How to Change Sheets in a Nursing Home Safely and With Dignity

According to the CDC, proper hygiene is a crucial component of infection control in healthcare settings. Knowing how to change sheets in a nursing home for a bedridden resident is an essential caregiving skill that ensures comfort, prevents skin issues like bedsores, and upholds a person's dignity during a vulnerable time.

Quick Summary

A comprehensive guide on changing bed linens for residents who cannot leave their beds. It outlines the preparation, proper technique for maneuvering the patient, and ensuring a clean, comfortable, and safe environment for their well-being.

Key Points

• Pre-procedure Checklist: Always gather all necessary linens and supplies, explain the process to the resident, and prepare the bed by raising it to waist level and locking the wheels before starting.

• Use Proper Body Mechanics: Raise the bed to a comfortable working height to prevent back strain and use correct lifting techniques, especially when rolling a resident.

• Roll, Tuck, and Pull: The core technique involves rolling the resident to one side, tucking the clean linens, rolling them over the linens, and then pulling the clean sheet taut while removing the old one.

• Prioritize Resident Dignity: Maintain the resident's privacy by closing curtains, keeping them covered with a bath blanket, and communicating every step clearly and calmly.

• Prevent Skin Irritation: Smooth out all wrinkles in the sheets and use a draw sheet to minimize friction, which helps prevent skin breakdown and pressure ulcers.

• Ensure Safety First: Always raise bed rails on the opposite side of where you are working to prevent falls, and place the call light within reach before leaving.

• Communicate Constantly: Explain each step to the resident, especially those with cognitive impairments like dementia, to minimize anxiety and ensure cooperation.

Preparation is Key

Before beginning the process of changing occupied bed linens in a nursing home, it is essential to prepare all necessary supplies to ensure a smooth and efficient procedure. A well-organized approach minimizes discomfort for the resident and reduces the risk of caregiver strain. Gather your materials and follow these preliminary steps:

1. Gather Supplies: Collect all necessary linens and supplies, including clean sheets (fitted and top), a fresh pillowcase, a waterproof pad, a draw sheet (if used), a laundry bag or hamper, and personal protective equipment (PPE) like gloves. Arrange them on a clean, flat surface, such as a bedside table, in the order they will be used. A laundry bag should be easily accessible, but not on the bed itself.
2. Ensure Privacy and Communication: Always knock before entering a resident's room. Introduce yourself and explain the procedure in a calm and reassuring tone. Close the door and pull the privacy curtain to maintain the resident's dignity. Communication helps build trust and can ease any anxiety the resident might have.
3. Adjust the Bed: Raise the bed to a comfortable working height to prevent caregiver back strain. Lock the bed wheels to ensure it remains stable throughout the process. Lower the head of the bed to a flat position if the resident can tolerate it. Raise the side rail on the side the resident will roll toward for their safety.

The Occupied Bed-Making Procedure

The most common method for changing linens with a resident in bed involves rolling them from one side to the other, replacing the sheets in two stages.

Step 1: Roll the resident and prepare the first side.

• Don your gloves to maintain proper hygiene.
• Gently roll the resident onto their side, facing away from you. If they are able, ask them to hold onto the side rail for support. Use pillows or wedges behind their back for added stability if needed.
• Loosen the bottom sheet, waterproof pad, and any other under-linens on the unoccupied side. Roll the soiled linens tightly toward the resident's back, tucking them snugly against their body. Keep the soiled side rolled inward to minimize the spread of microbes.
• Wipe down the exposed mattress surface with a disinfectant if needed, and lay the clean linens onto this half of the bed. Fan-fold or roll the clean fitted sheet and waterproof pad toward the resident's back, positioning them next to the rolled-up dirty linens. Tuck the clean sheets securely under the mattress on your side.

Step 2: Roll the resident over the linens.

• Raise the side rail on the side you just finished to ensure the resident's safety.
• Move to the opposite side of the bed and lower that side rail.
• Gently help the resident roll over the "bump" of rolled-up clean and dirty linens, toward the clean side of the bed.
• Encourage the resident to assist as much as they can during this movement.

Step 3: Finish the second side and replace top linens.

• Untuck the rolled soiled linens from under the resident and remove them completely, placing them directly into the laundry bag. Avoid letting the soiled linens touch your uniform or the floor.
• Pull the clean linens smoothly across the mattress. Pull the fitted sheet tightly to eliminate wrinkles, which can cause skin irritation. Secure the sheet corners underneath the mattress.
• Place a new top sheet over the resident. You can ask them to hold onto the top edge while you remove the old one from underneath.

