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Repositioning clients: Clinical skills notes

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Notes

Basic Client Care Skills

Repositioning Clients

INTRODUCTION
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.  
COMMON CARE TIPS
  • If the person is large, confused, or non-cooperative, you might need to ask for assistance. 
  • Check for tubes and drains, so you don’t accidentally 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 privacy. 
  • 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 the client 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. 
  • 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. 

Figure 1: Common care tips.

MOVING TO THE SIDE OF THE BED
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.
 
  1. Slide your hands under the client’s head and shoulders to move their upper body gently towards you. 
  2. Slide your hands under the person's chest and move the torso towards you.
  3. Slide your hands under the hip and legs and move the lower body towards you.

Figure 2: Repositioning client to side of the bed.

If two people are needed to move the client:
 
  1. Place a moving sheet, or slide sheet, under the client. Make sure it reaches from the shoulders to the hips.
  2. Position yourselves so that you and your coworker are standing directly across from each other on opposite sides of the client.
  3. Roll the edges of the sheets towards the client to provide better grip.
  4. On the count of three, 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.

Figure 3: Repositioning client to side of the bed with two people.

MOVING UP IN BED
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:
 
  1. Lower the head of the bed to be flat to make the process easier, especially for larger people. 
  2. 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. 
  3. Ask them to bend their knees and, on the count of three, lift their buttocks and push with their legs slowly to move themselves up the bed as you support their head and torso. 

Figure 4: Repositioning client up in bed. A. Lower the head of the bed. B. Place one hand behind client's head and shoulder. C. Ask client to bend their knees. D. Ask client to push with legs as you help them move up the bed.

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; in this case:

  1. Place a lift sheet under the client. 
  2. Stand on each side of the person and hold the sheet at the shoulder level and hip level. 
  3. On the count of three, 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:
 
  1. Place one hand on their shoulder and one on their back. 
  2. On the count of three, lift them slowly upward. 
  3. Place them down again, gently, once the pillow is replaced. 
ROLLING ONTO SIDE
If you need to turn someone over on their side:

  1. Make sure the bed is flat. 
  2. Move them towards the side of the bed closest to you. 
  3. Cross their arms and bend the leg that’s closest to you at the knee. 
  4. Put one hand on their shoulder that’s furthest from you and the other at the hip furthest from you, then 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.  

Figure 5: Repositioning client to their side. A. Make sure the bed is flat. B. Move client towards the side of the bed that is closest to you. C. Cross client's arms and bend the leg that is closest to you. D. Put one hand on the client's shoulder that is furthest from you and then slowly roll them to their side.

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 three people.
 
  1. Use the lift sheet if available. 
  2. 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 towards which the client will be rotated. They reach over to grab the edges of the lift sheet at the shoulder and hip level and cross arms. 
  3. Person 1 counts to three, 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.   

Figure 6: Logrolling procedure. A. Person 1 gently presses arms against client's head and neck, keeping them stable; Persons 2 and 3 reach over client and grab edge of lift sheet. B. Person 1 gently rotates client's head while Persons 2 and 3 pull lift sheet towards them in a coordinated motion, rolling client to their side.

SUPINE INTO SITTING POSITION
To help the client from a supine position to a sitting position:
 
  1. Have the person bend their knees and push their feet against the bed. 
  2. Place one hand behind their shoulder and one under their knees.
  3. On the count of three, in one fluid motion, lift their shoulders up straight while moving their legs off of the bed.

Figure 7: Repositioning client to a sitting position. A. Have the client bend their knees. B. Place one hand behind the client's shoulders, and one hand behind their knees. C. Lift client's shoulders while moving their legs off of the bed.

DOCUMENTATION
Report wounds on the skin, particularly over bony areas if assessed, to the healthcare provider.

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