Home Nursing Manual

SJAM/SDE/HOME NURSING MANUAL 01/JAN/2016
1.0 INTRODUCTION OF NURSING

1.1 What is nursing?
“Assisting the individual, sick or well, in the performance of those
activities contributing to health or it’s recovery (or up to peaceful death)
that he would perform unaided if he had the necessary strength, will or
knowledge, and to do this in such a way as to help him gain independence
as rapid as possible.”
Virginia Henderson, 1950
Virginia Henderson’s Model : Human Needs Theory (1957)

It views the person as an integrated, organised whole who is motivated towards meeting basic
human needs. It relates to intellectual, interpersonal and technical skills needed to perform
nursing care function.
14 Activities of Daily Living

Helping the patient with the following activities or providing conditions under which he/she can
perform them unaided:
1. Breath normally
2. Eat and drink adequately
3. Eliminate body waste
4. Move and maintain desirable postures
5. Sleep and rest
6. Select suitable clothes – dress and undress
7. Maintain body temperature within normal range by adjusting clothing and modifying the
environment
8. Keep the body clean and well groomed and protect the integument (skin)
9. Avoid dangers in the environment and avoid injuring others
10. Communicate with others in expressing emotions fears or opinions
11. Worship according to one’s faith
12. Work in such a way that there is a sense of accomplishment
13. Play and participate in various forms of recreation
14. Learn, discover or satisfy the curiosity
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1.2 Definition of Home Nursing
1. Home Care Nursing is for people who needs care at home, temporarily or indefinitely, for a
variety of health reasons including:
- Being released from the hospital after surgery or a sudden event such as stroke or
serious injury;
- Worsening of a chronic condition that requires a higher level of care than is
available at home; and
- Living with ongoing health issues that are making it difficult to be at home.
2. Nursing is care given to an individual in the home. The care may be provided by a family
member or by nursing aids or assistant.
3. Nursing in the family means, to see to the sick person in totality:

- Give him/her the necessary care and attention;
- Stimulate his/her own healing potential;
- Motivate him to make use of existing resources
- Strengthen the immunity;
- See the illness in the individual life context
- Consider the family situation;
- Mobilisation.
4. Home nursing care given by a non-professional is differentiated from home care services
provided by professionals especially by visiting registered nurse, home health agencies,
hospital, or other organized community group.
5. Nursing aids and assistants can handle basic tasks under the direction of registered nurses.
They can handle basic tasks like doing personal hygiene, brushing patient’s teeth, bathing
them and combing their hair and changing their clothes.
- These nurse aids can assist patients to go to bathroom and assist patients in their
daily routine nursing care. Other duties that they can assist for the patients are
helping them to feed their meals, doing 2 hourly turning to prevent bed sore and
assist them in ambulating them.
6. The basic principle of human socialization, whether they are young or old is to assist
whenever they are sick or handicapped family members with temporary or long term caring
needs and to support their independence and self-esteem.
7. Hospitalization is a costly affair and in most cases can be shortened if the family can take
care of the patients themselves or get assistants through nursing agencies which cover the
basic needs of nursing the patient at home.
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8. It is the desire of most elderly patients to remain within their family settings. This does
however require a basic knowledge of care taking, proper knowledge in general nursing or
basic nursing is necessary and can be very beneficial to both the care giver and the care
receiver.
9. This home nursing care guide is regarded as a supplementary and supportive of the
professional nursing module. The concept of Home nursing providers is based on the concept
and understanding of the “nursing in the family”. It is an additional assistance in reflecting
the skill learned and to deepen the understanding of Home nursing.
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2.0 BED MAKING

2.1 Introduction and purpose
Aim
Patient comfort
Guidelines
1. Collect the required linens.
- Avoid disruption of procedure.
- Inconvenience to patient
2. Good body mechanics
3. Asepsis practice:
- Hand wash- before and after bed making
- Hold linens away from your uniform / cloth
- Prevent movement of dust – Do not shake linens
- Switch off fan
- Roll linens away from you when removing from bed.
- Avoid sitting on a patient’s bed. Risk of transfer microorganisms to next surface.
- Dirty linens- never put on the floor or on clean linen.
- Extra linen in a person room considered contaminated. Do not use it for other patients.
4. Linens
- Tightly tucked.
- Wrinkles cause discomfort & risk to development pressure sore.
Methods
1. Simple method
- Patient ca be taken / sit out of bed
2. Side to side method

- Patient is in lying position.
- Patient not allowed or unable to sit up.
3. Top to bottom method

- Patient is unable to lie in recumbent position.
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2.2 Simple Bed Making

Purpose:
To provide a clean, comfortable sleeping and resting environment for the patient.
Requirement:
Trolley with:
Top shelf: Linen (in order to use)
- Bed sheet
- Blanket
- Pillowcase
Bottom shelf: Pail for soiled linen
Procedure:
No Action Rationale
1 Prepare requirement and bring it to patient’s room To ease the procedure and
reduce workload
2 Explain procedure to patient To get co-operation from

patient
3 Switch off the fan if any. Avoid dust flying in the air
4 Remove blanket and pillow and place on a chair To ease bed sheet changing
5 Remove soiled linen and place it in a pail.
6 Clean the mattress with a cloth and kidney dish.
7 Push mattress to the head of the bed. Centre the

mattress if necessary.
8 Place clean bed sheet on mattress. Place the center

fold of the bed sheet in the middle of the mattress.
9 Open up the bed sheet side by side.
10 Tuck the top of the sheet under the head of the bed.
11 Miter the corners of the bed sheet at the head of the

bed. (Envelope corner)
12 Tuck the remaining end of the bottom sheet well

under the mattress and miter the corners.
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13 Fold blanket into quarters and place on mattress at

the foot of the bed. Tuck one end well into mattress.
14 Miter the corners of the blanket and tuck both ends To make it neat
well under the mattress.
15 Change pillow case.
16 Re-place pillow onto bed by the opening of pillow

case facing in the room.
17 Tidy up unit and wash hand To avoid cross infection
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2.3 Side to Side Bed Making

