BED MAKING

Nurses need to be able to prepare hospital beds in different ways for

specific purposes. In most instances, beds are made after the client receives
hygienic care and when beds are unoccupied. At times, however, nurses
need to make an occupied bed or prepare a bed for a client who is having
surgery (an anesthetic, postoperative, or surgical bed). Regardless of what
type of bed equipment is available, whether the bed is occupied or
unoccupied, or the purpose for which the bed is being prepared, certain
practice guidelines pertain to all bed-making.
PRACTICE GUIDELINES

Wear gloves while handling a clients used bed linen. Linens and
equipment that have been soiled with secretions and excretions harbor
microorganisms that can be transmitted to others directly or by the
nurses hands or uniform. Wash hands after removing gloves.
Hold soiled linen away from uniform.
Linen for one client is never (even momentarily) placed on another
clients bed.
Place soiled linen 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.
Do not shake soiled linen in the air because shaking can disseminate
secretions and excretions and the microorganisms they contain.
When stripping and making a bed, conserve time and energy by
stripping and making up one side as much as possible before working
on the other side.
To avoid unnecessary trips to the linen supply area, gather all linen
before starting to strip a bed.

Unoccupied Bed
can be either closed or open
Open Unoccupied Bed
Generally the top covers are folded back (thus the term open
bed) to make it easier for a client to get in.
Closed Unoccupied Beds

Made the same way with open bed, except that the top
sheet, blanket, and bedspread of a closed bed are drawn up to
the top of the bed and under the pillows.

Beds are often changed after bed baths. The replacement clean linen
can be collected before the bath. The linen is not usually changed unless it is
soiled. Unfitted sheets, blankets, and bedspreads are mitered at the corners
of the bed. The purpose of mitering is to secure the bedclothes while the bed
is occupied.
CHANGING AN UNOCCUPIED BED
PURPOSES:
1. To conserve the clients energy
2. To promote client comfort
3. To provide a clean, neat environment for the client
4. To provide a smooth, wrinkle-free bed foundation, thus minimizing
sources of skin irritation
ASSESSMENT
Assess skin condition and need for a special mattress (e.g., an eggcrate mattress), footboard, or heel protectors.
Assess clients ability to reposition self. Rationale: This will determine if
additional assistance is needed.
Determine presence of incontinence or excessive drainage from other
sources indicating the need for protective waterproof pads.
Note specific orders or precautions for moving and positioning the
client.
EQUIPMENT:
Two flat sheets or one fitted and one flat sheet
Cloth drawsheet (optional)
One blanket
One bedspread
Incontinent pads (optional)
Pillowcase(s) for the head pillow(s)
Plastic laundry bag or portable linen hamper, if available
1.

PROCEDURE
Introduce yourself, and verify the
clients identity. Explain to the
client what you are going to do,
why it is necessary, and how the

RATIONALE
Enhances cooperation and
participation; reduces anxiety and
fear

2.

3.
4.

5.

6.
7.

8.

client can cooperate.

Perform hand hygiene, and
observe
other
appropriate
infection control procedures. Put
on disposable gloves, if then is
soiled with bodily fluids.
Provide for client privacy.
Place the fresh linen on the
clients chair or overbed table; do
not use another clients bed
Assess and assist the client out of
bed using assistive devices (e.g.,
cane, walker, safety belt) as
appropriate.
Make sure that this is an
appropriate and convenient time
for the client to be out of bed.
Assist the client to a comfortable
chair
Raise the bed to a comfortable
working height.
Apply clean gloves if linens and
equipment have been soiled with
secretions and/or excretions.
Strip the bed
Check bed linens for any items
belonging to the client, and
detach the call bell or any
drainage tubes from the bed
linen.
Loosen
all
bedding
systematically, starting at the
head of the bed on the far side
and moving around the bed up to
the head of the bed on the near
side.
Remove the pillowcases, if soiled,
and place the pillows on the
bedside chair near the foot of the
bed.

Reduces transmission of
microorganisms.

