What should the nursing assistant do when making an occupied bed? A step-by-step guide

According to healthcare protocols, maintaining a clean and comfortable bed is crucial for patient well-being, morale, and preventing skin issues. A primary responsibility for many healthcare providers is to know precisely what should the nursing assistant do when making an occupied bed to ensure both safety and a high standard of care.

Quick Summary

This guide provides a comprehensive step-by-step procedure for the nursing assistant on how to make an occupied bed safely and efficiently, including preparation, patient positioning, and infection control measures.

Key Points

• Safety First: Always raise the side rail on the unattended side of the bed to prevent the patient from falling.

• Infection Control: Never place soiled linens on the floor or shake them, and always use gloves during the procedure.

• Maintain Privacy: Keep the patient covered with a bath blanket and draw curtains to ensure their dignity and comfort.

• Check Skin Integrity: Use the opportunity to observe the patient's skin for any signs of breakdown or pressure sores.

• Clear Communication: Explain each step of the process to the patient to ensure their cooperation and reduce anxiety.

• Prevent Wrinkles: Smooth out all linens to prevent skin irritation and pressure injuries for the patient.

• Toe Pleat: Create a toe pleat in the top sheet and blanket to allow the patient's feet to move freely and prevent pressure.

Preparation: The Foundation of Safe Bed Making

Before approaching the patient, a nursing assistant must complete several critical preparatory steps to ensure a smooth, safe, and dignified procedure. Skipping these steps can compromise patient safety and lead to potential contamination.

Gather Necessary Supplies

Having all required items readily available prevents leaving the patient unattended. A typical occupied bed-making procedure requires the following:

• Clean linens (fitted sheet, flat sheet, pillowcase, draw sheet, or incontinence pad if needed)
• Gloves
• A linen hamper or bag for soiled linens
• A privacy blanket or bath blanket
• Barrier to place clean linens on (like a covered tray table)

Prior to Entering the Room

1. Perform hand hygiene: Wash or sanitize your hands before gathering equipment.
2. Organize supplies: Arrange linens on a clean, covered surface in the order of use to streamline the process.
3. Explain the procedure: Briefly explain to the patient what you will be doing to gain their cooperation and reduce anxiety.
4. Ensure privacy: Close the door and pull the privacy curtain around the bed.

The Step-by-Step Procedure for Making an Occupied Bed

This process is typically divided into working on one side of the bed at a time to maintain patient safety and comfort.

Phase 1: Preparing the First Side

1. Wash and glove hands: Perform hand hygiene and don a pair of clean gloves.
2. Adjust the bed: Raise the bed to a comfortable working height to prevent back strain. Ensure the bed wheels are locked.
3. Position the patient: Carefully roll the patient onto their side, facing away from you. Instruct the patient to hold onto the side rail for assistance if possible. The side rail on the opposite side (the unattended side) must be raised.
4. Remove and roll soiled linens: Loosen the soiled bottom sheets from the bed. Roll them inward toward the patient's back, tucking them snugly against the patient. Do not shake or hold linens against your uniform.
5. Apply clean bottom linen: Place the new fitted sheet and any protective pads on the newly exposed side of the bed. Fanfold the clean sheets and tuck them under the rolled, soiled linen. Secure the sheet to the mattress corners on your side, and ensure the sheets are free of wrinkles.

Phase 2: Moving the Patient to the Clean Side

1. Raise the side rail: Before leaving the side of the bed, raise the side rail for patient safety.
2. Move to the opposite side: Go to the other side of the bed and lower the side rail on that side.
3. Reposition the patient: Gently roll the patient over the folded linen bump onto the newly made side of the bed. The patient can use the side rail for support. Ensure the side rail you just lowered is now raised before proceeding.
4. Remove soiled linen: Gather the soiled sheets that were rolled under the patient. Roll them inward to contain any contamination and place them directly into the linen hamper. Never place soiled linens on the floor.
5. Pull and secure clean linen: Pull the clean fitted sheet and pads smoothly over the mattress and secure the remaining corners. Smooth out any wrinkles under the patient.

