Changing Bed Linen: A Guide

• Changing bed linen for patients involves a series of steps, from initial assessment to finalization, focusing on patient safety, comfort, and hygiene.

Assessment

• Assess the patient’s skin condition and need for a special mattress to detect early signs of pressure injuries and implement preventive strategies, such as using air or gel mattresses.
• Evaluate the patient’s ability to reposition themselves to determine the level of assistance needed, promoting autonomy and minimizing strain for both the patient and the nurse.
• Assess the potential for incontinence or excessive drainage to prepare additional absorbent materials, protecting the mattress and enhancing patient comfort and skin integrity.
• Check the chart for movement or positioning precautions to avoid causing harm by moving the patient incorrectly, ensuring safety and adherence to the medical care plan.

Nursing Diagnosis

• Identify nursing diagnoses such as "Risk for impaired skin integrity" or "Impaired bed mobility," which guide clinical judgment and care planning.
• Recognizing a risk for skin breakdown prompts the nurse to prioritize wrinkle-free linen placement and frequent position changes.
• Identifying impaired mobility alerts the nurse to use proper body mechanics and seek assistance if needed.

Planning

• Review medical orders for movement or positioning restrictions to tailor the procedure to the patient's unique health status and prevent compromising the treatment plan.
• Identify the patient using two identifiers to prevent errors and potential harm, adhering to the "Five Rights" of patient safety.
• Explain the procedure to the patient to reduce fear or confusion, build trust, and increase cooperation and safety.
• Prepare equipment and supplies to minimize interruptions, maintain patient safety and warmth, and reduce the risk of contamination.

Implementation: Introduction & Preparation

• Introduce self and verify patient identity to build rapport and ensure adherence to safety protocols before physical contact.
• Offer bedpan or urinal to prevent soiling freshly changed linens, ensuring patient comfort and dignity.
• Hand hygiene is critical to prevent the spread of pathogens and protect both the nurse and the patient from healthcare-associated infections.
• Gloves should be worn if soiling is likely to minimize direct contact with bodily fluids or soiled linens, reducing the nurse’s exposure to pathogens.
• Arrange linen and remove unnecessary items from the bed area to reduce the risk of tripping, dropping clean linen, or mixing clean and dirty items.
• Provide privacy by closing the curtain or door to respect the patient’s dignity, ensuring that the patient feels secure and not exposed to others.
• Lock the bed wheels and adjust the bed height to stabilize the bed and promote good ergonomics, reducing the risk of falls and back strain.

Implementation: Removing Soiled Linens

• Remove top linens while keeping the patient covered with a bath blanket to ensure modesty and warmth.
• Loosen all bottom linens from the bed frame to prepare for easy removal without jostling the patient or pulling out medical lines and tubes.
• Adjust the pillow and head of bed as needed to ensure patient comfort and appropriate head elevation for breathing and circulation.
• Move the patient to one side of the bed, facing away, to provide space for linen removal and insertion and allow for a partial skin assessment.
• Roll soiled linen toward the patient and tuck under their back to prevent the spread of contaminants and make the linen easier to remove.

Implementation: Applying Clean Linens

• Place a clean bottom sheet on the mattress and tuck it under soiled linens for smooth replacement without over handling.
• Tuck the clean sheet securely under the mattress corners to prevent slipping or bunching, which can cause discomfort and pressure points.
• Roll the clean sheet toward the patient to make it accessible on the other side after repositioning, saving time and minimizing repositioning.
• Reposition the patient onto the clean side to allow access to the soiled side and ensure the patient is not lying on dirty or damp linens.
• Remove soiled linens and discard properly to prevent the spread of infection and maintain cleanliness in the room.
• Unroll and secure the remaining clean linens to finish the bottom half neatly and ensure a clean, smooth surface under the patient.
• Apply a draw sheet or waterproof pad if needed to protect linens and the mattress from soiling and aid in turning or repositioning the patient.

Implementation: Replacing Top Linens

• Place a clean top sheet over the bath blanket to maintain patient warmth and dignity while allowing the nurse to remove the bath blanket.
• Ask the patient to hold the top sheet while removing the bath blanket to engage the patient and preserve modesty.
• Apply a blanket and bedspread if desired to provide additional comfort, warmth, and a sense of normalcy for the patient.
• Tuck top linens under the foot of the bed and miter corners to keep linens in place, improve the bed's appearance, and enhance safety.
• Loosen top linens over the feet to prevent foot drop, improve circulation, and avoid pressure or friction injuries to toes and ankles.

Finalization

• Change the pillowcase and replace the pillow under the patient’s head to ensure the head area is fresh and free from accumulated oils, sweat, or microorganisms.
• Ensure the patient is comfortable and properly aligned to reduce the risk of joint or muscle pain, promote healthy circulation, and aid breathing.
• Raise side rails if required and lower the bed to a safe position to prevent falls and injury after care is complete.
• Dispose of soiled linens according to facility protocol to prevent the spread of infectious organisms.
• Remove gloves and perform hand hygiene to eliminate any residual pathogens.
• Document the procedure and patient response to ensure legal accountability, continuity of care, and communicate relevant observations.