NCM 103A FUNDAMENTALS OF NURSING
Bed Making
BED MAKING
Bed making is a procedure, which enables the nurse to make the bed.
Bed making procedure in nursing is a fundamental of nursing work. The systematic procedures
followed in bed-making are as follows :
• The uniform of nursing staff should not touch the bed while making a bed.
• Soiled linens should not be thrown on floor.
• First lift the mattress while loosening the bed-linen or removing the sheets. The sheets should not
be pulled forcefully.
• The bed linens should be folded from top to bottom or side to side. This applies to fold the
mattress also while making one unoccupied bed.
• As self precaution while tucking bedding under mattress, the palm of the hand should face
downwards to prevent injury of nails.
• The open end of the pillow should not face to the entrance of ward.
• The beds should be in one line for better look.
Bed making is one of the important nursing techniques to prepare various types of bed for patients or
clients to ensure comfort and useful position for a particular condition. The bed is especially important
for patients who are sick. The nurse plays inevitable role to ensure comfort and cleanliness for ill
patient. It should be adaptable to various positions as per patient’s need because they spend
varying amount of the day in bed.
Purposes of Bed Making:
Bed-making is a nursing art. The purpose of the bed-making should be patients or clients-centered.
The main purposes of bed-making are to prevent complications by ensuring comfort and security to
patient.
1. To provide rest and sleep.
2. To provide physical and psychological comfort and security to the patient.
3. To give the unit neat appearance and helps the bed & patient’s unit look tidy.
4. To establish an effective nurse patients relationship.
5. To provide active and passive exercise to the patient.
6. To promote fresh and cleanliness.
7. To develop skill in the posture/body alignment of the nurse in bed-making.
8. To observe, identify and prevent patient’s complications.
9. To accommodate the patient’s needs.
10. To reduce patient’s exertion by bed-making.
11. To eliminate irritants to skin from patient’s body, removes the dirt & germs from patient’s bed.
12. To dispose soiled and dirty linen properly.
13. Another purpose of bed-making is to save time, effort and material properly.
14. Enhances the esthetic looks of the patient’s unit.
A. On changing an unoccupied bed
– to promote the client's comfort
– to provide a clean near environment for the client
– to provide a smooth, wrinkle-free bed foundation, thus minimizing sources of skin
irritation
B. On changing an occupied bed
– to conserve the client's energy and maintain current healthy status
– to promote the client's comfort
– to provide a clean near environment for the client
– to provide a smooth, wrinkle-free bed foundation, thus minimizing sources of skin
irritation
IMPORTANCE OF BEDMAKING
1. It helps maintain a clean, orderly and comfortable room which contributes to the patients
sense of well-being.
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NCM 103A FUNDAMENTALS OF NURSING
Bed Making
2. Helps the patient secure proper rest and comfort which are essential for health and refresh
him/her by providing cleanliness
3. It helps prevent or avoid microorganisms to come in contact with the patient which could
cause tribulations.
4. It minimizes the sources of skin irritation by providing smooth, wrinkle-free bed foundation.
Types of Beds:
Nursing staff make different types of bed according to patient condition those are listed below:
1. Simple bed or unoccupied bed.
• Close bed (Admission bed),
• Open bed,
2. Occupied bed,
3. Cardiac bed,
4. Fowler’s bed,
5. Fracture bed,
6. Operation bed.
Principles involved in Bed Making:
Skillful bed making contributes patients comfort. Some basic principles of bed-making are pointed
below
1. It is important to learn that how to make a bed in such a way where least amount of energy
and time is required.
2. During bed-making, use good body movement and make each step purposeful.
3. Keep everything ready on bed side before starting bed-making.
4. Change bed linen frequently to assure cleanliness.
5. To ensure the patient need by providing a safe and comfortable bed.
6. It should have a finished appearance.
7. To make bed tight and free from wrinkles, place all linen straight line on the bed.
8. Prevent complications of prolonged bed ridden patient such as pressure sore.
9. Soiled linen or linen whether clean or dirty should not be thrown on the floor, but it is should be
kept in a dirty linen box.
10. After cleaning bed, dump soap water and disinfectant properly.
11. Try to prevent cross infection of microorganism during bed-making.
12. Ensure all bed-making in a nursing unit alike for uniformity of appearance.
Clean to unclean
Simple to complex
Principles of body mechanics
Principles of anatomy & physiology
Principles of microbiology
PRECAUTIONS TO BE TAKEN DURING BED MAKING:
1. The uniform of the nurse should not touch the bed while making a bed.
2. Soiled linen should not be thrown on floor.
3. First lift the mattress while loosening the bed linen or removing the sheets. The sheets should not
be pulled forcefully.
