1. C ARE OF THE RESIDENT ’ S ENVIRONMENT Section II, Unit 2

2. Considerations for Care 1.Respect resident’s room as private space. 2.Respect resident’s preferences and privacy. 3.Respect resident’s personal belongings as irreplaceable. 4.Maintain a safe environment.

3. Role of the nurse aide in use and care of emergency equipment and supplies in resident’s room 1.Bed 2.Siderails 3.Call signal 4.Privacy curtains/screens 5.Window curtains if applicable 6.Resident’s belongings 7.Other items

4. Role of the nurse aide in environmental control Respect resident’s private environment. Share in the role of a homelike environment that is safe and clean. a.Cleanliness – team effort b.Control of odors c.Safety d.Comfort and convenience

5. Role of the nurse aide in bed making 1.Making the unoccupied bed 2.Making the occupied bed

6. MAKING THE UNOCCUPIED BED P ROCEDURAL G UIDELINE #11 ON P ERFORMANCE R ECORD

7. Types of Beds Closed bed: bed is not in use Top linens not folded back Open bed: a bed in use Top linens folded back An occupied bed: bed made w/ person in it (a different procedural skill)

8. Linens 1. Always hold linens away from your body and uniform 2. Never shake in the air 3. Never place clean linens on a dirty surface 4. Collect just enough for the resident; once in patient’s room linen is considered contaminated 5. Dirty Linens: a. Roll away from you b. Wear gloves 6. Drawsheets (cotton or plastic) a. Small sheet placed over the middle of the bottom sheet b. Helps keep the mattress and bottom linens clean and dry c. Used for lifting and repositioning

9. Make the Unoccupied Bed

10. Unoccupied Bed-Procedural Guidelines 1.Wash hands. Wear gloves and follow Standard Precautions. If the resident is in isolation, check with the nurse. 2.Gather needed supplies at bedside on a clean, dry surface such as bedside or overbed table: a.Laundry bag, dirty linen container, or leak proof bag for wet linen following facility policy b.2 sheets – a top sheet and a bottom sheet c.Draw sheet or incontinent pads if used d.Blanket and/or bedspread if needed e.Pillowcase(s)

11. Unoccupied Bed-Procedural Guidelines 3.Lower side-rails and remove call signal and resident's personal items. 4.Adjust bed flat, elevate bed to comfortable working height, lock wheels and use good body mechanics.

12. Unoccupied Bed-Procedural Guidelines 5.Remove soiled linen from the bed. a.Check linen for misplaced items such as dentures, hearing aids, eyeglasses. b.Roll soiled linen away from you with dirty side inside. c.Avoid touching soiled linen against your clothing. d.Handle soiled linen as little as possible, and avoid shaking linen. e.Place soiled linen directly into soiled linen container following facility policy. Keep the outside of the container clean. Do not place soiled linen on clean surfaces or on the floor unless it is in a leak proof bag. f.Clean, dry and straighten mattress as needed. Observe for tears or holes in mattress and report them to the nurse. g.Remove gloves and wash hands.

13. Unoccupied Bed-Procedural Guidelines 6.Apply clean bottom linen, working on the side of bed near the clean linen. Do not allow clean linen to touch the floor. a.For a fitted bottom sheet: Place the fitted sheet corners over the top and bottom mattress corners. b.For a straight sheet: Center and unfold lengthwise with bottom edge even with or just over the foot of the mattress. Tuck top of sheet under head of mattress and miter top corner. c.If used, center drawsheet or pad on the bed. d.Tuck in the bottom linen on the side where you are working.

14. Unoccupied Bed-Procedural Guidelines 7.Apply top linen on same side of bed. a.Center and unfold top sheet lengthwise, with upper edge even with top of mattress. b.Center and unfold blanket and/or bedspread, with upper edge slightly below the edge of top sheet. c.Tuck in top linen at the foot of bed and make a smooth corner following facility policy. 8.Move to the opposite side of the bed to complete bedmaking.

