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For those of you working in the field of nursing care, and those of you who are just starting to learn nursing care, changing the position of users is an important part of daily care. However, you may sometimes feel anxious, wondering, "Is this really the right position?" or "Am I putting a burden on the user?"
In this column, we will share some tips for those new to nursing care or those who are not yet familiar with positioning to help them change positions confidently, safely, and easily. Learning the proper method will enable you to provide more comfortable and secure care for both the user and yourself.
What is position change? Its purpose and importance
Positioning refers to regularly changing the orientation and position of a user who is sleeping in a bed or other place. This is not just about moving the body. It is a very important form of care in nursing care to keep the user comfortable and healthy.
In particular, for those who have difficulty moving freely on their own or who are bedridden, changing positions greatly affects the quality of their daily lives. By changing positions appropriately, it is possible to reduce various risks to the body and provide a more comfortable life.
Preventing bedsores
When a user stays in the same position for a long time, pressure continues to concentrate on certain parts of the body that are in contact with the bed. This pressure is particularly likely to be felt on areas with protruding bones, such as the buttocks, sacrum, heels, elbows, and back of the head. This pressure impedes blood flow, preventing sufficient oxygen and nutrients from reaching the skin tissue, eventually causing the skin to become red and sore, resulting in the development of bedsores (commonly known as "bedsores").
Pressure ulcers are a very troublesome condition that not only cause severe pain and discomfort to users, but also increase the risk of infection and take a long time to heal. Regular positioning to distribute pressure on areas is an essential care method for effectively preventing the occurrence of pressure ulcers and relieving users' pain.
Preventing and improving contractures
Staying in the same position for a long time can impair joint movement and cause contractures, which cause muscles to stiffen and shorten. Contractures limit the range of motion of the joints, making daily activities such as dressing and toileting difficult and can even cause pain.
Changing positions regularly moves joints and prevents certain muscles from being constantly tense, which can prevent the development of contractures, slow the progression of existing contractures, and even promote improvement in some cases.
Promotes blood circulation and maintains respiratory function
Changing positions can also be expected to improve blood circulation throughout the body. If you stay in the same position for a long time, blood flow tends to become stagnant, increasing the risk of swelling and blood clots. Moving your body improves blood flow, allowing oxygen and nutrients to be delivered to cells more efficiently.
In addition, changing posture helps to maintain respiratory function by aiding lung ventilation and encouraging the expulsion of phlegm. Effective expulsion of phlegm by changing posture is particularly important for users at risk of aspiration pneumonia.
Providing mental comfort and comfort
In addition to the physical aspects, changing positions also contributes to the mental well-being of users. Staying in the same position for a long time can not only cause physical discomfort, but can also lead to feelings of mental blockage and loneliness. Changing positions regularly and providing a change of scenery and physical sensations can provide a change of mood and a sense of comfort and relaxation.
Caregivers' words of encouragement and gentle assistance will provide opportunities for communication with users and will be important times for deepening relationships of trust.
Three basic principles for safe and comfortable position changes
There are a few tips for safely and comfortably changing positions. It is important to be aware of the body's mechanisms and how to use assistive devices, rather than relying on force.
1. Use body mechanics
Body mechanics are the principles of how to use the body safely with minimal force. By being aware of this, you can reduce the burden on the user and prevent back pain for the caregiver.
Keep your center of gravity low and your base wide: When changing positions, keep your hips low and your legs apart for stability.
Use the principle of leverage: Instead of trying to lift the user's body all at once, be conscious of creating fulcrums in parts and moving them.
Pull rather than push: When moving your body, pull rather than push, and you will use less force.
Reduce friction: If there is a lot of friction between the bed and the user's body, more force is required. By using a sliding sheet, which will be described later, you can reduce friction and move smoothly.
Make the most of the user's remaining abilities: Encourage the user to move on their own as much as possible by telling them to "cross their arms" or "keep your knees up", etc.
2. Thorough advance preparation and communication
By preparing in advance rather than suddenly moving your body, you can change positions more safely and smoothly.
Environmental improvement: Remove obstacles around the bed to ensure there is ample space for care.
Speaking to the user: Always say something like, "I'm going to turn my body over now," to help prepare the user mentally. Sudden movements can startle the user and make them anxious.
Adjusting the bed height: Adjust the bed height to make it easier for the caregiver. Ideally, it should be at a height that does not put strain on the caregiver's lower back.
