The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [228]
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 Place one or two pillows in a ‘butterfly’ position under the patient’s head, ensuring the airway remains patent. Extra care should be taken for those patients with a tracheostomy, central lines or recent head and neck surgery. To support the head in mid-position. E
To support shoulder contours. E
5 Ask/assist the patient to semi-flex the lowermost leg at the hip and the knee. Extra care should be taken with the degree of flexion for those patients who have hip or knee pain or loss of movement, fracture involving the femur or pelvis, leg oedema, femoral lines or other venous access devices. To support the patient in a stable position and prevent rolling. E
6 Either:
Ask/assist the patient to semi-flex the uppermost leg at the hip and knee. Use a pillow to support under the leg placed on the bed.
Or:
Place a pillow between the patient’s knees.
To prevent lumbar spine rotation. E
To support the pelvic girdle. E
To aid pressure care. E
7 Place the underneath arm in front with scapula protracted* (this would not be appropriate for patients with shoulder pathology). Extra care should be taken with patients with low tone in the affected arm, swollen arms or who have access lines in that arm. To promote patient comfort. E
To promote shoulder alignment. E
To provide additional support and comfort. E
Procedure guideline 7.4 Positioning the patient: lying down to sitting up
See Figures 7.6, 7.7 and 7.8
Figure 7.6 Lying to sitting (stage 1).
Figure 7.7 Lying to sitting (stage 2).
Figure 7.8 Lying to sitting (stage 3).
Essential equipment
Manual handling equipment may be required dependent on risk assessment, 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 patients or 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 bend both knees and turn their head towards the direction they are moving. Abdominal wounds should be supported by the patient’s hands. Extra care should be taken with patients who have joint pathology, oedema, ascites or positional vertigo*. To assist the patient to roll using their bodyweight. E
5 Ask patient to reach towards the side of the bed with the uppermost arm and roll on to their side.
6 Ask the patient to bend their knees and lower their feet over the edge of the bed.
7 Ask the patient to push through the underneath elbow and the upper arm on the bed to push up into sitting. As the patient sits up, monitor changes in pain or dizziness which could indicate postural hypotension or vertigo. Be aware that the patient with neurological symptoms or weakness may not have safe sitting balance. To help to lever the patient into a sitting position using the weight of their legs. E
8 Achieve upright sitting position with appropriate alignment of body parts. To ensure safe sitting position achieved. E
Positioning the patient: in a chair/wheelchair
Preprocedural considerations
Equipment
Pressure cushion