12.8.6: Procedure- Positioning the Patient
Patients who are bedbound or who are unable to turn themselves must be turned and repositioned every two hours. This helps to prevent pressure ulcers development. There are a variety of positions Home Health Aides/Personal Care Aides can choose to rotate the patient to.
On Back ( Supine P osition )
- Explain the procedure to the patient.
- Wash your hands and apply gloves as needed.
- Assemble equipment (pillows, clean pillow cases, towels)
- Center the patient in the middle of the bed.
- Turn the patient onto their back.
- Ensure the patient’s body is in proper alignment.
- Replace soiled or damp pillow cases with clean ones.
- Place a pillow underneath the back of the patient’s head.
- Place a pillow underneath the small of the patient’s back if they prefer.
- Place a pillow underneath each bony prominence of the patient’s hips. To do this, slightly turn the patient to one side and slide a pillow lengthwise along their hips. The pillow will be partly under their back and partly sticking out from their sides. The top of the pillow should be near their lower back, with the bottom of the pillow underneath their buttocks. This will ensure that the bony prominences of their hips are not pressing against the bed, creating a possible pressure ulcer. Repeat on the other side of the patient’s hips.
- Place one pillow underneath each leg of the patient. One pillow should be used per leg. Pillows should be placed lengthwise. Make sure that the patient’s heels are not pressing against the pillow or mattress. You may slightly tuck the end of the pillow closest to the patient’s feet by slightly rolling it under. This ensures that the patient’s heels are floated (free from pressing against surfaces).
- Ensure that the patient is comfortable and appropriately covered for warmth and privacy.
- Remove your gloves. Wash your hands.
- Record time of procedure and any observations or changes in behavior or condition. Also record and inform a supervisor of any changes in skin condition or observations of skin breakdown or pressure ulcers.
- Remember to turn and position the patient every two hours to prevent pressure sore formation.
Lateral Position (A lso C alled a S ide -L ying P osition )
- Explain the procedure to the patient.
- Wash your hands and apply gloves as needed.
- Assemble equipment (pillows, clean pillow cases, towels).
- Center the patient in the middle of the bed.
- Safely turn the patient to one side using one fluid motion to move their entire body. This helps to keep their body in alignment.
- Once turned to their side, ensure that the patient’s body is in proper alignment.
- Place a pillow under the patient’s head and neck.
- Place a pillow between the patient’s legs so that the knees are not pressing against each other, causing a possible pressure ulcer.
- Place a pillow underneath the arm that is on top of the patient’s hip.
- Place a pillow underneath the patient’s feet to float the heels.
- Place a pillow at the small of the patient’s back to provide support so they do not roll over. To do this, place the pillow lengthwise and then slightly roll it to tuck the ends under.
- Ensure that the patient is comfortable and appropriately covered for warmth and privacy.
- Remove your gloves. Wash your hands.
- Record the time of procedure and any observations or changes in behavior or condition. Also record and inform a supervisor of any changes in skin condition or observations of skin breakdown or pressure ulcers.
- Remember to turn and position the patient every two hours to prevent pressure sore formation.
Prone P osition ( on Abdomen )
- Explain the procedure to the patient.
- Wash your hands and apply gloves as needed.
- Assemble equipment (pillows, clean pillow cases, towels).
- Move the patient to the side of the bed.
- Gently turn/assist the patient onto their abdomen (stomach).
- Ensure the patient’s body is in proper alignment.
- Turn the patient’s head to the side and ensure it is in proper alignment. Place a pillow under the patient’s head.
- Position the patient’s arms for comfort by gently bending them upward on either side of the patient so that their palms are facing down on the bed. Ensure that arms are not tucked under their body. Place pillows under the patient’s arms for comfort.
- Place a pillow underneath the patient’s lower legs to elevate their heels.
- Ensure that the patient is comfortable and appropriately covered for warmth and privacy.
- Remove your gloves. Wash your hands.
- Record the time of procedure and any observations or changes in behavior or condition. Record and inform a supervisor of any changes in skin condition or observations of skin breakdown or pressure ulcers.
- Remember to turn and position the patient every two hours to prevent pressure sore formation.
Assisting Patients to Transfer to and from Different Positions
Patients may require assistance moving among positions. They may need assistance moving from a lying down to a sitting position and from a sitting upright position to moving to the edge of the bed. If the patient would like to get out of bed, the Home Health Aide/Personal Care Aide should assist them to a sitting position and allow them to sit at the edge of the bed for a few minutes prior to standing. This helps their bodies adjust to changes in blood pressure and helps prevent falls.
This section provides instruction for how to assist patients move from a lying down to a sitting position, from a sitting upright position to the edge of the bed, and finally to a standing position. Assisting with walking (ambulation) is also discussed. This is an important skill for the Home Health Aide/Personal Care Aide. Patients benefit from exercise in order to maintain and improve muscle and bone strength. Instruction is also provided for assisting patients transfer to a wheelchair, chair, toilet, commode, and shower.
Proper positioning of a patient while in a wheelchair is also discussed. Patients who spend a great deal of time in wheelchairs are at risk for pressure ulcers. They should be encouraged or assisted to turn and position every two hours. Pillows may be used to relieve pressure points.