Definition
Preparing an open or unoccupied bed is a fundamental nursing procedure designed to ensure comfort, cleanliness, and readiness for a patient who is either ambulatory or expected to return to bed shortly.
Purpose
- To provide comfort and to promote rest
- To maintain a clean environment and neat appearance to the unit.
- To reduce transmission of microorganisms
- To economize time, material and effort
- To promote cleanliness.
- To observe patients and to prevent complications.
- To ambulate the patient
- To provide smooth, wrinkle free bed thus minimizing sources of skin irritation.
Articles
- A tray for carbolization containing:
- duster-2(1-dry,1-wet)
- bowl /basin with disinfectant solution (1:20 savlon)
- kidney tray
- Bed (proper functioning)
- Mattress and pillow
- Chair or stool to keep the linen clean.
- Bed side locker
- Set of clean linen- bottom sheet, top sheet, draw sheet, pillowcase, counter pan(optional), blanket(optional)
- Mackintosh
- Linen bag /bucket for soiled linen
Procedure
| Nursing action | Rationale | |
| 1 | Before procedure Assess patient’s general condition movement and check doctor’s order for any specific Instruction regarding movement restriction. | Determines if patient can be made to sit out of bed. |
| 2 | Explain to the patient the need and purpose for making a bed and how he has to cooperate. | Wins the patient’s cooperation and confidence |
| 3 | Assess whether there is need for change of linen and collect fresh linen as needed. | Ensures an organized approach towards carrying out procedure. |
| 4 | Provide privacy. | |
| 5 | Move furniture away from the bed. | Provides adequate space for nurse to move |
| 6 | Place the tray on the bedside locker. Keep hamper/linen basket at the bed side. | Arranging articles at the bedside saves time and energy |
| 7 | Place a stool at the foot end of the bed and place fresh linen on it in the reverse order of use. | Keeping articles in a convenient place and within reach promotes ease of work and saves time. |
| 8 | Assist patient to get out of bed of (if not contraindicated) and sit comfortably on a stool or chair near the bed. | |
| 9 | Lower head end of bed. Keep bed in flat position and lower side rails. | Working with the bed in lowered position promotes good and body mechanics.Keeping the bed in flat position enables the nurse to make a wrinkle free bed |
| 10 | Remove wristwatch and wash hand | Prevent chance of cross infection. |
| 11 | During procedure. Switch off fan. | Prevents spread of dust and microorganisms. |
| 12 | Remove pillow and place it over the seat of the chain/stool with open end away from the entrance to room | Reduces chance of accumulation of dust |
| 13 | Remove any personal items on the bed, inside the pillow cover, under the pillow, under the mattress, etc. | Avoids loss of patient’s belonging |
| 14 | Stand on the side of the bed. | |
| 15 | Strip linen from all sides starting from head end to foot end. Move around the bed systematically. | Moving around the bed systematically prevents stretching, reaching and possible muscle strain. |
| 16 | Bundle the linen one at a time and discard it into the linen hamper if they are not to be reused. | |
| 17 | If reusing liners; Remove blanket from foot end, dust, fold and place on the stool Remove towels, dust and place neatly on stoolTake pillow, hold free end downwards, dust and place on the stool. If pillowcase is dirty, remove and discard into the hamper.Fold top sheet on the bed itself into four-folds. Hold both ends of sheet, shake gently into the hamper and place on the stool. Remove draw sheet, dust it and four-fold and place on stool. Clean mackintosh with the damp duster from head end to foot end, roll it and keep on the stool. Fold bottom sheet lengthwise with head end of both sides touching and feet end on both sides touching into four folds. | Prevents sheet from dragging on the floor. Dusting into hamper avoids spread of dust and microorganisms. Vigorous shaking of sheets should never be done. Folding lengthwise reduces risk of contamination from foot end to head end. |
| 18 | Clean top of mattress with a dry duster from head end to foot end and collect into kidney tray. | Damp dusting causes mildew on the mattress. |
| 19 | Fold mattress from top to bottom and clean under surface of mattress with dry duster. | |
| 20 | Clean head end and half of body of cot with damp duster. | |
| 21 | Now fold mattress from bottom to top, clean the under surface of mattress and body of cot from the middle to foot end as described above. | |
| 22 | Replace duster and keep mattress flat | |
| 23 | Place bottom sheet at the center of the bed. | |
| 24 | Unfold the bottom sheet and spread straight over the top of the mattress, and then at the foot end and tuck on that side moving from head to foot Separate the feet slightly apart and flex the knees instead of bending the back when tucking line under the bed. | Making mitered comers and tucking prevents slipping of sheet and keep bed firm Maintaining good body mechanics prevents undue strain on nurses back. |
| 25 | Spread mackintosh and place draw sheet over it. Tuck them together on the side you are standing. Tuck the middle portion first, then head end followed by foot end. | Mackintosh prevents soiling of the bottom sheet. Draw sheet avoids direct contact of mackintosh with the skin. |
| 26 | Move to other side of bed, tighten bottom sheet and make mitered corners at head and foot ends. (If sheet is not long enough, make mitered corner at head end only. Leave foot end of sheet even with foot end of bed). While tucking pull the sheets with both hands | Pulling and tucking the sheet ensures a wrinkle free bed. |
| 27 | Tuck the mackintosh and draw sheet together on the side. | While tucking, keep palms downwards in order to get even appearance |
| 28 | Place the top sheet in four-fold with the top end at level with head end of the mattress. Spread the sheet | |
| 29 | Place blanket over the top sheet 15-30cm below from the top of the matters. cuff the top of the sheet over the blank | Smooth cuff protects patient’s skin from irritation caused by the blanket. |
| 30 | Make a toe fold about 15 cm from the bottom of mattress. | Ensures adequate space for the toes under the shee |
| 31 | Tuck the top sheet and blanket together at the foot end and make a modified mitered corner, allowing the sides to hang free. | |
| 32 | Change pillowcase and replace pillow with free end facing away from entrance of room or door. | Free end of pillow away from entrance gives neat appearance and prevents collection of dust |
| 33 | Place or tie towels at the head end of bed (bath towel, sponge towel, and face towel). | Allows easy access for the patient |
| 34 | Clean inside and outside of locker and arrange patient’s belongings neatly. Promotes a neat appearance. | Promotes a neat appearance. |
| 35 | After procedure Replace articles. | Reduces risk of transmission of microorganisms |
| 36 | Wash hand |
Special Considerations
- Assess the patient’s pulse, respiration and blood pressure before ambulating
- Any comfort device used by the patient should be replaced.
- The patient should be assisted back to bed.
- The whole unit of the patient must be made neat and tidy.
- Used dusters must be disinfected, washed and dried.
- If linen is soiled with feces, urine or any other body fluids, segregate such linen for laundry as per the hospital policy.
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 India Pvt Ltd, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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