Repositioning Patients in Healthcare
Repositioning in Nursing: Preventing Pressure Ulcers
Patient repositioning (or repositioning patient in healthcare) means moving someone in bed or in a chair to a new position. This helps take pressure off areas like the back, heels, and hips, which can get sore if someone stays in one spot too long. To help prevent pressure sores, people should be moved at least every 6 hours, or every 4 hours if they are at high risk.
Repositioning is a type of care where a nurse or carer changes a patient’s position in bed. It helps stop pressure sores and keeps the skin healthy by spreading body weight and improving blood flow. Patients are usually moved every two hours.
This is very important for people who can’t move by themselves or stay in one position for too long. Carers can turn patients from their back to their side or stomach, making sure their arms and legs are not pressing against each other.
In hospitals or care homes, repositioning is done by a team – including nurses, physios, and paramedics – to give the best care. Special tools like hoists and slide sheets can be used to make repositioning safer. Staff need training to use this equipment properly.
Repositioning often helps skin stay healthy and lowers the chance of getting sores. Some people need to be moved more often than others, and carers decide what works best based on the person’s needs.
Key Tools for Moving and Repositioning Patients
There are many helpful tools that carers and nurses can use to move and reposition patients safely. These tools help protect the patient’s skin and also make the job easier for staff.
Slide Sheets and Transfer Sheets
Slippery sheets placed under the patient to help slide and turn them more easily. They reduce rubbing on the skin and stop injuries. Some can be used once and thrown away, others are washable.Turning and Repositioning Systems
These are special sheets with handles or built-in supports. They help carers move the patient while keeping their body in the right position.Ceiling Track Hoists
Lifting machines fixed to the ceiling. They help move patients safely without lifting by hand. Good for patients who cannot move by themselves.Mobile Floor Lifts
These are portable hoists that can be moved from room to room. They lift patients with a sling when a ceiling hoist is not available.Electric Profiling Beds
Special hospital beds that move up and down or tilt to help with moving and caring for patients. Features may include:Raising the head or feet
Tilting the whole bed
Built-in scales to weigh the patient
Pressure Redistributing Mattresses
Mattresses made to spread body weight and protect the skin. These can include:Foam mattresses
Air mattresses that change pressure
Mattresses that allow airflow
Mixed systems using different types
Positioning Wedges and Cushions
Soft supports used to keep the patient in a safe and comfy position. These include:Wedges for turning
Cushions to lift heels
Head, neck, and knee supports
Special pillows to separate body parts
Air-Assisted Transfer Devices
Inflatable mats that use air to help slide the patient. They are helpful for larger patients.Transfer Boards
Hard or semi-hard boards that help move a patient from one surface to another, like from a bed to a wheelchair.Handling Belts and Walking Belts
Belts with handles that go around the patient’s waist. They give support when helping someone to stand or move in a chair.Turn Sheets with Handles
Strong sheets with handles to help carers turn or move the patient safely.
Using these tools the right way helps protect the patient and stops carers from getting hurt. They make repositioning safer and more comfortable for everyone.
What Repositioning a Patient Means
Repositioning a patient means changing how they are sitting or lying down. This can be in a bed, chair, or wheelchair. It is an important skill for nurses and carers, especially when the person cannot move by themselves.
This helps take pressure off certain parts of the body. It is very important to prevent pressure sores, improve blood flow, and make the person feel more comfortable. It also helps keep people healthy, especially those who cannot move much on their own.
Repositioning should be done often to stop problems like pressure ulcers or bedsores. The new positions can include lying on the back, lying on the side, sitting up in bed, sitting in a chair, or even walking if they are able to.
Care staff can move a person by hand or use special equipment like hoists or pressure-relieving beds. How often someone should be moved depends on their health. People in bed might need moving every 2 hours. People in wheelchairs may need to change position every 15 minutes to 1 hour.
What Does Repositioning Mean?
It can include:
Turning a person from one side to the other
Moving them from their back to their side or the other way round
Helping them sit up if they were lying down
Changing their position in a chair or wheelchair
Using pillows to lift or support parts of their body
Following a turning plan, like moving them every 2 hours
Making small moves to spread out pressure
How Is Repositioning Done?
Repositioning depends on:
The person’s size, health, and how much they can move
If they can help move or not
What tools are available (like sliding sheets or hoists)
How many staff are helping
Any health problems that affect movement
Steps usually include:
Telling the person what you are going to do
Moving safely so no one gets hurt
Using equipment if needed
Making sure the body is lined up properly
Using pillows or cushions to support them
Writing down the new position and time it was done
Image Credit: Science Direct: Prevention of Pressure Ulcer Among People With Spinal Cord Injury.
Types of Repositioning and When to Use Them
Repositioning helps stop pressure sores and keeps the body working well. Different positions are used for different reasons. Here are the common ones and when to use them:
Common Positions
Supine – lying flat on their back.
