basic nursing procedure : bed making

1. BED MAKING
By
GHAVYA.B.M B.Sc. Nursing RN RM

2. BED MAKING
DEFINITION:
Bed making is a key nursing skill that is essential
for the promotion of patient’s comfort, hygiene and well
being.
Purpose:
• To provide the clients with a safe and comfortable bed to take
rest and sleep
• To give the unit or ward a neat appearance
• To adapt to the needs of the client and to be ready for any
emergency or critical conditions
• To economize time material and comfort
• To prevent bed sore

3. • To promote cleanliness
• To provide an active and passive exercise to the client
Principles:
• Micro organisms are found everywhere on the skin, on
the articles used by the client and in the environment.
The nurse takes care to prevent the transference of micro
organism from the source to the new host by direct or
indirect contact or prevent the multiplication of micro
organism
• Systematic ways of functioning saves time, energy and
material

4. ,
• A safe and comfortable bed will ensure rest, sleep and prevent several
complications in bed ridden clients
• Good body mechanism maintain the body alignment and prevents
fatigue
TYPES OF BED:
• Un occupied bed
• Occupied bed
• Operation bed
• Amputation bed/ divided bed
• Cardiac bed/ fowler's bed
• Fracture bed
• Burn’s bed
• Open bed

5. Preliminary assessment:
• Check the doctors order for specific precautions
regarding the movement and positioning of the
client
• Assess the client ability for self care
• Check the furniture and linen available at the client
unit
• Assess the number of clean linen added
• Assess the articles needed for the comfort of the
client e.g. blankets, backrest etc.

6. GENERAL INSTRUCTION FOR BED MAKING:
• Wash hands before and after the procedure
• Do not expose the patient unnecessarily
• Do not cover patients face while placing the linen
• Do not mix clean linen with soiled linen
• Do not let the linen to touch your uniform or body
• Make the bed firm, smooth and wrinkleless
• Maintain good body mechanics
• Keep a reasonable distance from the face of the patient to
prevent cross infection

7. Making an Un-occupied Bed
Definition: A bed prepared to receive a new patient is an un-
occupied bed.
Purpose
• 1. To provide clean and comfortable bed for the patient
• 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

8. Equipment required:
• 1. Mattress (1)
• 2. Bed sheets(2):
Bottom sheet (1)
Top sheet (1)
• 3. Pillow (1)
• 4. Pillow cover (1)
• 5. Mackintosh (1)
• 6. Draw sheet (1)
• 7. Blanket(1)
• 8. Savlon water or Dettol water in basin
• 9. Sponge cloth (4):
to wipe with solution (1)
to dry (1)
When bed make is done by two nurses, sponge cloth is needed two each.

9. • 10. Kidney tray or paper bag (1)
• 11. Laundry bag or Bucket (1)
• 12. Trolley (1).

10. Procedure:
By one nurse Care Action Rationale Providing information fosters
cooperation.
• 1. identify the patient , Explain the purpose and procedure to the
client.
• 2. Perform hand hygiene. (To prevent the spread of infection.)
• 3. Prepare all required equipments and bring the articles to the
bedside. (Organization facilitates accurate skill performance It
makes space for bed making and helps effective)
• 4. Move the chair and bed side locker
• 5. Clean Bed-side locker: Wipe with wet and dry. To maintain the
cleanliness

11. 6. Clean the mattress:
• Stand in right side.
• Start wet wiping from top to center and from center to
bottom in right side of mattress.
• Gather the dust and debris to the bottom.
• Collect them into kidney tray.
• Give dry wiping as same as procedure 2).
• Move to left side.
• Wipe with wet and dry the left side. To prevent the spread of
infection
7. Move to right side.

12. Bottom sheet:
• Place and slide the bottom sheet upward over the top of the
bed leaving the bottom edge of the sheet.
• Open it lengthwise with the center fold along the bed center.
• Fold back the upper layer of the sheet toward the opposite
side of the bed.
• Tuck the bottom sheet securely under the head of the mattress
(approximately 20-30cm).
Make a mitered corner.
• Pick up the selvage edge with your hand nearest the hand of
the bed.

