BASIC NURSING PROCEDURES

BED MAKING
Definition
Bed making is the process of applying or changing bed linens. It is a trolley procedure.

Rationales
 To make safe and comfortable bed for the patient
 To prevent infection
 To prevent bed sore
 To maintain personal and environmental hygiene
 To beautify the ward.

Indications for bed making

1. Soiled or damp linens
2. Morning hygiene care when necessary
3. Wrinkled bed

Objectives of bed making

1) To provide a clean environment
2) To promote physical environment
3) To promote psychological comfort by providing a neat environment in which the client can
receive visitors
4) To prevent cross contamination
5) To prevent undue strain on client and nurse

Types of Bed Making

1. Simple Bed
Simple bed can be unoccupied bed:
a. Unoccupied bed
There are two types of unoccupied bed:
i. Unoccupied open bed
This is a bed that nobody is on or when the occupant is able to be up while the bed is
made. A bed is open when its top cover is turned down so that it is easily accessible to
a client.
ii. Unoccupied closed bed
It is made with the bed spread pulled to the top of the bed to prevent dust from setting
onto the sheet. It is used to keep beds clean between clients or if a patient will be
ambulatory for the major period of the day.

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 b. Occupied bed
It is for a client that is unable to get out of bed and so their beds are made while they
are in them.

2. Special beds
i. Admission bed
ii. Cardiac bed
iii. Surgical/Post-Operative bed
iv. Fracture bed
v. Amputation/divided bed
vi. Blanket bed

TYPES OF BED MAKING

SIMPLE BED SPECIAL BED

OCCUPIED UNOCCUPIED ADMISSION BED

CARDIAC BED
OPEN BED CLOSED BED
SURGICAL/POST OP BED

FRACTURE BED

AMPUTATION/DIVIDED BED

BLANKET BED

General Rules to be observed in Bed Making

i. Collect all requirements before commencing.
ii. Two nurses are required and they should work in harmony avoiding jerky movements.
iii. Strip bed neatly, clothes not touching the floor, handle bed clothes carefully and avoid
flapping to minimize risk of cross infection by spreading dust.
iv. Have bed stripper or 2 chairs (placed back-to-back) at foot of the bed (or near) for pillows and
bed accessories.
v. Keep patient in position required for his treatment throughout.
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vi. Keep patient well covered with blanket in bed linen, the patients face must never be covered
with linen or blanket.
vii. Support patient when necessary. One nurse may do this while the other makes one side of
bed.
viii. Pull mattress well up to the head of bedstead.
ix. Shake pillows at each making, turn away from the patient.
x. Turn in the end of the cases firmly and replace with open end away from door.
xi. Arrange pillows to make patient comfortable.
xii. Allow room for patient’s feet, when replacing top bed clothes.
xiii. Call for help when necessary to move heavy or very ill patient.
xiv. Consider whether extra items found on the bed are still necessary or needed before
automatically replacing them.
xv. Any conversation during bed making should include the patient and should not be on personal
matters between the nurses.
xvi. Replace furniture etc. safely and conveniently, before leaving the bed.

STRIPPING OF BED
Requirements
 Bed stripper or 2 chairs
 Dirty linen bin
 Soiled linen bucket
 Clean bed linens (as required)
 Latex gloves.
Method
1. Wash hands and put on gloves
2. Place bed stripper or 2 chairs (back-to-back) at foot of bed.
3. Loosen sides and foot of bed, starting at top of bed.
4. Turn back top sheet.
5. Remove counterpart by folding into three and placing it on the stripper or chair at foot of
bed.
6. Remove blankets and bottoms sheet in the same day as 5 above.

SIMPLE/UNOCCUPIED BED
Requirements for simple/unoccupied bed
On the trolley
 2 Bed sheets
 1 Pillowcase
 1 Draw sheet if necessary
 1 blanket or counterpane
 1 draw Mackintosh if necessary
 1 Long mackintosh if no mattress cover
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  Latex gloves.
Method
1. Wash hands and dry.
2. Wear gloves
3. Place the long mackintosh over the mattresses and tuck it in at the head and foot of the bed.
If the mattress is not covered.
4. Place bottom sheet over the mattress, completely cover the head of the mattress.
5. Tuck in the sheet at the head of the bed and make envelope corners, at each side.
6. Move to the foot of the bed and pull the sheet tightly and make envelope corner at each
sides.
7. Tuck in the sheet tightly along sides.
8. Place the draw mackintosh across the center of the bed and tuck in tightly on both sides
9. Place the draw sheet over the draw mackintosh and tuck in under the mattress.
10. Place pillow in pillowcase at the head of bed with the open end away from the door.
11. Place the top sheet on the bed and spread it.
12. Tuck in the sheet at the foot of the bed and make envelope (mitre corners) with the top end
untucked.
13. Place blanket over the top sheet with the top edge 24cm from the head of the bed.
14. Fold the top sheet down over the top edge of the blanket.
15. Cover the whole bed with counterpane.
16. Tuck in the blanket and counterpane at the foot of the bed and make envelop corner at each
side
17. Tuck in the edges along the side of the bed.
18. Tidy patient environment.
19. Wash hand and dry.

