Positioning Patients in Bed
Problems of contractures and deformities can often be prevented by proper positioning of the patient. Regardless of the position selected it is essential that the patient maintains a correct body alignment while in bed and it is very important for the nurse to evaluate patient position during each contact throughout the shift. To achieve proper body positioning and alignment, it is imperative for the nurse to suggest and assist ways and methods of preventing deformities and contractures.
The most common positions that a patient assumes in bed are the following:
- Supine: dorsal
- Side-lying: lateral
- Prone: on abdomen
Nursing Responsibilities of the Nurse in Patient Positioning:
- Help the patient assume the desired or required bed position. The nurse assists the patient to achieve proper body positioning and alignment.
- Support patient’s body in correct alignment using pillows or splints.
- Assure the proper use of supportive devices.
- Frequently monitor and evaluate the position selected.
- Provide skin care.
- The head should be positioned in line with the spine. Patient’s head should be about 2 to 3 inches from the head of the bed. A pillow should be placed under the patient’s head. It should be extended about two inches below the patient’s pillow while maintaining the head in line with the spine.
- Hip flexion should be minimized by positioning the trunk well. To do so, a trochanter roll can be placed along the greater trochanter of affected hip or along both hips to prevent external rotation if the patient has little control over the legs. Trochanter roll is a supportive device that can be bought or can be manually devised by simply rolling a bath blanket to a rolled shaped with a length of about 12 to 14 inches. It is essential to keep in mind that trochanter rolls should be long enough to reach the areas above the hip and above the knee from each edge. With the use of this supportive device, external hip rotation is prevented.
- Flex the arms of the patient at the elbow and let the hands rest against the lateral side of the abdomen.
- Legs are extended with a small and firm support under the popliteal area. Pillows can be used in these instances.
- To prevent footdrop and if care plan indicates, the toes should be pointed straight up and supported by a foot board. If foot board is not available for use, placing a folded pillow to support the patient’s feet will produce the same effect. The ankles should be at 90 degree angle.
- Laterally turn the head to either side. Keep in mind that the head should be in alignment with the rest of the body. The spines should be straight and the legs extended.
- Abduct the arms and position it externally rotated at the shoulder joint. Elbows can be flexed or extended, depending on the patient’s preference for his or her comfort. Pillows can be placed under the arms.
- To reduce pressure against female breast’s a rolled towed can be placed under the shoulder or a small pillow can be placed under the abdomen. This method also relieves pressure on the back.
- A small flat support is placed under the pelvis. The length of this support should extend from the level of the umbilicus to the upper third of the thigh.
- Lower extremities should be maintained at a neutral position.
- The toes are suspended over the edge of the mattress.
- The head should be positioned in line with the spine. Support the patient’s head with a pillow.
- Make sure that body alignment is correct – spines are straight, and not twisted.
- Flex the shoulders and the elbow and support the upper arm with a pillow. If right lateral position is desired right shoulder and elbow should be flexed while the palm is positioned facing up. The left arm is slightly flexed and supported with a pillow.
- Slightly forward the uppermost hip joint and slightly abduct the leg by supporting it with a pillow. The hip, knee and ankle of the patient should be at approximately the same height.
- To help maintain or support the position, a pillow may be place behind the patient or at his or her back.
- The feet should be placed and supported in neutral dorsiflexion.