67. CCA Study Notes: Client Room Furniture, Beds, and Bed Positions

The Big Picture

A client’s room should support comfort, privacy, and safety. Furniture and equipment need safe placement, regular care, and correct use.

Beds need extra attention because their height, controls, wheels, rails, mattresses, and position affect client and worker safety. Different bed positions also have specific uses and rules.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

Client Room Furniture and Equipment

Client rooms contain furniture and equipment that support comfort, daily activities, privacy, and care. Safe placement and correct cleaning are important.

Overbed Tables

An overbed table can be moved over a bed and adjusted for someone in bed or sitting in a chair.

It can be used for:

• meal trays and eating
• reading and writing
• other activities
• a work surface for bedside procedures

Never: Put bedpans, urinals, or soiled linens on an overbed table.

Clean the table carefully after each use with the appropriate cleaning wipes. Follow facility policy.

Bedside Furniture

Hospitals and long-term care ⓘ facilities usually have bedside stands for personal items. Furniture in private homes varies.

No matter the setting, place bedside furniture safely out of the client’s pathway.

Chairs

Hospital rooms usually have one or two chairs. Long-term care clients may use chairs brought from home, while home care clients often have a favourite chair.

Keep chairs clean and free of food particles. Plump cushions regularly.

Privacy Curtains and Screens

Hospitals and long-term care facilities commonly use privacy curtains around the bed before care.

Privacy curtains:

• prevent other people from seeing the client
• do not block sound
• do not prevent conversations from being overheard

Portable privacy screens can be used in home care.

Closet and Drawer Space

Hospitals and long-term care facilities provide storage space for clothing.

In some provinces, legislation ⓘ states that long-term care clients must have easy access to the closet and its contents.

Bathrooms

Most facility bathrooms have:

• a sink
• a call bell
• a mirror
• a toilet with handrails

Some also have showers.

Some facilities use higher toilets. These can make movement to and from a wheelchair easier, especially for clients with joint problems.

Private home bathrooms often do not have elevated toilets or handrails. In home care, make sure the client’s bathroom is clean and safe.

The Client’s Bed

Comfort becomes especially important for a client who spends a lot of time in bed.

Many home care clients use regular beds. Pillows can help a client sit comfortably in a regular bed.

Hospital beds are used in hospitals, long-term care facilities, and some private homes.

Regular Beds

Private homes may contain many types of beds, including:

• twin, double, queen, and king beds
• waterbeds
• sofa sleepers
• cots
• recliners
• motorized or electrically adjusted beds

Clients receiving palliative care in the community often use hospital-type beds.

Regular Bed Height and Worker Safety

Regular beds cannot be raised.

A low bed makes you bend and reach more during care or bed-making. Use good body mechanics to protect your back.

Mattress Condition

A good mattress should be neither too hard nor too soft.

A poor-quality mattress may fail to give enough support or comfort and may harm the client’s back or skin. Report concerns about a client’s mattress to your supervisor.

Many clients who are thin or bedridden, or who need frequent repositioning, are prone to skin breakdown and pressure ulcers.

Alternating Pressure Mattresses

An alternating pressure mattress contains alternating areas of pressure created by air, gel, or water baffles. These changing pressure areas help reduce the risk of pressure sores.

Bed Linens and Pads

Too many layers of bed linen can reduce the mattress’s effectiveness.

Most manufacturers recommend that incontinence pads of any type not be used on these mattresses. Some manufacturers also recommend that a bottom sheet not be used.

An incontinence pad, also called an absorbent pad or soaker pad, is placed in the centre of the bed over the bottom sheet to protect the sheets from body fluids.

If a bottom sheet is allowed:

• do not tuck it under the mattress
• allow it to hang down at the sides

If the client needs repositioning, use a slider sheet or slider sheet system designed for this purpose.

An untucked bottom sheet can wrinkle beneath the client. Pull and straighten the sheet whenever the client is repositioned because wrinkles can create pressure areas under fragile skin.

Safety Checks

Check clients using an alternating pressure mattress frequently.

Clients have died after becoming wedged between an air mattress and the bed frame.

Bed rails can also injure a client using an alternating pressure mattress.

Follow the client’s care plan ⓘ for bed-rail use. Regularly monitor clients who have side rails.

Hospital Beds

Hospital beds use electrical or manual controls.

The entire bed can be raised horizontally during care. This reduces worker bending and reaching.

The lowest horizontal position:

• helps the client get out of bed more easily
• is required as a client safety measure

The head of the bed can remain flat or be raised to different levels for comfort.

