A nurse is making a bed occupied by a client. what is a recommended step for this procedure?

An occupied bed is making the bed where the patient physically available in the bed or the bed is being retained for the patient. Soiled linen is infectious to the patient. If a patient is unable to move or leave the bed, you will need to change the bed sheets while the patient is occupied in bed. Occupied bed-making is tough for one person. This is the best bed accomplished by two nurses. Before starting the procedure, make sure all supplies are ready beforehand to streamline the process as much as possible.

Fig: Occupied bed-making process

Purpose of Occupied Bed Making:

The main purposes of occupied bed making have listed in the following:

To provide a neat and clean bed.
To refresh the patient who is confined to the bed.
To change the linen with the least possible disturbance to the patient.
To draw or fix the sheets under the patients very firmly so that it would not wrinkle.
To remove crumbs from the bed.
To make the patient feel comfortable.

Equipment of Occupied Bed Making:

The below equipment is very important for occupied bed making:

Bed or cot,
Mattress with cover,
Bedsheet -2,
Pillowcase -1 or 2,
1 Protective sheet and cotton draw sheet,
Mackintosh-1,
Paper bag,
Chair-1,
Bucket-1.

The procedure of Occupied Bed Making:

All the procedures of occupied bed making have presented the below:

Two nurses must work together when the patent is seriously ill or difficult to manage.
Wash hand before making the occupied bed or occupied bed making.
Gather all equipment at the patient’s bedside and explain the procedure to the patient.
Loosen the tucked linens at the foot part that covers all around the bed.
Remove pillow unless contraindicated.
Place the clean and dry top sheet over the dirty top sheet and then remove the dirty linen one by one.
Leave one cover over the patient and maintain privacy by bedside screening.
Turn the patient on half of the bed on the other side of the bed and keep side rails up.
Place a pillow between the patient and side rails.
Work on the unoccupied side of the bed and roll the draw sheet, mackintosh, and bottom sheet if soiled.
Rolls the soiled linens toward the patient’s back and tucks the roll slightly under the patient.
Covers dirty and moist areas of the soiled linen with a waterproof pad.
Place clean bottom sheet and tuck head part miter corner.
Place draw sheet over the mackintosh on the near side of the mattress, with the center vertical fold at the center of the bed.
Place the patient on the clean side of the bed.
Work on the other side and remove dirty linens.
Make the other side of the bed and spread clean linens.
Tuck the head part of the bottom sheet, miter at the side.
Place the patient in the center of the patient.
Place the pillow and make the patient comfortable.
Spread the top sheet and fold the head part up to the patient’s chest.
Arrange a blanket if necessary.

Remember During Occupied Bed Making in Hospital:

You must have to remember the below points during occupied bed making in the hospital:

Maintain privacy as situations require.
Carefully turn the patient to prevent over-exertion and feeling insecure.
Carefully observe the patient skin to identify any signs of bedsore.
If the patient wears glasses, ask for removing to prevent broken and injury.
Ensure enough space for the patient to roll without smacking nose on a side rail.
Ensure the patient’s arm on the bed is not in an awkward position when the patient is rolled.
Ensure bed in a flat position and rise to an appropriate working height.
Remove patient’s personal items from bed and disconnect call devices.
Carefully checks that no tubes (such as IVS pole, Foley catheter, oxygen tube, gastric tube, NG tube, drain) are entangled in the bed linens.
Apply diaper when a patient in the side position.
Do not place clean linen on another patient’s bed or furniture.
Keep side rails up when patient turn.
Keep bed sheet smooth and wrinkles free to prevent friction.
Ask the patient to help if the patient can participate.
Place all dirty linens in a laundry bag or hamper without contaminating the uniform.
Never put soiled linen on the floor or the other surfaces.
Return bed in a low and safe position and keep side rails up.
After occupied bed making, attaches call light within the patient’s reach.
Re-position bedside table and over bed table within patient reach.

