Repositioning clients

Most clients will reposition themselves when they get uncomfortable from staying in the same position for too long. However some people, like those in a coma, in a hip or full body cast, or recovering from surgery, will need your assistance.

In addition, many clients will need to be repositioned for procedures or other activities. Now, you’ll need to know the different procedures when moving a client into different positions, but there are a few things to keep in mind for all of them.

If the person is large, confused, or non-cooperative, you might need to ask for assistance. Be sure to check for tubes and drains, so you don’t accidently pull them out.

Make sure the wheels on the bed or wheelchair are locked and hand rails on the bed are lowered. Check to see if the client is properly covered for their modesty.

Be sure to use good body mechanics. Stand with your feet spread shoulder-width apart and knees slightly bent to protect your back.

Be gentle and do not lift them by their limbs. When moving someone with a cast that’s still wet, try to use only the palms of your hands.

This will help spread the force over a larger area and prevent deforming the cast before it can dry. For immobile clients resting in the supine position, first reposition them to a lateral position, then back to the supine position, and finally the lateral position on the other side.

Remember everyone needs to reposition at least once every two hours to prevent complications, like pressure ulcers and contractures, and some will need to be moved more frequently.

When you’re done, check that their clothing and the bedsheets are not tangled and replace any pillows you moved. When moving someone towards one side of the bed for easier access during a procedure, first make sure the bed is raised to a height that’s comfortable for you to work with.

Make sure the head of the bed is flat. Slide your hands under their head and shoulders to move their upper body gently towards you.

Next, slide your hands under the person's chest and move the torso towards you. Finally, slide your hands under the hip and legs and move the lower body towards you.

If they need two people to move them, place a moving sheet, or slide sheet, under them and make sure it reaches from the shoulders to the hips.

You and your co-worker should be standing directly opposite each other. Roll the edges of the sheets towards the client to provide better grip.

On the count of 3, slowly lift the client and move them towards the side of the bed. The slide sheet method is preferred because it decreases the risk of shearing.

You might need to move someone up in bed because, if the head of the bed is elevated, they’ll eventually slide down. To do this, lower the head of the bed to be flat to make the process easier, especially for larger people.

Next, place one hand behind the person’s head and shoulder. Use your other hand to hold their arm: the one that’s closest to you.

Ask them to bend their knees and, on the count of 3, lift their buttocks and push with their legs slowly to move themself up the bed as you support their head and torso.

Some hospital beds will have a trapeze bar above the clients; others may have a side rail or assist bar next to the bed.

If the client is strong enough, ask them to hold on to these bars and either pull or push themselves up while you lift them.

Many hospitals require two people to perform this procedure, so in this case, place a lift sheet under them. Stand on each side of the person and hold the sheet at the shoulder level and hip level.

On the count of 3, lift the client and move them towards the head of the bed slowly; be careful not to hit their head on the headboard.

If you need to lift the person’s head, like when you need to add a pillow, start by placing one hand on their shoulder and one on their back.

On the count of 3, lift them slowly upward and place them down again, gently, once the pillow is replaced. If you need to turn someone over on their sides, make sure the bed is flat and then move them towards the side of the bed closest to you.

Cross their arms and bend the leg that’s closest to you at the knee. Put one hand on their shoulder that’s furthest from you and the other at the hip furthest from you and slowly roll them onto their side.

If side rails are available and the person is strong enough, they can help pull themselves onto their side while you’re rolling them.

In some cases, you need to roll a person over, but their spine needs to remain aligned. This is important if they have a back injury, for example.

This requires the Logrolling procedure, and it needs at least 3 people. Use the lift sheet if available.

Person 1 stands at the head of the bed and slides their hands behind the client’s neck and upper back, then squeezes the head lightly with their forearms: just enough to keep the head and neck stable.

Persons 2 and 3 stand in front of the client’s shoulder and hip on the side of the bed that the client will be rotated. They should reach over to grab the edges of the lift sheet at the shoulder and hip level and cross arms.

Next, person 1 will count to 3, and in one coordinated and continuous motion, persons 2 and 3 pull the sheet towards themselves while person 1 moves the head, so the client is rolled onto their side.

This should be done in unison, so the head, neck, and spine remain aligned. Finally, to help the patient from a supine position to a sitting position, have the person bend their knees and push their feet against the bed.

Place one hand behind their shoulder and one under their knees. On the count of 3, in one fluid motion, lift their shoulders up straight while moving their legs off of the bed.

There are a few things you must report to the nurse if you notice them: Any disconnected or leaking IV, feeding tube, colostomy bags, or draining tubes; color change; or wounds on the skin, particularly over bony areas.

Also, you should report if the client reports of warm, painful swelling in the lower limbs; new onset of urinary or bowel incontinence; chest pain; or problems breathing.

After you report these findings, be sure to document them. Also document who took part in the procedure, what support devices were used, how much assistance was needed, and if any additional personal care was given.

Allright, as a quick recap… Clients should reposition at least every 2 hours, and sometimes, this requires your assistance.General considerations include determining if help is needed and what supplies are required.

When moving a client, keep feet shoulder-width apart for stability and slightly bend the knees. Different procedures include moving them toward one side of the bed, moving them up the bed, lifting their head and shoulders, turning them onto their side, logrolling, and supine to sitting position.

Be sure to leave proper documentation after the procedure is finished.