BED MAKING Provide Support to Meet Personal Care Needs

Bed Making Ongoing provision of basic cleanliness, comfort and safety Clients may spend long periods of time in bed, undertaking various activities – depending on individual health state, and on situational factors (ie if at home, or in a health care agency)

Principles Factors to consider with each bedmaking episode: Prevention of cross-infection Safety and comfort for the client Maintenance of good body mechanics

Prevention of cross-infection Wash hands or use alcohol hand rub before and after making each bed If linen is very soiled, wear gloves for removal Dirty linen is put immediately into soiled linen bag (white or brown bag) or as per organization – never onto floor !!

Don’t shake or flick linen excessively Linen shouldn’t touch floor, or be held up against carer’s clothing Linen should only be put onto a clean surface prior to bed making NO interchange of linen between clients

Client safety and comfort Ensure that bed brakes are on, and that bed is returned to its original position (usually to a height the resident can easily access), after bed making is complete Promote comfort, by having sheets free of rough areas, wrinkles or creases, food crumbs and foreign bodies

Avoid areas of potential pressure, i.e. hems of sheets away from direct contact with client’s skin If waterproofing layer is used, must not come into contact with client’s skin Need to particularly consider safety and comfort, if client occupies bed whilst it is being made

Body mechanics of the carer Maintain good body alignment when bed making – avoid bending, stretching and twisting Use large leg muscles (bend knees), rather than back muscles Work smoothly and rhythmically – 2 people to make beds together is optimal

If able, raise bed to a comfortable working height (usually waist high) – to avoid bending and back strain Prepare well – gather all equipment initially, and avoid legwork

Bed features Many types of beds available, with multiple modifications possible In health agencies, most are “hi-lo”, allowing adjustment of the bed base up and down Most also allow position changes, ie head/feet up/down

Different types of operation – some have hand-winding action, others with hydraulic foot pump mechanism and release button, some are electric Bed brakes Bed heads and feet are detachable, for emergency access situations, or for transfer of clients on their beds

Bed “attachments” Trapeze/overhead “monkeybar” Bedstick Drainage tube bag hangers Client call bell Bed siderails – may constitute restraint!

Bed aids Most bed aids relate to the comfort and correct positioning of a client If bed aids used, need to be appropriately selected and used Pillows – with waterproof cover

Bed aids - Mattress Many different types Air alternating Egg carton

Bed cradle Sheepskin – for under buttocks, or elbow/heel protectors Wedges/wedge shaped pillows Footboards/foot bolsters Absorbent layers

Sheepskins Medical sheepskins – green in color 30mm pile (springy), especially tanned High density-creates a cushion that distributes body weight & pressure points over a large area-each fibre acts as a spring

Sheepskins Cont. Wool can absorb moisture up to 33% of its weight without feeling wet Reduces friction & shear Medical sheepskins are stamped

The steps to making an unoccupied bed Wash & dry hands Place clean linen & soiled linen skip near the bed Ensure that there is a chair on which to place the bed clothes Ideally there would be two people to make the bed

PATIENT POSITIONING Fowler's Position- A person in the Fowler's position is sitting straight up or leaning slightly back. Their legs may either be straight or bent. High fowlers’ position is when the patient is sitting upright. Low fowlers’ position is when the patient’s head is only slightly elevated. Trendelenberg Position - A person in the Trendelenberg position is lying supine with their head slightly lower than their feet.

PATIENT POSITIONING

Supine- Someone in the supine position is lying on his or her back. Prone - Someone in the prone position is lying face down.

PATIENT POSITIONING

Right Lateral Recumbent- The Right lateral recumbent, or RLR, means that the patient is lying on their right side. Left Lateral Recumbent -The left lateral recumbent, or LLR, means that the patient is lying on their left side.

PATIENT POSITIONING

Abduction is movement away from the midline, or to abduct. Adduction is movement toward the midline, or to add.

PATIENT POSITIONING

Flexion-decreasing the angle between two bones. Extension-movement by which the two ends of any jointed part are drawn away from each other.

