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Bed making is an essential procedure in nursing in which nurses prepare and arrange different types of beds for the client's comfort in the hospital or other healthcare institutions. Bed making procedure ensures the patient's comfort according to the situation. It may vary on the client's conditions, purposes and procedures such as open bed, closed bed, occupied bed, cardiac bed, fracture bed, blanket bed etc.

Nurses have a major role in bed making procedures in hospitals. So, a nurse should learn and follow the proper and standard techniques of bed making procedures.

Bed Making Procedure

Definition of Bed Making -

Bed making is a technique in which different types of beds are prepared to make a client or patient comfortable according to the situations and procedures.

Purposes of Bed Making -

1. To provide a safe and comfortable bed to the clients or patients.
2. To organize a specific ward.
3. To be prepared for any critical or emergency condition.
4. To prevent bedsores.
5. To promote neat appearance and cleanliness.
6. To teach the relatives to take care of the sick at home.

Principles of Bed Making at Nursing -

1. Micro-organisms are present everywhere on the used articles, skin, clothing and environment. Prevent the spreading of micro-organisms from the contaminated source to the new host by taking precautions and preventing the multiplication of the micro-organisms.

Action -

• The nurse should wash her/his hands before and after the bed making procedure to prevent cross-infection.
• Bed linen and clothes must be changed frequently to ensure cleanliness.
• Do not drop the removed bed linen on the floor.
• Gently shake the linen to remove dust. Do not flap the bed clothing because it transfers dust and bacteria easily.
• Linen should be folded and held away from the nurses to prevent direct contact with dust and micro-organisms.
• Daily cleaning and dusting of beds and units will keep them free from dust and micro-organisms. Soap, water, air and sunshine will help them to be clean.
• Damp dusting is recommended because dry dusting raises dust.
• Nurses should maintain a necessary distance from patients to prevent droplet infection.
• Clean the less contaminated area first and then the clean high contaminated area to minimize the spreading of micro-organisms to the clean area.
• Linens should be disinfected before sending them to the laundry.
• Nurses who have respiratory infections should not attend to the clients.

2. A protected and comfortable bed will provide rest, and sleep and avoid many complications for bedridden clients e.g. bedsores, foot drops etc.

Action -

• The nurse should make a smooth and unwrinkled bed because a wrinkled bed exerts pressure on bony prominence and lumps. The wrinkles cause bedsores due to friction between the skin and wrinkled sheets.
• Pull the bottom sheet tightly to avoid wrinkles.
• Tuck the linen far enough and tightly to keep it fixed.
• Smooth the mattress, if there is a collection of cotton in one place before making a bed.
• Do not keep any wet linen on the bed.
• Daily dusting should be done to remove any peeling or seeds that are adhered to the bed linen of a bedridden client.
• A bed should have enough space to move from side to side. The movements prevent bedsores, stimulate blood circulation and maintain muscle tone.
• Use comfort devices to provide additional comfort to the client.

3. Good body mechanisms maintain body alignment and prevent fatigue.

Action -

• The stability of the body is assured by keeping the centre of gravity over its base. In the standing position, the nurse can have a wide base by separating his/her feet.
• The nearer to the centre of gravity a weight is held, the less strain is produced. E.g. it is more suitable to place the linen on the edge of the bed instead of holding it above shoulder level.
• Flex the knees and hips when tucking the sheet under the mattress. This position shifts the work to the long and strong muscle of the thigh and keeps the back in good alignment.
• When placing and tucking the linen, face the direction of the work and move with the work rather than twisting the body and overreaching.

4. Planned and organized ways of working save energy, time and equipment.

Action -

• Collect and arrange all the articles before starting the bed making procedure.
• At the first finish on one side of the bed making and then go to the opposite side.
• Remove the bed linen one by one holding the open end towards the floor when stripping the bed so that the client's possessions and the hospital articles are not sent to the laundry.
• The bed sheets are folded in such a way that they can be replaced easily.