Checking the user's physical condition: Understand the user's physical condition (whether they are in pain, what is the range of motion of their joints, etc.) and assist them within a reasonable range.
3. Make good use of assistive devices
In recent years, there are various welfare devices available to support position changes. Utilizing these devices can significantly reduce the burden on caregivers and make users more comfortable.
Sliding sheet/glove: Made of thin fabric that reduces friction and allows the user to slide and move, making it possible to change positions with little effort.
Positioning cushion: By filling in gaps and supporting the body, it stabilizes the user's posture and distributes pressure.
Pressure-relieving mattresses (bedsore prevention mattresses): Some mattresses have a function that automatically switches air in and out of the mattress, periodically shifting the areas where pressure is applied and redistributing body pressure. When used in conjunction with position changes, this leads to more effective bedsore prevention.
Basic steps for changing position
Here we will introduce the general procedure for changing positions. Please respond flexibly according to the user's condition. Here we will introduce the general procedure for changing positions. Please respond flexibly according to the user's condition.
1. Calling and preparation
Talk to the user and adjust the bed height.
2. Pull the body towards the caregiver
Pull the user's body slightly toward the caregiver, which will reduce the risk of them falling off the bed when they turn to the side.
3. Crossing your arms and bending your knees
Have the user cross their arms in front of their chest and raise the knee of the leg they want to lie on their side.
4. Support your shoulders and lower back
Place one hand on the shoulder and the other on the waist and gently pull the person towards you, turning them onto their side.
5. Positioning
Once you are lying on your side, use cushions to stabilize your body and find a comfortable position. Place cushions especially around any overlapping or floating parts of your body.
6. Check the status
After changing the position, we check the user's condition by asking questions such as, "Are you in any discomfort?" and "Is there anywhere that hurts?"
"Could it be a bedsore?" Important actions to take when you discover
During daily positioning and care, you may notice changes in the skin of your client. In particular, the following changes are likely to be signs of bedsores.
・The skin is red and does not turn white when pressed (redness)
Blisters on the skin
- Burned or peeling skin
The skin turns purple
Heat or swelling in a specific area
・The user complains of pain or discomfort in that area
Know the areas where pressure sores are likely to occur
Pressure ulcers tend to develop particularly easily in areas where weight is placed and bones protrude. Check the diagram below to see the main areas where pressure ulcers are likely to develop so that you can be aware of them during your daily care.
If you notice any signs of a bedsore, never treat it yourself and take the following actions immediately. Early detection and appropriate treatment are essential to prevent the bedsore from worsening and minimize the suffering of the user.
● Immediately report to your supervisor or nurse.
Even if you notice any abnormalities, no matter how minor, report them immediately to a supervisor or nurse. At nursing facilities, nurses and doctors with specialized knowledge of pressure ulcers will make appropriate judgments and take appropriate measures. Accurately explain the situation and ask for instructions.
● Avoid applying pressure to the affected area
Make sure that no pressure is being applied to areas showing signs of pressure ulcers. Turn the patient's position more frequently and use repositioning cushions or pressure-relieving mattresses to keep the area from coming into contact with the bed.
● Keep it clean
It is important to keep the affected area clean and dry at all times. After gently washing and wiping, be careful not to rub the area.
● Record your progress
Keep detailed records of when, where, and what kind of abnormality was observed, as well as the size, color, and the user's reaction. Photographs are very useful as objective information. This information will be important in determining the course of treatment.
● Do not treat on your own judgment.
Please do not self-diagnose and apply over-the-counter medicine or a bandage, thinking that "this is fine." Improper treatment may actually make the condition worse.
Spotting the signs of pressure ulcers is a testament to your observation skills, and working with the right team can help protect the health of your patients.
Mastering position changes makes life easier for both users and caregivers
Positioning is an essential part of care in the field of nursing care. If positioning is not done properly, the user may end up in painful and difficult conditions such as bedsores and contractures. Once these conditions occur, not only is the user in pain, but the caregiver's workload increases dramatically, placing a heavy mental and physical burden on them.
The important thing is not to try to do everything perfectly at once, but to be mindful of each point carefully and practice it repeatedly in your daily work. Use body mechanics to reduce the strain on your own body and hone your powers of observation so that you can notice even the slightest changes in your clients.
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