Definition
Moving a patient up in bed is a fundamental nursing skill that promotes comfort, alignment, and respiratory function, while also preventing complications like pressure injuries and muscle strain.
Purposes of Moving a Patient Up in Bed
| Purpose | Rationale |
|---|---|
| Maintain proper body alignment | Prevents musculoskeletal strain, contractures, and postural deformities |
| Enhance respiratory function | Promotes lung expansion and reduces risk of hypostatic pneumonia |
| Improve circulation | Reduces venous stasis and risk of deep vein thrombosis (DVT) |
| Prevent skin breakdown | Relieves pressure on bony prominences, reducing risk of pressure ulcers |
| Support comfort and rest | Alleviates discomfort from sliding down or awkward positioning |
| Facilitate feeding and communication | Helps patient engage in meals, conversation, and care participation |
| Prepare for procedures or transfers | Ensures optimal positioning for exams, hygiene, or bed-to-chair transfers |
Procedure
| Nursing action | Rationale | |
| 1 | Before procedure Adjust the bed and position. lower the head of the bed to a flat position or as low as the patient can tolerate. raise the bed to the height of your center of gravity. lock the wheels of the bed and raise the side rails on the side opposite to you. remove all pillows and place one against head of the be | Moving the patient upward against gravity requires more energy expenditure. Ensures good body mechanics and prevents strain on nurse’s back. Prevents falls and accidents. Protects from accidental injury by hitting against head end of the bed when moving up. |
| 2 | Assess the mobility status and strength of patient. | Assess the patient’s stability to cooperate and participate in the procedure. |
| 3 | Explain procedure to patient, the purpose of the procedure and how he can cooperate | Reduces anxiety and ensures cooperation. |
| 4 | Instruct patient on how he can help during the procedure. Ask the patient to flex hip and knees and position feet flat on the bed. So that they can be used effectively for moving the bed.If patient can pull himself upholding a trapeze or holding the head of the bed that should be encouraged. | Patient participation can lessen nurse’s workload. Flexing hips and knees keeps entire leg off bed surface, thereby reducing friction. Utilizing a trapeze when moving patient reduces effort on the part of the nurse. |
| 5 | During procedure Position 2-3 nurses depending on patient’s ability to assist in the lifting and moving efforts. Two nurses: one nurse is positioned at the level of the patient’s upper body with arm closest to the head of bed, under the neck supporting head and shoulder on the opposite side. The other arm of the nurse is under the trunk of the patient. The second nurse is positioned at the level of the lower part of the patient’s body with one arm under the waist of the patient and the other arm under the thighs just below the buttocks. Three nurses: If the third nurse is present, she is positioned at the lower extremities, one arm supporting under the thighs and the second arm supporting under the legs (three nurses are needed if the patient is unable to help himself). | |
| 6 | Flex at the knees. Support patient’s weight on forearms with forearms resting on bed. | Supporting weight on forearms and bringing object close to your center of gravity reduces the effort required. |
| 7 | Stand with feet apart. Keep the foot near the head of the bed, behind the other foot (forward, backward stance). | Standing with feet apart increases stability. |
| 8 | Instruct patient to push with heels and elevate trunk if possible, thus moving towards head end of bed, to the count of three. | Patient’s assistance will help in reducing friction. |
| 9 | On count of three, shift your weight from front foot to back foot and at the same time shifting patient to the top of bed. Tighten your gluteal, abdominal, leg and arm muscles as you do it. | Shifting your weight counteracts patient’s weight and helps in reducing force needed to move the load. Using the gluteal, leg and arm muscles reduces strain. |
| 10 | Realign and position patient as required. | Prevents injury to musculoskeletal system. |
| 11 | Lower bed. | Reduces risk of falls. |
| 12 | Position patient comfortably. | |
| 13 | After procedure Wash hands. | Reduces risk of transmission of microorganisms |
Variation with Two Nurses
| Nursing action | Rational | |
| 1 | Follow steps (1 to 4) of above procedure. Place a draw sheet/pull sheet folded in half under patient extending from shoulder to thighs. Fan fold the sheet close to the body of patient with two nurses standing on either side of patient. Grasp the sheet at shoulder and Buttocks. | A draw sheet distributes weight more easily. Draws the weight closer to the nurse’s center of gravity. Increases nurse’s balance and stability permitting a smooth movement. |
| 2 | Continue with steps (7) of above Procedure |
Special Considerations
- Never pull by arms or shoulders—risk of dislocation or skin injury.
- Use friction-reducing devices for heavier or immobile patients.
- Monitor for orthostatic hypotension or dizziness post-move.
- Secure tubes, catheters, and IV lines before repositioning.
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
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