Side-lying (lateral) – lying on one side.
Prone – lying on the stomach (used in special cases).
Semi-Fowler’s – head raised about 30 to 45 degrees.
High Fowler’s – sitting up more, at 60 to 90 degrees.
30-degree tilt – slightly turned to one side to reduce pressure.
People in bed are usually moved every 2 to 4 hours. Those in chairs are moved every hour. This helps prevent pressure sores. The exact timing depends on each person’s needs and care plan. Let’s go in each in details below:
Supine Position (Lying on Back)
When to use:
To check airways or do medical checks
For care or treatment on the front of the body
When eating (head should be raised)
For people with certain back problems
Things to know:
Can put pressure on the back, heels, and head
Risk of choking if the head is not raised
Not good for long periods if the person can’t move much
30° Lateral Tilt Position
When to use:
To move pressure away from the back
For people at high risk of pressure sores
If the person can’t fully lie on their side
Things to know:
Use pillows to keep the body tilted
Helps protect bony parts like hips
Often more comfy than full side-lying
Lateral Position (Side-Lying)
When to use:
To take pressure off the back
For washing or giving back care
For people with lung problems (put good lung down)
To stop choking in people who are not awake
Things to know:
Use pillows between knees and under arms
Make sure hips, shoulders, and ears are not in a straight line
Semi-Fowler’s Position (Head Raised 30–45°)
When to use:
After meals to help with digestion
For breathing or heart problems
To take medicine by mouth
Things to know:
Helps breathing and stops choking
May need to lift knees slightly to stop sliding
Less pressure on heels than lying flat
High Fowler’s Position (Head Raised 60–90°)
When to use:
When eating or drinking
For breathing problems
To help people feel more alert and talk
Things to know:
Can cause sliding down the bed
Use pillows or supports for safety
Not good for long times without pressure checks
Prone Position (Lying on Tummy)
When to use:
In ICU for breathing support
For certain back treatments
To take pressure off the back
Things to know:
Needs training and a team to do safely
Not safe for some people (e.g. pregnant or facial injuries)
Needs careful watching
Chair Position
When to use:
During the day to help with normal life
For eating, social time, and better breathing
Things to know:
Must move more often (about every hour)
Use soft cushions if needed
Make sure the person sits properly
Special Techniques
Microshifting
Small changes in position
Good for people with very sore or weak skin
Used between big moves
Bridging and Rolling
Used to help move someone in bed
Helpful when changing sheets or using lifting aids
Log Rolling
For people with back injuries
Keeps the spine straight
Used after certain surgeries
How Often to Reposition
High-risk patients (in bed): Every 2 hours
In chairs: Every hour, shift weight every 15 minutes
Lower risk: Every 2–4 hours depending on skin checks
Very ill patients: As often as needed, based on their condition.
Each repositioning plan should be individualised based on the patient’s condition, risk factors, comfort, and clinical needs.
Why Repositioning is Important in Nursing
Repositioning means helping a patient move into a different position. It is one of the most important things nurses and care workers do. It helps in many ways:
- Prevents Pressure Sores
When a person lies or sits in the same position for too long, pressure builds on certain body parts like the bottom, heels, or shoulders. This can stop blood flow and cause painful skin sores (called pressure ulcers). Moving the person often helps prevent these sores. - Helps with Breathing
Changing positions helps the lungs open up and keeps chest muscles working. If someone stays lying down too long, fluid can collect in the lungs, which may cause chest infections. Repositioning helps the person breathe better and keeps their lungs healthy. - Keeps Joints Moving
If a person doesn’t move for a long time, their joints and muscles can become stiff. Repositioning helps keep their arms, legs, and back flexible. This prevents tightness and helps with movement later on. - Improves Blood Flow
Moving helps the blood go around the body properly. If someone stays still for too long, they might get blood clots in their legs. Repositioning helps stop this from happening. - Makes People Feel Better
Being in the same spot can be uncomfortable or painful. Helping someone change position gives them relief and helps them sleep better. It also shows respect for their comfort and dignity. - Helps with Digestion and Toileting
Some positions help the body digest food and pass waste properly. Moving around helps stop problems like constipation, which are common in people who stay in bed a lot. - Lowers Infection Risk
If the skin breaks down from pressure, it can let germs in and cause infection. Repositioning helps keep the skin healthy and lowers the risk of infections. - Keeps the Mind Active
Moving into new positions gives the brain different feelings and views. This helps the person stay more alert, especially if they are in bed for a long time.
Repositioning is a simple but very important part of care. Every person is different, so nurses and care staff should check each patient’s needs. Changing positions often helps prevent problems and keeps the patient safe, healthy, and comfortable.
Best Practices for Manual Patient Repositioning.
