Lecture # 012:
Positioning and Transferring the Patient -
Moving a Person in Bed and out of Bed

(Parts of this lecture are taken from the text "Foundations for Caregiving" published by the American Red Cross, 1993.)

You may have experienced pressure in your arm if it was held in the same position for a long period of time. How did this feel? What did you do to relieve the pressure to the arm? How would you feel if you could not move to change the position of your arm?

If your patient is in bed for a long period of time, you must give frequent care to his skin and help him change his position. To relieve pressure, help your patient turn over in bed, help move his arms, legs, and body into different positions. When changing positions, relieve the pressure to the bony points of his body - shoulders, lower back, heels, and elbows. If he was on his side, look at his ear, shoulder, hip, knee, and ankle for redness. It is not good to change a person's position from lying on his back with his back raised to lying on his back with the bed flat. This is because the pressure is not relieved on his lower back, and heels.

Meditate Word By Word On These Verses:
biblia02/nz04/Ioann05.htm#1">John 5:1-15.

Make sure your patient's bones and joints are in a natural position and are comfortable to him. Since muscles that flex joints are stronger than those that extend joints, a paralyzed arm or leg may curl upward. When positioning a person who has a weak or paralyzed arm, support the arm so that the wrist is higher than the elbow. Since the arm or leg may curl upward, people who are unable to move them need special supports to prevent this curling.

There are also persons who have dense paralysis who cannot feel their arm or leg or where they are positioned. They may turn on their paralyzed side and lie for hours on an arm and leg. This causes the arm and leg to increase in size because pressure stops circulation. When this person is moved, he has great pain in the arm and leg he has been lying on. Sometimes there is equipment on beds that helps a person to move by himself. Most helpful is a trapeze that a person can grasp to help pull himself upward.

Question 1: What should you do if a paralyzed person doesn't feel where his limbs are located?

Turning a person in Bed
When a person is in bed, positioning him with a sheet is easy, even if he is large. Use a simple draw sheet under him that reaches from his shoulders to the middle of his thigh. When you turn him, do the following:

1. Grasp the turning sheet at the shoulder and lower back level
2. Pull him toward the side of the bed using the sheet.
3. Place his arm over his chest and bend his knee over his other leg. If he cannot bend his leg due to arthritis or knee problems, place his ankle over the other ankle so that his hip will be easier to turn.
4. Then lift the sheet and turn, he should be on his side
5. Tuck a pillow behind his back so that he does not roll backward.
6. Look for any reddened areas on his hip and lower back, if these areas are red, gently rub in some lotion to improve circulation.
7. Bend his knees slightly to help him stay on his back
8. Put a small pillow between his knees to prevent skin irritation
9. Go to the other side of the bed and gently lift his shoulder so that he does not lie directly on it. (There is a nerve in the arm that is pinched if he lies directly on it.)
10. Move his head so that it is comfortable on a pillow
11. Ask if he is comfortable and make adjustments to his position if he is not comfortable.

If he is confined to bed for a long period of time, turn him every 2-3 hours and help him to breathe deeply. This is done by simply asking him to take large, deep breaths and cough as he exhales. This exercise helps him to increase his lung capacity and improve circulation.

Lifting a Person Up in Bed
If a person is in bed, he usually slides down to the end of the bed after a period of time. To help him increase his lung capacity and comfort, he needs to be lifted up in bed. You will need two persons to do this:

1. Tell the person what you are going to do
2. Be sure the bed brake is locked or the bed is stable
3. Take the pillow away from the person's head
4. On either side of the bed, grasp the turn sheet at the shoulder and hip level, count to three and lift him up
5. If the patient is unable to lift his head, put the sheet high enough so that his head is lifted as you lift the sheet
6. Position him, and place his pillow under his head

Question 2: How many people are needed to lift a person in bed?
(Only one of the following answers is correct.)
one.
two.
three.

To prevent aspiration of fluids into the lungs, when a person eats, it is better that he sit upright. Some people can do this by sitting at the edge of the bed and balancing without difficulty. Others should sit at an almost 90 degree angle to eat. If he sits almost upright, gravity helps the food get to his stomach and stay there. This is also a good position for a person who wants to wash himself as much as possible or brush his teeth.

