Demonstrate Bed Making (PEX 1.4.1 - 1.4.9)

BED MAKING: Bed making is a key nursing skill that is essential for the promotion of patient care, comfort, hygiene and wellbeing.

Bed making requires technical and practical skills and consideration should be given to issues of safety, moving and handling and infection control practices.

There are many types of beds to suit the different conditions of the patient.

Two nurses should work together to make a bed and should face each other. Work from top to bottom of the bed except when putting on a counter pane (bed cover).

Purpose of Bed Making

To keep the ward neat and tidy.
To keep/make the patient comfortable.
To prevent cross infection and complications such as bed sores.
For treatment of certain conditions e.g. shock or quickening of healing of the patient.

Rules of Bed Making

All equipment should be collected before starting the procedure.
Any conversation during bed making should not be on personal matters between the nurses but should be focused on the patient.
Close adjacent windows to protect the patient from draught on a cold day.
Patient must never be exposed, screen the bed and close the ward to visitors.
The bed should be made free from crumbs and creases, so as to give maximum comfort to the patient.
Sheets have to be smooth and when tucking in, MITRE the corners.
Pillows and other bed accessories should be well arranged to give support and comfort where necessary.
When pillows are being shaken, the nurse should turn away from the patient and not over the patient.
The bed should be made in a way suitable for treating certain conditions such as shock and to prevent complications as a result of bad nursing.
Always use clean beddings and linen for each patient.
Always wash hands after making beds of infectious or septic patients before moving to the next bed.
Do not put any linen of another patient to the next patient’s bed.
If linen is dropped on the floor, it should not be used.
Always have a dirty linen container or hamper at hand in which to put dirty linen, never put it on the floor or carry the across the ward to prevent cross infection.
The patient’s face should not be covered with sheets or blankets.
The open end of a pillow case should face away from the main door or entrance of the ward.
Two nurses are required and they should work in harmony avoiding unnecessary movements of the bed and themselves.
Extra assistance should be available and if necessary, one should be called upon to help lift the patient.
Do not make a bed when a sterile procedure is in progress in the ward.
Beddings from the infectious patients should first be soaked in a disinfectant e.g. jik (3.5%=3.5/0.5-1=6) 1.6,(6%=6/0.5-1=11)1.11 for 24 hours before washing.
Use large mackintoshes for incontinent patients to protect the beddings.
Use small mackintoshes at the head of the bed for unconscious or post operative patients.
Use a bed cradle over leaking wounds e.g. in burns.
Beds should be made in such a way that the patient can be put in without difficulty.
Allow room for the patient’s feet for free movement or turning when placing the top sheet over the patient.
Always wash hands before and after bed making.

Types of Beds

Unoccupied bed/hospital bed
Occupied bed
Admission bed
Admission bed for burns
Operation/post-operative bed
Bed for complete rest
Cardiac bed
Divided bed
Plaster and fracture bed

Appliances Used in Bed Making

Mackintosh/plastic sheet: Protects the beddings during procedures. Protects the beddings in case of vomitus, urine, blood, faeces from soiling the bed sheets and the mattress.
Hot water bottles: To provide added warmth to the patient. The hot bottles must always be covered and the cover tight enough before use. Never place it directly on the patient’s skin to avoid burns.
Bed cradle: To keep the weight of the bed sheets away from the patient’s affected area e.g. in burns.
Bed blocks/bed elevators: To elevate the top or bottom of the bed e.g. in patients with shock, cardiac problems etc. To promote drainage in case of chest drainage.
Backrest/bed rest: To help the patient sit up-right for those with chest problems (breathing difficulties), cardiac problems etc. different degrees of elevation can be made with pillows placed on top of the backrest.
Sandbags: To prevent movement of limbs in the treatment of some conditions like fracture of the limbs.
Air rings: These are place under the buttocks to relieve pressure so as to prevent bed sores.
Foot rest: A small piece of wood or cloth rolled neatly at the foot of the bed for the patient to support his/her feet in-order to prevent slipping/falling down the bed.
A cardiac table: It is the table place in front of the patient over the bed for meals, medicine or any leisure activity e.g. a magazine newspaper or work etc. it is used in patients with cardiac conditions in cardiac bed.
Fracture boards: To make a firm surface for support and it is placed across the bed springs under the mattress.

