Patient and his bed : Bed Making and Types of Bed in Hospital

Patient and his bed Bed Making

Bed making is an art. Skillful bed making contributes materially to the patient' s comfort. Clean and comfortable bed includes the patient' s unit in the hospital.

Purpose:

            To provide clean and comfortable bed to the patient

            To observe and prevent patient' s complications

            To save time, effort and material

            To provide a neat appearance of the ward/ unit

            To adapt  the needs of the patient

Equipments

Open (Simple) Bed

                        Bed

                        Duster

                        Chair and stool

                        Protective sheet

                        Bed linen, i.e. mattress, mattress cover, bottom sheet one , draw sheet one, pillow, pillow cover, top sheet

one, one or more blankets with blanket covers or one counterpane or bedspread in winter.

Closed (Unoccupied) Bed

· Supplies as above Occupied Bed

            Chair

            Duster

            Cover sheet

            Fresh linen as necessary.

Admission Bed

1.  Supplies as in open bed

Post-operative Bed

          Supplies as in open bed except pillow.

            Extra supplies

                        A tray containing, bowl of gauze pieces, forceps, mouth guard or tongue forceps, airway, small towel, small protective sheet and anaesthetic sheet and towel.

                        Kidney tray, paper bag, safety pins.

                        Shock blocks, intravenous stand.

                        Sterile drainage bag with rubber tubing and a glass connection if patient comes with urinary catheter.

                        2-3 hot water bottles with covers or other means of warming the bed in winter.

Fracture Bed

            Supplies as in open bed.

            Extra supplies, i.e. fracture boards, bed cradle, sand bags, cover sheet, hot water bottles with covers, if required.

Plaster Bed

            Supplies as in fracture bed.

            Extra supplies, i.e., protective sheet and draw sheet, sand bags and draw sheet heat cradle or electric heater or hot water bottles with covers if required.

Amputation or Stump Bed

            Supplies as in plaster bed.

            Extra supplies i.e. extra set of top clothes, a pillow covered with protective cover and cotton cover, tourniquet and shock blocks.

Cardiac Bed

            Supplies as in open bed.

            Extra supplies, i.e., back rest, pillows 4-5, foot rest board, cardiac table.

Blanket (Rheumatism or Renal ) Bed

            Supplies as open bed

            Extra supplies

            Long protective sheet one, bath sheets two, electric blanket or ordinary woolen blankets-two or more.

            Bed cradle or hot water bottles with covers.

            Pillows or sand bags.

Guidelines

1. The beds are of two types, ordinary and special beds. Ordinary Bed

         Open (simple) bed: This is prepared for an ambulatory patient.

            Indication

                        Provide a clean smooth comfortable bed to the patient.

Closed (unoccupied) bed: This is an empty bed in which the top covers are arranged in such a way that all linen beneath the counterpane or bedspread is fully protected from dust and dirt until the admission of new patient. On arrival of the patient, this bed is converted into open bed.

1       Indication

            Keep the bed ready for receiving the new patient.

            Occupied bed: This bed is prepared for bed- ridden patient, lying in the bed.

            Indication

            Provide a clean and comfortable bed with the

least disturbance of the patient in it.

Special Beds

         Admission bed This is prepared for the newly admitted patient.

            Indications

            Provide minimum disturbance to the patient during admission bath and physical examination.

            Protect bed linen during admission bath and leave a fresh bed immediately ready for the use.

          Post-operative bed. This is prepared for the patient who has undergone surgery.

            Indications

            Protect bed linen from vomiting, bleeding, drainage and discharges.

            Provide warmth and comfort to the patient to prevent shock.

         Fracture bed This is a hard firm bed designed for the patient with fracture particularly of spine, pelvis or femur.

            Indications

            Aid in immobilizing the fracture.

            Prevent unnecessary pain.

            Provide warmth and comfort to the patient.

            Prevent undue sagging of the mattress.

          Plaster bed This is a hard bed designed for the patient with plaster.

            Indications Aid in immobilizing the part until the plaster dries.

            Aid in drying the plaster in correct position and shape.

            Provide warmth to dry the plaster and keep the patient comfortable.

          Amputation or stump bed : In this type of bed the top bed clothes are divided or split. This is known as amputation or stump bed when it is used for the patient with amputation of legs.

             Indications

            Avoid disturbance to the patient during constant observation, repeated applications or treatments

are necessary for abdomen or lower limbs.

            Take the weight of the clothes off the side of the amputated limb or stump.

            Keep the stump in good position.

            Watch stump for hemorrhage constantly and apply a tourniquet instantly if necessary.

         Cardiac bed  This is prepared for a patient with heart disease.

             Indications

            Relieve dyspnoea.

            Assist in recovery of the patient.

            Provide comfort to the patient.

            Prevent complications.

