Essay Example on Nursing: Patient Positioning for Physiological Safety

Introduction

Patient position is one of the critical practices in nursing. Patient positioning involves maintaining a proper body alignment of the patient by systematically changing their position. The practice is essential for several reasons, such as airway management, controlling unnecessary exposure, and ventilation. The most crucial purpose is for physiological safety. The main objective of this paper is to discuss the role and process of patient positioning.

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According to Stewart and Long (2020. p 91), it is crucial to know that patients’ positioning depends on the type and length of procedure, required devices, and anesthesia access to the patient, among other factors to be discussed. The safe and effective positioning of patients is a team effort of nurses. All members of the profession in healthcare play a significant role in sharing responsibilities for establishing and maintaining the right positions of the patients. The general objective for considering positions is to provide comfort and safety for the patients. Also, prevent injuries on musculoskeletal, nerves, and soft tissues. In surgical procedures, it allows surgeon accessibility to the surgical sites and also anesthetic administration.

Patient Positioning Guidelines

Following Stewart and Long (2020. p 97), correct execution is required during the procedures of positioning patients to prevent injuries for both patients and nurses. The following procedures are essential when positioning patients. First, nurses should enlighten the procedures. Nurses are required to give descriptions to the patients on how their positions are changed and the importance of having such positioning. Creating an understanding with the patients will convince and allow more efficient maintenance concerning the correct positioning. Determining if the patient can entirely or moderately help themselves will tell the extent of the need to help him or her. However, nurses should be aware of the patient’s conditions before building trust in the client’s response. Sometimes patients can cause injuries to themselves while trying to position themselves. The primary goal for allowing patients to put their efforts is to create an arrangement of exercise, promote individuality, and self-confidence for the patients.

Subsequently, nurses are required to get adequate help while planning to position patients (Stewart & Long, 2020. p 100). Nurses should ask for help from other caregivers in the health facility. Also, remember to seek help from professional caregivers to avoid injuries to the patients and also protect themselves from infections. Some convenient ways include the use of mechanical aids such as boards, cushions, patient lifts, slide boards, and patient dangles. It will facilitate efficiency in the process of changing positions. Raising the patient’s bed by adjusting and repositioning allows the weight of the patient to lie along the gravity center of the nurse.

Moreover, it is crucial to have frequent changes in the positioning of the clients. Note that every position that is either right or wrong can be harmful to the patient if positioned for a lengthy time. Change in position should be done at least every 2 hours to control complications such as pressure, skin breakdown, and ulcers. It is necessary to avoid friction and shearing during positioning and repositioning. While moving patients, a nurse can consider lifting rather than sliding to prevent skin from damage and creating an added risk of skin damage.

Lastly, appropriate body procedures protect both nurses and patients. Observing proper body mechanics entails the use of arms and legs and not your back. Also, the caregivers should evade twisting their back, neckline, and pelvis by maintaining the parts aligned. Caregivers should position themselves in a position close to the client and flex their knees while keeping feet wide apart. In preparation for the positioning, tighten gluteal and abdominal muscles. Those patients having the weightiest load require coordinate energies of the caregivers and pledges timing. In following this guideline, caregivers, especially nurses, can work with ease and safety while positioning their patients (Stewart & Long, 2020. p 102)

Patient Positions

The subsequent paragraphs provide the usually used positioning of the patients and descriptions for performing accurate and effective positioning.

Supine Position

Supine positioning is a common position where the client is placed flat on the back. The head and shoulders of the patient are a little raised using soft materials such as pillows. Some of the beds are modified to have a self-adjustment mechanism that can elevate the position. This positioning cannot be applied in circumstances where the patients are contraindicated with problems, including spinal anesthesia and spinal surgery. Supine positioning can vary because legs may be stretched or a little bend. The position is generally implemented during physical assessment and examination. However, such positioning can put the patient at significant risk of pressure ulcers and nerve damage (Desilets et al., 2018. p 237).

Nevertheless, skin damage of the patient should be examined regularly. To increase efficiency in the supine positioning, caregivers need to use small pillows below the head of the patient and also lumbar curving (Desilets et al., 2018. p 238). The pillow or ankle roll must be used to protect the patient from pressure. Placing footboard will protect the client from extended plantar flexion. Supine positioning is commonly used during the process that involves the anterior part of the patient. The anterior includes abdominal parts, cardiac and thoracic parts. It is vital to note that extreme rotation of the head in the surgery process can result in obstruction in the vertebral artery.