I. Prepare and Make an Unoccupied Bed (PEX 1.4.1)

Is an empty bed and is fully covered with a counter pane to protect it from dust and dirt while waiting for the new patient for admission.

Purpose:

To protect the bed from dust and dirt
To keep a ready bed for the admission and emergency.
To give the room/ward a neat and tidy appearance.

Requirements:

Items on the trolley: Spring cover, 2 bed sheets, 1 mackintosh/draw mackintosh, 1 ground mackintosh, 1 draw sheet, 1 pillow and pillow case, 1 blanket, 1 bed cover/counter pane.
Items in the ward: 2 chairs/stools for stripping the bed, a dirty linen container/hamper, hospital bed, mattress and mattress cover.
Appliances needed for the unoccupied bed: Foot rest, bed blocks, bed cradle, fracture board.

Procedure:

No.	Action	Rationale / Elaboration
1	Collect 1st all the requirements needed. Bring always the hamper with you.	Promotes efficiency and workflow. A hamper prevents carrying dirty linen across the ward, reducing cross-infection.
2	Clear the room 1st of unnecessary equipment e.g. kidney dishes, bed pans and the belongings of the patient or from the family.	Provides a safe, uncluttered working environment and maintains ward tidiness.
3	Pull the bed from the wall.	Allows nurses to access all sides of the bed without straining, promoting good body mechanics.
4	Place the 2 chairs at the foot of the bed.	Provides a clean surface to place stripped reusable linen or new linen.
5	Wash hands.	Standard infection control precaution.
6	Turn the mattress to see whether the spring cover is straight or complete springs (not broken).	Ensures patient safety and comfort; broken springs can cause injury or pressure points.
7	Replace the ground mackintosh then the bottom sheet and start to tuck in from the top (see that the right side is up). Mitre the corners, tuck in at the bottom and then the sides.	Mitering secures the sheet firmly to the mattress, preventing wrinkles that can cause skin breakdown.
8	Replace the mackintosh/draw mackintosh, put at the height of the patient’s buttocks. Place the draw sheet covering the mackintosh completely.	Protects the bottom sheet from soiling. The draw sheet absorbs moisture and prevents the patient's skin from touching the plastic/rubber mackintosh.
9	Put on the top sheet, tuck in the bottom, mitre each corner and leave the top free.	Secures the top linens while allowing room for the patient to enter.
10	Place the blanket on the bed then turn back the blanket and top sheet on top of the blanket.	Provides warmth and creates a neat fold at the top for aesthetic and functional purposes.
11	Replace the pillow(s) to the bed (open ends away from the entrance) after shaking them.	Shaking fluffs the pillow for comfort. Pointing open ends away from the door improves aesthetic appearance and reduces collection of dust/drafts inside the case.
12	Put the bed cover to the bed, tuck in the bottom only, mitre corners and leave the sides hanging down but make sure it is covering the whole bed.	Protects the underlying clean linens from dust while awaiting a new patient.
13	Push back the patient’s bed to the original position. Clear away and wash hands. Document the procedure and replace the equipment to their place of storage.	Restores the ward environment and ensures proper documentation.

II. Demonstrate Stripping and Changing of Patient Linen (PEX 1.4.2)

STRIPPING THE BED: This means undressing the bed or removing the bed linen from the bed in preparation to lay/make afresh.

Requirements:

As for the unoccupied bed (requirements list above).
Trolley.

Procedure:

No.	Action	Rationale / Elaboration
1	Collect 1st all the requirements needed. Bring always the hamper with you.	Organization prevents delays and breaks in infection control.
2	Clear the room 1st of unnecessary equipment e.g. kidney dishes, bed pans and the belongings of the patient or from the family.	Prevents accidental spills or breakage during bed stripping.
3	Pull the bed from the wall and place the 2 chairs at the foot of the bed.	Ensures ergonomic access and a place to temporarily store reusable items.
4	Wash hands.	Prevents the spread of microorganisms.
5	Un-tuck all the beddings first.	Prevents tearing the linen and makes folding easier.
6	Take away the pillows and undress.	Pillows are stripped and cases discarded into the hamper.
7	Fold the bed cover, blanket, top sheet in three, the bottom part should be on top and put on the chairs provided one by one. Fold the draw sheet and mackintosh, put on the chairs. Bottom sheet is also folded in three, bottom part 1st as the top will be tucked in first when putting it on again.	Folding reusable linen methodically ensures the clean side remains protected and makes re-making the bed highly efficient. Soiled items go directly to the hamper.
8	Remove the ground mackintosh by rolling it off the bed and put to the chairs.	Rolling contains any potential dust or debris.
9	Re make the bed as required (refer to procedures for occupied or unoccupied bed).	Provides a fresh environment for the patient.

