a. General.

Changing bed linen and making a comfortable, neat bed while it is occupied by a patient usually follows the completion of a cleansing bath.

During this time, excellent opportunities are provided to establish good relations with the patient through patient-centered conversation and for instructing the patient how to move, turn, conserve energy, and maintain good body alignment.

If the patient is helpless or unconscious, two individuals should work together. The operator gives instruction and performs the procedure while the assistant holds the patient and helps to turn him. When an assistant is unavailable to assist a helpless patient, the side rails of the bed opposite the operator should be raised to prevent the patient from falling out of bed.

b. Precautions in Making a Patient Occupied Bed.

Some precautions in making a patient occupied bed are to prevent exposing the patient, provide for his safety, and (by the proper handling of linen) prevent the possible spread of microorganisms.

c. Equipment.

The following equipment should be obtained as required.

(1) Washbasin containing an appropriate solution.

(2) Cleaning cloth.

(3) Two sheets.

(4) One pillowcase.

(5) Protective sheet and cotton drawsheet as necessary.

(6) Paper bag.

(7) Clothes hamper.

d. Procedure.

The following procedure for making a patient’s occupied bed is appropriate when the patient is not helpless.

(1) Step 1.

(a) Remove the pillow and use the crank handle to level the bed if permitted.

(b) Loosen the bed linen while moving around the bed, slightly raise the mattress and lift the linen edges free. To prevent the linen from snagging on the springs, do not tug or jerk it.

(c) Pull mattress up to the head of the bed as necessary.

(d) Remove the spread and blanket, leaving the top sheet as a cover for the patient.

(e) Assist the patient to turn toward you, to the side of the bed, keeping his body covered with the sheet. If required, raise and latch the bedrail when the patient’s position has been adjusted.

(2) Step 2.

(a) Go to the opposite side of the bed. Place the chair in a convenient location.

(b) Roll all bedding in layers close to the patient’s back. Smooth and tighten the mattress cover from top to bottom.

(c) Place the clean foundation (bottom) sheet on the exposed section of the mattress with the hem seam down and the centerfold in the midline of the bed. It should be folded against the patient, bottom edge even with the foot of the mattress. Tuck under the top edge, miter the corner, and smooth and tuck the side under, moving from head to foot.

(d) Replace the protective sheet, if used. Hold the linen folds in place in the center of the bed with one hand, and bring the rolled protective sheet back over the linen folds to the clean foundation. Place the clean cotton drawsheet over the protective sheet, rolling the excess folds toward the patient.

Smooth and tuck under the sides of both sheets to complete the near side of the foundation. (The cotton drawsheet should completely cover the protective sheet in order to prevent irritation of the patient’s skin, when it is exposed to either the rubber or laminated cotton sheet.)

(e) Tuck all linen folds under the patient as smoothly as possible. Assist the patient to roll over the linen folds to the clean foundation side.

(3) Step 3.

(a) Secure the side of the bed, if needed, before going to the opposite side of the bed.

(b) Go to the opposite side of the bed. Pull the rolled linen through. Keep the clean linen close to the patient’s back; remove the soiled linen and place it in the clothes hamper. Tighten the mattress cover, head to foot. Complete the foundation.

NOTE: If protective sheets (or drawsheet only) are used, pull taut and wrinkle free by tightening the center portion first, then the upper and lower ends.

(c) Turn the patient to the center of the bed. Center the clean top sheet over the patient. Instruct the patient to hold the clean top sheet while you remove the soiled top sheet from underneath, pulling gently from top to bottom. Place the soiled sheet in the clothes hamper.

(d) Replace the blanket and spread, instructing the patient to check for free movement of his feet to be sure the top bedding is loose enough before tucking under and maturing the corners at the foot.

(e) Complete the cuff at the head of the bed. Fold down the top bedding to a level comfortable for the patient.

(4) Step 4.

(a) Place a clean case on the pillow. Replace the pillow under the patient’s head. Use the crank handle at the foot of the bed and adjust as needed. Also adjust the sides of the bed as needed.

(b) Place the bedside cabinet and the signal cord within the patient’s reach.

(5) Step 5.

(a) Damp-dust the unit. Attach the clean paper bag and place towels and washcloth in the proper place.

(b) Remove all unnecessary equipment and articles from the unit. Leave the unit clean and orderly.

(c) Return the clothes hamper to the storage area. Discard the waste. Wash and sanitize the equipment that is returned to the utility room. Wash your hands.