Repositioning a patient involves carefully moving them to a new posture in bed or a chair to prevent complications such as pressure injuries and improve overall comfort and circulation. This essential aspect of patient care ensures well-being and can significantly impact recovery and quality of life.
Why Repositioning is Crucial
Regular repositioning is vital for several reasons, primarily to:
- Prevent Pressure Injuries (Bedsores): Prolonged pressure on the same area can restrict blood flow, leading to tissue damage. Repositioning redistributes pressure, allowing blood to flow freely and nourish the skin and underlying tissues. Learn more about preventing bed sores.
- Improve Circulation: Changing positions stimulates blood flow throughout the body.
- Enhance Respiratory Function: Shifting position can aid in lung expansion and prevent fluid accumulation in the lungs, reducing the risk of pneumonia.
- Boost Comfort and Dignity: A new position can alleviate discomfort, reduce stiffness, and improve the patient's sense of well-being.
- Maintain Skin Integrity: Beyond preventing pressure injuries, repositioning helps keep the skin dry and free from friction and shear forces.
General Principles for Repositioning
Before beginning, always consider these fundamental principles:
- Communication: Explain the process to the patient, even if they cannot respond. This can reduce anxiety and encourage cooperation.
- Assess the Environment: Ensure there is enough space to work safely. Clear any obstacles.
- Gather Equipment: Have pillows, wedges, or a draw sheet ready.
- Ensure Safety: Lock bed wheels, lower side rails on the side you are working on (while keeping the opposite side up for safety).
- Protect Yourself: Use proper body mechanics to prevent injury. Bend at your knees, not your back, and use your leg muscles. If available, use assistive devices or enlist the help of another caregiver.
- Maintain Privacy: Close doors or curtains.
Step-by-Step Repositioning Techniques
The method of repositioning depends on the patient's mobility, condition, and the desired new position. Here are common approaches, with a focus on repositioning a bedbound patient to their side:
Repositioning a Bedbound Patient (Using a Draw Sheet)
This technique is effective for moving a patient with minimal effort and reducing the risk of friction or shear on their skin, especially with two caregivers.
- Preparation:
- Ensure the patient is lying flat or with the head of the bed slightly elevated.
- Gently position their arms across their chest or upper body.
- Lower the side rail on the side you are moving the patient towards.
- Utilize the Draw Sheet:
- If using a draw sheet (a sheet folded in half placed under the patient from shoulders to thighs), stand on the side of the bed towards which you intend to move the patient.
- Reach over the patient and grasp the draw sheet firmly on the opposite side.
- A second caregiver should stand on the opposite side of the bed.
- Coordinated Movement:
- Slowly pull the drawsheet towards you, gently rolling the person over onto their side as you do so.
- As this pull occurs, your partner (on the opposite side) should gently push the person's hips and shoulders to help with the roll, ensuring a smooth and coordinated turn.
- Final Positioning:
- Once the patient is on their side, use pillows or wedges to support their back, head, and between their knees to maintain the position and prevent rolling back.
- Ensure their ear is not folded, and their shoulder is comfortable.
- Check for comfort and alignment.
Repositioning in a Chair
Patients in wheelchairs or recliners also need regular repositioning to prevent pressure and improve comfort.
- Weight Shifts: Encourage the patient to shift their weight every 15-30 minutes, if possible.
- Tilting/Reclining: If the chair allows, tilt or recline the patient every hour to redistribute pressure.
- Assistive Devices: Use pressure-relieving cushions specifically designed for chairs.
- Full Reposition: If the patient cannot shift independently, lift them slightly and reposition them back in the chair using a gait belt or a sliding board, ensuring their buttocks are against the back of the chair.
Key Considerations for Caregivers
| Aspect | Description |
|---|---|
| Frequency | Generally, reposition a bedbound patient every 2 hours (or more frequently if high risk). For chair-bound patients, every 15-60 minutes. |
| Skin Assessment | Each time you reposition, quickly inspect the skin, especially over bony prominences (heels, hips, tailbone, elbows, shoulder blades). Look for redness, warmth, or broken skin. |
| Patient Preferences | Involve the patient in the decision-making if possible. Ask about their comfort and preferred side (unless medically contraindicated). |
| Hydration & Nutrition | Proper hydration and nutrition are vital for healthy skin and tissue integrity, complementing repositioning efforts in preventing pressure injuries. |
| Documentation | For formal care settings, document the time of repositioning and the patient's skin condition. |
Repositioning is a fundamental skill in patient care that significantly impacts health outcomes. By following these guidelines and adapting to individual patient needs, caregivers can ensure comfort, prevent complications, and promote healing.
