Foundations of Nursing I

Subtopic:

Bed making

BED MAKING

 The Hospital Bed

The bed is one of the most essential items for patients. It is therefore very important that the bed should be as comfortable as possible at all times.
Hospital beds differ from normal beds in height, length, and adjustability in order to satisfy the needs of both the patient and the medical team.

Bed Making

All patients in hospital have their beds made at least once a day, and more often if their nursing care demands it—for example, whenever the bed gets soiled.
Unconscious patients who are incontinent need their beds made each time the linen becomes soiled.

Bed making is like any other procedure and therefore has aims and rules for carrying it out.

Objectives

  1. Mention the aims of bed making.

  2. Mention the rules of bed making.

  3. Identify the various bed appliances used for bed making.

  4. Identify the requirements of making a hospital bed.

  5. Make various hospital beds.

  6. Lift the patients using different techniques.

  7. Position the patients using different methods.

Aims of Bed Making

  1. To provide comfort and safety to the patient.

  2. To promote neatness and clean appearance of the ward.

  3. To provide a suitable position for the patient according to their condition.

  4. To avoid complications.

  5. To improve nursing standards of hygiene and general care.

Rules of Bed Making

  1. Rule: Close the door, if there is a patient screen the bed and close the windows.
    Rationale: To promote patient’s privacy and prevent chilling.

  2. Rule: All the equipment necessary for bed making should be brought at the bedside.
    Rationale: Organization facilitates performance of task.

  3. Rule: There must be two nurses to carry out the procedure.
    Rationale: To allow quick and efficient performance.

  4. Rule: Always pull the bed away from the wall to have enough space and push it back after a procedure.
    Rationale: To create space.

  5. Rule: Hands must be washed before and after the procedure. Soiled and clean sheets must not be worn by nurses during the procedure.
    Rationale: To prevent and control infection.

  6. Rule: The nurses should not converse with each other during the procedure but can converse with the patient.
    Rationale: To promote nurse patient relationship.

  7. Rule: If there is a patient in bed, do not cover the face, privacy must be provided by screening the bed.
    Rationale: To promote comfort and privacy.

  8. Rule: Visitors should not be in the ward.
    Rationale: To save time.

  9. Rule: No soiled procedure should be in progress during bed making.
    Rationale: To prevent infection.

  10. Rule: No linen should touch the floor but if it does it must be discarded.
    Rationale: Promotes adherence to standards.

  11. Rule: Linen from one bed should not be put on another patient’s bed.
    Rationale: To prevent and control infection.

  12. Rule: Soiled linen should be put in buckets not in dirty linen container.
    Rationale: To prevent and control infection.

  13. Rule: Beds must be made methodically, tucking in bed linen and miter the corners.
    Rationale: Promotes adherence to standards.

  14. Rule: Never shake bed linen in air or over the patient’s bed.
    Rationale: To prevent and control infection.

  15. Rule: Avoid unnecessary movements, stand with legs apart in the middle of the bed.
    Rationale: To save time and avoid straining the back.

  16. Rule: Change all or part of the bed linen as necessary.
    Rationale: To promote patient’s comfort.

  17. Rule: Patients nursed in special positions need not to be changed to another position during bed making.
    Rationale: To avoid complications.

  18. Rule: If a patient has been in bed for a long time the springs need to be checked and the mattress changed. If necessary change the patient to another bed and mattress.
    Rationale: To promote patient’s comfort.

Bed Appliances / Accessories

  1. Macintoshes or plastic sheet
    To prevent soiling of the bed.

  2. Back rest
    To help the patient to sit upright in bed.

  3. Fracture board
    To make the bed firm in order to prevent mal-union of the fracture.

  4. Trapeze (lifting pole)
    It helps the patient lift himself off the mattress and change position. Facilitates many procedures for the nurse, relieves pressure, and promotes independence.

  5. Hot water bottles
    To give added warmth to the patient. To help in relieving pain.

  6. Bed cradle
    Prevents pressure on sensitive areas and keeps the weight of the bedclothes off any part of the body.

  7. Bed-block / Elevator
    To elevate the top or the bottom of the bed to increase blood flow to the vital organs or reduce intracranial pressure.

  8. Air ring
    It relieves pressure on the peri-anal area after haemorrhoidectomy.

  9. Foot rest
    To prevent foot drop.

  10. Cardiac table
    Aids the patient to lean forward, eat, and change position.

  11. Side rails
    Attached to the bed as a safety measure to prevent restless and disoriented patients from falling.

  12. Sand bags
    To restrict jerking of the amputated stump.

  13. Pillows
    To provide comfort and propping up the patient in bed to ease breathing, or prevent pressure where two body parts are in contact with each other.

