Chapter 3. Safe Patient Handling, Positioning, and Transfers
Positioning a patient in bed is important for maintaining alignment and for preventing bed sores (pressure ulcers), foot drop, and contractures (Perry et al., 2014). Proper positioning is also vital for providing comfort for patients who are bedridden or have decreased mobility related to a medical condition or treatment. When positioning a patient in bed, supportive devices such as pillows, rolls, and blankets, along with repositioning, can aid in providing comfort and safety (Perry et al., 2014).
Patient Positions in Bed
Positioning a patient in bed is a common procedure in the hospital. There are various positions possible for patients in bed, whichmay be determined by their condition, preference, or treatment related to an illness. Table 3.6 lists patient positions in bed.
|Supine position||Patient lies flat on back. Additional supportive devices may be added for comfort.|
|Prone position||Patient lies on stomach with head turned to the side.|
|Lateral position||Patient lies on the side of the body with the top leg over the bottom leg. This position helps relieve pressure on the coccyx.|
|Sims position||Patient lies between supine and prone with legs flexed in front of the patient. Arms should be comfortably placed beside the patient, not underneath.|
|Fowler’s position||Patient’s head of bed is placed at a 45-degree angle. Hips may or may not be flexed. This is a common position to provide patient comfort and care.|
|Semi-Fowler’s position||Patient’s head of bed is placed at a 30-degree angle. This position is used for patients who have cardiac or respiratory conditions, and for patients with a nasogastric tube.|
|Orthopneic ortripod position||Patient sits at the side of the bed with head resting on an over-bed table on top of several pillows. This position is used for patients with breathing difficulties.|
|Trendelenburg position||Place the head of the bed lower than the feet. This position is used in situations such as hypotension and medical emergencies. It helps promote venous return to major organs such as the head and heart.|
|Data source: ATI, 2015a; Perry et al., 2014; Potter et al., 2011|
Moving a Patient up in Bed
When moving a patient in bed, perform a patient risk assessment prior to the procedure to determine the level of assistance needed for optimal patient care. If a patient is unable to assist with repositioning in bed, follow agency policy regarding “no patient lifts” and the use of mechanical lifts for complex and bariatric patients. See Checklist 25 for the steps to move a patient up in bed.
Watch these three videos for more information about how to move a patient up in bed.
Take this Repositioning a Patient in Bed, Caregivers at Head course to learn how to move a patient up in bed, with caregivers at the head of the bed.
Take this Repositioning a Patient in Bed, Caregivers Facing Each Other course to learn how to move a patient up in bed, with the caregivers facing each other.
Take this Repositioning a Patient in Bed, Diagonal Technique course to learn how to move a patient up in bed, with the caregivers standing positioned diagonally.
Positioning a Patient to the Side of the Bed
Prior to ambulating, repositioning, or transferring a patient from one surface to another (e.g., a stretcher to a bed), it may be necessary to move the patient to the side of the bed to avoid straining or excessive reaching by the health care provider. Positioning the patient to the side of the bed also allows the health care provider to have the patient as close as possible to the health care provider’s centre of gravity for optimal balance during patient handling. Checklist 26 describes how to safely move a patient to the side of the bed.
Take this Repositioning a Patient to One Side of the Bed course to learn how to position a patient to one side of the bed.
- Name five body mechanic principles that should be used when moving a patient up in bed.
- A health care provider completes a risk assessment for a patient and determines the patient is unable to assist with repositioning. What should the health care provider do next?
- Your patient is experiencing shortness of breath related to heart failure. Which position in bed is best for this condition?