CNA Skill: Making An Occupied Bed

Many times, it is not possible or practical to move a patient in order to change his or her sheets.  Soiled linens can lead to infection, as well as being uncomfortable for your patient.  If your patient is not able to leave the bed while you change bedding, you will need to change the linens while the patient remains in bed.  Whenever possible, this is best accomplished by two people.   Before you begin, wash your hands carefully and put on gloves.  Begin by greeting your patient and explaining that you will be changing his or her bedding.  Then, follow these steps:

1. Roll the patient gently onto his or her side, ensuring that thepatient will not fall.  Then, undo the fitted sheet and roll it toward the patient, placing the top of the sheet where it touched the patient into the rolled up sheet.
2. Unfold a clean fitted sheet and place it on the portion of the bed that has been unmade.  Place a pad on top of the fitted sheet so that it will lie underneath the patient’s hips.  Gather the clean linen by rolling it inward, and place it underneath the edge of the dirty linen.
3. Gently roll the patient to the other side of the bed so that they are lying on the clean, rolled linen.  Remove all dirty linen and place it into the appropriate container.
4. Unroll the clean fitted sheet and pad, and pull it tightly against the bed to make sure there are no wrinkles.  Secure the sheet to the bed, and roll the patient onto his or her back.
5. Cover the patient with a clean flat sheet and blanket, and then secure the lower corners of the flat sheet using mitered or “hospital” corners.
6. Assist the patient in moving to a comfortable position, and adjust sheets and blankets as necessary.
7. Dispose of your gloves, and then wash your hands.

Replacing linens often is part of a comprehensive infection control system.  Clean linens also help the patient remain comfortable, and keep the room looking tidy.  By following this procedure, you will be able to complete linen changes in a quick and efficient manner, minimizing discomfort for your patient.

Examiners Checklist For This Skill

1) Performed beginning tasks.
2) Removed top linen, keeping person covered.
3) Positioned individual on one side of bed with side rail up (if
applicable) using appropriate safety measures on unprotected side,
and using appropriate body mechanics.
4) Tucked dirty linen under individual. Used gloves if linen is
contaminated with blood or body fluids.
5) Replaced bottom linen on first side. Tucked corners and sides
neatly under mattress.
6) Repositioned individual to other side using appropriate safety
measures on unprotected side.
7) Removed dirty linen by rolling together, held away from clothing,
and placed dirty linen in appropriate container. Disposed of gloves,
if used, and washed hands.
8 ) Completed tucking clean linen under mattress with corners and
sides tucked neatly under mattress on the second side.
9) Repositioned the individual to a comfortable position.
10) Placed top sheet over individual. Removed dirty covering. Tucked
bottom corners and bottom edge of sheet under mattress, as
indicated.
11) Placed blanket/spread over person. Tucked bottom corners and
bottom edge or blanket/spread under mattress, as indicated. Pulled
top edge of sheet over top edge of blanket/spread.
12) Removed and replaced pillowcase appropriately. Replaced pillow
under individual’s head.
13) Placed bed in appropriate position.
14) Performed completion tasks.

Expert Tip by Tanya Glover, CNA

This can be one of the most nerve wracking items on the skills test. If you do not have actual hands on work experience, changing an occupied bed can be an awkward experience until you get the hang of it. When I first began, I was so nervous about doing it because it seemed almost impossible! Rest assured however, that it is not impossible. In fact, it is one of the easier tasks you will have during your long day at work. Think of it this way, if you are changing a bed with the patient in it, that person is likely not to be getting up that day and that is one less person you will have to dress and get up in a wheel chair! Thinking of it like that makes your work load seem a bit lighter right?

There are a few things to remember about changing a bed with a patient in it. First of all, make sure you have everything you need right at your fingertips. You do not want to have to start and stop to get a forgotten item. Second, since you will have to roll your patient to get the job done right, be sure that the bed rail is up on the side which your patient is rolling towards. If they are not totally dependent and can offer assistance, let them! It is so much easier when a patient can roll up on their sides with minimal assistance and hold on to the bed rail! Once you do it a few times, you will find that it is easier than you thought and you may even get it done faster than you ever imagined!