Bed Making

Clinical Importance of Proper Bed Making Techniques

Bed making is a fundamental nursing skill that ensures patient comfort, safety, and infection control. In the CNA exam and clinical practice, mastery of both occupied and unoccupied bed making is essential. Proper technique prevents skin breakdown, reduces the risk of falls, and maintains a clean environment.^[1]

This skill is tested because it reflects a nursing assistant’s attention to patient dignity, body mechanics, and standard precautions. Errors in bed making can lead to pressure injuries, cross-contamination, or patient injury.^[2]

Essential Bed Making Terminology and Classifications

• Unoccupied bed – A bed prepared when the patient is out of bed (e.g., at a procedure or bath).
• Occupied bed – A bed made while the patient remains in bed (e.g., for mobility-limited patients).
• Closed bed – A bed fully made with the top sheet, blanket, and bedspread pulled up and not yet opened for a new patient.
• Open bed – The top linens are folded back to allow the patient to enter.
• Mitered corner – A neat, tight corner fold that keeps sheets secure and prevents wrinkling.^[3]
• Friction and shearing – Forces that can damage skin when dragging linens; avoided by lifting the patient (occupied bed).
• Standard precautions – Use of clean gloves when handling soiled linens; hand hygiene before and after.^[4]

Step-by-Step Protocols for Bed Making

General Principles

• Perform hand hygiene before and after bed making.
• Gather all linens before starting to avoid leaving the patient alone.
• Keep clean linens away from your uniform to prevent contamination.
• Never shake linens – this disperses microorganisms.^[1]
• Work from the head to foot and from clean to dirty.
• Use proper body mechanics: bend knees, keep back straight, avoid twisting.^[3]
• Place soiled linens directly in the hamper; do not place on the floor.

Step-by-Step: Unoccupied Bed Making (Closed/Open Bed)

1. Raise the bed to a comfortable working height and lower the side rails.
2. Remove soiled linens; roll them inward to contain contaminants.
3. Place the fitted sheet (or bottom sheet) smoothly over the mattress; secure corners.
4. Place the drawsheet (if used) over the middle of the bed, tucking firmly.
5. Place the top sheet, blanket, and bedspread evenly; leave the bottom hem loose for foot movement.
6. Make mitered corners at the foot of the bed for the top linens.
7. For an open bed, fold the top of the top sheet and blanket back about 6–8 inches.
8. Pillowcase: place the pillow inside the case without touching the outer case to your uniform.
9. Lower the bed to its lowest position and leave the call light within reach.

Step-by-Step: Occupied Bed Making

1. Explain procedure to the patient and provide privacy (close curtain/door).
2. Raise bed to working height; lower the side rail on your side; keep opposite side rail up for safety.
3. Loosen the top linens at the foot; remove blankets and keep top sheet over patient.
4. Fan-fold soiled bottom linens (fitted sheet and drawsheet) toward the patient’s back.
5. Place clean bottom sheet and drawsheet on the exposed half; tuck and secure.
6. Roll the patient to the clean side (use a turning sheet or log-roll if needed).
7. Remove soiled linens from the other side; discard in hamper.
8. Smooth and tuck the clean linens on the opposite side.
9. Replace top sheet and blanket while asking patient to hold the clean top linen; remove soiled top sheet from beneath.
10. Make mitered corners at the foot; leave space for feet.
11. Reposition patient comfortably; lower bed; ensure call light is accessible.

Important: During an occupied bed change, always keep the patient covered to maintain dignity and warmth.^[2]

Preventing Injuries and Complications During Bed Making

• Skin shearing – Avoid pulling linens from under a patient without lifting; use a draw sheet to lift.
• Pressure injuries – Wrinkled linens increase pressure on bony prominences; keep sheets smooth.
• Fall risk – If patient is left alone during bed making, both side rails must be up and bed lowered.
• Infection transmission – Soiled linens contaminated with blood or body fluids must be handled with gloves and placed in a leak-proof bag.^[4]
• Musculoskeletal injury – Use proper body mechanics; ask for help when repositioning a heavy patient.
• Patient discomfort – Always provide for privacy and avoid sudden exposure.

Common Exam Pitfalls and Critical Reminders

• On the CNA exam (skills test), you will perform either an occupied or unoccupied bed change. Common errors: forgetting to lower the bed before leaving, not washing hands, or failing to keep the patient covered.^[5]
• Memory Aid for Mitered Corners: “Triangle, tuck, fold, secure” – creates a neat 45‑degree fold.
• Always check for patient’s belongings (glasses, call light, water) before leaving the room.
• Know the difference: closed bed (all linens tucked tight, no opening) vs. open bed (top linens folded back).
• Infection control emphasis: Shaking linens is a critical failure during most state exams.^[1]
• The drawsheet (or “lift sheet”) is often used to help reposition patients; it is placed under the patient’s midsection.

References & Sources

1. Potter, P. A., & Perry, A. G. (2021). Fundamentals of Nursing (10th ed.). Elsevier. https://shop.elsevier.com/books/fundamentals-of-nursing/potter/978-0-323-67772-1
2. Sorrentino, S. A., & Remmert, L. (2020). Mosby's Textbook for Nursing Assistants (10th ed.). Elsevier. https://shop.elsevier.com/books/mosbys-textbook-for-nursing-assistants-soft-cover-version/sorrentino/978-0-323-65560-6
3. National Council of State Boards of Nursing (NCSBN). (2023). NNAAP Practice Test & Skills Checklist. https://www.ncsbn.org/public-files/2023_RN_Test%20Plan_English_FINAL.pdf
4. Centers for Disease Control and Prevention (CDC). (2007). Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. https://www.cdc.gov/infection-control/media/pdfs/Guideline-Isolation-H.pdf
5. Saunders Comprehensive Review for the NCLEX-PN® Examination. (2022). 8th ed. Elsevier. (CNA skills portion). https://evolve.elsevier.com/cs/product/9780323733410?role=student