Fundamentals of Nursing: Comprehensive Guide to Bed Making
Clinical Overview and Objectives of Bed Making
Bed making is a specialized nursing technique utilized to prepare various types of beds for patients, ensuring they are comfortable or positioned appropriately for their specific medical conditions. This module, prepared by Denzyl Hubert S. Bautista, RN, LPT for NCMA113: Fundamentals of Nursing, establishes several core objectives for nursing students. Practitioners must be capable of performing the correct procedures for bed making, identifying and applying the specific guidelines for both unoccupied and occupied beds, and implementing safety and comfort measures that underpin the entire process.
Purpose and Clinical Importance of Bed Making
The primary goals of bed making involve both the physiological and psychological well-being of the patient. One central purpose is to conserve the client's energy and maintain their current health status through minimal exertion during repositioning. It is designed to promote maximum comfort and provide a clean, orderly environment. By ensuring a smooth, wrinkle-free bed foundation, nurses minimize potential sources of skin irritation and breakdown. Furthermore, the process is essential for infection control, as it promotes hygiene and limits the spread of microorganisms within the clinical environment.
The importance of this task extends to the patient's psychological state; a clean and orderly room contributes significantly to a sense of well-being. Proper bed making facilitates the rest and comfort necessary for health recovery and refreshes the patient through environmental cleanliness. From a preventative standpoint, it prevents microorganisms from coming into contact with the patient, which could otherwise cause medical tribulations.
Essential Nursing Terminologies and Definitions
Several specific terms describe the techniques used in hospital bed preparation. Fanfold refers to the action of grasping the upper edge of the linen with both hands and folding the edge of the sheet outward by approximately . A mitered corner is a specific method used to anchor sheets to the mattress. This technique secure the bedclothes in place whether the bed is occupied or not and is accomplished on the bottom sheet by placing the end of the sheet evenly under the mattress and folding the corners at an angle.
A toe pleat is a specific intentional fold made in the top bedclothes to provide additional space for the patient’s toes, preventing unnecessary pressure. This is related to the prevention of foot drop, which is defined as the dropping of the foot due to paralysis of the anterior muscle of the leg. Foot drop involves the plantar flexion of the foot accompanied by permanent contracture of the gastrocnemius (calf) muscle and tendon.
Structural Components and Physical Dimensions of Hospital Beds
A standard hospital bed is primarily divided into three sections and follows specific dimensions. The length of the bed is typically (), the width (noted as weight in transcripts) is (), and the height is generally (), though this height can vary based on clinical circumstances.
Specific parts of the bed include the mattresses, which must be firm, thick, and smooth to provide adequate support; they should always have a washable cover and typically feature a width of . Siderails serve as a safety mechanism to prevent patients from accidentally falling. A footboard or footboot is used to support an immobilized patient's foot at a normal right angle to the legs, preventing plantar flexion contractures. Bed cradles, sometimes called an Anderson Frame, are curved, semi-circular metal devices placed over the body to keep top bedclothes from touching the feet, legs, or abdomen. Finally, intravenous rods or IV poles, usually made of metal, are used to support infusion containers while fluids are administered.
Classification of Hospital Bed Types
Beds are categorized as either occupied, when a patient is currently in the bed, or unoccupied, when the bed is empty. Unoccupied beds are further subdivided into specific types based on their readiness for a patient. An open bed is one where the top covers are fanfolded to the bottom third of the bed or folded to one side so the client can easily enter. A closed bed is prepared before a new client is admitted, with the top sheet, blanket, and bedspread drawn all the way up to the head of the mattress and tucked under the pillows.
A surgical, recovery, or postoperative bed is a modified version of the open bed designed for patients who have undergone surgery or received anesthetics. This type is specifically arranged to allow for the easy transfer of a patient from a stretcher to the bed, particularly for those with large casts or other conditions making movement difficult. A cradle bed incorporates a cradle under the top sheet to prevent linen contact with the body, which is essential for patients with burns, skin ulcers, lesions, blood clots, fractures, or post-operative sites. Some cradles are equipped with light bulbs to provide heat for therapeutic purposes.
Specialized Therapeutic Bed Systems
Advanced clinical scenarios require specialized beds. A water bed is a mattress filled with water that allows for temperature control and reduces pressure on body parts, making it ideal for patients confined for long periods. Turning frames, such as the Stryker Wedge, allow for repeated changes between the supine and prone positions without disturbing the alignment of the spine, which is vital for preventing complications like atelectasis, pneumonia, decubitus ulcers, and renal calculi.
Rotation beds promote postural drainage and peristalsis while preventing the complications of immobility, particularly for patients with spinal cord injuries or severe burns. The cyclometric bed allows for frequent turning of injured or immobilized patients with minimal trauma or extraneous movement, helping to treat pressure ulcers and circulatory complications. The Clinton Therapy Bed, also known as an air-fluidized bed, is used for managing burns and various disabilities. Similarly, air therapy beds provide tailored levels of support to different body parts to protect patients at risk for skin breakdown.
Procedural Guidelines for Bed Making
The bed making procedure requires specific equipment, including clean gloves (if needed), two flat sheets (or one fitted and one flat), an optional cloth drawsheet, one blanket, one bedspread, optional incontinent pads, pillowcases, and a plastic laundry bag or portable linen hamper.
The procedure begins with professional etiquette: knock before entering, identify and greet the client, and explain the procedure while maintaining privacy and performing hand hygiene. The bed should be raised to a height that allows for good body mechanics. When removing old linens, the nurse should roll them away from themselves so the surface that touched the resident is inside the roll.
To place the bottom sheet, unfold it lengthwise with the center crease in the middle of the bed and the lower edge even with the mattress bottom. After opening the sheet from the side and fanfolding it toward the other side, the nurse should go to the head of the bed to tuck the sheet and create a mitered corner, ensuring it is tight and smooth. A draw sheet is then placed on the middle of the mattress, opened, fanfolded, and tucked before moving to the other side to repeat the mitered corners.
The bedspread is applied with the upper hem even with the top of the mattress; care must be taken to ensure the side facing the door is even and covers all linens. The linens are tucked together at the foot of the bed with a mitered corner. The pillowcase is applied with the open end facing away from the door. Finally, the bed is lowered, the signal light is placed within the resident's reach, and the nurse performs hand hygiene and records all observations.