15. Unoccupied Bed-Procedural Guidelines 9.Place corners of fitted sheet over mattress or miter top corner of bottom sheet. 10.Pull and tuck in bottom linen, keeping it straight and centered. Assure bottom linen is tight, smooth and free of wrinkles (unless waterbed, egg crate, gel or air mattress). 11.Tuck in top bedding at foot of bed, keeping it straight and centered. Make a smooth corner following facility policy. 12.Smooth top linen and fold top sheet over edge of blanket if used. 13.Apply clean pillowcase (with zippers and tags inside) and replace pillow on bed. 14.Replace call signal and any needed items within resident's reach. 15.Adjust height of bed and position of bed as appropriate.

16. MAKING THE OCCUPIED BED P ROCEDURAL G UIDELINE #12 ON P ERFORMANCE R ECORD

18. Occupied Bed Procedural Guidelines 1.BEGINNING STEPS a.Gather needed supplies at bedside on a clean, dry surface such as bedside or overbed table: 1.Laundry bag, dirty linen container, or leak proof bag for wet linen following facility policy 2.2 Sheets -- a top sheet and a bottom sheet 3.Drawsheet or incontinent pad if used 4.Blanket and/or bedspread if needed 5.Pillowcase(s) 2.Lock wheels of bed, put head of bed as flat as tolerated and assist resident to roll on side. 3.Check linen for misplaced items such as dentures, hearing aids, and eyeglasses.

19. Occupied Bed Procedural Guidelines 4.Remove blanket and bedspread and set aside if they are to be reused. Leave resident covered with top sheet or bath blanket following facility policy. 5.Loosen bottom linen and roll or fanfold linen, soiled side inside, to center of bed. 6.Clean, dry and straighten mattress as needed.

20. Occupied Bed Procedural Guidelines 7.Apply clean bottom linen, working on side of bed near clean linen. Do not allow clean linen to touch the floor. a.For fitted bottom sheet: Place fitted corners over top and bottom mattress corners. b.For straight sheet: Center and unfold lengthwise with bottom edge even with or just over the foot of the mattress. Tuck top of sheet under head of mattress and miter the top corner. c.If used, center the drawsheet or pad on the bed. d.Tuck in the bottom linen on the side you are working, keeping linen straight and centered. e.Roll the clean bottom linen to the center of the bed. If soiled linen is wet, keep clean linen separated from soiled linen by using a towel or other material.

21. Occupied Bed Procedural Guidelines 8.Raise siderail, assist resident to roll over linen toward you, and assure that resident is comfortable and safe. 9.Raise siderail, then go to opposite side of bed and lower siderail.

22. Occupied Bed Procedural Guidelines 10.Remove soiled linen from the bed. a.Roll soiled linen off of bed with dirty side inside. b.Avoid touching soiled linen against clothing. c.Handle soiled linen as little as possible and avoid shaking linen. d.Place soiled linen directly into soiled linen container following facility policy. Keep the outside of the container clean. Do not place soiled linen on clean surfaces or on the floor. e.Clean, dry and straighten mattress as needed. Report tears or holes in mattress to nurse. f.Remember to raise side rail before you leave the bedside, make sure call signal is in reach. g.Remove gloves and wash hands.

23. Occupied Bed Procedural Guidelines 11.Pull clean bottom linen away from resident's back. 12.Pull and tuck in bottom linen, assuring bottom linen is tight, smooth, and free of wrinkles (unless waterbed, egg crate, gel or air mattress). 13.Assist resident to roll back to the center of the bed. 14.Remove the pillow, change pillowcase (with zippers and tags inside), and replace pillow, providing support for resident's head if needed. 15.Remove the used top sheet or bath blanket as you apply the clean top sheet over the resident, avoiding unnecessary exposure. 16.Apply remaining top linen, keeping it straight and centered and tucking it in at foot of bed with smooth corners following facility policy.