Step 4: Change the pillowcase and ensure comfort.

• Gently support the resident's head with one hand while removing the pillow with the other.
• Change the pillowcase by turning the clean one inside-out, grabbing the pillow at the corner, and pulling the case over it.
• Replace the pillow under the resident's head and check that they are comfortable. A fluffier pillow might be better than a flat one.

Step 5: Final adjustments and departure.

• Adjust the top sheet and any blankets, leaving enough slack for foot room to prevent pressure on the toes.
• Return the bed to a comfortable, low position and raise the side rails as per facility protocol.
• Place the call light within easy reach of the resident.
• Remove your gloves and perform hand hygiene.
• Open the privacy curtain and leave the room, confirming the resident has everything they need.

Comparison of One vs. Two-Person Bed-Making

Feature	One-Person Technique	Two-Person Technique
Resident Mobility	Best for residents who can assist by rolling or are lighter weight.	Ideal for residents who are heavier, less mobile, or require more support.
Caregiver Strain	Higher risk of back strain and fatigue, especially with heavier residents.	Significantly reduces physical strain on caregivers.
Efficiency and Speed	Can be done efficiently by a single, experienced caregiver.	Often quicker and smoother, with one person focusing on rolling the resident while the other handles linens.
Safety	Requires close attention to resident stability to prevent falls.	Provides an extra layer of safety and security for the resident.
Complexity	Requires careful body mechanics and coordination.	Simpler execution as tasks are divided between caregivers.

Best Practices for Specific Situations

• For Residents with Dementia: Approach calmly, explain every step simply, and use gentle, non-threatening touch. Be prepared to pause if the resident becomes agitated and offer reassurance.
• For Soiled Linens: If the sheets are significantly soiled, wear a waterproof apron over your uniform. The immediate goal is to contain the mess to prevent cross-contamination and to clean the resident before applying clean linens.
• For Residents with Skin Integrity Issues: Use a draw sheet for repositioning to avoid friction and shear forces on the skin. Ensure all linens are pulled taut to remove wrinkles, which can contribute to pressure ulcers.

Conclusion

Changing sheets for a bedridden resident is a routine yet critical part of caregiving in a nursing home. By following a structured process that prioritizes resident safety, dignity, and comfort, caregivers can complete this task efficiently while minimizing risk to both themselves and the person they are assisting. Proper preparation, communication, and attention to detail are the cornerstones of this fundamental nursing skill. The correct technique ensures a clean and hygienic environment, which is vital for the resident's overall health and well-being. For additional training and tips, many professional caregiver resources offer detailed guides.

Frequently Asked Questions

What supplies do I need to change sheets on an occupied bed?

You will need a clean fitted sheet, a clean top sheet, a clean pillowcase, a draw sheet and/or waterproof pad (if used), a laundry bag or hamper, gloves, and a bath blanket for resident privacy.

How do you roll a resident safely to change the bed?

To roll a resident safely, first raise the bed rail on the far side. Gently turn the resident onto their side, away from you. You can use a pillow to support their back. Communicate the motion clearly, and ensure their legs and arms are positioned comfortably.

Is it better to have one or two people change occupied bed sheets?

While a single person can change sheets, having two people is safer and more efficient, especially for residents who are heavier, less mobile, or anxious. It reduces physical strain on caregivers and increases stability for the resident.

What is the purpose of a draw sheet when changing linens?

A draw sheet is a smaller sheet placed under the resident's torso. It helps in moving or repositioning the resident with minimal friction, reducing the risk of skin damage and pressure ulcers.

How do you avoid wrinkles in the bed sheets for a bedridden resident?

To avoid wrinkles, pull the clean sheets tautly across the mattress when applying them. The occupied bed-making process, which involves rolling the resident to pull the sheet smoothly, is designed to minimize wrinkles.

How often should bedridden residents' sheets be changed?

Linens for a bedridden resident should be changed regularly, often at least once a week, and immediately if they become soiled. Some facilities may have more frequent protocols for residents with incontinence or other hygiene needs.

What if the resident becomes agitated during the sheet change?

If a resident becomes agitated, pause the procedure and offer reassurance. Speak in a calm voice and explain what you are doing in simple, clear terms. You may need to take a break or seek assistance from a colleague.