Safe Patient Handling
Assisting with Positioning a Patient in Bed
Select a Skill:
- » Assisting with Moving a Patient in Bed
- » Assisting with Positioning a Patient in Bed
- » Transferring from a Bed to a Wheelchair Using a Transfer Belt
- » Transferring from a Bed to a Stretcher
- » Performing Passive Range-of-Motion Exercises
- » Applying Elastic Stockings
- » Assisting with Ambulation Using a Gait Belt
- » Using a Sequential Compression Device
- » Using a Hydraulic Lift
Take the Review Test:
Safety
For your safety when moving a patient:
- Outline any special safety precautions to be followed.
- Raise the level of the bed to a comfortable working height.
- Keep back, neck, pelvis, and feet aligned, and avoid twisting.
- Tighten the stomach muscles, and tuck the pelvis to protect your back.
- Bend at the knees, and let the strong muscles of the legs do the lifting.
- The person with the heaviest load coordinates the efforts of the personnel involved in transferring.
For patient safety when positioning:
- Verify the patient’s range of motion (ROM).
- Obtain additional help as needed for positioning a patient.
- Verify the health care provider’s order for position changes. Some positions may be contraindicated in certain situations such as spinal cord injury, hip fracture, respiratory difficulties, certain neurological conditions, or presence of incisions, drains, or tubing.
- Keep the patient's neck and spinal column in alignment to prevent further injury.
- Before flattening the bed, account for all tubing, drains, and equipment to avoid dislodgment and spills.
- Increase the frequency of positioning the patient if the patient reports discomfort.
- Supervise and aid assistive personnel when positioning a patient in bed who is unable to assist with the movement.
- Explain what to report back to the nurse.
Equipment
(Roll cursor over items to see labels)
Pillows
Drawsheet
Bath towels/washcloths
Trochanter rolls (optional)
PrintableDelegation
The skill of positioning patients in bed and maintaining correct body alignment can be delegated to nursing assistive personnel (NAP). Be sure to inform NAP of the following:
- Explain any positioning restrictions, such as avoiding the prone position if the patient has weakness on one side of the body.
- Designate specific times throughout the shift at which NAP must reposition the patient.
- Provide information regarding the patient’s individual needs for body alignment, for example, if the patient has a spinal cord injury.
Preparation
- Assess the patient’s range of motion (ROM), body alignment, and comfort level while the patient is lying down.
- Assess for risk factors that contribute to complications of immobility, such as decreased sensation, impaired mobility, impaired circulation, and very young or older adult age.
- Assess the patient’s level of consciousness.
- Assess the condition of the patient’s skin, especially over bony prominences.
- Assess the patient’s physical ability to help with positioning, which may be affected by age, level of consciousness, disease process, strength, ROM, and coordination.
- Assess for the presence of tubes, incisions, and equipment, such as traction.
- Assess the motivation of the patient and the ability of family caregivers to participate in positioning.
- Check the physician’s or health care provider’s orders before positioning the patient.
- Raise the level of the bed to a comfortable working height.
- Remove all pillows and devices used in the previous position.
- Get extra help as needed.
- Explain the procedure to the patient.
Follow-up
- Assess the patient’s body alignment, position, and level of comfort. The patient’s body should be supported by an adequate mattress, and the vertebral column should be without observable curves.
- Measure the patient's range of motion (ROM).
- Observe for areas of erythema or breakdown involving the skin.
Documentation
- Record the procedure and observations such as the condition of the skin, joint movement, and the patient’s ability to assist with positioning.
- Report your observations at change of shift and document.
- Record time and position changes of the patient throughout the shift.
Review Questions
1. When positioning a hemiplegic patient in the supported Fowler’s position, what is the primary reason a trochanter roll is placed alongside the patient’s legs?
To reduce the risk of a fall while the side rails are down
To reduce the risk of contracture- To control pain
- To cushion the legs
INCORRECT. The placement of a trochanter roll alongside the patient's legs will not reduce the risk of a fall while the side rails are down. The side rails must be raised to prevent the patient from falling.
CORRECT. A trochanter roll is placed alongside the patient’s legs to prevent external rotation of the hips, which contributes to contracture.
INCORRECT. Although a trochanter roll placed alongside the patient’s legs may assist to control pain, the primary reason a trochanter roll is placed alongside of the patient's legs is to prevent external rotation of the hips, which contributes to contracture.
INCORRECT. A trochanter roll placed alongside the patient’s legs may provide cushioning to the legs; however, the primary reason a trochanter roll is placed alongside of the patient's legs is to prevent external rotation of the hips, which contributes to contracture.
2. To which position would the nurse assist the patient who is experiencing difficulty breathing?
INCORRECT. A Sims' position or semiprone position requires the head of the bed to be lowered and the patient is positioned towards the abdomen. The position would not facilitate maximal breathing space and respirations would be difficult for the patient.
INCORRECT. The 30-degree lateral or side-lying position requires the head of the bed to be lowered completely or as low as the patient can tolerate. The patient is positioned on the side. Lying on the side will not promote maximal breathing space and respirations would be difficult for the patient.
CORRECT. In the Fowler's position the head of the bed is elevated and maximal breathing space in the thoracic cavity is promoted. Fowler's is the position of choice for a patient having breathing difficulties.
INCORRECT. In the prone position, the patient is positioned flat and on the abdomen. Lying flat on the abdomen would not facilitate respirations and is a difficult position for the patient to maintain.
3. When repositioning a patient, what can the nurse do to prevent the patient’s hips from rolling outward?
- Apply therapeutic boots to the feet.
- Place sandbags along the legs.
- Place a small pillow at the lumbar region of the back.
- Place a pillow under the calves.
INCORRECT. Therapeutic boots will not prevent the hips from rolling outward.
CORRECT. Placing sandbags along the legs will prevent the hips from rolling outward.
INCORRECT. A small pillow at the lumbar region of the back will not prevent the hips from rolling outward.
INCORRECT. A pillow under the calves will not prevent the hips from rolling outward.
4. The nurse is preparing to move a patient with hemiplegia into the prone position. What action should the nurse take when rolling the patient onto her side?
- Place a small pillow under the shoulder.
- Use the affected arm as a guide during rolling.
- Place a pillow on the abdomen.
- Place rolled bath blankets along the dependent leg.
INCORRECT. Placing a small pillow under the shoulder will not help when rolling a patient with hemiplegia onto her side while moving into the prone position.
INCORRECT. The nurse should not use the affected arm as a guide when rolling a patient with hemiplegia onto her side while moving into the prone position.
CORRECT. When rolling a patient with hemiplegia onto her side while moving into the prone position, the nurse should place a pillow on the patient’s abdomen.
INCORRECT. The nurse should not place rolled bath blankets along the dependent leg when rolling the hemiplegic patient onto her side while moving into the prone position.
5. The nurse is preparing to logroll a patient in bed. Why are two assistants needed on the side toward which the patient is being turned?
- To position the pillows
- To keep the spine in alignment
- To roll the patient as a unit
- To ease the patient back onto the support pillows
INCORRECT. The pillows are positioned by the nurse who is standing on the side from which the patient was turned.
INCORRECT. Two assistants are not needed to keep the patient’s spine straight while logrolling a patient.
CORRECT. Two assistants are needed to roll the patient as a unit, using one smooth, continuous motion. One assistant grasps the draw sheet at the lower hips and thighs, and the other assistant grasps the draw sheet at the patient’s shoulders and lower back.
INCORRECT. When logrolling, two assistants are not needed to ease the patient back onto the support pillows.
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