Which position do you need to place the resident in when making an occupied bed?

According to healthcare standards, a clean and wrinkle-free bed is critical for preventing skin breakdown and infections in bedridden patients. To safely and effectively accomplish this, caregivers must know exactly which position do you need to place the resident in when making an occupied bed.

Quick Summary

The resident must be turned onto their side, facing away from the caregiver, while a raised side rail acts as a safety barrier during an occupied bed change. This side-lying, or lateral, position allows for the linens to be changed one half of the bed at a time, protecting the resident's safety and privacy.

Key Points

• Lateral Position: The resident should be turned onto their side, facing a raised side rail, for a safe and effective occupied bed change.

• Safety Rails are Critical: The side rail on the side the resident is turned towards must always be up to act as a security barrier and prevent falls.

• Good Body Mechanics: Caregivers should raise the bed to waist height and use proper form to avoid back strain during the procedure.

• Wrinkle-Free Sheets: Ensuring the bottom sheet is smooth and free of wrinkles is essential for preventing pressure sores on the resident's skin.

• Dignity and Privacy: Always use a bath blanket to keep the resident covered and explain each step to them, affirming their dignity throughout the process.

The Correct Positioning: The Lateral Position

When changing the linens on a bed with a resident still in it, the safest and most efficient position is the side-lying, or lateral, position. The resident is turned onto their side, facing away from the caregiver, towards a raised side rail. This creates a safe space to roll and tuck the soiled linens, as well as place the new, clean ones. The entire process is performed methodically, one half of the bed at a time, to ensure the resident is never left without support or privacy.

Preparing for the Occupied Bed Change

Before beginning, proper preparation is key to a smooth and safe procedure. By having all supplies and protocols in place, you can minimize the time the resident is in a vulnerable position and reduce the risk of infection or injury.

Key Preparation Steps:

• Gather all supplies: This includes a bottom sheet, top sheet, incontinence pad (if used), pillowcases, gloves, and a hamper or bag for soiled linens. Place them in the order of use on a clean surface, such as a bedside table.
• Perform hand hygiene and don gloves: Wash your hands thoroughly and put on fresh gloves to protect both yourself and the resident from potential infection.
• Ensure privacy: Close the door and pull the privacy curtain around the bed.
• Communicate with the resident: Explain the procedure clearly, even if they are non-verbal. Reassure them and ask for their assistance if they are able.
• Adjust bed height and lock wheels: Raise the bed to a comfortable working height for the caregiver to prevent back strain. Ensure the wheels are locked to prevent the bed from moving during the process.

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

Executing the bed change correctly requires a specific sequence of actions to maximize safety and efficiency.

1. Lower the head of the bed: If the resident is in a raised position, gently lower the head of the bed to a flat or near-flat position, as tolerated.
2. Turn the resident onto their side: Carefully and gently roll the resident onto their side, facing away from you, towards a raised side rail. Use a supportive pillow behind their back if needed to maintain the position.
3. Roll and tuck soiled linens: On the side you are working on, loosen the soiled bottom sheet and any incontinence pads. Tightly roll them inward, towards the resident's back, tucking them firmly against their body.
4. Place clean linens on the first side: Place the clean fitted or flat bottom sheet on the empty half of the bed. Fan-fold or roll the remaining portion of the clean sheet and tuck it snugly against the rolled soiled linen under the resident.
5. Assist resident to roll back: Raise the side rail on the side you just finished. Move to the opposite side of the bed, lower the rail, and gently assist the resident to roll over the 'hump' of linens and onto the clean side of the bed.
6. Remove soiled linens: From the new side, unroll the soiled linens completely and place them directly into the designated hamper. Avoid touching your uniform or the floor with the soiled materials.
7. Smooth and tuck clean linens: Pull the clean bottom sheet tightly and smoothly across the bed, removing any wrinkles. Securely tuck the edges under the mattress.
8. Reposition the resident: Assist the resident to roll back onto their back, centering them in the bed for comfort.
9. Change top linens: Remove the old top sheet and blanket, keeping the resident covered with a bath blanket for warmth and privacy. Replace with the clean top sheet and blanket, making sure to create a toe pleat at the foot of the bed to prevent pressure on the feet.
10. Change the pillowcase: Remove the soiled pillowcase by pulling it down and over the pillow. Carefully place the pillow into a new, clean pillowcase.
11. Final adjustments: Ensure the resident is comfortable, lower the bed to its lowest position, raise the side rails, and place the call light within their reach. Perform hand hygiene.

