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Pivoting
Place one foot slightly ahead of the other.
Turn both feet at the same time, pivoting on
the heel of one foot and the toe of the What do we use in Positioning
other.
Maintain a good center of gravity while Pillows
holding or carrying the object Blankets
Heel protectors
Splints, slings & braces
Positioning Clients Seat cushions
Why do we spend time on positioning? Wedges
Patient comfort/decrease pain
Support and stability to patients’ trunk & Standard Positions
extremities. Supine
Prevent development of pressure sores Pillow under head to keep c-spine neutral.
Prevent joint contractures Small pillow or towel roll for cervical support.
To have easier access to area being Support under popliteal space to ↓ lumbar
treated lordosis.
Decrease edema Ankle support to relieve pressure on
Increased function calcaneus.
The most comfortable for the patient may Support under elbows to relieve pressure on
not be the best for them bony prominence.
May need to be positioned to aid in the
treatment of a specific diagnoses or Purpose
condition CBR
Positioning Clients Liver biopsy
Considerations with Positioning Post spinal anesthesia
Who is at risk?
Elderly Contraindicated for patients with DOB,risk for
Those unable to change their own aspiration.
position Prone
Those with decreased sensation
Pillow under head
Those who may be unable to
communicate their discomfort Pillow under lower abdomen to ↓ lumbar
lordosis
Rolled towel under anterior shoulder to
adduct (retract) scapula
Towel roll/pillow/bolster under ankles to Moving and Transferring/Turning Clients in Bed
relieve stress on hamstrings, also allows pelvis Transferring
and lumbar spine to stay relaxed refers to moving a patient from bed to a
PURPOSE –for patients who underwent BKA for the chair or to a stretcher, or to a wheelchair
first 24 hours with maximum comfort and safety for
Contraindicated for patients with abdominal patient and nurse.
surgery and respiratory problems Reasons for transferring:
Side lying Improvement of the patient’s condition
Patient in center of bed – not near edge (from ICU to medicine unit .
Head, trunk, pelvis in alignment Worsens of patient’s condition (to ICU)
LE’s are flexed at hip & knee with pillows The need for surgery or X ray
between legs & top Le slightly forward of Transfers at the patient’s request
bottom LE For any other diagnostic tests.
Pillow at chest &/or back for to prevent patient Reasons for moving
from rolling Change position
Pillow under top arm to keep chest open Repositioning the client
Semi-fowler Client’s slid down in bed from fowler’s
Head of bed is lifted 30° - can use pillow, position
wedge or bolster as well .Pillow under popliteal Changing the bed linen
space Methods of transferring
For a Fowler position head of bed is 45° By wheel chair
Used for NGT feeding By stretcher
High Fowlers Position – 90 degrees angle with head , By a movable bed
arms and leg support Actions applicable before moving the Client
NGT insertion Assess:
DOB The client’s physical abilities
facilitates the relaxing of tension of the Degree of comfort or discomfort when moving
abdominal muscles, allowing for improved Client’s weight
breathing Your own strength and ability to move the
Contraindicated for post spine and brain surgery client
Lithotomy Position Prepare supportive equipment (pillows)
a common position for surgical procedures and Explain the procedure to the client and listen
medical examinations involving the pelvis and to any suggestions of the client
lower abdomen, as well as a common position Raise the height of the bed to bring the client
for childbirth close to your center of gravity
Dorsal Recumbent Lock the wheels on the bed and raise the rail
Patient is on his back with knees flexed and on the side of the bed opposite you to ensure
soles of feet flat on the bed. client safety
Trendelenburg Position Face in the direction of the movement to
the body is laid supine, or flat on the back on a prevent spinal twisting
15-30 degree incline with the feet elevated Logrolling
above the head. For improvement of patients the log roll or logrolling is a maneuver used to
with low cardiac output move a patient without flexing the spinal
Sims Position column. Patient's legs are stretched, the head
used for rectal examination, treatments, and is held, to immobilize the neck.
enemas. Transferring Clients
It is performed by having a patient lie on Transferring the patient from bed to wheel
their left side, left hip and lower extremity chair:
straight, and right hip and knee bent. It is also Review the medical record and nursing plan
called lateral recumbent position. of care for conditions that may influence the
Knee Chest /Genupectoral Position patient’s ability to move or to be positioned
The knee-chest position is a position used in Perform hand hygiene and put on PPE, as
a number of medical situations including indicated. Identify the patient. Explain the
gynecological examination and surgery and procedure to the patient
lumbar spine surgery. Provide privacy
The knee-chest position is recommended in Raise the head of the bed to a sitting
those with a cord prolapse until delivery can Make sure the bed brakes are locked. Put the
occur. chair next to the bed. If available, lock the
brakes of the chair. If the chair does not have the surface of the stretcher. Ensure that the
brakes, brace the chair against a secure wheels on the bed are locked.
