This article is written for Nurses, by a Lecturer in Health Sciences. It describes the commonly used nursing positions. Diagrams and Pictures are included. This article will also be useful for individuals caring for sick relatives and friends.
Pad arms and legs for safety and comfort. Do not allow the arms, shoulders or legs to hang over the edge of the bed.
Hips . The key goal to remember with hip placement, whether the patient is in a vertical, prone, Trendelenburg or reverse Trendelenburg position, is to maintain proper alignment. During orthopaedic procedures, the hips are prone to lumbar plexus damage if they are put under excessive strain. Keeping the hips aligned takes a lot of pressure off both the lower back and the hip joints themselves. When caring for patients please do the following:
Always lift both the patient’s legs together, rather than one at a time.
Always use hip supports so that the hips do not flex, this is particularly important when the patient is in the operating theatre.
Always insure that the clients legs are straight and are not twisted in some uncomfortable position.
Use positioning aids wherever possible. A nurse is the patient’s advocate. You may need to initiate action to get positioning devices.
Buttocks . In many instances buttocks bear most of the weight of the body, they remain in contact with bed sheet and the buttocks are the first indicators of poor quality of nursing care; this can cause pressure sores and other complications. Avoid this by placing padding underneath the buttocks and frequent turning.
Knees and lower extremities . Always keep the client’s knees flexed wherever possible. Surgical socks, soft bolsters, pillows can be helpful for maintaining circulation and reduce pressure on the lower extremities.
This is ordinarily called lying on back, flat with a pillow under the head. The position of the patient should be in the middle of the bed, about three inches below the head of the bed.
The pillow under the patient’s head should extend about two inches below the patient’s shoulders, with the head in the middle of the pillow.
A trochanter roll should be placed along the affected hip or along the both hips if the patient has little control over the legs. A trochanter roll is devised by rolling a bath blanket into a shape about 12-14 inches in length. The roll should be just long enough to reach from above the hip to above the knee. The trochanter roll prevents external rotation of the hip.
Place pillows under the legs to reach from above the back of the knee to the ankle so that the ankles and heels do not rub on the sheets. When patients skin rubs against the sheet, pressure sores are formed and often take a long time to heal.
Position the footboard or place a folded pillow to support the patient’s feet. The ankles should be at 90° angles.
Extend the patient’s arms and place small pillows to reach from the elbow to below the wrist. The hand should be in alignment with the wrist. This positioning will prevent nerve injury due to hyper extension.
This position is sometimes called the coma position. On a bed, the patient lies on his/her side at a 45 degree angle to the patient’s back and the bed.
You may place a pillow behind the patient’s back for support, comfort and warmth.
Make sure the patient’s left shoulder forward is slightly to the forward. Also you may need to Flex the elbow of the left arm and place the lower left arm, palm up, on a pillow. This will insure proper circulation and there will be no pressure on any nerve.
Flex the elbow of the right arm and bring the forearm across the chest with palm down.
Extend both legs. Place right leg a little behind left leg. Support right leg with two pillows folded in half that extend from groin to ankle.
In this position the patient is lying on his stomach with face down (onto the pillow). Make sure that the patient is not suffocated by pillow(s). Ironically, in the ICU, this is the position in which a patient is nursed when he/she is in respiratory distress.