III. Prepare and Make an Occupied Bed (PEX 1.4.3)

OCCUPATION BED: Is a suitable, comfortable and appropriate bed for hospitalized patients. It is made as usual and one corner of the linen is folded back at 90° to let the patient in. (Open bed: Patient is allowed out of bed).

Purpose:

To provide clean bed
To provide comfort to the patient.

Requirements:

The requirements needed are as for the hospital bed/unoccupied bed.
In addition: gloves.

Procedure:

No.	Action	Rationale / Elaboration
1	Collect all the equipment needed. Explain the procedure to the patient.	Ensures patient is informed and cooperative.
2	The patient is allowed out of bed when able. Pull the bed from the wall.	Facilitates easier bed making when the patient can safely sit in a chair.
3	Wash hands thoroughly and put on gloves.	Standard precautions against bodily fluids that may be on the linens.
4	Strip the bed and replace with clean linen.	Removes soiled items directly to the hamper.
5	The bed is made in the same way as the unoccupied bed except for the bed cover. Fold 1st the blanket, then put the bed cover over the blanket and fold the top sheet back over the bed cover.	Protects the blanket from touching the patient's face and creates a neat edge.
6	Fold half of the beddings back in a corner of 90° at the side of the locker, so that it is easy for the patient to get into the bed.	This is the hallmark of an "open bed," signaling it is ready for immediate patient use.
7	Push back the patient’s bed to the original position. Clear away, wash hands, and document.	Maintains ward safety and updates nursing records.

IV. Prepare and Make a Closed Bed (with patient in bed)

With the patient in bed / closed bed: The bed is made with the patient in, for a patient who is not able to get out of bed. It is usually done by two nurses.

Purpose:

To provide comfort to the patient
To change the soiled bed linen.

Requirements:

As for the unoccupied bed
In addition: gloves

Procedure:

No.	Action	Rationale / Elaboration
1	Collect the equipment, explain the procedure, screen the bed, and close adjacent windows for privacy.	Preserves patient dignity and prevents drafts exposing the patient to cold.
2	Pull the bed from the wall. Wash hands thoroughly and put on gloves. Place 2 chairs at the foot of the bed.	Ensures adequate working space for both nurses.
3	Remove all the pillows except one for the patient to rest his head. Loosen the beddings on all sides and then strip the bed.	Minimizes bulk making it easier to turn the patient. Retaining one pillow provides neck support.
4	Turn the patient on his left, placing one pillow under his head. The nurse towards the side the patient is facing should support the patient so that he does not feel afraid of falling down.	Ensures patient safety and trust during turning maneuvers.
5	Roll the draw sheet and mackintosh to the center of the bed near the patient’s back. If the bottom sheet needs changing, roll it to the center of the bed near the back of the patient.	Contains the soiled linen in the center, freeing up half the mattress for clean linen.
6	Place the clean bottom sheet to halfway the bed over the mattress. Make sure that the middle fold is in the middle of the bed. Tuck the head end first, mitre the corner at the top, bottom and then sides.	Provides a tight, wrinkle-free foundation on the first side.
7	Bring back the mackintosh and draw sheet if clean, tuck them under the mattress.	Re-establishes the protective layers.
8	Turn the patient on his right side, placing one pillow under his head, the nurse towards the side the patient is facing should support the patient.	Rolls the patient over the "bump" of dirty and clean linen to the clean side of the bed.
9	The 2nd nurse removes the soiled linen and puts the linen in the dirty linen container. Straightens out the bottom sheet, mackintosh, draw sheet and tuck them separately and firmly. Mitres the corners beginning from top then bottom and sides.	Completes the bottom foundation tightly, removing all sources of wrinkles and infection.
10	Turn the patient back to the center of the bed and support him whilst his pillows are plumped and arranged. Position the patient comfortably.	Restores proper body alignment.
11	As soon as the top sheet has been replaced over the patient, the sheet or blanket covering him may be removed and replace the top bed clothes.	Maintains patient modesty and warmth at all times; they are never left exposed.
12	Ensure that the bed clothes are loose enough over the patient’s feet. A bed cradle may be used to support their weight if needed but in the absence of this, the patient is asked to cross one foot over the other whilst the bed is being made, ensuring plenty of room for his feet.	Prevents foot drop (plantar flexion contracture) by relieving the downward pressure of tight linens on the toes.
13	Push back the patient’s bed, replace locker, open windows. Clear away, wash hands, and document.	Restores the environment.

