Mobility, Positioning, and Skin Integrity
Mobility and safety
Maintain mobility as long as safely possible to preserve function and dignity. Use gait belts, proper body mechanics, and the patient's own strength. Encourage short walks or chair sitting when tolerated. Balance activity with rest.
Positioning and pressure
Reposition at least every two hours (more often if skin is fragile), using pillows to protect bony prominences (heels, sacrum, hips, elbows, ears). Keep heels off the mattress. Avoid dragging the patient during transfers.
Skin integrity
Inspect skin at every turn and during bathing. Risk factors include immobility, moisture, incontinence, poor nutrition, and friction. Keep skin clean and dry, use barrier creams, and avoid harsh soaps. Report redness that does not blanch, open areas, or new bruising.
Traps to watch
- Repositioning only when the patient complains - immobile patients may not feel pressure.
- Using hot water or vigorous rubbing, which damages fragile skin.
- Ignoring moisture from incontinence or wound drainage.
- Failing to document and report skin changes.
Rule of thumb
"Two hours, two heels, two eyes" - turn every two hours, float the heels, and look at the skin each time.
Worked example: While turning a patient, the assistant notices a reddened area over the sacrum that does not blanch when pressed. The assistant avoids massaging it, relieves pressure, keeps the area clean and dry, and reports it to the RN promptly.