When Making An Occupied Bed The Nurse Aide Should

When Making an Occupied Bed: A Comprehensive Guide for Nurse Aides

Making an occupied bed is a fundamental skill for nurse aides, requiring a delicate balance of efficiency, patient comfort, and infection control. This process, while seemingly simple, demands precision and awareness to ensure the patient’s safety and dignity while maintaining a clean and hygienic environment. This comprehensive guide outlines the step-by-step procedure, crucial considerations, and potential challenges encountered when making an occupied bed.

Preparing for the Procedure: Prioritizing Patient Safety and Comfort

Before commencing, thorough preparation is paramount. This phase is crucial for preventing accidents and ensuring a smooth, comfortable experience for the patient.

1. Gather Necessary Supplies:

• Clean linens: This includes a fitted sheet, a top sheet, a blanket, and a pillowcase. Ensure these are fresh and wrinkle-free. The number of items may vary depending on facility policy and patient preference.
• Gloves: Always wear gloves to maintain proper hygiene and infection control.
• Optional supplies: Depending on the patient’s needs and facility protocols, you may also require incontinence pads, bed protectors, and extra pillows.

2. Assess the Patient:

• Mobility and Cognitive Status: Evaluate the patient's ability to assist in the process and their level of understanding. Explain each step clearly and patiently, ensuring cooperation and minimizing anxiety. Adapt your approach according to their cognitive abilities and physical limitations. A patient with decreased mobility or cognitive impairment will require more assistance and careful handling.
• Pain Levels: Inquire about any discomfort or pain the patient is experiencing. Adjust your technique accordingly to avoid exacerbating any existing pain. Pain medication administration prior to the procedure might be necessary, subject to doctor’s orders.
• Skin Condition: Check for any skin breakdown, pressure ulcers, or irritations. Take extra precautions to avoid further injury or discomfort during the bed-making process. Handle the patient's skin gently.
• Medical Devices and Tubes: Note the presence of any intravenous lines, catheters, oxygen tubing, or other medical devices. Ensure these remain untangled and unobstructed during the procedure.

3. Positioning the Patient:

• Comfortable Positioning: Begin by ensuring the patient is in a comfortable and safe position. This usually involves raising the head of the bed to a semi-Fowler's position (30-45 degrees) or as comfortable for them.
• Privacy and Dignity: Maintain the patient's privacy and dignity throughout the process. Offer appropriate draping to protect their modesty.
• Safety Measures: Use appropriate safety measures like bed rails (if needed and allowed) to prevent falls.

The Step-by-Step Procedure: A Methodical Approach

The following steps provide a detailed guide on making an occupied bed. Remember to adapt the procedure based on individual patient needs and capabilities.

1. Removing Dirty Linens:

• Roll Away Dirty Linens: Starting from the far side of the bed, carefully roll the dirty top sheet and blanket towards the patient, away from their body. Tuck the rolled-up linens tightly.
• Remove Pillowcases: Remove the pillowcases carefully, ensuring not to disturb the patient’s head. Replace with fresh pillowcases, tucking the corners securely.
• Remove Bottom Linens: Remove the soiled bottom sheet. If the patient can assist, gently roll the patient to their side and help them roll the soiled sheet under them. Alternatively, if the patient cannot assist, carefully loosen the dirty sheet, tuck it in, and gradually work it away from the patient's body. Replace with fresh, clean linens.

2. Placing Clean Linens:

• Fitted Sheet Placement: Place the clean fitted sheet neatly over the mattress, making sure the elastic edges are properly positioned. Tuck the sheet under the mattress at all four corners. Smooth out any wrinkles.
• Top Sheet Placement: Place the clean top sheet neatly over the patient, ensuring even coverage from the top of their body to the bottom, keeping the edges straight and untucked.
• Blanket Placement: Drape the blanket over the top sheet, ensuring it is even on both sides.
• Mitering Corners: If required by your facility, learn and correctly apply the mitering technique to the corners of the bed linen to create a neat and professional finish.

3. Final Adjustments and Patient Care:

• Patient Comfort: Adjust the pillows to support the patient's head and neck comfortably. Ensure the blankets are adequately covering them to prevent chills, yet not restrictive to movement.
• Infection Control: Discard the soiled linens according to the facility's infection control guidelines.
• Patient Re-Positioning: Gently reposition the patient if needed to improve their comfort and to ensure they are properly settled.

Addressing Potential Challenges and Variations

Making an occupied bed presents several challenges that require skillful maneuvering and adaptation.

1. Patients with Limited Mobility:

Nurse aides will need to utilize proper body mechanics and seek assistance if needed. Patients with limited mobility may require assistance with turning and positioning. A mechanical lift may be necessary in some cases.

2. Patients with Medical Devices:

Care must be taken to avoid dislodging or damaging any medical devices like IV lines or catheters. Work around the tubes and devices carefully, taking extra care to not put pressure on these tubes.

3. Incontinent Patients:

Extra care is required to ensure proper hygiene and infection control with incontinent patients. Use disposable underpads to protect the bed linens and change soiled linens as needed.

4. Patients with Cognitive Impairments:

Clear and simple instructions, calm demeanor, and patience are crucial when dealing with patients who have cognitive impairments. Consider frequent verbal reassurances and break the procedure into smaller, manageable steps.

5. Dealing with Resistance:

Some patients may be resistant to the procedure, which requires understanding and communication skills. Explain the importance of bed making for comfort and hygiene, while still respecting their boundaries. If the patient strongly objects, seek assistance from a supervisor.

Maintaining Infection Control: A Crucial Aspect

Infection control is paramount during occupied bed making. Following these guidelines minimizes the risk of spreading microorganisms:

• Hand Hygiene: Wash hands thoroughly before and after the procedure. Use alcohol-based hand rubs between steps, if appropriate.
• Personal Protective Equipment (PPE): Always wear gloves. Consider wearing a gown or mask if the patient has an infectious disease.
• Waste Disposal: Dispose of soiled linens and other waste materials in appropriate receptacles.
• Environmental Cleaning: Clean the bedside area, including the over-bed table, with an appropriate disinfectant after completing the bed-making process.

Documentation and Communication: Completing the Process

After completing the occupied bed making, remember these important steps:

• Documentation: Record the procedure in the patient's chart, noting any observations regarding the patient's condition, any assistance provided, and any difficulties encountered.
• Communication: Communicate any significant changes in the patient's condition or any issues encountered to the supervising nurse.

Conclusion: A Skill Requiring Practice and Precision

Making an occupied bed is a skill that requires practice and precision. Nurse aides should strive for efficiency while prioritizing patient comfort, safety, and dignity. By understanding the step-by-step procedure, addressing potential challenges, and maintaining rigorous infection control measures, nurse aides can effectively perform this essential task and contribute to optimal patient care. Continuous learning, adhering to facility protocols, and seeking guidance when needed are integral components of mastering this vital skill. Regular practice and mentorship will enhance proficiency and build confidence in this fundamental aspect of nursing care. Remember, the goal is to provide a clean, comfortable, and safe environment for the patient while maintaining high professional standards.