Bedmaking

Objectives

• Define the key terms listed in this chapter.

• Describe open, closed, occupied, and surgical beds.

• Explain when to change linens.

• Explain how to use drawsheets.

• Handle linens following the rules of medical asepsis.

• Perform the procedures described in this chapter.

• Explain how to promote quality of life.

Key terms

cotton drawsheet A drawsheet made of cotton; it helps keep the mattress and bottom linens clean

drawsheet A small sheet placed over the middle of the bottom sheet

waterproof drawsheet A drawsheet made of plastic, rubber, or absorbent material used to protect the mattress and bottom linens from dampness and soiling

Most residents are up during the day. Some are always in bed. Food, fluid, hygiene, and elimination needs are met while in bed. Some persons are incontinent of urine or feces. Clean, dry, wrinkle-free linens are important for all residents to:

• Promote comfort

• Prevent skin breakdown and pressure ulcers

Beds are made every day. They are usually made in the morning after baths. Or they are made while the person is in the chair or out of the room. Beds are made and rooms straightened before visitors arrive.

To keep beds neat and clean:

• Straighten linens whenever loose or wrinkled.

• Straighten loose or wrinkled linens at bedtime.

• Check for and remove food and crumbs after meals.

• Check linens for dentures, eyeglasses, hearing aids, sharp objects, and other items.

• Change linens whenever they become wet, soiled, or damp.

• Follow Standard Precautions and the Bloodborne Pathogen Standard. Contact with blood, body fluids, secretions, or excretions is likely.

Types of beds

Beds are made in these ways:

• A closed bed is not used until bedtime (Fig. 19-1). Or the bed is ready for a new resident. Top linens are not folded back.

• An open bed is in use. Top linens are fan-folded back so the person can get into bed. A closed bed becomes an open bed by fan-folding back the top linens (Fig. 19-2).

• An occupied bed is made with the person in it (Fig. 19-3).

• A surgical bed is made to transfer a person from a stretcher (Fig. 19-4). This bed also is made for persons who arrive by ambulance.

Linens

In nursing centers, linens are not changed every day. The center is the person’s home. People do not change linens every day at home. A complete linen change is usually done on the person’s bath day. This may be once or twice a week. Pillowcases, top and bottom sheets, and drawsheets (if used) are changed twice a week. Linens are always changed if wet, damp, soiled, or very wrinkled.

Handling linens

When handling linens and making beds, practice medical asepsis. Your uniform is considered dirty. Always hold linens away from your body and uniform. Never shake linens. Shaking spreads microbes. Place clean linens on a clean surface. Never put clean or dirty linens on the floor.

Collect enough linens. If the person has two pillows, get two pillowcases. The person may need extra blankets for warmth. Do not bring unneeded linens to a person’s room. Once in the person’s room, extra linen is considered contaminated. Do not use it for another person.

Collect linens in the order you will use them:

• Mattress pad (if needed)

• Bottom sheet (flat or fitted)

• Waterproof drawsheet or waterproof pad (if needed)

• Cotton drawsheet (if needed)

Use one arm to hold the linens. Use your other hand to pick them up. The first item to use is at the bottom of your stack. (You picked up the mattress pad first. It is at the bottom. The bath blanket is on top.) You need the mattress pad first. To get it on top, place your arm over the bath blanket. Then turn the stack over onto the arm on the bath blanket (Fig. 19-5). The arm that held the linens is now free. Place the clean linen on a clean surface.

Fig. 19-5 Collecting linens. Linens are held away from the body and uniform. A, The arm is placed over the top of the stack of linens. B, The stack of linens is turned onto the arm. Note that the linens are held away from the body.

Remove dirty linen one piece at a time. Roll each piece away from you. The side that touched the person is inside the roll and away from you (Fig. 19-6).

Fig. 19-6 Roll dirty linen away from you.

Drawsheets

A drawsheet is a small sheet placed over the middle of the bottom sheet.

• A cotton drawsheet is made of cotton. It helps keep the mattress and bottom linens clean.

• A waterproof drawsheet is made of plastic, rubber, or absorbent material. It protects the mattress and bottom linens from dampness and soiling. Some are rubber or plastic on one side—the waterproof side. The waterproof side is placed down, away from the person. The other side is cotton. It is placed up, toward the person. Other waterproof drawsheets are disposable. They are discarded when wet, soiled, or wrinkled.

