Whether a nurse is working in the OR, acute care, home health, or a nursing home, patient positioning is an essential nursing skill. Positioning is a key element of patient safety, and it can help prevent complications such as tissue injuries, equipment abrasions, and more. Nurses are key leaders in advocacy when it comes to positioning, so learn more about how to help your patients.
Priorities When Determining the Positioning of a Patient
What should you keep in mind when positioning a patient? Here are some guidelines to follow:
- Airway: Ensure that the patient is in an adequate position for breathing.
- Perfusion: Limbs should not be compressed underneath one another or equipment.
- Comfort: Avoid unnecessary bending and contortions to prevent nerve damage.
- Privacy: Minimize skin exposure to promote patient dignity and keep the patient warm.
- Shear: Avoid folding or rubbing underlying tissue to prevent injury.
- Equipment: Ensure endotracheal tubes, feeding tubes, and other equipment are not injuring the patient.
Common Patient Positions
Understanding the lexicon of patient positioning can help you chart more accurately and know your options when it’s time to reposition your next patient. Here are some positions, and the potential areas of injury for each one.
Supine
The patient is flat on their back. Supine is one of the most common bed positions for patients. Common areas of injury are the back of the head, scapula, thoracic vertebrae, elbows, sacrum, and heels. When possible, elevate the heels or knees to avoid injury.
Sitting
The patient is in a chair or upright in the bed. The most common injuries from a seated position result from pressure on the sacrum, so be sure to use a pillow and perform frequent checks to avoid injury.
Lateral
The patient is on their side. Areas to be aware of are along the side that is bearing weight — if a patient is on their left side, their left ear, shoulder, elbow, hip, knee, and ankle are potential areas for pressure issues.
Prone
The patient is flat on their stomach. When using the prone position, ensure that the patient is able to breathe properly by turning their head to the side. One arm may be bent up with the hand by the head, while the other may be down at the side. Prone positioning is typically used for short amounts of time under close supervision.
Trendelenburg
The patient is supine, with the head of the bed angled lower than the feet. Injuries can occur if a patient slides down the bed, causing friction, shear, or even head injuries. This position is common in procedural areas and is not used without supervision.
Reverse Trendelenburg
The patient is supine, with the head of the bed angled higher than the feet. Friction and shear are major risks. Reverse Trendelenburg is also more common in surgical procedures.
Nursing Considerations When Changing Positions for Patients
As with any procedure, first introduce yourself and educate the patient on why they are being repositioned. Ask about their preferences before choosing a new position on their behalf.
Another priority is respecting any previous injuries or limitations and ensuring that any equipment is not harming the patient. As much as they are able, the patient should assist with repositioning.
Remember that repositioning a patient doesn’t always have to mean changing their position entirely. Shifting a pillow from one side to the other, placing a foam pillow under the knees, or adjusting the head of the bed can all be small yet meaningful positioning tweaks if you’re not making a major change.
Repositioning can be a risky procedure for staff, and maintaining your own safety is essential. Here are some tips:
- Ask for help from other staff members.
- Use aids like patient lifts whenever possible.
- Raise the bed to align with your center of gravity.
- Avoid twisting.
- Keep your back in a neutral position, and tighten your abdomen and back.
- Let your legs do most of the work.
- Lift rather than slide the patient to avoid friction.
Positioning a Patient for Surgery: Special Considerations
Surgical patients under general anesthesia cannot move or communicate. That’s why patient positioning is of major importance for OR nurses, who serve as the patient’s advocate when they cannot speak for themselves.
Positioning in the operating room prioritizes the items above, with the addition of these items:
- Site: Providing adequate access to the surgical area.
- Protection: Ensuring that fingers, toes, and genitals are shielded from injury.
- Cushioning: Padding for muscles, nerves, and bony prominences.
The most common nerve positioning injuries in the OR are to the brachial plexus, peroneal, and facial areas. Patients who are underweight or obese, have poor nutritional status, are over 70 years old, or have preexisting conditions are especially at risk for positioning injuries.
The Importance of Frequent Repositioning in Nursing
While repositioning sounds like a relatively mundane nursing task, it’s extremely essential. Pressure injuries (PIs) that result from positioning harm patients and can even lead to death. Some estimates show that 2.5 million hospital-acquired PIs occur each year in the United States. It’s for this reason that most facilities require patient turns every two hours.
PIs occur as a direct result of prolonged pressure, most commonly on bony prominences and areas beneath medical devices. They’re often used as a nursing-sensitive quality care indicator, which are metrics assessing patient outcomes that are directly influenced by nursing care. However, they’re also the result of structural issues such as short staffing and a lack of support.
Once a patient has a pressure injury, it can be very difficult to heal. The affected area needs lessened pressure to allow blood flow and tissue repair. Professionals like wound care nurses and wound care nurse practitioners specialize in pressure injury treatment and healing.
Get Ready to Care For Your Next Patient
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