Fowler’s Position

The etymology of this positioning elaborates that the position was named after George Ryerson Fowler, who found out that such a position decreases mortality of peritonitis. Fowler’s position is also called a semi-sitting position in which the patient’s bed is raised to about 45 to 65 angle. However, Fowler’s positioning varies, including low Fowler’s, semi Flower’s, and high Flower’s, where the bed is elevated at 15 to 60 degrees, 30 to 45 degrees, and approximately vertical, respectively. The positioning is utilized to promote lung expansion. Most of the patients who have difficulty in breathing are positioned according to Fowler’s position. The mechanism behind this type of positioning is that gravity pulls the diaphragm downwards. As a result, it allows for more magnificent chest and lung expansion (Desilets et al., 2018. p 263).

Nevertheless, the positioning is helpful for NGT, patients having cardiac or neurological problems. It is commonly optimal for patients having a nasogastric tube in place. It is also essential when preparing a patient for dangling or walking.

Following the study of Desilets et al. (2018. p 291), caregivers are required to keen whenever there is faintness in the process of changing the position. Other mistakes to be checked include poor neck alignment, which can be contributed by placing large pillows behind the head of the patient. However, the positioning will encourage the expansion of the neck flexion contractures. Nurses are encouraged to allow their patients to have relaxation deprived of pillows for a short period diurnally to encompass the neck abundantly. They should use a footboard to keep the patient’s feet in correct alignment and prevent foot drop. The positioning is utilized in some surgeries that are operated on the shoulders.

Tripod or Orthopneic Position

According to Jackson (2017. p 49), an orthopneic position is set such that the client is placed in a deskbound posture. This positioning allows the patient to have a maximum expansion of the chest. Thus, patients with difficulty in breathing can have a conducive position for breathing. The overbed table is supportive to the patient having difficulties with exhaling because the patient can press their chest on against the pillows placed on the board

Prone Position

The positioning allows the clients to lie on their stomach while the head is twisted to lie sideways. The patient’s hips are not bent. This positioning’s uniqueness is the clients’ ability to have a complete stretch of the knee and hip joints. It can control flexion contractures of knees and hips. Besides, the position is helpful for patients with spine complications. The action of gravity as the client lie develops marked lordosis, thus contraindicated for spinal problems. A point to note is that the position can only be applied to patients if their back is correctly aligned. Drainage of secretions can be efficient in this position, especially for patients recovering from surgery of the throat and mouth. Extensively, the prone position is commonly used in neurosurgery, spine injuries, and the neck. Nurses can practice this prone by placing a cushion below the head and another towel or pillow below the abdomen (Jackson 2017. p 97).

Lateral Position

This positioning is well known as side-lying, where a patient is placed or lies sideways of the body. The knee and the hip are flexed while the upper leg lies in Infront of the lowest leg. The flexion is done by engaging one the leg to spread, which produces a wide and three-sided base and therefore achieving larger stability. The increased stretch of the upper knee and hip also provide balance to the patient. Also, it promotes good back alignment and reduces lordosis (Jackson 2017. p 133).

The position helps in relieving pressure on the sacrum, particularly for patients kept on bed rest in Fowlers or supine positioning. The position allows the weight of the body to be distributed since the weightiness is spread to the lateral feature of the bottom scapular, and the greater trochanter of the femur. Nurses or patients can achieve this lateral position by using the support of pillows where necessary.

Sims’ Position

Sims’ positioning requires that the client undertakes a posture midway of the prone and the lateral position. The lower arm of the patient is positioned behind while the other arm is stretched at the elbow and the shoulder. The patient’s lower leg is less stretched than the upper leg, which is acutely stretched at both the knee and the hip. The position is useful for preventing aspiration of fluids, pregnant women comfort, perineal are visualization and treatment and lowering the body pressure. Supporting the position requires body alignment with pillows (Malchau et al., 2017. p 27)

Lithotomy Position

From the study of Malchau et al., (2017. p 49), the position is commonly used during vaginal examination and childbirth. Lithotomy position can vary from low, standard, and high. The difference is inflated based on how high the patient is raised for the procedure. This position is more specific such that it does not take concern bed rest but used during certain circumstances, as mentioned.

Trendelenburg’s Position

This positioning entails lowering down the top of the bed and elevating the bottom while the arms of the patient are placed at the edges. The positioning helps in venous return, and patients experiencing hypotension can get an effective posture. Also, it is useful in postural drainage of the basal lung lobes. Some of the patients might require different tilt or even shorter periods while in this position during postural drainage. The adjustment should be made as tolerated (Malchau et al., 2017. p 57).

Besides, there is a reverse Trendelenburg’s position where the patient’s head is raised while lowering the bottom of the bed. It is exactly contrary to the Trendelenburg’s positioning.