The Importance of Frequent Repositioning
For residents with limited mobility, spending extended periods in a wheelchair can lead to a host of serious health complications, with pressure injuries being one of the most common and preventable issues. A Certified Nursing Assistant's (CNA) diligence in following proper repositioning protocols is a cornerstone of effective, compassionate care that prioritizes resident safety and well-being.
The Standard Repositioning Schedule for Wheelchair Users
While the specific frequency can vary based on a resident's individualized care plan, the widely accepted standard for how often residents in wheelchairs be repositioned in CNA is at least every hour. For bedbound residents, the guideline is typically every two hours. The more frequent schedule for wheelchair users is necessary because the seating position puts direct, sustained pressure on key bony prominences, such as the tailbone (coccyx), buttocks, and hips, which have minimal cushioning. Maintaining consistent pressure on these areas, combined with the forces of friction and shear, can quickly damage skin and underlying tissue.
Factors Influencing Repositioning Frequency
Customizing a resident's repositioning schedule is vital for providing person-centered care. The CNA, in collaboration with nursing staff, should consider several factors:
- Skin Condition: Residents with delicate or compromised skin, a history of pressure injuries, or areas of redness require more frequent checks—sometimes as often as every 15 minutes.
- Mobility Level: Residents who can shift their weight or reposition themselves independently may require less hands-on assistance, but should still be reminded to do so frequently.
- Medical Conditions: Conditions like diabetes, poor circulation, or neurological disorders can increase the risk of skin breakdown and necessitate a stricter repositioning schedule.
- Type of Cushion: A resident using a standard foam cushion will need more frequent repositioning than someone with a specialized pressure-relieving air or gel cushion.
Proper Repositioning Techniques
CNAs play a pivotal role in ensuring proper positioning to maximize comfort and minimize risk. Here are key techniques for repositioning a resident in a wheelchair:
- Assess the Resident: Before moving, explain the procedure to the resident. Assess their comfort level, check for red or painful areas on their skin, and note their ability to assist.
- Use a Gait Belt: For residents who can bear some weight, a gait belt is a crucial safety device. It provides a secure grip point for the CNA, protecting both parties from injury during the lift or shift.
- Ensure Proper Body Mechanics: Lock the wheelchair brakes. Stand in front of the resident, bending your knees and bracing their legs with your own. Keep your back straight and lift with your legs to prevent straining.
- Boost the Resident Up: For a resident who has slid down, help them to stand or perform a weight-shifting boost. Once in a standing position, or partially standing, smooth out any wrinkles in their clothing or cushion.
- Re-Position the Resident: Help the resident to sit back in the chair with their hips fully against the backrest. Their feet should be placed flat on the footrests, not dragging or caught behind the leg supports.
- Use Pillows and Cushions: Place pillows behind the back for support, under the arms, or to elevate the heels if necessary. This helps offload pressure and maintain proper alignment.
Documenting Repositioning
Documentation is not just a procedural step; it is a critical component of resident safety. A CNA must record each time a resident is repositioned, noting the time and the new position. This creates a record that ensures continuity of care, especially across different shifts, and holds all staff accountable for following the established care plan. Accurate documentation helps identify patterns of risk and informs necessary adjustments to the care plan. It is a safeguard against potential neglect and contributes to better overall outcomes.
Comparison: Wheelchair vs. Bed Repositioning
| Feature | Wheelchair Repositioning | Bed Repositioning |
|---|---|---|
| Standard Frequency | At least every 1 hour | At least every 2 hours |
| Primary Goal | Relieve pressure on coccyx, hips, and buttocks to prevent ulcers | Relieve pressure on back, heels, hips, and shoulders to prevent ulcers |
| Common Positions | Proper seated alignment, 30° tilt, forward lean | Supine, lateral, Sims', Fowler's |
| Key Risks | Shear and friction from sliding; pressure on bony areas | Prolonged pressure leading to skin breakdown |
| Tools Used | Pressure-relieving cushions, gait belts, pillows, leg rests | Draw sheets, pillows, heel protectors, wedges |
Potential Challenges in Repositioning and Best Practices
Understaffing and high workloads are persistent challenges in many care facilities, which can make it difficult for CNAs to adhere strictly to hourly repositioning schedules. This is a systemic issue that impacts resident care and can lead to adverse health events.
Best practices for CNAs to manage these challenges include:
- Time Management: Organizing tasks efficiently to ensure repositioning rounds are prioritized.
- Communication: Clearly communicating with other staff to ensure coverage and avoid missed turns.
- Advocacy: Raising concerns about unsafe staffing levels to supervisors to advocate for better resident care. For more detailed nursing procedures and safety guidelines, consult authoritative resources like the National Center for Biotechnology Information.
Conclusion
For CNAs, understanding how often should residents in wheelchairs be repositioned in CNA is a foundational aspect of competent care. By adhering to the standard hourly schedule, individualizing care plans, and using proper techniques, CNAs directly contribute to the prevention of pressure injuries and a higher quality of life for residents. The commitment to diligent repositioning is a powerful demonstration of a CNA's professional dedication to health, comfort, and safety.
