FUNDAMENTALS OF NURSING SKILL

1. BEDMAKING
DEBBY KOSGEI
MScN (UON)

2. Introduction
■ Bed making is an art.
■ It is a way of preparing the appropriate bed
based on the condition of the patient which
adopts scientific principles of nursing.
■ Skillful bed making promotes comfort for the
patient. Nurses need to be able to prepare
hospital beds in different ways for specific
purposes.

3. ■ In most instances, bed are made after
a client receives certain care and when
beds are unoccupied.
■ At times, nurses need to make an
occupied bed or prepare a bed for a
client who is having surgery can
anesthetic post operative, or surgical
bed.

4. Purpose of Bed Making in Hospital:
■ Bed-making is nursing art. The purpose of
the bed-making should be patients or client-
centered.
■ The main purposes of bed-making are to
prevent complications by ensuring comfort
and security to the patient.
■ To provide rest and sleep.
■ To provide physical and psychological
comfort and security to the patient.

5. ■ To give the unit a neat appearance.
■ To establish an effective nurse patients
relationship.
■ To provide active and passive exercise to
the patient.
■ To promote freshness and cleanliness.
■ To develop skill in the posture/body
alignment of the nurse in bed-making.
■ To observe, identify, and prevent patient
complications.

6. ■ To accommodate the patient’s needs.
■ To reduce patient’s exertion by bed-making.
■ To eliminate irritants to the skin from the
patient’s body.
■ To dispose of soiled and dirty linen properly.
■ Another purpose of bed-making is to save
time, effort, and material properly.

7. BED APPLIANCES
Bed Cradles
■ These are wooden or metal frames used
to lift weight of bed clothes from the
patient. It is also used for:
1. Drying of wet plaster of Paris
(P.O.P)
2. Viewing of parts of body. Example,
bleeding stump after amputation.

8. Elbow or Heel Ring
■ This is a small ring similar to the one used
in preventing pressure sores.
Mackintosh/waterproof sheet
■ Any obliquely shaped water proof material
put either on mattress to protect the
bottom sheet from soiling or wetting.
Example, in cases of incontinence or
during vaginal examination. It is also used
to protect pillows. Example, in cases of
bleeding and vomiting.

9. How to care for mackintosh
1. If the mackintosh is stained with
discharge or blood, immerse the whole
mackintosh in parazone 1:10 for 10 minutes.
2. Take it out and wash with soap and
water.
3. Mob dry or hang to dry
4. Powder, roll and store.

10. Water, Air or Ripple Bed
This is a type of mattress made of water proof
sheet filled with water or air. It is put on the bed
to prevent pressure sores especially in
emaciated or paralyzed patients.
How to care for these beds
1. Deflate the bed.
2. If stained with blood or discharges,
decontaminate with Sodium hypochloride 1:10.
3. Wash with soap and water.
4. Dry, powder and store or inflate ready for
use.

11. Sand Bags
This is a strong thick material of various
shapes and sizes filled with smooth sand and
is used to maintain the position of a patient.
How to care for Sand Bags
1. When dirty, open up the bag and
empty completely.
2. Wash back with soap and water.
3. Dry, iron and refill with smooth sand.
4. Sew end firmly and keep in cupboard
ready for next use.

12. Bed/Heart/Cardiac Table
It is made of metal or wood put in front of
patient for meals, medication, or with pillows
for patient to lean forward on to ease
difficulty in breathing.
How to care for Bed Tables
1. Clean with savlon, dry and oil wheels
if necessary.

13. Bed Rest
It is a type of wooden or metal adjustable
framework or bed attachment, used in
helping patient to sit upright in bed. Example
to ease difficulty in breathing.
Care for Bed Rest
1. Clean item with 1% savlon, dry and
lubricate joints of materials if necessary and
store for use.

14. Foot Rest
It is a small piece of wood fitted at the foot
end of the bed to support the feet in order to
prevent foot drop.
How to care for foot rest
1. Clean with hibitane (or available
disinfectant) 1 in 1000 and store for next
use.

15. Urinal
These are made of glass, stainless steel or
plastic (some plastics are disposable).
How to care for Urinal
1. Disinfect with appropriate
disinfectant.
2. Discard disposable ones.
3. Scrub with vim and wash with soap
and water.
4. Rinse, dry and store on shelve or rack
ready for next use.