object. Pull the draw sheet out from both sides of
Lower the side rail, if necessary, and stand the bed. Place the stretcher parallel to the
near the patient’s hips. Stand with your legs bed.
shoulder width apart with one foot near the Four nurses or helpers are required. One
head of the bed, slightly in front of the other stands at the opposite side of the bed.
foot Remaining three stands across the stretcher
Assist the patient to sit up on the side of the one supporting the head and shoulders,
bed. second one supporting the hips and thighs
and the third one supporting the feet and
Wrap the gait belt around the patient’s waist, legs.
based on assessed need and facility policy. Grasp the draw sheet tightly
Stand facing the patient. Spread your feet Co-ordinate lifting by counting the numbers
about shoulder width apart and flex your hips of 1, 2, 3 and receive the patient in stretcher
and knees by pulling the draw sheet and the patient
Ask the patient to slide his or her buttocks to towards the stretcher, quickly and gently.
the edge of the bed until the feet touch the The sheet can be removed by turning the
floor. patient from side to side
Position yourself as close as possible to the
patient, with your foot positioned on the out Three persons lifting the patient
side of the patient’s foot Three people, all standing on the same side
Using the gait belt, assist the patient to stand of the patient, slip their hands, palms facing
Rock back and forth while counting to three. up, beneath the patient.
On the count of three, use your legs (not your First person holds the head and shoulder,
back) to help raise the patient to a standing second person holds the trunk up to thigh
position . If indicated, brace your front knee and the third person holds the legs.
against the patient’s weak extremity as he or Cradle the patients in the arms so that the
she stands. patients weight rests against the nurses
Pivot on your back foot and assist the patient chests and the patient faces nurses.
to turn until the patient feels the chair against Care must be taken so that the patient will
his or her legs not be dropped down suddenly.
Ask the patient to use an arm to steady him- The nurses should bend over and release the
or herself on the arm of the chair while slowly weight of the patient gradually and until it
lowering to a sitting position . Continue to rests gently upon the bed or stretcher
brace the patient’s knees with your knees and Moving the client up in bed
hold the gait belt. Flex your hips and knees Review the medical record and nursing plan
when helping the patient sit in the chair. of care for conditions that may influence
Assess the patient’s alignment in the chair. the patient’s ability to move or to be
Remove gait belt , if desired. Depending on positioned . Assess for tubes, IV lines,
patient comfort, it could be left in place to incisions, or equipment that may alter the
use when returning to bed. Cover with a positioning procedure. Identify any
blanket, if needed movement limitations.
Transferring between bed and stretcher and vice Consult patient handling algorithm for
versa: moving the patient. Perform hand hygiene
Transferring the patient from bed to stretcher and put on PPE. Identify the patient. Explain
and from the stretcher to the bed is done to patients who the procedure to the Patient
cant help themselves and need help. The selection of Close curtains around bed and close the
transfer technique is individualized. door to the room, if possible
The following methods can be used. Adjust the head of the bed to a flat position.
Draw sheet method Remove all pillows from under the patient.
Patient is lifted by three persons
Leave one at then head of the bed, leaning
Mechanical devices like hydro ureter lift
upright against the headboard. Moving the
client up in bed
Position at least one nurse on either side of
Draw sheet method
the bed, and lower both side rails . Ask the
Lower the head of the bed until it is flat.
patient (if able) to bend his or her legs and
Raise the bed so that it is slightly higher than
put his or her feet flat on the bed to assist Put a gait belt around the client's waist.
with the movement. Stand in position of good body mechanics.
One nurse should be positioned on each Assist the client to a standing position by
side of the bed. Grasp the friction-reducing straightening your legs as you lift with the
sheet securely, close to the patient’s body gait belt and the client pushes down with his
Moving the client up in bed hands on the mattress.
Flex your knees and hips. Tighten your Pause to allow the client to regain balance.
abdominal and gluteal muscles and keep Walk with the client by placing one hand on
your back straight. the gait belt in front of his waist and your
On the count of three, move the patient up other hand in back under the gait belt. Walk
in bed. Assist the patient to a comfortable on the weaker side and encourage the
position and readjust the pillows and client to hold the handrail, if available, with
supports, as needed. Return bed surface to strong arm.
normal setting Walk in the same pattern as the client (both
step with left foot at the same time). Assist
Ambulating Clients the client to step forward with strong foot
To walk from place to place or move about. first.
It is a technique of post operative care in which Walk the client the distance instructed by
a patient gets out of bed and engages in light supervisor or as indicated by the service
activity (as sitting, standing, or walking) as soon plan.
as possible after an operation. NOTE: IF THE CLIENT LOSES WEIGHT-BEARING ABILITY,
Some time this term is also use in the place of
PULL THE CLIENT'S BODY INTO CLOSE ALIGNMENT
walking.