Making Various Hospital Beds

Requirements for Making a Hospital Bed

Trolley:

  • Top Shelf:

    • Counterpane
    • Blanket
    • Top sheet
    • Draw sheet
    • Mackintosh
    • Bottom sheet
    • Long mackintosh
    • Pillow cases

  • Bottom Shelf:

    • Pillows

Bed Side:

  • The hospital bed
  • Mattress
  • Hand washing equipment

Procedure

StepActionRationale
1Explain the purpose and procedure to the client.Providing information fosters cooperation.
2Perform hand hygiene.To prevent spread of micro organisms.
3Prepare all required equipment and bring the trolley to the bedside.Organization facilitates accurate skill and performance.
4Move the bed away from the wall and bed side locker.It makes the space for bed making and also helps effective action.
5Adjust the bed to the high position and drop the side rails.To prevent strain on the nurse while working.
6Turn the mattress to check on the springs.To ensure patient’s safety.
7Turn the mattress.Prevent creases that cause discomfort and irritate the skin.
8Straighten the mattress cover.Bottom sheet:
9Place the bottom sheet evenly on the bed. 
10Tuck the bottom sheet securely under the head of the mattress (approximately 20–30 cm).To secure the linen firmly so that it does not pull out easily.
11Make a mitered corner.A mitered corner has a neat appearance and keeps the sheet secure under the mattress.
12Pick up the selvage edge with your hand nearest the head of the bed.To secure the bottom sheet on one side of the bed.
13Tuck the triangle over the side of the bed (Fig. 4a). 
14Drop the triangle over the side of the bed (Fig. 4c–4d). 
15Tuck the sheet under the entire side of bed (Fig. 4e); repeat the same procedure at the end of the corner of the bed. 
16Tuck the remainder in along the side.Mackintosh and draw sheet:
17Place a mackintosh at the middle of the bed (if used), then put on the draw sheet and tuck it at the sides.To protect bottom sheet.

.

Occupied Bed (Open Bed)

Note: Follow the general rules and use the same requirements for making a hospital bed.

Procedure:

  • Strip the bed first, make the bed in the same way as unoccupied bed.

  • Fold the blanket inwards and the bed cover, then the top sheet over the bed and bed cover.

  • Fold half of the bedding back so that it is easy for patient to get into the bed.

Stripping a Bed

Additional Requirements at the Bedside:

  • Dirty linen container

  • Two chairs / bed stripper

  • Screen

Procedure

StepActionRationale
1Place the two chairs at the foot of the bed.To place the clean bed linen that is stripped from the bed.
2Follow the general rules of carrying out nursing procedures.To maintain recommended standards.
3Remove the pillows and place them on the chair and remove any other bed appliances.To make the task of the nurse easy.
4Loosen and un-tuck all the bed clothes easily starting at the top of the bed and work towards the bottom.Soiled linen can easily be removed and clean linen is positioned to make the other side of the bed.
5Fold the bed cover, blanket and top sheets. Each one folded into three folds and placed on the chair.To reduce spread of infection.
6Any dirty linen should be placed in the dirty linen container. 
7Roll the long mackintosh and place it on the chair. 
8Check to see whether there is any dust or cramps on the mattress. If found, remove them.To avoid skin irritation.
9Clear away and take the dirty to the laundry.To promote hygienic environment.

Bed for a Patient with a Fracture

Requirements: Additional

  • Fracture boards

  • A bed cradle

 

StepActionRationale
1After checking the bed springs, the fracture boards are put on the bed.To make the bed firm.
2The mattress and the bed are made up like an ordinary bed. 

A Bed for a Patient with Head Injury

Requirements: In addition to admission bed requirements

Trolley:

  • Top shelf: A small towel, A pillow, A small mackintosh

  • Bottom shelf: A pillow, A draw sheet

Bed side: Vital Observation tray, Bed elevator placed at the head of the bed, Head injury observation chart, suction machine, catheters, Side rails

Procedure

StepActionRationale
1Make the bed as an admission bed and place the small mackintosh and towel at the head of the bed. 
2Place a pillow against the head of the bed.To prevent the patient from knocking his head on the bars.

