Patient Positioning – Nursing is a profession within the healthcare sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other healthcare providers by their approach to patient care, training, and scope of practice. Nurses practice in many specialisms with differing levels of prescriber authority.
Many nurses provide care within the ordering scope of physicians, and this traditional role has shaped the public image of nurses as care providers. However, nurses are permitted by most jurisdictions to practice independently in a variety of settings depending on training level. In the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.
Nurses develop a plan of care, working collaboratively with physicians, therapists, the patient, the patient’s family, and other team members, that focus on treating illness to improve quality of life. Nurses may help coordinate the patient care performed by other members of an interdisciplinary healthcare team such as therapists, medical practitioners, and dietitians. Nurses provide care both interdependently, for example, with physicians, and independently as nursing professionals.
Patient Positioning
Definition of Positioning:
Positioning is a nursing intervention defined as deliberate placement of the patient or a body part to promote physiological and/or psychological well-being.
or
Positioning of the patient in bed may be defined as placing the patient in good body alignment as needed therapeutically.
Types of Positioning in Bed:
1. Supine position.
2. Prone position.
3. Lateral position or Inside line position.
4. Sims’ position.
5. Fowler’s position
- a) High Fowler’s position:-60-90° angled
- b) Mid Fowler’s position:-45° angled.
- c) Low fowler’s position: -30° angled
6. Orthopneic position.
7. Lateral oblique position.
8. Trendlenburg position.
9. Dorsal recumbent position.
10. Knee-chest position.
11. Lithotomy position.
Some of the example of the positioning of patient in bed with short description of each of them are given below:
A. Supine position – Patient lies flat on back. Additional supportive devices may be added for comfort
B. Prone position – Patient lies on stomach with head turned to the side.
C. Sims position – Patient lies between supine and prone with legs flexed in front of the patient. Arms should be comfortably placed beside the patient, not underneath.
D. Fowler’s position – Patient’s head of bed is placed at a 45-degree angle. Hips may or may not be flexed. This is a common position to provide patient comfort and care.
E. Semi-Fowler’s position – Patient’s head of bed is placed at a 30-degree angle. This position is used for patients who have cardiac or respiratory conditions, and for patients with a nasogastric tube.
F. Orthopneic or tripod position – Patient sits at the side of the bed with head resting on an over-bed table on top of several pillows. This position is used for patients with breathing difficulties
G. Trendelenburg position – Place the head of the bed lower than the feet. This position is used in situations such as hypotension and medical emergencies. It helps promote venous return to major organs such as the head and heart.
Purposes of Positioning:
1. To promote comfort to the patient.
2. To prevent complications caused by immobility.
3. To stimulate circulation.
4. To promote normal physiological functions
General principles for positioning:
1. Change the inactive patient’s position at least every 2 hours. 2. Maintain good body mechanics 3. Obtain assistance as required 4. Ensure that the mattress is firm and level of bed is at working height.
5. Raise the bed to an appropriate height. 6. Remove pillows and positioning devices. 7. Unfasten drainage tubes from the bed linen. 8. Turn the patient as a complete unit to avoid twisting the spine
9. Place the patient in good alignment, with joints slightly flexed.
10. Replace pillows and positioning devices.
11. Support limbs in a functional position.
12. Ensure patient comfort.
13. Wash hands before and after procedure.
Articles Need for Positioning:
1. Clean, dry firm bed.
2. Different types of mattresses.
3. Bed boards.
4. Pillows.
5. Foot board/foot boot.
6. Sand bags.
7. Hand rolls
8. Trochanter rolls.
9. Bed blocks.
10. Over bed table.
11. Additional sheets.
12. Trapeze bar.
[Articles are used as per requirement of each type of position. Additional articles may be used as per availability]
Purposes of Fowler’s position:
1. To relieve or minimize dyspnea.
2. To relieve tension on abdominal sutures.
Procedure of Fowler’s Position:
1. Inform patient of the position, he will be in and provide needed explanation.
2. Elevated head of the bed-Fowler’s (45 to 90 degree) Semi Fowler’s (15 to 45 degree) High Fowler’s (90 degree)
3. Rest head against mattress or small pillow.
4. Use pillow to support arm.
5. Place a small pillow at lower back.
6. Place a small pillow / roll under thigh.
7. Place small pillow under ankle.
8.Place foot board at bottom of patient’s feet.
Problem to Be Prevented In Fowler’s Position:
1. Posterior flexion of lumbar curvature.
2. Hyperextension of neck.
3. Edema of hands and arms.
4. Possible dislocation of shoulder.
5. Flexion contracture of the wrist.
6. Hyperextension of the knees.
7. External rotation of hips (Trochanter roll to be placed).
8. Pressure on heals.
9. Plantar flexion of feet/foot drop
Indications of Prone Position:
1. For patient with pressure sores, burns, injuries and operations on the back.
2. For patients after 24 hours of amputation of lower limbs.
3. Position for renal biopsy
Problems to Be Prevented In Prone Position:
1. Flexion/hyperextension of neck.
2. Hyperextension of lumbar curvature.
3. Pressure on breasts, heels and genitals.
4. Foot drops.
Indications of Side Lying Position:
1. Patients who require periodic position changes e.g. bed ridden patient.
2. In immediate postoperative patients to prevent the risk of aspiration (except in spinal and epidural)
Problems to Be Prevented In Side Lying Position:
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.
Indications of Sim’s Position:
1. Vaginal and rectal examination.
2. Administration of enema and suppository.
3. Position for sigmoidoscopy and proctoscopy.
Problems to be prevented:
1. Lateral flexion of neck.
2. Internal rotation of shoulder.
3. Internal rotation and adduction of hip and leg
4. Foot drop.
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