1. Make a Repositioning Plan for Each Patient
Every person is different. Check their skin, comfort, and how well they can move. Most at-risk adults should be moved every 2 to 4 hours, but some may need more or less. Use your judgement and follow care plans.
2. Choose the Best Positions
The 30° side-lying position is better than lying flat on the back or fully on the side (believed to be). It puts less pressure on bony parts like hips and back. Don’t leave patients sitting fully upright for too long, as this can cause pressure and sliding.
3. Use Safe Moving Techniques
Never drag patients across the bed—it can hurt their skin. Use tools like slide sheets, hoists, pillows, or wedges to move them safely. Follow your workplace rules and check instructions on how to use each item.
4. Check Skin and Comfort
Look at the skin each time you move the patient. Check for red marks or sore spots. Make sure there are no wires, tubes, or objects under them, and that they’re lying in a comfy and safe position.
5. Talk to the Patient
If the patient can speak or understand, ask what’s comfortable for them. Let them know what you are doing. If they are in pain, they may need pain relief before moving. Talking helps them feel calm and cared for.
6. Write It Down (Document)
Keep a note of when the patient was moved, the position used, and how their skin looked. This helps other staff and shows early signs if there’s a problem.
Tools and Scales for Patient Repositioning
There are different scales and tools used in healthcare to measure, record, and guide how patients are moved. These tools help make sure care is consistent and patients are repositioned at the right times.
Pressure Sore Risk Tools
1. Braden Scale
This is used to check how likely a patient is to get pressure sores.
It looks at how well the patient can move.
A lower score means the person needs to be moved more often.
If the total score is below 18, more care is needed.
2. Waterlow Scale
This scale is often used in the UK.
It checks how mobile the person is.
It also looks at if they have any nerve problems.
A higher score means the person needs to be moved more often.
3. Norton Scale
This was one of the first scales used.
It looks at five things: body condition, mental state, activity, movement, and wetness.
Lower scores mean more risk and more need to move the patient often.
Charts and Tracking Tools
4. Turning Clocks
These are charts with times shown like a clock.
Staff use it to mark when the person was last moved.
It shows what position the patient was in.
It also shows who did the moving and how the skin looked.
5. Repositioning Charts
These charts track:
How often the patient is moved
How long they stay in each position
If the patient was happy or in pain
If any pillows or supports were used
6. Electronic Monitoring Tools
Some hospitals use special machines or beds that:
Show how long a person has been in the same spot
Send alerts when it’s time to move the patient
Create reports to help staff keep track
Movement and Help Levels
7. Functional Independence Measure (FIM)
This shows how much help a patient needs to move.
The scores go from 1 (needs full help) to 7 (fully independent).
Lower scores mean the patient needs help with moving and turning.
8. Barthel Index
This tool checks how well a patient does daily tasks.
It includes moving from bed to chair and walking.
The score helps decide how much help they need to be moved.
Extra Tools for Better Repositioning
9. Pressure Mapping Systems
These are high-tech tools that show where pressure is high on the body.
They help find sore spots.
They show if the patient’s position is good or needs to change.
10. Pain and Comfort Scales
These are used to check if the patient is in pain when moved.
Patients might rate pain using numbers or faces.
For patients who can’t talk, staff look at body signs like grimacing or moaning.
Top Dangers of Repositioning Patients.
1. Patient Falls
If a patient is not moved safely or left unsupported, they might fall. Falls can cause broken bones or head injuries, especially in older or weak people.
2. Skin Damage from Dragging
Pulling a patient across the bed without lifting can hurt their skin. This can lead to cuts, bruises, or pressure sores.
3. Injuries to Staff
Nurses and carers can hurt their backs, shoulders, or necks if they move patients the wrong way. This can cause serious problems and stop them from working.
4. Tubes or Wires Coming Loose
If a patient has tubes (like drips or feeding tubes), moving them carelessly can pull these out, which can be painful or dangerous.
5. Pain for the Patient
Some patients may feel pain when moved, especially if they have sore joints, wounds, or had surgery. It’s important to move them gently.
6. Breathing Problems
Some positions can make it hard for a patient to breathe, especially if they already have breathing problems.
7. Feeling Dizzy or Faint
If a patient is moved too quickly, they might feel dizzy or even faint. This can happen more with very ill patients or those on strong medicine.
8. Joints Popping Out
If you move someone with weak joints the wrong way, their joints can pop out of place (dislocate), especially if they have had joint problems before.
9. Hurting the Spine
Some patients need to keep their back very straight. Moving them the wrong way can hurt their spine, especially after surgery or an injury.
10. Pressure in the Wrong Places
If pillows or supports are not put in the right place, the pressure can move to another area and cause new pressure sores.
To stay safe: staff should be trained, use the right equipment, and work together to move patients the right way. This helps keep both patients and carers safe.
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