These learning notes about nursing positions are for nursing students and can be used in the home, community and the hospital settings with minor modifications to suit the patient's individual condition and need. Patients who cannot move themselves must be moved two to four hourly, again depending on the patient's condition. This is to prevent skin breakdown (formation of pressure sores / decubitus ulcers).
Bed sores or pressure sores have been given names. These include decubitus sore, pressure ulcer, bedsore, ischial tuberosity ulcer, bed rest injury, bedrest injury, chronic ulceration, pressure ulceration, decubitus ulceration. All these terms mean about the same thing – patient injury while lying helpless in bed.
Picture 1. Shows a conscious client sitting up comfortably. This type of sitting facility is not suitable for the paralyzed or unconscious patient.
Most institutions have a “no lift policy” so please use the slippery slide sheet or a pat slide for the appropriate movement of a patient. For moving non-weight bearing patients out of bed you must use a hoist. Please check that the hoist's safe working load is appropriate. No employer will be responsible for any injury to you or any other employee if you did not follow the institution's policies and procedures.
When positioning a patient it is helpful to be able to focus on key parts. The key parts are the skin, head and neck, arms and shoulders, hips, buttocks, knees and extremities. For the acutely ill patient position should be comfortable and safe. If you, are working in the Operating Theatre you will also need to consider accessibility to the area to be operated on.
Picture 2: Lifting and moving patients up the bed was standard of care then. Now it is disallowed in most facilities.
Skin . All nurses caring for patients must examine the skin of all patients, even healthy ones, and help patients prevent injury. Pressure sores cost the health service billions of dollars. Lesions, bruises, pressure, friction and dry skin lead to many skin problems.
Head and neck . Pillows and head rests should be used strategically. Use “donoughts” if the patient is in the the supine or Trendeleberg position to protect bony prominences on the back of the head.
When a patient is in bed, evaluate the patients' pressure areas. Check the eyes, ears, and nose. Ensure that these areas aren't being pinched or obstructed. In female patients, insure that their hair is placed properly, make sure they aren't wearing hair clips or twists.
Arms and shoulders . The general guideline is to keep the arms at a 90 degree angle to the rest of the body. Some studies suggest that you should never have abduction greater than 60 degrees. These suggest that if you abduct more than 60 degrees you can cause brachial plexus injuries. There are times when you may have to move the patient's arms to 90 degrees, but as a practical rule, the less severe the angle, the better off the patient will be.
Pad arms and legs for safety and comfort. Do not allow the arms, shoulders or legs to hang over the edge of the bed.
Hips . The key goal to remember with hip placement, whether the patient is in a vertical, prone, Trendelenburg or reverse Trendelenburg position, is to maintain proper alignment. During orthopaedic procedures, the hips are prone to lumbar plexus damage if they are put under excessive strain. Keeping the hips aligned takes a lot of pressure off both the lower back and the hip joints themselves. When caring for patients please do the following:
Always lift both the patient's legs together, rather than one at a time.
Always use hip supports so that the hips do not flex, this is particularly important when the patient is in the operating theatre.
Always insure that the clients legs are straight and are not twisted in some uncomfortable position.
Use positioning aids wherever possible. A nurse is the patient's advocate. You may need to initiate action to get positioning devices.
Buttocks . In many instances buttocks bear most of the weight of the body, they remain in contact with bed sheet and the buttocks are the first indicators of poor quality of nursing care; this can cause pressure sores and other complications. Avoid this by placing padding underneath the buttocks and frequent turning.
Knees and lower extremities . Always keep the client's knees flexed wherever possible. Surgical socks, soft bolsters, pillows can be helpful for maintaining circulation and reduce pressure on the lower extremities.
SUPINE POSITION
This is ordinarily called lying on back, flat with a pillow under the head. The position of the patient should be in the middle of the bed, about three inches below the head of the bed.
The pillow under the patient's head should extend about two inches below the patient's shoulders, with the head in the middle of the pillow.
