15.1 Positioning, Turning, and Side-Lying (Skill 17)

15.1 Positioning, Turning, and Side-Lying (Skill 17)

Quick Answer: On Colorado Skill 17 — Positions on Side, you explain, provide privacy, lower the head of the bed before turning, raise the side rail on the side the body will turn toward, assist a slow roll toward that raised rail, place or adjust a pillow under the head, reposition the arm and shoulder so the client is not lying on the arm, support the top arm, place a supportive device behind the back, place a supportive device between the legs with the top knee flexed and the knee and ankle supported, leave the signaling device in reach, put the bed in the low position, and wash your hands. The Skill 17 card has no bold critical-element line, but every listed step still counts toward the skill cut. Facilities commonly reposition about every two hours (q2h) — that interval is typical unit practice, not a number Credentia publishes on the card. Do not massage red areas. Report Stage-looking skin. Use Fowler, semi-Fowler, supine, prone, Sim's, or Trendelenburg only as ordered. Log-roll if the nurse has ordered spinal precautions. Let the client help.

Why this section is on the exam

On the 2024 National Nurse Aide Assessment Program (NNAAP) outline Colorado uses, Self Care/Independence is leaf I.C inside Physical Care Skills. I.C is 7% of the 60 scored written items — typically 4 questions. The Colorado outline prints no numbered sub-topics under I.C, and the word prevention appears in the I.B.2 Safety/Prevention/Emergency leaf name instead. Treat I.C as two working ideas: prevent contractures, foot drop, and pressure injuries, and promote self-care and independence. Positioning is how you prevent the first list and honor the second.

Skill 17 is one of the 23 Colorado skills. The Skills Evaluation assigns 5 skills in 30 minutes. You must pass all five. Skill 17 is not a measurement skill and it has no bold critical element on the Credentia Colorado card, so candidates treat it as just a roll. That is how they miss the head-of-bed step, leave the person lying on an arm, or skip the device between the knees. Enough missed ordinary steps still fail the skill.

Colorado 3 CCR 716-1.11 puts promoting independence and basic restorative services in the approved curriculum, and promoting independence is inside the first 16 pre-clinical hours. A turn the client can help with is restorative care, not a wrestling match.

/practice/co-cnaPractice questions with detailed explanations

Skill 17 — Positions on Side (official order)

Follow the Credentia Colorado card in order. Do not invent a faster path.

1. Explain the procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Provide privacy with a curtain, screen, or door.
3. Before turning, lower the head of the bed. A raised head makes the roll a slide down the mattress and twists the spine.
4. Raise the side rail on the side to which the body will be turned. That rail is the destination and a stop — not a restraint for the whole bed.
5. Assist the client to slowly roll onto the side toward the raised side rail. If the person can hold the rail, let them help.
6. Place or adjust a pillow under the head for support.
7. Reposition the arm and shoulder so the client is not lying on the arm. A trapped arm goes numb and becomes a pressure point.
8. Support the top arm with a supportive device (a pillow is the usual device on the test).
9. Place a supportive device behind the client's back so the person does not roll onto the back.
10. Place a supportive device between the legs with the top knee flexed; the knee and ankle are supported. Stacked bony knees and ankles grind on each other.
11. The signaling device is within reach and the bed is in the low position.
12. After completing the skill, wash your hands.

Why the head of the bed comes down first

Candidates fail this step because the person looks more comfortable sitting up. Skill 17 is a side-lying skill, not a Fowler skill. A raised head of bed (HOB) during the roll turns the move into a downhill slide. Lower the HOB, then turn. If the care plan later wants the head up, that is a different position after the person is safe on the side — and only if it is ordered or assigned.

The destination rail

Raise the rail on the side the body will turn toward. Then roll toward that rail. Do not pull the person toward an open side and hope they stop. Do not raise both rails and walk away — two-rail confinement without an order is a restraint and rights problem (Chapter 5). On the skill, one raised destination rail is the safety step.

Support so the side-lying position actually lasts

Alignment means the head, spine, and legs look as if the person could stand up in that shape. A twisted trunk, a hanging foot, or a shoulder jammed under the chest is not a finished Skill 17.

