1. Textbook for Nursing Assistants
Chapter 15: Bedmaking

2. Linens and Other Supplies for Bedmaking

3. Learning Objectives
1. Describe ways that a properly made bed can increase a person’s comfort and well-being.
2. List the different types of linens and their uses.
3. Demonstrate the proper way to handle and care for linens.

4. Linens Many types of linens are used to make a bed
Linens that you may commonly see in use in a health care facility include the following:
Mattress pads
Bottom and top sheets
Draw sheets
Bed protectors
Blankets

5. Linen and other supplies
Pillows and pillowcases
Bath blankets
Occasionally, other equipment or supplies are used on a person’s bed, depending on the specific needs of the patient or resident. Some of the items used include the following:
A pressure-relieving mattress
A bed board
A bed cradle
A footboard

6. Linens: Mattress Pads
A mattress pad is a thick layer of padding that is placed on the mattress to help make the bed more comfortable for the patient or resident, and to protect the mattress from moisture and soiling
Fitted mattress pad
Has elasticized sides that wrap around and underneath the mattress, holding the pad securely to the mattress
Flat (non-fitted) mattress pad
Pad is not secured to the mattress

7. Linens: Bottom and Top Sheets
A bed is made with two sheets, a bottom sheet and a top sheet
Bottom sheet may be
Flat, or non-fitted
Fitted
The top sheet is a flat sheet.
The sheets may be white or colored, plain or print

8. Linens: Draw Sheets
A draw sheet is a small, flat sheet that is placed over the middle of the bottom sheet, covering the area of the bed from above the person’s shoulders to below his or her buttocks
A lift sheet is simply a draw sheet that is used to help lift or reposition a person who needs assistance with moving in bed

9. Linens: Bed Protector
A bed protector is a square of quilted absorbent fabric backed with waterproof material
It measures approximately 3 feet by 3 feet
It may be disposable, or it may be laundered and reused
It is used for people who are incontinent or have draining wounds
Sometimes, only the bed protector needs to be changed, resulting in more efficient and economical care

10. Linens: Blankets
Blankets are usually woven cotton and should be available as requested by a person for his or her comfort
Blankets may be of wool, cotton, or synthetic, depending on the person’s preference and the climate
Electric blankets should be checked for faulty wiring or plugs and may not be safe to use if the person is incontinent or unable to adjust the controls independently; should only be used according to facility policy

11. Linens: Bedspreads
A bedspread adds the finishing touch to a well-made bed and can add a decorative touch to a person’s room
Hospitals and extended-care facilities may supply bedspreads for their patients to use
Long-term care facilities may encourage their residents to use their own bed coverings
Allowing a person to use his or her bedspread from home is one way to foster a sense of independence and individuality in residents

12. Linens: Pillows and Pillowcases
Pillows are used for comfort and to aid in positioning
They may be available in many sizes, are made from a variety of materials, and may be covered with waterproof material or treated with a waterproofing substance
Pillows are always covered with clean pillowcases

13. Linens: Bath Blankets
A bath blanket is a lightweight cotton blanket or flannel sheet that is used to provide modesty and warmth during a bed bath or a linen change
A flat sheet may also be used for this purpose if the facility does not provide a special bath blanket

14. Linens: Pressure-Relieving Mattress
May be placed on top of the regular mattress to help prevent skin breakdown in patients and residents who must stay in bed for long periods of time
Newer versions of pressure-relieving mattresses may be filled with air or water, and are made out of a material that is easily cleaned

15. Linens: Bed Board
A bed board is a piece of wood (usually plywood) that is placed under the mattress to provide extra support
It keeps the mattress from sagging, helping to keep the person’s body properly aligned

16. Linens: Bed Cradle
A bed cradle is a metal frame that is placed between the bottom and top sheets to keep the top sheet, the blanket, and the bedspread away from the person’s feet
Bed cradles are often used for people who are recovering from burns to prevent the top sheet from touching the burned skin, which would be very painful
They are also often used for people who are at risk for developing pressure ulcers on their feet

