COLLEGE OF MEDICAL SCIENCES,

SCHOOL OF NURSING.

FUNDAMENTALS OF NURSING

PREPARED BY:
 DEFINITION
The fundamentals of nursing refer to the basic principles, concepts, and skills that are essential
for providing safe, effective, and compassionate care to patients. These fundamentals are
considered the building blocks of nursing practice and provide a strong foundation for nurses to
deliver high-quality care.

The concept of the fundamentals of nursing encompasses several key aspects,

including:

1. Nursing theory and practice: This involves understanding and applying nursing theories,
models, and frameworks to provide holistic care to individuals, families, and communities. It
involves the use of evidence-based practices, critical thinking, and problem-solving skills.

2. Health promotion and disease prevention: Nurses play a crucial role in promoting health and
preventing disease by educating patients about healthy lifestyle choices, administering
vaccinations, and screening for various health conditions.

3. Patient-centered care: This involves providing care that is individualized, respectful, and
responsive to patients' preferences, needs, and values. It requires effective communication,
empathy, and advocacy for patients' rights.

4. Assessment and monitoring: Nurses are responsible for conducting thorough assessments of
patients to gather important data about their health status. They also monitor and document
changes in patients' conditions, vital signs, and response to treatments.

5. Nursing interventions and skills: Nurses perform a wide range of clinical skills, such as
administering medications, wound care, IV therapy, and assisting with procedures. They also
provide emotional support, comfort, and assist patients with activities of daily living.

6. Collaboration and teamwork: Nurses work collaboratively with other healthcare professionals
to provide comprehensive care. This includes effective communication, coordination, and
cooperation to ensure the best outcomes for patients.

Overall, the fundamentals of nursing provide a framework for nurses to deliver safe, patient-
centered, and holistic care. It is important for nurses to continuously update their knowledge and
skills in these fundamentals to adapt to the evolving healthcare landscape and meet the
changing needs of patients.
INTRODUCTION TO NURSING THEORY

1. Maslow's hierarchy of needs

In a 1943 paper titled "A Theory of Human Motivation," American psychologist Abraham Maslow
theorized that human decision-making is undergirded by a hierarchy of psychological needs. In
his initial paper and a subsequent 1954 book titled Motivation and Personality, Maslow
proposed that five core needs form the basis for human behavioral motivation.

What Is Maslow’s Hierarchy of Needs?

Maslow's hierarchy of needs is a theory of motivation which states that five categories of human
needs dictate an individual’s behavior. Those needs are physiological needs, safety needs, love
and belonging needs, esteem needs, and self-actualization needs.
What Are the 5 Levels of Maslow’s Hierarchy of Needs?
Maslow's theory presents his hierarchy of needs in a pyramid shape, with basic needs at the
bottom of the pyramid and more high-level, intangible needs at the top. A person can only move
on to addressing the higher-level needs when their basic needs are adequately fulfilled.

kinship. Additionally, membership in social groups contributes to meeting this need, from
belonging to a team of coworkers to forging an identity in a union, club, or group of hobbyists.

4. Esteem needs: The higher needs, beginning with esteem, are ego-driven needs. The
primary elements of esteem are self-respect (the belief that you are valuable and deserving of
dignity) and self-esteem (confidence in your potential for personal growth and
accomplishments). Maslow specifically notes that self-esteem can be broken into two types:
esteem which is based on respect and acknowledgment from others, and esteem which is
based on your own self-assessment. Self-confidence and independence stem from this latter
type of self-esteem.

5. Self-actualization needs: Self-actualization describes the fulfillment of your full potential as a

person. Sometimes called self-fulfillment needs, self-actualization needs occupy the highest
spot on Maslow's pyramid. Self-actualization needs include education, skill development—the
refining of talents in areas such as music, athletics, design, cooking, and gardening—caring for
others, and broader goals like learning a new language, traveling to new places, and winning
awards.
Deficiency Needs vs. Growth Needs on Maslow’s Hierarchy
Maslow referred to self-actualization as a “growth need,” and he separated it from the lower four
levels on his hierarchy, which he called “deficiency needs.” According to his theory, if you fail to
meet your deficiency needs, you’ll experience harmful or unpleasant results. Conditions ranging
from illness and starvation up through loneliness and self-doubt are the byproducts of unmet
deficiency needs. By contrast, self-actualization needs can make you happier, but you are not
harmed when these needs go unfulfilled. Thus, self-actualization needs only become a priority
when the other four foundational needs are met.
 2. Ericsson’s development theory

What is Erikson's Psychosocial Development Stages?

Have you ever wondered why some people seem more confident and independent while others
struggle with trust and intimacy? The answer may lie in Erik Erikson's theory of psychosocial
development.

Erikson's theory proposes that individuals go through eight stages of development, each with its
own unique challenge and resolution. Understanding these stages can help us better
understand ourselves and others, and navigate the challenges of life with greater ease.

The German psychologist Erik Erikson proposed a psychosocial theory demonstrating that
people pass through eight stages of psychosocial struggle in their lifetime. These psychosocial
struggles contribute to people’s personalities all throughout their development.
The eight Psychosocial stages proposed by Erikson are as follows: Trust vs. Mistrust
(infancy), Autonomy vs. Shame and Doubt (toddlerhood), Initiative vs. Guilt (preschool),
Industry vs. Inferiority (school-age), Identity vs. Role Confusion (adolescence), Intimacy
vs. Isolation (young adulthood), Generativity vs. Stagnation (middle adulthood), and Ego
Integrity vs. Despair (late adulthood).

Each stage involves a specific psychosocial struggle that must be resolved to move on to the
next stage. The success or failure of these struggles contributes to the development of an
individual's personality and sense of self.

3. Roy's adaptation theory

Roy's adaptation theory is a nursing theory developed by Sister Callista Roy. It focuses on the
holistic approach to patient care and the concept of adaptation. According to the theory,
individuals are constantly adapting to their environment in order to maintain their overall well-
being.

