12.8.11: Procedure- Positioning Patient in Chair or Wheelchair
Positioning a patient comfortably and safely in a chair or wheelchair is an important task of the Home Health Aide/Personal Care Aide. Just as in bed, patients need to be re-positioned every two hours when they are in a chair or wheelchair. Patients can also slide down while in a wheelchair or chair, and may require assistance to maintain a proper sitting position. Patients should sit on pressure distribution devices, such as wheelchair cushions. This helps to prevent pressure ulcer formation. If the patient is able, Home Health Aides/Personal Care Aides should instruct them to shift their weight from side to side every two hours to relieve pressure on their buttocks. Use a draw sheet/bed pad under a patient sitting in a wheelchair or chair. This will help a HHA/PCA with safely repositioning and lifting the patient.
- Explain the procedure to the patient.
- Wash your hands and don gloves as needed.
- If the chair reclines : Obtain assistance from another person. Lock the wheels. Recline the chair. This allows gravity to help you move the patient up in the chair. Using a draw sheet, fold and grasp one end. Ensure you use proper body mechanics. Just as in the procedure , “ Turning the Patient in Bed ”, on the count of three, each person will lift the person up toward the head of the chair.
- If the patient is able to assist you with standing : Lock the wheelchair or chair locks. Move footrests or stools out of the way. Apply a gait belt, if using. Instruct the patient to hold onto the armrests and to push down on your instruction. Stand in front of the patient and brace their legs and knees with your own. Ensure you use proper body mechanics. On the count of three, ask the person to push down against the armrests as you assist them to a stand.
- Once the patient is standing : Straighten wrinkles in chair pads or draw sheets, fluff pillows, and check their skin for any reddened areas.
- When positioning the patient back into the wheelchair or chair : Reverse the procedure used to assist them to a stand. Ensure patient’s hips are as far back in the chair as possible. Position feet so they are in proper alignment with their body. Make sure feet are on footrests if using a wheelchair and that they are not caught behind the footrests or chair legs.
- Check for positioning of male genitals. The patient should not be sitting on their scrotum.
- Place a pillow behind the patient’s back if they wish.
- Position arms on arm rests or comfortably on the patient’s lap. You may also use pillows for positioning the arms.
- If the patient requests, recline their legs and feet by reclining the chair, if it reclines, or by positioning a stool or foot rest in front of them. Elevate legs and feet with pillows, ensuring the heels are floating off the pillow. This prevents pressure ulcer formation.
- Remove gloves if wearing and wash your hands.
- Document the procedure and any observations or changes in condition.
- Just as in bed, reposition the patient every two hours when sitting in a wheelchair or chair.
- Wheelchair pillows and pressure redistribution devices should be used with patients who will spend long periods of time in wheelchairs or chairs. These will help prevent pressure ulcers.