Minimizing Injury for Caregiver and Resident

Proper body mechanics are essential for caregivers to prevent injury. Always raise the bed to waist level to avoid bending over, use your legs to lift and turn, and get assistance for heavier or less mobile residents. For the resident, maintaining a smooth, wrinkle-free bed surface is paramount to prevent pressure injuries and skin irritation.

Comparing Occupied vs. Unoccupied Bed Making

Making an unoccupied bed is a more straightforward process, but for occupied beds, the primary consideration is the resident's safety and comfort. Here is a comparison of the key differences:

Feature	Occupied Bed Making	Unoccupied Bed Making
Resident's Presence	Resident is in the bed throughout the process.	Bed is empty; resident is out of the room or in a chair.
Positioning	Requires turning the resident to a lateral position (on their side) twice to change linens one side at a time.	Bed is flat; linens are changed in one continuous motion.
Privacy	A bath blanket is used to maintain privacy and warmth.	No need for a privacy blanket as the resident is not present.
Safety Measures	Requires raised side rails and constant communication with the resident.	Primarily involves locking the bed wheels to ensure it remains stationary.
Process	Methodical, two-stage process for changing linens.	Continuous, single-stage process for faster completion.

Conclusion

Mastering the proper technique and positioning for an occupied bed change is a vital skill for any caregiver. The lateral, or side-lying, position is the cornerstone of this procedure, allowing for a safe, efficient, and dignified experience for the resident. By prioritizing safety, communication, and hygiene throughout the process, caregivers can provide a high standard of care that promotes the resident's comfort and well-being.

For more detailed protocols on this topic, a reputable source is Medicine LibreTexts Medical Training Guidelines for Occupied Bed Making.

Frequently Asked Questions (FAQs)

• How do you prevent the resident from rolling off the bed? Ensure the side rail on the side the resident is facing is always up while you work on the other side. This acts as a crucial safety barrier, and you should remind the resident to hold onto it if they are able.
• What should I do if the resident is in pain during the procedure? Communicate with the resident constantly. If they express pain or discomfort, stop the procedure immediately, readjust their position, and assess their condition. Report any concerns to a supervisor or nurse.
• Why is it important to smooth out all wrinkles? Wrinkles in the bed linen can cause uncomfortable pressure points on the skin, leading to skin irritation and an increased risk of pressure sores or ulcers in bedridden individuals.
• Can one person make an occupied bed? Yes, a single caregiver can make an occupied bed by following the proper rolling and safety procedures. However, for heavier or more dependent residents, having a second person can provide additional safety and support.
• What is a toe pleat and why is it necessary? A toe pleat is a loose fold made in the top sheet and blanket at the foot of the bed. It provides extra space for the resident's feet to move, preventing pressure from tight linens that can restrict circulation or cause discomfort.
• How often should an occupied bed be changed? The linens on an occupied bed should be changed at least weekly, or more frequently if they become soiled or damp. Regular changes are vital for resident hygiene and infection control.
• What should I do if I find personal belongings in the bed? Any personal belongings found while changing the bed should be returned to their proper place. Explain to the resident or their family that you found the item and are returning it.
• How can I maintain a resident's dignity during the bed change? Providing ample privacy by using a curtain or screen, ensuring the resident is always covered with a bath blanket, and explaining each step of the process are all key to maintaining dignity. Your respectful communication and gentle movements are also crucial.

