In what position will the nurse place the patient to move him or her up in the bed?

Avoiding Injury

You must move or pull someone up in bed the right way to avoid injuring the patient's shoulders and skin. Using the right method will also help protect your back.

It takes at least 2 people to safely move a patient up in bed.

Friction from rubbing can scrape or tear the person's skin. Common areas at risk for friction are the shoulders, back, buttocks, elbows, and heels.

Never move patients up by grabbing them under their arms and pulling. This can injure their shoulders.

Preparing to Move the Patient

A slide sheet is the best way to prevent friction. If you do not have one, you can make a draw sheet out of a bed sheet folded in half. Follow these steps to prepare the patient:

• Tell the patient what you are doing.
• If you can, raise the bed to a level that reduces the strain on your back.
• Make the bed flat.
• Roll the patient to one side, then place a half rolled-up slide sheet or draw sheet against the person's back.
• Roll the patient onto the sheet and spread the sheet out flat under the person.
• Make sure the head, shoulders, and hips are on the sheet.

Pulling up

The goal is to pull, not lift, the patient toward the head of the bed. The 2 people moving the patient should stand on opposite sides of the bed. To pull the person up both people should:

• Grab the slide sheet or draw sheet at the patient's upper back and hips on the side of the bed closest to you.
• Put one foot forward as you prepare to move the patient. Put your weight on your back leg.
• On the count of three, move the patient by shifting your weight to your front leg and pulling the sheet toward the head of the bed.
• You may need to do this more than once to get the person in the right position.

If using a slide sheet, make sure to remove it when you are done.

If the patient can help you, ask the patient to:

• Bring the chin up to the chest and bend the knees. The patient's heels should remain on the bed.
• Have the patient push with the heels while you pull up.

References

American Red Cross. Assisting with positioning and transferring. In: American Red Cross. American Red Cross Nurse Assistant Training Textbook. 4th ed. American National Red Cross; 2018:chap 11.

Craig M. Essentials of patient care for the sonographer. In: Hagen-Ansert S, ed. Textbook of Diagnostic Sonography. 8th ed. St Louis, MO: Elsevier; 2018:chap 2.

Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M. Body mechanics and positioning. In: Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M, eds. Clinical Nursing Skills: Basic to Advanced Skills. 9th ed. New York, NY: Pearson; 2017:chap 12.

Version Info

Last reviewed on: 10/23/2021

Reviewed by: Jennifer K. Mannheim, ARNP, Medical Staff, Department of Psychiatry and Behavioral Health, Seattle Children's Hospital, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Patient positioning involves properly maintaining a patient’s neutral body alignment by preventing hyperextension and extreme lateral rotation to prevent complications of immobility and injury. When positioning a patient in bed, supportive devices such as pillows, rolls, and blankets, along with repositioning, can aid in providing comfort and safety.

Patient Positions in Medical Bed

Positioning a patient in a medical bed is a common procedure in the hospital. There are various positions possible for patients in bed, which may be determined by their condition, preference, or treatment related to an illness.

1. Supine position

In supine position, patient lies flat on back,legs may be extended or slightly bent with arms up or down. Additional support devices may be added for comfort. The supine position is commonly used for general examination or physical assessment.

2. Prone position

In prone position, patient lies on stomach with head turned to the side and the hips are not flexed. To support a patient lying in prone, place a small pillow under the head and a pillow under the legs.The prone position is used in medical settings to help patients with certain conditions and symptoms get relief.

3. Lateral position

The patient lies on the side of the body with the top leg over the bottom leg and the hip and knee flexed. This position helps relieve pressure on the coccyx. Support pillows are needed to correctly position the patient in a lateral position.

4. Sims position

The patient lies between lateral and prone with legs flexed in front of the patient. The lower arm is positioned behind the client, and the upper arm is flexed at the shoulder and the elbow. This position is usually used for rectal examination, treatments, enemas, and examining women for vaginal wall prolapse.

5. Fowler's position

Fowler's position is a standard patient position in which the patient is seated in a semi-sitting position (30-90 degrees) and may have knees either bent or straight. This is a common position to provide patient comfort and care.

There are several Fowler's  positions :

* Low Fowler's position: head of the bed raised 15-30 degrees. This position can be used post-procedure, to reduce lower back pain, administer drugs and prevent aspiration during tube feeding.

* Semi Fowler's position: head of the bed raised 30-45 degrees. Semi Fowler’s Position can be used when the patient faces difficulty breathing or is undergoing breathing treatments and when drainage occurs after an abdominoplasty.

* High Fowler's position (Full Fowler's position): head of the bed raised between 60 and 90 degrees. High Fowler's position is usually prescribed to elderly patients as it is scientifically proven to aid in the digestion process and help the patient overcome breathing problems.

6.Trendelenburg position

Place the head of the bed lower than the feet. The patient's arms should be tucked at their sides. This position is used in situations such as hypotension and medical emergencies. It helps promote a venous return to major organs such as the head and heart.

7.Reverse Trendelenburg Position

Place the head of the bed higher than the feet. It is the opposite of Trendelenburg's position. Reverse Trendelenburg is often used for patients with gastrointestinal problems as it helps minimize esophageal reflux.

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References

1. https://nurseslabs.com/patient-positioning/

2. https://nurse.plus/nclex-terminology/terms-abbreviations/fowlers-position/

3. https://healthjade.net/fowlers-position/

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