The theory is based on the belief that adaptation is crucial for survival and that individuals have
innate abilities to adapt to changes in their health and environment. It emphasizes that
adaptation is a process that occurs on multiple levels, including physiological, psychological,
and social.

The theory includes four main concepts: the human being, the adaptive mode, the stimuli, and
the nursing process. The human being is viewed as an adaptive system, constantly interacting
with the environment. The adaptive mode consists of four subsystems: the physiological, self-
concept, role function, and interdependence modes. The stimuli are external or internal factors
that can influence the individual's adaptation. The nursing process involves assessing the
individual's adaptation level, setting goals, implementing appropriate interventions, and
evaluating the effectiveness of the interventions.

Roy's adaptation theory has been widely used in nursing practice, education, and research. It
provides a framework for nurses to assess and intervene in patients' adaptation processes. By
understanding the individual's adaptive responses and providing appropriate care, nurses can
promote health and well-being. Additionally, the theory highlights the importance of the nurse-
patient relationship and the nurse's role in facilitating adaptation.

Overall, Roy's adaptation theory emphasizes the importance of the individual's ability to adapt to
changes, and the role of nursing in promoting and supporting adaptation for optimal health
outcomes.
 4. Orem's self-care model

Orem's self-care model is a nursing theory developed by Dorothea Orem. It focuses on the
concept of self-care and the role of nursing in assisting individuals to meet their self-care needs.
According to the theory, individuals have the ability to engage in self-care activities in order to
maintain their health and well-being.

The theory is based on the belief that individuals are responsible for their own self-care. It
emphasizes that individuals have self-care deficits when they are unable to meet their own self-
care needs. Nursing is seen as a supportive and facilitative role to assist individuals in meeting
their self-care needs.

The theory includes three main concepts: self-care, self-care deficit, and nursing systems. Self-
care refers to the activities individuals perform to promote and maintain their health. Self-care
deficit occurs when individuals are unable to perform these activities on their own. Nursing
systems are put in place to support and facilitate individuals in meeting their self-care needs.

According to Orem, there are three levels of nursing systems: wholly compensatory, partially
compensatory, and supportive-educative. The wholly compensatory system is used when
individuals are unable to meet their self-care needs and require complete assistance from the
nurse. The partially compensatory system is used when individuals can perform some self-care
activities but still require assistance from the nurse. The supportive-educative system is used
when individuals are able to meet their self-care needs but require education and support from
the nurse to maintain or enhance their self-care abilities.

Orem's self-care model has been widely used in nursing practice, education, and research. It
provides a framework for nurses to assess individuals' self-care abilities, identify self-care
deficits, and intervene to promote self-care independence. By assisting individuals in meeting
their self-care needs, nurses can promote health and well-being. Additionally, the theory
highlights the importance of the nurse-patient relationship and the collaborative role of the nurse
in enhancing individuals' self-care abilities.

Overall, Orem's self-care model emphasizes the importance of individuals' active participation in
their own care and the role of nursing in supporting and facilitating self-care for optimal health
outcomes.
 5. Florence Nightingale environmental theory:

Florence Nightingale, often regarded as the founder of modern nursing, developed her
environmental theory of nursing during the 19th century. She believed that the environment
plays a vital role in promoting the health and well-being of individuals. According to Nightingale,
the physical, social, and psychological aspects of the environment significantly impact a
person's health.

Nightingale emphasized the importance of clean air, proper lighting, appropriate nutrition, and
cleanliness to create a conducive environment for healing. She also emphasized the need for
individuals to have access to nature and natural light, as she believed it had a positive impact
on mental and emotional well-being.

This theory highlighted the significance of the nurse's role in creating a healing environment.
Nurses were encouraged to be knowledgeable about sanitary practices, ventilation, and hygiene
to maintain a clean and safe environment for patients. Nightingale's environmental theory
contributed to the development of modern healthcare practices, particularly in terms of infection
control and the importance of a therapeutic environment.

6. Henderson theory of basic needs:

The Henderson theory of basic needs, proposed by Virginia Henderson, focuses on the
fundamental needs of individuals that require nursing care. Henderson believed that nursing
involves assisting individuals in accomplishing activities that lead to independence and well-
being. Her theory emphasizes the importance of meeting the basic needs of patients to promote
health and enable recovery.

Henderson identified 14 basic needs that individuals require assistance with, including the need
for air, water, nutrition, elimination, activity, sleep, and rest. Additionally, she highlighted the
need for shelter, hygiene, social interaction, relaxation, learning, and a sense of purpose.
According to Henderson, these needs must be met for an individual to achieve optimal health
and well-being.

The Henderson theory of basic needs outlines the role of nurses as caregivers, educators, and
advocates. Nurses are responsible for assessing the patient's needs and providing the
necessary interventions to fulfill those needs. The theory encourages a holistic approach to
nursing, where physical, psychological, and social aspects of health are considered in delivering
care.

This theory has been influential in guiding nursing practice, particularly in the development of
care plans and the assessment of patient needs. Henderson's emphasis on meeting basic
needs provides a framework for nurses to support patients in their journey towards
independence, self-care, and overall wellness.
 NURSING PROCESS

The nursing process is a systematic approach used by nurses to plan and deliver patient care. It
involves a series of steps, including assessment, nursing diagnosis, planning, implementation,
and evaluation.

GOAL
The goal of the nursing process is to provide individualized, holistic care to patients. It aims to
promote the health and well-being of patients, prevent illness and injury, and facilitate the
patient's recovery and optimal functioning.