PATIENT POSITIONING

Making an Unoccupied Bed Move the bedside locker & over bed table if necessary Adjust the height of the bed – it should sit about hip height Place pillows on the bed. Place any soiled pillow slips in the skip Loosen the upper bed clothes

Making an Unoccupied Bed Remove each item of upper bed clothes separately, fold & place on the chair. Loosen the bottom bed clothes, fold & place on the chair. Any soiled items are placed in the linen skip Roll, rather than fold the waterproof sheet (if applicable)

Making an Unoccupied Bed Pull the mattress well up to the head of the bed Commencing with the bottom sheet, each item is replaced separately Ensure the hem of the sheets is facing outward to protect the resident’s skin

Some facilities will have fitted bottom sheets Note the centre of the sheet follows down the middle of the bed

Making an Unoccupied Bed If a draw sheet or Kylie sheet / Kylie pad is used it is positioned approximately 25cm from the head of the bed. The bed clothes should be centred and unless being made up as an open bed, tucked in around the mattress

The mitred or military corner Most hospitals and residential care facilities will make their beds with the sheets having a mitred corner

The steps Once the sheet is placed on the bed tuck the bottom end of the sheet under the end of the mattress Pick up, about 20-30cm from the end of the sheet, and place it on the top of the bed – this should make a bit of a triangle shape Tuck the sheet that is still hanging toward the floor under the bottom of the matteress

The steps continued Then bring the top part of the triangle down and tuck into the mattress for the BOTTOM sheet Each layer of linen is tucked in the same way Often the top sheet and blankets are left without the step above so that all of the sheets are not tucked in along the side of the bed – this makes it easier to get patients and residents back into bed

A mitred corner

Making an Unoccupied Bed At the top end of the bed, fold the top sheet over the blanket. The top layer of blanket is generally tucked under from the top Ensure there are no wrinkles in any layer of the linen

Many facilities will have their own policies about using resident’s own linen, and how the bed should look Some facilities do not like to have blankets underneath showing Be aware of your facility’s policy on laundering of personal linen

Replace & arrange the pillows to meet the resident’s needs If a person is to return to bed, the top corner of the upper bed clothes may be folded back Ensure the bed is returned back to an appropriate level for the resident to get back into bed, and place call bells etc in reach Make sure there is no linen hanging on the floor

Replace any furniture Tidy around the resident’s bed side eg serviettes, tissues etc Remove linen skip Wash & dry your hands

Now to make the occupied bed Wash & dry hands Explain the procedure to the individual & ensure privacy Collect clean linen & linen skip before commencing to make the bed Move the bedside locker & over bed table if necessary

Making an Occupied Bed Ensure there is a nearby chair on which to place the bed clothes Adjust the height of the bed Leaving sufficient pillows to support the individual, place the reminder on the chair Remove each item of upper bedclothes separately. Bed clothes to be replaced are folded and put on the chair. Cover the person with a procedure blanket before removing the top sheet. Place soiled items into the linen skip Remove accessories such as bed cradle

Making an Occupied Bed Support the individual & gently turn him onto one side of the bed. If only one nurse is making the bed, the side rail away from her should be elevated (if insitu) Loosen the bottom sheets on the occupied side, and roll each one towards the centre of the bed. Brush out any debris eg crumbs. Eliminate any creases from the mattress cover Working at the unoccupied side of the bed, either: Unroll, pull the bottom sheets taut, and tuck in around the mattress OR If using a fresh sheet, place on the bed and unfold it so that centre laundry crease lies at the centre of the mattress. Tuck in at the top, bottom and side. Roll the excess to the centre of the bed

Making an Occupied Bed Carefully turn the individual to the other side of the bed, providing adequate support as he is moved. If appropriate, elevate side rail From the opposite side of the bed, either: Remove any soiled sheets and place in the linen skip OR Untuck and roll sheet/s to the centre of the bed Ensure that side of the mattress is free from debris and ceases, unroll and tuck the sheet/s in around the mattress Assist the individual back into the centre of the bed, arrange the pillows to meet the need and assist him into position

Making an Occupied Bed Replace any accessories, put on the top sheet and remove the procedure blanket Replace the blankets and quilt, ensuring that they are positioned to cover the individual’s chest and shoulders. Make foot pleats in the upper bed clothes and avoid tucking them in to tightly Adjust the height of the bed – ensure nurse call bell within reach Replace any furniture. Remove the linen skip. Wash and dry hands.