TRINITY VALLEY COMMUNITY COLLEGE

ASSOCIATE DEGREE NURSING

RNSG 1216

PROCEDURE GUIDE AND CHECK-OFF SHEET

POSITIONING

Changing the patient’s position in bed helps maintain maximal function of the joints, stimulates circulation, maximizes respiratory function, and prevents skin breakdown. Caution should be taken when positioning patients in order, to prevent injury by utilizing good body mechanics. Additional assistance should be used.

Delegation: This procedure may be delegated to unlicensed assistive personnel with proper training. An assessment of the patient’s ability to move by a nurse should be completed prior to delegation.

Procedure /
Scientific Rationale
/
1.  The following equipment is needed for this skill:
a.  pillows
b.  turning or draw sheet.
2. TURNING A PATIENT IN BED WITH MINIMAL ASSISTANCE:
a.  Lock bed’s wheels.
b.  Assess patient’s condition.
c.  Lower head of bed. Raise bed to comfortable working height.
d.  Move patient to one side of bed by sliding your arms under patient’s shoulders and back, moving patient’s body to one side of bed.
e.  Slide your arms under patient’s hips and pull hips to side of bed. Then move patient’s feet and legs to side of bed.
f.  Patient’s arms should be crossed on the chest and the legs at the ankles.
g.  Roll patient towards you by placing one hand on patient’s shoulder and the other hand on the patient’s hips.
h. Turn patient forward so that you can release one hand and position a pillow behind the patient’s back as needed.
i. A turning or draw sheet may be used if positioning requires additional personnel. / a. Prevents bed from moving.
b. Determines how much assistance is needed.
c. Avoids moving against gravity and helps reduce back strain.
d. Allows room to turn patient to the opposite side.
f. Helps body turn as an unit.
g. Pulling is easier than pushing.
i. A turning or draw sheet extends from the patient’s shoulders to below the hips. Assists in pulling the patient’s hips and shoulders in the direction of the turn.
3. MOVING A PATIENT UP IN BED WITH MINIMAL ASSISTANCE:
a.  Have patient bend knees and place feet flat on the bed.
b.  Place one hand under patient’s back and one hand under the thighs.
c.  Ask patient to push with legs on a count of three. Slide patient toward the head of bed.
d.  A trapeze bar attached over the bed, can be used if patient has good upper body strength and patient can lift body with minimal assistance.
f. A turning or draw sheet may be used if additional personnel is needed. / a. Assists in pushing.
c. Coordinates work effort.
f. Assists in sliding patient’s torso up in the bed.
4. LATERAL/SIDE-LYING:
The patient is placed on the side where the trunk is at a right angle to the bed. One or more legs are bent, and both arms extended in front of the body.
5. SEMIPRONE/SIMS:
The trunk is rotated 15-30 degrees forward from the lateral position. The superior arm and leg supported in front of the body. / Patient is usually positioned on the left side for certain procedures.
6. SUPINE:
The body is in a horizontal position with the patient on their back.
7. HIGH-FOWLERS:
The body is in a sitting position with the head of the bed elevated to 90 degrees.
8. SEMI-FOWLERS:
The body is in a sitting position with the head of the bed elevated to 45 degrees.
9. LOW-FOWLERS:
The body is in a sitting position with the head of the bed elevated to about 30 degrees. Patient’s knees are usually slightly bent.
10. PRONE:
The patient is on abdomen with the face turned to the side and one or both arms turned up. / This position is seldom used due to possible complications (back).
11. Change patient’s position every 2 hours if patient is unable to do so. / Prevents skin breakdown, stimulates circulation, and promotes comfort.
12. Make sure patient is in proper body alignment and that all joints are in a functional position. Make sure all joints are supported when moving the patient. (Positioning devices: pillows, trochanter rolls, footboards, hands rolls, heel protectors should be used.) / Prevents skin breakdown, stimulates circulation, prevents foot drop, and promotes comfort.
13. Document position assumed and patient’s tolerance of procedure. / All data must be entered in patient’s record. Helps maintain continuity of care.

N:ADN/ADN Syllabus/CBC Curriculum/Level I/1216/Performance Checklist for Basic Skills - Positioning Reviewed 04/16

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