Advantages of using the Nursing Process

The benefits of the nursing process include improved patient outcomes, increased patient
satisfaction, enhanced communication and collaboration among healthcare team members, and
efficient use of resources.
When used effectively, the nursing process offers many advantages:
— It is patient centered, helping to ensure that your patient’s health problems and his/her
response to them are the focus of care.
— It enables you to individualize care for each patient.
— It promotes the patient’s participation in the care, encourages independence and
concordance and gives the patient a great sense of control - important factors in a positive
health outcome.
— It improves communication by providing you and other nurses with a summary of the patients
recognized problems or needs
— It promotes accountability for nursing activities, which in turn promotes quality assurance.
— It promotes critical thinking, decision - making and problem - solving.
NURSING PROCESS STEPS
- Assessment
- Nursing diagnosis
- Planning
- Implantation
- Evaluation
These steps are inter-related, with each one influencing all the subsequent steps for instance.
-Your assessment must be thorough and accurate so that you formulate the appropriate nursing
diagnosis
- The nursing diagnosis you formulate must be appropriate to ensure that you choose
reasonable outcomes.
- The outcomes you identify must be appropriate to ensure that you choose reasonable
outcomes
- The interventions you choose must be appropriate so that your patient will make progress
towards the outcomes you have established.
Assessment
The first step in the nursing process is assessment, involves the systematic collection of data. A
comprehensive assessment gives you a wide angle of view of your patient’s health problems,
Aiding in crucial decisions about patient care. Assessment, involves data collection to identify
the patients actual and potential health problems and needs.
The goal is to gather as much information about your patient as possible.
Assessment findings fall into two broad categories;
-Subjective data
-Objective data
SUBJECTIVE DATA
Subjective data assessment represents the perception or reality experienced by the person
reporting the information. It may come directly from the patient or indirectly from family
members, caregivers or other health care providers. For example,

Admission and discharge of the patient involves the process of admitting a patient to a
healthcare facility and ensuring a smooth transition from hospital to home or another care
setting. It includes tasks such as completing necessary paperwork, obtaining medical history,
conducting physical assessments, and coordinating discharge planning.

Transfer of patient refers to the movement of a patient from one healthcare facility to another.
This may be necessary for specialized care, diagnostic procedures, or to ensure continuity of
care. It requires proper communication and documentation to ensure a safe and seamless
transition.

Referral occurs when a healthcare provider determines that a patient requires specialized
services from another healthcare professional or facility. It involves making arrangements for the
patient to receive the necessary care and ensuring relevant information is shared between
providers.

Rehabilitation and continuity of care are essential components of the nursing process.
Rehabilitation focuses on helping patients regain independence and functionality after an illness
or injury. Continuity of care ensures that patient care is uninterrupted and coordinated across
different settings and providers.
Interviewing and counseling are important skills used by nurses to gather information about a
patient's health history, concerns, and needs. Counseling involves providing emotional support,
education, and guidance to patients and their families to promote health and coping skills.

Principles of reporting and recording involve accurately documenting information about a

patient's care, including assessments, interventions, and outcomes. This ensures continuity of
care, legal and professional accountability, and facilitates communication among healthcare
providers.

Taking and handing over refers to the process of receiving a patient from another nurse or
healthcare provider and then passing care to another provider. It involves exchanging essential
information about the patient's condition, care plan, and any relevant concerns or changes. This
handover ensures smooth and safe continuation of care.

Sterilization and disinfection of hospital equipment

One of the dangers to which patients may be exposed is cross. infection, that is, an infection
which the patient acquires after entering hospital. The media of transportation of such infection
any articles with which the patient comes in contact and the people with whom the patient
comes in contact, for example, nurses, doctors and other patients. This chapter will deal with
the methods used to prevent cross infection through the articles used by patients. The safe
treatment of patients by doctors and nurses will be dealt with later under the heading of aseptic
technique.

Sterilization and disinfection are necessary to treat four main groups of articles.
1 Those which have been in contact with infected discharge, for example, pus from a wound.
2 Those which have been contaminated by excreta, infected or otherwise.
3 Those which have been in contact with a patient suffering from a communicable disease.
4 Equipment being prepared for use in the carrying out of aseptic procedures, equipment
necessary for ward dressings, and other techniques carried out in the ward or the operating
theatre.

Terminologies

Asepsis: The state of being free from micro-organisms.

Aseptic technique: The name given to the method of carrying out surgical dressings and
operative treatments where the aim is to prevent the entry of micro-organisms into a wound. All
equipment used must be sterile.

Sterile: Being absolutely free from micro-organisms.

Antiseptic or bacteriostatic agent: A substance, usually a chemical substance, which inhibits

the growth and multiplication of microorganisms.

Disinfectant or bactericidal agent: An agent which is capable of destroying micro-organisms.

It may be of a physical nature, such as heat or sunlight, or of a chemical nature of higher
concentration than that used as antiseptic.

Sterilization: The process of rendering articles free from all living micro-organisms.
Sterilizing agents
Sterilizing agents can be divided into two categories: physical agents and chemical agents.

Physical sterilizing agents

Physical sterilizing agents can be sunlight, wind, or heat. Sunlight and wind have the ability to
kill micro-organisms because of their drying power, but as their activity cannot be gauged
accurately they are not usually considered as suitable agents for use in hospitals.
Heat plays a vital part in the sterilization of equipment in hospitals and is widely used. For
convenience heat may be divided into two types: dry heat and moist heat.

Dry heat
1 Incineration or burning
Burning articles is a method of ensuring that infection is not trans mitted. The articles which can
be burned must of course be of little value and may include soiled dressings, sanitary pads,
badly infected bandages, or such articles as tooth brushes which may have been used by a
patient suffering from a communicable disease.

2 Hot air ovens

By this method the articles being sterilized are subjected to heated air in an enclosed oven. A
thermometer must be attached to the Oven so that the temperature within the oven can be
observed. The time taken to sterilize articles by hot air varies according to the used. The
following table includes some suggested temperature
temperatures but it must be emphasized that a micro biologist should be consulted and regular
tests of the sterilizing regime carried out.