4. The bed linen should be folded from top to bottom or side-to-side. This applies to fold the
mattress also while making one unoccupied bed.
5. As self-precaution while tucking bedding under mattress, the palm of the hand should face
downwards to prevent injury of nails.
6. The open end of the pillow should not face to the entrance of ward.
7. The beds should be in one line for better look.
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NCM 103A FUNDAMENTALS OF NURSING
Bed Making
REMEMBER DURING BED MAKING IN HOSPITAL:
During bed-making we should remember some knowledge those are useful for us and also to patient.
1. During bed-making, bed position keep elevated and ensures nursing staff’s good body
alignments
2. During the procedure, the nurse should study her movements so as to avoid waste of time and
energy.
3. After completing, bed should be lower position.
4. During occupied bed making, confirm patient safety and comfort.
5. Wash hands before and after bed making and use gloves during bed-making.
6. Maintain privacy while making bed.
7. Keep soiled linen away from uniform which may have germs.
8. Do not shake dirty linen to prevent germs spread around room.
9. Do not mix soiled and clean linen during bed-making.
10. For bed ridden patient, mattress must be turned air and ensure free of lumps and fold.
DEFINITION OF TERMS
1.1 Bed making
– the ability of the nurse to keep the bed clean and comfortable
– the technique of preparing different types of bed in making patients/clients
comfortable in his/her suitable position for a particular condition
– it requires keen inspection to be sure that the linens are clean, dry and wrinkle-free
1.2 Fanfold
– is done by grasping the upper edge of the linen with both hands
– specifically folding the edge of the sheet used in the bed 6-8 inches outward
1.3 Mitered corner
– a means of anchoring sheets on mattresses
– method of folding the bed clothes at the corners to secure them in place while the bed
is occupied
– it is accomplished on the bottom sheet by placing the end of the sheet evenly under
the mattress
– folding the bedding at the corners when making a bed so that the sheet is tightly
stretched with no wrinkles.
1.4 Toe pleat
– a fold made in the top bed clothes to provide additional space for patient’s toes
1.5 Foot drop
– dropping of the foot from paralysis of the anterior muscle of the leg
– plantar flexion of the foot with permanent contracture of the gastrocnemius (calf)
muscle and tendon
1.6 Bed cradle
– is a curved, semi-circular device made of metal that can be placed over a portion of
the patient’s body
– is sometimes called an Anderson frame, is a device designed to keep the top
bedclothes off the feet, legs, and even abdomen of a client
1.7 Magic corner
– corners of a folded linen when upon opening it automatically positions the sheets the
way it is placed on the bed
RELATED TERMINOLOGIES
“Top of the bed” – refers to the top sheet, the blanket & the bedspread.
“Bottom of the bed” – refers to the mattress pad, if used; the bottom sheet & the draw sheets.
Draw sheet – small sheet made of plastic, rubber, or cotton placed across the middle of the bed to
cover & protect the bottom sheet & assist in moving the client.
Decubitus ulcer (bedsore) – open wound which occurs from lack of blood supply to an area usually
located on a bony prominence.
Seam – a line where 2 pieces of cloth have been sewn together.
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NCM 103A FUNDAMENTALS OF NURSING
Bed Making
Seamless – done or made so that you do not notice where part ends & another part begins.
TYPES OF BED
Bed
- is primarily divided into 3 sections
- length: 1.9m (6.5ft).
- weight: 0.9m (3ft.)
- high: 66cm (26in.)
- but sometimes varies depending on circumstances
A. Common Types of Bed
1. Occupied bed
the occupied bed is made when the patient is not able or not permitted to get out of the bed
the important part of making an occupied bed is to get the sheets smooth and tight under the
patient so that there will be no wrinkles to rub against the patient’s skin
the client’s privacy, comfort and safety is also important when making the bed
2. Unoccupied bed
• the unoccupied bed is made when there is no patient confined in bed
• A unoccupied bed may be:
A. Open bed
– the top covers are generally folded back so that a client can easily get into bed
– surgical, recovery and postoperative bed is a modified version of the open bed; the
top bed line is arranged for easy transfer of the client from a stretcher to the bed
– the top sheets are folded to one side or fanfolded to the bottom third of the bed
B. Close bed
– the top sheet blankets and bedspreads are drawn up to the head of the mattress and
under the pillows, this is prepared in a hospital room before a new client is admitted to
that room
C. Cradle Bed
– Contains cradle, a device for holding the top covers off.
