At the end of the session students will be able to describe the hygienic care that nurses provide to clients. identify the factors influencing hygienic practice identify normal and abnormal assessment findings while providing hygienic care to the clients. provide hygienic care of the skin - bath and pressure points, feet and nail, oral cavity, hair care, eyes, ear and nose. assess the hygienic environment. explain the various types of beds.

1. B.Sc NURSING 1st YEAR
FUNDAMENTALS OF NURSING
UNIT IX – MEETING NEEDS OF PATIENT
TOPIC: BEDMAKING

2. OBJECTIVES
At the end of the session students will be able to
 describe the hygienic care that nurses provide to clients.
 identify the factors influencing hygienic practice
 identify normal and abnormal assessment findings while providing
hygienic care to the clients.
 provide hygienic care of the skin - bath and pressure points, feet and
nail, oral cavity, hair care, eyes, ear and nose.
 assess the hygienic environment.
 explain the various types of beds.

3. OVERVIEW
 Define Hygiene.
 The Factors influencing Hygienic practice
 The normal and abnormal assessment findings while
providing Hygienic care to the clients.
 Providing Hygienic care of the skin - bath and pressure
points, feet and nail, oral cavity, hair care, eyes, ear
and nose.
 Supporting a hygienic environment.
 The various types of beds.

4. INTRODUCTION
• Bed making is an essential procedure in nursing in
which nurses prepare and arrange different types of
beds for the client's comfort in the hospital or other
health care institutions
• . Bed making procedure ensures the patient's
comfort according to the situation. It may vary on the
client's conditions, purposes and procedures such
as open bed, closed bed, occupied bed, cardiac
bed, fracture bed, blanket bed etc.

5. • Nurses have a major role in bed making procedure
in hospital. So, a nurse should learn and follow the
proper and standard techniques of bed making
procedure.
•

6. BED MAKING
 It is the techniques of preparing different types of bed
in making a clients comfortable or his/her position
suitable for a particular condition.

7. Purpose of Bed making
 To provide the client with a safe & comfortable bed to
take rest & sleep.
 To keep the ward neat and tidy.
 To adapt to the needs of the client and to be ready for
any emergency or critical condition of illness.
 To economize time, material & effort.
 To prevent bedsores.
 To observe the client.
 For patients comfort.
 To prevent cross infection.

8. PRINCIPLES OF BED MAKING

9. PRINCIPLE - 1
1. Micro-organisms are present everywhere on the used
articles, skin, clothing and environment. Prevent the
spreading of micro-organisms from the contaminated
source to the new host by taking precautions and
preventing the multiplication of the micro-organisms.
Action -
The nurse should wash her/his hands before and after the bed making
procedure to prevent cross-infection.

10. • Bed linen and clothes must be changed frequently to ensure cleanliness.
• Do not drop the removed bed linen on the floor.
• Gently shake the linen to remove dust. Do not flap the bed clothing because
it transfers dust and bacteria easily.
• Linen should be folded and held away from the nurses to prevent direct
contact with dust and micro-organisms.

11. • Daily cleaning and dusting of beds and units will keep them free from dust
and micro-organisms. Soap, water, air and sunshine will help them to be
clean.
• Damp dusting is recommended because dry dusting raises dust.
• Nurse should maintain a necessary distance from patients to prevent droplet
infection.

12. • Clean the less contaminated area first and then the clean high contaminated
area to minimize the spreading of micro-organisms to the clean area.
• Linens should be disinfected before sending them to the laundry.
• Nurses who having respiratory infections should not attend to the clients.

13. PRINICIPLE - 2
2. A protected and comfortable bed will provide rest,
sleep and avoid many complications of bedridden
clients e.g. bedsore, foot drop etc.
Action -
• Nurse should make a smooth and unwrinkled bed because a wrinkled bed
exerts pressure on bony prominence and lumps. The wrinkles cause
bedsores due to friction between skin and wrinkled sheets.
• Pull the bottom sheet tightly to avoid wrinkles.
• Tuck the linen far enough and tightly to keep it fixed.

14. • Smooth the mattress, if there is a collection of cotton in one place before
making a bed.
• Do not keep any wet linen on the bed.
• Daily dusting should be done to remove any peeling or seeds that are
adhered to the bed linen of a bedridden client.
• A bed should have enough space to move from side to side. The
movements prevent bedsore, stimulate blood circulation and maintain muscle
tone.
• Use comfort devices to provide additional comfort to the client.

15. PRINICIPLE - 3
3. Good body mechanisms maintain body alignment
and prevents fatigue.
Action -
• The stability of the body is assured by keeping the centre of gravity over its base. In the standing
position, the nurse can have a wide base by separating his/her feet.
• The nearer to the centre of gravity a weight is held, the less is strain produced. E.g. it is more
suitable to place the linen on the edge of the bed instead of holding it above shoulder level.
• Flex the knees and hips when tucking the sheet under the mattress. This position shifts the
work to the long and strong muscle of the thigh and keeps the back in good alignment.
• When placing and tucking the linen, face the direction of the work and move with the work
rather than twisting the body and overreaching.

