Positioning, Mobility Assistance and Fall Prevention
Positions you must know
- Supine: flat on the back, head neutral.
- Lateral: side-lying; a 30-degree tilt off the back protects the sacrum.
- Prone: on the abdomen, only when prescribed, with the face free and pressure areas padded.
- Fowler's: head raised 45-60 degrees; semi-Fowler's 30 degrees; used for breathlessness and feeding.
- Sims': semi-prone, left side, used for enemas and perineal inspection.
- Trendelenburg: head down, only on medical instruction.
Turn and reposition at least every two hours, more often for fragile skin, and inspect heels, sacrum, hips, elbows and ears each time. Document the position and the time.
Body mechanics
Feet shoulder-width apart, back straight, knees bent, load held close, no twisting. Use a slide sheet for a dependent patient and always get a second helper - never lift alone. Bed at working height, brakes on, side rail down only on the working side.
Transfer routine
Explain and get consent, lock the chair, place it on the patient's strong side at a slight angle, apply a gait belt, ask the patient to lean forward with nose over toes, push up with the strong arm and pivot. The GDA stands on the weak side.
Fall prevention
Assess with the ward tool, flag the bed, keep the bed low, lock the wheels, keep the call bell and personal items within reach, use non-slip footwear, toilet the patient regularly and round hourly. After a fall, do not move the patient immediately; check consciousness and injury, call the nurse, take vital signs and document.
Worked example
A stroke patient with right hemiplegia is to sit in a chair. The chair goes on the left, the GDA stands on the right supporting the weak arm, and the gait belt is on. Pulling the weak arm would injure the shoulder capsule.
Traps
Pulling on the affected arm, leaving the bed high, and moving a fallen patient before assessment.