          Rheumatism or renal bed: This is prepared to provide extra warmth to the patient.

             Indications

            Provide extra warmth to the body incase of general debility and shock.

            Provide comfort to the aching joints in patients with acute rheumatism.

Improve perspiration for excretion of waste products incase of nephritis.

           Burns bed This is prepared for a patient with burns.

             Indications

            Prevent infection to the burnt area.

            Help in healing of the burnt area.

            Provide comfort to the patient.

            Prevent the patient from sticking to the sheet as a

result of exudates oozing from the burnt area.

          The beds must be versatile and adaptable to different needs of the patients with following arrangements.

          Siderails  These are used to

             Prevent the patient from falling out of bed.

             Protect the restless patient.

            Provide the patient support to grasp and hold when moving about.

           Handcranks These are located at the foot of bed and used to:

           Adjust the height of bed.

          Raise or lower the head, foot or knee sections in order to maintain various bed positions for treatment or comfort.

          Special attachments The attachments of various poles, frames and equipment for traction are used to modify the beds to meet various needs of the patient for treatment and

comfort.

          Collect all the supplies which are likely to be required, place on the stool or bedside table.

            Use a damp duster for enamel painted iron bed and dry one for the varnished bed. Dust mattress and sheets with dry duster and furniture with damp duster.

            When stripping the bed, strip in the following manner:

          Loosen the bedding all around starting from the head end and proceed to the foot end. Lift the mattress while loosening it.

Pick up gently, do not pull with force, shake gently and fold the clean linen which can be used again.

            Fold the counterpane or bed spread twice bringing the top end to the bottom end and then pick up from the center.

            Fold the other top clothes the same manner.

            Fold the draw sheet in two.

            Roll the protective sheet to prevent creases on it.

            Fold the other bottom clothes as top clothes.

            Place the folded clean linen which can be used again, over the back of the chair and those, which cannot be used, again should be thrown in the dirty linen receptacle. Never throw the soiled linen on the floor to prevent spread of microorganisms.

            Turn the mattress top to bottom or from side to side.

            Turn the pillow.

            Air the cotton mattress and pillow to keep them fresh and soft. Most of the dunlop mattresses are smooth on one side only.

          When the patient is incontinent or has profuse drainage, use protective sheet under the patient.

           Two nurses should work together to make the bed for helpless patient opposite to one another or at each side of the bed.

          Modify the bed according to the weather, needs and habits of the patient.

          When tucking the bed linen under the mattress, pull the sheets with both hands and the palms face down in order to protect your knuckles from bed springs.

            Never discard woolen blankets in the receptacle along with the soiled clothes. If soiled, treat them separately.

            Make the bed firm, smooth and free of wrinkles.

After completing the bed making, arrange the locker, bed and bedside furniture properly.

            When making an occupied bed, make every effort to minimize the discomfort to the patient.

            When the patient is in traction, the bed is made without disturbing the traction weights.

            Inspect bed and bedding for vermin and treat accordingly, if present.

            Do not let your uniform touch the bed and bed linen.

            Observe patient' s physical condition to assess patient' s ability for self care.

            Develop relationship ( nurse-patient ) with the patient.

            The following are the principles of bed making which need to be kept in mind while making bed.

          Barrier nursing to prevent cross infection.

          Clean and comfortable bed to ensure rest and sleep and prevent complications.

            Appropriate body mechanics to maintain body alignment and prevent fatigue.

            Organised functioning to save time, effort and material.

            Keep in mind the nursing principles while making bed.

Nursing activity

            Collect and take the supplies to the bed side.

            Place the supplies on  the stools.

            Tidy the shelves and move the locker a little away.

            Explain the patient that you are going to make his or her bed.

            Maintain patient' s privacy by using screen.

            Wash your hands.

            Make the bed as mentioned below accordingly

Open Bed

          Assist the patient out of bed as necessary and offer chair to sit.

          Remove any equipment attached to the bed linen.

Adjust the bed in flat position to a comfortable height to prevent straining your back.

            Strip the bed clothes, fold them one by one and place on the back of a chair, incase to be reused. Remove the mattress cover and bed cover, fold and keep them also

            Dust the bed with damp duster and mattress with dry duster. Turn the mattress

            Spread the bed cover on the bedsprings to protect the under surface of the mattress. Put on the mattress cover, if it is loose the excess can be tucked under the mattress. Pull the mattress to the top.

            Place the bottom sheet at the foot of bed, seam side down with the lower hem even with the edge of the mattress and the centerfold on the center of the bed. Then, unfold the upper layer onto the head of bed.

            Tuck in excess sheet at the head of the bed

            Miter the corner as below at the head end of bed, making smooth and neat corner.

            Pick up the side edge of the sheet, so that the sheet forms a triangle with the head of bed and the side edge perpendicular to the bed.

