Definition
Preparing an occupied bed is a delicate nursing procedure performed while the patient remains in bed, often due to immobility, illness, or post-operative restrictions. The goal is to maintain cleanliness and comfort without compromising the patient’s safety or dignity.
Purposes
- To provide comfort for patients whose physical condition confines them to bed and for patients on imposed bed rest for therapeutic reasons.
- To change wet/soiled linen for the bed-ridden patients.
- To maintain neat appearance and clean environment.
- To provide a smooth wrinkle free bed foundation thus minimizing sources of skin irritation.
Articles
- Dusters-2
- Chair/stool
- Basin with disinfectant solution
- Hamper or dirty linen basket
- Bucket for soiled linen
- Clean bed linen
- Clean gloves (optional)
- Kidney tray,
Procedure
| Nursing action | Rationale | |
| 1 | Before procedure Assess patient’s general condition and check for any limitation in physical activity. | Determines level of activity and ensures patient’s safety during procedure |
| 2 | Explain to patient the need for bed making | Facilitates patient cooperation |
| 3 | Wash hands. | Prevents spread of microorganisms. |
| 4 | During procedure Assemble all equipment and arrange on the bedside chair in the order of use | Organized efforts facilitate ease of performance of task. |
| 5 | Clote door/curtain. | Provides privacy. |
| 6 | Adjust the height of the bed. Lower side rails near to you, leaving the opposite side rails up. Release any equipment attached to the bed linen with clips, such as call light, IV tubes, Foley catheter, drains, etc. | Adjusting height of bed reduces strain on the nurse. Releasing equipment attached to bed linen prevents discomfort and accidental dislodgement of the tubes. |
| 7 | Check bed linen for patient’s personal items. Remove extra pillows. | Avoids loss of personal items: |
| 8 | Loosen the top bedding from head end to foot end. Remove blanket leaving the top sheet over the patient. | Makes removal of blanket easier |
| 9 | If the blanket and bedspread are to be reused, fold lengthwise and keep on the chair. | Facilitates replacement and prevents wrinkling. Lengthwise folding prevents contamination of head end of sheet. |
| 10 | Position the patient on side on the far side of the bed facing away Adjust the pillow under the head. Be sure that the farthest side rails are up. | Provides space for placement of fresh bed linen. Side rails ensure safety |
| 11 | Loosen bottom linen from head end to foot end on both sides. | |
| 12 | Fan fold the draw sheet towards the patient and push it as close to the patient as possible. | |
| 13 | Clean and roll the mackintosh towards the patient. | Provides maximum workspace for placing clean linen |
| 14 | Fan fold the bottom sheet towards the patient. | When the patient turns to the other side these soled can be easily removed |
| 15 | Dust the mattress with dry duster. | Dusting minimizes the number of microorganisms |
| 16 | Apply clean bottom linen which is fan-folded lengthwise to the exposed half of the bed, keeping the centerfold in center of the bed. Fan fold the bottom sheet towards the patient. Smoothen the bottom layer over the mattress and bring edge over near side. Allow the sheets to hang about 25 cm over the mattress edge, make mitered corner at the head end of the bed. Tuck the hanging sheets on the sides till the foot end. The lower hem of the bottom should be even with the bottom edge of mattress. bring the mackintosh back into place and clean it using dry duster (if soiled replace the mackintosh). Place the clean draw sheet over the. mackintosh and tuck both mackintosh and draw sheet under the mattress. | Applying linen over bed in successive layers minim expenditure of time and energy Keeping seam edges down eliminates irritation to pe skin. Mitered corners will secure the sheet on the bed Protects bed line from soiling. |
| 17 | Raise the side rails on working side and go to the other side. | Maintains safety. |
| 18 | Lower the side rails and assist the patient to roll slowly to the other side of bed over the fold of linen. | Exposes opposite side of bed for removal of soiled line and placement of clean line. |
| 19 | Loosen the edges of the soiled linen from underneath the mattress. | Makes linen easier to remove. |
| 20 | Remove the draw sheet by folding it into a bundle and place in the linen bag. Remove the bottom sheet and put it in linen bag. Clean and roll mackintosh towards the patient. | |
| 21 | Dust the mattress with dry duster and spread the fan-folded clean linen. smoothly over the edge of the mattress from head end to foot end | Dusting minimizes the number of microorganisms. |
| 22 | Pull taut and secure the bottom sheet under the head of the mattress. Miter corners. Pull the side of the sheet taut and tuck under the side of the mattress. | Removes wrinkles and creases in linen, which are uncomfortable to lie on. |
| 23 | Straighten the mackintosh and draw sheet. | Smooth linen will not irritate patient’s skin |
| 24 | Assist the patient in rolling back to supine position and reposition the pillow. | Maintains patient’s comfort |
| 25 | Tuck the mackintosh and draw sheet in the same manner. | Tucking will keep the bed firm. |
| 26 | Place top sheet over the patient with center-fold lengthwise down the middle of the bed. Open the | Sheets should be equally distributed over bed by correctly positioning the center-fold. |
| 27 | Ask the patient to hold the top line and tuck around the shoulders. Remove the used top sheet by pulling from down and place it in the line bag. | The top sheet prevents exposure of body parts. Having patient hold the sheet encourage participation in care. |
| 28 | Place the blanket over top sheet as in an open bed. | Provides warmth for the patient. |
| 29 | Make a horizontal toe pleat and modified mitered corner in the foot end allowing the sides to hang free. | Tucking the linen together gives neat appearance and toe plate provides adequate room for the legs under the sheet. |
| 30 | Place the upper edge of blanket 5-6 inches lower than the top sheet as in open bed. Fold it over the blanket’s upper border to form a cuff. | Provides warmth for the patient. This type of fold covering the upper edge of blanket avoids irritation from direct contact of patient’s skin with blanket. |
| 31 | Change the pillowcase and replace pillow/pillows with open end facing away from door or entrance to room. | Maintains neat appearance. |
| 32 | Place the call signal and all other tubing’s back and place the patient in comfortable position. | Ensures safety and comfort. |
| 33 | After procedure Discard the dirty linen in the linen bag and wash hands. | Prevents transmission of microorganism |
| 34 | Record the observations made on the patient in the nurses’ notes. | Provides accurate documentation. |
Special Consideration
Patients with respiratory and cardiac disorders may be unable to tolerate lying flat during bed making. Top to bottom method of occupied bed making can be used for such patients.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
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