Purpose:
Provide clean, comfortable sleeping and resting environment for the patient.
Requirements:
Trolley with:
Top shelf: Linen (in order to use)
- Bed sheet
- Draw sheet / disposable linen protector
- Blanket
- Pillowcase
Procedure:
No Action Rationale
reduce workload

patient
3 Switch off the fan and air conditioner. Avoid dust flying in the air
4 Remove blanket and extra pillows and place on a chair To ease bed sheet changing
5 Turn patient slowly to the side, while second nurse Avoid patient from falling
supporting him at the shoulder and hip. down
6 Loosen bed sheet and roll them up until it is as near as To ease removal of soiled
possible to the patient linen
7 Place clean bed sheet to the middle of the mattress
8 Roll half of the bed sheet to the middle of mattress
9 Tuck in bottom half of the bed sheet under mattress To allow second nurse
getting it
10 Place clean linen protector with its center fold in the

middle of the mattress
11 Turn patient over slowly
12 Remove dirty linen, roll into bundle and place in pail To ease the disposal of linen
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13 Unroll bed sheet and tuck under mattress
14 Unroll linen protector
15 Miter all corners
16 Change pillow case and place under patient’s head and

shoulder
17 Replace blanket, miter the corners To make it neat
18 Make patient comfortable To provide comfortable place

to patient
19 Tidy up unit and wash hand To avoid cross infection
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2.4 Top to Bottom Bed Making

Purpose:
Provide clean, comfortable sleeping and resting environment for the patient
Requirements:
Trolley with:
Top Shelf: Linen (in order to use)
- Bed sheet
- Draw sheet / disposable linen protector
- Blanket
- Pillowcase
Procedure:
No Action Rationale
reduce workload

patient
3 Switch off the fan or air-conditioner Avoid dust flying in the air
4 Prepare bed sheet (roll the top to middle. Fold and To ease bed sheet changing
place on trolley.
5 Remove blanket and extra pillows from patient’s bed.

Place them at the end of the bed
6 Put patient in sitting position and slide him down a bit, Avoid patient from falling
second nurse support the patient down
7 Loosen all the linen at the head and foot of the bed
8 Fold the old linen in towards the patient’s buttock To ease removal of soiled
linen
9 Place bed sheet into the top of the mattress with the
rolled end as deep under the patient’s buttock as
possible. Make the bed at the top of the bed with the 2
nurses taking turns ensuring the patient is constantly
supported
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10 Ask patient lift the buttock (by pressing both hands on

the mattress to lift patient up and move him
backwards)
11 Remove the soiled linen by folding it inwards and put To ease the disposal of linen
inside the pail
12 Complete bed making To make it neat and tidy
13 Make patient comfortable To make patient comfortable
14 Tidy up unit
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3.0 BODY MECHANICS
3.1 Definition
The application of kinesiology to the use of proper body movement in daily activities.
3.2 Purpose
1. To prevent back injury
2. To maintain normal body posture
3. To ensure safety for home care providers and patient
3.3 Principle of Body Mechanics

i) Maintain a stable center of gravity
ii) Keep center of gravity low
iii) Keep back straight
iv) Bend at knees and hips not back
v) Maintain a wide base of support to provide maximum stability while lifting
vi) Keep feet apart
vii) Place one foot slightly ahead of the other
viii) Flex knees to absorb jolts
ix) Turn with feet not back
x) Keep the object being lifted close to your body
xi) Maintain proper body alignment
xii) To push, pull or roll an object if possible instead of lifting
xiii) Use arm and leg muscles as much as possible instead of back muscles
xiv) Ask for help if the object is too heavy to be lifted alone
xv) Always perform task at waist level
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4.0 POSITIONING
4.1 Types of position of patient on the bed
(A) Supine
(B) Recumbent
Description:
- Patient lies flat on the bed.
- A pillow is to put under the head and shoulder.
- Hands are supported by pillows.
- Foots are 90°supported by pillow.
Purpose:
- To carry out procedures (eg: physical examination)
- To provide an alternative position to ensure rest and comfort.
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(C) Lateral
Description:
- Patient is lying to a side either is left or right.
- The head is resting a side on a pillow.
- The leg which is near to the bed is to put straight while another leg is to flex 90°.
- A pillow is to put under the flexed leg to promote comfort.
- The hand which is away from the bed is to flex in front of the chest and supported by a
pillow.
Purpose:
- To provide an alternative position to prevent pressure sores.
- To provide an alternative position to ensure rest.
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(D) Semi prone
Description:
- Patient is partially lying face down.
- The head is resting a side on a pillow.
- The hand which is away from the bed is to flex in front of the chest and supported by a
pillow while another hand is to put straight behind the body.
- The leg which is near to the bed is to put straight while another leg is to flex 90°.
- A pillow is to put under the flexed leg to promote comfort.
Purpose:
- To provide an alternative position to prevent pressure sores.
- To provide an alternative position to ensure rest.
Prone
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(E) Fowler’s
Description:
- The head of the bed is to lift up 45°– 90°.
- A pillow is to put under the head and shoulder.
- A pillow is to put under the knee to prevent patient from sliding down.
- Foots are 90°supported by pillow.
Purpose:
- For patient who is having difficulty in breathing. (eg: asthma)
- For patient who had just done operation.
- For patient who has big abdomen.
- For patient to perform activity daily living (eg: eating, washing face, reading or
eliminating on the bed.
Low Fowler’s
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4.2 Pressure points
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4.3 Sit patient up in the bed

No Action Rationale
1. Inform patient. Let patient understand so that he or
she will give cooperation throughout
the procedure.
2. Lock the wheel of the bed. Ensure safety.

4. One hand hold across the patient’s arm and Prevent patient from falling to the
another hand support the back. back.
5. Inform patient you will lift her up after the count

of 3.
6. Lift patient up slowly and gently. Ensure you are stabilized before
lifting patient.
7. Check for any giddiness from patient. Easier for nurse to hold patient while
turning.
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4.4 Sit patient up at the side of the bed

No Action Rationale
1. Inform patient. Let patient understand so that he or
she will give cooperation throughout
the procedure.
3. Inform patient will move her body near to Easier to stabilize patient after sit up.
the side of the bed.
4. One hand hold across the patient’s arm and

another hand support the back.
5. Sit the patient up in the bed by facing the

foot of the bed.
6. Stand with both legs apart for 10” in Ensure you are stabilized before
between and facing the patient, leg which is lifting patient.
going to pivot put behind.
7. Inform patient to flex both hands in front of Easier for nurse to hold patient while
the chest, bend the head down towards the turning.
chest and flex both knee.
8. Support patient’s shoulder and legs.
9. Pivot and bring patient’s leg down beside

the bed.
10. Ask patient to swing her legs, check for any Improve venous return, ensure no
giddiness or difficulty in breathing from complication.
patient.
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4.5 Lifting patient from bed to chair

No Action Rationale
1. Inform patient. Let patient understand so that he or she
will give cooperation throughout the
procedure.
3. Place chair at the head of bed parallel to

the side of bed.
4. Sit patient up at the edge of the bed.
5. Instruct patient to hold your shoulder with Ensure patient is stable and supported
both hands. while standing.
6. Put both of your hands at patient’s axilla Ensure patient is stable and supported
by thumbs facing up. while standing.
7. Put one of your legs in between her legs.
8. Instruct patient to stand up in the count of