V. Prepare and Make an Admission Bed (PEX 1.4.4)

ADMISSION BED FOR NEW PATIENTS: The bed is made for the newly admitted patients. It contains the pack that can be lifted off the bed or fixed on one side.

Requirements:

As for the hospital bed
Additional: 2 admission sheets

Procedure: Admitting the patient in a clean bed

No.	Action	Rationale / Elaboration
1	Collect equipment, pull bed from wall, wash hands, place 2 chairs at foot of bed, turn mattress to check springs.	Standard preparation and safety check.
2	Place the bottom sheet, mitre corners from top to bottom. Add the mackintosh and draw sheet, tuck in firmly then place the bottom admission sheet, mitre corners from top to bottom and tuck in the sides.	The admission sheet acts as an extra protective layer for a newly arrived patient who may be soiled or bleeding before a full admission bath is done.
3	The top admission sheet is placed over the admission bottom sheet and left hanging. The other top sheet and blanket are added on top of the admission sheets and then the bed cover.	Prepares the top layers efficiently.
4	Turn back the bed cover, blanket and the two top sheets to make a pack. Tuck one side or don’t, roll the beddings to the other side while the top admission sheet is rolled together to the pack.	Creating a "pack" (folding the linens to one side or the bottom) allows rapid and easy transfer of a stretcher/trolley patient directly into the bed.
5	Push the bed back to its original position. Place the chair at the top side of the bed and put the pillow whilst waiting for the patient.	Ensures the room is ready for the incoming admission.

N.B:

Admit the patient between the admission sheets.
Cover the whole bed with a bed cover if the patient is not yet admitted to prevent dust and dirt.
Remove the admission sheets after the bed bath has been given to the patient.

VI. Prepare and Make Bed for Burns (PEX 1.4.6)

ADMISSION BED FOR BURNS: It is the bed made for new patient with burns only.

Requirements:

As for the unoccupied bed
Additional: 2 old sheets and if possible sterile sheets, Mackintosh pillow cover, A mosquito net, Bed cradle, Bed blocks.
At the bedside: Infusion stand.

Procedure:

No.	Action	Rationale / Elaboration
1	Collect all the equipment needed, pull bed from wall, wash hands, place 2 chairs at foot of bed.	Standard preparation.
2	Make as an admission bed instead of admission sheets, use old or sterile sheets and make a pack.	Sterile sheets reduce the high risk of infection in burn patients who have lost their primary skin barrier. Old sheets are used if heavy exudate/ointments will permanently stain linens.
3	Cover the pillows with the mackintosh covers before putting on the pillow cases.	Protects the pillows from serous fluid weeping from face/neck burns.
4	Push back the bed to the original position. Put/hang the mosquito net to protect the patient from flies.	Flies can carry severe pathogens into open burn wounds; physical barriers are essential.
5	Place the bed cradle over the affected area to relieve weight of the beddings over the affected part.	Even the light weight of a sheet causes excruciating pain and tissue damage on exposed burn surfaces.
6	Bed blocks are used to elevate the foot of the bed if the patient is in shock.	Trendelenburg-like positioning promotes venous return to the heart in severe hypovolemic burn shock.
7	If the patient is bathed on admission, the sheets are removed when it is completed. If patient is still in shock or the burns are extensive, then the sheet should be left until the patient has recovered from shock and the admission bath is then given.	Prioritizes hemodynamic stability and life-saving measures over routine hygiene.
8	Clear away, wash hands, and document the procedure.	Maintains medical records.

