Definition
Positioning a patient in bed is essential for comfort, safety, and prevention of complications like pressure ulcers, contractures, and respiratory issues.
Purposes
- To promote comfort to the patient
- To prevent complications caused by immobility.
- To stimulate circulation.
- To promote normal physiological functions.
Articles
- Clean, dry, firm bed
- Different types of mattresses.
- Bed boards.
- Pillows.
- Foot board/foot boot.
- Sandbags.
- Hand rolls.
- Trochanter rolls
- Bed blocks.
- Over bed table.
- Additional sheets.
- Trapeze bar.
(Articles are used as per requirement of each
of position. Additional articles may be used as
availability)
General Principles
- Obtain assistance as required.
- Ensure that the mattress is firm, and the level of bed is at working height.
- Avoid placing a body part directly over another to prevent pressure.
- Plan a regular position change schedule for the patient for 24 hours.
- Ensure patient comfort.
- Wash hands before and after the procedure.
A. Fowlers Position
Procedure
| Nursing action | Rationale | |
| 1 | Inform patient of the position he will be in and provide needed explanation. | Understanding reduces anxiety and promotes relaxation. |
| 2 | Elevate the head of the bed (Fowlers 45 to 90o). Semi Fowlers (15 to 45o). High Fowlers (90o). | Increases comfort and relaxation. |
| 3 | Rest head against mattress and small pillow | Prevents cervical flexion contractures |
| 4 | Use pillow to support arms. | Prevents shoulder dislocation, promotes circulation and prevents flexion contractures of arms and wrists. |
| 5 | Place a small pillow on the lower back. | Supports lumbar vertebrae and prevents exaggerated flexion of vertebrae. |
| 6 | Place a small pillow/roll under thigh. | Prevents hyperextension of knee and occlusion of popliteal artery from pressure of body weight. |
| 7 | Place a small pillow under ankle. | Prevents prolonged pressure on heels. |
| 8 | Place foot board at the bottom of the patient’s feet | Maintains dorsiflexion and prevents foot drop. |
Problems to be Prevented in Fowler’s Position
- Hyperextension of neck
- Edema of hands and arms
- Possible dislocation of shoulder
- Flexion contracture of the wrist.
- Hyperextension of the knees
- External rotations of hip
- Pressure on heels
- Plantar flexion of feet/foot drop
B. Orthopneic Position
High Fowler’s position with over bed table placed in the front of the patient. Patient to rest both hands-on over bed table/on pillow placed on it and lean forward. Leaning forward facilitates respiration by allowing maximum chest expansion.
Indications
- Patients with severe dyspnea.
- Cardiac patients.
- Position for thoracentesis.
- Patient with chest drainage tubes.
C. Supine Position/ Dorsal Recumbent /Back Lying
| Nursing action | Rationale | |
| 1 | After providing explanation about the procedure, place patient on back with head of the bed flat. | |
| 2 | Place small, rolled towel under lumbar area of the back. | Provides support for lumbar spine. |
| 3 | Place pillow under head, neck and upper shoulders | Maintains correct alignment and prevents flexion contractures of cervical vertebrae and hyperextension of neck |
| 4 | Place trochanter rolls/sandbags parallel to lateral surface of thighs. | Reduces external rotation of hip |
| 5 | Place small pillow under thighs. | Prevents hyperextension of knees. |
| 6 | Place small pillow/roll under ankle to elevate heels | Reduces pressure on heels |
| 7 | Place foot board under pronated bottom of feet. | Prevents plantar flexion/foot drop |
| 8 | Place pillow under pronated arm maintaining upper arm parallel to body. | Reduces internal rotation of shoulder and extension of elbows. |
| 9 | If patient is paralyzed place hand rolls in hand. | Reduce extension of finger and abduction of thumb. Maintains thumb in slight abduction and in apposition |
Problems to be Prevented in Dorsal Recumbent Position
- Hyperextension of neck.
- Posterior flexion of lumbar curvature.
- External rotation of legs.
- Hyperextension of knees.
- Plantar flexion.
- Pressure on heels.
D. Prone Position
Indications
- For patients with pressure sores, burns, injuries and operations on the back.
- For patients after 24 hours of amputation of lower limb.