3.
9. Instruct patient to move one step in front. More spacious and nearer to chair while
pivoting.
10. Pivot patient to the front of the chair.
11. Instruct patient to move behind until she Easier for patient to sit down.
can feel the chair behind.
12. Put one of your legs in front, flex knee and Prevent patient from fall.
instruct patient to sit down.
13. Make patient comfortable.
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4.6 Lifting patient from chair to bed

No Procedure Rationale
1. Inform patient. Let patient understand so that he or she
will give cooperation throughout the
procedure.
3. Stand in front of the patient.
4. Flex knee with one leg in front, backbone Ensure you are stabilized before lifting
straight. patient.
5. Instruct patient to hold your shoulder with Ensure patient is stable and supported
both hands. while standing.
6. Put both of your hands at patient’s axilla Ensure patient is stable and supported
by thumbs facing up. while standing.
7. Put one of your legs in between her legs.
8. Instruct patient to stand up in the count of

3.
9. Pivot patient to the front of the bed.
10. Instruct patient to sit on the bed. Put both Ensure patient stabilize herself while
of her hands on the bed and help her to sitting on the bed.
move herself behind.
11. Put your left hand behind patient’s Prevent patient from falling to the back.
shoulder and right hand under the thigh.
12. Bring patient back to the bed.
13. Instruct patient or help her to move herself Ensure patient is in good alignment.
to the center of the bed.
14. Check whether patient is in good

alignment.
15. Make patient comfortable.
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5.0 PERSONAL PROTECTIVE EQUIPMENT (PPE)

5.1 Definition
Specialized clothing or equipment worn by employees for protection against infectious materials.
5.2 Purpose
1. To prevent contact of infectious agent and body fluids which may contain
infectious disease.
2. To protect staff and reduce opportunities for transmission of microorganisms.
5.3 Types of PPE
Face Mask
Latex Gloves
Types of PPE
Gown Goggles
Face Shield Mask
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6.0 HAND WASHING

6.1 Five moment of Hand Hygiene
6.2 Purpose:
1. To reduce the amount and growth of microorganism in hands.
2. To prevent the spread of microorganisms.
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6.3 Procedure:
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7.0 TAKING BODY TEMPERATURE
7.1 Method of taking body temperature
Route Duration Description

Oral 3 minutes Easier method, comfortable for patient and accurate.
Axilla 5 minutes Safe but less accurate.
Rectal 1 minute Use when oral and axilla route are contraindicated. The most
accurate but less comfortable.
7.2 Reading and recording

Degree of temperature
Subnormal - 35.0 °C to 36.4 °C
Normal - 36.5 °C to 37.4 °C
Low grate fever - 37.5 °C to 38.0 °C
High grate fever - 38.1 °C to 39.0 °C
7.3 Types of thermometer
Scale Stem
Bulb Mercury
Clinical or Note the

Mercury difference
Thermometer in the bulb
Rectal
thermometer
Infrared Skin
Digital thermometer
Thermometer
Tympanic thermometer
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7.4 Measuring body temperature (Oral)

Purpose:
1. To establish baseline data for subsequent evaluation
2. To determine whether the core temperature is within normal range
3. To determine changes in the core temperature in respond to specific therapy
4. To monitor client at risk for imbalanced body temperature
Requirement:
1. Top Trolley
 Thermometer
 Alcohol swabs
 Disposable plastic sheath
 Pen and observation chart
2. Bottom Trolley
 Receiver
No Action Rationale
1. Review previously recorded temperature Provide guideline for comparison
measurement and determines site to use for
measurement
2. Observe client’s ability to support a thermometer To ensure client comfort and
within the mouth and to breath adequately through promote efficiency of the procedure
the nose with the mouth closed
3. Read client’s history to assess for contraindication To ensure client safety and ensure
for oral site e.g. recent seizures. accuracy
4. Determine if client consumed any hot or cold To ensure accuracy. Cold or hot
substances or smoke a cigarette within the past 30 liquid, smoking or performing
minute or performed any activities, if so, wait 20- activities will alter temperature
30 minutes before measuring oral temperature.
5. Wash hand To reduce transmission of

microorganism
6. Greet client and explain the procedure. To gain co-operation from client and
allay anxiety
7. Remove thermometer from storage container and To ensure client’s safety

check for any breakage.
8. Wipe the thermometer from bulb to stem with To ensure hygiene.

alcohol swab using rotating manner. Ensure fingers
do not touch thermometer directly.
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9. Discard the swab into receiver.
10. Hold thermometer at eye level, rotate until mercury To ensure an accurate reading
line is visible and read. Ensure the level of mercury
is below 35.5°C. If necessary, flick the
thermometer by using wrist movement, away from
body
11. Put thermometer into disposable plastic sheath if

available.
12. Instruct client to open his mouth and raise his

tongue.
13. Place thermometer either on the right or left side of To ensure contact with large blood
the frenulum (under the tongue). vessels under the tongue
14. Instruct client to close his mouth and not to talk or To prevent environmental air from
bite the thermometer. coming in contact with the bulb.
To ensure client’s safety.
15. Leave the thermometer in place for 3 minutes. To ensure an accurate reading.
16. Remove thermometer from mouth. Remove To allow accurate reading of

disposable plastic sheath if apply before this. temperature
17. Discard the thermometer sheath into receiver.
18. Read at eye level and rotate slowly until mercury To ensure an accurate reading of
level is visualized temperature
19. Shake the thermometer down and swab it with

alcohol swab from stem to bulb.
20. Discard the swab into receiver. Return

thermometer to storage container.
21. Wash hand To prevent multiplication of

microorganisms
22. Record reading. To promote accurate

documentation for data comparison
23. Report any abnormalities
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Put thermometer bulb at the left or right frenulum
Wipe with downward motion after taken temperature
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7.5 Measuring Body Temperature (Axillary)
Purpose :
1. To establish baseline data for subsequent evaluation
2. To determine whether the core temperature is within normal range
3. To determine changes in the core temperature in respond to specific therapy
4. To monitor client at risk for imbalanced body temperature
No Action Rationale
1. Review previously recorded temperature Provide guideline for comparison
measurement. and determines site to use for
measurement.
2. Observe client’s ability to support a thermometer To ensure accurate reading.
within the armpit. (eg. too skinny may not be able
to hold the thermometer)
3. Make sure axillary skin is dry, pat dry if necessary. To prevent a false low reading.
4. Prepare requirement (same as oral temperature).
5. Wash hand To reduce transmission of

microorganism
6. Greet client and explain the procedure To gain co-operation from client and
allay anxiety
7. Remove thermometer from storage container and To ensure client’s safety

check for any breakage
8. Wipe the thermometer from bulb to stem with To ensure hygiene.