– The outer cradle is made of wood, metal or at home for a brief period, a cardboard art
to shape.
D. Postoperative Bed
– Also known as recovery bed or anesthetic bed.
– Used not only for clients who have undergone surgical procedures but also for clients
who have given anesthetics for a certain examination.
– Used for a patient with a large cast or other circumstance that would make it difficult
for him to transfer easily into bed.
B. Special Types of Beds
1. Water bed
Special mattress filled with water.
It controls temperature of water reducing pressure on body parts.
Indications:
Patients confined to bed for long periods
2. Turning Frames (Stryker Wedge)
– It allows repeated changes between the supine and prone positions without disturbing
spinal alignment.
– Indications:
complication of immobility such as atelectasis, pneumonia, decubitus ulcer and renal calculi.
3. Rotation Bed
– promote postural drainage, peristalsis and helps prevent the complications of mobility
–
Indication:
patients with spinal cord injury, severe burns
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NCM 103A FUNDAMENTALS OF NURSING
Bed Making
4. Circolectric Bed
– Permits frequent turning of several injured or immobilized patient with minimal trauma or
extraneous movement.
– Helps prevent and treat pressure ulcers, respiratory and circulatory complications
– Indications:
Patients confined to bed for long periods of time
5. Clinton Therapy Bed
– Also called the air-fluidized bed
– Designed for managing burns and patients with various disabilities.
– Indications:
Patients with managing burns and patients with various disabilities.
6. Air Therapy Bed
– For patients who have risk skin breakdown
– Provide different levels of support to different body parts.
– Indications
Patients who are at risk to skin breakdown
• COMMON BED POSITIONS
➢ Contour
Head section is elevated; the knee and foot section are elevated.
➢ Indications: used for certain injuries or disease of the lower extremities.
PRINCIPLES IN BEDMAKING
• BODY MECHANICS
it is important to the nurse to observe the correct body mechanics in order to prevent quick tiring,
back problems and muscle pain.
• ANATOMY & PHYSIOLOGY
the conscious knowledge of the normal state and condition of certain parts of the body wherein one
would be able to tell any abnormality.
the body exerts uneven points of pressure against different areas of the mattress. The sacrum may
become the site for pre-assure sore because of the weight of the patient’s body and a reduced
blood supply to the tissues over bony prominence.
• CHEMISTRY
woolen blanket fibers may cause irritation to the patient’s skin; there must always be a sheet to
separate the blanket from the patient
strong detergent, soap and bleaches used in commercial laundries may cause skin irritation if bed
linens are not thoroughly rinsed
• MICROBIOLOGY
pathogenic microorganism may be transferred from the source to a new host directly by
contaminated linen. Hands should be washed before and after making bed.
bed linen should be folded away from the body to minimize the transfer microorganism to the
clothing
fanning bed clothing stirs up bacteria in the air, and air motion is a method of transfer.
• PHYSICS
friction can irritate the skin and cause rashes. It is therefore appropriate to keep the lines smooth and
wrinkle-free.
stability of body (center of gravity over its base)
• PSYCHOLOGY
use skill and efficiency in making the bed to minimize undue exertion and fatigue for the patient. If
the procedure brings comfort and relaxation, his attitude will improve.
• SOCIOLOGY
the nurse should know how to talk to patients. The nurse should also know the subject of conversation
which interests the patient including his condition, family, and work.
KINDS OF LINENS
1. Blanket
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NCM 103A FUNDAMENTALS OF NURSING
Bed Making
a large piece of cloth often soft, woolen and is used for warmth as a bed cover
2. Top sheet
used to cover the patient to provide warmth, made of thick cotton, thermal material
3. Cotton drawn sheet
a piece of cloth that covers the rubber sheet and is used to absorb and protect moisture
4. Bottom sheet
used to cover the bed after mattress cover
5. Rubber sheet
• used to protect the bottom sheet from soothing due to patient secretions and prevent the
patients from getting bedsore. It is usually placed over the center of the bottom sheet
6. Mattress cover
• a piece of cloth to cover the mattress
7. Woolen blanket
• a large rectangle piece of cloth of soft fabric often either bound edges used especially for
warmth as a bed covering. It should be light, warm and large enough to cover the shoulder
and to tuck in well at the foot and to extend over sides.