Temperature
Time of exposure
190 °C.- -----8 minutes
180 °C.-------16 minutes
170 °C.--------31 minutes
160 °C.--------- 60 minutes
Hot-air oven
The timing of sterilization starts when the required temperature
within the oven has been reached, not the time when the articles were put in.
This method of sterilization can seriously damage textiles, rubber and plastic materials. It has its
greatest value in the sterilization of glassware and is widely used to sterilize glass syringes. It
greatest advantage is that the syringes can be assembled after washing and cleaning and are
therefore ready for immediate use after sterilization.
Hot-air ovens may be used for large scale syringe sterilization such as in a Central Syringe
Sterilizing Unit which could supply a whole hospital or they may be used on a smaller scale
simply to
supply, for example, an operating theatre or an out-patient department.
Great care is required to prevent contamination of the syringes after their removal from the
oven. One method of ensuring that contamination does not occur is to place the assembled
syringe with its needle attached in a thin metal cylindrical container the open end of which can
be sealed by tin foil.

Note All articles must be thoroughly clean before sterilizing, this is best done by rinsing in cold
water, washing in hot soapy water and rinsing again.

Moist heat

1. Boiling
By this method the articles to be sterilized are completely immersed in boiling water. The time of
sterilizing begins when the water boils. Non-sporing micro-organisms will be destroyed by
boiling for five minutes. (If cold articles are placed in boiling water this will cool the water,
therefore it is important to wait till the water boils again before timing the sterilizing period.)
Sodium carbonate (washing soda) can be added to the water to make a 2 per cent solution (the
amount of sodium carbonate will have to be calculated depending upon the amount of water in
the sterilizer.) The sodium carbonate solution boils at a slightly higher temperature than plain
water and is therefore a better sterilizing agent; it also helps to prevent rusting of metal
instruments.

2. Steam under pressure

The apparatus used for this purpose is the autoclave. The physical principle employed is that by
increasing the pressure of steam its temperature is raised. Normally atmospheric pressure at
sea level is 100 kilonewtons per square metre or 1 bar (fifteen pounds per square inch) and at
this pressure the steam from boiling water is at temperature of 100 °C (212 °F)'. By increasing
the pressure by 1 bar the temperature of steam is increased to 121 °C. The temperature of
steam therefore can be increased by increasing the pressure within the autoclave. The
maximum temperature for most hospital equipment is 134 °C. For effective sterilization the most
important factors are temperature and time of exposure to steam. Although the pressure reading
on the gauge of the machine may read 1 bar, the temperature of 121 °C will not be reached
unless the air has been evacuated from the materials being sterilized, before the air outlet is
closed. The actual sterilizing time does not begin until the air has been removed from the
autoclave and the required temperature reached. Although sterilization is achieved in a shorter
time when higher temperatures are used. consideration needs to be given to the type of material
involved and its expected reaction to steam. For example, Some fabrics may be damaged by
very high temperatures even
1The pressure gauge is calibrated in bars or lbs per sq in or both.
2 The temperature gauge is calibrated in centigrade degrees.

Autoclave
when exposed for a very short time and others, if exposed to relatively low temperatures for the
longer time needed for sterilization. Autoclaving is the best method of sterilizing most hospital
equipment, especially linen, bowls, gallipots, kidney dishes, and instruments. Other methods of
sterilization are only used if the articles will be damaged by steam, for example, endoscopes.
Simple types have largely been replaced by more complex automatic machines which work on
the same physical principle. All autoclaves used to sterilize equipment that have an air exhaust
pipe to facilitate the downward displacement of air from the inner chamber and extraction
pumps to remove moisture from the materials after they have been sterilized.

POSITIONS USED IN NURSING THE PATIENT

1 Prone position
The patient lies flat on his front with one pillow under his head, which is turned to one side. The
feet should be raised on a pillow to prevent the toes pressing into the bed. Sometimes, if the
patient is overweight, a small pillow needs to be placed under the chest

2 Semi-prone (recovery) position

The patient lies on his side with the uppermost arm bent at the elbow and the arm raised so that
the elbow is at the same level as the shoulder. The other arm is placed behind the patient. The
uppermost leg is bent at the knee and hip into a position which will prevent the patient from
rolling onto his face. The other leg is straight. The risk of airway obstruction is already reduced
because the patient's head is to the side. This preventive measure may be enhanced by
bending the head slightly forward.

3 Recumbent or dorsal position

The patient lies flat on his back with one pillow under the head. The bedclothes should be
tucked in loosely over the patient's feet, though in some instances it may be necessary to use a
bed cage to take the weight of the bedclothes off the feet.

4 Semi-recumbent position
The patient lies on his back with two or three pillows under his head.

5 Left lateral position

This position is used for the examination of the patient and for certain treatments, e.g., enemata.
The patient lies on the left side with a small flat pillow under the head. The head is bent forward
onto the chest and the back is usually flexed. The knees are bent up towards the trunk, the right
knee more so than the left. The arms should be folded on the chest.

6 Extreme upright position

The patient is placed in a sitting position and is supported by pillows and a back rest. The
pillows are usually arranged 'arm-chair fashion' so that the arms are supported. A water or air
cushion is placed under the buttocks to relieve pressure. Sometimes a bed table is placed in
front of the patient and padded with a pillow so that the patient can have a change of position by
leaning forward.
GENERAL BEDMAKING

Routine bedmaking
Hospital patients spend varying amounts of the day in bed and its comfort, therefore, is of
considerable importance. To ensure this the bed should be fresh, free from crumbs and
creases, and the pillows arranged to give support where necessary

Bedsteads
. Those used in hospital wards are usually made of metal with wire springs. The smooth outline
of the metal facilitates cleaning and prevents the collection of dust. The most common size is six
feet six inches by three feet, of a suitable height to allow the nurse to attend to the patient
conveniently without undue physical strain. The beds in a hospital ward should be placed at
least five feet apart.

Mattresses
Hair, interior spring and sorbo-rubber mattresses are the types most commonly used in hospital
wards. They are sometimes covered with a protective waterproof material.

Bolsters

These are usually stuffed with hair and the pillows with feathers. If, however, a firm pillow is
required it is stuffed with hair

Blankets
Turkish toweling, cellular cotton, synthetic material or Wool blankets may be used to give the
necessary warmth without too much weight. They should always be washed when a patient is
discharged.