16. PRINICIPLE - 4
4. Planned and organized ways of working saves
energy, time and equipment.
Action -
• Collect and arrange all the articles before starting the bed making procedure.
• At the first finish on one side of the bed making and then go to the opposite
side.
• Remove the bed linen one by one holding the open end towards the floor
when stripping the bed so that the client's possessions and the hospital
articles are not sent to the laundry.
• The bed sheets are folded in such a way that they can be replaced easily.

17. BED MAKING
 Universal Precautions
 Observe universal precaution if linen is
contaminated by blood or body fluids
 Wash hands frequently and wear
gloves while handling linen
 Follow agency policy for proper
disposal of linen
 Body Mechanics
 Maintain good body alignment.
 Work smoothly and rhythmically
 Push or pull rather than lift
because it requires less effort.
 Using your own weight to
counteract the weight of an object
decreases the effort and strain.

18. Guidelines for Bed Making
 Wash hand thoroughly before and after handling clients bed linen which
helps to control nosocomial infection.
• Gather all the required linen and accessories before making the bed.
• Avoid shaking the linen to prevent the spread of microorganisms and dust
particles.
• Avoid placing linens clean or dirty on another patient’s bed.
• Don’t place dirty linen on floor instead put in linen bag.
• Always use good body mechanics.
• Stay on one side of the bed until it is completely made.
• Observe the patient and document any nursing observations made.

19. Kinds of Linens
A - Blanket: a large piece of cloth often soft, woolen and is
used for warmth as a bed cover.
B - Top sheet: used to cover the patient to provide warmth,
made of thick cotton, thermal material.
C - Cotton draw sheet: a piece of cloth spread over the
rubber sheet and is used to absorb and moisture.
D - Bottom sheet: used to cover the bed after mattress
cover.
E - Rubber sheet/Mackintosh: used to protect the bottom
sheet from soiling due to patient secretions and prevent the
patients from getting bedsore.

20. Types of Bed Making
A - Occupied Bed: Is made when the patient is not
able or not permitted to get out of the bed. Or when
patient is already occupied in the bed.
B - Unoccupied Bed: Is made when there is no patient
confined in bed.

21. 1 - Open bed: the top covers are folded back so the
patient can easily get back in to bed and is prepared for
ambulatory patients.
2 - Closed bed: the top sheet blankets and bedspreads
are drawn up to the head of the mattress .
3 - Post-operative bed: known as recovery bed or
anaesthetic or surgical bed.
4 - Amputation or Divided bed: This is a bed that is
prepared for a patient having amputated limb.
Types of Bed Making Contd..

22. 5 - Fracture bed: This is a hard firm bed designed for the
patient with fracture particularly of spine, pelvis or femur.
6 - Cardiac bed: this is prepared for patient with breathing
difficult and make use of cardiac table to relieve their
dyspnoea.
7 - Therapeutic bed: are used to treat clients with severe
joint contractures, prolonged immobility, or skin wounds
such as pressure ulcers or severe burns. These beds
reduce or relieve the effects of pressure against the skin
through various mechanisms.
Types of Bed Making Contd..

23. 8.Blanket Bed -
• The blanket bed is made for a client who is suffering
from renal disease to promote elimination through the
skin.
Purpose of blanket bed:
• To lift the weight of the bedclothes away from the
painful joints.
• To maintain the client's warmth.
• To encourage elimination via the skin.

25. • Preparation of the articles for bed making
procedure -
1. Cot
2. Mattress and pillow
3. Chair or stool
4. Bedside table
5. Mackintosh
6. Blanket
7. Mattress cover
8. Top sheet and bottom sheet
9. Draw sheet
10. Pillowcase
11. Counterpane
12. Laundry bag
13. Dusters

26. Closed Bed-Articles
1. Two large sheets.
2. Draw sheet.
3. Blankets.
4. Bed spread.
5. Pillow cases.
6. Rubber Mackintosh.
7. Linen Hamper.
8. Bedside Table.
9. Disposable Gloves.

27. Closed Bed - Procedure
1. Wash hands and wear disposable gloves.
2. Assemble and arrange equipment on bed side table.
3. Fold and keep reversible linens such as blanket or bedspread
on bedside table.
4. Bundle all soiled linen in bottom sheet and directly place into
the laundry bag.
5. Place the bottom sheet with its center fold in the center of bed
and towards the top to have sufficient sheet to tuck under the
head of the mattress.
6. Unfold the bottom sheet, spread it over the mattress and tuck in
with mitten corner.

28. 7. Spread the mackintosh at the center of the bed and tuck it along the
side.
8. Place the draw sheets over the mackintosh and tuck it along the
side.
9. Move the opposite side and tuck the sheets.
10. Place the blanket over the top sheet about 6 inches below the top of
the sheet.
11. If the bed spread is used place it over the blanket.
12. Tuck the top sheet, blanket and bed spread under the foot of the
bed on the side close to you and miter the corners.
Closed Bed – Procedure Contd..

