The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [226]
Cognitive state
It is important to explain to the patient the reasons for moving and positioning appropriate to their level of understanding. Always explain what will happen step by step and give clear instructions to the patient to enable them to participate in the movement.
It is known that impaired cognition* and depression are intrinsic risk factors for falls in older people (DH 2001).
Privacy and dignity
In order to maintain privacy and dignity (CSP 2008) during positioning, ensure the environment is as private as possible by shutting the door and/or the curtains prior to moving the patient. It may be appropriate to ask visitors to wait outside. The process of uncovering the patient may make them feel vulnerable and/or distressed, so keep them covered as much as is practically possible during the procedure. Make sure catheter bags and drains are hung as discreetly as possible under the patient’s bed/chair.
Patient explanation/instruction
Explain to the patient the reasons for changing their position and where possible gain their verbal consent. If patients are fully informed of the planned change in position they may be able to participate with the manoeuvre and reduce the need for assistance.
Documentation/liaison with multidisciplinary team (MDT)
It is important to check to see if there are any instructions or indications regarding positioning or moving the patient in their documentation. If unsure then check with the MDT as this may provide guidance on what positions are more appropriate and any special precautions that need to be considered prior to moving and positioning.
Equipment
Sliding sheets are used to assist patients to roll or change position in bed. Due to the slippery surface of the slide sheet fabric, friction is reduced and it is easier to move or relocate the patient with very minimal effort or discomfort.
Procedure guideline 7.1 Positioning the patient: supine
Essential equipment
Pillows/towels
Sliding sheets/manual handling equipment if indicated following risk assessment in accordance with local manual handling policy
Bed extension for tall patients
Preprocedure
Action Rationale
1 Explain and discuss the procedure with the patient. To ensure that the patient understands the procedure and gives their valid consent (NMC 2008, C).
2 Wash hands thoroughly or use an alcohol-based handrub. To reduce the risk of contamination and cross-infection (Fraise and Bradley 2009, E).
3 Ensure that the bed is at the optimum height for handlers. If two handlers are required try to match handlers’ heights as far as possible. To minimize the risk of injury to the practitioner (Smith 2005, C).
Procedure
4 Either:
Place one pillow squarely under the patient’s head according to patient comfort. For patients with an airway or head and neck surgery, take care not to occlude or displace tubes or increase pressure to vulnerable areas. To support the head in a neutral position and to compensate for the natural lordosis* of the cervical spine. E
To ensure the airway is patent. E
To increase patient support and comfort. E
Or:
Use two pillows in a ‘butterfly’ position so that two layers of pillow support the head with one layer of pillow under each shoulder.
This may be necessary for the patient with pain, breathlessness (see Moving and positioning of the patient with respiratory compromise) or an existing kyphosis*. E
Or:
Use a folded towel under the patient’s head if this provides natural spinal alignment.
To prevent excessive neck flexion. E
5 Ensure the patient lies centrally in the bed. To ensure spinal and limb alignment. E
6 Place pillows and/or towels under individual limbs to provide maximum support for the patient with painful, weak or oedematous limbs. To ensure patient comfort. E
7 Ensure the patient’s feet are fully supported by the mattress. For taller patients use a bed extension