Beds and Bed Preparation Techniques

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Beds and Bed Preparation Techniques


A hospital bed is the piece of equipment most frequently used by the hospitalized patient. Hospital beds are also found in long-term-care facilities, as well as patients' homes. The ideal hospital bed should be selected for its impact on patients' comfort, safety, medical condition, and ability to change positions.


The purpose of a well-made hospital bed, as well as an appropriately chosen mattress, is to provide a safe, comfortable place for the patient, where repositioning is more easily achieved, and pressure ulcers are prevented.


When selecting a bed, the nurse should consider the patient's mobility, overall medical condition, and risk for pressure ulcer development. Safety factors should also be considered. Unless a patient is accompanied by a health care professional or other caregiver, the bed should always be placed in its lowest position to reduce the risk of injury from a possible fall.

Another precaution to take, especially for weak or bed-bound patients, or for those with altered mental status, is to elevate the side rails. However, health care professionals should be aware of a safety alert issued by the Food and Drug Administration (FDA) in 1995 concerning the use of hospital beds' side rails. Because of a number of injuries and deaths related to side rail entrapment, the FDA recommends the following actions to prevent potential deaths and injuries related to side rail entrapment:

  • All hospital bed frames, side rails, and mattresses should be inspected regularly to identify potential areas of entrapment. The alignment of the bed frame, side rail, and mattress should leave no gap that is wide enough to entrap a patient's head or any other part of the body.
  • Be alert for side rails or mattresses that have been replaced. Not all of these are interchangeable, and may increase the potential for entrapment.
  • Check side rails for proper installation.
  • Consider additional safety measures for those patients at high risk for entrapment. Side rail protective barriers may be used to close off open spaces.
  • Do not use side rails as a substitute for patient protective restraints.


The usual hospital bed consists of a mattress on a metal frame that can be raised or lowered horizontally. The frame is separated into three sections so the head and foot of the bed can be raised and lowered, in addition to inclining the entire bed with the headboard up or down. The majority of hospital beds are powered by electrical motors, but some are run manually (using a crank) or by hydraulic methods.

The bed's position is typically changed by using electrical controls that may be located on the side or foot of the bed, in a bedside table, or on a pendant. The electrical controls enable patients to reposition the bed with very little effort. Patients should be instructed how to use the bed controls. They should also be cautioned against raising the bed to a position that may contribute to injuries or falls. At its lowest level, a hospital bed is usually about 26-28 inches (65-70 cm) above the floor.

Various safety features are present on hospital beds. These features include:

  • Wheel locks: These should be used whenever the bed is stationary.
  • Side rails: They help to protect patients from accidentally falling out of bed, as well as provide support to the upper extremities as the patient gets out of bed.
  • Removable headboard: This feature is important during emergency situations, especially during cardiopulmonary resuscitation.

Most hospital beds have water-repellent mattresses. However, a number of specially designed beds, frames, and mattresses have been created to aid in caring for bed-bound patients. Some of these beds help to turn the immobile patient, and may make it easier for nurses to lift or reposition the patient. The major categories of specialized beds are:

  • Air-fluidized beds: These are also known as bead beds, sand beds, and high-air-loss beds. Air is circulated via silicone microspheres, creating a fluid-like state.
  • Low-air-loss beds. These beds have interconnected air cells with a minimum depth of five inches (12-13 cm). They allow air to escape from the surface of the bed.

There are also a variety of support surfaces that can be placed on top of the existing mattress, or specialized mattresses that can reduce the risk of pressure ulcer formation. These surfaces and mattresses include:

  • static air-filled overlays
  • alternating air-filled mattress overlays
  • gel- or water-filled mattress overlays
  • foam mattresses
  • low-air-loss replacement mattresses

The rotokinetic bed is used primarily for severely immobilized patients or patients with spinal cord injuries. The bed can rotate a patient up to 270°. Bariatric beds are available for morbidly obese patients.