This prevents cross contamination

(the movement of microorganisms
from one client to another) via
soiled linen.
This ensures client safety.

For the nurses comfort during the

procedure.
Protect the nurse from harboring
microorganisms.

Moving around the bed

systematically prevents stretching
and reaching and possible muscle
strain.

Reduces transmission of
microorganisms.

Fold reusable linens, such as the

bedspread and top sheet on the
bed, into fourths. First, fold the
linen in half by bringing the top
edge even with the bottom edge,
and then grasp it at the center of
the middle fold and bottom
edges.
Remove the incontinent pad and
discard it if soiled.
Roll all soiled linen inside the
bottom sheet, hold it away from
your uniform, and place it directly
in the linen hamper, not on the
floor.
Grasp the mattress securely,
using the lugs if present, and
move the mattress up to the
head of the bed.

Folding linens saves time and

energy when reapplying the linens
on the bed and keeps them clean.

Reduces transmission of
microorganisms.
These actions are essential to
prevent
the
transmission
of
microorganisms to the nurse and
others.

Remove and discard gloves if Reduces

transmission
used. Perform hand hygiene.
microorganisms.
9.

Apply the bottom sheet and

drawsheet (optional).
If using a flat sheet, place the
folded bottom sheet with its
center fold on the center of the
bed. Make sure the sheet is hemside
down
for
a
smooth
foundation. Spread the sheet out
over the mattress, and allow a
sufficient amount of sheet at the
top to tuck under the mattress
If using a fitted sheet, pull sheet
over ends of mattress. Place the
flat sheet along the edge of the
mattress at the
foot of the bed and do not tuck it
in (unless it is a contour or fitted
sheet).

of

The top of the sheet needs to be

well tucked under to remain
securely in place, especially when
the head of the bed is elevated.

Miter the sheet at the top corner To secure the sheet

on the near side and tuck the
sheet
under
the
mattress,
working from the head of the bed
to the foot.
If a drawsheet is used, place it So that the center fold is at the
over the bottom sheet.
centerline of the bed and the top
and bottom edges extend from the
middle of where the clients back
would be on the bed to the area
Fanfold the uppermost half of the where the midthigh or knee would
folded drawsheet at the center or be.
far edge of the bed and tuck in
the near edge.
Optional: Before moving to the Completing one entire side of the
other side of the bed, place the bed at a time saves time and
top linens on the bed hem side energy.
up, unfold them, tuck them in,
and miter the bottom corners.
10 Move to the other side and
.
secure the bottom linens.
Tuck in the bottom sheet under To secure the bottom sheet.
the head of the mattress, pull the
sheet firmly, and miter the corner
of the sheet.
Pull the remainder of the sheet Wrinkles can cause discomfort for
firmly so that there are no the client and breakdown of skin.
wrinkles.
Tuck the sheet in at the side.
Tuck
in
the
drawsheet,
if To secure the drawsheet.
appropriate.
11 Apply or complete the top sheet,
.
blanket, and spread.
Place the top sheet, hem side up, So that its center fold is at the
on the bed.
center of the bed and the top edge
is even with the top edge of the
mattress.
Unfold the sheet over the bed.
Optional: Make a vertical or a To provide additional room for the
horizontal toe pleat in the sheet.
clients feet.
Vertical toe pleat: Make a fold
in the sheet 5 to 10 cm (2 to 4

12
.

in.) perpendicular to the foot

of the bed.

Horizontal toe pleat: Make a

fold in the sheet 5 to 10 cm (2
to 4 in.) across the bed near
the foot.
Loosening the top covers
around the feet after the client
is in bed is another way to
provide additional space.
Follow the same procedure for
the blanket and the spread, but
place the top edges about 15 cm
(6 in.) from the head of the bed.
Tuck in the sheet, blanket, and
spread at the foot of the bed, and
miter the corner, using all three
layers of linen. Leave the sides of
the top sheet, blanket, and
spread hanging freely unless toe
pleats were provided.
Fold the top of the top sheet
down over the spread, providing
a cuff.
Move to the other side of the bed
and secure the top bedding in the
same manner.
Put clean pillowcases on the
pillows as required.
Grasp the closed end of the
pillowcase at the center with one
hand.
Gather up the sides of the
pillowcase and place them over
the hand grasping the case. Then
grasp the center of one short side
of
the pillow
through the
pillowcase.
With the free hand, pull the
pillowcase over the pillow.