17. Linens: Footboard
A footboard is a padded board that is placed upright at the foot of the bed
The person’s feet rest flat against the footboard, helping to keep the feet in proper alignment

18. Handling of Linens

19. Guidelines for Handling Linens1.
WHAT YOU DO
WHY YOU DO IT
Always wash your hands before collecting clean linens
Washing your hands prevents microbes on your hands from being transferred to the clean linens

20. Guidelines for Handling Linens2.
WHAT YOU DO
WHY YOU DO IT
Do not hold linens, clean or dirty, against your uniform
If you hold clean linens against your uniform, microbes on your uniform could be transferred to the linens
If you hold dirty linens against your uniform, microbes from dirty linens could be transferred to your uniform

21. Guidelines for Handling Linens3.
WHAT YOU DO
WHY YOU DO IT
When collecting linens, collect only those that you will need for that person’s bed
Extra linens brought into a person’s room are considered soiled and, therefore, must not be returned to the clean linen cart or used for another person
These linens must now be laundered, which costs the facility extra money and manpower and creates additional wear on the linens, shortening their lifetime of use

22. Guidelines for Handling Linens4.
WHAT YOU DO
WHY YOU DO IT
Collect linens in the order that they will be used and flip the stack over so that the item you will need first is on the top of the stack
Collecting linens in the order that they will be put on the bed helps you to remember which linens you need to collect
You will be able to make the bed more efficiently, without searching through the stack for the proper item

23. Guidelines for Handling Linens5.
WHAT YOU DO
WHY YOU DO IT
Place clean linens on a clean surface in the room, such as the over-bed table or a chair
Do not place clean linens on the floor
Clean linens can become contaminated with microbes if you place them on a “dirty” surface, such as the floor

24. Guidelines for Handling Linens6.
WHAT YOU DO
WHY YOU DO IT
Wear gloves when removing used linens from a bed
Roll the linens toward the center of the bed to confine the soiled area inside
Any item contaminated with blood or other body substances is a potential source of exposure to pathogens for the health care worker
Following the standard precautions –wearing proper (PPE) will help to minimize your exposure
Confining the soiled area to the inside of the linens helps to ensure that other people, such as the people in the laundry, do not come in contact with the potentially infectious material

25. Guidelines for Handling Linens7.
WHAT YOU DO
WHY YOU DO IT
If body fluids or substances leak through the linens to the mattress or bed frame, the mattress or bed frame should be wiped with an appropriate cleaning solution before placing clean linens on the bed
Remove your gloves and wash your hands before handling the clean linens
These infection control methods help to prevent the clean sheets from becoming contaminated

26. Guidelines for Handling Linens8.
WHAT YOU DO
WHY YOU DO IT
After removing the dirty linens from the bed, place them in the linen hamper immediately
Your facility may require you to place dirty linens in a plastic bag or pillowcase before placing them in the linen hamper
Do not place dirty linens on the floor or on any other surface
Placing the dirty linens in the linen hamper immediately helps to control the spread of infection

28. STOP & THINK
Case Study 1
You are making an occupied bed. There is no linen hamper in the room, and you have already removed the soiled linens from the bed. Mrs. O’Shea, the patient, is lying on her side in the bed, covered with a bath blanket.
Discussion Points
What should you do with the soiled linens until you can take them to the linen room or hallway hamper?

29. STOP & THINK
Case Study 2
Barbara is a PCT on 3 West. She has already changed the bed linens twice during her shift for one of her patients, Mrs. Bridges. Mrs. Bridges is receiving chemotherapy for cancer, and one of the side effects of the medication is uncontrollable diarrhea. When Barbara answers Mrs. Bridges’ call light, she sadly informs her that she just could not wait and has soiled the bed again. As Barbara heads toward the linen closet to collect her supplies, she is mentally making a list of the items she needs to collect.
Discussion Point---What are some items that Barbara should remember to collect along with clean sheets?

