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Positioning Clients

Adapted from DepositPhotos.com
Adapted from DepositPhotos.com

 

Not all clients can independently move nor position themselves in bed. Immobility may be due to factors like growth development, health status, nutrition, personal values and attitudes, and excessive humidity.

Positioning a client in good body alignment and changing position regularly are essential aspects of nursing practice. It is essential to provide meticulous care to a client who must remain in bed. Healthcare givers’ measures should ensure to preserve the joints, bones and skeletal muscles and must be carried out for all clients who require bed rest. Positions in which clients are placed, methods of moving and turning should all be based on the principles of maintaining the musculoskeletal system in proper alignment. The health care provider must also use good body mechanics when moving and turning clients to preserve his or her own musculoskeletal system from injury.

Why is it important?

  • Promote comfort
  • Restore body function
  • Prevent deformities and muscle strain
  • Stimulate proper respiration and circulation
  • Administer treatments or perform examinations
  • Provide hygiene, bed bath or sponge bath
  • Assess skin conditions
  • Assess wounds/dressings
  • Change linens
  • Obtain specimen

Considerations before positioning a client    

  • Follow/carry out Physician’s orders meticulously
  • Perform hand hygiene
  • Identity client and introduce yourself
  • Explain to the client the need for moving or positioning him/her
  • Explain to the client the need for employing equipment/devices
  • Provide privacy; properly drape the client
  • Assess skin condition of  the client
  • Gerontologic considerations (Muscle atrophy, limited mobility level, kyphosis, bone changes, osteoporosis, osteoarthritis)

 

Body Mechanics

The process of using alignment, posture and balance in a synchronized manner to perform tasks such as moving, bending and lifting.

  • Assume a proper stance before moving or positioning clients.
  • Establish a comfortable height. Keep the client as close as possible to your body.
  • Push and pull objects when moving them to conserve energy. Avoid leaning and stretching.
  • Use the large muscles for lifting and moving, not the back muscles. Maintain low back in neutral position. Move the hip and shoulders as one unit. Avoid twisting your body.
  • To avoid strain, request assistance from other members of the health care team when handling equipment/devices while working with heavy clients.

Client Teaching

  • Teach the importance of passive or assistive range of motion (ROM) exercises to maintain joint mobility
  • Incorporated ADLs into exercise program if appropriate
  • Explain the need for schedule, frequency or duration of turning and moving him in bed
  • Offer an ambulation schedule
  • Discuss pain control measures required before positioning or moving the client
  • Teach the use of proper body mechanics especially for those times when assistive equipment is not used
  • Teach ways to prevent postural hypotension

Expected Outcomes

  • Client comfort is increased
  • Proper body mechanics are used when preparing for and providing client care. Center of gravity is maintained when lifting objects/equipment
  • Injuries are prevented to both the nurse and the client
  • Clients and nurses are not injured when nursing care is provided
  • Breathing is adequate
  • Joint movement is maintained
  • Skin remains intact without evidence of breakdown

Documentation

  1. Injury to client resulting from poor body mechanics
  2. Client’s acceptance and feelings about the procedure
  3. Time when client was moved, and the duration of administering the procedure
  4. Devices needed for positioning client
  5. Number of health care personnel required for turning and moving client
  6. Ways in which client assists in moving (Identify whether patient was Independent or dependent, or if Partial Assist was necessary)
  7. Special requirements of client for proper body alignment (e.g. support pillows)

Assistive Equipment/Devices useful when positioning clients

  • Pillows
  • Friction-reducing sheet (Lateral Assist)
  • Drawsheet (Trochanter roll)
  • Trapeze
  • Transfer board (polyethylene board) and gurney covered with sheets
  • Bath blanket
  • Gurney, bed or CT table
  • Gait belt
  • Electric beds
  • Powered stand-assist device
  • Powered full-body lift
  • Chair
  • Hoyer lift base
  • Canvas straps

Positions for Client Care

 

POSITIONS PLACEMENT RATIONALE
High-Fowler’s Head of bed 60° angle Thoracic surgery, severe respiratory conditions
Fowler’s Head of bed 45°-60° angle; hips may or may not be flexed Postoperative, gastrointestinal conditions, promote lung expansion
Semi-Fowler’s Head of bed 30° angle Cardiac, respiratory, neurosurgical conditions
Low-Fowler’s Head of bed 15° angle For ease of breathing, promote skin integrity, provide comfort
Knee-Gatch Lower section of bed (under knees) slightly bent Provide comfort
Trendelenburg Head of bed lowered and foot raised Percussion, vibration and drainage (PVD) procedure, promote venous return
Reverse Trendelenburg Bed frame is tilted up with foot of bed down Gastric conditions, prevent esophageal reflux
Orthopneic Client sits either in bed or on the side of the bed with an overbed table across the lap Facilitate respiration
Dorsal recumbent position Client’s head and shoulders are slightly elevated on a small pillow Provide comfort and facilitate healing following certain surgeries  or anesthetics
Prone position Client lies on the abdomen with the head turned to one side; hips not flexed. Prevent flexion contractures of the hips and knees; promote drainage from the mouth especially from unconscious clients recovering from surgery of the mouth or throat.
Lateral Client lies on one side of the body; top hip and knee flexed Provide comfort for clients with sensory or motor deficits on one side  the body.
Sim’s (Semi-prone) Client assumes a posture halfway between the lateral and prone positions; lower arm is positioned behind the client, upper arm is flexed at the shoulder and elbow. Facilitate drainage from the mouth and prevent aspiration of fluids, especially for unconscious or paralyzed clients.

Sources:

Adapted from Altman 3rd Ed. – Fundamentals and Advanced Nursing Skills

Adapted from Craven 7th Edition – Fundamentals of Nursing

Adapted from Perry & Potter 8th Ed.

Adapted from Berman 10th Edition – Kozier & Erb’s Fundamentals of Nursing

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