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This is a piece of equipment designed to evenly redistribute the weight of a patient to provide pressure relief for those who are vulnerable to skin breakdown (see Chapter 4). They are an effective aid to increasing patients’ sitting tolerance. There are various types available and they are usually provided by the OT dependent on the specific needs of the patient.

Procedure guideline 7.5 Positioning the patient: in a chair/wheelchair

Essential equipment

Upright chair with arms that support elbow to wrist – if using a wheelchair, make certain that the chair has been measured by an occupational therapist (OT) to ensure correct fit and position of the foot rests

Manual handling equipment may be required following risk assessment, for example a hoist, depending on local policy

Pillows/rolled-up towel

Footstool if the patient has lower limb oedema

Pressure cushion

Procedure

Action Rationale

1 Place a pressure cushion in the chair and ask the patient to sit well back in the chair. They should have a maximum 90° angle at their hips and knee joints. The patient may not be able to achieve this position if they have pain, abdominal distension or hip/back pain. It may be necessary to refer the patient to the OT for chair raises, a specialized cushion or appropriate seating if a comfortable or safe position cannot be achieved. Patients with reduced mobility are at greater risk of pressure skin damage.

To provide a stable base of support for balance. E

To ensure good body alignment. E

To achieve a safe sitting position. E

2 Place a pillow or rolled-up towel in the small of the patient’s back as is comfortable for the patient. To allow the patient’s back to be supported in a good position. E

3 Ensure the patient’s feet are resting on the floor or supported surface. Use pillows or a rolled-up towel to support under the feet if necessary. Make sure the patient’s feet are supported on the foot rests if using a wheelchair. To provide postural alignment and support the lumbar spine. E

4 If the patient has lower leg oedema, use a foot stool, ensuring the whole leg and foot are supported and avoiding hyperextension* at the knees. To improve venous drainage. E

5 Discourage the patient from crossing their legs. To reduce risk of developing a DVT (O’Donovan et al. 2006, R4).

Moving the patient from sitting to standing

Preprocedural considerations

If the patient stands from the side of a hospital bed, it is helpful to raise the bed slightly to reduce the work of standing for the patient to ensure that the hips are level or higher than the knees with the feet in contact with the floor.

A physiotherapy referral may be appropriate. See Figure 7.9 and Figure 7.10.

Figure 7.9 Sitting to standing (stage 1).

Figure 7.10 Sitting to standing (stage 2).

Procedure guideline 7.6 Moving from sitting to standing: assisting the patient

See Figure 7.9 and 7.10

Essential equipment

Walking aid if required (if previously issued by physiotherapist)

Suitable non-slip, well-fitting, supportive and flat footwear (if not available then bare feet are preferable to socks or stockings which may slip) (Figure 7.11)

Figure 7.11 Examples of supportive shoes.

Procedure

Action Rationale

1 Ask the patient to lean forward and ‘shuffle’ (by transferring their weight from side to side) and bring their bottom closer to the front of the chair or edge of the bed. To bring the patient’s weight over their feet. E

2 Ask the patient to move their feet back so they are slightly tucked under the chair with their feet hip width apart. To provide a stable base prior to moving. E

3 Instruct the patient to lean forward from their trunk. To help initiate movement. E

To facilitate a normal pattern of movement. E

4 Instruct the patient to push through their hands on the arms of the chair or surface on which they are sitting as they stand. Encourage a forward and upward motion whilst extending their hips and knees. To minimize energy expenditure. E

5 Once standing, ask the patient to stand still for a moment to ensure balance is achieved before