PRESSURE ULCERS AND POSITIONINGIt is important to position people correctly and to ensure that their position is changed regularly. Proper positioning makes people feel more comfortable. It also helps with breathing and promotes blood circulation. Proper positioning techniques, along with regular position changes, help prevent pressure ulcers and contractures.
Some people are able to position themselves. Others will need your assistance. To properly position a person, you will have to assist him to turn from side to side or to move up in the bed. Due to their mental or physical condition, some people will not be able to assist at all with position changes.
Tips to Position People with Pressure Ulcers
• Ensure that you follow good body mechanics as you perform these procedures. Body mechanics refers to moving your body efficiently and safely. Using proper techniques will prevent injuries to yourself and the person in your care.
• Reposition the person regularly. It is generally recommended that people who cannot move on their own be turned and positioned every two hours. A two-hour turn schedule will work well for many people, but it may not meet the needs of everyone. So follow the care plan for your particular person to ensure that individual needs are met.
• Use pressure management devices as ordered for all the surfaces that may come into contact with the person’s skin while sitting or lying down. Different types of mattresses, including foam, gel, air or fluid, have been used for this purpose. Special cushions are also available for wheelchairs or chairs to reduce pressure on the client’s skin.
• Encourage people who are in a sitting position – either in a chair, a bed or a wheelchair – to change position every 15 minutes, even if only slightly. The person can lean over to shift the weight from one side to the other. Encourage as much activity as the person can tolerate.
• Avoid the use of donut-shaped (ring) cushions when seating someone. They have been found to reduce blood flow and cause swelling. They can actually increase the risk of pressure ulcers and should never be used.
• Plan what you are going to do and gather the items you will need before you position the person
• Ensure the privacy of the person you are caring for.
• Inform the person about the move that is to be made.
• If the person can assist with moving or repositioning in the bed, encourage him/her to do so as per the care plan.
• Follow the care plan and recommendations about lifting, transferring and positioning . Many organizations follow a “no lift” policy that stipulates that a mechanical lift must be used to lift people. It is often recommended to get help when positioning a person. Lift teams are regularly used in many health care facilities.
• Use a lift sheet to prevent friction and sheer injuries when moving a person up in bed or turning the person to the side. A lift sheet can be a drawsheet or a cotton sheet folded in half. Place it under the person so that it extends from under the head to just above the knees. Some facilities use a turning pad in place of a sheet or drawsheet. Remember to ask for advice or help with positioning as needed. Avoid dragging people up in the bed.
• Ensure that the bed is clean, dry, and unwrinkled. Wrinkles or damp sheets increase the risk of pressure ulcers developing.
• Use protective devices, such as a bed cradle, heel elevators, elbow protectors, pillows and foam wedges as ordered to relieve pressure. These devices are used for comfort as well as to protect bony prominences from coming in contact with one another. For example, a pillow placed between the knees can prevent pressure from the knees rubbing against each other when the person lies on the side.
• Ensure that the person’s limbs and joints are properly positioned and supported (good body alignment). Gather all pillows, rolls and other equipment that you will need before you move the person. Pay particular attention to a paralysed limb. The person will have decreased sensation in this limb. Support the paralysed limb on a pillow to prevent injury and swelling.
• When you have finished positioning the person in your care, ensure that the call bell, if used, is within reach.
Wheelchair users have special concerns which you should be aware of. These include:
• Has the person been trained and can she perform self repositioning such as “roll”, “forward lean” and “lift off”?
• Has an appropriately trained individual assessed the person’s needs for seating?
• Have the family and caregiver been informed of the importance of repositioning every 15 minutes?
• Is the person using any prescribed pressure redistributing cushion? These cushions are available in foam, oil based, gel and dynamic (also called alternative or active).
• You should be aware that cushion covers may also be recommended for transfer, incontinence, body heat or other reasons.
• You should understand that the best seated posture is that which does not impede a person’s ability to carry out any activities he wishes to perform.
GOOD BODY MECHANICS
Good body mechanics include:
• Planning your move. Think about what you want to do and how you will do it. Will you need to ask others to help you? Will you need to use a lift?
• Position yourself close to the object you wish to move.
• Assume a wide stance and bend your knees before you begin your move.
• Avoid stretching, reaching, or twisting your body.
• Keep your abdominal muscles tight and tuck in your pelvis before moving an object.
• Hold objects as close as possible to your center of gravity when moving or carrying them.
• Avoid lifting. Instead, push, slide, roll, turn or pull objects.