CALAMBA DOCTORS’ COLLEGE

Bachelor of Science in Nursing

Name: __________________________ Date:______________ Score: __________

BED MAKING GUIDELINES

MAKING AN OCCUPIED BED

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 a special mattress (e.g., an egg-crate mattress), footboard, bed
cradle, or heel protectors.
 Client’s ability to reposition self. This will determine if additional assistance is needed.
 Assess the potential for patient incontinence or excess drainage on bed linen. Determines the
need for protective waterproof pads or extra bath blankets on the bed and whether gloves are likely
needed for the procedure.
 Check chart for orders or specific precautions concerning movement and positioning. Ensures
patient safety and use of proper body mechanics

PLANNING
DELEGATION CONSIDERATIONS
The skill of making an occupied bed can be delegated to nursing assistive personnel (NAP). The nurse
reviews any precautions or activity restrictions. Instruct the NAP about:
• Any activity or positioning restrictions for the patient.
• Looking for wound drainage, dressing materials, drainage tubes, or intravenous (IV) tubing that
becomes dislodged or is found in the linens.
• What to do if the patient becomes fatigued.

EQUIPMENT
 Linen bag,
 Mattress pad (optional depending on facility practice; needs to be changed only when soiled),
 Bottom sheet (flat or fitted),
 Drawsheet,
 Top sheet,
  Blanket (optional depending on patient preference),
 Bedspread,
 Waterproof pads and/or bath blankets (optional),
 Pillowcases,
 Bedside chair or table,
 Clean gloves (optional),
 Towel, and
 Disinfectant

IMPLEMENTATION
Preparation
Determine what linens the client may already have in the room to avoid stockpiling of unnecessary extra
linens.

STEPS/RATIONALE 1 2 3 4
1. Prior to performing the procedure introduce yourself and verify the
client’s identity using agency protocol.

2. Explain the procedure to the patient, including that he or she will be

asked to turn on the side and rollover linen.
Minimizes anxiety and promotes cooperation.

3. Gather needed supplies, being sure to not let clean linen touch your
uniform.
Securing needed supplies ensures that the procedure can be implemented
without interruption. Uniform is less clean than clean linen.

4. Perform hand hygiene and apply clean gloves (wear gloves only if old
linen is soiled or there is a risk of contact with body secretions).
Reduces transmission of microorganisms.

5. Arrange equipment on the bedside chair or over-bed table. Remove

unnecessary equipment such as a dietary tray or items used for
hygiene.
Organizing equipment provides for smooth procedures and assists in
increasing patient comfort. Placing linen on a clean surface minimizes the
spread of infection.

6. Pull the room curtain around the bed and/or close the door.
Maintains patient privacy.

7. Adjust bed height to a comfortable working position with bed flat if

the patient can tolerate it. Lower raised side rail on one side of the
bed. Remove call light.
Minimizes strain on the back. It is easier to remove and apply linen evenly to
the bed in the flat position. Provides easy access to bed and linen. If the
patient has trouble breathing, leave the head of the bed elevated to the
comfort level.

8. Remove any equipment attached to the bed linen, such as a signal

 light.

9. Loosen top linen at foot of the bed.

Makes linen easier to remove.

10. Remove bedspread and blanket separately. If the spread and blanket
are soiled, place them in a linen bag. Keep soiled linen away from the
uniform.
Reduces transmission of microorganisms.

11. If blanket and spread are to be reused, fold them by bringing the top
and bottom edges together. Fold the farthest side over onto the
nearer bottom edge. Bring the top and bottom edges together again.
Place folded linen over the back of the chair.
The folding method facilitates replacement and minimizes wrinkles.

12. Cover the patient with a bath blanket in the following manner:
unfold the bath blanket over the top sheet. Ask the patient to hold
the top edge of the bath blanket. If the patient is unable to help, tuck
the top of the bath blanket under the shoulders. Grasp top sheet
under bath blanket at patient’s shoulders and bring sheet down to
the foot of the bed. Remove the sheet and discard it in a linen bag.
A bath blanket provides warmth and keeps body parts covered during linen
removal.

13. With assistance from 1 or 2 other care providers, slide the mattress
toward the head of the bed if needed.
If the mattress slides toward the foot of the bed when the head of the bed is
raised, it is difficult to tuck in linen. In addition, it is uncomfortable for the
patient because his or her feet may be pressed against or hang over the foot
of the bed.

14. Position the patient on the far side of the bed, turned onto the side,
and face away from you. Be sure that the side rail in front of the
patient is up. Adjust pillow under patient’s head.
Turning the patient onto the side provides space for the placement of clean
linen. Side rail ensures patient’s safety from forwarding falls from bed
surface and helps patient in moving.