alcohol swab using rotating manner. Ensure fingers
do not touch thermometer directly.
9. Discard the swab into receiver.
10. Hold thermometer at eye level, rotate until To ensure an accurate reading.
mercury line is visible and read. Ensure the level
of mercury is below 35.5°C. If necessary, flick the
thermometer by using wrist movement, away
from body.
11. Put thermometer into disposable plastic sheath if

available.
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12. Roll client’s sleeve up.
13. Place thermometer in the middle of axilla, To ensure accurate reading.

ensuring it will be in between two skin fold.
14. Assist client to hold his arm tightly across the To maintain the device in proper
chest to keep thermometer in place. position
15. Leave the thermometer in place for 5 minutes. To ensure an accurate reading
16. Remove thermometer from mouth. Remove

disposable plastic sheath if apply before this.
17. Discard the thermometer sheath into receiver.
18. Read at eye level and rotate slowly until mercury To ensure an accurate reading of
level is visualized temperature
19. Shake the thermometer down and swab it with

alcohol swab from stem to bulb.
20. Discard alcohol swab into receiver. Return

thermometer to storage container
20. Wash hand To prevent multiplication of

microorganisms
21. Record reading. To promote accurate

22. Report any abnormalities
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8.0 TAKING PULSE & RESPIRATION RATE
8.1 Normal and subnormal rate
Normal Pulse Rate Normal Respiration Rate

Adult 60 – 80 beats per minute Adult 14 – 20 breaths per minute
Children 80 – 100 beats per minute Children 21 – 25 breaths per minute
Infant 100 -120 beats per minute Infant 26 – 30 breaths per minute
Lower than normal rate : Bradycardia Lower than normal rate : Bradypnea
Higher than normal rate : Tachycardia Higher than normal rate : Tachypnea
Carotid Femoral Posterior tibia Dorsalis pedis
Radial
Brachial
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8.2 Recording and reporting

Purpose: To assess the patient’s cardio vascular status and breathing pattern.
Requirement:
Watch, pen, observation chart.
Procedure:
No. Action Rationale
1. Greet and explain to the patient. To gain co-operation from client and
allay anxiety
2. Ensure patient has been rested ½ an hour prior to To ensure reading not affected by
procedure. If not, take the pulse and breathing after activity.
half an hour.
3. Rest or support patient’s arm. To let patient feel comfortable.
4. Place your first, second and third finger tips lightly

along the radial artery.
5. Press gently along the radius. To feel the pulse.
6. Apply enough pressure to feel the pulsating artery.

Use a watch and count the number of pulsation
(beat) per minute.
7. Note the rate, rhythm and strength of the pulse.
8. Note the rise and fall of patient’s chest with each Observe respiration rate as a
inspiration and expiration. complete cycle.
9. Count the respiratory rate for 1 minute.
10. Observe the rate, depth, rhythm and any other

characteristics of the respiration.
11. Record in the observation chart. To promote accurate

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9.0 GIVING AND REMOVING BEDPAN

Purpose:
To assist patient in elimination when on bed rest.
Requirement:
Bedpan and cover
Glove
Toilet paper
Soap, water and towel.
Procedure:
1. Explain procedure and provide privacy. Get co-operation from patient and care of
patient’s image.
2. Put patient lie flat on the bed.
3. Loosen and remove sarung or pants. To prevent it from getting wet.
4. Instruct patient to flex both knees, rest her Help patient to raise up her buttocks.
weight on the back and heels then raise the
buttocks by pressing both hands on the
mattress.
5. Slip the bedpan gently under patient’s Ensure urine or feces go into bedpan
buttocks. correctly.
6. If patient unable to help, turn patient to the

side, place bedpan snugly and assist patient
to roll over onto the bedpan.
7. Adjust the bedpan, prop patient up. Easier for patient to pass urine / motion.
8. Allow time for complete elimination,

ensuring privacy.
9. Wear disposable gloves and assist patient Prevent cross infection.

to clean up when elimination completed.
10. Assist patient lie back on bed.
11. Instruct patient to lift the buttocks. If

patient unable to lift up her buttock, turn
the patient to another side.
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12. Remove bedpan and place on the floor or Ensure eliminates do not contaminate work
lower shelf of trolley. place and patient’s bed.
13. Give patient a basin of water and soap to Care of patient’s hygiene.
wash hands.
14. Dry hands with towel.
15. Ensure patient is comfortable.
Bedpan Uriner
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10.0 ORAL CARE

Purpose:
To maintain and preserve the health of the lips, tongue and oral mucosa of an ill patient.
Requirements:
Thymol gargle or Chlorhexidine mouthwash (eg. Oradex)
2 gallipots or plastic containers
Cotton buds
Wooden spatula
Gauze
Towel or incopad (any protective sheet)
Face towel
Receiver/ waste bag
Vaseline
Disposable glove
Preparation
1. Wrap gauze round the wooden spatula.
2. Chorhexidine mouthwash into gallipots each.
3. Preparation of Thymol gargle:- 1 part of Thymol gargle : 3 parts of water
Procedure:
1. Greet patient, explain and provide privacy.
2 Place incopad/ small towel around neck. Protect clothes from getting
wet/dirty
3 Remove dentures if any, soak in water and Ensure good protection to

brush with tooth paste and tooth brush later. dentures.
4 Soak prepared spatula and cotton buds into

solution about 6 each respectively.
5 Clean using spatula of Chlorhexidine in the To ease cleaning

manner of inside the cheek to outwards (teeth)
in an up and down movement.
6. Clean the in between teeth by using cotton buds Cleaning inside out to prevent
in the same manner as number 5. from pushing in the debris into
the mouth as our aim is to clean
in out.
7 Clean the palate and tongue from inside out in To thoroughly clean the
same manner as No.5. remaining debris
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8 Clean the lips and apply lubricant using cotton Remove remaining dirt and
bud. moisturize the lips.
9. Make the patient comfortable and tidy up the

place.
Mouth
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11.0 HAIR WASH

Purpose:
To keep patient’s hair clean and healthy and make patient comfortable.
Requirements:
2 big jug with warm water 2 bath towels
1 empty pail Shampoo / soap
2 empty basin Receiver
1 short mackintosh Linen – bed sheet, pillow case, shirt
1 cape mackintosh/ small towel Cotton wool to protect the ears x2
2 small towels Comb and hair dryer
No. Procedure Rational