            Hold the sheet against the side of mattress using the palm of your hand and tuck the excess sheet under the mattress.

            Drop the sheet from your top hand to the side of mattress.

           Miter the corner as above at the foot end of bed.

           Tuck the sheet under the mattress from head to foot of bed on one side.

          Place a protective sheet and drawsheet in the middle of the bed with the centerfold on the center of bed and unfold. Then tuck in on one side.

            Place the top sheet at the head of bed, seam side up with the top hem even with the head of mattress and the centerfold on the center of bed, then unfold the upper layer on to the foot

of the bed.

          In winter, placed the blanket and bedspread over the top sheet as under.

            Place the blanket over the top sheet, at the head of bed, about 6-8 inches below the top sheet with the centerfold of the blanket on the center of bed. Unfold the blanket on the center of bed. Then unfold the upper layer onto the foot of the bed.

            Place the bedspread on the blanket

           Make a vertical or horizontal toe pleat as under while tucking the top bedclothes at the foot of the bed.

            Vertical pleat-Fold a six inches pleat lengthwise in the top clothes from the center to the foot end, at the center of mattress.

            Horizontal pleat-Fold a two inches pleat across the top clothes at the center of foot of the mattress.

          Tuck in the excess sheet, blanket and bedspread together at the foot of the bed.

          Miter the corner of top clothes at the foot of bed as in step i allowing the top linen to hang over the side of the bed.

         Repeat the procedure on the opposite side, if you do not have other nurse to help you on the other side. Pull the linen tight and smooth out any wrinkles.

         Fold back the top sheet at the head of the bed to the shoulder height. If blanket and bedspread are used, fold back the top sheet over the edge of blanket and bedspread.

           Put a clean pillow cover on pillow and place the pillow at the center of the head of bed, with open end of the cover away from the door of the room.

          Fanfold the top clothes toward the foot of the bed or pie fold them as under for easy entering.

            Fanfold Fold the half of the top clothes toward the foot

of the bed which is further folded into 2-3 accordianpleats so that the top clothes are at the foot end of the bed.

            Pie fold Place one finger at the center of the top clothes facing the head of bed. Lift the edge of the top clothes and fold it back toward the center of the bed, making a triangle.

Closed Bed

        The procedure is the same as in open bed except for the bedspread.

            Place the bedspread, keeping seam side down with its centerfold on the center of the bed.

            Unfold the spread on to the head side of bed, adjust the top edge of spread even with the edge of mattress, tuck in and miter the corners.

            Unfold the spread onto the foot side of bed, tuck in and miter the corners.

          Follow the steps as mentioned above to convert this bed into

an open bed, on the arrival of the new patient.

Occupied Bed

          Lower the siderails. Strip the bed and replace the top clothes by a cover sheet (top sheet can be used, incase it is not soiled).

          Fold top clothes one by one to remove and place on the back of the chair in case to be reused.

            Bedspread Fold it in half, top edge to bottom edge or longitudinally with side edge to side edge. Grasp the center and fold in half, then in half one more time.

            Blanket Fold it as above.

            Top sheet Fold it as above.

          Move the patient and mattress well up in the bed.

          Turn the patient towards you.

Fold or roll the unclean draw sheet, protective sheet, bottom  sheet, one by one as close to the patient' s back as possible, soiled side inward, on the far side of the bed.

         Dust the mattress thoroughly. Place the clean bottom sheet, protective sheet, draw sheet on the far side and fold or roll the excess bottom clothes one by one close to the patient.

          Raise the far side rail. Turn the patient away from you. Patient may hold the far side rail for support.

          Roll the unclean bottom clothes on the near side towards you and remove.

        Dust the mattress and unroll the clean bottom clothes towards you.

        Straighten the bottom clothes tight and smooth out wrinkles, tuck these one by one firmly under the mattress and miter the corners.

          Replace the cover sheet by top clothes.

        Repeat the steps as mentioned in preparing the open bed. N.B: If the patient cannot be turned, the bottom clothes are

changed from head to foot. The bed linen is changed after giving bath to the patient.

Admission Bed

          Prepare the bed as an open bed.

          Fanfold the top clothes neatly to the foot end of the bed.

          Cover the bed with long protective sheet and two bath sheets. Turn down the top bath sheet to the shoulder height and fanfold it lengthwise towards the locker. Place hot water

bottles between the blankets to warm the bed in winter.

          Adjust the height of bed to the level of stretcher, if necessary. N.B: After giving bath, turn the patient towards you, roll the

bath sheet and protective sheet and keep close to the patient' s back. Turn the patient to the other side, remove bath sheet and protective sheet and cover the patient with top clothes.

Surgical Bed

a.  Prepare the bottom of the bed as in open bed.

          Place top clothes on the bed but do not tuck in. Fold them using any one of the following methods.