GUIDELINES IN BEDMAKING
1. Wash hands thoroughly after handling client’s bed linen.
2. Hold soiled linens away from the body.
3. Linen for one client is never placed on another client’s bed.
4. Soiled linen is placed directly in a portable linen hamper or tucked into a pillow case at the
end of the bed before it is gathered up for disposal in the linen hamper or in linen chute.
Pillowcase is then tied and labeled with: name, room number, communicable/noncommunicable
5. Soiled linen is never shaken in air.
6. When stripping and making a bed, conserve time and energy by stripping and making up one
side as completely as possible before working on the other side.
7. Gather all needed linen before starting to strip the bed.
8. Keep the patient’s environment as clean and as neat as possible.
BEGINNING SKILLS IN BEDMAKING
A. STRIPPING THE BED
Removal of used linen and the airing of the mattress.
Procedure:
1. Place chair at the foot of the bed.
2. Remove pillow case from pillow. Place pillow on chair. Place soiled pillow case on lower
bar of the bed.
3. Loosen all bed linens starting at center of head of bed, raising the mattress with one
hand and drawing out bed clothes with other.
4. Remove sheets separately. Fold each linen with soiled part inside. Wrap them all in a
sheet and place on lower bar of the bed.
5. Roll rubber sheet and place on chair.
6. Remove mattress cover.
7. Arranging clean bed linens on patient’s bed ready for admission.
Equipment: a. mattress cover
e. top sheet
b. bottom sheet
f. pillow cases - 2
c. rubber sheet
g. blanket
d. cotton draw sheet
Procedure:
1. Refold each sheet according to its system of use.
2. Place clean linens on chair in order of use. See to it that the bed is flat.
3. Cover mattress.
4. Place bottom sheet with center fold in center in line with rim of mattress at foot part. Spread
across bed. Make mitered corner of head part. Tuck extra sheet at side from head to foot.
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NCM 103A FUNDAMENTALS OF NURSING
Bed Making
5. Put rubber sheet 12-15 inches from the head of mattress. Cover with drawsheet. Spread across
bed. Tuck together extra length.
6. Place topsheet in line with mattress at head part and spread across bed. Tuck extra length of
sheet at foot part. Miter corners. Allow to hang free at sides.
7. Go to opposite side and repeat same procedure.
8. Put pillow case on pillow. To put on, grasp middle of slip’s bottom. Flip open and grasp short
side of pillow. Pull pillow slip over body of pillow.
9. Spread top sheet over pillow.
10. Pull folds of clean sheets into place. Tuck bottom sheet at head part and miter at the side.
11. Tighten rubber sheet and draw sheet. Tuck together with bottom sheet.
12. Help patient to roll on his back at center of bed.
13. Place clean fanfolded sheet over patient. Cover shoulders. Draw fanfolded sheet together
with used top sheet at foot part.
14. Tuck clean top sheet at foot part. Miter corner.
15. Fit pillow into pillow case.
16. Fold dirty linens separately. Wrap in one sheet.
17. Carry soiled linens to laundry.
Making an Unoccupied Bed
Safety
• Follow infection control guidelines, because bed making increases the risk of exposure to—
and transmission of—microorganisms. Be sure to wear clean gloves to remove soiled linen.
Hold soiled linen away from your uniform, and avoid shaking or fanning it.
• Use proper body mechanics when making a bed.
• Assess the environment for safety; check the room for spills, make sure equipment is working
properly, and ensure that the bed is in the locked, low position.
• Remember to lower the side rails when preparing to make the bed.
• Check the position of the chair for transfer.
Equipment List for Making an Unoccupied Bed
• Linen bag or hamper
• Mattress pad (optional, change only when soiled)
• Bottom sheet (flat or fitted)
• Top sheet
• Drawsheet (optional)
• Large, quilted waterproof pads
• Bath blanket
• Bedspread
• Pillowcases
• Bedside chair or table
• Clean gloves
• Washcloth
• Towel
• Antiseptic cleanser
Delegation
The skill of making an unoccupied bed can be delegated to nursing assistive personnel (NAP). Before
delegating, be sure to inform the NAP of the following:
• Any position or activity restrictions that affect the patient’s ability to get out of bed.