Comparison of One vs. Two Caregivers for Occupied Bed Making

Feature	Single Caregiver	Two Caregivers
Safety Rails	Absolutely essential to use the raised side rail as a safety barrier when the resident is turned.	One caregiver can act as the barrier while the other changes the linens, though using side rails is always good practice.
Resident Support	The caregiver must be able to support and move the resident safely, potentially using a draw sheet for assistance.	Caregivers can work in tandem to lift and turn the resident more easily, reducing the risk of injury for both parties.
Efficiency	Can take longer as the caregiver must move around the bed multiple times to complete each side of the process.	Significantly faster, as each caregiver can work on one half of the bed simultaneously, or one can steady the resident while the other works.
Best Suited For	Residents who are more mobile and can assist with the turning process.	Heavier or less mobile residents who require maximum support and assistance.

Safety Protocols: The Caregiver's Checklist

Beyond proper positioning, a few safety protocols are non-negotiable for a successful occupied bed change:

• Good Body Mechanics: Avoid bending at the waist. Use your legs to lift, and keep your back straight. The bed height adjustment is your best tool for this.
• Infection Control: Never let clean linens touch your uniform or the floor. Roll soiled linens inward and place them directly into the hamper. Do not shake linens, as this can spread microorganisms.
• Constant Communication: Narrate your actions to the resident. This helps to orient them and reduces anxiety, even if they are unable to respond.
• Post-Procedure Checks: Once the bed is made, perform a quick safety check. Ensure the bed is low and locked, the call light is in reach, and the resident is comfortable before you leave.

The Importance of Dignity and Hygiene

Changing an occupied bed is more than just a task; it is an intimate act of care. Maintaining the resident's dignity and privacy is just as important as the physical act of changing the sheets. By following the correct procedures, using privacy measures, and communicating respectfully, you affirm the resident's worth and provide a sense of security and well-being. A clean and fresh bed contributes significantly to a resident's comfort and overall health, helping to prevent complications and improve their quality of life.

Key Takeaways

• Optimal Position: For safety and efficiency, the resident must be in the lateral, or side-lying, position, facing a raised side rail during the occupied bed change.
• Safety First: Always lock bed wheels, raise side rails, and use good body mechanics to prevent injury to both the resident and caregiver.
• Process is Key: The step-by-step method of changing linens one side at a time is crucial for resident security and comfort.
• Prevent Complications: Ensure bed linens are wrinkle-free and provide a toe pleat to prevent skin irritation and pressure sores.
• Dignity and Hygiene: Always maintain the resident's privacy, communicate clearly, and follow strict infection control practices throughout the procedure.

Frequently Asked Questions

What is the very first step in preparing to make an occupied bed?

The very first step, after hand hygiene and gathering supplies, is to explain the procedure to the resident and provide for their privacy by closing the door and pulling the curtain.

Why do you raise the bed to a working height for the caregiver?

Raising the bed to the caregiver's waist level allows them to work without bending over, which helps prevent back strain and other musculoskeletal injuries. It is a key aspect of safe body mechanics.

How do you ensure the resident is never fully exposed during the bed change?

A clean bath blanket is placed over the resident at the beginning of the process. This blanket is used to keep them covered as the top sheet is removed, ensuring their privacy and comfort.

What does 'making a toe pleat' mean and why is it important?

A toe pleat is a fold in the top sheet and blanket at the foot of the bed. It is important because it provides enough room for the resident's feet to move, preventing pressure that can lead to discomfort or foot deformities.

What are the proper infection control measures when changing an occupied bed?

Proper infection control includes using gloves, never shaking linens to avoid spreading airborne pathogens, and keeping soiled linens from touching your uniform or the floor. Dispose of them immediately in the designated hamper.

What should I do immediately after the bed change is complete?

After the bed change, you must perform hand hygiene, lower the bed to its lowest position for resident safety, ensure the side rails are up, and place the call light within the resident's reach. Always ask if they are comfortable.

Is it better to have one or two caregivers for this task?

While one caregiver can perform the task, two caregivers are often safer and more efficient, especially for heavier or more dependent residents. The additional help reduces strain and enhances safety for both the resident and the caregivers.