Phase 3: Completing the Bed

1. Replace top linens: Place the clean flat sheet over the patient, asking them to hold the top edge if they are able. Remove the privacy blanket from underneath and place it in the hamper. Smooth out the sheet and make a toe pleat at the foot of the bed to allow for movement.
2. Make hospital corners: Create mitered corners at the foot of the bed to secure the top sheet and blanket.
3. Change the pillowcase: Gently lift the patient's head to remove the old pillow and pillowcase. Replace with a clean pillowcase, positioning the pillow so the open end is away from the door.
4. Final adjustments: Adjust the patient's position for comfort. Lower the bed to its lowest position and lock the wheels.
5. Final safety check: Place the call light within the patient’s reach and confirm they are comfortable and have everything they need.

Single vs. Two-Person Occupied Bed Making

Aspect	Single Person Bed Making	Two-Person Bed Making
Patient Involvement	Higher patient participation is required (holding rails, rolling).	Less patient exertion is needed, making it suitable for more frail or immobile patients.
Physical Strain	Places more physical strain on the single nursing assistant.	Distributes the workload, reducing the risk of injury for both the patient and the caregivers.
Efficiency	Takes longer as the assistant must move from one side to the other.	Faster and more streamlined, as each person can work on one side of the bed simultaneously.
Patient Safety	The risk of falls is managed by ensuring side rails are always raised on the unattended side.	Enhanced safety with a partner ensuring stability and control of the patient's position.
Task Suitability	Appropriate for patients who are cooperative and have some mobility.	Essential for heavier patients or those with limited mobility, pain, or post-operative restrictions.

Important Considerations for Patient-Centered Care

• Maintain dignity: Always use a bath blanket or top sheet to keep the patient covered during the procedure to preserve their modesty.
• Communicate effectively: Throughout the process, tell the patient what you are doing. This builds trust and helps them feel more in control.
• Respect privacy: The provision of privacy is a fundamental right. Always close curtains and doors.
• Monitor for skin integrity: As you change the sheets, observe the patient's skin for any signs of redness, irritation, or pressure sores. This is an excellent opportunity for a quick skin check.
• Use good body mechanics: Utilize proper posture and leverage when repositioning the patient to prevent injury to yourself.
• Follow infection control: Always wear gloves and never let soiled linens touch your uniform or the floor. Place them directly into the designated hamper.

Conclusion

Knowing what should the nursing assistant do when making an occupied bed is a fundamental skill that combines safety, efficiency, and compassionate patient care. By following a structured, step-by-step process that prioritizes patient dignity and infection control, nursing assistants ensure that bedridden patients remain in a clean, comfortable, and safe environment. Regular practice and attention to detail are key to mastering this essential procedure, whether working alone or with a partner.

For more detailed training on this and other vital CNA skills, consult your facility's official training resources or certified educational programs like those found on CNA Training Institute.

Frequently Asked Questions

Why is it important to make an occupied bed correctly?

Making an occupied bed correctly is important for patient hygiene, comfort, and safety. A clean, wrinkle-free bed prevents pressure sores and skin breakdown, reduces the spread of infection, and provides a sense of security and dignity to the patient.

What is the most crucial safety step when making an occupied bed?

The most crucial safety step is to always ensure the side rail on the side of the bed opposite the nursing assistant (the unattended side) is raised. This prevents the patient from falling out of bed while you are working.

Can a nursing assistant make an occupied bed alone?

Yes, a nursing assistant can make an occupied bed alone, but it is often easier and safer with two people, especially for heavier or less mobile patients. A partner helps manage the patient's position and reduces the physical strain on the caregiver.

What should be done if the linens are soiled?

If linens are soiled, roll them inward to contain the contamination. Never place them on the floor or hold them against your uniform. Place the soiled items directly into the designated laundry hamper.

What is a 'toe pleat' and why is it necessary?

A toe pleat is a loose fold made in the top sheet and blanket over the patient's feet. It is necessary to prevent tightness that could restrict foot movement and cause pressure on the toes, which can lead to foot deformities or discomfort.

What should the nursing assistant do after completing the bed making?

After completing the bed making, the nursing assistant should ensure the patient is comfortable, lower the bed to its lowest position, and place the call light within easy reach. The privacy curtain should be opened, and hands should be washed.

How do you apply a clean pillowcase while changing an occupied bed?

To apply a clean pillowcase, turn it inside out and grasp the center of the closed end. With your hand inside, grab the corner of the clean pillow and pull the case over it. Do not shake the pillow or place it under your chin during the process.