13. • Lay a triangle over the side of the bed
• Tuck the hanging part of the sheet under the mattress.
• Drop the triangle over the side of the bed.
• Tuck the sheet under the entire side of bed
• Repeat the same procedure at the end of the corner of the bed
• Tuck the remainder in along the side unfolding the sheet in
this manner allows you to make the bed on one side. A
mitered corner has a neat appearance and keeps the sheet
securely under the mattress
• Tucking the bottom sheet will be done by turn, the corner of
top firstly and the corner of the bottom later. To secure the
bottom sheet on one side of the bed.

17. 8. Mackintosh and draw sheet:
• Place a mackintosh at the middle of the bed (if used), folded
half, with the fold in the center of the bed. Used), folded half,
with the fold in the center of the bed.
• Lift the right half and spread it forward the near Side.
Mackintosh and draw sheet are additional protection for the
bed and serves as a lifting or turning sheet for an immobile
client
• Tuck the mackintosh under the mattress.
• Place the draw sheet on the mackintosh. Spread and tuck as
same as procedure 1)-3).

18. 9. Move to the left side of the bed. Bottom sheet, mackintosh and draw
sheet:
• Fold and tuck the bottom sheet as in the above procedure 7.
• Fold and tuck both the mackintosh and the draw sheet under the
mattress as in the above procedure 8. Secure the bottom sheet,
mackintosh and draw sheet on one side of the bed
10. Return to the right side.
• Top sheet and blanket:
• Place the top sheet evenly on the bed, centering it in the below 20-
30cm from the top of the mattress.
• Spread it downward.
• Cover the top sheet with blanket in the below 1 feet from the top of
the mattress and spread downward.

19. • Fold the cuff (approximately 1 feet) in the neck part
• Tuck all these together under the bottom of mattress. Miter
the corner.
• Tuck the remainder in along the side A blanket provides
warmth. Making the cuff at the neck part prevents irritation
from blanket edge. Tucking all these pieces together saves
time and provides a neat appearance.
11. Repeat the same as in the above procedure 10 in left side. To
save time in this manner
12. Return to the right side.
• Pillow and pillow cover:
• Put a clean pillow cover on the pillow.

20. • Place a pillow at the top of the bed in the center with the open
end away from the door. A pillow is a comfortable measure.
Pillow cover keeps cleanliness of the pillow and neat. The
open end may collect dust or organisms. The open end away
from the door also makes neat.
• 13. Return the bed, the chair and bed-side table to their
proper place. Bedside necessities will be within easy reach for
the client.
• 14. Replace all equipments in proper place. Discard lines
appropriately. It makes well-setting for the next. Proper line
disposal prevents the spread of infection. To prevent the
spread of infection.

21. • 15. Perform hand hygiene Do not let your uniform touch the
bed and the floor not to contaminate yourself. Never throw
soiled lines on the floor not to contaminate the floor. Staying
one side of the bed until one step completely made saves steps
and time to do effectively and save the time.

22. OCCUPIED BED

23. Changing an Occupied Bed
Definition:
• The procedure that used lines are changed to a hospitalized
patient is an occupied bed.
Occupied bed Purpose:
• 1. To provide clean and comfortable bed for the patient
• 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

24. Equipment required:
• 1. Bed sheets(2) :
Bottom sheet( or bed cover)
(1) Top sheet (1)
• 2. Draw sheet (1)
• 3. Mackintosh (1) (if contaminated or needed to change)
• 4. Blanket (1) ( if contaminated or needed to change)
• 5. Pillow cover (1)
• 6. Savlon water or Dettol water in bucket
• 7. Sponge cloth (2):
to wipe with solution (1) to dry (1)When the procedure is done by two
nurses, sponge cloth is needed two each.
• 8. Kidney tray or paper bag (1)
• 9. Laundry bag or bucket (1)
• 10. Trolley

25. Procedure: by one nurse Care Action Rationale To assess necessity
and sufficient condition
• 1. Check the client’s identification and condition. Providing
information fosters cooperation
• 2. Explain the purpose and procedure to the client To prevent the
spread of infection.
• 3. Perform hand hygiene
• 4. Prepare all required equipments and bring the articles to the
bedside. Organization facilitates accurate skill performance To
maintain the client’s privacy.
• 5. Close the curtain or door to the room. Put screen.
• 6. Remove the client’s personal belongings from bed-side and put
then into the bed-side locker or safe place. To prevent personal
belongings from damage and loss.