Admission Bed for a Patient with Burns

Requirements: Additional to hospital bed

Trolley:

  • Top shelf: Four soft sterile sheets, Mackintosh pillow covers

  • Bottom shelf: Mosquito net

Bed side: Infusion stand, Bed cradle, Bed blocks or bed elevator, A gown on a hanger, Gloves, Masks, A tray with all feeding utensils, Vital Observation tray, A bed pan with a cover, Bottle with disinfectant, Hand-washing equipment

Note: All the above must be marked and kept within the screen/room and outside of the screen/room, there must be a label “ISOLATION”.

StepActionRationale
1Make up the admission bed using soft sterile sheets instead of admission sheets. 
2Cover the pillows with the mackintosh cover before putting on the pillow cases.To maintain hygiene.
3If the patient is bathed on admission, the sheets are removed and replaced with warm sheets. If there is shock, the bed blocks are elevated; then remove them when the patient has recovered from shock and the admission bath is then given and sheets replaced with sterile ones.To increase blood supply to the brain.
4Use bed blocks if the patient goes into shock; remove the pillow first. 
5Put the bed cradle between the admission sheets according to the position of the burns (e.g. if burns are on the chest, put the bed cradle at the chest area).To prevent contact with patient open wounds.
6Put mosquito net to cover the bed.To prevent flies from going to the wound.

Bed for Infectious Patients

  • This is a bed for patients who have infectious diseases.

  • Requirements are as for isolation/barrier nursing.

  • Linen is the same as for an occupied bed except it is marked with a sign indicating infection.

  • A screen around the bed or an isolation room is necessary.

Post-Operative Bed

Requirements: Additional

Trolley:

  • Top Shelf: Dressing Mackintosh and dressing towel

Bedside Special Requirements:
Bed elevator or bed blocks, Oral Vital observation tray, Mouth care tray, Bottle of Antiseptic lotion, Suction machine, Gallipots with gauze swabs, Gallipot with normal saline, Gallipot with bicarbonate of sodium, Two receivers (one for used instruments, one for used swabs)

Airway tray containing: Plastic airway, Tongue clip/forceps, Sponge holding forceps, Mouth gag, Tongue depressor/spatula, Two long artery forceps, Non-toothed dissecting forceps, Laryngoscope for examining the larynx

StepActionRationale
1Follow the general rules.To maintain standards.
2Make the bottom bed as before up to the top sheet.To maintain standards.
3Put the pillow at the head of the bed. Put the mackintosh and towel across top of the bed and tuck it in at the top.Mackintosh prevents bottom sheet from being soiled.
4Place top bedding as before but don’t tuck in at the bottom.The open side of bed is more convenient for receiving client than the other closed side.
5Fold both sides of the bed clothes into a hot pack which can be easily removed when lifting the patient onto the bed.To keep the bed warm.
6Cover the whole bed with a counterpane. 
7Push the bed back and clear away. 

A Bed for a Patient with Dyspnea (Cardiac Bed)

Additional Requirements (to hospital bed):

Trolley Top Shelf & Bedside Items:

  • A bell

  • A small pillow

  • A patient’s shawl

  • Small blanket

  • Airing cushions

  • 4 or more pillows with pillow cases

  • Foot support/rest

StepActionRationale
1Make the bed as before.To maintain standards.
2Place the backrest at the head of the bed and put extra pillows on it.So that the patient is comfortable in a sitting up position. For easy breathing and comfort.
3Put the air ring at the level of the buttocks.Provide comfort for the patient.
4Position the table in the middle of the bed.To promote comfort.
5Place a foot rest/support in position.To prevent foot drop.

Changing Sheet from Top to Bottom

Used when a patient is nursed in an upright position and cannot lie flat.

Additional Requirements (to occupied bed):

Trolley Top Shelf:

  • 1 sheet

  • 1 draw sheet

  • 1 draw mackintosh

  • Stool at the side of the bed

  • Screen

  • Mattress cover

  • Bedspread

Trolley Bottom Shelf:

  • 1 draw sheet

  • 2 chairs back to back at the foot of the bed

  • Dirty linen container

StepActionRationale
1Follow the general rules.Easy placement on the bed and accessibility.
2Place the clean linen on the trolley at the foot of the bed and the soiled linen bucket beside the trolley.To save time.
3Fold the clean sheet across the width in three.To prevent unnecessary exposure of the patient.
4Strip the top bedclothes as usual, leaving the top sheet covering the patient. 
5Remove backrest, air ring and foot rest.To create room for placing clean linen.
6Both nurses lift the patient, lift the draw sheet and support the patient’s lower limbs on the stool.To prevent the patient from falling down. To prevent bedsores.
7One nurse supports the patient while the other rolls the draw sheet and mackintosh.To replace the soiled linen, draw mackintosh and sheet.
–Rolls the soiled bottom sheet down as far as possible at the back. 
–Straightens the mattress cover and mackintosh. 
8Puts on the clean sheet, tucking it in at the top and her/his side as far as the dirty sheet.To provide comfort.
9Puts on a clean draw mackintosh and draw sheet and tucks in her/his side. 
10Both nurses lift the patient back up the bed and make sure that the pillows are comfortable.To provide comfort.
11Then tuck in the draw mackintosh and draw sheet on the second side.To secure the beddings.
12Draw the soiled sheet to the bottom of the bed from the patient’s leg, and put it in the soiled linen bucket.To clear away.
13With the hand, brush out any crumbs and creases from the mackintosh if present and mattress, and straighten it. Put the clean sheet down to the bottom of the bed and tuck in.To prevent bedsores.
14Make the top as usual.To provide comfort.

POSITIONS USED IN NURSING

Objectives:

  1. Identify the different positions used in nursing.

  2. Identify requirements for the different positions.

  3. Place the patient in various positions used in nursing.

Requirement: Refer to requirements of different types of beds and accessories/appliances.

Recumbent Position

Variations:

  1. Recumbent/Supine position: Patient lies flat with one pillow.

  2. Semi-recumbent: Patient lies in bed propped up with two or three pillows.

  3. Dorsal position: Patient lies on the back with head and shoulders slightly raised on one or two pillows, with thighs flexed and knees abducted.

Procedure: Recumbent Position

StepActionRationale
1Position the patient on the back. Place a pillow under his shoulders and head.To provide comfort.
2Support the lumbar curve with a rolled towel or small pillow.Provides support and prevents strain in this area.
3If the arm is paralysed, the forearm and hand may be positioned on a pillow. Rest on the arm may occur on the upper or sides and middle fingers for location, size, shape, and texture of the gland.Promotes comfort and prevents edema.
4If flexion contractures in the hand are a possibility, a hand roll or a special hand splint may be used.Prevents contractures and the formation of claw-hand.
5If the lower limbs are paralysed, trochanter rolls may be placed along the lateral aspects of the thighs opposite the lesser trochanter.To prevent external rotation of the hips.
6The knees are normally in slight flexion. Maintain this by placing a pillow under the thighs superior to the popliteal space.Prevents pressure on the popliteal space with consequent deep vein thrombosis or nerve damage. Also prevents pressure on the heels. To remove the weight of the bed clothes.
7Use a footboard or a folded pillow to support the feet in dorsiflexion. 

The Prone Position

Procedure

StepActionRationale
1Turn the patient on the abdomen.Promotes drainage of oral and nasal secretions; maintains an open airway.
2Turn the head laterally and position it on a small pillow. Place another pillow just below the diaphragm.Supports the lumbar curve, facilitates breathing, and relieves pressure on female breasts.
3Place a pillow under the lower legs or let the feet hang over the edge of the mattress.Relieves pressure, prevents plantar flexion, and slightly flexes the knees.

Lateral or Side-Lying Position

Procedure:

StepActionRationale
1Turn the patient onto the left or right side.Relieves pressure on bony prominences (e.g., greater trochanter, scapula, ileum).
2Place a pillow under the neck and head.Facilitates respiration and prevents internal hip rotation and adduction.
3Flex both arms in front of the body. Place the upper arm on a pillow, and the lower arm with fingers pointing toward the head of the bed.Prevents friction and provides comfort.
4Flex both legs, with the upper leg more than the lower. Place a pillow between the knees.Provides alignment and reduces pressure/friction.
5Place a pillow behind the patient’s back.Provides support and prevents rolling.
6Place a rolled towel under the curve of the waist.Supports the back and maintains posture.

Sims' Position (Semi-Prone or Recovery Position)

StepActionRationale
1Turn the patient into a lateral and slightly prone position. Place the bottom arm behind the back. Flex the top arm at the elbow and shoulder, with fingers pointing to the head of the bed.Provides comfort and ensures patient safety.
2Place a pillow under the head and neck. (Skip if there are profuse secretions.)Supports the head and neck.
3Flex both legs at the hips and knees, with the upper leg more flexed.Maintains comfort and alignment.
4Place a pillow between the legs.Prevents skin friction and pressure.
5Place a rolled towel under the feet to maintain dorsiflexion.Prevents plantar flexion and foot-drop.