To allow a cuff of sheet to be folded

over them.

A cuff on the sheet makes it easier

for the client to pull the covers up.

Adjust the pillowcase so that the

pillow fits into the corners of the
case and the seams are straight.

13
.

14
.

A smoothly fitting pillowcase is

more comfortable than a wrinkled
one.

Place the pillows appropriately at

the head of the bed.
Provide for client comfort and
safety.
Attach the signal cord so that the
client can conveniently reach it.
If the bed is currently being used This makes it easier for the client to
by a client, either fold back the get into the bed.
top covers at one side or fanfold
them down to the center of the
bed.
Place the bedside table and the
overbed table so that they are
available to the client.
Leave the bed in the high
position if the client is returning
by stretcher, or place it in the low
position if the client is returning
to bed after being up.
Document and report pertinent
data
Bed-making is not normally
recorded.
Record any nursing
assessments, such as the
clients physical status and
pulse and respiratory rates
before and after being out of
bed, as indicated.

SURGICAL BED
Surgical bed is used for the client who is having surgery and will return
to bed for the postoperative phase.
When making a surgical bed, the linens are horizontally fanfolded to
facilitate transfer of the client into the bed. In some agencies, the client is
brought back to the unit on a stretcher and transferred to the bed in the
room. In other agencies, the clients bed is brought to the surgery suite and
the client is transferred there. In the latter situation, the bed needs to be
made with clean linens as soon as the client goes to surgery so that it can be
taken to the operating room when needed.
1.
2.

3.

4.

5.

6.

PROCEDURE
Strip the bed
Place and leave the pillows on
the bedside chair.

RATIONALE

Pillows are left on a chair to

facilitate transferring the client into
the bed.
Apply the bottom linens as for an A flannel bath blanket provides
unoccupied bed. Place a bath additional warmth
blanket on the foundation of the
bed if this is agency practice.
Place the top covers (sheet,
blanket, and bedspread) on the
bed as you would for an
unoccupied bed. Do not tuck
them in, miter the corners, or
make a toe pleat.
Make a cuff at the top of the bed
as you would for an unoccupied
bed. Fold the top linens up from
the bottom.
On the side of the bed where the
client will be transferred, fold up
the two outer corners of the top

linens so they meet in the middle

of the bed forming a triangle.
7.

Pick up the apex of the triangle

and fanfold the top linens
lengthwise to the other side of
the bed.
Leave the bed in high position
with the side rails down.
Lock the wheels of the bed if the
bed is not to be moved.

8.
9.

This facilitates the clients transfer

into the bed.

The high position facilitates the

transfer of the client.
Locking the wheels keeps the bed
from rolling when the client is
transferred from the stretcher to
the bed.

CHANGING AN OCCUPIED BED

GUIDELINES IN CHANGING AN OCCUPIED BED:

Maintain the client in good body alignment. Never move or position a

client in a manner that is contraindicated by the clients health. Obtain
help if necessary to ensure safety.
Move the client gently and smoothly. Rough handling can cause the
client discomfort and abrade the skin.
Explain what you plan to do throughout the procedure before you do it.
Use terms that the client can understand. Encourage client
participation when appropriate.
Use the bed-making time, like the bed bath time, to assess and meet
the clients needs.

PURPOSES
To conserve the clients energy
To promote client comfort
To provide a clean, neat environment for the client
To provide a smooth, wrinkle-free bed foundation, thus minimizing
sources of skin irritation
ASSESSMENT
Assess skin condition and need for a special mattress (e.g., an eggcrate mattress), footboard, or heel protectors.

Assess clients ability to reposition self. Rationale: This will determine if

additional assistance is needed.
Determine presence of incontinence or excessive drainage from other
sources indicating the need for protective waterproof pads.
Note specific orders or precautions for moving and positioning the
client.