The nurse normally makes the bed in the morning after a patient's bath, or when the patient is out of the room for tests. The nurse should straighten the linens throughout the day, making certain they are neither loose nor wrinkled. Any sheets that become wet or soiled should be changed promptly.

When changing bed linen, the nurse should keep the soiled linen away from the uniform, and place it in the appropriate linen bag or other designated container. Never fan or shake linens, which can spread microorganisms and, if any of the sheets touch the floor, they should be replaced.

The bed can be made in a variety of ways, depending on the particular patient situation. The categories of unoccupied bed making include:

  • Open unoccupied: In an open bed, the top covers are folded back so the patient can easily get back into the bed.
  • Closed unoccupied: In a closed bed, the top sheet, blanket, and bedspread are pulled up to the head of the mattress and beneath the pillows. A closed bed is done in a hospital bed prior to the admission of a new patient.
  • Surgical, recovery, or postoperative: These techniques are similar to the open unoccupied bed. The top bed linens are placed so that the surgical patient can transfer easily from the stretcher to the bed. The top sheets and bedspread are folded lengthwise or crosswise at the foot of the bed.

The other method of making a hospital bed is an occupied bed, where the patient is in the bed while the linens are being changed. The nurse should perform the following when making the occupied bed:

  • Raise the bed to a comfortable working height. Loosen the top linens, and help the patient assume a side-lying position.
  • Roll the bottom linens toward the patient.
  • Place the bottom sheet on the mattress, seam side down, and cover the mattress. Miter the corners of any non-fitted sheets.
  • Place waterproof pads and/or a draw sheet on the bed.
  • Tuck in the remaining half of the clean sheets as close to the patient as possible.
  • Assist the patient to roll over the linen. Raise the side rail, and go to the other side of the bed.
  • Remove the dirty linen and dispose of appropriately.
  • Slide the clean sheets over and secure. Pull all sheets straight and taut.
  • Place the clean top sheets over the patient and remove the used top sheet and blanket. Miter the corners of the top linens at the foot of the bed. Loosen the linens at the foot of the bed for the patient's comfort.
  • Change the pillowcase.
  • Return the patient's bed to the appropriate position, at its lowest level.

The nurse also needs to place the bed into one of the following positions, considering the particular needs of each patient:

  • Fowler's: The head of the bed is raised to an angle of 45° or more; a semisitting position. This position is appropriate when the patient is eating. It is also used during nasotracheal suctioning or during nasagrastic tube placement.
  • Semi-Fowler's: In this position, the head of the bed is raised about 30°. This position helps to promote adequate lung expansion.
  • Trendelenburg: The entire bed frame is tilted with the head of the bed down. This helps to promote postural drainage or to promote venous return in patients with poor peripheral circulation.
  • Reverse Trendelenburg: The entire bedframe is tilted with the foot of the bed down. This position is not frequently used, though it may help to prevent esophogeal reflux.
  • Flat: Keeping the bed flat is appropriate for some patients with spinal injuries, and for those in cervical traction. It may also be used for patients with hypotension. It is a position preferred by many for sleeping.


After preparing the hospital bed, the patient should be assessed for comfort and safety.

Health care team roles

Selecting and preparing a bed for the patient are important responsibilities for the nurse. The nurse or nursing assistant normally makes up the bed, but it is important that all health care professionals be aware of the positive impact an appropriate, well-made bed has on a patient's care, safety, and sense of comfort.


Draw sheet— A sheet placed over the bottom sheet to help lift or move a patient and to protect the bottom sheet from soiling.

Fowler's position— A bed position where the head of the bed is raised to an angle of 45° or more; a semisitting position.

Trendelenburg— A bed position where the entire frame of the bed is tilted with the head of the bed down.



Potter, Patricia A., and Anne G. Perry. Fundamentals of Nursing, 5th ed.St. Louis, MO: Mosby, 2001.


Warren, Joseph B., et al. "Development of a Decision Tree for Support Surfaces: A Tool for Nursing." Medical Surgical Nursing 8 (August 1999): 239.


The Hospital Bed Safety Work Group. 〈http://www.fda/gov/cdrh/beds〉.