Electric Bed Controls

Most hospital beds use electric controls. Controls may be located:

• on a side panel
• on a bed rail
• on a panel at the foot of the bed

Clients are taught how to use these controls safely. They are also told about the risks of leaving the bed high and about any limits on the positions they should use.

Many electric beds can be locked into a position. Locking prevents the client from raising or lowering the head or foot of the bed.

Some clients who must remain in certain positions may need their bed controls locked.

Be alert when bed controls are easy to reach for:

• children
• confused clients
• clients with impaired cognition
• clients with altered levels of consciousness

Follow the care plan and check with your supervisor.

Manual Bed Controls

Some facilities and homes still use manually operated hospital beds.

These beds have three cranks at the foot:

• Left crank: raises or lowers the head of the bed
• Right crank: adjusts the knee position
• Centre crank: raises or lowers the whole bed

Pull the cranks out and up to use them.

After use, push them in and turn them down. A crank left pointing upward is a safety hazard because someone walking past could bump into it.

Hospital Bed Height Safety

Hospital beds should always be left in their lowest position for client safety.

Raise a hospital bed only immediately before:

• giving care
• making the bed

Return the bed to its lowest position as soon as you finish.

Never: Leave the client alone while the bed is raised.

Bed Wheels

Hospital beds have wheels so they can be moved.

Keep the wheels locked at all times unless you are moving the bed to another location.

If you move a client in the bed within a facility, make sure the bed rails are up.

A moving bed during care or a transfer can injure the client or the worker.

Bed Rails

Many hospital beds have partial bed rails.

Bed rails have safety hazards and can act as a form of restraint. Raise or lower them only as directed by your supervisor and the care plan.

Basic Bed Positions

The main bed positions are:

• flat
• low Fowler’s
• semi-Fowler’s
• high Fowler’s
• Trendelenburg
• reverse Trendelenburg

Flat Position

The flat position is the usual sleeping position.

It is also used:

• after a spinal cord injury or surgery
• for cervical traction
• while providing care

Low Fowler’s Position

Low Fowler’s is a semi-sitting position.

The head of the bed is elevated 15 to 30 degrees. A backrest or pillow can also support the client.

Semi-Fowler’s Position

Semi-Fowler’s is another semi-sitting position.

The head of the bed is raised 30 to 45 degrees. A backrest or pillows can also support the client.

The knee portion of the bed may be raised to help stop the client from sliding downward. Raising the knee portion can interfere with leg circulation.

Check the care plan and your supervisor before placing a client in semi-Fowler’s position.

High Fowler’s Position

High Fowler’s is a semi-sitting position with the head of the bed elevated 45 to 90 degrees.

Clients are not often positioned above 60 degrees because that angle is too uncomfortable.

Clients who must eat in bed are placed in high Fowler’s position to reduce the risk of choking and aspiration.

After the meal, the client can be returned to semi-Fowler’s position.

Trendelenburg Position

In Trendelenburg position:

• the head of the bed is lowered
• the foot of the bed is raised

The position can be created by placing blocks under the legs at the foot of the bed or by tilting the entire bed frame.

Trendelenburg position requires a physician’s order. It is used for postural drainage.

Reverse Trendelenburg Position

Reverse Trendelenburg is the opposite position.

In reverse Trendelenburg:

• the head of the bed is raised
• the foot of the bed is lowered

Blocks can be placed under the legs at the head of the bed, or the entire bed frame can be tilted.

Reverse Trendelenburg requires a physician’s order. It is used to promote gastric emptying.

Fowler’s Positions in Regular Beds

Low Fowler’s and semi-Fowler’s positions can also be created in regular beds in the community.

Use a combination of backrests and pillows.

Check that the headboard is sturdy because it must support the client leaning against it.

Large, sturdy sofa pillows can be used when a backrest is unavailable.

Common Mix-Ups

Wrong Idea	Better Idea
Privacy curtains block both sight and sound.	They block the view, but conversations can still be heard.
A hospital bed can stay raised after care.	Return it to the lowest position as soon as care is finished.
Bed wheels stay unlocked for convenience.	Keep wheels locked unless the bed is being moved.
Low and semi-Fowler’s use the same elevation.	Low Fowler’s is 15 to 30 degrees. Semi-Fowler’s is 30 to 45 degrees.
High Fowler’s always means a full 90-degree angle.	The range is 45 to 90 degrees, but clients are not often placed above 60 degrees.
Trendelenburg and reverse Trendelenburg are the same position.	Trendelenburg lowers the head and raises the foot. Reverse Trendelenburg does the opposite.
Bed rails should be raised whenever they seem useful.	Raise or lower them only as directed by the supervisor and care plan.