OCCUPIED BED
Patient preparation:
 Bath patient before the procedure
 Explain procedure to the patient
 Assess patient.
Methods of Making Occupied Bed
a. Head to foot or top to bottom Method
b. Side to side Method
A. Head To Foot/Top To Bottom Method
Procedure
1. Wash hands and dry
2. Put on gloves
3. Strip the blanket or counterpane in the usual way (1/3 top down, 1/3 bottom up) leaving the
patient covered with the top sheet.
4. Untuck bottom sheet
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 5. Move the patient to the foot of bed, still covered with top sheet.
6. Place the pillows on the stripper or chair
7. Pull mattress cover and bottom sheet straight.
8. Brush crumbs off and remake bed.
9. If bottom sheet is soiled, roll bottom sheet towards the foot of the bed.
10. Spread the new bottom sheet on the bed and tuck in at the top.
11. Mitre the top corners.
12. Shake well and place the pillow at head of the bed.
13. Roll the rest of the sheet under the patient.
14. Lift the patient to the top of the bed.
15. Remove soiled bottom sheet into soiled linen sheet.
16. From the foot of the bed pull the sheet straight.
17. Tuck in the bottom sheet at the foot of the bed and mitre the corners.
18. Tighten the sheet and tuck in sides.
19. Lift top sheet on to the bed.
20. Spread the clean top sheet over the patient by holding the clean sheet over the patient
shoulder with the hand nearest the head of the patient, with the other hand remove the dirty
top sheet and discard.
21. Measure amount for the turn over approx. 45cm or 18inches below the edge of the pillow
and tuck its back.
22. Tuck in bottom of top sheet.
23. Mitre the bottom corners leaving the sides hanging.
24. Make patient comfortable.
25. Discard soiled linens in the sluice room.
26. Wash hand and dry.
B. Side to side Method
Repeat actions 1 – 4
5. Log Roll the patient to the side (away from you) leaving one pillow under patient head.
6. Pull mattress cover and bottom sheet straight.
7. Brush out crumbs and remake bed.
8. If bottoms sheet is soiled, roll bottom linen nearest to patient.
9. Maintain an adequate amount of sheet at head, foot and side for tucking.
10. Mitre the bottom sheet 1st at the head of bed, then foot of bed and then tuck in sides.
11. Log roll patient to the other side (facing you)
12. Remove soiled linen by rolling it into a bundle.
13. Discard in the soiled linen bucket without touching uniform
14. Unfold/unroll the bottom sheet.
15. Pull tightly while leaning back with your body weight.
16. Tuck in and mitre corners as described above.
17. Repeat actions 19-26 in A above.

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SPECIAL BEDS
ADMISSION BED (EMERGENCY ADMISSION BED)
This is a bed prepared on the ward in readiness for an acute admission.

Objectives/Rationales
 To make a comfortable and safe bed for the patient.
 To make bed ready for the patient.
 To receive the patient in a warm bed.

Requirements
 1 pillow with mackintosh cover
 1 pillow case
 2 bath sheet
 2 bed sheet
 Pyjamas/Gown
 1 counterpane
 1 draw mackintosh
 1 draw sheet if necessary
 1 latex glove
 1 Long mackintosh

Method
1. Make the foundation of the bed as usual.
2. Place the pillow on the bed.
3. Spread the long mackintosh so that the bed including the pillow is covered.
4. Open the bath sheet and spread over mackintosh.
5. Fold the top sheet in a pack that can be conveniently lifted on to a chair (i.e. fold down top
and instead of tucking in bottom, the bottom ½ up and the top ½ down).
6. Place pack in the middle of the bed.
7. Spread the counterpane to cover the white bedsheet.
FRACTURE BED
Objectives/Rationales
 To make a comfortable bed for the patient.
 To immobilize the site of the fracture.
 To provide a firm base and to prevent sagging of the mattress.

Requirements
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In addition to requirement for foundation bed
 Fracture board placed between the mattress and the bed stead
 Draw mackintosh/draw sheet
 Large bed cradle if necessary
 1 pillow with mackintosh cover
 1 pillowcase
 2 covered sandbags

Method
1. Make foundation bed as usual
2. Place mackintosh and draw sheet under the plaster avoid holding or pressing.
3. Place covered sandbags on either side of the lower limb.
4. Place cradle at the foot of the bed.
5. Lift top sheet on the cradle.
6. Measure amount required for turnover, approx 45cm below the edge of the pillow and turn
back.
7. Make up foot of bed with either an open end or tent at the foot with the top sheet on the
cradle.
8. Tidy patient’s environment.
9. Wash hands and dry.