VII. Prepare and Make Post-Operative Bed (PEX 1.4.7)

POST-OPERATIVE BED: This bed is prepared to receive the patients who have undergone surgical procedures, recovering from the effects of anesthesia.

Purpose:

To place the patient in bed with minimum discomfort.
To make a comfortable and safe bed for the patient who is recovering from the effects of anesthesia.
To prepare to meet any emergency.

Requirements:

As for the unoccupied bed
Additional: A small mackintosh and towel, Bed elevator, Emergency tray (mouth gag, air way piece, tongue depressor, drugs e.g. adrenaline, swabs), Hot water bottles.
At the bedside: Infusion stand.
On the locker: Post-operative observation tray (BP machine, stethoscope/pulsometer or watch, thermometer and observation chart).

Procedure:

No.	Action	Rationale / Elaboration
1	Collect equipment, pull bed from wall, wash hands, place chairs at foot of bed, strip bed in usual way, put dirty linen into hamper.	Clears the area completely to provide a fresh, sterile environment post-surgery.
2	Make a clean bed with clean linen, making it as the hospital bed but with a pack which can easily be removed when lifting the patient onto the bed.	A "pack" allows rapid, smooth transfer of an unconscious or sedated patient from the theater stretcher to the bed without manipulating limbs excessively.
3	Instead of the pillows, put the small mackintosh and towel across the top of the bed and tuck in at the top.	Post-op patients frequently experience nausea/vomiting from anesthesia; this protects the mattress. Pillows are avoided initially to maintain an open, unobstructed airway (preventing neck flexion).
4	Push the bed back to the wall. Put the pillow(s) on the chair/stools, which will be used later when the patient recovers.	Readies the pillows for when the patient is fully conscious and airway reflexes are intact.
5	Clear away, wash hands, and document.	Prepares the room fully for immediate emergency intake.

VIII. Prepare and Make a Cardiac Bed (PEX 1.4.5)

CARDIAC BED: Is used to help the patient to assume a sitting up position; which can afford him great comfort with least strain. Cardiac bed is used for patients with heart diseases, those with dyspnoea to provide easy breathing.

Purpose:

To relieve dyspnoea
To assist recovery of the patient
To provide comfort and prevent complications

Requirements:

As for the unoccupied bed
Additional: Back rest, At least 4-6 pillows and pillow cases, Air cushion/air ring and cover if required, Bed blocks, Sand bags and cover/foot support (i.e. small board, a pillow, rolled cloth etc; may be necessary to support the feet), Cardiac table.
On the locker: Sputum mug, a bell: so that the patient can reach it easily.

Procedure:

No.	Action	Rationale / Elaboration
1	Collect the equipment needed, wash hands, place 2 chairs at foot of bed.	Standard preparation.
2	Prepare the bed as the open bed with the patient but in a sitting up position.	Orthopneic position drops the diaphragm and reduces venous return, significantly easing respiratory effort in cardiac failure.
3	When making the bed, take care to see that the patient’s shoulders are covered if possible. It is better to use a bed jacket or shawl or a small blanket - the bed clothes will be restricting.	Provides warmth without the heavy restriction of full blankets pulling down on the chest, which increases work of breathing.
4	Place the back rest and pillows so as to support the patient in upright position and use a bed elevator or bed blocks to prevent the patient from slipping down the bed.	Proper support prevents muscular fatigue and maintains the chest expansion necessary for adequate oxygenation.
5	Place sandbags/board/small pillow/rolled cloth against the feet where necessary as foot support.	Prevents the patient from sliding down the bed, which would cause friction/shearing on the sacrum and reduce the effectiveness of the upright position.
6	Push the bed back to its original position. Place the cardiac table over the bed for the patient to use whilst reading or performing any tolerable activity.	The table allows the patient to lean forward (tripod position) resting their arms, utilizing accessory muscles to breathe more effectively.