EQUIPMENT
Two flat sheets or one fitted and one flat sheet
Cloth drawsheet (optional)
One blanket
One bedspread
Incontinent pads (optional)
Pillowcase(s) for the head pillow(s)
Plastic laundry bag or portable linen hamper, if available

1.

2.

3.
4.

PROCEDURE
Introduce yourself, and verify the
clients identity. Explain to the
client what you are going to do,
why it is necessary, and how the
client can cooperate.
Perform hand hygiene, and
observe other appropriate
infection control procedures. Put
on disposable gloves, if then is
soiled with bodily fluids.
Provide for client privacy.
Remove the top bedding.
Remove any equipment attached
to the bed linen, such as a signal
light.
Loosen all the top linen at the
foot of the bed, and remove the
spread and the blanket.
Leave the top sheet over the
client, or replace it with a bath
blanket as follows:
Spread the bath blanket over
the top sheet.
Ask the client to hold the top

RATIONALE
Enhances cooperation and
participation; reduces anxiety and
fear

Reduces transmission of
microorganisms.

5.

edge of the blanket.

Reaching under the blanket
from the side, grasp the top
edge of the sheet, and draw it
down to the foot of the bed,
leaving the blanket in place.
Remove the sheet from the
bed, and place it in the soiled
linen hamper.

Change the bottom sheet and

draw sheet.
Assist the client to turn on to side
facing away from the side where
the clean linen is.
Raise the side rail nearest the
client. If there is no side rail, have
another nurse support the client
at the edge of the bed.
Loosen the foundation of the
linen on the side of the bed near
the linen supply.
Fanfold the draw sheet and the
bottom sheet at the center of the
bed, as close to the client as
possible.
Place the new bottom sheet on
the bed, and vertically fanfold the
half to be used on the far side of
the bed as =close to the client as
possible. Tuck the sheet under
the near half of the bed, and
miter the corner if contour sheet
is not being used.
Place the clean draw sheet on the
bed with the center fold at the
center of the bed. Fanfold the
uppermost half vertically at the
center of the bed, and tuck the
near side edge under the side of
the mattress.

This protects clients from falling

and allows them to support
themselves in the side-lying
position.

Doing this leaves the near half of

the bed free to be changed.

Assist the client to roll over

toward you onto the clean side of
the bed. Have the client roll over
the fanfolded linen at the center
of the bed.
Move the pillows to the clean side
for the clients use. Raise the side
rail before leaving the side of the
bed.
Move to the other side of the bed,
and lower the side rail.
Remove the used linen, and place
it in the portable hamper.
Facing the side of the bed, use
both hands to pull the bottom
sheet so that it is smooth, and
tuck the excess under the side of
the mattress.
Unfold the fanfolded bottom
sheet, from the center of the bed.
Facing the side of the bed, use
both hands to pull the bottom
sheet so that it is smooth, and
tuck the excess under the side of
the mattress.
Unfold the drawsheet fanfolded
at the center of the bed, and pull
it tightly with both hands. Pull the
sheet in three sections:
Face the side of the bed to pull
the middle section.
Face the far top corner to pull
the bottom section.
Face the far bottom corner to
pull the top section.

6.

Tuck the excess drawsheet under

the side of the mattress.
Reposition the client in the center
of the bed.
Reposition the pillows at the

7.

8.

9.

center of the bed.

Assist the client to the center of
the bed. Determine what position
the client requires or prefers, and
assist the client to that position.
Apply or complete the top
bedding.
Spread the top sheet over the
client and either ask the client to
hold the top edge of the sheet or
tuck it under the shoulders. The
sheet should remain over the
client when the bath blanket or
used sheet is removed.
Complete the top of the bed.
Ensure the continued safety of
the client.
Raise the side rails. Place the bed
in the low position before leaving
the bedside.
Attach the signal cord to the bed
linen within the clients reach.
Put item used by the client within
easy reach.
Bed making is not normally
recorded.