How to position a patient in a hospital bed: a caregiver’s guide

The Centers for Disease Control and Prevention (CDC) estimates that pressure injuries, or bedsores, affect millions of patients each year, many of whom are bedridden. A primary strategy for preventing these painful sores is to understand how to position a patient in a hospital bed properly and safely. This guide provides essential techniques for caregivers to ensure patient comfort and prevent injury.

Quick Summary

Safely positioning a patient in a hospital bed involves using proper body mechanics, assistive devices like draw sheets, and frequent position changes to prevent pressure injuries. It requires careful technique and communication to ensure patient comfort and avoid strain for both the patient and caregiver.

Key Points

• Use Proper Body Mechanics: Bend your knees and use a draw sheet when moving patients to prevent caregiver back injury.

• Reposition Frequently: Turn or reposition bedridden patients at least every two hours to prevent pressure injuries (bedsores).

• Utilize a Draw Sheet: A slide or draw sheet is the safest tool for moving a patient up or turning them in bed, reducing friction and shear.

• Provide Strategic Support: Use pillows and foam wedges to maintain spinal alignment and support limbs in various positions, such as the lateral position.

• Monitor Skin Condition: Regularly inspect the patient's skin, especially over bony prominences, for redness or irritation that could indicate pressure damage.

• Prioritize Communication: Always explain the repositioning process to the patient, ensuring their cooperation and maintaining their sense of dignity.

• Ensure Comfort and Safety: Lock bed wheels, raise the bed to a working height, and confirm the patient is comfortable and securely positioned before leaving.

Importance of Proper Patient Positioning

Proper patient positioning is more than just a matter of comfort; it is a critical component of comprehensive care for bedridden or mobility-impaired individuals. Frequent repositioning and correct alignment are crucial for several reasons:

• Preventing pressure injuries (bedsores): Sustained pressure on bony areas of the body can reduce blood flow, leading to tissue damage and open wounds. Regular repositioning redistributes pressure, allowing blood to circulate freely.
• Promoting circulation: Changing a patient's position helps prevent blood pooling in the limbs, which can lead to complications like deep vein thrombosis (DVT).
• Maintaining skin integrity: Reducing friction and shear force—the sliding motion that can damage skin layers—is vital. Proper lifting and moving techniques minimize this risk.
• Enhancing respiratory function: Certain positions, like Fowler’s, can improve lung expansion and make breathing easier for patients with respiratory issues.
• Improving comfort and dignity: Regularly adjusting a patient's position alleviates discomfort and stiffness, contributing to their overall well-being and sense of dignity.

Essential Equipment and Preparation

Before beginning, gather all necessary supplies and prepare the environment to ensure safety for both you and the patient.

• Adjustable hospital bed: Use the bed's controls to raise it to a comfortable working height (around waist level) to prevent caregiver back strain. Lock the bed wheels to prevent movement.
• Draw sheet or slide sheet: A draw sheet is a folded sheet placed under the patient from the shoulders to the thighs. A specialized slide sheet, made of low-friction material, is also highly effective. Never pull or drag a patient by their limbs.
• Pillows and wedges: These are essential for providing support and maintaining correct body alignment in different positions.
• Communication: Clearly explain each step to the patient, even if they appear unresponsive. Communication helps build trust and can encourage cooperation.

Techniques for Repositioning a Patient

1. Moving a Patient Up in Bed

For patients who have slid down in the bed, use the following method, ideally with a second person to assist.

1. Preparation: Lock the bed wheels. Raise the bed to a comfortable height. Both caregivers should stand on opposite sides of the bed.
2. Position the patient: Ask the patient to bend their knees, with their feet flat on the bed. Have them cross their arms over their chest. Place the draw sheet under the patient, covering the area from their shoulders to their hips.
3. Lift and move: On the count of three, both caregivers should grasp the draw sheet firmly and lift together, shifting the patient towards the head of the bed. Use your legs and core strength, not your back, and avoid any dragging motion.
4. Secure the position: Once the patient is in place, you can slightly elevate the foot of the bed and place a pillow under their knees to prevent them from sliding down again.

2. Turning a Patient Onto Their Side (Lateral Position)

This is a common position to relieve pressure on the back.

1. Preparation: Move the patient to the side of the bed opposite the direction you plan to turn them. Lock the bed wheels and raise it to waist level. Stand on the side toward which you will be turning the patient.
2. Position the patient's limbs: Cross the patient's arm closer to you over their chest. Cross the far leg over the near one, or bend the knee of the leg that will be on top.
3. Perform the turn: Place one hand on the patient's shoulder and the other on their hip. Roll them gently toward you, using your body weight to assist.
4. Support and secure: Once on their side, place a pillow behind the patient's back for support. Use another pillow between their knees and ankles to keep the spine aligned and prevent pressure. Ensure their lower arm is not trapped under their body.

