Repositioning a patient who has limited mobility is a fundamental aspect of safe and compassionate care. This regular movement, known as turning and positioning, maintains comfort and prevents complications associated with prolonged immobility. Shifting body weight helps normalize blood flow and relieve sustained pressure over bony areas. Failing to reposition a patient quickly leads to tissue damage, manifesting as pressure injuries, commonly called bedsores, which are painful and difficult to heal.
Essential Preparation and Caregiver Safety
Before attempting any movement, assess the patient’s condition, including their current pain level and their ability to assist with the maneuver. Gather all required equipment, such as a friction-reducing device or a draw sheet, and ensure all tubing and medical lines are clear and untangled. The bed wheels must be locked, and the bed should be raised to a comfortable working height, typically around the caregiver’s waist, to minimize bending.
Caregiver safety depends on proper body mechanics to reduce the risk of back injury. Always bend the knees and keep the back straight, engaging the large leg muscles for power. Maintain a wide, stable stance and shift body weight from the back foot to the front foot during the pull or push motion. This ensures the work is done by the leg muscles, preventing unnecessary strain for both the patient and the caregiver.
Technique for Moving the Patient Up in Bed
Moving a patient vertically toward the head of the bed is necessary because gravity causes sliding, especially if the head of the bed is elevated. A draw sheet or slide sheet must be used to reduce friction and shear force on the patient’s skin, which can cause tissue damage. If two caregivers are available, one should stand on each side, grasping the rolled edges of the sheet near the patient’s shoulders and hips.
Caregivers should coordinate the move using a clear count, pulling the sheet toward the head of the bed while shifting their body weight backward. Lowering the head of the bed to a flat position before the move reduces effort and minimizes damaging shear forces. If the patient is conscious, ask them to bend their knees and push with their feet, or to cross their arms over their chest, allowing them to assist and protecting their limbs. A single caregiver must perform the move in segments, first moving the upper body and then the hips, repositioning between segments to maintain safe body mechanics.
Turning the Patient for Pressure Relief
Turning the patient onto their side is a primary defense against pressure injuries, shifting weight off bony prominences and allowing blood flow to return to those areas. The goal is to achieve a 30-degree lateral tilt, which is a semi-side-lying position. This position places body weight on the large, fleshy muscles of the buttocks and back, rather than directly on the hip bone (trochanter). To prepare, move the patient toward the side of the bed opposite the direction of the turn. This creates momentum and prevents the patient from rolling out of bed.
Before the roll, position the patient’s arms and legs. The arm opposite the direction of the turn should be placed across the chest, and the far leg should be crossed over the near leg. Execute the turn by placing one hand on the patient’s shoulder and the other on the hip, rolling the patient gently toward the caregiver. For patients with spinal concerns, a log-rolling technique is used. This keeps the head, neck, and torso perfectly aligned, moving the patient as one solid unit to prevent twisting of the spine. Place a pillow or wedge behind the patient’s back to maintain the 30-degree position and ensure stability.
Final Positioning and Repositioning Schedule
After a successful turn, the patient’s body must be properly supported to ensure comfort and to maintain the pressure-relieving position. Place pillows under the patient’s uppermost arm and between their bent knees to keep the hips aligned and prevent bone-on-bone contact. Ensure the patient’s heels are completely suspended off the mattress, often achieved by placing a pillow beneath the lower legs to elevate the ankles.
The head of the bed should be elevated no more than 30 degrees, as higher angles increase the risk of sliding and creating shear forces on the sacrum. A fixed repositioning schedule is non-negotiable for pressure injury prevention. The widely accepted standard is a turn every two hours, though individual needs may require more frequent changes. Complete the process by confirming the call light is within easy reach and that the bed rails are positioned according to the patient’s safety plan.