Counterpanes
These are usually light t in color and in weight. As they require to be laundered frequently they
should be made of a durable material.

Cotton draw sheets

A fairly heavy cotton is the most suitable material. The standard size is two yards wide (one
yard wide when folded) and one and a half yards long This is placed across the bed under the
patient's buttocks so that, at frequent intervals, it can be 'drawn' to give the patient a clean, cool,
fresh piece of sheet on which to lie

Waterproof draw sheets

These consist of pieces of rubber or plastic sheeting about thirty inches square with a piece of
material stitched to each end. It is tucked in and held firmly in position under the cotton draw
sheet by which it must be completely covered.

Sheets
Cotton, polyester/cotton mixture or linen is used.

Long waterproof sheets

In some hospitals these are used on all beds as a matter of routine but in others they are used
only for selected patients. They are made long enough to stretch over the whole mattress with
enough excess to tuck in at the top and bottom of the bed; they may be provided with a cotton
attachment at each end for tucking in.

Rules to be observed in making hospital beds

1 All requirements should be collected before starting.
2 Two nurses are required and they should work in harmony,
avoiding jerky movements and jarring the bed.
3 The patient's face must never be covered by sheets or blankets.
4 The patient must never be exposed.
5 Extra assistance should be available and, if necessary, should be
called upon to help to lift the patient.
6 When pillows are being shaken the nurse should turn away from
the patient.
7 Any conversation during bedmaking should include the patient and should not be on personal
matters between the nurses.

To make an unoccupied bed

Requirements
1 Two bed sheets.
2 One cotton draw sheet if necessary
3 One waterproof draw sheet if necessary
4 Two pillow slips.
5 A flannelette sheet to be put next to the patient if so desired.
6 Blankets, if required
7 One counterpane.
8 One long waterproof sheet if necessary
Method
1 The above articles should be collected and put over two chairs placed back to back at the
bottom of the bed. It is helpful to place the linen in the order in which it is required.
2 The bottom sheet is put on and care must be taken to see that it is in the middle of the bed. It
is tucked in at the top, bottom, and sides. It should be pulled tight so that there are no wrinkles.
3 The pillows are placed on the bed so that the open ends of the pillow slips are away from the
ward door.
4 If it is to be used the waterproof draw sheet is placed across the bed with the upper border
just under the edge of the pillows. A cotton draw sheet is arranged to cover it completely. Only a
small amount of this sheet is tucked in at one side and the remainder is rolled up or folded and
tucked in at the other side so that the patient may be given a clean piece of sheet to lie on
without necessitating a change of sheet.
5 The top sheet is put on next and the nurse must note that:
a) it will be right side out when folded over the blankets at
the top of the bed;
b) about twenty inches of sheet are available to fold over at
the top;
c) the sheet is loosely tucked in at the bottom so that the patient will not feel that the movements
of his feet are uncomfortably restricted.
6 The blankets, if used, are put on the bed with the top edge pulled half-way up the pillows. This
ensures that, when a patient goes into the bed, there will be sufficient blanket to cover his chest.
The top corners of the blanket are turned back so that the patient is not 'pinned down' in bed but
has sufficient room to move about without disarranging the bedclothes. The blanket is then
tucked in at the bottom and sides
7 Last to be put on the bed is the counterpane. This may hang loosely over the bed, be tucked
in at the bottom and a half envelope corner made or be tucked in all round with envelope
corners at the bottom. At the top the counterpane should cover the blankets completely
8 At the top, the top sheet is folded over the blankets and the counterpane
9 When the bed has been made the nurse must see that the locker has been returned to its
position at the bedside, and that the two chairs used have been replaced in their proper
position.

To make a simple occupied bed

Method
1 Two nurses should always work together if it is at all possible.
2 In case it is needed, clean linen is taken to the bedside on a trolley together with a receptacle
for soiled linen.
3 Two chairs are placed at the foot of the bed and the bedside locker moved to allow free
access to all parts of the bed.
4 For routine bedmaking the ward is closed,' that is, a screen is placed across the ward door
and the only persons allowed to enter are the nursing staff. If routine bedmaking is not in
progress the individual bed is screened.
5 The counterpane is removed and folded carefully.
6 The two nurses working together untuck the bedclothes at both sides and at the bottom of the
bed.
7 The blanket is folded, lifted off the bed and placed across the two chairs in such a way that it
does not touch the floor.
8 If the patient's condition will allow it, all the pillows are removed except one. This pillow is
pulled to one side of the bed and the nurse at that side rolls the patient towards her. To do this
she must stretch across the patient, put one hand behind the shoulders and the other behind
the buttocks.
9 While the patient is being supported in this position the other nurse rolls the draw sheet and
the draw mackintosh up to the patient's back. She then removes all crumbs from the bottom
sheet and pulls it tight, tucking it in under the mattress at the side.
10 The patient is then asked to roll on to his back, then helped to roll to the other side, the pillow
being moved with him.
11 The cotton and waterproof draw sheets are removed and freed from crumbs. All crumbs and
dust are removed and the bottom sheet pulled tight. The draw sheets are then replaced in the
same way as they were removed, i.e., by rolling the patient from one side to the other.
12 When the draw sheets have been pulled tight and are free from wrinkles both nurses
together lift the patient into a sitting position where he is supported by one nurse while the other
shakes and rearranges the pillows.
13 Having settled the patient both nurses turn their attention to the bottom of the bed. One of
them lifts the patient's feet while the other removes any crumbs and dust, then together they pull
the sheet tight and tuck it in under the mattress.
14 The bed is then made up as above though some special points must be noted.
a) The bedclothes should not be tucked in too tightly around the
patient, particularly over the feet. He should be allowed
freedom to move.
b) The blanket must come far enough up to cover the patient's
shoulders.
c) The locker must be replaced in a position convenient to the
patient.