POST-OPERATIVE BED
It is a bed made to receive a client returning from surgery who is still drowsy from the effect of
anaesthesia, and may have difficulty turning due to painful incision. It is also used for patients
with gadgets that make it difficult for them to get into bed.
Objectives/Rationales
1. To receive a patient from the theatre who had surgery.
2. To ease and hasten the transfer of the patient into the bed.
Requirements
In addition to foundation bed, other requirements are:
 Anaesthetic towel and anaesthetic mackintosh to protect bottom sheet.
 Drip Stand
 Oxygen Cylinder
 Suction machine
 Emergency tray containing:
- Mouth gag, tongue depressor, gauze in gallipot, sponge holding forceps, 2 small bowls,
one containing cold water while the other contains mouth wash and small receiver.
 Vomit bowl
 Special equipment may be added as per the type of surgery.
Method
1. Make foundation bed.
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 2. Draw mackintosh and draw sheet may be used depending on the type of surgery.
3. In place of pillows, put anaesthetic mackintosh and anaesthetic towel on a side of the head
of bed.
4. Top sheet folded in pack of three as for admission bed and placed in the middle of the bed.
5. Counterpane is folded and placed on chair.
6. Place a vomit bowl with lid or receiver with lid on bedside locker.
7. Place drip stand, oxygen cylinder and suction machine in position (in good working
condition)
8. Wash hands and dry.

CARDIAC BED
This is a special bed made for patients with failing heart and on some occasions for patients with
severe respiratory diseases where there is difficulty in breathing.
Objectives/Rationales
1. To make the patient as comfortable as possible when sitting upright
2. To make a bed for a patient with cardiac and respiratory problems.
3. To ease breathing.
Requirements
In addition to requirement for foundation bed
 Light blanket (If needed)
 Back rest
 Air ring
 Bed Table
 Pillows (four-six)
 Sand bags
 Bell
 Oxygen Cylinder
 Vomit bowl/Sputum Carton (Disposable)
 Bed cradle
Method
1. Make foundation bed as far as draw sheet
2. Position backrest at the head of bed.
3. Arrange pillows in arm chair fashion
4. Place covered air-ring at the middle of the draw sheet.
5. Place sand bags to support the feet.
6. Place top sheet and blanket over the bed cradle.
7. Pull top linen gently high enough to cover up to the patient’s shoulder.
8. Place bed table across the bed.
9. Place a soft pillow on top of the bed for patient to lean on.
10. Place bell, sputum mug or vomit bowl on the patient’s bed side locker
11. Place the oxygen Cylinder within reach in case the patient needs it.
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Note: Bed cradle will be used if patient has ascites or oedema to lift weight of bed linen off
patient’s body.

DIVIDED BED
Objectives/Rationales
 For examination of the lower part of the abdomen.
 For examination of the rectum of vagina
 For dressing of wounds on the perineal region.
 For the treatment of fracture of the lower limb
 For procedures such as Catheterization.
Requirements
In addition to the requirements for foundation bed
 1 bed sheet
 1 bed cradle
 2 sand bags
 Roller’s sheet
 Dressing sheet and dressing mackintosh
Method
1. Make the foundation bed as far as the draw sheet.
2. Fold the first top sheet in three, top third down and bottom third up.
3. Cover the upper part of the body with this sheet.
4. Fold the second top sheet in two tuck in at the bottom leaving the sides hanging loose.

Note – If bed cradle is required as in cases of burns, abdominal surgery. The second sheet covers
the cradle and is tucked in at the bottom leaving the sides hanging loose.

DIVIDED BED FOR AMPUTATION

Requirements
In addition to the requirements for foundation bed:
 Draw mackintosh and towel
 Bed cradle
 Roller towel
 2 bed sheets
 2 sand bags
 Tourniquet
Method
1. Make foundation bed as usual
2. Arrange treatment mackintosh and towel under the stump.
3. Arrange roller towel over the stump.
4. Fix in position with two sand-bags.

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 5. Spread the first top sheet and fold into three that is top third down and bottom third up. Use
this cover the chest.
6. Place the bed cradle over the stump cover the cradle with the second top sheet.
7. Make an open end or tent at the level of the stump.
8. Place a tourniquet on a tray with a dressing towel within easy reach, but out of view of the
patient.

BLANKET BEDS
Objectives/Rationales
 To provide comfort for the patient.
 To absorb excessive moisture.
 To prevent chilling.
Indications for blanket bed
1. Acute rheumatism
2. Kidney Disease
Requirements
 In addition to foundation bed
 Two soft white blankets or flannelette sheets.
 Abed cradle
 Two covered hot water bottles.
 One pillow (for acute rheumatism bed)
 Extra pillows (for kidney bed)
 A narrow draw mackintosh and draw sheet.
 A warm bed jacket is desired.
Method
1. Make foundation bed as far as bottom sheet.
2. Place one of the blankets on top of the bottom sheet, and tuck it in all round.
3. Place the narrow draw mackintosh and draw sheet on the blanket where the patient’s
buttocks will rest.
4. Place the bed cradle over the lower limbs.
5. Cover the patient snugly with the second blanket.
6. Patient’s head is rested on one pillow.
7. Place the covered hot water bottles on top of the first fixed blanket.
8. Rest patient’s limbs on a protected pillow if desired.
Note: patient may wear a warm bed jacket if necessary.

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