            Fold the sides to the middle, then top and bottom to the middle, thus making a packet in the center of the bed which can be easily moved for the reception of the patient. Place this packet over the hot water bottles in winter.

            Turn down the top clothes to the shoulder height and then fanfold toward the locker, having the other side clear for receiving the patient. Place hot water bottles in the middle of the bed under the fanfolded top clothes in winter.

          Instead of pillow, place a small protective sheet and a towel on the head end of bed.

          Keep the tray (mentioned in supplies) on the locker or table nearby and shock blocks on floor near the foot end of the bed ready incase of necessity.

          Adjust the height of the bed to the level of the stretcher. N.B: When the patient is received in bed, place kidney tray on

the bed near the mouth and pin up the paper bag with the bottom sheet on the side.

Fracture Bed

          Place the fracture board directly over the bedsprings.

          Make the bed as in open bed and spread cover sheet between the bottom and top clothes. Place hot water bottles in between, to warm the bed in winter.

          Place the sand bags to support the part in order to maintain the position.

          When the patient is received in bed, place the bed cradle over the fractured part between the cover sheet and top clothes to take off the weight of the clothes.

Plaster Bed

1.       Prepare the bed as fracture bed.

            Put on protective sheet and draw sheet where the plaster parts are to be placed to protect the bed linen.

          Keep the sand bags covered with draw sheet to support the part so that the plaster dries in correct position and shape.

          When the patient is received in the bed, keep bed cradle over the plastered part between the cover sheet and top clothes to take the weight of the clothes off the plastered part.

        If possible, the patient may be exposed to the sun rays and if not, then use heat cradle or electric heater. If this is also not possible or available, use hot water bottles to dry

the plaster.

N.B: Any part of the patient, not covered by the plaster, must be kept warm with a blanket and if the feet are exposed, they may be covered with warm woolen socks.

Divided Bed

            Prepare the bottom of bed as in plaster bed.

            Arrange two sets of top clothes in such a fashion that they are divided in the middle so that the gap will come where it is required.

            Place a pillow covered with protective cover and cotton cover under the stump for support. Sand bags covered in a draw sheet are also placed on the sides to support the limb in order to keep the stump in good position.

            Tie the tourniquet to the bed loosely to apply instantly when hemorrhage is detected. Keep shock blocks near the foot end of the bed ready incase of necessity. When the patient is received in bed, cover with cover sheet except at the site where it must be folded back. Place a bed cradle over the stump to relieve the pressure of the top clothes. Use hot water bottles or radiant heat (heat cradle) to supply warmth to the limb.

Cardiac Bed.

            Prepare the bed as open bed.

            Place back rest at the patient' s back making it comfortable with pillows and adjust according to the need of the patient

            Keep air cushion under the buttocks, a pillow under the knees and support the feet with foot rest board.

            Place the cardiac table in front of the patient with a pillow on it so that he or she can lean forward to rest his or her head and arms on it when gets tired in

upright position.

N.B: In acute heart disease, the patient is best nursed in flat position and in a chronic heart disease if there is difficulty in breathing the patient must be nursed in an upright position.

Blanket Bed

          Prepare the bottom of bed as open bed.

          Place long protective sheet and bed sheet over the bottom sheet and then arrange a small protective sheet and draw sheet in the usual manner.

          Arrange the electric blanket as per direction on the product, allow it to warm. If electric blanket is not available, arrange two or more ordinary woolen blankets on bed sheet and then arrange the top clothes.

          Arrange pillows or sand bags covered with drawsheet after receiving the patient in bed (dressed in woolen clothes) to support the limbs steadily in case of arthritis for providing a comfortable position.

          Place bed cradle to take the weight of the top clothes off the painful joints.

Provides extra warmth by using hot water bottles or radiant heat (heat cradle) to warm the patient, if necessary.

Burn Bed

          Repeat the steps as mentioned above in the preparation of open bed. Cover the mattress completely with long protective sheet. If mattress is without protective cover and then place sterile bottom sheet.

          Place three sterile draw sheets (top, middle and bottom) over the sterile bottom sheet and nicely tuck them under the mattress. These are helpful to permit changing by the nurse with minimal discomfort to the patient. In well established institutions microdon (3 M.co.) sheeting is used over the sterile bottom sheet. This prevents the patient from sticking to the sheet as a result of the exudate' s oozing from the burn area.

         Place the bed cradle over the burn area after receiving the patient in bed. Place a sterile sheet on the top and then cover with top clothes as in plaster bed. This prevents the patient from sticking to the sheets and helps to take the weight of top clothes off the burn area.

          Discard dirty and soiled linen in the dirty linen receptacle.

          Replace the locker. Dust the chair and stool and replace them also. Wash the duster, dry and replace it.

            Wash your hands.