To change the bottom sheet when the patient can roll from side to
side
Method
1. See that the bed is screened or the ward closed. The nearby windows should be closed if
necessary and the procedure explained to the patient.
2 Clean linen and a receptacle for soiled linen are collected before starting.
3 Two nurses working together should strip the bed, leaving the patient covered with a
flannelette sheet or the top sheet.
4 One pillow is left with the patient and the others are removed.
5 The patient is rolled to one side and the draw sheets are rolled up to his back. He is then
rolled to the other side and the two draw sheets removed. The cotton draw sheet is placed in
the receptacle for soiled linen and the waterproof draw sheet is draped over the other
bedclothes at the foot of the bed,
6 With the patient still lying on one side the soiled bottom sheet is rolled up to his back. The
clean bottom sheet is then unfolded and placed on the bed. Sufficient is taken to the top and the
side of the bed to tuck in, and the remainder rolled up to the soiled sheet at the patient's back. It
is then tucked in at the top and side. The waterproof draw sheet and the clean cotton draw
sheet are placed on the bed, tucked in at one side, and the remainder rolled up to the patient's
back.
7 The patient is then rolled over the bundle in the middle of the bed and his pillow is moved with
him.
8 The soiled bottom sheet is removed and placed in the receptacle and the clean bottom sheet
and the clean draw sheets are pulled through
9 Now the patient rolls on to his back and, while he rests, the nurse tucks in the bottom sheet at
the top of the bed, and the bottom sheet and the draw sheets are tucked in at the side.
10 The patient is now lifted into a sitting position by both nurses and supported by one while the
other rearranges the pillows.
11 After the patient is comfortably settled on his pillows both nurses pull the sheet tight at the
bottom of the bed and tuck it under the mattress.
12 The bed is then made up as before.
13 All soiled linen is removed to the sluice room where it is placed in the soiled linen receptacle.

To change the bottom sheet when the patient cannot lie flat on the bed If,
because of his condition, the patient cannot lie flat on the bed, it is necessary to change the
sheet from the top of the bed to the bottom.

Method
1 After the bed has been screened, the requirements are collected and the bed stripped.
2 With the help of another nurse, or two nurses if necessary, the
patient's buttocks are raised off the bed and the draw sheets are pulled out.
3 The patient is then lifted as far down the bed as possible, but not so far that his legs are over
the side or the end of the bed.
4 While one nurse supports the patient in his new position the other removes all the pillows. She
then rolls the soiled sheet down from the top of the bed to the patient's back. The clean sheet is
put on, tucked in at the top, and the remainder rolled down to the soiled sheet. The draw sheets
are replaced by rolling them down towards the patient.
5 The pillows are shaken and rearranged.
6 The patient is then lifted by the two nurses over the rolled-up sheets and allowed to lie back
on the pillows.
7 One nurse lifts the patient's legs while the other removes the soiled bottom sheet and pulls
down the clean bottom sheet and the draw sheets. Together the two nurses pull the bottom
sheet tight and tuck it in. The draw sheets are pulled tight and tucked in at the sides.
8 The bed is then made up as before
N.B. The patient must never be left uncovered, therefore when he is lifted down the bed he must
have the top sheet wrapped around him.

Special appliances used in bedmaking

Special beds are used on many occasions for the comfort of the patient, for the protection of
bed linen, for the prevention of pressure sores, to facilitate putting the patient into bed without
delay.
and in the care of patients with certain conditions and diseases. Extra appliances may be added
to the requirements for a simple bed in the preparation of special beds.

Waterproof materials
These are used to protect bed sheets, draw sheets, blankets, counterpanes, pillows, and
mattresses. Waterproof pillow cases can be specially made to protect pillows.
Hot-water bottles
These are used to give added warmth to the patient. They may be
made of:
rubber;
earthenware ;
copper or aluminum.
Care must be taken in the filling of hot-water bottles.

Rules for the filling of rubber hot-water bottles

1 The bottle is never filled directly from the kettle. A funnel is placed in the opening of the bottle
and the water, which should be just off the boil, is poured into the bottle from a jug.
2 The bottle is filled three-quarters full.
3 Air is expelled and the stopper screwed firmly in position.
4 The bottle is inverted and inspected to ensure that there are no leaks.
5 The bottle is then placed in a flannel cover which is tied securely.
6 When the bottle is placed in a patient's bed there must be at least one fixed or tucked-in
blanket between the patient and the bottle.
The filling of earthenware, copper and aluminum hot- water bottles This also is done with the aid
of a jug and funnel. In this instance the bottles are heated first by placing some hot water in the
bottom, which is poured out after a few seconds. The bottles are then filled completely with
boiling water. The same precautions regarding testing and covering and placing in the bed are
carried out as for rubber hot-water bottles.
N.B. Leaking bottles must be sent immediately for repair. They may only require a new washer.
It is vital for student nurses to realize the importance of covering and placing hot-water bottles
properly in the patient's bed to prevent the occurrence of burning accidents.

Foam rubber rings

These rings may be placed under the patient's buttocks to relieve pressure.

Water beds
These appliances also help in the prevention of pressure sores. The
water bed completely covers the mattress and is filled with water.

Requirements for the preparation and filling of a water bed

The water bed.
Fracture boards.
Two blankets.
Bed linen as for a simple bed.
A jug.
A funnel.
A long waterproof sheet.
A lotion thermometer.

Procedure for filling a water bed

The bed is stripped, the Iinen and blanket being placed neatly over two chairs. The mattress is
removed and the fracture boards placed over the springs of the bed to immobilize them and
support the weight of the water bed. The mattress is then placed on the fracture boards and
covered, first with the waterproof sheet, then a blanket. The water bed is put on top of the
blanket. The bed is wheeled to a convenient water tap and, using the funnel and jug. the water
bed is filled with water at 38 °C (100 °F). Air is expelled before securely fitting the stopper. To
check that a suitable amount of water has been added, the nurse should place her forearms
about a foot apart on the water bed and. with moderate pressure, she should just feel the under
surface. The bed is then wheeled into position and the water bed is covered with the second
blanket which is tucked in all round. It is then made up in the usual way Half-sized water beds
can also be used and should be filled in the same manner; pillows may be used to make the
surface level. After one week a gallon of water is drained off and replaced by an equal amount
of water at a temperature of 65 °C (150 °F) to keep the temperature at the desired level. At the
end of a fortnight the water bed is emptied and washed and if still required it is re- filled with
fresh water at a temperature of 38 °C (100 °F).

