Procedure in Making an Occupied Bed

EXPECTED BEHAVIOR RATIONALE

1. Assess client for potential Determine need for protective waterproof
incontinence or of excess drainage on pads extra bath blankets on bed.
the linen.

2. Check chart for orders or specific Ensures clients safety and use of proper
precautions concerning movements and body mechanics.
positioning.

3. Explain procedure to the client, Minimizes anxiety and promotes

noting that the client will be asked on cooperation.
turn inside and turn over linen.

Perform hand hygiene and apply gloves Reduces transmission of microorganism.

(gloves are worn only if linen is soiled
or there is risk for contact with body
secretions).

4. Assemble equipment, and arrange on Assembling all equipment provides for

bedside chair or table. smooth procedure and assists in increasing
client’s comfort.
Remove unnecessary equipment such Placing linen on clean surface minimizes
as a dietary tray or items used for spread of infection.
hygiene.

1. Draw room curtain around bed or Maintains client’s privacy.

close door.
2. Adjust bed height to comfortable Minimizes strain on back. It is easier to
working position. remove and apply linen evenly to flat
position.

Lower any raised side rail on one side Provides easy access to bed and linen.
of bed.

3. Loosen top linen at foot of bed. It makes linen easier to remove.

4. Remove bedspread and blanket
separately.
5. If spread and blanket are soiled,
placed them in linen bag.
6. If blanket and spread are to be
reused, fold them by bringing the
top and bottom edges together.
Reduces transmission of microorganisms.
Keep soiled linen away from uniform.
Folding method facilitates replacement and
fold farthest side over unto nearer bottom
edges together again.

Place folded linen over back of chair. Minimizes wrinkles.

7. Cover client with bath blanket in Bath blanket provide warmth and keeps
the following manner: body parts covered during linen removal.
Unfold bath blanket over top sheet. Ask
client to hold top edge of bath blanket.
If client is unable to help, tuck top of
bath blanket under shoulder.

Grasp top sheet under bath blanket at

client’s shoulders and bring sheet and
discard in linen bag.

8. With assistance from another nurse, If mattress slides towards foot of bed when
slide mattress toward head of bed. head of bed is raised, it is difficult to tuck
in linen. In addition, it is uncomfortable for
pressed against or hang over the foot of the
bed.
9. Position client on the far side of the Turning client unto side provides space for
bed turned onto side and facing placement of clean linen. Side rail ensures
away from you. Be sure side rail in client’s safety from toward falls from the
front of client is up. Adjust pillow bed surface and help clients in moving.
under client’s head.
10. Loosen bottom linens, moving from Prepares for removal of all bottom linen.
head to foot. With seam side down Provides maximum work space for placing
(facing the mattress), fanfold clean linen. Later when client turns to other
bottom sheet and draw sheet toward side, soiled linen can be removed easily.
client – first draw sheet then bottom
client – first draw sheet then bottom
sheet. Tuck edges of linen just
under buttocks back and shoulder.
Do not fanfold mattress. Pad it is if
to be reused.
11. Wipe off any moisture on exposed Reduces transmission of microorganisms.
mattress with towel and appropriate
disinfectant.
12. Apply clean linen to expose half of Applying linen over bed in successive
bed. layers minimizes energy and time used in
a. Place clean mattress pad on bed by bed making.
folding it lengthwise with center
crease in middle of bed. Fanfold top
layer over mattress. ( If pas is
reused, simply smooth out any
wrinkles. )
b. Unfold bottom sheet lengthwise so Proper positioning of linen on one side
that center crease is situated ensures that adequate linen will be
lengthwise along center of bed. available to cover opposite side of bed.
 Fanfold sheet’s top layer toward Keeping seam edges down eliminates
center bed alongside the client. irritation to client’s skin.
Smooth bottom layer of sheet over
mattress, and bring edge over
closest side of mattress. Pull fitted
sheet smoothly over mattress ends.
Allow edge of flat unfitted sheet to
hang about 25 cm (10 in) over
mattress edge. Lower hem of
bottom flat sheet should lie seen
down and even with bottom edge of
mattress.

13. Miter bottom flat sheet at head of Ensures secure flat sheet will not loosen
bed. easily.
14. Face head of bed diagonally. Place
hand from head of bed under top
corner of mattress, near mattress
edge and lift.
15. With other hand, tuck top edge of
sheet smoothly under mattress so
that side edges of sheet above and
below mattress would meet if
brought together.
16. Face side of bed and pick up top
edge of sheet at approximately 45
cm (18 in) from top of mattress.
17. Lift sheet, and lay it on top of
mattress to form a lower base
triangular fold, with lower base of
triangular fold, with lower base of
triangle even with mattress side
edge.
18. Tuck lower edge of sheet, which is
hanging free below the mattress,
under mattress. Tuck with pals
down, without pulling triangular
fold.
19. Hold portion of sheet covering side Mitered corner cannot be loosened easily
of mattress to place with one hand. even if client moves frequently in bed.
With the other hand pick up top of
triangular linen fold and bring it
down over side of mattress. Tuck
remaining portion of sheet under
mattress.
Tuck remaining portion of sheet under Folds of linen are source of irritation.
mattress, moving toward foot of bed.
Keep linen smooth.

