When making an occupied bed, the nurse aide should? Prioritize Patient Safety and Comfort

According to healthcare standards, proper technique is vital to prevent patient falls and skin injuries during care. So, when making an occupied bed, the nurse aide should? follow a meticulous procedure that emphasizes safety, comfort, and infection control to protect the patient's well-being.

Quick Summary

A nurse aide must always raise the side rail on the unoccupied side and use a bath blanket for privacy, all while ensuring a wrinkle-free bottom sheet to prevent skin breakdown.

Key Points

• Prioritize Safety: Always raise the side rail on the unattended side to prevent falls while working on the other side.

• Maintain Dignity: Use a bath blanket to cover the patient for warmth and privacy during the entire process.

• Ensure Comfort: Keep the bottom sheet and all linens taut and wrinkle-free to prevent friction and skin breakdown.

• Work Efficiently: Complete one half of the bed at a time, rolling soiled linens toward the center and tucking them under the patient before moving to the clean side.

• Communicate Clearly: Explain every step to the patient to reduce anxiety and encourage cooperation.

• Practice Infection Control: Never place soiled linens on the floor or shake them, and always use proper hand hygiene and PPE.

The Foundational Principles of Occupied Bed Making

Making an occupied bed is a fundamental skill for nurse aides (NAs) that directly impacts a patient's comfort and health. It involves changing the linens while the patient remains in the bed, making safety and proper technique paramount. Beyond maintaining hygiene, a well-made bed prevents skin irritation and pressure sores by eliminating wrinkles that can cause friction. This process also provides an opportunity to observe the patient's skin for any new issues and to engage in respectful, empathetic communication.

Prioritizing Patient Safety Above All

Before beginning, the nurse aide must ensure a safe environment. This includes gathering all necessary supplies (linens, gloves, laundry hamper) and explaining the procedure to the patient to gain their cooperation and minimize anxiety. The NA must also confirm the bed's locking mechanisms are engaged to prevent movement during the process. One of the most critical safety steps is ensuring the patient is protected from falling. When making an occupied bed, the nurse aide should raise the side rail on the side of the bed opposite to where they are working. This creates a physical barrier, preventing the patient from rolling out of bed while the aide’s attention is focused on the linens on the other side.

Maintaining Dignity and Privacy

Patient privacy and dignity are non-negotiable. The nurse aide should always pull the privacy curtain or close the door before starting. A crucial part of this is using a clean bath blanket to cover the patient during the linen change. The bath blanket is placed over the existing top sheet, and the top sheet is then removed from underneath it. This ensures the patient is never fully exposed. Throughout the process, the NA should communicate with the patient, explaining each step to keep them informed and comfortable.

The Step-by-Step Procedure

1. Preparation: Gather all linens and place them on a clean, protected surface, such as an overbed table. Stack them in the order they will be used. Perform hand hygiene and put on gloves.
2. Initial Patient Positioning: Loosen the top linens from the foot of the bed. Cover the patient with the bath blanket and remove the top sheet. Carefully roll the patient onto their side, facing away from you, toward the raised side rail. Tuck the soiled bottom linens tightly against the patient's back.
3. Clean One Side: Place the new fitted sheet and any underpads on the vacant half of the bed. Tuck the sheets securely under the mattress, pulling them taut to remove all wrinkles. Fan-fold the remaining clean linen and tuck it tightly against the patient's back, next to the soiled linens.
4. Cross to the Other Side: Raise the side rail on the side you just finished. Go to the opposite side of the bed. Lower the side rail. Gently roll the patient toward you, over the 'lump' of linen, onto the clean side of the bed.
5. Clean the Second Side: Roll the soiled linens inward and place them in the designated hamper, never on the floor. Pull the clean linens through and smooth them over the mattress, ensuring there are no wrinkles. Tuck the sheets securely under the mattress.
6. Final Touches: Assist the patient to a comfortable position, typically on their back. Replace the pillowcase and position the pillow. Pull the top sheet and blanket over the patient, removing the bath blanket from underneath. Make a toe pleat at the foot of the bed by folding the top sheet and blanket to allow for foot movement. Ensure the bed is in a low and locked position, the call light is within reach, and the patient is comfortable before leaving.

Comparison of Occupied vs. Unoccupied Bed Making

Feature	Occupied Bed Making	Unoccupied Bed Making
Patient Presence	Patient remains in bed	Patient is out of bed
Technique	Performed in sections (one side at a time)	Entire bed stripped and made at once
Equipment	Requires a bath blanket for privacy	Bath blanket not necessary
Safety Focus	High risk of falls, requires careful positioning and side rail use	Lower risk of falls, primarily focused on ergonomic safety for staff
Time Commitment	Generally takes longer due to careful patient handling	Quicker to complete
Primary Goal	Patient comfort and hygiene with minimal disturbance	Preparing a clean, safe bed for patient use

Essential Considerations for a Nurse Aide

Beyond the physical steps, a nurse aide must remain vigilant to the patient's needs and surroundings. Communication is key; a simple, "I'm just going to roll you gently to your side now" can prevent startles and increase cooperation. Observe the patient’s skin condition throughout the process. Look for any new redness, sores, or changes that might require reporting to a supervisor. The use of a draw sheet is also vital, as it can help in repositioning the patient and protecting the bottom sheet from soilage. For more information on general patient care and safety standards, visit The American Nurses Association.

Conclusion: A Seamless and Compassionate Process

When making an occupied bed, the nurse aide should prioritize patient safety, comfort, and dignity at every turn. By following a structured, methodical approach—including proper patient positioning, side rail use, and maintaining privacy—NAs can efficiently and respectfully change linens without compromising the patient's well-being. A wrinkle-free bed is a small detail that makes a significant difference in preventing skin breakdown and promoting a healing, comfortable environment for those who are bed-bound.

Frequently Asked Questions

What is the very first step a nurse aide should take when making an occupied bed?

The very first step is to gather all necessary equipment and explain the procedure to the patient. You must also perform hand hygiene and ensure the bed is locked.

Why is it important to use a bath blanket when making an occupied bed?

A bath blanket is used to provide warmth and privacy for the patient during the linen change, ensuring their dignity is maintained and they do not feel exposed.

When making an occupied bed, how should soiled linens be handled?

Soiled linens should be rolled inward, away from the nurse aide, and placed directly into a designated laundry hamper or bag. They should never be placed on the floor.

What is the purpose of a 'toe pleat' when making an occupied bed?

A toe pleat is a loose fold made at the foot of the bed with the top sheet and blanket. This allows the patient's feet and toes to move freely, preventing pressure and potential foot deformities.

What is the correct procedure for using side rails during an occupied bed change?

The side rail should always be up on the side of the bed that the nurse aide is not actively working on. This prevents the patient from falling out of bed. Lower the rail only when you are working on that specific side.

How can a nurse aide prevent a bed-bound patient's skin from breaking down during bed changes?

To prevent skin breakdown, a nurse aide must ensure all bottom sheets are completely wrinkle-free. Wrinkles cause friction and pressure that can lead to pressure sores.

What should the nurse aide do after completing an occupied bed change?

After completing the bed change, the nurse aide should ensure the bed is in a low and locked position, the call light is within the patient's reach, and the patient is comfortable.