15. Loosen bottom linens, moving from head to foot. With seam side
down (facing the mattress), fanfold bottom sheet and drawsheet
toward patient—first drawsheet, then a bottom sheet. Tuck edges of
linen just under buttocks, back, and shoulders. Do not fanfold the
mattress pad if it is to be reused.
Prepares for removal of all bottom linen simultaneously. Provides a
maximum workspace for placing clean linen. Later, when the patient turns
to the other side, you can remove soiled linen easily

16. Wipe off any moisture on the exposed mattress with a towel and
appropriate disinfectant. Make sure that the mattress surface is dry
before applying linens.
Reduces transmission of microorganisms.
17. Apply clean linen to the exposed half of the bed:
a. Place a clean mattress pad on the bed (if used) by folding it
lengthwise with a center crease in the middle of the bed. Fanfold the
top layer over the mattress. (If the pad is reused, simply smooth out
any wrinkles.)
Applying linen over the bed in successive layers minimizes energy and time
used in bed making.

b. If using a flat sheet for the bottom sheet, unfold the sheet
lengthwise so the center crease is situated lengthwise along the
center of the bed. The fanfold the top layer of the sheet toward the
center of the bed alongside the patient. The smooth bottom layer of
the sheet over the mattress brings an edge over the closest side of
the mattress. If using a fitted sheet, pull the sheet smoothly over the
mattress ends. Allow the edge of the flat unfitted sheet to hang about
25 cm (10 inches) over the mattress edge. Make sure that the lower
hem of the bottom flat sheet lies seam down and even with the
bottom edge of the mattress.
Proper positioning of linen on one side ensures that adequate linen is
available to cover the opposite side of the bed. Keeping seam edges down
eliminates irritation to the patient’s skin.

18. If the flat sheet is used for the bottom sheet, miter the bottom flat
sheet at the head of the bed: Ensures that a secure flat sheet does
not loosen easily.
a. Face head of bed diagonally. Place hand away from the head of the
bed under the top corner of the mattress, near the mattress edge,
and lift.

b. With the other hand tuck the top edge of the bottom sheet
smoothly under the mattress so the side edges of the sheet above
and below the mattress meet when brought together.

c. Face the side of the bed and pick up the top edge of the sheet at
approximately 45 cm (18 inches) from the top of the mattress.

d. Lift the sheet and lay it on top of the mattress to form a neat
triangular fold, with a lower base of the triangle even with the
mattress side edge.

e. Tuck the lower edge of the sheet, which is hanging free below the
mattress, under the mattress. Tuck with palms down without pulling
the triangular fold.

f. Hold a portion of the sheet covering the side of the mattress in

place with one hand. On the other hand, pick up the top of the
triangular linenfold and bring it down over the side of the mattress.
Tuck this portion under the mattress. A mitered corner cannot be
loosened easily even if the patient frequently moves in bed.
19. Tuck the remaining portion of the sheet under the mattress, moving
toward the foot of the bed. Keep linen smooth.
Folds of linen are a source of irritation.

20. (Optional) Open the clean drawsheet so it unfolds in half. Lay

centerfold along the middle of the bed lengthwise and position the
sheet so it is under the patient’s buttocks and torso. Fanfold the top
layer toward the patient with the edge along the patient’s back.
Smooth the bottom layer out over the mattress and tuck the excess
edge under the mattress (keep palms down).
Drawsheet is used to lift and reposition the patient. Placement under the
patient’s torso distributes most of the patient’s body weight over the sheet.

21. Place the waterproof pad over the drawsheet, (optional) with a
centerfold against the patient’s side. Fanfold the top layer toward
the patient.
Protects bed linen from being soiled.

22. Advise the patient that rolling over a thick layer of linens is
necessary and that he or she will feel a lump. Have the patient roll
slowly toward you over the layers of linen. Raise the side rail on the
working side before going to the other side of the bed.
Positions patient for removal and placement of linens. Maintains patient
safety.

23. Lower side rail. Assist patient in positioning on another side as

needed. Loosen edges of soiled linen from under the mattress.
Ensures patient comfort. Exposes opposite side of the bed for removal of
soiled linen and placement of clean linen. Makes linen easier to remove.

24. Remove soiled linen by folding it into a bundle or square with the
soiled side turned in. Discard in a linen bag. If necessary, wipe the
mattress with an antiseptic solution and dry the mattress surface
before applying new linen.
Reduces transmission of microorganisms.

25. Pull clean, fan-folded linen smoothly over the edge of the mattress
from head to foot of the bed.
Smooth linen does not irritate a patient’s skin.

26. Help the patient roll back into a supine position. Reposition pillow.
Maintains patient’s comfort.

27. Pull fitted sheet smoothly over mattress ends. Miter the top corner
of the bottom sheet. When tucking the corner, be sure that the
sheet is smooth and free of wrinkles. Wrinkles and folds cause
irritation to the skin.

28. Facing the side of the bed, grasp the remaining edge of the bottom
flat sheet. Lean back, keep back straight, and pull while tucking
excess linen under the mattress. Proceed from head to foot of the
bed. (Avoid lifting mattress during tucking to ensure fit.)
 Proper use of body mechanics while tucking linen prevents injury.

