Moving and Positioning Clients
Key Points
- Immobile residents require routine repositioning to prevent pressure injuries and immobility complications.
- Lift sheets reduce friction and shear and should be used for assisted bed movement.
- Correct alignment, pressure-relieving supports, and position rotation schedules improve safety and comfort.
Pathophysiology
Immobility concentrates pressure over bony prominences and impairs local perfusion, increasing risk of tissue ischemia and pressure injury. Repeated friction and shear further damage fragile skin and subcutaneous tissue.
Older adults are highly susceptible because skin integrity and cushioning decline with age. Poor repositioning technique can create skin tears, bruising, and musculoskeletal strain in both resident and caregiver.
Therapeutic positioning also affects respiratory expansion, aspiration risk, and circulation. Position choice therefore links directly to comfort, oxygenation, and skin outcomes.
Classification
- Repositioning frequency: Routine at least every two hours, with hourly schedules for higher-risk skin cases.
- Pressure-relief tools: Lift sheets, pillows, wedges, foam boots, and foot cradles.
- Core positions: Supine, Fowler’s, lateral, Sims’, and prone.
- Technique focus: Slide with lift sheet rather than lifting/pulling directly on limbs or skin.
Nursing Assessment
NCLEX Focus
Priority questions often ask which positioning choice best protects skin while supporting breathing and safety.
- Assess skin over bony prominences for redness, tenderness, or early breakdown.
- Verify spinal alignment and centered bed position after each turn.
- Identify friction/shear risk patterns, especially in Fowler’s when sliding downward.
- Monitor repositioning adherence and document move-from/move-to position with time.
Nursing Interventions
- Use a lift sheet for assisted repositioning to reduce friction and shear.
- Coordinate two-person boosts with count-based movement and neutral body mechanics.
- Float heels using pillow under calves or use ordered pressure-relief devices.
- Rotate among supine and side-lying positions per care plan to offload pressure points.
- Keep bed low/locked and call light reachable after each repositioning event.
Shear and Skin Injury Risk
Pulling residents on linens without a lift sheet or allowing prolonged unrelieved pressure can cause preventable skin damage and is unsafe care.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| analgesics | Pre-turn pain-management contexts | Coordinate repositioning after pain control to improve participation and reduce guarding. |
| sedatives | Rest-promoting medications | Sedation can reduce spontaneous movement; reinforce scheduled repositioning vigilance. |
Clinical Judgment Application
Clinical Scenario
A bedbound resident with heel redness and coccyx discomfort slides downward repeatedly in Fowler’s position.
Recognize Cues: Pressure risk at heels/coccyx with visible shear pattern. Analyze Cues: Current positioning strategy is causing recurrent friction and pressure loading. Prioritize Hypotheses: Highest priority is immediate pressure offloading and shear reduction. Generate Solutions: Use lift sheet for boost, float heels, adjust lower bed section, and rotate to lateral offloading schedule. Take Action: Implement repositioning plan and report skin changes to nurse. Evaluate Outcomes: Pressure sites improve and resident comfort increases without new skin injury.
Related Concepts
- body-mechanics-and-safe-equipment-use - Caregiver mechanics influence repositioning safety and injury prevention.
- complications-of-immobility - Regular repositioning reduces pulmonary, circulatory, and skin complications.
- making-an-occupied-bed - Linen and turning workflows intersect during in-bed care.
- fall-prevention - Post-reposition bed safety checks prevent accidental injury.
- documenting-and-reporting-data - Time-position documentation supports skin-risk tracking.
Self-Check
- Why is lift-sheet sliding safer than direct pulling on skin or limbs?
- Which position-related factor increases shear risk in Fowler’s position?
- What should be documented after each repositioning event for high-risk residents?