Air bed
This is similar to a water bed but it is inflated with air in the same way as an air cushion. It is
lighter than a water bed and fracture boards are therefore not required. Otherwise the bed is
made up in the same way.

Electric blankets
These appliances are used when quick and concentrated heat is required. They should be
placed on top of the first fixed blanket. They may be used in beds prepared for the return of
patients from the operating theatre. The electric blanket is removed before the patient is put into
the bed. They are usually thermostatically controlled, but the nurse must ensure that they do
not overheat.

Bed cradles
These appliances may be made of metal or wicker and they vary in size. They are used to keep
the weight of the bedclothes off the patient's legs or body. When in use a flannelette sheet or
soft blanket may be placed next to the patient.
Bed rests
These may be attached to, or separate from, the bed. The attached type forms part of the head
of the bed and is pulled forward if required. The separate type is usually made of wood with
canvas. It is used when it is necessary for a patient to sit upright in bed. Pillows are placed
between the patient and the rest. The bed rest also reduces the number of pillows required.
Different degrees of elevation can be arranged to suit the height required for individual patients.

Bed elevators and bed blocks

Bed elevators are made of metal and have several rungs at varying heights on which the bar of
the bed may be supported at the desired height. They are used to elevate either the bottom or
the top of the bed in the treatment of certain conditions. Bed blocks are used for similar reasons.
They are made of wood and have a depression at the top into which the castors of the bed fit.
They vary in height.

Sandbags
These are bags made of an impermeable material which are filled with sand and used to
immobilize a limb or limbs in the treatment of special conditions, for example, fractures. They
must always be covered with cotton covers.

Bed tables
These are specially made tables which can be drawn up in front of the patient and may be used
for the following purposes.
1 During meals, on which the patient's tray may be placed.
2 For a patient who is very breathless and finds breathing easier when sitting upright and
leaning slightly forward. In this instance a pillow is placed over the table on which the patient
may rest his arms and head.

Fracture boards
These are boards which fit across the springs of the bed and are
used to prevent the mattress from sagging. They are required when
water beds are in use and in the treatment of some fractures and
back injuries. If single boards are used and are not perforated.
spaces are left between the boards for ventilation purposes.
Special beds
Admission bed
The objects in preparing this bed
1 To have it made up in such a way that the patient can be admitted without delay.
2 To have it warmed, if necessary for the comfort of the patient.
3 To allow for the immediate admission to bed of acutely ill patients. After accidents it is not
always suitable to remove working clothes before admission to bed, and in many cases certain
treatments, for example that of shock, must be carried out immediately. This can be done in the
admission bed before undressing and bathing the patient.
4 To facilitate bathing the patient without undue disturbance. Extra requirements over and
above those required for a simple bed A long waterproof sheet. Two blankets or flannelette
sheets. Two covered hot-water bottles or an electric blanket, if necessary. Bed blocks or bed
elevator, and bed cradle depending upon the condition of the patient being admitted. Method of
making the bed The bed is made up as for a simple bed until the draw sheet is in position. The
bottom linen and pillows are covered with the long
waterproof sheet and one of the blankets is placed over it and tucked in all round or folded
under itself. The second blanket is now placed over the bed and the sides folded under all
round. If required the hot-water bottles or electric blanket should be placed between these two
blankets. The top bedclothes are now put on and are individually turned over at the bottom and
not tucked in. The bed clothes at the side of the bed nearest to the door are folded over, leaving
this side open to facilitate quick admittance. The bedclothes on the other side may be tucked in.
The counterpane may be placed loosely over the bed and removed when the patient arrives.

Operation bed
The objects in preparing this bed
1 To have a bed ready to receive the patient on his return from the
operating the atre.
2 To Counteract shock.
3 To get the patient into bed as quickly as possible.
4 To protect linen from vomit and saliva.
5 To clear the mouth of any saliva or vomit, for which p purpose a tray is prepared.
Extra requirements in addition to those required, for a simple bed Waterproof and dressing
towels. Flannelette sheet. Two covered hot-water bottles or an electric blanket, if necessary Bed
blocks or bed elevator, bed cradle, intravenous infusion stand, and oxygen apparatus,
depending on the condition of the patient.
A tray by the beside containing:
a vomit bowl; dressing towel.
A kidney dish containing:
swab-holding forceps, dissecting forceps. tongue forceps,
tongue spatula.
A gallipot containing small gauze swabs.
A receiver for soiled swabs.
A gallipot of cold water and a mouth wash in a feeding cup with
a receiver for the return mouth wash.

Method of making the bed

The bed is made up as for a simple bed until the draw sheet is in position. The waterproof and
dressing towels are placed at the top of the bed in place of the pillows. The flannelette sheet is
positioned loosely with the hot-water bottles or electric blanket placed under it, if required. The
top bedclothes are placed as for the admission bed, being turned back at the bottom. They may
be folded into a packet or folded over the bed so that the side nearest to the door of the ward is
left open to allow for quick admittance.

Fracture bed
The object of making this bed is to provide a firm base to prevent sagging of the mattress and
movement of the part. This is done by placing fracture boards on the frame of the bed under the
mattress. The bed is then made up to suit the requirements of the patient.

Drying a plaster of Paris bed

The object of this bed is simply to dry a plaster of Paris splint or cast as quickly as possible.
Plaster of Paris is used to immobilize a particular area of the body, for example, a fractured
limb. It is applied moist and when completely dry is very hard and firm, The preparation of the
bed depends upon where the plaster of Paris has been applied.
In this context the preparation described is of a bed used for drying a plaster applied to a limb.