Raising the Head of the Bed

If you are in the home and the head of the bed does not rise, you can turn a straight-backed chair upside down against the head of the bed and put pillows in place. You may also use a cardboard box to make a back support. Here are the directions for a cardboard backrest:

1. Use a sturdy, square box that had a television inside it.
2. Cut down the front side of the box at the corners. Let this front flap fall out of the box.
3. Cut partially through the two sides of the box diagonally from corner to corner on the inside. Bend the sides inward along the lines you cut.
4. Bring the back cover flap over the folded sides.
5. Bring the front flap up and over the folded sides and tape securely.
6. Put the backrest under the pillow.

Question 3: When is it important for a patient to sit up straight? Why?

Placing a person on a Bedpan

1. Bend the knee close to you and put over the opposite leg
2. Use the turn sheet to turn the person on his side
3. Place the bedpan under him, being sure that the bedpan is in the proper place
4. Turn him to his back again
5. When the person is finished, turn to his side again and take out the bedpan.

In order to move a person, you must adequately assess your own strengths and the needs of the person you are going to move. You will need information about the person's ability to move (mobility), level of independence, and his environment.

To find out this information, talk with the person who cares for him in the home or with the doctor at the hospital. Find out about his ability to move his arms and legs so you know how much he can help you when you move him. It is also important to know if he understands directions when spoken to. It is necessary for him to move with you when you move, therefore you will need to tell him what you are going to do and what he needs to do to help. Ask these questions:

• Can he understand directions?
• Can he bear weight on both legs, or on one leg?
• Does he have a sense of balance?
• Does he have visual problems or perception problems?
• Does he have pain when he moves?
• Is he afraid of being moved?
• Are his movements predictable?

Question 4: Who should you ask about the patient, and what questions should you ask?

Ask the following questions about his environment:

• How much room do you need to move him?
• What personal items are in the way?
• What equipment do you need?
• What height should the bed be for maximum help to move him?
• Does he have a drawsheet (turning sheet)?
• Are the bed and the chair you use stable?
• How will you position yourself to avoid injury?

After you have gathered this information, determine if you need help to move him. You will need to prevent injury to yourself and to the person you move. Arrange with the family member or a co-worker to help you. Be sure to explain to him what you want him to do.

Tell the person you are moving how he can help and make sure that you have his cooperation. For example you tell the patient that you are going to stand him to his feet, turn him, and sit him in the chair. You ask if he will help you to stand, be certain to tell him that you will move him on the count of "three". This gives him a verbal cue as to when to make an effort to move.

When you are finished with the move, make sure that the person is comfortable in his new position. Are his feet flat on the floor for stability? Does he look comfortable? Are his clothes straight? Do you need to take his blood pressure?

Question 5: How can the patient help you move him? What do you need to do for this?

sitting a person up in bed

Getting a Person Out of Bed
Before getting a person out of bed, find out how long he has been lying in bed. If it is a few weeks, you need to gradually get him accustomed to sitting up. Use pillows or other support to sit him up in bed. Start doing this for 1/2 hour periods and increase the time he sits daily.

When he is sitting for two hours without having skin problems and dizziness, sit him on the edge of the bed. Put a chair or small stool under his feet so that his feet are resting on something flat. Then he has support to balance himself. As you sit him, do the following:

1. Move him to the edge of the bed.
2. Bend his knees and put his feet down over the edge of the bed.
3. Using the arm that is opposite the head of the bed, have him push his body upward (if he is unable to do this, simply lift him around the shoulders and pull him straight up.
4. Put the stool under his feet and stay beside him.

You can do this twice a day for 2-3 days depending on the person's strength, and then get him out of bed to sit in a chair. The chair must be stable and not move when he sits in it. Ideally, it should have a back and arm rests so that it supports him. If the home has no such chair, try using what is available. A kitchen stool is not supportive enough for the person when he first gets out of bed.

