29. Open drawsheet so it unfolds in half. Lay center fold along
middle of bed lengthwise , and position sheet so it will be
under client’s buttocks and torso. Fanfold top layer toward
client with edge alongside client’s back. Smooth bottom
layer out over mattress and tuck excess edge under
mattress.
30. Place water proof pad under drawsheet with center fold
against client’s side. Fanfold far half toward client.
31. Raise side rail on working side of bed and go to other side.
32. Lower side rail. Assist client to roll slowly onto other side,
onto the folds of linen.
33. Loosen edges of soiled linen from underneath mattress.
34. Remove soiled linen by folding into a bundle or squares,
with soiled side turned in. Discard in linen bag.
35. Spread clean, fanfolded linen smoothly over edge of
mattress from head to foot of bed.
36. Assist client in rolling back into supine position. Reposition
pillow.
37. Miter top corner of bottom sheet.
38. When tucking corner, be sure sheet is smooth and free of
wrinkles.
39. Grasp remaining edge of bottom sheet. Keep back straight
and pull as excess linen is tucked under mattress. Proceed
from head to foot of bed.
40. Smooth fanfolded drawsheet over bottom sheet. Grasp
edge of sheet with palms down, lean back, and tuck sheet
under mattress. Tuck from middle to top and to bottom.
41. Place top sheet over client, with centerfold lengthwise
down middle of bed. Open sheet from head to foot, and
unfold it over client.
42. Ask client to hold clean top sheet , or tuck sheet around
 client’s shoulders. Remove bath blanket and discard in
linen bag.
43. Place blanket on bed, unfolding it so that crease runs
lengthwise along middle of bed. Unfold blanket to cover
client. Top edge of blanket should be parallel with edge of
topsheet and 15 to 20 cm down from top sheet’s edge.
44. Place spread over bed according to step 31. Be sure top
edge of spread extends about 2.5 cm above blanket’s
edge. Tuck top edge of spread over and under top edge of
blanket.
45. Make cuff by turning edge of topsheet down over edge of
blanket and spread.
46. Lift mattress corner slightly with one hand and tuck top
linens under mattress. Topsheet and blanket are tucked
under together. Allow for movement of client’s feet.
47. Make modified mitered corner with top sheet, blanket, and
spread.
48. Pick up side edge of top sheet, blanket, and spread
approximately 45 cm up from foot of mattress. Lift linens to
form triangular fold, and lay it on bed.
49. Tuck lower edge of sheet, which is hanging free below
mattress, under mattress. Do not pull triangular fold.
50. Pick up triangular fold and bring it down- over mattress
while holding linen in place along side of mattress. Do not
tuck up tip of triangle.
51. Raise side rail. Make other side of bed. Spread sheet,
blanket, and bedspread out evenly. Fold top edge of
spread over blanket, and make cuff with top sheet. Make
modified corner at foot of bed.
52. Change pillowcase: Have client raise head. Remove pillow
while supporting client’s head.
53. Remove client’s pillow case and discard it in linen bag.
54. Grasp clean pillowcase at center of closed end. Gather
case, turning it inside out over hand holding it. Pick up
middle of one end of pillow. Pull pillowcase down with other
hand.
55. Fit pillow corners evenly in corners of pillowcase.
56. Support client’s head under neck and place pillow under
head.
57. Place call light within client’s reach. Return bed to
comfortable position.
58. Open room curtains. Rearrange furniture.Place personal
items easily within client’s reach on overbed table or
bedside stand. Return bed to comfortable height.
59. Discard dirty linen in linen humper.
60. Wash hands.

Evaluation
 Conduct appropriate follow- up, such as determining client’s comfort and safety, patency
of all drainage tubes, and client’s access to call light to summon help when needed.
 Reassess all tubing, oxygen apparatus, IV pumps, and so forth. Rationale: This prevents
errors in supportive devices resulting from procedure.
 Ask if client is comfortable after bed is made
 Observe client’s skin for signs of irritation.