IX. Prepare and Make a Divided Bed (PEX 1.4.8)

DIVIDED/AMPUTATION/STUMP BED: The bed is used for the patients who have had an amputation of the leg or have had a fractures lie in extension or for pelvic examination or treatment. It is commonly used for patients whose leg(s) has been amputated in order to keep the stump visible and elevated.

Purpose:

To keep the stump in a good position.
To help in the observation of the stump for bleeding constantly and apply tourniquet instantly if necessary.
To ensure safety and comfort to the patient by preventing soiling and staining of the linen.
To prevent jerking movements of the amputated leg, causing complications.

Requirements:

As for the unoccupied bed
Additional: 1 sheet, 1 blanket, 2 sandbags and covers, Mackintosh and dressing towel, Tourniquet and towel (only if ordered by the doctor in charge of the case), An emergency dressing trolley, Bed cradle.

Procedure:

No.	Action	Rationale / Elaboration
1	Collect equipment, pull bed from wall, wash hands, place 2 chairs at foot of bed.	Standard preparation.
2	Make the bed in two halves; across the middle or for the amputation bed at the level of amputation. The top half having a sheet, blanket and counter pane and then the bottom half having a sheet and the blanket.	This division allows the nurse to instantly inspect the surgical site/stump for catastrophic hemorrhage without exposing the patient's entire body.
3	This may be too hot for the patient at day time, so the top blanket may be omitted. At night, however it is much colder and both blankets may be needed.	Thermoregulation is customized based on environmental conditions and patient comfort.
4	On completion push back the bed to its original position. Clear away, wash hands, and document.	Maintains ward standards and clinical records.

X. Prepare and Make a Fracture Bed (PEX 1.4.9)

PLASTER AND FRACTURE BEDS: Is used for a patient with fracture of the trunk or extremities to provide firm support by use of a fracture board placed under the mattress. Fracture bed is a hard firm bed designed for the patient with a fracture particularly of the spine, pelvis or femur.

Purpose:

To make the patient comfortable.
To maintain the position and give support to the fracture.
To aid in immobilizing the fracture.
To prevent unnecessary pain.

Requirements:

As for the unoccupied bed
Additional: Fracture board, Bed cradle, Sandbag with cover, Extra pillows (at least 3).

Procedure:

No.	Action	Rationale / Elaboration
1	Collect equipment, pull bed from wall, wash hands, place 2 chairs at foot of bed.	Standard preparation.
2	This bed is made as the occupied bed.	Accommodates the immobilized patient.
3	The fracture boards are made the same width as the bed, and their purpose is to make a firm surface for placed support. They are placed across the bed springs under the mattress.	A sagging mattress would cause misalignment of the healing bone fragments, leading to non-union, malunion, or severe pain, particularly in spinal fractures.
4	Put the bed cradle over the affected part, so as to lift the weight of the beddings from the patient.	Weight from blankets can alter the alignment of a fracture (especially foot/leg) or cause pressure sores on toes (foot drop).
5	Push back the bed to the original position. Clear away, wash hands, and document.	Restores the environment.

XI. To Change the Bottom Sheet From Side to Side

This method is used for changing the bottom sheet for most patients in the hospital especially those not able to move out of bed.

Requirements:

Trolley: 1 air ring and cover, 1 draw sheet, 1 draw mackintosh, A tray for treating pressure areas may be required, 1 sheet, Gloves.
At the bedside: 2 stools/chairs, Hamper, Screen.

Procedure:

No.	Action	Rationale / Elaboration
1	Collect equipment, explain procedure, close windows, screen bed, pull from wall, place stools, wash hands, put on gloves, arrange clean linen and hamper.	Ensures privacy, warmth, workflow efficiency, and infection control.
2	Fold the clean sheets across the width in three or roll them for easy placement.	Makes positioning the sheet under the patient seamless and quick.
3	Strip the top bed clothes as usual, leaving the sheet covering the patient on a hot day or a blanket and sheet on a cold day. Back rest, air ring, and foot support are removed.	Maintains modesty and temperature control while removing obstacles to turning.
4	Both nurses lift the patient carefully down the bed off the draw sheet.	Repositioning prevents skin shearing and gives access to the linens.
5	One nurse supports the patient, while the other removes the draw sheet and mackintosh, and then rolls the soiled bottom sheet down as far as the patient’s back and straightens the mattress cover and ground mackintosh.	Rolling keeps the soiled parts contained and away from the patient's skin.
6	The same nurse puts in the clean sheet, tucking it at the top and on her side as far as the dirty linen. She then puts in the draw mackintosh and draw sheet, tucks on her side. Replace the backrest, pillows and air ring. Treat pressure areas if necessary.	Establishes the clean foundation on one half of the bed. Treating pressure areas is ideal at this moment while the back is exposed.
7	Both nurses lift the patient back up the bed and make sure that the pillows are comfortable. Then tuck in the mackintosh and draw sheet, top side of the bottom sheet on the second side.	Completes the transition of the patient onto the fresh linen.
8	Draw the soiled sheet to the bottom of the bed from under the patient’s legs and put it in the hamper.	Safely removes the contaminated linen.
9	Brush any crumbs/creases from the mackintosh and mattress, straighten them. Pull clean sheet down to bottom, tuck in, mitre corners.	Ensures the foundation is tight, smooth, and free of pressure-inducing wrinkles.
10	Put on top bed clothes, push bed back, clear away, remove gloves, wash hands, and document.	Completes the procedure.

NB. Some means should be used to prevent the patient in this position from slipping down the bed. This may be achieved by putting a sand bag or a pillow (with mackintosh cover) against the feet. This will also prevent foot drop or the foot of the bed may be raised on a bed elevator/bed blocks.

XII. To Change the Bottom Sheet From Top to Bottom

This method is used for changing the bottom sheet when the patient is nursed in an upright position and must not be flat e.g. chronic heart disease.

Requirements:

Trolley: 1 air ring and cover, 1 draw sheet, 1 draw mackintosh, A tray for treating pressure areas may be required, 1 sheet, Gloves.
At the bedside: 2 stools/chairs, Hamper, Screen.

Procedure:

No.	Action	Rationale / Elaboration
1	Collect equipment, explain procedure, close windows, screen bed, pull from wall, place stools, wash hands, put on gloves, arrange clean linen and hamper.	Maintains privacy, dignity, and infection control protocols.
2	Fold the clean sheets across the width in three or roll them for easy placement.	Allows the sheet to be fed down from the top of the bed smoothly.
3	Strip the top bed clothes as usual, leaving the sheet covering the patient on a hot day or a blanket and sheet on a cold day. Back rest, air ring, and foot support are removed.	Prevents chilling and exposure, while clearing the working space.
4	Both nurses lift the patient carefully down the bed off the draw sheet.	Safely shifts the patient's weight downward to expose the top half of the mattress.
5	One nurse supports the patient, while the other removes the draw sheet and mackintosh, and then rolls the soiled bottom sheet down as far as the patient’s back and straightens the mattress cover and ground mackintosh.	Rolling soiled linen downwards prevents contamination of the newly exposed mattress area.
6	The same nurse puts in the clean sheet, tucking it at the top and on her side as far as the dirty linen. She then puts in the draw mackintosh and draw sheet, tucks on her side. Replace the backrest, pillows and air ring. Treat pressure areas if necessary.	Secures the top foundation. Patients who must remain upright can immediately lean back onto the clean upper portion.
7	Both nurses lift the patient back up the bed and make sure that the pillows are comfortable. Then tuck in the mackintosh and draw sheet, top side of the bottom sheet on the second side.	Moves the patient off the lower soiled linens entirely.
8	Draw the soiled sheet to the bottom of the bed from under the patient’s legs and put it in the hamper.	Removes the dirty linen completely without pulling it over the patient.
9	Brush any crumbs/creases from the mackintosh and mattress, straighten them. Pull clean sheet down to bottom, tuck in, mitre corners.	Creates a smooth, tight finish that protects skin integrity.
10	Put on top bed clothes, push bed back, clear away, remove gloves, wash hands, and document.	Leaves the patient comfortable and restores the ward.

References

World Health Organization (WHO) Guidelines for Patient Safety and Infection Control in Healthcare Settings.
Standard Nursing Fundamentals: Clinical Skills and Bed Making Procedures (PEX 1.4.1 - 1.4.9).
Basic Nursing Care and Ward Management Protocols.

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