What should the nursing assistant do when making a person's bed? A Comprehensive Guide

According to the World Health Organization, proper hygiene is critical in healthcare settings to prevent infections. Therefore, knowing exactly what should the nursing assistant do when making a person's bed is a fundamental skill that promotes cleanliness, patient safety, and comfort. This guide details the essential steps and protocols for nursing assistants to follow.

Quick Summary

A nursing assistant must prepare supplies, perform hand hygiene, ensure patient safety and privacy, and follow specific procedures for occupied or unoccupied beds. Key protocols involve changing linens properly, preventing wrinkles, and using good body mechanics to ensure patient comfort and prevent infection.

Key Points

• Pre-Procedure Steps: Always gather all supplies, perform hand hygiene, explain the procedure to the patient, and ensure privacy before starting bed making.

• Infection Control: Never shake linens, as this spreads germs. Roll soiled linens inward and immediately place them in a hamper, never on the floor.

• Patient Safety: Raise the bed to a safe, comfortable working height. Always use side rails to prevent falls, especially when a patient is in an occupied bed.

• Wrinkle Prevention: Ensure all sheets, especially the bottom sheet, are pulled taut and free of wrinkles to prevent skin irritation and pressure sores.

• Occupied Bed Technique: Roll the patient gently from side to side, changing linens in two parts. Use a bath blanket for privacy and warmth throughout the process.

• Proper Body Mechanics: Protect your back by raising the bed to waist level, bending your knees, and moving with your feet rather than twisting your body.

• Post-Procedure Steps: After finishing, return the bed to its lowest, locked position, place the call light within the patient's reach, and check that they are comfortable.

Preparing for Bed Making

Before starting any procedure, proper preparation is key to ensuring efficiency and safety. The nursing assistant should take several preparatory steps:

• Gather all necessary supplies. This includes clean sheets, a pillowcase, a draw sheet (if used), a fitted sheet (or a flat sheet for a mitered corner), and a bath blanket or privacy blanket. Having all materials on hand prevents repeated trips away from the patient's bedside, reducing infection risk and saving time.
• Perform hand hygiene. Wash hands thoroughly or use hand sanitizer before entering the patient's room and before handling clean linens.
• Knock and introduce yourself. Greet the patient, introduce yourself, and explain the procedure to gain their cooperation and trust.
• Ensure privacy. Close the door, pull the privacy curtain, and cover the patient with a bath blanket during the procedure to maintain their dignity.
• Adjust the bed. Raise the bed to a comfortable working height to prevent back strain. Ensure the bed wheels are locked for safety.

Making an Unoccupied Bed

An unoccupied bed is one that the patient has left, either for a bath, physical therapy, or upon discharge. The process for making an unoccupied bed is as follows:

1. Remove soiled linens. Roll or fold the dirty linens inward, away from your uniform and the patient's face, to contain microorganisms. Place them immediately into the designated soiled linen hamper or bag, never on the floor. Before removing, check the sheets for any personal items like glasses, dentures, or remote controls.
2. Clean the mattress. If soiled, clean the mattress with a disinfectant and allow it to dry completely.
3. Place the bottom sheet. Place the fitted sheet smoothly over the mattress, ensuring there are no wrinkles. For a flat sheet, tuck it in tightly at the head of the bed. Wrinkles can cause skin irritation and increase the risk of pressure ulcers.
4. Add protective pads. If using a draw sheet or absorbent pad, center it from the patient's shoulders to their knees and smooth out any wrinkles.
5. Place the top sheet and blanket. Position the top sheet and any blanket, ensuring they are evenly distributed. Create a toe pleat at the foot of the bed to provide extra room for the patient's feet, preventing foot drop and pressure.
6. Make mitered corners. At the foot of the bed, make sure to use this special technique to secure the linen snugly under the mattress.
7. Replace the pillowcase. Remove the old pillowcase, placing it in the linen hamper. Put on a clean pillowcase, ensuring the open end faces away from the room's entrance.

Making an Occupied Bed

Making an occupied bed requires careful coordination and awareness of the patient's comfort and safety. This is done when the patient is unable to get out of bed.

