POSITIONING OF PATIENTS

NURSING INDICATIONS:
The skill of moving and positioning patients in bed can be delegated to nursing assistive
personnel (NAP). The nurse is responsible for assessing the patient's level of comfort and for
any hazards of immobility. Instruct NAP about:
 Any moving and positioning imitations unique to patient.
 Individual needs for body alignment (e.g., patient with spinal cord injury).
 Scheduled times to reposition patient through the shift.
 When to request assistance (e.g., if the patient has a spinal cord injury, when the patient
is unable to assist the nurse, has a lot of equipment, or is confused).

EQUIPMENTS:
 Pillows
 Drawsheet
 Therapeutic boots, splints if needed
 Trochanter roll
 Hand rolls
 Side rails
 Appropriate safe patient-handling assistive device (e.g., friction-reducing device)

POSITIONING OF PATIENTS
PROCEDURE RATIONALE
1. Silently recite a prayer for the success To ensure that the procedure will be done
of the procedure. smoothly without error with the guidance of
the Lord.
2. Place patient in a Fowler’s position
2.1 Elevate head of bed 45 to 60 Increases comfort, improves ventilation and
degrees. increases patient’s opportunity to socialize or
relax.
2.2 Rest client’s head against Prevents flexion contractures of cervical
mattress or pillows vertebrae.
2.3 Use pillows to support client’s arm Prevents shoulder dislocation from effect of
and hands if client does not have downward pull of unsupported arms,
control of use of them. promotes circulation by preventing venous
pooling and flexion contractures of arms and
wrist.
3. Place client on a Semi-Fowler’s
position.
3.1 Elevate head of bed 15 to 45 Increases comfort, improves ventilation and
degrees. increases patient’s opportunity to socialize or
relax.
3.2 Rest client’s head against Prevents flexion contractures of cervical
mattress of pillows. vertebrae.
3.3 Use pillows to support client’s Prevents shoulder dislocation from effect of
arms and hands if client does not downward pull of unsupported arms,
have control of use of them. promotes circulation by preventing venous
pooling and flexion contractures of arms and
wrist.
4. Place patient on a High-Fowler’s
position.
4.1 Elevate head of bed 60 to 90
degrees.
4.2 Rest client’s head against
mattress of pillows
4.3 Use pillows to support client’s
arms and hands if client does not
have control of use of them.
5. Place patient on an erect position
5.1 Ask patient to stand beside the
bed.
5.2 Give slippers or place paper
towels at the floor.
6. Place patient on a prone position
6.1 Assist client to lie on his
abdomen.
6.2 Turn client’s head to one side.
6.3 Support head with small pillow.
6.4 Use pillows to elevate toes.
7. Place patient on a supine position
7.1 Place clients on his back with
head of bed flat
7.2 Place pillow under client’s upper
shoulders, neck, or head
7.3 Place small pillow or roll under
client’s ankles to elevate heels.
7.4 Place foot board or firm pillows
against bottom of client’s feet.
7.5 Place pillows under client’s
pronated, forearms, and keep client’s
upper arms parallel to client’s body
8. Place client on a Sim’s position
8.1 Help patient to lie on either on his
right or left side
8.2 Assist patient to rest his left arm
behind his body
8.3 The right arm is forward with the
elbow flexed and the arm resting on a
pillow placed under the head
9. Place patient on a dorsal
recumbent position
9.1 Assist client to lie on his back
close to the examining table
Increases comfort, improves ventilation and
increases patient’s opportunity to socialize or
relax.
Prevents flexion contractures of cervical
vertebrae.
Prevents shoulder dislocation from effect of
downward pull of unsupported arms,
promotes circulation by preventing venous
pooling and flexion contractures of arms and
wrist.
To maintain body alignment.
To provide safety and comfort to the patient’s
feet.
Prepares patient for assessment and to
maintain body alignment.
Prevents flexion or hyperflexion of cervical
vertebrae.
Increase comfort
Maintain proper body alignment. Reduces
risk of joint dislocation. Prevents footdrop.
Eliminates mattress pressure on toes.
Prepares client for assessment.
Maintains correct alignment and prevents
flexion contractures of cervical vertebrae.
Reduces mattress pressure on the heels.
Maintains foot in dorsiflexion and prevents
footdrop.
Reduces internal rotation of shoulder and
prevents extension of elbows. Maintains body
alignment.
Support the body of the client prior to the
preparation for assessment.
To place patient rolled partially on his/her
abdomen
Maintains proper alignment and prevent
lateral neck flexion. Prevents internal rotation
of the shoulder.
Prepares client for assessment.
 9.2 Separate the client’s leg and
knees are bent, the soles of the feet
rest flat on the bed or table
9.3 Place a pillow under the head of
the patient.
10. Place client in a lithotomy position
10.1 Assist client to lie on his back
close to the examining table
10.2 Separate the client’s leg and
knees are bent, the soles of the feet
rest flat on the bed or table
10.3 Place a pillow under the head of
the patient
10.4 Bring the buttocks close to the
edge of the table.
10.5 The knees are flexed, and the
feet are supported in a stirrup.
11. Place client on the knee-chest or
nonelectoral position.
11.1 The patient rests on his knees
and chest.
11.2 The body is flexed approximately
90 degrees at the hips
11.3 The head is turned at one side
resting on a pillow
11.4 The chest may be supported by
a small pillow
11.5 The arms are flexed at the
elbows and rests alongside the
patient’s head
11.6 The lower legs are perpendicular
to the thighs
12. Record each position change and
include amount of assistance needed
and client’s response and tolerance
13. Record and report any signs of
redness (e.g. in areas over bony
prominences)
Maintains proper alignment, prevent flexion of
the lumbar curvature, external rotation of
legs, and hyperflexion of the knees.
Prevents flexion contractures of cervical
vertebrae.
Prepares client for assessment.
Maintains proper alignment, prevent flexion of
the lumbar curvature, external rotation of
legs, and hyperflexion of the knees
Prevents flexion contractures of cervical
vertebrae.
Provide maximal exposure of female
genitalia.
To support legs and feet.
Prepares client for assessment.
Reduces hip dislocation, maintains body
alignment, prevent external rotation of the
hips.
Maintains proper alignment and prevent
lateral neck flexion. Prevents internal rotation
of the shoulder.
Increase comfort
Reduces internal rotation of shoulder and
prevents extension of elbows. Maintains body
alignment.
Maintains body alignment
Determines effectiveness of positioning.
Indicates complications of immobility or
improper position of body part. Determines if
need exists for increasing frequency of
repositioning patient.
 LOG ROLLING

