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8 Place a pillow at the end of the hospital bed to support the ankles at 90° of flexion if the patient has weakness or is immobile around the ankle. To ensure patient comfort. E

To prevent loss of ankle movement. E

Positioning the patient: sitting in bed

Evidence-based approaches

Rationale

Indications

Patients should be encouraged to sit up in bed periodically if their medical condition prevents them from sitting out in the chair (Figure 7.4). If the patient is unable to participate fully in the procedure, manual handling equipment should be used to help achieve the desired position.

Figure 7.4 Sitting up in bed.

Attention should also be given to sitting posture. Poor posture is one of the most common causes of low back pain which may frequently be brought on by sitting for a long time in a poor position (McKenzie 2006) as it causes an increase in pressure in the disc (Norris 1995).

Contraindications

Post lumbar puncture, patients should lie flat to prevent dural headache in accordance with local policy.

Procedure guideline 7.2 Positioning the patient: sitting in bed

Essential equipment

Pillows

Manual handling equipment may be required, for example sliding sheets or a hoist, depending on local policy

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 Ask the patient to sit up in bed. The angle at which the patient sits may be influenced by pain, fatigue, abdominal distension or level of confusion/agitation. To encourage haemodynamic* stability. E

To enable effective breathing patterns, maximizing basal expansion (Pryor and Prasad 2008, R4).

To assist in functional activities such as eating and drinking. E

5 Ask the patient to position their hips in line with the hinge of the automatic mattress elevator or backrest of the bed. To ensure good postural alignment, that is, flexing at the hip when sitting up in bed. E

To prevent strain on the spine. E

6 Place a pillow under the patient’s knees or use the electrical control of the bed to slightly bend the patient’s knees. Extra care should be taken if the patient has a femoral line or is on haemofiltration*. To reduce strain on the lumbar spine. E

To maintain the position. E

7 Place a pillow under individual or both upper limbs for patients with a chest drain, upper limb weakness, trunk weakness, surgery involving shoulder/upper limb/breast/thorax, fungating wounds involving axilla, breast and shoulder, upper limb/truncal lymphoedema or fractures involving ribs or upper limbs. To provide upper limb support. E

To maintain trunk alignment. E

To encourage basal expansion (Pryor and Prasad 2008, E).

Positioning the patient: side-lying

Evidence-based approaches

Rationale

Indications

This can be a useful position for patients with:

compromised venous return, for example pelvic/abdominal mass, pregnancy

global motor weakness

risk of developing pressure sores

unilateral pelvic or lower limb pain

altered tone (see Moving and positioning the patient with neurological impairment)

fatigue

chest infection, for gravity-assisted drainage of secretions

lung pathology (see Moving and positioning the patient with respiratory compromise)

abdominal distension, for example ascites*, bulky disease, to optimize lung volume (see Moving and positioning the patient with respiratory compromise).

Contraindications

Suspected or actual spinal fracture or instability.

Procedure guideline 7.3 Positioning the patient: side-lying

See Figure 7.5

Figure 7.5 Side-lying.

Essential equipment

Pillows

Manual handling equipment