16. Types of Bed Making in
Hospital:
The nursing staff makes different types of
the bed according to patient condition those
are listed below:
■ Simple bed or unoccupied bed.
■ Close bed (Admission bed),
■ Open bed,
■ Occupied bed,

17. ■ Cardiac bed,
■ Fowler’s bed,
■ Fracture bed,
■ Cradle Bed
■ Post operative Bed
■ Amputation Bed

18. Basic Principle of Bed Making in
Hospital:
■ Skillful bed making contributes to patients’ comfort.
Some basic principles of bed-making are pointed
below
■ It is important to learn how to make a bed in such a
way where the least amount of energy and time is
required.
■ During bed-making, use good body movement and
make each step purposeful.
■ Keep everything ready on the bedside before
starting bed-making.

19. ■ Change bed linen frequently to assure
cleanliness.
■ To ensure the patient’s needs by
providing a safe and comfortable bed.
■ It should have a finished appearance.
■ To make the bed tight and free from
wrinkles, place all linen straight lines on
the bed.
■ Prevent complications of prolonged
bedridden patient such as pressure
sores.

20. ■ Soiled linen or linen whether clean or dirty
should not be thrown on the floor, but it is
should be kept in a dirty linen box.
■ After cleaning the bed, dump soap water,
and disinfectant properly.
■ Try to prevent cross-infection of
microorganisms during bed-making.
■ Ensure all bed-making in a nursing unit
alike for uniformity of appearance.

21. Remember During Bed Making
in Hospital
■ During bed-making, we should remember
some knowledge that is useful for us and
also to the patient.
■ During bed-making, bed position keep
elevated and ensures nursing staff’s good
body alignments
■ During the procedure, the nurse should
study her movements to avoid waste of time
and energy.

22. ■ After completing, the bed should be in a
lower position.
■ During occupied bed making, confirm
patient safety and comfort.
■ Wash hands before and after bed making
and use gloves during bed-making.
■ Maintain privacy while making the bed.

23. ■ Keep soiled linen away from uniform
which may have germs.
■ Do not shake dirty linen to prevent germs
spread around the room.
■ Do not mix soiled and clean linen during
bed-making.
■ For the bedridden patient, the mattress
must be turned the air and ensure free of
lumps and fold.

24. Striping the Bed:
This is a procedure to remove bed linen
from a bed, which has been previously
used. This is required either to air the bed or
put the bed in sun or making it ready for
future

25. Procedure:
■ When a chair or a stool has been provided
with the bed, the chair or stool is placed at
the foot end of the bed.
■ Place the pillow over the seat of the chair or
on stool.
■ The bed sheet should be loosened from
right.
■ Fold bed sheet twice, bring top hem to
bottom hem, pick up at the center.
■ The blanket should be folded in similar way.

26. ■ Soiled sheets should be removed &
should not be thrown on floor.
■ Fold the draw sheet in two & place it over
the chair.
■ The mackintosh should be folded in
similar pattern.
■ The mattress should be turned from top to
bottom or from side to side.

27. Closed Bed
■ The term “closed bed” is used to designate the
hospital bed which remains empty until the
admission of another patient. It is termed
“closed bed making” because the top covers
are so arranged the all linen beneath the
spread is fully protected from dust and dirt

28. Principles of Closed Bed Making in
Hospital:
■ To give a suitable bed ready for the
admission of a new patient.
■ To provide a clean and fresh
environment.
■ To provide a good appearance.
■ To reduce the source of infection.

29. Equipment’s Needed
for Closed Bed
Making in Hospital:
■ The below equipment
has needed for
closed bed making in
hospital:
■ Bed or cot,
■ Mattress with cover,
■ Bed sheet-2 ( one for
top, another for
bottom),
■ Blanket-1 ( during
winter),
■ Pillow with cases-1
or 2,
■ Mackintosh or long
waterproof sheet -1,
■ Cotton draw sheet-1,
■ Chair -1,
■ Duster-1,
■ Bucket-1 (for
receiving dirty linen).

30. The procedure of Closed Bed Making in
Hospital:
■ A well-organized, fresh, and clean bed is
very important for a patient who has spent
most of the time in bed during his or her
illness. The following procedures have to
maintain during closed bed making in the
hospital:
■ Wash hand properly before and after
handling the patient’s bed.

