carmiPORTAJADAejercito LPT RM RN MAN

Nursing Process Data

 Assessment: Data Base
 Assess the patient’s need to have linen changed.
 Determine if the patient’s condition will permit a
change of bed linen.
 Determine how many and what types of linens will
be required.
 Check patient’s unit for available linens.
 Determine patient’s prescribed level of activity and
any special precautions in movement.
 Assess patient’s ability to get out of bed during linen
change.

CARMI B PORTAJADA RN RM (bedmaking) 2

Nursing Process Data
 Planning: Objectives
 To provide a clean, comfortable sleeping and resting
environment for the patient.
 To eliminate irritants to skin by providing wrinkle-free
sheets and blankets.
 To avoid patient exertion while making bed while
occupied. (Do not move more than necessary.)
 To enhance patient’s self-image by providing a clean,
neat, and comfortable bed.
 To properly dispose of soiled linens and not promote
cross-contamination.
 To correctly align patients to assist in promoting a
physically and emotionally safe and comfortable position.
 To prevent stress to the nurse’s back or limbs during
procedure.

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Nursing Process Data
 Implementation: Procedures
 Folding a Mitered Corner
 Changing a Pillowcase
 Making an Unoccupied Bed
 Making a Surgical Bed
 Changing an occupied Bed

 Evaluation: Expected Outcomes

 Patient is rested during and after bedmaking procedure.
 Bed remains clean, dry, free of wrinkle or other skin
irritants, and at a comfortable temperature.
 Skin remains free of irritation caused by contact with
linens.
 The nurse feels no stress to back or limbs during the
procedure.
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FOLDING A MITERED CORNER
 Equipment:
 Same as for Unoccupied Bed

 Procedure:
1. Tuck the sheet tightly and smoothly under mattress at
top of the bed.
2. Grasp edge of sheet with hand and bring sheet onto
mattress so that edge forms a right angle.
3. Tuck lower edge of sheet under mattress.
4. Place finger on sheet where it meets mattress and lower
top of sheet over finger.
○ Rationale: This action makes the mitered corner neat
and tight.
5. Remove finger without disturbing folds.
6. Tuck sheet securely under mattress.
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CHANGING A PILLOWCASE
 Equipment:
 Clean pillowcase

 Procedure:
1. Pick up center of closed end pillowcase.
2. Continue to firmly grip end of pillowcase; then with
other hand gather pillowcase from open end and fold
back (inside-out) over closed end.
3. Pick up center of one end of pillow with the hand
holding the gathered pillowcase.
4. Pull pillowcase over pillow with other hand. Do not
place pillow and/or case under arm, chin, or in teeth.
○ Rationale: Contamination occurs from using these methods.
5. Adjust pillow corners in pillowcase by placing hand
between case and pillow.
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MAKING AN UNOCCUPIED BED
 Equipment:
 Chair or table
 Linen hamper
 Linens (in order of use)
○ Bath blanket
○ Mattress pad
○ Bottom sheet
○ Drawsheet
○ Incontinent pad, if needed
○ Top sheet
○ Blanket
○ Bedspread
○ Pillowcase
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MAKING AN UNOCCUPIED BED
 Preparation:
1. Gather linen and hamper and bring to room.
2. Explain need for patient to be out of bed during
procedure.
3. Wash hands.
4. Assist patient out of bed and into chair.
5. Arrange chair and hamper conveniently for use.
6. Wipe chair off before placing linen on chair.
○ Rationale: This action provides a clean surface and
promotes infection control.
7. Place linen on chair.
8. Remove call signal from linen.
9. Adjust bed to a comfortable working height.
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MAKING AN UNOCCUPIED BED
 Procedure:
1. Lower the side rails.
2. Loosen linen on all sides, including head and foot of the bed.
3. Remove spread and blanket. If they are to be reused, fold them and place
on the chair.
4. Remove top, draw, and bottom sheet and place in linen hamper.
○ Rationale: Never place dirty linen on the floor as cross-contamination occurs from this action.
5. Push mattress to the head of bed. Center the mattress if necessary.
6. If mattress pad is not changed, smooth out wrinkles and recenter pad on the
bed surface.
7. Make up one side of the bed, then move to the other side of bed and make
it.
○ Rationale: This step saves time and energy.
8. Place clean bottom sheet on mattress. Place the center fold of the sheet in
the middle of the mattress with the end of the sheet even with the end of the
mattress.
9. Unfold the bottom sheet under the head of the bed.
10. Tuck the top of the sheet under the head of the bed.
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MAKING AN UNOCCUPIED BED
 Procedure:
11. Miter the corner of the bottom sheet at the head of the bed.
○ Rationale: A mitered corner is tighter and less likely to come apart.
12. Tuck the remaining side of the bottom sheet well under the mattress.
13. If the patient needs a drawsheet, center the drawsheet on the
bed and open draw sheet top to opposite side. Tuck the sheet under
the mattress. Smooth out wrinkles.
a. If a pull sheet is needed, fold draw sheet in half or quarters. Position
sheet in middle of bed.
 Rationale: Pull sheets are used with heavy or difficult-to-move patients.
b. If absorbent pad is needed, center it on bed over draw or pull sheet.
14. Move to the other side of the bed. Pull linen toward you and straighten
out linen.
15. Tuck the top of the sheet under the head of the bed.
16. Miter the corner of the bottom sheet at the head of the bed.
17. Tuck the remaining bottom sheet well under the mattress. Gather sheet
into your hand, lean away from the bed, and pull sheet downward. Tuck
sheet under mattress.
18. If drawsheet is used, tighten and tuck the same as bottom sheet.
19. Straighten out absorbent pad and pull sheet if used.
20. Place top sheet, blanket, and spread full length on top of bed.
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MAKING AN UNOCCUPIED BED
 Procedure:
21. Leave a cuff of top sheet and spread at the head of the bed.
22. Tuck sheet, spread and blanket well under foot of mattress,
one side at a time.
23. Miter corners at the foot of the bed, one side at a time.
24. Make a small pleat to allow room for patient’s feet.
25. Fanfold linen to foot of bed.
26. Change pillowcase.
27. Return bed to lowest position. Reattach call signal to linens.
28. Pull side rail up on side furthest from patient.
29. If the unit is unassigned, leave top linen pulled up, covering the
bed.
30. Dispose of soiled laundry.
31. Wash your hands.
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MAKING A SURGICAL BED
 Equipment:
 Same as for Unoccupied Bed