You have determined that Mr. S can get out of bed with minimal help. He can do much of his own weight bearing and he understands directions. You help him to do the following:

1. Move to the edge of the bed.
2. Bend his knees and put his feet down over the edge of the bed.
3. Using the arm that is furthest from the head of the bed, he reaches across his body and begins to push up.
4. With the arm that is close to the head of the bed, he supports himself on his elbow.
5. He pushes himself to a sitting position.
6. If he needs a little help, you can take his shoulders and bring him upright.
7. Be sure to let any person you move, sit for a minute or two before trying to move them anywhere.

Question 6: With which arm should he support his body?
(Only one of the following answers is correct.)
The arm that is furthest from the head of the bed.
The arm that is closest to the head of the bed.
Whichever arm is more convenient for him.

If he is unable to get out of bed himself, do the following:

1. Check the height of the bed and the placement of the chair he will sit in, the chair should be right next to the bed.
2. Pull him to the edge of the bed, using the draw sheet.
3. Put his feet over the edge of the bed and tell him what you will do next.
4. Grasp him firmly under both arms and bring him slowly to an upright position.
5. Stand in front of him to protect him from falling forward and let him adjust to the upright position.
6. Place his feet flat on the floor, explain that you are getting ready to move him and that he must help you to stand upright when you count to three.
7. Put your feet on either side of his feet, put your knees against his to give him stability, then grasp around his chest. Rock him forward and on "three" lift and turn him into the chair.

If the person is tall or very large, but can bear his own weight, you will need help to lift. In this case, do the following,

1. Bring the person to a sitting position at the edge of the bed.
2. Place yourselves on either side of the person.
3. Each of you place one knee against his knee for stability, count to "three" and
4. Lift up under each arm and pivot him into the chair.

Use the opposite sequence to get the person back into bed. If one side is paralyzed, always stand and turn the person on his strong side because he can help you better. This means that his chair will have to be moved to the opposite side of the bed to get him back to bed with the least effort.

special transfer belt

If the person is large, use a transfer belt to move him. Put the transfer belt around his waist. When two of you lift him, grasp the transfer belt and his arms for extra power.

Be sure to bend with your knees, keep your back straight, and lift with your legs and not your back.

Always get your patient back into bed before he is too tired. If he sits for a long time, he may be so weary he is unable to help you move him back to bed. Be sure that the person's strong side is on the same side as the bed. Do the reverse procedure:

1. Explain that it is time to return to bed.
2. He is to help you to stand, turn and sit on the bed.
3. Stand in front of him and brace his knees with your knees.
   
   
4. Gently rock him forward and count to three then lift and turn him to the bed.
5. Lay the upper part of his body on the bed and then bring his feet onto the bed.
6. Position him in bed with the sheet, or he may position himself.

When a person is in bed, positioning him with a sheet is easy, even if he is large. Use a simple draw sheet under him that reaches from his shoulders to the middle of his thigh. If you turn him, do the following:

1. Pull him toward the side of the bed using the sheet.
2. Place his arm over his chest and bend his knee over his other leg. If he cannot bend his leg due to arthritis or knee problems, place his ankle over the other ankle so that his hip will be easier to turn.
3. Then lift the sheet and turn, he should be on his side.
4. Tuck a pillow behind his back so that he does not roll backward.
5. Look for any reddened areas on his hip and lower back, if these areas are red, gently rub in some lotion to improve circulation.
6. Bend his knees slightly to help him stay on his back.
   
7. Put a small pillow between his knees to prevent skin irritation.
8. Go to the other side of the bed and gently lift his shoulder so that he does not lie directly on it. (There is a nerve in the arm that is pinched if he lies directly on it.)
9. Move his head so that it is comfortable on a pillow.
10. Ask if he is comfortable and make adjustments to his position if he is not comfortable.

If he is confined to bed for a long period of time, turn him every 2-3 hours and help him to breathe deeply. This is done simply by asking him to take large, deep breaths and cough as he exhales. This exercise helps him to increase his lung capacity and improve circulation.

If a person is in bed, he usually slides down to the end of the bed after a period of time. To help him increase his lung capacity and comfort, he needs to be lifted up in bed.

Question 7: Have you done all of these activities?
true / false.