The following are reasons for changing a patient's position.

1. To promote comfort and relaxation.

2. To restore body function.

   • Changing positions improves gastrointestinal function.

   • It also improves respiratory function.

     • Changing positions allows for greater lung expansion.

     • It relieves pressure on the diaphragm.

3. To prevent deformities.

   • When one lies in bed for long periods of time, muscles become atonic and atrophy.

   • Prevention of deformities will allow the patient to ambulate when his activity level is advanced.

4. To relieve pressure and prevent strain (which lead to the formation of decubiti).

5. To stimulate circulation.

6. To give treatments (that is), range of motion exercises).

1. Maintain good patient body alignment. Think of the patient in bed as though he were standing.

2. Maintain the patient's safety.

3. Reassure the patient to promote comfort and cooperation.

4. Properly handle the patient's body to prevent pain or injury.

5. Keep in mind proper body mechanics for the practical nurse.

6. Obtain assistance, if needed, to move heavy or helpless patients.

7. Follow specific physician's orders. A physician's order, such as one of the following, is needed for the patient to be out of bed.

   • "Up ad lib."

   • "Up as desired."

   • "OOB" (out of bed).

8. Do not use special devices (that is., splints, traction) unless ordered. Ask if you do not know what is allowed.

a. General Principles for Turning the Adult Patient.

Sometimes the physician will specify how often to turn a patient. A schedule can be set up for turning the adult patient throughout his "awake" hours. The patient should be rotated through four positions (unless a particular position is contraindicated):

1. Prone (see figure 4-1 and section 4-13).

2. Supine (figure 4-2 and section 4-13).

3. Left Sim's (figure 4-3).

4. Right Sim's (figure 4-3).

Plan a schedule and follow it. Record the position change each time to ensure that all positions are used.

Figure 4-1. Prone position.

Figure 4-2. Supine position.

Figure 4-3. Sim’s position.

One example of a schedule for turning would be:

1000-- Prone position

1200--Left Sim's position

1400--Supine position

1600--Right Sim's position

1800--Prone position

Notice that in the preceding sequence, the patient is required to make only a quarter turn rather than a half turn each time the position is changed. If the patient experiences pain while turning, a quarter turn will be less painful than a half turn.

Certain conditions may make it impossible to turn the patient. Turning may be impossible if the patient has fractures that require traction appliances. Turning may be harmful to patients with spinal injuries. In these cases, you need to rub the back by lifting the patient slightly off the bed and massaging with your hand held flat. It is especially important to prevent skin breakdowns in the person who lies on his back for long periods of time.

NOTE: For the initial development of skin breakdown, a patient does not have to lie on his back for long periods of time, especially if moisture and sheet wrinkles are present.

You may want to turn a patient only to wash or rub the back or change the bed.

Logrolling (see figure 4-4).

Description.

1. Logrolling is a technique used to turn a patient whose body must at all times be kept in a straight alignment (like a log).

2. This technique is used for the patient who has a spinal injury.

3. Logrolling is used for the patient who must be turned in one movement, without twisting.

4. Logrolling requires two people, or if the patient is large, three people.

Technique.

1. Wash your hands.

2. Approach and identify the patient (by checking the identification band) and explain the procedure (using simple terms and pointing out the benefits).

3. Provide privacy.

4. Position the bed.

   • The bed should be in the flat position at a comfortable working height.

   • Lower the side rail on the side of the body at which you are working.

5. Position yourself with your feet apart and your knees flexed close to the side of the bed.

6. Fold the patient's arms across his chest.

7. Place your arms under the patient so that a major portion of the patient's weight is centered between your arms. The arm of one nurse should support the patient's head and neck.

8. On the count of three, move the patient to the side of the bed, rocking backward on your heels and keeping the patient's body in correct alignment.

9. Raise the side rail on that side of the bed.

10. Move to the other side of the bed.

11. Place a pillow under the patient's head and another between his legs.

12. Position the patient's near arm toward you.

13. Grasp the far side of the patient's body with your hands evenly distributed from the shoulder to the thigh.

14. On the count of three, roll the patient to a lateral position, rocking backward onto your heels.

15. Place pillows in front of and behind the patient's trunk to support his alignment in the lateral position.

16. Provide for the patient's comfort and safety.

    • 1 Position the call bell.

    • 2 Place personal items within reach.

    • 3 Be sure the side rails are up and secure.

17. Report and record as appropriate.

Patients who must lie on their backs much of the time should be kept as comfortable as possible to prevent body deformities. The paraplegic and quadriplegic may not be able to tell you if their position is uncomfortable. You must be especially attentive in this case to prevent possible problems from malalignment.

Pillows can be used to support the patient's head, neck, arms, and hands and a footboard used to support the feet.

1. Proper alignment gives respiratory and digestive organs room to function normally.

2. The footboard is slanted to support the feet at right angles to the leg (a normal angle) and prevent foot drop.

If the patient's trunk must lie flatter than the neck and head:

1. The patient should have only one pillow to support the head and neck.

2. The patient may have a pillow placed under the legs to prevent pressure on the heels.