• Any special linen instructions if the patient is on an airflow mattress.
• Specify that Standard Precautions are to be used when making an unoccupied bed.
Preparation
• Gather all needed equipment and supplies
• Wear gloves when removing soiled linen.
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NCM 103A FUNDAMENTALS OF NURSING
Bed Making
•
•
Assess activity orders or restrictions on mobility or positioning, to ensure that the patient can
get out of bed for the procedure.
Help the patient into a bedside chair, or plan to make the bed when the patient is out of the
room.
Procedural Guideline for Making an Unoccupied Bed
1. Perform hand hygiene.
2. Assess the environment for safety, such as checking the room for spills, making sure equipment is
working properly, and ensuring that the bed is in the locked, low position. Check the position of
the chair for transfer. Pull the room divider curtain or close the room door to provide privacy.
3. Assess activity orders and mobility restrictions in deciding whether the patient can get out of bed
for the procedure. Help the patient into a bedside recliner or other chair.
4. Clean linen should be stacked in the order that it will be used. Apply gloves to remove the soiled
linen.
5. Lower the side rails on both sides of the bed, and raise the bed to a comfortable working height.
Loosen the top linen at the foot of the bed. Remove the bedspread and blankets separately. If
they are soiled, place them in a linen bag or linen hamper, holding them away from your uniform.
If the blanket or bedspread is to be reused, fold into a square and place on the chair. Remove
the pillowcase and leave it on the bed. Place the pillow on the chair.
6. Move to the other side of the bed and lower the side rail. Remove the soiled linen, holding it away
from your uniform and placing it in a linen bag or linen hamper. Avoid shaking or fanning the
linen.
7. Reposition the mattress, and wipe off any moisture using a washcloth moistened with antiseptic
solution (consult agency housekeeping policy). Dry thoroughly.
8. Apply all bottom linen on one side of the bed before moving to the opposite side.
A. For a fitted sheet: Make sure the fitted sheet is placed smoothly over the mattress and over the
top and bottom mattress edges. Fit the corners on one end and then on the other.
B. For a flat sheet: Place the sheet over the mattress. Allow about 25 cm (10 inches) to hang over
the side edge of the mattress. The lower hem of the sheet should lie seam down and even with
the bottom edge of the mattress. Pull the remaining top portion of the sheet over the top edge of
the mattress. While standing at the head of the bed, miter the top corner of the bottom sheet. To
miter a corner, pick up the top of the sheet about 45 cm (18 inches) from the top of the mattress.
Lift the sheet and lay it on top of the mattress to form a triangular fold, with the lower base of the
triangle even with the side edges of the mattress. Tuck in the lower edge of the sheet, which is
hanging free under the mattress. Hold the portion of the sheet covering the side of the mattress in
place with one hand. With the other hand, pick up the triangular linen fold and bring it down over
the side of the mattress. Tuck with your palms down, without pulling the triangular fold. Tuck this
portion under the mattress. Tuck the remaining portion of the sheet under the mattress, moving
toward the foot of the bed. Keep the linen smooth.
C. Optional: Apply a drawsheet and/or a waterproof pad, laying the center fold lengthwise along
the middle of the bed. Smooth the drawsheet and/or waterproof pad over the mattress, and tuck
the excess edge under the mattress, keeping your palms down.
9. Move to the opposite side of the bed, and spread the bottom sheet smoothly over the edge of
the mattress, from the head to the foot of the bed.
A. For a fitted sheet: Make sure the fitted sheet is placed smoothly over the mattress, from the head
to the foot of the bed and over the mattress edges.
B. For a flat sheet: Miter the top corner of the bottom sheet, making sure the corner is taut. Grasp the
remaining edge of the flat bottom sheet, and tuck it tightly under the mattress while moving from
the head to the foot of the bed.
10. Smooth the waterproof pad or folded drawsheet over the bottom sheet, and tuck it under the
mattress, first in the middle, then at the top, and then at the bottom.
11. Place the top sheet over the bed with the vertical centerfold positioned lengthwise down the
middle of the bed. Open the sheet out from head to foot, being sure the top edge of the sheet is
even with the top edge of the mattress.
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NCM 103A FUNDAMENTALS OF NURSING
Bed Making
12. Tuck in the remaining portion of the sheet under the foot of the mattress. Then place the blanket
over the bed, with the top edge parallel to the top edge of the sheet and 15 to 20 cm (6 to 8
inches) down from the edge of the sheet. (Optional: Apply an additional bedspread over the
bed.)