Many times, it is not possible or practical to move a patient in order to change his or her sheets. Soiled linens can lead to infection, as well as being uncomfortable for your patient. If your patient is not able to leave the bed while you change bedding, you will need to change the linens while the patient remains in bed. Whenever possible, this is best accomplished by two people. Before you begin, wash your hands carefully and put on gloves. Begin by greeting your patient and explaining that you will be changing his or her bedding. Then, follow these steps:

Roll the patient gently onto his or her side, ensuring that thepatient will not fall. Then, undo the fitted sheet and roll it toward the patient, placing the top of the sheet where it touched the patient into the rolled up sheet.
Unfold a clean fitted sheet and place it on the portion of the bed that has been unmade. Place a pad on top of the fitted sheet so that it will lie underneath the patient’s hips. Gather the clean linen by rolling it inward, and place it underneath the edge of the dirty linen.
Gently roll the patient to the other side of the bed so that they are lying on the clean, rolled linen. Remove all dirty linen and place it into the appropriate container.
Unroll the clean fitted sheet and pad, and pull it tightly against the bed to make sure there are no wrinkles. Secure the sheet to the bed, and roll the patient onto his or her back.
Cover the patient with a clean flat sheet and blanket, and then secure the lower corners of the flat sheet using mitered or “hospital” corners.
Assist the patient in moving to a comfortable position, and adjust sheets and blankets as necessary.
Dispose of your gloves, and then wash your hands.

Replacing linens often is part of a comprehensive infection control system. Clean linens also help the patient remain comfortable, and keep the room looking tidy. By following this procedure, you will be able to complete linen changes in a quick and efficient manner, minimizing discomfort for your patient.

Examiners Checklist For This Skill

1) Performed beginning tasks. 2) Removed top linen, keeping person covered. 3) Positioned individual on one side of bed with side rail up (if applicable) using appropriate safety measures on unprotected side, and using appropriate body mechanics. 4) Tucked dirty linen under individual. Used gloves if linen is contaminated with blood or body fluids. 5) Replaced bottom linen on first side. Tucked corners and sides neatly under mattress. 6) Repositioned individual to other side using appropriate safety measures on unprotected side. 7) Removed dirty linen by rolling together, held away from clothing, and placed dirty linen in appropriate container. Disposed of gloves, if used, and washed hands. 8 ) Completed tucking clean linen under mattress with corners and sides tucked neatly under mattress on the second side. 9) Repositioned the individual to a comfortable position. 10) Placed top sheet over individual. Removed dirty covering. Tucked bottom corners and bottom edge of sheet under mattress, as indicated. 11) Placed blanket/spread over person. Tucked bottom corners and bottom edge or blanket/spread under mattress, as indicated. Pulled top edge of sheet over top edge of blanket/spread. 12) Removed and replaced pillowcase appropriately. Replaced pillow under individual’s head. 13) Placed bed in appropriate position.

14) Performed completion tasks.

Expert Tip by Tanya Glover, CNA

This can be one of the most nerve wracking items on the skills test. If you do not have actual hands on work experience, changing an occupied bed can be an awkward experience until you get the hang of it. When I first began, I was so nervous about doing it because it seemed almost impossible! Rest assured however, that it is not impossible. In fact, it is one of the easier tasks you will have during your long day at work. Think of it this way, if you are changing a bed with the patient in it, that person is likely not to be getting up that day and that is one less person you will have to dress and get up in a wheel chair! Thinking of it like that makes your work load seem a bit lighter right?

There are a few things to remember about changing a bed with a patient in it. First of all, make sure you have everything you need right at your fingertips. You do not want to have to start and stop to get a forgotten item. Second, since you will have to roll your patient to get the job done right, be sure that the bed rail is up on the side which your patient is rolling towards. If they are not totally dependent and can offer assistance, let them! It is so much easier when a patient can roll up on their sides with minimal assistance and hold on to the bed rail! Once you do it a few times, you will find that it is easier than you thought and you may even get it done faster than you ever imagined!