31. ■ Collect all the supplies and equipment at
the patient’s bedside.
■ Place the equipment on the
chair( blanket, top sheet, draw sheet,
mackintosh, and bottom sheet)
■ Locked the bed carefully.

32. ■ Lower the bed to a comfortable position to
prevent back strain.
■ Wear gloves and remove all soiled linen and
pillowcases and place them in the laundry
bag.
■ Keep the pillow on the bedside chair.
■ Dust the mattress and clean it properly.
■ Turn the mattress side to side or from head
to foot.
■ If the mattress is slid downward, pulled well
up to the head of the bed.

33. ■ Put the bottom sheet with a center fold in
the center of the bed and open and
spread the sheet over the mattress.
■ Tuck well under the top of the mattress
and along the side on which you are
working.
■ Place mackintosh about 18’’ inches below
from the head of the bed.

34. ■ Place draw sheet over mackintosh and tuck
in one side.
■ Go to the opposite side of the bed and tuck
in all the linen there.
■ Place the top sheet with a center fold in the
center. The top sheet should be given with
the mattress.
■ If the blanket is being used, apply in the
same manner. The edge should be about 6’’
inches from the head of the bed. Tuck
blanket smoothly under the bottom of the
mattress and miter corner.

35. Occupied Bed
■ An occupied bed is making the bed where
the patient physically available in the bed or
the bed is being retained for the patient.
■ Soiled linen is infectious to the patient. If a
patient is unable to move or leave the bed,
you will need to change the bed sheets while
the patient is occupied in bed.

36. ■ Occupied bed-making is tough for one
person. This is the best bed
accomplished by two nurses. Before
starting the procedure, make sure all
supplies are ready beforehand to
streamline the process as much as
possible.

37. Purpose of Occupied Bed Making:
The main purposes of occupied bed making
have listed in the following:
■ To provide a neat and clean bed.
■ To refresh the patient who is confined to the
bed.
■ To change the linen with the least possible
disturbance to the patient.
■ To draw or fix the sheets under the patients
very firmly so that it would not wrinkle.
■ To remove crumbs from the bed.
■ To make the patient feel comfortable.

38. Equipment of Occupied Bed Making:
The below equipment is very important for occupied
bed making:
■ Bed or cot,
■ Mattress with cover,
■ Bedsheet -2,
■ Pillowcase -1 or 2,
■ 1 Protective sheet and cotton draw sheet,
■ Mackintosh-1,
■ Paper bag,
■ Chair-1,
■ Bucket-1.

39. the procedure of Occupied Bed Making:
All the procedures of occupied bed making
have presented the below:
■ Two nurses must work together when the
patent is seriously ill or difficult to manage.
■ Wash hand before making the occupied
bed or occupied bed making.
■ Gather all equipment at the patient’s
bedside and explain the procedure to the
patient.

40. ■ Loosen the tucked linens at the foot part
that covers all around the bed.
■ Remove pillow unless contraindicated.
■ Place the clean and dry top sheet over the
dirty top sheet and then remove the dirty
linen one by one.
■ Leave one cover over the patient and
maintain privacy by bedside screening.
■ Turn the patient on half of the bed on the
other side of the bed and keep side rails up.
■ .

41. ■ Place a pillow between the patient and
side rails Work on the unoccupied side of
the bed and roll the draw sheet,
mackintosh, and bottom sheet if soiled.
■ Rolls the soiled linens toward the patient’s
back and tucks the roll slightly under the
patient.
■ Covers dirty and moist areas of the soiled
linen with a waterproof pad.
■ Place clean bottom sheet and tuck head
part miter corner.

42. ■ Place draw sheet over the mackintosh on
the near side of the mattress, with the
center vertical fold at the center of the
bed.
■ Place the patient on the clean side of the
bed.
■ Work on the other side and remove dirty
linens.
■ Make the other side of the bed and
spread clean linens.

43. ■ Tuck the head part of the bottom sheet, miter
at the side.
■ Place the patient in the center of the patient.
■ Place the pillow and make the patient
comfortable.
■ Spread the top sheet and fold the head part
up to the patient’s chest.
■ Arrange a blanket if necessary.