26. • 7. Lift the client’s head and move pillow from center to the left side.
The pillow is comfortable measure for the client.
• 8. Assist the client to turn toward left side of the bed. Adjust the
pillow. Leaves top sheet in place. Moving the client as close to the
other side of the bed as possible gives you more room to make the
bed. Top sheet keeps the client warm and protect his or her privacy.
• 9. Stand in right side: Loose bottom bed linens. Fanfold (or roll)
soiled linens from the side of the bed and wedge them close to the
client. Placing folded (or rolled) soiled linen close to the client
allows more space to place the clean bottom sheets.
• 10. Wipe the surface of mattress by sponge cloth with wet and dry.
To prevent the spread of infection.

27. 11. Bottom sheet, mackintosh and draw sheet:
• Place the clean bottom sheet evenly on the bed folded lengthwise
with the center fold as close to the client’s back as possible.
• Adjust and tuck the sheet tightly under the head of the mattress,
making mitered the upper corner.
• Tighten the sheet under the end of the mattress and make mitered
the lower corner.
• Tuck in alongside.
• Place the mackintosh and the draw sheet on the bottom sheet and
tuck in them together. Soiled linens can easily be removed and clean
linens are positioned to make the other side of the bed.

28. • 12. Assist the client to roll over the folded (rolled) linen to
right side of the bed. Readjust the pillow and top sheet.
Moving the client to the bed’s other side allows you to make
the bed on that side.
• 13. Move to left side: Discard the soiled linens appropriately.
Hold them away from your uniform. Place them in the
laundry bag (or bucket). Soiled linens can contaminate your
uniform, which may come into contact with other clients.
• 14. Wipe the surface of the mattress by sponge cloth with wet
and dry. To prevent the spread of infection.

29. • 15. Bottom sheet, mackintosh and draw sheet:
Grasp clean linens and gently pull them out from under the
client.
Spread them over the bed’s unmade side. Pull the linens
Wrinkled linens can cause skin irritation
Tuck the bottom sheet tightly under the head of the mattress
and miter the corner.
Tighten the sheet under the end of the mattress and make
mitered the lower corner.
Tuck in alongside.
Tuck the mackintosh and the draw sheet under the mattress.
• 16. Assist the client back to the center of the bed. Adjust the pillow.
The pillow is comfort measure for the client.

30. • 17. Return to right side: Clean top sheet, blanket:
• Place the clean top sheet at the top side of the soiled top sheet.
• Ask the client to hold the upper edge of the clean top sheet.
• Hold both the top of the soiled sheet and the end of the clean
sheet with right hand and withdraw to downward. Remove
the soiled top sheet and put it into a laundry bag (or a bucket).
• Place the blanket over the top sheet. Fold top sheet back over
the blanket over the client.
• Tuck the lower ends securely under the mattress. Miter
corners. After finishing the right side, repeat the left side.
• Tucking these pieces together saves time and provides neat,
tight corners.

31. • 18. Remove the pillow and replace the pillow cover with clean
one and reposition the pillow to the bed under the client’s
head. The pillow is a comfortable measures for a client
• 19. Replace personal belongings back. Return the bed-side
locker and the bed as usual. To prevent personal belongings
from loss and provide safe surroundings To prepare for the
next procedure
• 20. Return all equipments to proper place.
• 21. Discard linens appropriately. Perform hand hygiene. To
prevent the spread of infection.

33. Equipment required:
1. Bed sheets: Bottom sheet (1) Top sheet (1)
2. Draw sheet (1-2)
3. Mackintosh or rubber sheet (1-2) According to the type of
operation, the number required of mackintosh and draw sheet is
different.
4. Blanket (1)
5. Hot water bag with hot water (104- 140 ℉) if needed (1)
6. Tray1 (1)
7. Thermometer, stethoscope, sphygmomanometer: 1 each
8. Spirit swab
9. Artery forceps (1)

34. 10. Gauze pieces
11. Adhesive tape (1)
12. Kidney tray (1)
13. Trolley (1)
14. IV stand
15. Client’s chart
16. Client’s cadre
17. According to doctor’s orders: - Oxygen cylinder
with flow meter - O2cannula or simple mask -
Suction machine with suction tube -Airway -
Tongue depressor - SpO2monitor - ECG - Infusion
pump, syringe pump

35. Procedure:
by one nurse Care Action Rationale To prevent the spread of
infection
1. Perform hand hygiene Organization facilitates accurate skill
2.Assemble equipments and bring bed-side performance
3. Strip bed. Make foundation bed as usual with a large
mackintosh, and cotton draw sheet. Mackintosh prevents bottom
sheet from wetting or soiled by sweat, drain or excrement. Place
mackintosh according to operative technique. Cotton draw sheet
makes the client felt dry or comfortable without touching the
mackintosh directly.

