In a healthcare setting, patient positioning is a critical aspect of the nursing practice. It involves maintaining a patient’s good body alignment by constantly changing their position.
Nurses must ensure that they position the patients properly.
All nursing professionals should take the principles of patient positioning in nursing seriously. These principles are important for many reasons including airway management, ventilation, controlling unnecessary exposure, and most importantly physiological safety.
In this blog, we will understand about patient positioning, its importance, and different patient positions used in healthcare settings.
What is Patient Positioning?
Patient positioning is a practice involving maintaining a patient’s body in neutral alignment by preventing hypertension, and extreme lateral rotation.
Learning the rules for patient positioning in nursing is an important practice and a responsibility of the Registered Nurse. In surgery, specimen collection and proper patient positioning ensure optimal surgical site exposure while maintaining patient dignity by minimizing unnecessary exposure.
Patient positioning is important for ensuring patient safety not just during a surgical procedure but also before and after. Proper patient positioning during surgery ensures optimal site access, controls unnecessary exposure, and prevents long-term issues like nerve damage or pressure ulcers.
In most healthcare settings, patient positioning offers airway management and ventilation while maintaining body alignment and providing physiological safety.
Goals of Patient Positioning:
It is important to note that patient positioning in nursing is important for a safe and effective surgical procedure.
Proper patient positioning in the operating room depends on the procedure type, length, anesthesia access, and required medical devices.
Nurses often ensure that safe positioning is done correctly, even though it is a team effort. During surgery, all team members help maintain the correct patient position.
The main goal of patient positioning in nursing is to protect the patient from injuries and complications due to immobility.
To be specific, the primary goals of patient positioning are mentioned below:
- Comfort and Safety: Patient positioning in nursing helps in supporting the patient’s airway and maintaining circulation all through the procedure. The impaired venous returning to the heart and ventilation to perfusion mismatch are relatively common complications that arise. Proper positioning promotes comfort and prevents nerve damage by preventing any unnecessary extension.
- Dignity and Privacy: Proper patient positioning in surgery respects patient dignity by reducing exposure.
- Visibility and Success: Proper patient positioning in nursing ensures easy surgical access and anesthetic administration during the perioperative phase.
Nurses must ensure the following things when positioning patients.
- Maintaining the patient’s airway and circulation all through the procedure.
- Preventing nerve damage.
- Allowing access to the surgical site as well as for anesthetic administration.
- Offering comfort and safety to the patients.
- Preventing any soft tissue or musculoskeletal patient injury.
Common Patient Positions:
Fowler’s Position:
Also called the sitting position, Fowler’s position is used in neurosurgery and shoulder surgeries. Surgical staff should minimize the patient’s head elevation and keep it neutral when positioning a patient this way. This position raises the patient’s head and trunk 40 to 90 degrees. The low Fowler’s position raises the head and trunk 15 to 45 degrees. The high Fowler’s position raises the head and trunk 90 degrees.
Doctors recommend the Fowler position for patients suffering from respiratory, cardiac, or neurological problems. Align the patient’s feet with a footboard in these positions. Secure the patient’s arms across the body, pad the buttocks, and flex the knees to about 30 degrees.
Orthopneic or Tripod Position:
The patient sits on the side of the bed and leans on an over-bed table. They use several pillows for support. Patients with breathing problems use the tripod position to expand their chest and ease breathing. This position allows maximum chest expansion, aiding those with breathing difficulties. The orthopneic position helps patients with exhaling issues by letting them press their lower chest against the table edge.
Supine or Dorsal Position:
Another common patient position in nursing is the Supine or Dorsal position.
Also known as Dorsal Decubitus, medical professionals frequently use it for procedures. In this reclining position, the patient faces upwards. Place the patient’s arms at their sides, tucking them with a bedsheet secured by arm guards to sleds. Flex the arms and secure them across the body or extend and secure them on padded arm boards.
Medical staff often use this position for post-surgery patients to aid recovery and provide comfort. However, it puts extra pressure on the elbows, sacrum, occiput, scapulae, coccyx, and heels. Professionals commonly use the supine position in procedures involving the body’s anterior surface, including the abdomen, cardiac, and thoracic areas. Use a small pillow or donut to stabilize the head and prevent vertebral artery occlusion during surgery.
Prone Position:
In the prone position, the patient lies on their abdomen with their head turned to one side. This position allows the hips to flex while also allowing for full extension of the knee joints. This position is for patients who are either unconscious or who have undergone surgery on the mouth or throat. A pillow under the head, along with a towel roll under the abdomen, is placed to provide support to a patient lying in the prone position.
The prone position is often used for spine and neck surgeries, vascular surgeries, neurosurgery, tendon repairs, colorectal surgeries, etc. The foam and gel positioners may also be used for spinal procedures. When the patient is in a prone position, the pressure is kept off the eyes, ears, cheeks, and breasts. At any given time, four members of the surgical staff must be available when turning a patient prone. Common risks associated with the prone position include increased abdominal pressure, bleeding, nerve injuries, cardiovascular compromise, ocular injuries, etc.
Lateral Position:
Another important patient positioning in nursing is the lateral position, also known as the side-lying position. Here, the patient lies on one side with the top leg in front of the bottom leg and both knees flexed. Most body weight is on the lower scapula and the greater trochanter of the femur. This position relieves pressure on the sacrum and heels, helpful for people sitting most of the day.
It’s used during back, colorectal, kidney, and hip surgeries, as well as thoracic, ENT, and neurosurgeries. Maintaining spinal and neck alignment and securing a safety restraint across the hips is crucial. Risks include pressure on the ears, ribs, hips, knees, and ankles, brachial plexus injury, reduced lung capacity, venous pooling, and DVT.
The Scope of Learning About Patient Positioning in Canada
For nursing students in Canada, mastering the art and science of patient positioning is a critical component of their education. Studying nursing in Canada offers a comprehensive curriculum that emphasizes the importance of proper patient positioning to ensure comfort, prevent complications, and facilitate recovery. Students will learn evidence-based techniques for positioning patients to reduce the risk of pressure ulcers, improve respiratory function, and enhance overall patient care.
Furthermore, understanding patient positioning is integral to optimizing diagnostic accuracy and therapeutic interventions. By acquiring these vital skills, nursing students in Canada prepare themselves to deliver high-quality, patient-centered care in diverse healthcare settings. This approach ensures better outcomes and enhances patient satisfaction.
Conclusion:
Patient positioning is an essential aspect of the job responsibilities of nurses. Hence, nurses must be well-versed in various patient positions to excel in their roles.