Moving a patient in bed You must move or pull someone up in bed the right way to avoid injuring the patient's shoulders and skin. Using the right method will also help protect your back. It takes at least 2 people to safely move a patient up in bed. Friction from rubbing can scrape or tear the person's skin. Common areas at risk for
friction are the shoulders, back, buttocks, elbows, and heels. Never move patients up by grabbing them under their arms and pulling. This can injure their shoulders. A slide sheet is the best way to prevent friction. If you do not have one, you can make a draw sheet out of a bed sheet folded in half. Follow these steps to prepare the patient: Pulling upThe goal is to pull, not lift, the patient toward the head of the bed. The 2 people moving the patient should stand on opposite sides of the bed. To pull the person up both people should:
If using a slide sheet, make sure to remove it when you are done. If the patient can help you, ask the patient to:
ReferencesAmerican Red Cross. Assisting with positioning and transferring. In: American Red Cross. American Red Cross Nurse Assistant Training Textbook. 4th ed. American National Red Cross; 2018:chap 11. Craig M. Essentials of patient care for the sonographer. In: Hagen-Ansert S, ed. Textbook of Diagnostic Sonography. 8th ed. St Louis, MO: Elsevier; 2018:chap 2. Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M. Body mechanics and positioning. In: Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M, eds. Clinical Nursing Skills: Basic to Advanced Skills. 9th ed. New York, NY: Pearson; 2017:chap 12. Version InfoLast reviewed on: 10/23/2021 Reviewed by: Jennifer K. Mannheim, ARNP, Medical Staff, Department of Psychiatry and Behavioral Health, Seattle Children's Hospital, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.  Pressure injuries (AKA pressure ulcers) impact an estimated 2.5 million patients each year in U.S. acute care facilities[1]. While some pressure injuries are unavoidable, most can be prevented, and an effective way to prevent a pressure injury is by moving and changing position frequently. The current accepted “guideline for care” is to turn patients every two hours[2]; however, there is much more involved in finding the right solution for your patient. The frequency of turns should be individualized to your patient based on such factors as:
Testing a patient’s tissue tolerance involves documenting the time it takes the skin to redden over bony prominences. The test is a step-by-step procedure, where the caregiver gradually increases the amount of time the patient is left in the same position until reddened skin is detected. Once that time has been established, set the turn frequency to 30 minutes less than the time interval. In addition to determining the frequency of turn, you also need to move and reposition the patient using proper technique. First, when you reposition the patient, make sure that pressure is actually relieved or redistributed. Second, avoid positioning the individual on bony prominences with existing non-blanchable skin, which is an early sign of skin breakdown. Third, lift—don’t drag—the patient while repositioning. This will reduce damage to skin due to friction and shear. Bed Positioning Reposition bedridden patients according to the “Rule of 30.” A good guideline for repositioning a bedridden patient is the “Rule of 30”[4]. The Rule of 30 means the head of the bed is elevated at no more than 30 degrees from horizontal and the body is placed in a 30-degree, laterally inclined position. In the laterally inclined position, tilt the patient’s hips and shoulders 30 degrees from supine, and use pillows or wedges to keep the patient positioned without pressure over the hips or buttocks. Repositioning can be difficult. Here are some helpful step-by-step tips for repositioning: Getting a patient ready
If you are turning the patient onto the stomach, make sure the person’s bottom hand is above the head first. Turning a patient
You may need to repeat steps 3 and 4 until the patient is in the right position. When the patient is in the right position Rule of 30 guidelines.
Seated Repositioning Seated patients need to be turned more frequently than bed-bound patients. Teach the chair-bound patient to shift his or her weight every 15 minutes. If the patient is unable to reposition, move the patient every hour. In addition, use a pressure redistribution cushion, which will distribute the weight of the body without impeding function or increasing potential for skin damage. Use pressure redistribution cushions
for correct fit — and to prevent skin breakdown. When working with seated patients, ensure the equipment is properly fitted. Observe for the “hammock effect,” where a sagging seat causes a patient’s thighs to roll inward and expose the hips to pressure from the sides of the chair. Also, poor-fitting chairs can cause patients to slouch, which will lead to increased pressure on the buttocks, thighs and spine. Placing a cushion on a sagging seat will not fix the problem; you’ll need to replace the sagging seat with a solid seat that’s covered with an appropriate pressure-reducing cushion. Mobilizing and repositioning bedbound and chair-bound patients is just part of the care to prevent the development of pressure injuries, and each patient will present different needs. Other factors, such as the patient’s nutrition, medical condition, skin condition, and tissue tolerance will also impact the treatment objective and patient outcome. Taking into account the whole picture will help yield better results. [1] Wound Care Education Institute, 2015. [2] Journal of Rehabilitation Research & Development (JRRD): http://www.rehab.research.va.gov/jour/2013/504/peterson504.html [3] National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Emily Haesler (Ed.). Cambridge Media: Osborne Park, Western Australia; 2014. [4] Wound Care Education Institute, 2015 [5] Medline Plus. U.S. National Library of Health; 2014. https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000426.htm For more information about preventing pressure and treating pressure injuries, see related articles and resources here: Which positioning aid increases cervical flexion?Which positioning aid increases the cervical flexion? Rationale: When thick pillows are used under the patient's head, it increases cervical flexion.
Which positioning of the patient by the nurse will help prevent flexion contracture of the cervical vertebrae?Prone position is the only bed position that allows full extension of the hip and knee joints. It also helps to prevent flexion contractures of the hips and knees. Contraindicated for spine problems.
Which positioning aid prevents external rotation of the hips when the patient is in supine position?Trochanter Roll
This technique prevents external rotation of the hips when a patient is in a supine position. A rolled up towel is placed slightly underneath each hip.
Which aspect of positioning a patient in the supported Fowler's position?Fowler's Position
The patient's arms should be flexed and secured across the body, the buttocks should be padded, and the knees flexed 30 degrees. In Fowler's position, the patient is at an increased risk for air embolism, skin injury from shearing and sliding, and DVT forming in the patient's lower extremities.
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Which positioning aid decreases the shearing action from sliding across up and down in bed?
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