29. Smooth fan-folded drawsheet out over the bottom sheet. Grasp the
edge of the sheet with palms down, lean back, and tuck the sheet
under the mattress. Tuck from middle to top and then to bottom.
Tucking first at the top or bottom pulls the sheet sideways, causing a poor
fit.

30. Place the top sheet over a patient with a centerfold lengthwise
down the middle of the bed. Open sheet from head to foot and
unfold over the patient.
Correctly positioning the centerfold ensures that the sheet is equally
distributed over the bed.

31. Ask the patient to hold a clean top sheet or tuck sheet around his or
her shoulders. Remove bath blanket and discard in a linen bag.
The sheet prevents exposure to body parts. Having a patient hold sheet
encourages patient participation in care.

32. Place a blanket on the bed, unfolding it so the crease runs

lengthwise along the middle of the bed. Unfold blanket to cover
patient. Make sure that the top edge is parallel with the edge of the
top sheet and 15 to 20 cm (6 to 8 inches) from the edge of the top
sheet.
A blanket covers the patient completely and provides adequate warmth.

33. Place spread over the bed. Be sure that the top edge of the spread
extends about 2.5 cm (1 inch) above the edge of the blanket. Tuck the
top edge of spread over and under the top edge of the blanket.
Gives the bed a neat appearance and provides extra warmth.

34. Make a cuff by turning the edge of the top sheet down over the top
edge of the blanket and spread. Protects patient’s face from rubbing
against blanket or spread.
35. Standing on one side at foot of the bed, lift the mattress corner
slightly with one hand and tuck linens under the mattress. The top
sheet and blanket are tucked together. Be sure that linens are loose
enough to allow movement of the patient’s feet. Making a horizontal
toe pleat is an option.
Makes a neat-appearing bed. Pressure ulcers develop on the patient’s toes
and heels from feet rubbing against tight-fitting bed sheets.

36. Make a modified mitered corner with a top sheet, blanket, and
spread.
Ensures that top covers do not loosen easily.

a. Pick the upside edge of a top sheet, blanket, and spread

approximately 45 cm (18 inches) from the foot of the mattress. Lift
linen to form a triangular fold and lay it on the bed.

b. Tuck the lower edge of the sheet, which is hanging free below the
mattress, under the mattress. Do not pull the triangular fold.
 c. Pick up a triangular fold and bring it down over the mattress while
holding linen in place alongside the mattress. Do not tuck the tip of
the triangle.
Secures top linen but keeps even edge of the blanket and top sheet draped
over the mattress.

37. Raise side rail. Make another side of the bed; spreadsheet, blanket,
and bedspread out evenly. Fold the top edge of the spree spread-
over blanket and make a cuff with the top sheet; make a modified
mitered corner at foot of the bed.
Correct use of side rails aids patient’s movement in bed.

38. Change pillowcase:

a. Have the patient raise their head. While supporting the neck with
one hand, remove the pillow. Allow patient to lower head.
Support of neck muscles prevents injury during flexion and extension of the
neck.

b. Remove the soiled case by grasping the pillow at the open end
with one hand and pulling the case back over the pillow with
another hand. Discard the case in a linen bag.
Pillows slide out easily, thus minimizing contact with soiled linen.

c. Grasp clean pillowcase at the center of closed-end. Gather the

case, turning it inside out over the hand holding it. With the same
hand pick up the middle of one end of the pillow. Pull pillowcase
down over pillow with another hand.
Eases sliding of pillowcase over the pillow.

d. Be sure that pillow corners fit evenly into the corners of the
pillowcase. Place a pillow under the patient’s head.
Poorly fitting case constricts fluffing and expansion of pillow and interferes
with patient comfort.

39. Place call light within patient’s reach and return bed to comfortable
position and height.
Ensures patient safety and comfort.
40. Open room curtains and rearrange the furniture. Place personal
items within easy reach on an over-bed table or bedside stand.
Promotes a sense of well-being.

41. Place dirty linen in hamper or chute. Remove gloves (if worn);
dispose of and perform hand hygiene.
Prevents the transmission of microorganisms.

EVALUATION

 Ask if the patient feels comfortable. Ensures that bed linens are smooth and the patient is
positioned comfortably.
  Inspect the skin for areas of irritation. Folds or creases in linen cause pressure on the skin.
 Assess the patient for signs and symptoms of fatigue, dyspnea, pain, or discomfort. Provides you
with data about the patient’s level of activity tolerance and ability to participate in other
procedures.
 Reassess all tubing, oxygen apparatus, IV pumps, and so forth. Rationale: This prevents errors in
supportive devices resulting from the procedure.

UNEXPECTED OUTCOMES AND RELATED INTERVENTIONS

 Patient feels discomfort from linenfold.

• Tighten sheets.
• Change patient’s position frequently.
 Patient’s skin shows signs of breakdown.
 Institute skin care measures to reduce the risk of pressure ulcers.
 Change patient’s position more frequently.

RECORDING AND REPORTING

• Making an occupied bed does not need to be recorded

Remarks:

Signature over printed name

CLINICAL INSTRUCTOR STUDENT