13. Make a cuff by turning the edge of the top sheet down over the top edge of the blanket and
bedspread.
14. Standing on one side at the foot of the bed, lift the mattress corner slightly with one hand, and
with other hand tuck the top sheet, blanket, and bedspread under the mattress. Make a modified
mitered corner with the top sheet, blanket, and bedspread. After making a triangular fold, do not
tuck the tip of the triangle.
15. Go to the other side of the bed. Make a horizontal toe pleat: stand at the foot of the bed and
fanfold the sheet 5 to 10 cm (2 to 4 inches) across the bed. Pull the sheet up from the bottom to a
make the fold approximately 15 cm (6 inches) from the bottom edge of the mattress.
16. Fanfold the sheet, blanket, and bedspread at the foot of the bed, with the top layer ready to be
pulled up (this leaves an open bed).
17. Apply a clean pillowcase. Pick up the center of the closed end of the pillowcase. Hold the
pillowcase with a firm grip in one hand. With the other hand, open the pillowcase from the open
end and fold the back over the closed end (inside-out). Pick up the pillow with the hand holding
the pillowcase. Invert the pillow for the pillowcase to drape over the pillow. Pull the pillowcase
over the pillow with the other hand. Do not place the pillow or pillowcase under the chin, in the
teeth, or under the arms. Adjust the corners of the pillowcase with the hands between the
pillowcase and the pillow. Do not shake the pillow to position the pillowcase.
18. Place the call light within the patient’s reach on the bed rail or pillow, and return the bed to its
lowest position, to allow for patient transfer. Help the patient into bed.
19. Place the linen bag into an appropriate receptacle. Remove and dispose of your gloves.
20. Arrange and organize the patient’s room, and perform hand hygiene.
Follow-up
• Help the patient back to bed.
• Ensure that the call light is within the patient’s reach on the bed rail or pillow.
• Ask if the patient is comfortable.
• Periodically check the linen for cleanliness and tightness.
Making an Occupied Bed
Safety
• Use Standard Precautions to make an occupied bed.
• Assess the environment for safety before caring for a patient. Check the floor for spills, and
make sure all equipment is working properly.
• Be aware of the positions in which the patient may be turned while making the bed, so that
the patient remains safe at all times.
• If the patient is on aspiration precautions or has a respiratory condition, keep the head of the
bed no lower than a 30-degree angle.
• If you are making the bed without assistance, ensure that the side rails on the opposite side of
the bed are raised, so that the patient does not roll out of the bed.
• Assess the patient’s ability to reposition himself or herself, and consider making the bed with
another person to ensure the patient’s safety.
Equipment List for Making an Occupied Bed
•
•
•
•
•
•
Linen bag
Mattress pad (optional; change only when soiled)
Two flat sheets or one fitted and one flat sheet
Waterproof pads (optional)
Drawsheet (optional)
Pillowcases
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NCM 103A FUNDAMENTALS OF NURSING
Bed Making
•
•
•
•
•
•
Bedspread
Bedside chair or table
Clean gloves
Towels or washcloths
Bath blanket
Antiseptic cleanser
Delegation
The skill of making an occupied bed can be delegated to nursing assistive personnel (NAP). Be
sure to inform NAP of the following:
• Specify that Standard Precautions are to be used to make an occupied bed.
• Discuss any patient positions to avoid or activity restrictions to observe.
• Explain how to look in the linen for wound drainage, drainage from tubes, or IV tubing.
• Specify when to obtain help with positioning the patient during the linen change, in
order to observe good body mechanics and support the patient’s alignment.
• Review the following if the patient is on aspiration precautions:
o Keep the head of the bed no lower than a 30-degree angle.
o Report to you immediately if any excessive coughing or choking occurs during
the procedure.
Preparation
• Use Standard Precautions to make an occupied bed. Apply gloves if the linen is soiled
or if there is a risk of contact with blood or bodily fluids.
• If prescribed, administer an analgesic to the patient 30 to 60 minutes before the
procedure.
• Assess the environment for safety; check the room for spills, make sure equipment is
working properly, and ensure that the bed is in the locked, low position.
• Pull the room divider curtain or close the door to provide privacy.
• Determine if the patient has been incontinent or if there is excess drainage on the linen.