1 Explain procedure to patient. To prepare patient for the procedure
and reduce anxiety.
2 Assess patient’s general condition. For us to plan the position for hair
wash and how to assist patient.
3 Wash hands. Hygiene purpose.
4 Prepare necessary equipment. Procedure can be done smoothly.
5 Fold the 2 sides of mackintosh – making like a

drain, with one end slightly wider.
6 Assist the patient to move to the end of the bed

near to the side of the bed.
7 Put all pillows on the chair at the end of the Remove all unnecessary items to
bed. provide space for procedure.
8 Loosen the bedsheet at the head of the bed. To prepare for changing of linen at the
end of the procedure.
9 Put the basin on a chair or a pail on the floor To collect drained water.
just below the head.
10 Put the wider end of the mackintosh on the To make a drain-like system for water
mattress and the other end in the basin or pail. to flow down to the basin or pail.
11 Fold a towel horizontally and put on top of To support the neck.

mackintosh on the mattress under the patient’s
neck to hyperextend patient’s neck slightly.
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12 Put a cape mackintosh or small towel on To protect patient’s shirt from getting
patient’s chest wet.
13 Cover both eyes with small towel and give the To prevent the shampoo get into
patient 1 small towel to wipe his face. patient’s eyes.
14 Close both ears with cotton ball To prevent water from entering the
ears.
15 Comb patient’s hair To remove tangles.
16 Wet the patient’s hair with warm water.
17 Put the shampoo on your hand and apply to To prevent scratch on patient’s scalp.
patient’s hair. Massage the scalp using the ends
of your fingers until clean. Do not use
fingernails.
18 Rinse the hair using warm water until clean.
19 Change the basin if full and remove it once To prevent the water from splash.
finishes rinsing.
20 Place the towel over patient’s hair and sit

patient up.
21 Remove the mackintosh and tidy the bed. To tidy up the bed site.
22 Put the wet and dirty linen in the pail.
23 Dry and comb patient’s hair – use the

hairdryer.
24 Change the patient’s shirt and bedsheet if To make patient comfortable.

necessary.
25 Make the patient comfortable and tidy up unit.
38
12.0 BED BATH

Purpose :
1. To make patient comfortable.
2. To maintain patient’s personal hygiene by cleaning away body secretions (eg: sweat,
sebum, odor or other microorganism…).
3. To improve blood circulation.
4. To encourage muscle and joint exercise by active and passive movement.
Requirements :
Top shelf of trolley: Bottom shelf of trolley:
2 basins of warm water Clean pyjamas
Soap and soap dish Small towel
Comb 3 Bath towels
Skin lotion Linen as required (bed sheet, pillow case)
Powder Pail for soiled linen
Receiver
Moistened cotton wool
Procedure :
1. Collect necessary equipment and arrange in order Work can be done smoothly.
of use. Prepare working space.
2. Inform patient, provide privacy. Care of patient’s image.
3. Offer bed pan or urinal to patient to empty urine. Patient will feel more
comfortable after empty urine.
4. Remove blanket and extra pillows, placing them To prevent over exposure of
neatly on a chair at the foot of the bed. patient’s body.
5. Place bath towel on top and under the patient.
6. Remove soiled pyjamas from patient under bath Ensure privacy.

blanket then place it in a pail.
7. Wash and dry patient’s face:

- Put towel around patient’s neck
- Clean the eyes with wet small towel
- Ask patient whether she want her face to be
cleaned with soap or not.
- Clean the face and ear again until no soap
residue.
39
8. Wash and dry patient’s arms:

- Place bath towel under arm further away from Clean the limbs further from
you. you first to prevent
- Wash, rinse patient’s arm from wrist towards contamination of the clean part.
the shoulder including the axilla using gentle To encourage venous return to
strokes. the heart.
- Dry patient’s arm and hands.
- Treat pressure areas with skin lotion.
- Apply powder under axilla as desired.
- Repeat procedure with other arm.
9. Clean and dry the chest and abdomen: To prevent accumulation of dirt
- Cover chest with towel. which may cause skin infection.
- Wash, rinse and dry patient’s neck, chest,
axilla and abdomen.
- Beware of folded skin area.
10. Wash and clean patient’s legs:

- Expose patient’s leg further away from you.
- Place towel under patient’s leg.
- Instruct patient to bend her knee.
- Cover another leg, ensure privacy.
- Wash and rinse patient’s leg using gentle It is to encourage venous return
strokes towards the hip. to the heart.
- Dry patient’s leg and foot thoroughly.
- Treat pressure areas with skin lotion.
- Repeat procedure with another leg.
11. Wash and clean patient’s back:

- Turn patient to her side.
- Place towel to the back area.
- Use a clean basin of water, wash patient’s
back by circular movement.
- Rinse and dry patient’s back thoroughly.
40
12 Treat pressure area with skin lotion using circular Prevent pressure sore.
movement.
13 Help patient to dress in pyjamas top.
14 Assist patient back to recumbent position.
15 Wear gloves and wash patient’s genitalia with Care of patient’s hygiene.
moist swab.
- Assist patient to bent her legs and slightly part.
- Use moist swab to clean downwards, throw Prevent urinary tract infection.
swab after each stroke.
A. Cleanse the female’s vulva and perineum
using downward strokes.
B. The male’s penis is cleansed from the tip
toward the base. If the male is
uncircumcised, the foreskin is retracted
and the area under it is cleansed.
16 Change soiled linen as necessary. Ensure the bed is clean and

tidy.
17 Dress patient in pyjamas bottom.
41
18. Remove bath towel.
19. Comb patient’s hair and make patient comfortable.
20. Tidy up unit and wash hands. Ensure workplace is clean and
tidy.
Preparation of a bed bath trolley
42
13.0 TEPID SPONGING

Purpose:
To reduce the patient’s body temperature.
Equipment:
Top shelf of trolley : Clean clothes
A bowl of tap water
2 large towels
6 small towels
Mackintosh/ plastic sheet
Bottom shelf of trolley: Pail for dirty linen
Procedures:
No Action Rationale
1 Greet and explain procedure to patient. To gain co-operation from
client and allay anxiety
2 Wash hands. To prevent cross infection