 Procedure:
1. Wash your hands.
2. Bring linens to the room.
3. Arrange chair and linen hamper conveniently for use.
4. Wipe off chair before placing linen on it.
5. Raise bed to highest position.
6. Place the bottom sheet on the bed, using the same method for making an
unoccupied bed.
7. Place a plastic and/or cloth drawsheet and absorbent pad on the bed.
8. Lay top sheet, blanket, and bedspread over top of bed.
9. Fold up linen from foot, head, and one side of the bed toward the center of
the bed.
10. Fold bottom and top edges nearest you to the opposite side, forming a
triangle. Pick up center point of triangle.
11. Fanfold linen to side of the bed.
○ Rationale: Folding linen at side of the bed facilitates moving surgical patients into the bed.
12. Leave bed in HIGH position to facilitate easy transfer of surgical patient from
guerney to bed.
13. Change pillowcase and leave on chair or at foot of bed.
14. Move all objects away from bedside area.
○ Rationale: This allows surgical guerney to be placed close to bed for patient transfer.
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CHANGING AN OCCUPIED BED
 Equipment:
 Chair or table
 Linen hamper
 Linens (in order of use)
○ Bath blanket
○ Mattress pad
○ Bottom sheet
○ Plastic drawsheet, if needed
○ Cloth drawsheet
○ Incontinent pad, if needed
○ Top sheet
○ Blanket
○ Bedspread
○ Pillowcase
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CHANGING AN OCCUPIED BED
 Preparation:
1. Talk with the patient and explain how he can be
involved in the procedure.
2. Explain the sequence for the procedure.
3. Arrange furniture equipment, e.g., linen hamper
and chair for convenience of use.
4. Wipe chair or table before putting linen on it.
5. Wash hands and collect the linen.
6. Place linen on chair or table after wiping it off.
7. Remove call signal from linens.
8. Pull curtain closed to provide privacy for the
patient.
9. Adjust bed to a comfortable working height with
side rails up. Help patient into a supine position.
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CHANGING AN OCCUPIED BED
 Procedure:
1. Lower the side rail on your side of the bed but make sure side rail on
opposite side is in UP position.
2. Loosen top linens.
3. Remove spread, sheet and blanket at the same time the bath blanket is
pulled over patient. If they are to be reused, fold them and place on the
chair.
4. Place top sheet in linen hamper.
5. Push mattress to head of bed. Center the mattress if necessary.
6. Assist patient to the side of the bed, place in side-lying position facing
away from you as near the far side rail as possible.
7. Loosen bottom linens on your side of the bed.
8. Push dirty linen under or as close as possible to patient.
9. If mattress pad is not changed, smooth out wrinkles and recenter pad
on the bed surface.
10. With patient on the opposite side of the bed, place clean bottom sheet
on mattress. Place the center fold of the sheet in the middle of the
mattress with the end of the sheet even with the end of the mattress.
11. Unfold the bottom sheet and cover the mattress. Make sure the clean
bottom sheet is underneath any used linen.
12. Tuck the top of the sheet under the head of the bed.
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CHANGING AN OCCUPIED BED
 Procedure:
13. Miter the corner of the bottom sheet at the head of the bed.
14. Tuck the remaining bottom sheet well under the mattress from head
to foot.
15. Center the plastic and/or cloth drawsheet on the bed, if patient
requires a drawsheet, and fanfold half of the sheet under the patient.
Tuck side of the sheet under the mattress. Smooth out wrinkles.
a. Fold cloth drawsheet in half or quarters if a pull sheet is needed. Position
sheet in middle of bed. Fanfold half of the pull sheet under patient.
b. Fanfold absorbent pad and canter it on bed under patient’s buttocks. Place the
pad close to the patient for ease in pulling it through to the other side of the
bed, absorbent side up and plastic side down.
16. Help the patient roll over to the other side of the bed.
17. Tell the patient why there is a hump of linen in the center of the bed.
Make the patient comfortable.
18. Raise the side rail. Move to other side of bed.
19. Move linens to the other side of the bed, by gently pulling linens
toward you.
20. Lower side rail and loosen bottom sheets.
21. Pull dirty linen to side of bed and roll into a bundle at the foot of the
bed or place linen in linen hamper.
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CHANGING AN OCCUPIED BED
 Procedure:
22. Never place dirty linen on the floor.
○ Rationale: Cross-contamination occurs from this action.
23. Pull clean linen across mattress and straighten under patient.
24. Miter the top corner of the bottom sheet.
25. Gather bottom sheet into your hand, lean away from the bed
and pull linens downward at an angle. Tuck remaining
bottom sheet well under the mattress. If drawsheet is used,
tighten and tuck it in the same way.
26. Help the patient into a supine position and adjust the pillow.
27. Place top sheet, blanket, and spread over the patient. Leave
a 6-inch cuff at the head of the bed.
28. Remove bath blanket and straighten top sheet and blanket.
29. Miter corners at the foot of bed.
30. Pull up all layers of linen at patient’s toes. Make a small pleat
to allow room for patient’s feet.
31. Raise side rail.
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CHANGING AN OCCUPIED BED
 Procedure:
PRINCIPLES OF MEDICAL ASEPSIS
• Place dirty linen in hamper.
• Do not place dirty linen on floor.
• Discard all unused linen from patient area.
• Do not transfer linen from one patient area to another.
• Do not allow dirty linen to touch uniform.