36. • 4. Place top bedding as for closed bed but do not tuck at foot
Tuck at foot may hamper the client to enter the bed from a
stretcher To make the client ‘s transfer smooth
• 5. Fold back top bedding at the foot of bed. (Fig.10 ) Tucking
the top bedding on one side stops the bed
• 6. Tuck the top bedding on one side only. (Fig. 11 ) linens
from slipping out of place and
• 7. On the other side, do not tuck the top sheet. 1) Bring head
and foot corners of it at the center of bed and form right
angles. (Fig.12 ) 2) Fold back suspending portion in 1/3

37. • (Fig. 13 )and repeat folding top bedding twice to opposite side of
bed(Fig.14, 15) The open side of bed is more convenient for
receiving client than the other closed side. To maintain the airway
• 8. Remove the pillow. To receive secretion
• 9 Place a kidney-tray on bed-side. To prepare it to hang I/V soon
• 10. Place IV stand near the bed. To prevent moving the bed
accidentally when the
• 11. Check locked wheel of the bed. Client is shifted from a stretcher
to the bed
• 12.Place hot water bags(or hot bottles) in the middle of the bed and
cover with fan folded top if needed Hot water bags (or hot bottles)
prevent the client from taking hypothermia

38. • 13.When the patient comes, remove hot water bags if put
before To prepare enough space for receiving the client
• 14. Transfer the client:
1) Help lifting the client into the bed
2) Cover the client by the top sheet and blanket
immediately
3) Tuck top bedding and miter a corner in the end of the
bed. To prevent the client from chilling and /or having
hypothermia

42. AMPUTATION BED

44. Amputation bed or stump bed or divided bed
Purpose
• An amputation bed is used after amputation of the leg to take
off the weight of the bed cloths off sites of the operation
• to keep stump in good position
• To be able to watch the stump for hemorrhage and apply
tourniquet instantly if necessary
• A divided bed may be used to avoid disturbing the client when
constant observation or repeated applications or treatments
are necessary for abdomen or legs

45. Equipments:
• Articles necessary for an open bed
• An extra set of top linen- top sheet, blanket, bed cradle (if
necessary)
• Pillow with water proof cover
• Hot water bag to keep the bed warm
• Sand bags and towel and draw sheet to prevent jerking
movement of stump and to keep the stump in good alignment
• Dressing trays to be used in case of emergency hemorrhage
may take place in 24 hrs or secondary hemorrhage may take
place in 7 to 10 days

46. Procedure
• The foundation of the bed is made as in an open bed
• Top sheet- the other end does not reach the foot end , but it is
folded back towards the head end at the level of the stump or
the part that is to be observed.
• The other set of top linen starts from the level of the stump ,
but over lapping the first one and the excess is tucked and the
mattress at the foot end
• When the client is brought back form the operation theatre,
fan fold the two top sheets to one side of the bed and receive
the patient on the bed. Elevate the stump on a small pillow
protected with water proof cover

47. • Place the sand bags on the either side of the stump to present
the jerking movements of the stump
• Bed cradle may be used to take up the weight of the top linen
• Cover the client an keep the client warm

48. CARDIAC BED

50. Cardiac bed
• A cardiac bed is used to help the client in assume a sitting
position which can afford him a greatest amount of comfort
with least strain. The main purpose of cardiac bed is to releive
dyspnoea caused by cardiac disease
Equipments:
• Articles for an open bed
• Additional pillows
• Cardiac table, backrest
• Air cushion , knee pillow and foot rest

51. Procedure
• Make the bed as in open bed. Place the back rest and arrange
pillows in positions so that the back is well supported
• Keep the client in bed and cover him properly. Adjust the air
cushion in place.
• Place the knee pillow under to prevent slipping of the client
• Arrange the pillow on either side so that the arms are well
supported. Adjust the cardiac table with the pillow in front of
the client so that the client can lean forward and rest on it
• Make the client comfortable and leave the unit tidy

52. FRACTURE BED

53. FRACTURE BOARD