1. Prep the patient and linens. After gathering supplies, place a bath blanket over the patient and remove the top sheet underneath it. Ask the patient to hold the bath blanket for comfort and privacy.
2. Position the patient. Roll the patient onto their side, facing away from you, and raise the side rail on the side they are facing. Place their pillow under their head for support.
3. Roll and tuck soiled linens. Untuck the soiled bottom sheet and draw sheet. Roll them inward, tucking them snugly against the patient's back.
4. Place clean linens. Place the clean fitted sheet on the exposed side of the bed, tucking it under the mattress. Fan-fold the rest of the clean sheet and tuck it against the patient's back, next to the soiled linens.
5. Re-position the patient. Lower the side rail, move to the other side of the bed, and raise the side rail on the new side. Roll the patient back over the linen towards you, onto the clean side.
6. Finish the other side. Remove the soiled linens completely and place them in the hamper. Pull the clean sheets through, tucking them snugly and smoothing out all wrinkles.
7. Add top sheets and finalize. Spread the clean top sheet and blanket over the patient, removing the bath blanket from underneath. Make mitered corners and a toe pleat as needed. Ensure the patient is comfortable and reposition the bed to a low, locked position.

Comparison Table: Occupied vs. Unoccupied Bed Making

Feature	Occupied Bed Making	Unoccupied Bed Making
Patient Presence	Patient remains in bed throughout the process.	Patient is out of the bed, in a chair, or out of the room.
Safety Precautions	Requires extra care with patient movement, side rails, and communication.	Standard bed-making precautions apply; no need to move the patient.
Technique	Performed in halves, with the patient rolled from side to side.	Can be stripped entirely and remade from scratch.
Equipment	Often requires an extra person for larger or less mobile patients.	Can be completed by one person.
Time/Complexity	More complex and typically takes longer due to patient care.	Simpler and faster as there is no patient to navigate around.
Privacy	Continuous use of a bath blanket to ensure privacy and warmth.	Less frequent use of a privacy blanket; privacy is maintained by closing the curtain.

Best Practices for Patient and CNA Safety

• Communicate effectively. Throughout the process, explain each step to the patient to reduce anxiety and encourage cooperation.
• Use proper body mechanics. Raise the bed to a comfortable height to avoid bending and twisting. Keep your back straight and use your legs for leverage when tucking sheets.
• Prioritize infection control. Never shake linens, as this spreads airborne pathogens. Hold linens away from your uniform and dispose of soiled items promptly in a designated hamper.
• Assess the patient's skin. Use bed-making as an opportunity to observe the patient's skin for any signs of redness or breakdown, which should be reported to the nurse.
• Secure the bed. Always ensure the bed is in its lowest, locked position and the call light is within reach after completing the procedure.

Conclusion

Making a person's bed is a critical skill for a nursing assistant that directly impacts patient comfort, dignity, and safety. By following established procedures for both occupied and unoccupied beds, prioritizing infection control, and communicating effectively with the patient, a nursing assistant can ensure a clean, comfortable, and safe environment. Mastering this skill not only prevents complications like pressure ulcers but also builds trust and rapport with the individuals under your care.

Frequently Asked Questions

How do you make an occupied bed with a patient who cannot roll?

For a patient who cannot roll, the CNA must make the bed lengthwise, working on the top half and then the bottom half of the bed. This requires special care and possibly an additional person to assist, focusing on smoothing linens and preventing any patient discomfort during the process.

What is a mitered corner in bed making?

A mitered corner is a specific folding technique used by CNAs to create a neat, secure, and tight-fitting corner with a flat sheet. It involves tucking the sheet, folding it at a 45-degree angle, and then tucking the flap under the mattress.

Why is it important to prevent wrinkles in a patient's bed?

Preventing wrinkles is crucial because they can restrict circulation, cause skin irritation, and lead to pressure ulcers (bedsores), especially in patients with limited mobility who spend extended periods in bed.

What should a nursing assistant do with soiled linen?

Soiled linens should be rolled inward to contain contaminants and immediately placed into a designated laundry hamper or bag. They should never be placed on the floor, on other clean surfaces, or held against your uniform.

What is the purpose of a toe pleat?

A toe pleat is a loose fold made in the top sheet and blanket over the patient's feet. This provides extra room for foot movement, preventing pressure on the toes and avoiding foot drop caused by tight linens.

When should an occupied bed be made?

An occupied bed is made when the patient cannot or is not permitted to get out of bed. It is often done after the patient receives a bed bath and whenever the sheets become soiled, damp, or wrinkled.

How do you change a pillowcase while the person is in bed?

To change a pillowcase while a patient is in bed, explain the process first. Support the patient's head and neck while gently removing the old pillowcase. Scrunch up the clean case and slide it over the pillow, then place the pillow back under the patient's head with the open end of the case facing away from the door.