32. Remove pillow from bed and change pillowcase.

33. Return bed to lowest position. Reattach call signal
to linens.
34. Position patient for comfort.
35. Dispose of soiled laundry.
36. Wash your hands.
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CARMI B PORTAJADA RN RM (bedmaking)
CHARTING for Bedmaking
 Specificlinens or equipment that cause
discomfort for the patient.
 Special requirements for linens, e.g.,
certain detergents or elimination of
starch.
 Use of pull sheets, incontinent pads, or
specified ways to keep bed dry.

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CLINICAL PROBLEM SOLVING SKILLS
Potential Problems Suggested Solutions
Patient refuses to have • Assess reason for refusal. Patient may be in pain or does not
bed made. want to be disturbed.
• Offer to make the bed at a later time.
• Change only the pillowcase and drawsheet, if patient allows.
• Beds do not need to be changed unless soiled or damp so
allow patient’s independence if possible.
Cross-contamination • Provide adequate linen hampers for the nursing personnel.
occurs from improper • Attend in-service education programs on infection control.
linen disposal.
Patient’s skin becomes • Obtain hypoallergenic linen.
irritated from linen or • Place sheepskin under patient.
begins to break down. • Use eggcrate ,mattress.
The nurse feels stress on • Make sure bed is positioned for comfort of the nurse.
back during bedmaking • High position is generally used.
• If patient is heavy, ask for assistance with bedmaking,
especially in moving side-to-side.
• Attend in-service classes on “preventing back strain.”
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