The cotton drawsheet protects the person from contact with plastic or rubber and absorbs moisture. However, discomfort and skin breakdown may occur. Plastic and rubber retain heat. Waterproof drawsheets are hard to keep tight and wrinkle-free. Many centers use incontinence products (Chapter 22) to keep the person and linens dry. Others use waterproof pads or disposable bed protectors (Fig. 19-7).

Fig. 19-7 A, Waterproof pad. B, Disposable bed protector.

Cotton drawsheets are often used without waterproof drawsheets. Plastic-covered mattresses cause some persons to perspire heavily. This causes discomfort. A cotton drawsheet reduces heat retention and absorbs moisture. Cotton drawsheets are often used as assist devices to move and transfer persons in bed (Chapter 17). If used as an assist device, do not tuck it in at the sides.

The procedures that follow include waterproof and cotton drawsheets. This is so you learn how to use them. Ask the nurse about the type used in your center.

Making beds

Safety and medical asepsis are important for bedmaking. Follow the rules in Box 19-1.

Box 19-1

Rules for Bedmaking

• Use good body mechanics at all times (Chapter 16).

• Follow the rules in Chapter 17 to safely handle, move, and transfer the person.

• Follow the rules of medical asepsis.

• Follow Standard Precautions and the Bloodborne Pathogen Standard.

• Practice hand hygiene before handling clean linen.

• Practice hand hygiene after handling dirty linen.

• Bring enough linen to the person’s room. Do not bring extra linens.

• Bring only the linens that you will need. You cannot use extra linen for another person.

• Place clean linen on a clean surface. Use the bedside chair, overbed table, or bedside stand. Place a barrier (towel, paper towels) between the clean surface and the linens if required by center policy.

• Do not use extra linen in the person’s room for another resident. Extra linen is considered contaminated. Put it with the dirty laundry.

• Do not use torn or frayed linen.

• Never shake linens. Shaking spreads microbes.

• Hold linens away from your body and uniform. Do not let dirty or clean linen touch your uniform.

• Never put dirty linens on the floor or on clean linens. Follow center policy for dirty linen.

• Keep bottom linens tucked in and wrinkle-free.

• Cover a waterproof drawsheet with a cotton drawsheet. Plastic or rubber must not touch the person’s body.

• Straighten and tighten loose sheets, blankets, and bedspreads as needed.

• Make as much of one side of the bed as possible before going to the other side. This saves time and energy.

• Change wet, damp, and soiled linens right away.

See Delegation Guidelines: Making Beds.

DELEGATION GUIDELINES

Making Beds

Before making a bed, you need this information from the nurse and the care plan:

• What type of bed to make—closed, open, occupied, or surgical.

• If you need to use a cotton drawsheet.

• If you need to use a waterproof drawsheet, waterproof pad, or incontinence product.

• Position restrictions or limits in the person’s movement or activity.

• If the person uses bed rails.

• The person’s treatment, therapy, and activity schedule. For example, Mr. Smith needs a treatment in bed. Change linens after the treatment. Make Mrs. Carter’s bed while she is in physical therapy.

• How to position the person and the positioning devices needed.

• If the bed needs to be locked into a certain position (Chapter 18).

• When to report observations.

• What specific resident concerns to report at once.

See Promoting Safety and Comfort: Making Beds.

PROMOTING SAFETY AND COMFORT

Making Beds

Safety

You need to raise the bed for body mechanics. The bed also must be flat. If the bed is locked, unlock it. Then adjust the bed. Return the bed to the correct position when you are done. Then lock the bed.

Wear gloves when removing linen from the person’s bed. Also follow other aspects of Standard Precautions and the Bloodborne Pathogen Standard. Linens may contain blood, body fluids, secretions, or excretions.

After making a bed, lower the bed to a level appropriate for the person. Follow the care plan. For an occupied bed, raise or lower bed rails according to the care plan.

Comfort

For an occupied bed, cover the person with a bath blanket before removing the top sheet. Do not leave the person uncovered when making the bed. The bath blanket provides for warmth and privacy.

If the person uses a pillow, adjust it as needed during the procedure. After the procedure, position the person as directed by the nurse and the care plan. Always make sure linens are straight and wrinkle-free.

See Teamwork and Time Management: Making Beds.

TEAMWORK AND TIME MANAGEMENT

Making Beds

To save time and energy, make beds with a co-worker. Make one side of the bed while your co-worker makes the other.

Making beds with a co-worker is faster, easier, and safer for residents, you, and your co-worker. Always thank your co-worker for helping you. Also help your co-worker make beds when asked to do so.