General Instructions for Bed Making in Hospital -

• Wash hands properly before and after the procedure.
• Do not expose the client unnecessarily.
• Do not keep clean linen with soiled linen.
• Do not place the woollen blanket directly on the client's body without the bath blanket.
• Always ensure that the client does not lie down on the Macintosh without lining.
• Shake the linen gently.
• Maintain a distance so that the linen should not touch your body or uniform.
• Always maintain good body mechanics to prevent extra workload.
• Make the bed comfortable, smooth and unwrinkled.
• To prevent cross-infection maintain reasonable distance with the patient.

Bed Making Procedure -

• Preparation of the articles for bed making procedure -

1. Cot
2. Mattress and pillow
3. Chair or stool
4. Bedside table
5. Mackintosh
6. Blanket
7. Mattress cover
8. Top sheet and bottom sheet
9. Draw sheet
10. Pillowcase
11. Counterpane
12. Laundry bag
13. Dusters

• Steps of bed making procedure -

1. Wash hands.
2. Remove the pillow and place it on the chair.
3. Remove the top linen.
4. Fold the draw sheet. Bring the opposite end to the middle of the bed and fold them into three. Place it over the chair.
5. Roll the mackintosh and place it on the chair.
6. Remove the bottom sheet and the soiled mattress cover.
7. Dust the mattress with a dry duster.
8. Place the bottom sheet on the mattress and tuck it securely at the top on the near side.
9. Make a mitred corner and tuck at the foot end. Tuck the sheet along the sides.
10. Place the mackintosh nearly 37 cm from the head and tuck it along the sides.
11. Place the top sheet.
12. Place the blanket over the top sheet 15 to 20 cm below the top of the mattress.
13. Put the pillowcase on the pillow and place the pillow at the head end.

Types of Bed Making -

1. Closed bed
2. Open bed
3. Admission bed
4. Occupied bed
5. Operation bed or post-anaesthetic bed or recovery bed
6. Cardiac bed
7. Fracture bed
8. Amputation bed or stump bed or divided bed
9. Blanket bed

Closed Bed -

The closed bed is an empty bed, which is covered with the top linen so that all linen beneath the linen is fully protected from dust and dirt while waiting for the patient's admission.

The closed bed is uncovered when the client is admitted.

Open Bed -

The term open bed is used to describe the hospital bed when it is about to be occupied by a client. It is made either for a new client or an ambulatory client.

Admission Bed -

The admission bed is made as an open bed. The client gets into bed after a bath and changes into a hospital dress if it is a custom in the hospital.

Occupied Bed -

This is to make a bed with the client in. This is made for a client who cannot get out of bed. The preparation and the aftercare of the client will be the same as in an open bed.

Operation Bed or Post-anaesthetic Bed or Recovery Bed -

It is prepared for a client who is recovering from the effects of anaesthesia following a surgical operation.

Cardiac Bed -

A cardiac bed is used to help the client assume a sitting position that can afford him the greatest amount of comfort with the least strain. The main purpose of the cardiac bed is to relieve dyspnoea caused by cardiac disease.

Necessary requirements of cardiac bed:

• Items for an open bed. 
• Extra pillows. 
• Backrests and cardiac tables. 
• Air cushion, knee pillow, and footrest.

Fracture Bed -

It is used for a client with a fracture of the trunk or extremities to provide firm support by the use of a firm mattress that rests on a fracture board or bed board.

Amputation Bed or Stump Bed or Divided Bed -

An amputation bed is used after the amputation of the leg to take the weight of the bedclothes off the site of the operation.

Purpose of amputation bed or stump bed or divided bed:

• After the amputation of the leg, an amputation bed is used to remove the weight of the bedclothes from the operation site. 
• To maintain the stump's position. 
• To be able to check the stump for bleeding and apply a tourniquet as soon as possible if necessary.

Blanket Bed -

The blanket bed is made for a client who is suffering from renal disease to promote elimination through the skin.

Purpose of blanket bed:

• To lift the weight of the bedclothes away from the painful joints. 
• To maintain the client's warmth. 
• To encourage elimination via the skin.

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