- Position for renal biopsy
| Nursing action | Rationale | |
| 1 | After providing explanation, about the procedure, roll patient over with arm positioned close to the body with elbow straight, and hand under hips. Position the | |
| 2 | Turn patient heat to one side and support with a small pillow. | Reduces flexion or hyperextension of cervical vertebrae. |
| 3 | Place small pillow under abdomen below the diaphragm. | Reduces hyperextension of lumbar vertebrae back Reduces pressure on breasts for women and on genitals for men. |
| 4 | Support arm in flexed position at level of shoulder. | Reduces risk of shoulder dislocation |
| 5 | Support lower legs with pillows to elevate toes. | Prevents foot drop and external rotation of mattress on toes. |
Problems to be Prevented in Prone Position
- Flexion/hyperextension of neck
- Hyperextension of lumbar curvature.
- Pressure on breasts heels and genitals.
- Foot drop
E. Lateral/ Side lying Position
Indications
- Patients who require periodic position changes, e.g., bed-ridden patients.
- In immediate postoperative patients to prevent the risk of aspiration (except in spinal and epidural anaesthesia.)
Procedure
| Nursing action | Rationale | |
| 1 | Provide explanation and prepare patient for the position change. | |
| 2 | Lower head of bed as low as patient can tolerate | |
| 3 | Position patient to side of bed. | |
| 4 | Tum patient to one side (in helpless patient, flex patient’s knee that will be away from mattress, place hand on that side to patient’s hip and the other hand at shoulder, then roll patient to side). | |
| 5 | Place pillow under patient’s head and neck. | Maintains alignment, reduces lateral neck flexion and decreases strain on sternocleidomastoid muscle. |
| 6 | Bring shoulder blade forward | Prevents weight from resting directly over shoulder joint |
| 7 | Position both arms in flexed position. Upper most arm is supported by pillow on level with shoulder. | Decreases internal rotation and adduction of shoulder. Ventilation is improved as chest can expand. |
| 8 | Place tuck back pillow under back (pillow folded lengthwise and smooth area fucked under back) | Provides support to maintain patient on side. |
| 9 | Place pillow under semi flexed upper leg level at hip, from groin to foot | Prevents hyperextension of leg. Maintains alignment and prevents foot droop. |
| 10 | Place sand beg parallel to plantar surface of dependent foot. | Prevents foot drop |
Problems to be Prevented
1. Lateral flexion and fatigue of sternocleidomastoid muscle.
2. Internal rotation and adduction of shoulder and limited chest expansion.
3. Internal rotation and adduction of femur and twisting of spine.
F. Sim’s Position/ Semi Prone Position
Indications
- Vaginal and rectal examination.
- Administration of enema and suppository.
- Position for sigmoidoscopy and proctoscopy.
Procedure
| Nursing action | Rationale | |
| 1 | Provide explanation and prepare patient for the position. | |
| 2 | Place head of bed flat | |
| 3 | Place patient in supine position. | |
| 4 | Tum patient onto lateral position lying partially on abdomen . | |
| 5 | Place small pillow under head and neck | Maintains alignment and prevents lateral neck flexion. |
| 6 | Place pillow under flexed upper arm supporting arm level with shoulder. | Prevents internal rotation of shoulder. |
| 7 | Place pillow under flexed upper leg, supporting leg level with hip | Prevents internal rotation of hip. Maintains proper alignment. |
| 8 | Place sand bags parallel to plantar surface of dependent foot. | Prevents plantar flexion. |
Problems to be Prevented
- Lateral flexion of neck.
- Internal rotation of shoulder.
- Internal rotation and adduction of hip and leg.
- Foot drop
G. Lithotomy Position
Indications
1. For vaginal delivery and vaginal examination.
2. For rectal surgeries, e.g., hemorrhoidectomy, fissurotomy.
3. For vaginal hysterectomy.
Procedure
| Nursing action | Rationale | |
| 1 | Place patient in supine position. | |
| 2 | Place pillow under head and neck. | Prevents hyperextension of neck |
| 3 | Place both legs flexed at hip and knee, at 90″ with legs supported on stirrups. |
H. Trendelenburg Position
Entire frame of bed title with head of bed down.
Indication
- Postural drainage.
- Management of hypotension and shock.
- Patient with deep vein thrombosis.
Procedure
| Nursing action | Rationale | |
| 1 | explain procedure to patient | |
| 2 | Place patient in supine position | |
| 3 | Lower head end of the bed using bed key. If bed is not adjustable type, use bed blocks at foot end and tilt entire frame of bed down. |
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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