9.2 Bed Positioning, Repositioning & Pennsylvania Side-Lying Skill
Key Takeaways
- Positioning follows the resident’s diagnosis, skin risk, breathing, swallowing, comfort, devices, and care plan.
- Pennsylvania’s side-positioning skill lowers the head, raises the destination-side rail, rolls the client toward it, and supports head, top arm, back, and both top knee and ankle.
- Move the lower arm and shoulder so the client is not lying on them.
- Repositioning frequency and helper count are individualized; there is no universal 2-hour bed/1-hour chair/15-minute weight-shift schedule or two-person rule for every resident.
- Use draw/slide equipment and logrolling only as trained and prescribed, protect lines, avoid dragging, and report pain, skin change, dizziness, or breathing difficulty.
Alignment and individualized positioning
Good positioning supports breathing, swallowing, comfort, joints, skin, and function. Check the care plan for allowed positions, head-of-bed angle, turning surface, pressure relief, spinal or hip precautions, device placement, and number of helpers. Explain the move and encourage the resident to participate.
Common positions include supine, lateral, Sims, semi-Fowler, Fowler, and high Fowler. The angle named in a textbook is only a guide; use the ordered angle and equipment. A resident receiving enteral feeding or with dysphagia may need a specific elevation. A resident with respiratory distress may require urgent elevation and nurse assessment. Trendelenburg or prone positioning is never improvised by an aide.
Repositioning is individualized. Support surface, mobility, nutrition, perfusion, moisture, pain, goals of care, and tissue response determine frequency. A blanket rule of every 2 hours in bed, every hour in a chair, or weight shifts every 15 minutes is not correct for everyone. Follow the plan and report skin change or intolerance so the nurse can reassess.
Skill 17: Positions on side
- Explain and provide privacy.
- Lower the head of the bed before turning.
- Raise the side rail on the side toward which the body will turn.
- Assist the client to roll slowly toward the raised rail.
- Place or adjust a pillow under the head.
- Reposition the lower arm and shoulder so the client is not lying on the arm.
- Support the top arm with a supportive device.
- Place a supportive device behind the back.
- Place a supportive device between the legs with the top knee flexed, supporting both the knee and ankle.
- Place the signal within reach, leave the bed low, and wash hands.
Do not omit ankle support or leave the shoulder trapped beneath the body. The official list says supportive device rather than requiring exactly four pillows; use the available approved supports.
Moving up in bed
Use the care plan’s friction-reducing sheet, draw sheet, powered feature, or lift and the prescribed number of trained helpers. Lock the bed as directed, raise it to a working height, lower the head if allowed, protect tubes, and use a coordinated count. Lift or slide with the device rather than dragging skin. A pillow may protect the headboard area when the approved procedure calls for it. Restore head angle, alignment, covers, rails as planned, bed low, and signal accessible.
There is no universal rule that every boost requires exactly two staff; a dependent or bariatric resident may require a lift or more help, while another can reposition with guidance. Never attempt a move beyond the plan because a second person is unavailable.
Logrolling and support
Logrolling keeps head, shoulders, torso, hips, and legs aligned as one unit when spinal precautions or another plan requires it. It often needs multiple trained staff and a leader’s count. Do not logroll every resident routinely, and do not place a pillow or wedge that conflicts with surgery precautions.
For lateral support, keep ears, shoulders, and hips aligned; avoid direct pressure on the lower shoulder; support the upper arm; and separate knees and ankles. Float heels only with the prescribed device and do not place concentrated pressure behind the knee. Inspect bony prominences and device contact points during assigned care.
If movement causes new pain, numbness, weakness, breathing trouble, dizziness, tube traction, or loss of alignment, stop in a safe position and call the nurse. Document the position, assistance, devices, skin observations, and resident response actually provided.
Position verification
After a turn, step back and trace alignment from ear through shoulder and hip. Confirm the lower shoulder is free, the top arm is supported rather than pulling across the chest, and the upper knee and ankle are separated from the lower leg. Check that tubing is neither trapped nor stretched and that the resident can breathe and reach the signal. Ask about comfort before leaving.
A support can create a new hazard when it is too thick, placed directly behind a joint, or pushes a device into skin. Reinspect after the bed settles. A resident who slides toward the foot in Fowler position may be experiencing shear; do not repeatedly drag upward. Use the prescribed handling surface and ask the team to reassess angle, knee support, and mattress settings.
Which supports are required in Pennsylvania’s side-positioning skill?
How is repositioning frequency chosen?
What is safest when moving a dependent resident up in bed?