Positioning a patient in bed

Assessment
Assess patient's body alignment and comfort level in current position
Check patient's record and physician's order. Determine if any condition that influence patient's physical ability to move or to be positioned (e.g. muscle strength, fractures and presence of paralysis)
Note the presence of tubes, IV lines, incisions or equipment that may interfere with the positioning procedure
Assess patient's level of consciousness and ability to understand instructions in positioning
Assess patient's weight and your strength. Determine if additional assistance is needed

Planning
Collect the necessary equipment: pillows for positioning; draw or lifting sheet
Obtain sufficient assistance to complete the procedure with ease

Implementation (2 persons)
Perform hand hygiene
Identify patient and explain the procedure
Adjust the head of bed to flat position or as low as the patient can tolerate
Elevate the bed to a comfortable working height
Remove pillow and place it at the head of bed to prevent striking patient's head during lifting
Coordinate the movement between two staff. One staff is responsible for stating when to move patient, "on count of three"

For partially dependent patients:
a) Position one staff on each side of the patient
b) Each staff place one arm under the patient's shoulders and one arm under the patient's thighs. This supports the heaviest part of the body
c) Assume broad base of support; position front foot facing head of bed, body slightly turned toward head of bed
d) Ask patient to flex knees with feet flat on bed
e) Instruct patient to flex neck, tilting chin toward chest
f) Instruct patient to assist moving by pushing with feet on bed surface
g) Staff flex knees and hips, bringing forearms closer to the level of bed
h) Instruct patient to push with heels and elevate trunk while breathing out, thus moving toward head of bed on count of three

For totally dependent clients:
a) Position one staff on each side of bed
b) Place lifting sheet under patient's body extending from shoulder to the thighs
c) Position patient in a supine position
d) Roll up sides of lifting sheet as close as possible to the sides of patient
e) Assist patient to flex knees and fold arms across the chest, if not contraindicated
f) Each staff firmly grasp sheet at level of patient's upper back with one hand and at level of buttocks with the other hand, placing weight on back foot
g) Place feet apart with forward-backward stand. Flex knees and hips

Shift weight back and forth from the back leg to front leg, and on count of three, lifts patient toward head of the bed with a firm, coordinated and rocking movement
Repeat if necessary
Ensure patient is in correct body alignment, replace pillows and arrange bedding as necessary
Position drains, tubes and IV to accommodate a new position in order to prevent accidental dislodgement and discomfort from movement
Maintain patient safety. Raise the side rails and resume the bed to lowest position. Place cell bell within patient's reach
Perform hand hygiene

Position patient in side-lying position
Perform hand hygiene
Identify patient and note any mobility restrictions
Lower head of bed as flat as patient can tolerate if not contraindicated
Elevate the bed to a comfortable working height
Position one staff on each side of the bed and lowers the side rails
Using draw sheet. Roll up the sheet as close as possible to the patient's body and grasp firmly. Staff pull the patient with draw sheet to the opposite side of the bed that he will be turned
On the side that patient will be turned, abduct patient's arm slightly away from his body. On the other side, position patient's arm across the chest and flex the knee before turning
Place one hand on the patient's hip and the other hand on the shoulder
Staff assumes a broad stance with knees slightly flexed. Gently roll patient over onto the desired side by using the draw sheet
Observe patient's skin condition after turning
Maintain patient's body alignment
Place pillows under head and behind back to provide additional support to the spine
Bring shoulder blade forward and out from under patient (?)
Position both arms in slightly flexed position. Support patient's upper arm with pillow level with shoulder, if necessary
Place pillow lengthwise between patient's legs from thighs to foot. Shoulder and hips should be aligned
Raise the side rails and adjust the bed position as necessary. Place call bell within patient's reach
Perform hand hygiene

Evaluation
Patient's tolerance and response of procedure
The skin condition of patient
Patient's position in alignment and comfortable
Level of assistance received from patient