WITH YOUR HIP/THIGH AREA BY USING THE GAIT BELT
Ambulating the client keeps him more active
and improves muscle tone and strength in his AND LOWER HIM TO THE FLOOR USING THE LARGE
legs. It also slows loss of bone mass and MUSCLES OF YOUR LEGS.
density related to osteoporosis. Return the client to the bed/chair.
The client who is up walking has increased Make sure the client is comfortable.
peristalsis and circulation. The client also gets Remove the gait belt.
a sense of accomplishment and maintains 16. Wash your hands.
greater independence.
Procedure for Ambulating a Client With a Walker:
Gait Wash your hands.
is a term to describe human locomotion, it is Explain what you are going to do.
pattern of walking or a sequence of foot If using a hospital bed, lower the bed to
movements. lowest level.
Gait cycle or walking cycle Assist the client to sit on the edge of the
A cycle of walking is the period from the bed.
heel-strike of one foot to the next heel-strike Pause and allow the client to sit on the
of the same foot edge of the bed a few moments to regain
When a subject is walking on level ground, his balance.
than the movements of the lower limbs may Assist the client in putting on socks and
be divided into “swing” and “stance” nonskid shoes.
phases. Apply a gait belt.
The swing phase occurs when the limb is off Stand in a position of good body
the ground, and the stance phase when it is mechanics.
in contact with the ground and is bearing Assist the client to a standing position by
weight. straightening your legs as you lift with the
gait belt and the client pushes down with his
Procedure for Ambulating Client using a Gait Belt hands on the mattress.
Wash your hands. Instruct the client to position his body within
Explain what you are going to do. the frame of the walker.
Assist the client to sit on the edge of the Instruct the client to move the walker
bed. forward by lifting it up, moving it forward,
Pause and allow the client to sit on the and setting it down.
edge of the bed for a few moments to Instruct the client to take a step forward with
regain his balance. the weak leg.
Assist the client in putting on socks and Instruct the client to move strong leg
nonskid shoes. forward
Instruct the client to take short steps and It is a Movement at a regular and fairly slow
keep his head up and eyes looking forward. pace by lifting and setting down each foot
Walk the client the distance instructed by in turn, never having both feet off the
supervisor/nurse as indicated in the service ground at once.
plan. it is the highest level of motor control skill.
Return the client to bed or a chair. To The major requirements for successful walking
ambulate backward, the client steps back include:
with his strong foot, takes a step back with Support of body mass, by the lower
his weak foot, then walker is moved back. extremities
Have the client feel for the arm of chair or Production of locomotors rhythm
top of mattress with his hand. Dynamic balance control of the moving
Assist the client into the chair or bed; make body
sure the client is comfortable. Propulsion of the body in the intended
Wash your hands. direction
Walking aid
Procedure for Ambulating a Client with a Cane: is a device designed to assist walking and
Wash your hands. improve the mobility of people who have
Explain what you are going to do. difficulty in walking or people who cannot
Lower the bed to lowest level; assist client to walk independently
sit on edge of bed. Different Types of Walking aids
Pause and allow the client to sit on the walker
edge of the bed a few moments to regain Cane/Stick
his balance. Crutches
Assist the client in putting on socks and Purpose of walking aids
nonskid shoes. Increase area of support or base of support
Apply a gait belt. Maintain center of gravity over supported
Stand in a position of good body area
mechanics. Redistribute weight-bearing area by
Assist the client to a standing position by decreasing force on injured or inflamed part
straightening your legs as you lift with the or limb
gait belt and the client pushes down with his Can be compensate for weak muscles
hands on the mattress. Decrease pain
Instruct the client to move the cane forward Improve balance
and a little to the outside of his strong leg. Crutches
Client should use the cane on his stronger These are devices which are used to reduce
side. weight bearing on one or both legs and also
Instruct the client to take short steps and give support where balance is impaired and
keep his head up and eyes looking forward. strength is inadequate
Instruct the client to move his weak foot Prerequisites for crutches
forward to line up evenly with the tip of the Good strength of upper limb muscles is
cane. required.
Instruct the client to put weight on the cane Range of motion of upper limb should be
and weak foot while swinging his strong foot good.
forward. Muscle group which should be strong is
Walk in the same pattern as the client (both given below.
step with left foot at the same time). Shoulder flexor, extensors and depressor
Walk the client the distance instructed by Shoulder adductors
supervisor/nurse as indicated in the service Elbow and wrist extensors
plan. Finger flexors
Return the client to bed/chair.
Make sure the client is comfortable.
Wash your hands.