Trendelenburg Position

Description:

  • The patient lies flat on the back, with the head of the bed tilted downward at about 45°.
  • Can be achieved using an examination/theatre table or bed blocks placed under the feet of a regular bed.

Purpose:

    • Commonly used in situations like shock or certain surgical procedures to promote blood flow to vital organs.

Sitting-Up Positions (Orthopneic / Fowler’s Position)

Procedure:

  1. Put the patient in a sitting-up position.

  2. Adjust the backrest to a level that suits the patient’s individual needs to improve breathing and comfort.

Knee-Chest Position (Genu-Pectoral)

Procedure:

  1. Help the patient kneel with the chest, head, and knees resting on the bed or theatre table. This relieves pressure.

  2. Position the legs in slight abduction and ensure that the hips and knees are flexed at right angles to the body.

  3. Allow the feet to extend past the end of the bed for better body alignment.

  4. Place the patient’s arms on a pillow to provide comfort.

  5. Cover or drape the patient properly to prevent cold exposure and embarrassment.

Lithotomy Position

Requirements: Stirrups

Procedure:

  1. Position the patient on her back with a pillow under her head and shoulders.

  2. Two assistants are needed. Each person flexes one of the patient’s legs over her abdomen and places her feet into the stirrups. This helps prevent lower back injury.

Lifting and Turning Patients

Aims:

  • To provide safe care to patients.

  • To prevent self-injury or muscle strain in the caregiver.

  • To conserve energy and work more efficiently.

General Guidelines When Lifting and Moving a Patient

  1. Assess the patient’s condition and know which movements are contraindicated to prevent complications.

  2. Evaluate the patient’s abilities and encourage participation if the condition allows.

  3. Explain the procedure to the patient to ensure cooperation.

  4. Lock the wheels of any movable equipment like beds or stretchers to prevent accidents.

  5. Adjust the bed height to a level that is comfortable for you to prevent strain.

  6. Use proper body mechanics at all times. This includes:

    • Keeping the patient’s body aligned.

    • Moving rhythmically and avoiding jerky motions.

    • Using large muscles (e.g., flexing the knees instead of bending the back).

    • Holding objects close to your body to reduce effort.

Orthodox Lift

Refer to figure in training materials.

Australian Lift (Shoulder Method)

Procedure:

  1. Follow the general rules of lifting for safety.

  2. Two nurses stand facing each other.

  3. Both place their hands under the patient’s thighs. The patient bends the knees and crosses arms over the chest.

  4. The nurses hold each other’s forearms and support the patient’s back.

  5. They keep their feet apart with knees slightly bent.

  6. While keeping the back straight, they lift the patient by straightening their legs and transfer the patient in the required direction.

  7. The nurses should count together and lift the patient simultaneously to ensure coordination.

Lifting from Trolley to Bed

Procedure:

  1. Position the trolley at about an 80-degree angle to the foot of the bed.

  2. Both nurses stand close to the trolley with feet apart and knees slightly bent for stability.

  3. One nurse supports the patient’s head, shoulders, and back, while the other supports the buttocks and legs.

  4. Together, they straighten their legs and gently move the patient onto the bed.

Note:
If three nurses are available:

  • One supports the head, shoulders, and back.

  • The second supports the lower back and buttocks.

  • The third supports the legs.

Lifting from Bed to Trolley

Procedure:

  1. Follow all general rules for safety and patient comfort.

  2. Assist the patient to sit at the edge of the bed with legs hanging down.

  3. Two nurses face each other. The inner leg is slightly bent, and the outer leg is straight to ensure balance.

  4. Place one hand under the patient’s thighs and the other behind the back.

  5. Instruct the patient to place their arms around the nurses’ shoulders for additional support.

  6. On a coordinated count, straighten the knees and lift the patient smoothly onto the trolley.

Related Topics

• General Principles and Rules of All Nursing Procedures
• Hospital Economy
• Use of Personal Protective Equipment
• Routine and Weekly Cleaning of the Ward
• Waste Management and Disposal
• Isolation of Infectious Patients
• Causes of Infection
• Medical Waste Disposal and Management
• Cleaning Methods
• Carry out Adequate Feeding of Patients
• Perform Bladder and Bowel Care
• Passing a Flatus Tube
• Administration of Enema
• Ward Report
• Lifting/Positioning a Patient
• Tepid Sponging
• General Principles in Patient Care
• Ethics in Nursing Care
• Principles of Infection Prevention and Control
• Body Mechanics
• Bed Making
• Vital Observations
• Bed Bath
• Oral Care/Mouth Care
• Care and Treatment of Pressure Ulcers

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