Turning schedule and pressure-injury prevention

Pressure injuries form where bone meets a surface for too long: sacrum, heels, hips (trochanters), elbows, shoulder blades, ankles, ears, and the back of the head. Moisture, crumbs, and wrinkled linen add friction. Your job is to offload, smooth, and report — not to stage the wound.

Facilities commonly reposition a person in bed about every two hours (q2h) and more often for a person already at high risk. Credentia does not print every two hours on the Skill 17 card. Teach q2h as typical facility practice and then follow the care plan. If the assignment says turn hourly, you turn hourly.

• Keep the bottom sheet wrinkle-free and free of crumbs.
• Never massage red areas over bony prominences. Massage on intact-looking redness can worsen deep-tissue injury.
• Report Stage-looking skin — non-blanchable redness, a blister, an open area, a dark purple spot, or a dressing that is new to you — to the licensed nurse. You describe what you see. You do not write Stage 2 as a diagnosis.
• Heels float off the mattress when the care plan says so. Do not park both heels hard on the sheet for a whole shift.
• Use a lift or draw sheet if assigned so you lift rather than drag (shear tears skin).

Named positions — only as ordered

Written items name positions. Use them only when the care plan or the licensed nurse has that position.

• Supine: on the back. Skill 15 starts here.
• Prone: on the abdomen. Not a casual try the stomach.
• Lateral / side-lying: Skill 17.
• Sim's: a side-lying variant with the upper leg sharply flexed; often used for an enema if ordered.
• Fowler's: head of bed up, commonly taught around 45–60 degrees, for breathing or feeding when assigned.
• Semi-Fowler's: a lower head elevation, commonly taught around 30–45 degrees.
• Trendelenburg: head down, feet up — only if ordered. You do not tip the bed because a person looks faint.
• Reverse Trendelenburg: head up, feet down — again, only if ordered.

Log-roll if the nurse has ordered spinal precautions. The head, shoulders, and hips turn as one unit, usually with two or three staff and a draw sheet. You do not independently decide to log-roll, and you do not twist the spine of a person on spinal precautions just to finish a turn faster. On the skills test, unless the evaluator's scenario says otherwise, you follow the Skill 17 card.

Independence during a turn

I.C is self-care. Ask what the person can do. Hold this rail. Push with your foot. Tell me if anything hurts. A client who can roll half of the way should roll half of the way. Doing the entire roll for an able person is not kindness; it is learned dependence. Give time. Do not yank.

After the position is set, the call signal is in this client's reach — not on the far rail, not on the roommate's side. The bed is low. Then you wash.

Colorado scenario

You are in a Credentia skills room in Lakewood. The evaluator assigns Skill 17. Mrs. Alvarez is the volunteer. You leave the head of the bed in Fowler's so she can see you, skip the destination rail, and roll her toward the open side. Her bottom arm stays pinned under her ribs. You stuff one pillow behind her back, stack her legs with both knees straight, toss the call light onto the overbed table, and leave the bed high.

That performance misses the card in the places the evaluator is watching. Lower the HOB before the turn. Raise the rail she will roll toward and assist a slow roll toward that rail. Pillow under the head. Free the bottom arm. Support the top arm. Device behind the back. Device between the legs, top knee flexed, knee and ankle supported. Call signal in her hand. Bed low. Wash.

That evening on a Pueblo long-term-care unit, the same Mrs. Alvarez has a red, non-blanchable patch over the sacrum. You do not massage it. You smooth the sheet, follow the care plan's turn times (commonly about q2h, but you use her assignment), and report the Stage-looking skin to the licensed nurse.

Exam traps

• Turning with the head of the bed still up.
• Rolling away from an open side with no destination rail.
• Leaving the client lying on the bottom arm.
• Stacking knees and ankles without a device and without flexing the top knee.
• Massaging red bony areas.
• Treating every two hours as a Credentia-printed Skill 17 critical element.
• Putting a person in Trendelenburg or prone because you prefer it.
• Twisting a spine that has log-roll orders.
• Doing the entire roll for a person who can help.