For bedridden individuals, regular changes in body position are fundamental to their care. This consistent repositioning is important for maintaining overall health and preventing serious complications from prolonged immobility. This guide details the importance of turning patients, how often it should occur, and safe methods.
Why Patient Turning is Essential
Regular repositioning of bedridden patients offers several physiological benefits. It primarily prevents pressure injuries (bedsores), which occur when sustained pressure reduces blood flow to the skin and underlying tissues. Turning helps to redistribute pressure, ensuring adequate circulation to vulnerable areas of the body, such as the heels, sacrum, hips, and elbows.
Beyond skin health, repositioning promotes better blood circulation, helping to prevent issues like blood clots. It also supports respiratory health by allowing for better lung expansion and aiding in the clearance of secretions, which can reduce the risk of pneumonia. Repositioning helps maintain joint mobility and flexibility, preventing stiffness and contractures. It also enhances patient comfort and contributes to their overall sense of dignity.
Determining Turning Frequency
The general guideline for turning bedridden patients is every two hours. This frequency aims to prevent the sustained pressure that can lead to tissue damage. However, the optimal turning schedule is highly individualized and depends on several factors specific to each patient.
The patient’s skin condition and integrity are important considerations; individuals with fragile or compromised skin may require more frequent repositioning. Their level of mobility and ability to independently shift also influences the turning schedule, with less mobile patients needing more assistance. The patient’s overall health status and existing medical conditions, such as diabetes or circulatory issues, can affect tissue tolerance and increase their susceptibility to pressure injuries, necessitating more frequent turns.
The type of mattress or pressure-relieving support surface used also plays a role, as some specialized surfaces can help distribute pressure more effectively, potentially allowing for slightly longer intervals between turns, though the two-hour standard often remains a baseline. Finally, the presence of any existing pressure injuries requires careful management and may dictate a more intensive turning regimen to promote healing and prevent further damage.
Safe Turning Methods
Safely turning a patient involves careful planning and proper technique to protect both the patient and the caregiver. Before initiating a turn, assess the patient’s comfort and their ability to assist with the movement. If the patient is heavy or uncooperative, enlisting assistance from another person can prevent injury to the caregiver. Caregivers should use proper body mechanics, which includes maintaining a straight back, bending at the knees, and using leg muscles for lifting to prevent strain.
Assistive devices can facilitate safe turning. Tools like draw sheets or slide sheets reduce friction and shear forces on the patient’s skin, making it easier to move them without dragging. Trapeze bars, if available, allow patients to assist in their own repositioning by pulling themselves up.
Common turning positions include side-lying, often at a 30-degree angle to avoid direct pressure on the hip bone, or semi-Fowler’s position where the head of the bed is elevated. After repositioning, ensure proper alignment and support using pillows to cushion bony prominences and maintain comfort. Immediately after turning, a thorough check of the patient’s skin should be performed for any signs of redness or irritation.
Recognizing and Preventing Pressure Injuries
Pressure injuries are localized areas of skin and soft tissue damage caused by prolonged pressure, often combined with friction and shear forces. These injuries typically occur over bony prominences where tissue is compressed between bone and an external surface. Initial indicators may include persistent redness or discoloration of the skin that does not blanch (turn white) when pressed, warmth, swelling, or a feeling of hardness in the affected area. As pressure injuries progress, they can manifest as blistering or open sores.
Beyond regular turning, several other strategies are important for preventing pressure injuries. Daily skin inspection is crucial, especially over high-risk areas like the sacrum, heels, and hips, to detect early changes. Keeping the patient’s skin clean and dry helps maintain its integrity, as moisture can increase the risk of breakdown.
Ensuring adequate nutrition and hydration supports skin health and tissue repair. The use of specialized pressure-relieving devices, such as foam or alternating pressure mattresses and cushions, can further distribute weight and reduce pressure on vulnerable areas. Minimizing friction and shear forces during movement by lifting rather than dragging patients is also important. If any signs of a pressure injury are observed, prompt medical advice should be sought to prevent worsening of the condition.