44. ■ Remember During Occupied Bed Making
in Hospital:
■ You must have to remember the below points
during occupied bed making in the hospital:
■ Maintain privacy as situations require.
■ Carefully turn the patient to prevent over-
exertion and feeling insecure.
■ Carefully observe the patient skin to identify
any signs of bedsore.
■ If the patient wears glasses, ask for removing
to prevent broken and injury.

45. ■ Ensure enough space for the patient to
roll without smacking nose on a side rail.
■ Ensure the patient’s arm on the bed is not
in an awkward position when the patient
is rolled.
■ Ensure bed in a flat position and rise to
an appropriate working height.
■ Remove patient’s personal items from
bed and disconnect call devices.

46. ■ Carefully checks that no tubes (such as
IVS pole, Foley catheter, oxygen tube,
gastric tube, NG tube, drain) are
entangled in the bed linens.
■ Apply diaper when a patient in the side
position.
■ Do not place clean linen on another
patient’s bed or furniture.

47. ■ Keep side rails up when patient turn.
■ Keep bed sheet smooth and wrinkles free
to prevent friction.
■ Ask the patient to help if the patient can
participate.
■ Place all dirty linens in a laundry bag or
hamper without contaminating the
uniform.

48. ■ Never put soiled linen on the floor or the
other surfaces.
■ Return bed in a low and safe position and
keep side rails up.
■ After occupied bed making, attaches call
light within the patient’s reach.
■ Re-position bedside table and over bed
table within patient reac

49. Postoperative Bed Making
■ A postoperative bed or surgical bed is
prepared for the patient who returns from the
operating room or from another procedure
that requires transfer into bed from the
stretcher and sometimes from a wheelchair.
that is tucked tightly beneath the mattress.

50. ■ The bed should be in a flat position. The
bottom sheet may be covered with a
cotton bath blanket

51. ■ A postoperative bed or surgical bed is a
special type of bed made for the patient who
is coming from the operation theatre or from
another procedure that requires anesthesia.
The bed is made in such a way as to make
it easy to transfer the unconscious or weak
patient from a stretcher to the bed.

52. Purpose of Postoperative Bed Making:
■ The main purposes of postoperative bed-
making or surgical bed-making are pointed
below:
■ To protect the patient from immediate
comply anesthesia or choking.
■ To lift or transfer the patient easily into bed
from the stretcher.
■ To provide warmth and comfort for the
patient.
■ To observe and prevent patient
complications.

53. ■ To save time, effort, and materials.
■ To arrange the bed and other furniture to
facilitate the transfer of the patient from
stretcher to bed.
■ To combat postoperative complications
and shock.
■ To protect the mattress and other linen
from blood, vomits, and other discharges

54. Steps to Making a
Surgical Bed:
■ Equipment:
■ Equipment needed
for postoperative
bed-making or
surgical bed-
making is below:
■ Bed sheet-1,
■ Draw sheet-1,
■ Woolen blanket-2,
■ Rubber sheet or
Mackintosh sheet-
1,
■ Pillowcase- 1 or 2,
■ Bath towel-1,
■ Hot water bags
with cover-3,
■ Bed block or shock
block-2.

55. On the Bedside Table:
■ Stethoscope,
■ Sphygmomanometer,
■ Kidney basin,
■ Galipot,
■ Padded tongue depressor,
■ Sponge holder,
■ Airway tube.

56. In the Room:
■ Oxygen cylinder,
■ Tubing’s, humidifier and nasal catheter,
■ Suction apparatus,
■ IV pole or stand,
■ Sterile drainage bottles with the tube

57. The procedure of Postoperative Bed Making:
■ Postoperative bed-making is to permits easy
patient transfer from surgery and promotes
cleanliness and comfort. To make such a bed takes
the following steps:
■ A simple bed is made as per normal procedure
making.
■ Strip on the bed and turn the mattress.
■ The upper bedding is fan-folded to one side
accurate the stretcher.
■ The top sheet does not tuck at the foot part. (In
cold weather the hot water bottle is placed in the
middle of the bed and covered with fan-folded top
bedding).

58. ■ The temperature of water in a hot water
bottle should not exceed 50°C.
■ Fanfold together the top sheet and
blanket towards the side away from the
door.
■ The small mackintosh sheet covered with
a towel is open side at top of the bed.
■ Place the bath towel over the small
mackintosh sheet.
■ The transfusion stand is kept ready at the
bedside.