• Assess the patient for mobility or positioning restrictions. Explain the procedure to the
patient, including that he or she will be asked to roll over layers of linen.
• Assemble all equipment on the bedside table.
Procedural Guideline for Making an Occupied Bed
1. Perform hand hygiene.
2. Verify the health care provider’s orders. Assess any activity or mobility restrictions that
might affect patient position as the patient safety and comfort are of the utmost
priority.
3. Assemble the necessary equipment and supplies on the bedside table.
4. Provide for the patient’s privacy.
5. Introduce yourself to the patient and family if present.
6. Identify the patient using two identifiers, such as name and date of birth or name and
account number, according to agency policy. Compare these identifiers with the
information on the patient’s identification bracelet.
7. Explain the procedure to the patient. Check the floor for spills. Make sure the bed is in
locked position. Assemble the linen on a clean, dry bedside table and in order of use.
8. Raise the bed to a comfortable working height, and lower the head of the bed as
much as the patient can comfortably tolerate. If the patient is on aspiration
precautions, keep the head of the bed no lower than a 30-degree angle.
9. Apply a clean pair of gloves.
10. Loosen the top linen at the foot of the bed.
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NCM 103A FUNDAMENTALS OF NURSING
Bed Making
11. Remove the bedspread and blanket separately. If they are soiled, place them in the
linen bag. If either is to be reused, fold the item into a square and place it over the
back of a chair.
12. Cover the patient with a bath blanket, placing it over the topsheet. Have the patient
hold the top edge of the bath blanket, or tuck the blanket under the patient’s
shoulders. Reach beneath the blanket and remove the topsheet. Discard the topsheet
in the linen bag.
13. Lower the side rail on your side of the bed. Help the patient into a side-lying position,
facing away from you. Encourage the patient to use the side rail to turn. Then adjust
the pillow under the patient’s head.
14. Make sure no tension has been placed on any external medical devices, such as
indwelling urinary catheters, wound drains, or intravenous tubing.
15. Stand on one side of the bed. Loosen the bottom linens, moving from the head to the
foot of the bed. Fanfold or roll the bottom sheet and drawsheet or waterproof pad
toward and under the patient. Tuck the edges of old bottom linen alongside the
patient’s buttocks, back, and shoulders. Clean, disinfect, and dry the mattress surface,
if necessary.
16. Remove gloves and perform hand hygiene.
17. Apply clean linens to the exposed half of the bed in separate layers. Place the fitted
bottom sheet on the bed lengthwise. Secure the top and bottom corners on the near
side with the center crease in the middle of the bed. Fanfold this layer of bedding to
the center of the bed alongside the patient’s torso. Repeat this process with the
bottom sheet and the drawsheet or waterproof pad.
Follow-up
• Ask if the patient is comfortable.
• Observe the patient for signs of fatigue, dyspnea, pain, or discomfort.
• Periodically check the linen for cleanliness and tightness.
Making a Surgical Bed
Safety
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Use Standard Precautions when making a surgical bed.
Be sure to wear clean gloves to remove soiled linen. Hold soiled linen away from your
uniform, and avoid shaking or fanning it.
Assess the environment for safety, such as checking the room for spills and making sure
equipment is working properly.
Use proper body mechanics when making a surgical bed.
Be sure to lock the wheels on the bed to prevent accidental movement while making
the bed.
Remember to lower the side rails when preparing to make the bed.
Equipment List for Making a Surgical Bed
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Linen bag or hamper
Mattress pad (optional, change only when soiled)
Bottom sheet (flat or fitted)
Drawsheet (optional)
Large, quilted waterproof pad (optional)
Top sheet
Bath blanket
Bedspread
Pillowcases
Clean gloves (if linen is soiled or there is a risk of exposure to bodily fluids)
Antiseptic cleanser
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NCM 103A FUNDAMENTALS OF NURSING
Bed Making
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Towels or washcloth
Delegation
The skill of making a surgical bed can be delegated to nursing assistive personnel (NAP). Be
sure to inform NAP of the following:
• Specify that Standard Precautions are to be used when making a surgical bed.
• Specify any position or activity restrictions that can be expected when the patient
returns.
• Specify any special linen instructions, such as when the patient is on an airflow mattress.
Preparation
• Perform hand hygiene
• Use Standard Precautions when making a surgical bed. Wear gloves when removing
soiled linen. Assess the environment for safety, such as checking the room for spills and
making sure equipment is working properly.