Requirements in addition to those required for a simple bed

Fracture boards.
A flannelette sheet and woollen sock.
Waterproof and dressing towels.
A protected pillow if preferred
Bed cradle.

Method of making the bed

The fracture boards are placed under the mattress. The bed is made up as usual until the draw
sheet is in position. The flannelette sheet is placed over the patient's trunk and the unplastered
limb. A sock may be put onto the foot and drawn as far up the unplastered leg as possible. The
waterproof and dressing towels are placed under the plastered limb to prevent wetting the
sheet, or pillow if one is used. This pillow prevents the heel from resting on the mattress, thus
preventing indentation of the plaster while it is soft. The cradle is then placed over the plastered
limb. The plastered limb may be suspended by a broad sling from the cage, thus preventing
pressure on the plaster till it is thoroughly dry. The top bedclothes are placed in position and the
lower part of top sheet and counterpane are e turned back over the cage, leaving the bottom of
the bed open in other to allow for the circulation of air which will help to dry the plaster. The toes
of the plastered limb can be covered with cotton wool or a sock.

Cardiac bed
This bed is specially made for patients who have a failing heart and on some occasions for
patients with several respiratory disease where breathing is difficult. It is found that, in heart
failure and where there is difficulty in breathing, the patient is more comfortable when sitting in
the ex- upright position. The object of this bed is therefore to make the patient as comfortable as
possible when sitting upright. The patient has to be kept warm, as in heart failure the circulation
is impaired and the patient is liable to feel cold.

Extra requirements in addition to those for a simple bed

A bed rest.
As many pillows as necessary for the comfort of the patient.
A flannelette sheet.
Warm bed-jacket or shoulder blanket may be required
A bed table and soft pillow.
Two covered hot-water bottles if required.
A bolster or a foot rest.
Air ring in a cotton cover.
A foot rest.

Method of preparing a cardiac bed

The bed is made up as for a simple bed until the draw sheet is in position. The bed rest is
placed in position at the top of the bed and as many pillows placed behind the patient as are
necessary to keep the patient upright and comfortable, and to give support to the back. The
covered foam ring is placed under the patient's buttocks to keep them off the hard mattress and
to prevent the occurrence of pressure sores. The flannelette sheet is placed next to the patient
and tucked snugly round him. The bed-jacket or shoulder blanket may be placed over the
patient's shoulders. A foot rest may be placed between his feet and the bottom of the bed to
prevent the patient from slipping down. The bed is then made up as for a simple bed. If covered
hot-water bottles are needed these must be placed on top of the first fixed item of bedlinen.
Care may need to be taken to ensure that the patient's chest is well covered with the upper
bedclothes. In many instances the patient finds it more comfortable to lean slightly forward,
resting his arms and head on a pillow placed over the bed table which is drawn up as hear to
the patient as possible. This position may ease the difficult breathing and also gives the patient
a slight change of position.

Divided bed
As the name suggests this bed is made in two separate parts with. division in the center. It may
be used:
1 when an examination of the lower part of the abdomen is made.
2 when an examination of the rectum or vagina 1s being carried out:
3 in treatments such as catheterization: in the dressing of wounds of the perineal region:
5 in the treatment of fracture of femur. The dividing of the bed facilitates these examinations and
treatments and causes less disturbance and less chance of exposure of the patient, particularly
if these have to be repeated.

Extra requirements in addition to those required for a simple bed

A white cotton sheet.
A white counterpane.

Method of making up the bed

The bed is made up as for a simple bed until the draw sheet is in position. To make the top half
of the bed. one white sheet is spread over the bed, leaving enough at the top for overlay. A
blanket, if required, is folded in two and placed over this, the lower edge being placed at the
Centre of the bed. The lower part of the sheet is folded up over this blanket and the top part of
the sheet is brought down over a folded white counterpane to look like an ordinary overlay. To
make the lower half of the bed, the second sheet is spread over the bed and tucked in at the
bottom, a second folded blanket. if required, is placed on top of this overlapping the top divided
part by six inches; the sheet is then folded over this blanket and tucked in at the bottom and this
is covered with the second folded counterpane.
A modification of this bed can be used during the nursing of patient who have had an
amputation of the lower limb and is known as an amputation bed. This bed is made to facilitate
the dressing of the stump and to ensure that the stump is visible to the staff moving about the
ward. so that at a glance any hemorrhage may be observed. It is commonly found that the
stump quivers. This is uncomfortable and distressing for the patient. The stump can be
immobilized by using a towel and two sandbags.

Extra requirements in addition to those required for a simple bed

Waterproof and dressing towels.
Two sandbags in covers.
An extra dressing towel.
A cradle.
A flannelette sheet.
A counterpane.
A tray with a tourniquet and dressing towel.
One bed sheet.
The bed is modified depending upon where the amputation has
occurred. Firstly, the making of the bed if the amputation is at thigh level.
The bed is made as usual until the draw sheet is in position and the
flannelette sheet is placed over the patient's chest, trunk, and good leg. The waterproof and
dressing towels are placed where the stump will lie. To prevent quivering of the stump, the
second
dressing towel is placed over the thigh and held firmly by placing
leg. the sandbags over it at either side of the thigh. The cradle is then
placed over the stump. The bed is now made up as described
above, with the divide' at the level of the stump. The two parts
may be folded slightly back so that the stump can be seen without
disturbing the patient.
Secondly. the making of the bed if the amputation has been carried out just above the ankle.
The arrangement of the bed is as described above until the flannelette sheet and cage are in
position:
the bed is then made up as for a simple bed, but the top bedclothes at the stump side are
turned back Over the cage and tucked in the bottom on the other side, thus exposing the stump
to view The tourniquet on a tray with a dressing towel to protect the limb should be near at
hand, but out of the view of the patient. Every nurse should know how to apply a tourniquet as
she may have to do this if sudden severe hemorrhage occurs.