59. ■ Instead of a pillow, place a small
protective sheet and a towel on the head
end of the bed.
■ The basin for the collection of vomits is
placed on the bed stand.
■ BP instrument, pulse meter can be kept
ready at bed stand.
■ Place the necessary articles on the
bedside table and the irrigating stand,
suction machine, and oxygen set-up
adjacent to the bed.

60. ■ Keep the tray on the locker or table nearby
and shock blocks on the floor near the foot
end of the bed ready in case of necessity.
■ Adjust the height of the bed to the level of the
stretcher.
■ After the patient is transferred to the bed,
position the pillow for patient comfort.
■ Ensure safety cover by pulling the top point of
the sheet and blanket over the patient.

61. ■ Open the folds after covering the patient
tuck in the linens at the foot of the bed and
miter the corners.
■ Bottom sheet useful to absorb moisture
and stop dislocation of the bottom sheet.
■ When the patient is transferred to bed,
keep a kidney tray on the bed near the
mouth, and pin-up the paper bag with the
bottom sheet on the side.

62. cardiac Bed:
■ Cardiac bed prepared for heart cases.
Purpose:
1. To relieve dyspnoea caused by cardiac
diseases.
2. To provide comfort with least stain.
3. To Prevent complications.

63. Articles:
1. Bed sheet.
2. 36 inch mackintosh.
3. 36 inch drawsheet.
4. top sheet.
5. blanket.
6. bed spread.
7. pillow case.
8. duster - 2.
9. cardiac table. 1
0. extra pillows.
11. back rest.
12. foot rest, air
cushion.

64. ■ Procedure:
1. prepare the bed as open bed, with foot rest
at foot of the bed.
2. Place back rest at patients back, and
arrange pillows in comfortable positon.
3. Keep the patient in bed and cover properly.

65. ■ 4. Adjust the air cushion in place. Place the
knee pillow under the knees to prevent
slipping of the patient.
5. Place cardiac table in front of the patient
with the pillow on it. So that the patient may
lean forward to rest his head and arms on it.
6. Make the patient comfortable.

66. Amputation Bed:
■ Amputation bed is prepared for a patient
with amputation of the leg to take off the
weight of the bed clothes off site of the
operation.
■

67. ■ Purposes:
1. To Keep the stump in good position.
2. To be able to watch the stump for haemorrhage
and apply tourniquet instantly if necessary.
3. To allow the nurse to do repeated procedures
such as bladder irrigation, without exposing the
patient.
4. To allow the nurse to make frequent observations.
I.e. after amputation of the leg without disturbing the
patient.

68. ■ Articles;
1. Set of top extra bedding. 2. blankets
and counter pane. 3. bed cradle. 4.
tourniquet. 5. pillow and plastic cover. 6.
sand bags and draw sheet.

69. Procedure:
1. prepare the bed as simple open bed.
2. Make bottom half of the bed. Fold sheet
crosswise at the center of the bed at bottom
tuck in and make corners. Make upper half
of the bed. The other set of the top linen
starts from the stump; but overlapping the
first one and the excess is tucked under the
mattress at the foot.

70. ■ 3. When the patient is brought back from
the operation theatre, fan fold the two
sets of linen one side of the bed and
receive the patient on the bed.

71. 4. Bed cradle is used to take off the weight of the top
linen.
5. Cover the patient and keep him warm and
comfortable.
6. Amputation bed is usually used for amputation of the
leg, operation bed is used for an amputation of the
hand.
7. The two sections of the top linen should overlap
each other atleast by 8 to 10 inches. So that it can
easily lifted to observe the stump and also to prevent
unnecessary exposure of the patient.

72. Fracture Bed:
Fracture Bed is prepared for patient with
fracture of the trunk and extremities. A hard
firm board is used to give support.

73. Purposes:
1. To give firm, even support to the fracture
limbs and back.
2. To maintain position.
3. To immobilize the fractured so that the
pain is less.
4. To make the patient comfortable.

74. ■ Articles:
1. Bed Sheet. 2. drawsheet. 3. topsheet.
4. blanket. 5. bed spread. 6. pillow case.
7. duster. 8. fracture board. 9. sand bags
with cover. 10. bed cradle. 11. extra
pillows.

75. ■ Procedure:
1. place the fracture board directly over
the bed springs.
2. Place a thin firm mattress or pad over
the fracture board.
3. The bed is prepared as simple open
bed.