• Assemble all equipment on the clean and dry bedside table.
• Use body mechanics principles when making the bed.
• Adjust the bed to working height. Lower the side rails.
Procedural Guideline for Making a Surgical Bed
1. Perform hand hygiene.
2. Make sure the unoccupied bed is in the locked position.
3. Raise the bed to a comfortable working height. Lower the side rails on the side you will
work on first.
4. Apply clean gloves. Remove the soiled linen and place it in the linen bag, taking care
not to contact your uniform. Avoid shaking or fanning the linen.
5. Clean the mattress with antiseptic solution according to agency policy. Dry the
mattress thoroughly. Remove and discard your gloves, and perform hand hygiene.
6. To make a surgical bed, the linen is used in the same order as when making an
unoccupied bed. See the video for making an unoccupied bed.
A. For a fitted sheet: Make sure the fitted sheet is placed smoothly over the mattress and
over the top and bottom mattress edges. Fit the corners on one end and then on the
other.
B. For a flat sheet: Place the sheet over the mattress. Allow about 25 cm (10 inches) to
hang over the side edge of the mattress. The lower hem of the sheet should lie seam
down and even with the bottom edge of the mattress. Pull the remaining top portion of
the sheet over the top edge of the mattress. While standing at the head of the bed,
miter the top corner of the bottom sheet.
A. To miter a corner, pick up the top of the sheet about 45 cm (18 inches) from the top of
the mattress. Lift the sheet and lay it on top of the mattress to form a triangular fold,
with the lower base of the triangle even with the side edges of the mattress. Tuck in the
lower edge of the sheet, which is hanging free under the mattress. Hold the portion of
the sheet covering the side of the mattress in place with one hand. With the other
hand, pick up the triangular linen fold and bring it down over the side of the mattress.
Tuck with your palms down, without pulling the triangular fold. Tuck this portion under
the mattress. Tuck the remaining portion of the sheet under the mattress, moving
toward the foot of the bed. Keep the linen smooth. Move to the opposite side of the
bed. Repeat.
B. Optional: Apply a waterproof pad or draw sheet, laying the centerfold along the
middle of the bed lengthwise. Smooth the waterproof pad over the bottom sheet. If
using a draw sheet, smooth over the mattress and tuck the excess edge under the
mattress.
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NCM 103A FUNDAMENTALS OF NURSING
Bed Making
7. Place the top sheet over the bed, with the vertical centerfold positioned lengthwise
down the middle of the bed. Open the sheet out from head to foot, being sure the top
edge of the sheet is even with the top edge of the mattress. An option is to spread a
blanket or bedspread evenly over the bed in the same fashion.
8. At the top of the bed, make a cuff by turning the edge of the top sheet down. Turn
sheet down over the top edge of the blanket or bedspread (if used). Fold all the excess
linen from the foot of the bed to the center of the mattress so that the linen is even at
the foot of the mattress.
9. Fold the corners toward the opposite side of the bed to form a triangle. Fold the
hanging portion up. Move to the other side and finish making the bed.
10. Fanfold the linen toward you on the side of the bed opposite that on which the patient
will be transferred.
11. Apply a clean pillowcase and lay the pillow at the head of the bed. View the steps for
applying a pillowcase in the video for making an unoccupied bed.
A. Apply a clean pillowcase. Pick up the center of the closed end of the pillowcase. Hold
the pillowcase with a firm grip in one hand. With the other hand, open the pillowcase
from the open end and fold the back over the closed end (inside-out). Pick up the
pillow with the hand holding the pillowcase. Invert the pillow for the pillowcase to
drape over the pillow. Pull the pillowcase over the pillow with the other hand. Do not
place the pillow or pillowcase under the chin, in the teeth, or under the arms. Adjust the
corners of the pillowcase with the hands between the pillowcase and the pillow. Do not
shake the pillow to position the pillowcase.
12. Leave all the side rails down, and place the bed in the high position to match the
height of the stretcher.
13. Perform hand hygiene.
Follow-up
• Transfer the patient into bed.
• Ask if the patient is comfortable.
• Ensure that the call light is within the patient's reach.
• Periodically check the linen for cleanliness and tightness.
Documentation
The making of a surgical bed is not documented in the medical record.
Proverbs 2:6 The Passion Translation (TPT)
Wisdom is a gift from a generous God,
and every word he speaks is full of revelation
and becomes a fountain of understanding within you
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