29. 13. Fold the upper 6 inches of the top sheet down over
the spread and make a cuff.
14. Move to other side and follow the same procedure for
screening top sheets.
15. Put the pillow case and place the pillow at the head
end.
16. Fanfold or pie fold top linens.
17. Dispose off soiled linen and wash hands.
Closed Bed – Procedure Contd..

30. Open Bed-Articles
1. Bottom Sheet.
2. 36 inch Mackintosh.
3. 36 inch Draw sheet.
4. Top Sheet.
5. Blanket.
6. Bed Spread.
7. Pillow case.
8. Duster - 2.

31. Open Bed - Procedures
1. wash hands and collect required linen.
2. Arrange linen on chair in manner in which it is going to be used.
3. Explain procedure to the patient and relatives.
4. Screen patient, if necessary and loosen top bedding.
5. Lift patients head and remove extra pillow.
6. Loosen bottom bedding and remove top sheet by pulling it down
from under cover.
7. Brush off the mackintosh and roll it back loosely over patient.

32. 8.Roll bottom sheet as far under patients back as possible.
9. Place the clean sheet on the mattress with length wise fold at centre of
the bed.
10. Adjust sheet and tuck in at the top making a square corner. Then tuck
in at the side.
11. Bring back mackintosh lying over the patient.
12. Place clean draw sheet at the centre of the bed.
13. Pull and tighten bottom sheet and tuck in at top making a square
corner.
Open Bed – Procedures Contd..

33. 14. Pull and tighten mackintosh and draw sheet and tuck in well.
15. Turn the top of the counter pan and top sheet back over the blanket.
16. Return to the other side, fold and tuck in top bedding as on the first
side.
17. Change the pillow case and put it under patient’s head and
shoulders.
18. Discard soiled linen in dirty box.
19. Make the patient comfortable and Wash hands.
Open Bed – Procedures Contd..

34. Occupied Bed - Articles
1. Top Sheet.
2. Blanket.
3. Pillow Case.
4. Bottom Sheet.
5. 36 inch Mackintosh.
6. 36 inch Draw sheet.
7. counter pane.
8. Duster - 2.

35. Occupied Bed - Procedure
1. Assemble the equipment and arrange the linen within the easy reach.
2. Loosen the bedding on all sides and remove the spread and the
blanket leaving the top sheet over the client.
3. Fanfold the draw sheet to the clients and push it as close to the client
as possible.
4. Dust the mattress with a dry duster. Then by raising the mattress,
clean the cot with a damp duster.
5. Place the clean bottom sheet over the mattress making sure that the
middle fold is in the middle of the bed.
6. Bringing the mackintosh back into the place and tuck it tightly under
the mattress.

36. 7. Turn the client back over the folded linen and then towards you. Go
to the opposite side of the bed.
8. Remove the soiled linen and put them in the laundry bag.
9. Turn the client back to the middle of the bed. Place a clean top
sheet over the client and remove the soiled top sheet.
10. Replace the blanket and spread over the top sheet and make the
bed as in an open bed.
11. Tuck the foot end giving enough freedom for movement.
12. Place a foot board or cradle at the foot of the bed.
13. Put the clean pillow cases and place the pillows in position and
leave the client comfortable
Occupied Bed – Procedure Contd..

37. Post Operative Bed - Articles
1. Gauze, pieces, narrow Mackintosh and narrow sheet.
2. Artery forceps.
3. Mouth gag, air way.
4. TPR Tray B.P. apparatus.
5. Bed Blocks - 2.
6. Hot water bags with cover.
7. I.V stand.
8. Kidney tray and paper tray.
9. Suction apparatus and oxygen cylinder.

38. Post Operative Bed - Procedure
1. Prepare the foundation of the bed as simple bed.
2. Put narrow mackintosh and narrow sheet at the head
end to protect the bed from soiling the linen by vomitus.
3. The foot end of the top linen are left untucked.
4. The upper bedding is fan folded to one side, opposite
the stretcher.

39. Post Operative Bed – Procedure Contd..
5. Post anesthetic tray, bed blocks, I.V. stand etc are kept
ready at hand.
6. The pillow is used to protect the patient from injury by
hitting against the bars at the head end of the bed.
7. Hot water bags are used to keep the bed warm and they
are removed before receiving the patient in the bed.

40. Fractured Bed
Articles:
1. Bed Sheet & Drawsheet.
3. Topsheet & Blanket.
5. Bed spread & Pillow case.
7. Duster.
8. Fracture board.
9. Sand bags with cover.
10. Bed cradle.
11. Extra pillows.

41. Fractured Bed - 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.

42. Amputation Bed - 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.

43. Amputation Bed - 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.
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.
4. Bed cradle is used to take off the weight of the top linen.

44. Amputation Bed – Procedure Contd..
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.

45. References
BIBLIOGRAPHY
1. Potter,A,G.Perry, P.A.Stockert & A.M.Hall, Canadian
Fundamentals of Nursing(5th edition)
2. M.L.A.Kozier & Erb’s fundamentals of
Nursing:Concepts,process and practice.(2008)
NET REFERENCE
3.https://study.com/academy/course/nursing-hygiene-
training.html