3. Fowler's and Semi-Fowler's Position

This semi-seated position is beneficial for breathing and eating.

• Semi-Fowler's (30-45 degrees): Raise the head of the bed to a 30-45 degree angle. This helps reduce lower back pain and is often used post-surgery. Use a pillow under the patient's knees to prevent them from sliding down.
• Fowler's (45-60 degrees): Raise the head of the bed further to a 45-60 degree angle. This position is particularly helpful for patients experiencing respiratory distress or during meals.

Comparison of Patient Positions

Position	Description	Key Benefits	Best For	Considerations
Supine	Lying flat on the back.	Spinal alignment, general rest.	Post-operative recovery, general exams.	High risk for pressure ulcers on heels, tailbone, and head. Must be monitored.
Lateral	Lying on one side.	Reduces pressure on the back, aids circulation.	Preventing bedsores, improved breathing for some patients.	Ensure proper support with pillows between knees and behind back.
Fowler's/Semi-Fowler's	Semi-seated with head of bed elevated.	Enhances respiratory function, aids digestion.	Patients with breathing issues, feeding time, cardiac conditions.	Use a pillow under knees to prevent sliding down. Monitor for DVT.
Prone	Lying flat on the stomach.	Full extension of hip and knee joints, aids in some respiratory conditions.	Specific medical conditions (e.g., ARDS).	Contraindicated for spinal problems. Requires careful monitoring and positioning.

Additional Considerations for Safe Caregiving

• Establish a turning schedule: Reposition the patient at least every two hours, alternating between their back, right side, and left side. Keep a chart or log to track positions and timing.
• Assess skin condition: During each repositioning, perform a quick skin check, particularly over bony areas (heels, tailbone, hips, elbows). Look for any signs of redness, warmth, or irritation, and report concerns to a healthcare provider.
• Encourage active participation: If the patient has some mobility, encourage them to help as much as possible. Even small movements can reduce friction and make the process easier.
• Prioritize body mechanics: Always use proper lifting techniques—bend your knees, keep your back straight, and use a draw sheet. If the patient is heavy, ask for assistance to avoid caregiver injury.

Conclusion

Mastering how to position a patient in a hospital bed is a foundational skill for caregivers, directly impacting the patient’s health and comfort. By combining proper technique, the use of assistive devices like draw sheets, and a consistent repositioning schedule, you can prevent serious complications like bedsores. Remember, every patient is unique, and communication is key to ensuring their comfort throughout the process. For more detailed medical advice, always consult with a qualified healthcare professional or a registered nurse. For more information on preventing pressure injuries, visit the Wound, Ostomy and Continence Nurses Society website https://www.wocn.org/.

Frequently Asked Questions

How often should you reposition a patient in bed?

Patients should be repositioned at least every two hours. Some individuals with fragile skin or specific medical conditions may require more frequent turning. Always follow a healthcare provider’s recommendation.

What is the best technique for moving a patient up in bed?

The safest technique is to use a draw sheet with a two-person team. With the patient's knees bent and arms crossed, each person uses the sheet to lift and slide the patient towards the head of the bed, avoiding friction.

How can I prevent my patient from getting bedsores?

Prevent bedsores by frequent repositioning, using pressure-relieving support surfaces, maintaining skin hygiene, and ensuring good nutrition. Always check for signs of skin redness or irritation.

What is the Fowler’s position?

The Fowler's position involves raising the head of the bed to a 45–60 degree angle, placing the patient in a semi-seated position. It is used to improve breathing and promote comfort during meals.

What equipment is needed to position a patient?

Essential equipment includes an adjustable hospital bed, a draw sheet or slide sheet, pillows of various sizes, and foam wedges for support. Ensure the bed wheels are locked and the bed is at a safe working height.

Is it safe to turn a patient alone?

Turning a patient alone can be dangerous, especially if the patient is heavy or unable to assist. It is always recommended to have a second person help to prevent injury to both the caregiver and the patient.

How do you properly support a patient in the lateral (side-lying) position?

When a patient is on their side, place a pillow behind their back for stability and a pillow between their knees and ankles to keep their hips and spine aligned. A small pillow under the head and neck is also recommended.

How do you move a patient without a draw sheet?

While not recommended due to increased risk of injury, if a draw sheet is unavailable, two caregivers can place hands under the patient's shoulders and hips and use proper lifting techniques to move them. Never pull the patient's arms or legs.