Close door and window. To privacy to patient
Switch off the fan if necessary. To provide comfort to
patient
3 Remove blanket and pillows and place on a chair.
4 Cover the patient with bath towel.
5 Remove patient’s clothes.
6 Place a mackintosh/ plastic sheet with a bath towel To ensure the water does
underneath the patient by turning patient from side to side. not leak onto bed sheet.
7 Soak all small towels in a basin of tap water and squeeze

the towel to half dry.
8 Place the small wet towels on forehead (1) and both Those are the areas that
armpits (2) and groins (2). keeping body heat.
43
9 Dap patient’s arm with wet towel from shoulder to hands. To reduce heat
Allow moisture to remain on hands and body.
10 Soak all the small towel and squeeze to half dry. Replace To reduce the heat
on forehead, armpits and groin.
11 Dap patient’s body with wet towel from chest to abdomen. To reduce heat
Re-soak and re-place all small towels.
12 Dap patient’s legs from groin to feet. To reduce heat

Re-soak and re-place all small towels.
13 Turn patient to his side and dap his back from shoulder to To reduce heat
buttocks.
14 Discontinue the procedure if patient is shivering. To prevent hypothermia
15 Remove all small towels. Dap patient dry with bath towel To promote comfort of
and dress the patient with clean attire. the patient
16 Tidy up the bed when necessary To promote comfort of

the patient
17 Wash hands. To promote hygiene
18 Take patient’s temperature 30 minutes after the procedure. To evaluate effectiveness

Record the temperature. of procedure
44
14.0 DIET TRAY

14.1 Food Pyramid
Correct diet is as important in the maintenance of health as in the treatment of disease.
The preparation and serving of food to the sick person is a fundamental nursing duty, as it
is from food that the patient will derive the materials required for repair of body. Food
serves 3 main purposes in the body:
- To supply material for growth and repair of the body tissues.

- To supply fuel for heat and energy.
- To supply material to regulate body development and maintain resistance to
disease.
A normal well balanced diet must contain the correct proportions of proteins,
carbohydrates, fats, mineral salts, vitamins and water.
Food Pyramid
45
Nutrients Food example Function

Carbohydrates Rice, bread, flour, potatoes, cereals, Produce energy.
sugar.
Proteins Animal sources, meat, fish, eggs, Required for growth and repair body tissues
cheese, milk, cereals, peas, bean and
nuts.
Fats Milk, butter, cream, cheese, eggs, Main source of heat for maintenance of
animal fats, vegetable oils. body temperature and energy.
Mineral Salts :
(a) Calcium Milk, cheese, flour, green Growth and repair of bone, normal
vegetables. development of teeth.
(b) Phosphorus Fish, poultry, meat, whole grains, Provide energy and vigor by helping in the
eggs, nuts, seeds. metabolization of fats and starches.
Lessen the pain of arthritis.
Promote healthy gums and teeth.
(c) Sodium Salt, shellfish, carrots,, beets, dried Preventing heat prostration or sunstroke.
beef, bacon, brains, kidney. Help your nerve and muscle function
properly.
(d) Potassium Citrus fruits, banana, potatoes, all Aid in clear thinking by sending oxygen to
green leafy vegetables, mint leaves, brain.
sunflower seeds. Assist in reducing blood pressure.
(e) Iron Beef kidney, heart and liver, pork Promote resistance to disease.
liver, dried peaches, red meat, egg Prevent fatigue.
yolks, oyster, nuts, beans, asparagus, Cure and prevent iron-deficiency anemia.
oatmeal. Bring back good skin tone.
(f) Copper Dried beans, peas, whole wheat, Keep energy up by aiding in effective iron
prunes, calf and beef liver, shrimp absorption.
and most seafood.
(g) Iodine Onions, Seafood, vegetable grown in Promote proper growth and healthy hair,
iodine-rich soil. nails, skin and teeth.
Provide energy.
Improve mental alacrity.
Vitamins :
Fat soluble
Vitamin B Dried yeast, whole wheat, oatmeal, Improve mental attitude, memory and
peanuts, pork, most vegetables, milk, balance.
cheese. Keep nervous system, muscles and heart
functioning normally.
Relieve dental postoperative pain.
Vitamin C Citrus fruits, black-currants, Heal wounds, burns, and bleeding gums.
tomatoes, cauliflower, potatoes and Decrease blood cholesterol.
sweet potatoes. Treatment and prevention of common cold.
46
Water Soluble :
Vitamin A Fish liver oil, liver, carrots, green Protection of surface tissues and for the
and yellow vegetables, eggs, milk, visual purple in the eye.
margarine, yellow fruits. Build resistance to respiratory infections.
Vitamin D Fish-liver oils, milk, butter, eggs, Proper utilize calcium and phosphorus
sardines, salmon, tuna. necessary for strong bones and teeth.
Morning sunshine. Taken with Vitamin A & C it can aid in
preventing colds.
Help in treatment of conjunctivitis.
Vitamin E Wheat germ, green vegetable, Keep you looking younger by retarding
spinach, broccoli, soybeans, whole- cellular aging due to oxidation.
grain cereals, eggs, vegetable oils. Protect your lungs against air pollution by
working with Vitamin A.
Alleviate fatigue.
Aid in prevention of miscarriage.
Vitamin K Yogurt, egg yolk, green vegetables, Help in preventing internal bleeding and
soybean oil, fish-liver oils, sunflower hemorrhages.
oil. Aid in reducing excessive menstrual flow.
Promote proper blood clotting.
14.2 Categories of nutrients

Diet
There are four types of diets commonly served to clients in the hospital. Depending on
their health status:
a) Full diet / Normal diet
 This diet consists of rice, meat, vegetables and fried fish. It is served to clients
who are able to chew the food and have no problems with digestion.
b) Soft diet
 Soft diets are foods easily swallowed and easily digestible, such as steamed
fish, eggs, minced meat and finely chop vegetables. Oily food is not included
in this diet. Soft diet is suitable for clients who have lost their teeth and can’t
chew properly. It can also be served to a client who has poor appetite or who
has just undergone surgery.
c) Special diet/ therapeutic diet

 This is a specially prescribed diet by the medical doctor as part of the treatment
for the client.
 The most common ones as bellow.
47
Types of diet Description

