12.8.8: Procedure- Helping the Patient to Sit at the Side of the Bed
It is helpful when transferring a patient or assisting with ambulation to first assist a patient from a lying down to a sitting position. Care Plans may provide instructions for Home Health Aides/Personal Care Aides to assist patients to dangle (sit at the edge of the bed) for a certain amount of time per day. Care Plans may also instruct Home Health Aides/Personal Care Aides to allow their patient to dangle at the edge of the bed prior to standing or transfer. They should always watch their patient for signs of dizziness and inquire as to whether they feel faint when changing positions from a lying down to a sitting position. If dizziness or faintness persists once the patient is in a sitting position, assist them back into a lying down position and inform a supervisor.
- Explain the procedure to the patient.
- Wash your hands and don gloves as needed.
- Face the head of the bed. Place your outer foot forward. Your feet should be about 12 inches apart. Keep your hips aligned and slightly bend at the knee.
- Make sure the bed is in its locked position.
- For an independent patient who can sit up without assistance : Ask the patient to roll onto their side toward the side of the bed that they will be sitting on. Ask them to bend their knees and turn onto their side, facing you. Instruct the patient to grasp the mattress with their lower arm (the arm closest to the edge of the bed) and to use their other hand to push themselves up by reaching across their chest and reaching down to the mattress. Instruct them to push down on the mattress while swinging their legs over the side of the bed. They may also use a side rail for support while sitting up. Provide support and assistance as needed.
- For the patient who requires assistance to sit up : Place one arm (the arm closest to the patient) behind the patient’s shoulders. If it is a particularly frail patient or one who cannot control their neck or head, rest your forearm and hand behind their head. This prevents their head from rolling back. Place your other arm underneath the patient’s thighs.
- Do not hold them underneath their axilla (armpit) and do not pull against their clothing or other body part. You could cause them injury if you do so.
- Use a gentle rocking motion to assist the patient to propel forward and up into a sitting position. On the count of 3 (count aloud so the patient knows when they will be moving), help to move the patient to the sitting position by slowly turning them up and toward you. Rock forward and then backward, keeping your back aligned, and put your weight onto your rear foot to provide a firm base of support and balance while you assist the patient into a sitting position. Help position the patient’s legs over the edge of the bed.
- Place a pillow or two behind the patient’s back to keep them in an upright position. Position and cover the patient for comfort.
- Check for any changes in the patient’s condition such as dizziness, weakness, or shortness of breath. Make sure to record and report any conditions observed or statements made by the patient to indicate this. If the patient remains dizzy or continues to report feeling weak, return them to a lying down position. Immediately inform a supervisor.
- Remove gloves if wearing and wash your hands.
- Place the bed back into its lowest level and ensure side rails are raised.
- The Care Plan may provide instructions for assisting a patient to dangle their legs for a specific length of time before returning them to a lying down position. Or, it may instruct the HHA/PCA to allow the patient several minutes to dangle at the side of the bed prior to standing or transfer. Follow the Care Plan accordingly.
- Document the procedure and any observations or changes in condition.