30. Standard Bedmaking Techniques

31. Learning Objectives
1. Describe the different techniques used to prepare a closed, opened, surgical, and occupied bed .
2. Understand the infection control measures that are used during bedmaking.
3. Demonstrate techniques of proper bedmaking, including making a closed bed, opening a bed, preparing a surgical bed, and making an occupied bed

32. Standard Bedmaking Techniques
Routine bedmaking is usually done in the morning, before visiting hours, while your patients or residents are bathing or dressing
How often the linens on a person’s bed are changed will vary according to the type of health care facility and the person’s needs
However, a person’s bed must be remade each time any of the linens become soiled or excessively wrinkled, regardless of the time of day
Change as many of the bed linens as necessary to ensure a clean, dry, wrinkle-free bed for your patient or resident

33. How to Make a Mitered Corner
Mitering is a way of folding and tucking the sheet so that it lies flat and neat against the mattress

34. Closed Bed A closed bed is an empty bed
A bed that is unoccupied because the previous patient or resident has been discharged from the facility and a new patient or resident has yet to arrive is considered a closed bed
A bed that is unoccupied because the patient or resident is simply not in it at the moment (and is not expected back any time soon) is also considered a closed bed

35. Open Bed
When the top sheet, blanket, and bedspread of a closed bed are turned back, or fanfolded, the closed bed becomes an open bed, or a bed ready to receive a patient or resident.
The wheels of an open bed should always be loked and the bed should be in the lowest position

36. Surgical Bed
A surgical bed is a closed bed that has been opened to receive a patient or resident who will be arriving by stretcher

37. Occupied Bed
Some conditions make it difficult or impossible for a person to get out of bed for a linen change. When this is the case, it is necessary to change the linens while the person is still in the bed. This is called making an occupied bed

38. Guidelines for Bedmaking1.
WHAT YOU DO
WHY YOU DO IT
Always place linens on the bed so that the seams of the sheets face away from the person’s skin
The seams of the sheets can rub the person’s skin, causing irritation and leading to skin breakdown

39. Guidelines for Bedmaking2.
WHAT YOU DO
WHY YOU DO IT
Linens must be pulled tightly to avoid wrinkling. Layering should be kept to a minimum
The wrinkles and extra layers of linens can cause skin breakdown and contribute to the formation of pressure ulcers

40. Guidelines for Bedmaking3.
WHAT YOU DO
WHY YOU DO IT
Linens should be changed whenever they become soiled or wet, regardless of the time of day
Besides causing discomfort, soiled or wet sheets can cause skin breakdown and contribute to the formation of pressure ulcers

41. Guidelines for Bedmaking4.
WHAT YOU DO
WHY YOU DO IT
Do not shake linens when placing them on the bed
Recall that dust is a transport mechanism for microbes. Shaking linens stirs up dust from the floor. The dust then settles on surfaces in the room and can be easily transferred onto eating utensils or into a wound, causing an infection

42. Guidelines for Bedmaking5.
WHAT YOU DO
WHY YOU DO IT
When you need to change the linens on a person’s bed with the person still in the bed, always be sure to explain what you are doing throughout the procedure
Close the door, pull the privacy curtain, and keep the person covered
This can be a very frightening experience for a bedridden person, particularly if the person is unconscious
Even if the person is conscious, movement may cause pain, and incontinence can be very embarrassing if it occurs
If the person is mentally impaired, he or she may become combative
Talk reassuringly to the person, even if the person is unconscious
Always provide for privacy and modesty by keeping the person covered at all times

43. Guidelines for Bedmaking6.
WHAT YOU DO
WHY YOU DO IT
Check the bed linens for personal items before removing the linens from the bed
Personal items may become lost in the bed linens
Personal items may be expensive and inconvenient to replace
If they hold sentimental value, they may be irreplaceable

44. End of Presentation