Low calorie diet Mainly for clients who are overweight or obese; especially those with
conditions such as hernia, joint or back pain, diabetes mellitus, or
high blood pressure.
High protein Consists of 130 grams of protein and mainly used for clients with
diet mal-absorption, malnutrition proteinuria or chronic liver disease.
They can also be given for clients after burn injury as protein is
required in the regeneration of new tissues.
Low protein diet This is used mainly for clients with renal or liver disease. It must be
carefully calculated and evaluated so that there is enough protein to
meet the body requirement of the client.
Low fat diet This is a diet that consists of little fat, especially saturated fat and
cholesterol. They are given for clients with gall bladder or liver
disease. Sometimes it is also given for clients who have problem in
fat absorption.
Low salt diet Salt increases retention of water, thereby increasing the total fluid
volume in the body. Therefore, low salt diet is used for clients with
diseases whereby a decrease in the volume of body fluid will relieve
the symptoms of the disease. Examples of conditions where
controlled use of salt may be indicated are: severe health failure
impaired liver function, high blood pressure, and acute or chronic
kidney disease.
Diabetic diet This consists of 180 grams of carbohydrate distributed evenly

throughout the day. The calorie content in the diet is approximately
1200 to 1800 calories. Clients or theirs caregiver will be educated on
how to calculate and exchange foods from the same nutrient group
before discharge from hospital, e.g. two slices of bread is equivalent
to one serving of rice.
Feeds
There are two types of feeds:
 Full feeds and clear feeds
 Tube feeding
 For full feeds, client in allowed to drink milk, coffee, milo etc.
 For clear feeds, client is allowed to drink only water or any drink that is
clear, e.g. barley, glucose. This is usually served to client after some
invasive procedures or client who has just resumed diet.
48
 For tube feeding, client can either be having tube via nasogastric route
(nose to stomach), gastrostomy (abdomen to stomach) or jejunostomy
(abdomen to jejunum), whereby milk or other supplemental feeds is fed to
them through this tube. The amount of feeds to be fed will be ordered by
the medical doctor according to client’s status; and the client will be
referred to the dietician for calculation of daily needs according to client’s
body weight and health status.
14.3 Oral Feeding Procedure:

1. Assess client’s level of self-care and swallowing To prevent client from choke.
ability.
2. Prepares the environment: To promote the appetite and

- environment should be free of odours. comfort.
- no sweeping or mopping during meals time.
- avoid disturbances e.g. giving of medicines, etc.
3. Ensure client is free from pain during meals. So that appetite will not be
affected.
4. Mouth care should be provided prior to meals and To improve appetite.

whenever necessary to remove any unpleasant taste.
5. If client is on special diet, explain the reason and To prevent misunderstanding thus
needs of special diet. client will follow the orders.
6. Position client upright comfortably to ease To promote comfort and prevent

swallowing and digestion. client from choke.
7. Allow client to put on dentures before eating. So client able to chew the food
properly thus improve the
swallowing ability.
8. Wash hands and gathered tray and utensils. To maintain hygienic.
9. Help client to wear bib if needed. To protest clothing and bed linen
from accidental food spills.
10. In feeding helpless patient, serve a small amount at To prevent choke and promote
a time allow adequate time for client chew and digestion.
swallow food.
49
11. Do not feed client with cold food. As this will cause uncomfortable
thus affect the appetite.
12. Position tray in front of the client and arrange To prevent spillage when client
utensils within easy reach. trying to reach the utensils.
13. Clear the tray and tidy up the client after meal. To promote cleanliness of client’s
surrounding.
Sample of diet tray layout.
50
15.0 SERVING ORAL MEDICATION
15.1 Understanding of rights
Abrevation:
dly / OD - daily / on day
bd - twice a day
tds / t.i.d - 3 times a day
qds / q.i.d - 4 times a day
nocte / ON - on night
1/1 - 1 tablet
11/11 - 2 tablets
gm - gram
mgm - milligram
ml - milliliter
tab - tablet
cap - capsule
syr - syrup
Route:
Oral - swallow through mouth
Suppository - insert through anus
Gutt - eye drop
Intradermal - paste on the skin
Intramuscular - injection into muscle
Intravenous - injection into vein
Subcutaneous - injection into fat layer
51
15.2 Preparation of oral medication

Purpose:
Proper method of giving oral medication to ensure accurate amount and correct type of
medication is served.
Requirement:
Tray
Water
Medicine cup
Medications (Pills or syrup)
Procedure:
1. Check and confirm doctor’s prescription. To confirm the correct order.
2. Greet patient and explain procedure. To acknowledge the patient.
3. Identify patient Ensure right patient.

• Ask patient’s name
• Check name on medication chart
4. Assist patient to seating position or fowler’ position Easy for patient to swallow the
if necessary. medication
5. Wash hands To prevent cross infection
6. Check
• Label on the container against the prescription in Ensure right medication, right
the medication chart dose, right route and right time.
• Dosage
• Label again before taking out the medication
from container/ envelope.
7. Tablets/ Capsule
• Pour the tablets or capsule on to the bottle cap
and then transfer to the medicine cup
• Crush the tablet and mix with water if client has To mix the medication
difficulties in swallowing
Syrup
• Shake the bottle carefully
• Remove the cap and place it upside down on
Top of trolley.
• Hold the bottle with the label against the palm To avoid spillage on the label
• Hold the medication cup at eye level and fill to and blurring it.
52
the desired amount To ensure the correct amount

• Before capping the bottle, wipe the lid with
Disposable paper towel.
8. Give patient the medication and water.
9. Stay with the patient until the medication has been Ensure patient take medication
swallowed. completely.
10. Make the patient comfortable
11. Discard used items
12. Wash hands Self-protection from cross

infection.
13. Documentation Ensure right documentation.
53
16.0 WOUND DRESSING
16.1 Definition
Procedure that promotes a moist wound environment to stimulate rapid wound healing.
Purpose:
Prevent infection
Prevent injury
Prevent bleeding via pressure
Encourage wound healing
Provide patient comfort, reduce pain
Requirement:
Trolley with:
- Top shelf : Sterile dressing set
Sterile gloves (optional)
- Bottom shelf : Tray (Plaster, Scissors, Sterile gauze, Swab, Mask)
Normal Saline / Water for Irrigation (WFI)
Incopad (optional)
Receiver/Kidney dish
Crepe bandage/ roller bandage
16.2 Procedure:
No Action Rationale
1 Verify doctor’s order. Confirm the type of dressing needed.
2 Greet patient and explain procedure. Allay anxiety and get patient’s
cooperation.
3 Wash hand and wear mask. Minimize microorganism transmission.
4 Prepare dressing trolley and push it to Facilitate procedure.

patient’s bed side.
5 Provide privacy. Protect patient’s self-image.
6 Position patient as required. Facilitate procedure.

Place incopad under the wound if necessary. Prevent soiling of linen.
7 Perform quick wound assessment for Detect signs of infection.

erythema, edema or discharge.
8 Wash hand effectively. Minimize microorganism transmission for

Open sterile dressing set, arrange forceps etc., sterile procedure
pour in solution, prepare biohazard bag.
54
9 Wash hand effectively again. Wear sterile Practice surgical asepsis

gloves (If necessary). Maintain sterility.
10 Prepare cotton swabs and dressing as ordered. Ensure smooth performance of procedure.
11 Remove dirty dressing, Discard dressing and Dispose soiled items.

forceps into biohazard bag.
12 Place sterile sheet near the wound. Provide sterile field for dressing procedure.
13 Clean wound with prepared swabs Prevent wound contamination from

- Clean wound: Clean to Dirty surrounding area.
- Clean area around wound
14 Observe wound for abnormalities. Appropriate measures can be taken.
15 Apply the prescribed dressing, secure it with Protect wound & keep dressing intact.
micropore.
16 Leave patient comfortable. Promote sense of well being
17 Discard soiled dressings.
18 Clean & clear trolley. Ensure re-usability.