20. (Optional) Open drawsheet so that Drawsheet is used to lift and reposition.
it unfolds in half. Lay centerfold Placement under client’s torso distributes
along middle of bed lengthwise, most client’s body weight over sheet.
and position sheet so that it will be
under the client’s buttocks and
torso. Fanfold top layer toward
client, with edge along client back.
Smooth bottom layer out over
mattress, and tuck excess edge
under mattress.
21. Place waterproof pad over draw Protects bed linen from being soiled.
sheet, with centerfold against
client’s side. Fanfold top layer
toward client.
22. Have client roll slowly toward you, Position client for removal and placement
over the layers of linen. Raise side of linens. Maintain client’s safety and body
rail on working side, and go to alignment during turning.
other side of bed.
23. Have client roll slowly toward you,
over the layers of linen. Raise side
rail on working side, and go to
other side of bed.
24. Lower side rail. Assist client in Expose opposite side of bed for removal of
positioning on other side, over folds soiled linen and placement of clean linen.
of linen. Loosen edges of soiled Makes linen easier to remove.
linen from under mattress.
25. Remove soiled linen by folding it Reduces transmission of microorganism.
into a bundle or square, with soiled
side turned in. Discard in linen bag.
If necessary, wipe mattress with
antiseptic solution, and dry mattress
surface before applying new linen.
26. Pull clean, fanfold linen smoothly Smooth linen will not irritate the client’s
over edge of mattress from head to skin.
foot of bed.
27. Assist client in rolling back into Maintains client’s comfort.
supine position. Reposition pillow.
28. Pull fitted sheet smoothly over Wrinkles and folds can cause irritation to
mattress ends. Miter top corner of skin.
bottom sheet. When tucking corner,
be sure that sheet is smooth and free
of wrinkles.
29. Facing side of bed, grasp remaining Proper use of body mechanics while
 edge of bottom flat sheet. Grasp tucking linen prevents injury.
edge sheet. Lean back; keep back
straight and pull while tucking
excess linen under mattress.
Proceed from head to bed. (Avoid
lifting mattress during tucking to
ensure fit.)
30. Smooth fan folded draw sheet out Tucking first at top or bottom may under
over bottom sheet. Grasp edge of pull sheet sideways, causing poor fit.
set of palms down; lean back; and
tuck sheet mattress. Tuck from
middle to top and then to bottom
lifting mattress during tucking to
ensure fit.)
31. Place top sheet over clients with Sheet should be equally distributed over
centerfold lengthwise down middle bed by correctly positioning centerfold.
of bed. Open sheet from head to
foot, and unfold over client.
32. Ask client to hold clean top sheet, Sheets prevent exposure of body parts.
or tuck sheet around client’s Having client hold sheet encourages
shoulders. Remove bath blanket and client’s participation in care.
discard in linen bag.
33. Place blanket on bed, unfolding it Blanket should be placed to cover client
so that crease runs length wise completely and provide adequate warmth.
along middle of bed. Unfold
blanket to cover client. Top edge
should be parallel with edge of top
sheet and 15 to 20 cm (6 to 8 in)
from top sheet’s edge.
34. Place spread over bed according to Gives bed neat appearance.
step 35. Be sure that top edge of
spread extends about 2.5 cm (1in)
above blanket’s edge. Tuck top
edge of spread over and under top
edge of blanket.
35. Make cuff by turning edge of top Protects client’s face from rubbing against
sheet down over top edge of blanket tight, fleeting bed sheets.
and spread.
36. Standing on one side at foot of bed, Makes neat-appearance bed.
lift mattress corner slightly with one
hand and tuck linens under
mattress. Top sheet and blanket are
tucked under together.

Be sure that linens are loose enough to Pressure ulcers can develop on client’s toes
allow movement of client’s feet. Making a and heels from feet rubbing against tight-
horizontal toe pleat is an option. fitting bed sheets.

37. Make modified mitered corner with Ensures top covers will not loosen easily.
top sheet, blanket, and spread.
Pick up side edge of top sheet, blanket and
spread approximately 45 cm (18in) from
foot of mattress. Lift linen to form
triangular fold, and lay it at bed.

Tuck lower edge of sheet, which is hanging

free below mattress, under mattress. Do not
pull triangular fold.

Pick up triangular fold, and bring it down Secures top linen but keeps even edge of
over mattress while holding linen on place blanket and top sheet draped over mattress.
along side of mattress. Do not tuck tip of
triangle.

38. Raise side rail. Make other side of Side rails protects from accidental fall.
bed; spread sheet, blanket and
bedspread out evenly. Fold top edge
of spread over blanket and make
cuff will top edge spread over
blanket and make cuff with top
sheet; make modified mitered
corner at foot of bed.
39. Change pillowcase:
a. Have client raise head. While Support of neck muscles prevents injury
supporting neck with one hand, during flexion and extension of neck.
remove pillow. Allow client to
lower head.
b. Remove soiled case by grasping Pillows slide out easily, thus minimizing
pillow at open end with one hand, contact with soiled linen.
remove pillow.
c. Grasp clean pillowcase at center of Eases sliding of pillowcase over pillow.
closed end. Gather case, turning it
inside out over the hand holding it.
With the same hand, pick up
middle of one end of the pillow.
Pull pillowcase down over pillow
with the other hand.
d. Be sure pillow corners fit evenly Poorly fitting case constricts fluffing and
into corners of pillow case. expansion of pillow and interferes with
Place pillow under client’s head. client comfort.
40. Place call light within client’s reach Ensures client safety and comfort.
and return bed to comfortable
 position.
41. Open room curtains, and rearrange Promote sense of well-being.
furniture. Place personal items
within easy reach on over-bed table
or bedside stand. Return bed to
comfortable height.
42. Discard dirty linen in hamper or Prevents transmission of microorganisms.
chute and perform hand hygiene.
43. As if client feels comfortable. Ensures bed linens are clean and smooth.
44. Inspect skin for areas of irritation. Folds in linens can cause pressure on skin.
45. Observe client for signs of fatigue, Provides you with data about client’s level
dyspnea, pain, or discomfort. of activity tolerance and ability to
participate in other procedures.