Bed Making Procedures

Introduction and General Principles of Bed Making

Bed making is a fundamental clinical skill that directly impacts patient comfort, skin integrity, and the overall ward environment in Nigerian health facilities. A well-made bed prevents friction and shear against fragile skin, reduces the risk of pressure ulcers, and promotes psychological well-being for mothers and newborns recovering in the ward.

Every clinical procedure relies on core standards to protect both the patient and the midwife:

• Cleanliness: Always use clean, dry linen free of wrinkles that could cause pressure damage.
• Ergonomics: Adjust the bed height if adjustable, or maintain a wide stance with a straight back to prevent occupational back strain.
• Asepsis: Keep soiled linen away from your uniform and never shake bedclothes, as dust and micro-organisms spread through the air.
• Efficiency: Gather all required items before starting to minimize trips and avoid leaving a vulnerable patient unattended.

Making the Unoccupied Bed

An unoccupied bed is prepared when the patient is ambulatory, discharged, or yet to be admitted. This procedure provides an opportunity to air the mattress and ensure a clean foundation for incoming admissions.

1. Gather equipment: Collect a mattress cover, bottom sheet, draw sheet, waterproof sheet if needed, top sheet, blanket, and pillowcase, stacking them in the exact reverse order of use.
2. Strip the bed: Remove dirty linen one piece at a time, rolling each inward to contain contamination.
3. Sanitize: Wipe down the exposed mattress and frame with hospital-approved disinfectant and allow it to dry.
4. Make the foundation: Place the bottom sheet securely, tucking in mitred corners neatly at the head and foot of the mattress.
5. Layer top covers: Add the top sheet and blanket, making a toe pleat to give the patient foot room, then fold the top edge over the blanket to form a neat cuff.

Making the Occupied Bed with Minimal Disturbance

When a postpartum mother or high-risk antenatal patient is on strict bed rest, the midwife must change the linen while the patient remains in bed. This requires clear communication, gentle turning techniques, and working methodically from one side of the bed to the other.

Begin by explaining the steps to gain the patient's cooperation. Lower the bed to a comfortable working height if adjustable, and lock the wheels. Assist the patient to turn onto her side facing away from you toward the opposite side of the rail. Loosen the soiled bottom linen on your side and roll it tightly inward toward the patient's back. Place the clean bottom sheet, secure your side, and roll the excess clean linen close to the soiled roll. Assist the patient to roll gently over the center hump onto the clean side. Move to the opposite side of the bed, remove the old linen, pull the clean linen taut, tuck it in securely, and finish with the top covers while ensuring the patient remains covered and warm throughout.

Preparing and Managing the Post-Operative Bed

The post-operative or recovery bed, often called an anesthetic or admission bed, is specially arranged to receive a patient returning from theater. Its main goals are to keep the patient warm, facilitate easy transfer from a trolley, and provide quick access for emergency interventions like suctioning or intravenous therapy.

The bed is typically made as an unoccupied open bed with lightweight top covers folded lengthwise to one side or fan-folded to the foot of the bed. A waterproof sheet and draw sheet are placed at the head or middle section to protect against bleeding or vomiting. Essential emergency equipment—such as an oxygen mask, suction apparatus, and kidney dish—must be checked and placed near the bedside before the patient arrives.

Infection Control and Linen Handling Protocols

Hospital-acquired infections pose a major risk in maternity and surgical wards. Proper management of ward linen helps break the chain of infection among patients and staff.

• Personal Protective Equipment: Always wear plastic aprons and utility gloves when handling soiled or blood-stained linen.
• Containment: Never place dirty linen on the floor or furniture. Roll it inward and deposit it directly into a designated laundry hamper or leak-proof bag.
• Segregation: Separate infectious or heavily soiled linen from standard dry cotton sheets according to hospital policy.
• Hand Hygiene: Perform thorough handwashing with soap and water or alcohol rub immediately after removing gloves and finishing the bed-making task.

Ergonomics and Patient Safety Considerations

Midwives frequently experience lower back pain due to bending over low hospital beds while changing sheets or positioning patients. Applying sound ergonomic principles protects physical health and ensures patient safety.

Adjust the bed to a comfortable waist-high level whenever possible. When the bed is fixed and cannot be raised, bend at your knees and hips rather than rounding your lower back. Keep your feet apart to widen your base of support, and use your leg muscles to lift or shift weight. Always raise the side rails when leaving an occupied bed to prevent accidental falls, especially for sedated, weak, or postpartum mothers experiencing fatigue.