Perform hand washing. Minimize microorganism transmission.
19 Document & report wound condition Document on wound progress

- Type of dressing done Inform nursing team of patient’s progress
- Any abnormalities noted
Dressing Tray
Sterile field
Cotton
ball/Swab
Gauze Sterile forceps
55
Cleaning round wound

using circular motion.
Cotton
ball/Swab
Cleaning
long/incised wound
in vertical direction
16.2 Principle of Aseptic Technique:
 Avoid crossing the sterile instruments

 Avoid area from getting wet
 Expose wound minimally after cleaning and apply dressing as soon as possible
 Use one swab for each wipe
 Clean from inner layer to outer layer (clean to dirty) unless inner layer is dirtier
compared to outer layer.
 Touch sterile instruments only with sterile forceps
 Use only proper sealed dressing pack
 2.5cm/1 inch of sterile sheet margin is not consider as sterile
 Non-sterile items should never come in contact with sterile items
 Open the pack in such a way the item will fall in the middle of sterile field untouched in
the event of adding on extra items
 Anything below your waistline and above and ear level are considered not sterile.
 Never ever turn your back to the sterile field.
 Distance between the nurse and trolley should not be less than 15cm.
56
17.0 BANDAGING
17.1 Purpose:
1. To stop bleeding by applying pressure
2. To protect wound from external environment
3. To promote wound healing
17.2 Principle of bandaging:

1. Tie the knots on the unaffected side if indicated.
2. Roller bandage must always cover 2/3 of the previous layer when doing
bandaging.
3. Always roll from inwards to outwards.
4. Bandage should be applied firmly and fastened securely
5. Bandage should never be applied directly on the wound unless covered by a
medium (e.g. Gauze)
6. Bandage should not be applied too tightly that it may disrupt the blood circulation
nor too loosely that it allows to slip
7. Always fasten a triangular bandage with reef knot and safety pin/micropore for
roller bandage.
17.3 Types of Bandages
Crepe Roller Bandage Triangular Bandage
57
17.4 Types of bandaging method
Figure of eight
Bandaging
Spiral Bandage
Reverse Spiral
Bandage
Stump Bandaging
58
17.5 Neurovascular Assessment in Bandaging

Definition
It is an assessment for identifying early sign of tight bandaging and to prevent
Compartment Syndrome
How to Assess:
1. Colour – Observe the colour of the limb where bandage is applied. Eg. Pink
(good circulation), pale (poor circulation) or cyanosis (bad circulation).
2. Temperature – Assess for temperature of the part. Eg. Cold (Poor circulation) or
warm (Good circulation)
3. Pulse – Assess for presence of proximal pulse, usually appear absent if bandaging
is too tight causing poor circulation. Eg. Popliteal pulse, Posterior tibia pulse,
Dorsalis pedis pulse and etc.
4. CRT (Capillary Refill Time) – Assess the refill time of the nearby region. Eg.
<3s (If more than 3s, you should suspect the bandaging too tight)
5. Sensation – Assess patient’s sensation to touch or any numbness noted
(Numbness indicates tight bandaging causing poor blood flow).
6. Movement – Instruct patient to move the bandaged limb whether or not
restricting/tight. Loosen if necessary.
Please note that diabetic patient who is suffering from diabetic neuropathy may not be
having same assessment outcome as non-diabetic patient. Prompt observation should
always be performed to prevent development of Compartment Syndrome.
59
Notes
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SJAM/SDE/HOME NURSING MANUAL 01/JAN/2016

1.0 INTRODUCTION OF NURSING

Virginia Henderson’s Model : Human Needs Theory (1957)

14 Activities of Daily Living

1.2 Definition of Home Nursing

3. Nursing in the family means, to see to the sick person in totality:

2.0 BED MAKING

2. Good body mechanics

2. Side to side method

3. Top to bottom method

2.2 Simple Bed Making

2 Explain procedure to patient To get co-operation from

5 Remove soiled linen and place it in a pail.

6 Clean the mattress with a cloth and kidney dish.

7 Push mattress to the head of the bed. Centre the

8 Place clean bed sheet on mattress. Place the center

9 Open up the bed sheet side by side.

11 Miter the corners of the bed sheet at the head of the

12 Tuck the remaining end of the bottom sheet well

13 Fold blanket into quarters and place on mattress at

15 Change pillow case.

16 Re-place pillow onto bed by the opening of pillow

17 Tidy up unit and wash hand To avoid cross infection

2.3 Side to Side Bed Making

2 Explain procedure to patient To get co-operation from

7 Place clean bed sheet to the middle of the mattress

8 Roll half of the bed sheet to the middle of mattress

10 Place clean linen protector with its center fold in the

11 Turn patient over slowly

13 Unroll bed sheet and tuck under mattress

14 Unroll linen protector

15 Miter all corners

16 Change pillow case and place under patient’s head and

17 Replace blanket, miter the corners To make it neat

18 Make patient comfortable To provide comfortable place

19 Tidy up unit and wash hand To avoid cross infection

2.4 Top to Bottom Bed Making

2 Explain procedure to patient To get co-operation from

5 Remove blanket and extra pillows from patient’s bed.

10 Ask patient lift the buttock (by pressing both hands on

12 Complete bed making To make it neat and tidy

13 Make patient comfortable To make patient comfortable

3.0 BODY MECHANICS

3.3 Principle of Body Mechanics

(D) Semi prone

4.2 Pressure points

4.3 Sit patient up in the bed

2. Lock the wheel of the bed. Ensure safety.

5. Inform patient you will lift her up after the count

4.4 Sit patient up at the side of the bed

2. Lock the wheel of the bed. Ensure safety.

4. One hand hold across the patient’s arm and

5. Sit the patient up in the bed by facing the

8. Support patient’s shoulder and legs.

9. Pivot and bring patient’s leg down beside

4.5 Lifting patient from bed to chair

2. Lock the wheel of the bed. Ensure safety.

3. Place chair at the head of bed parallel to

4. Sit patient up at the edge of the bed.

7. Put one of your legs in between her legs.

8. Instruct patient to stand up in the count of

10. Pivot patient to the front of the chair.

13. Make patient comfortable.