NURSING INDICATIONS:
The skill of moving and positioning patients in bed can be delegated to nursing assistive
personnel (NAP). The nurse is responsible for assessing the patient's level of comfort and for
any hazards of immobility. Instruct NAP about:
 Any moving and positioning imitations unique to patient.
 Individual needs for body alignment (e.g., patient with spinal cord injury).
 Scheduled times to reposition patient through the shift.
 When to request assistance (e.g., if the patient has a spinal cord injury, when the patient
is unable to assist the nurse, has a lot of equipment, or is confused).

EQUIPMENTS:
 Pillows
 Drawsheet
 Trochanter roll
 Hand rolls
 Side rails
 Appropriate safe patient-handling assistive device (e.g., friction-reducing device)

LOG ROLLING
PROCEDURE RATIONALE
1. Check the doctor’s order for Placing patient in an inappropriate position
repositioning. causes injury.
2. Wash hands. Reduces transfer of microorganisms
3. Obtain assistance (2-3 people Ensure safe patient handling.
preferred).
4. Identify the client, provide privacy, Ensures correct client and helps to relieve
and explain procedure anxiety and allows patient to participate more
actively.
5. Don gloves Reduces transfer of microorganisms.
6. Perform a baseline assessment of Ensures patient’s mobility, coordination, and
client’s neurologic status, including strength. Determines need for additional help.
mental status, movement, and Ensures patient and nurse’s safety.
sensation.
7. Raise the bed to working height and Reduces any interference during patient
lock the wheels positioning.
8. Remove pillows and uncover the To provide privacy.
client, making sure the client is not
exposed.
9. Lower the side rail on the side you Prepares client for positioning.
and your assistants are on. You
should be facing the client.
10. If the client does not have a lift sheet Used to grip and pull in order to move the
under him, obtain one and put it in patient.
place.
11. To move the client toward one side of Distribute weight equally among nurses.
the bed, have one person grasp the
lift sheet and the other person grasp
the client’s lower legs and feet
12. Have the client place his arms over Prevents injury to arms.
his chest
13. . On the count of three, gently move To provide coordination, to move all the body
the client toward you. parts at the same time and to prevent tension
or twisting of the spinal column.
14. Have one person move the opposite Distribute weight equally among nurses.
side of the bed and lower the side rail.

15. Place the pillow or bath blanket under Prevents tension on the spinal column and
the client’s head, between the knees. adduction of the hips.

16. Obtain feedback from the client about Determine the success of positioning.
his comfort level
17. Cover the client and place the call To ensure patient safety and allows patients
bell within reach. in healthcare setting to alert staff remotely of
their need for help.
18. Raise both side rails. For patient’s safety
19. Return the bed to its lowest position.
20. Ensure client safety and comfort, Minimize risk of immobility complications.
keep items within reach.
21. Remove and dispose gloves. Reduces transfer of microorganisms
22. Wash hands Reduces transfer of microorganisms
23. Chart: Document date, time, resulting Evaluate patient’s response to positioning.
position, any signs of pressure areas,
use of supportive devices, ability of
the client to assist in moving and
turning, client’s tolerance and
response, any unusual occurrences.