Moving a patient to the prone position

Authors: V.Rednenko 

Editor: V.Rednenko 

Equipment for the practical skill:

• simulated patient (patient manikin)
• hospital bed with bedding
• chair
• foot support
• low pillow (under the head)
• pillow (15-20x30-35x10-12) - 2-3 pcs. (under limbs)
• roller (length 80-100, diameter 15-20 cm) (to support the body)
• roller (length 10-12 cm, diameter - 6-8 cm) - 2 pcs. (for hands)

Clinical situation:

Patient N. is in the neurological department with acute cerebrovascular accident, he is assigned to change body positions every 2 hours in order to prevent bedsores. The patient lies on his back. Place the patient in the Sims position from the supine position.

Order of the skill performance:

Preparatory stage:

• Introduce yourself
• Identify patient
• Obtain informed consent to the procedure (if the patient's condition allows it)
  • Give all the information to the person about what the procedure involves, including the benefits and risks, whether there are reasonable alternative, and what will happen without this procedure
  • Explain what you are going to do.
  • Ask the patient to consent to procedure.
  • Explain to the patient how he can help.
• Call an assistant if necessary
• Make sure you have the necessary equipment and put it on the chair next to the bed
• Sanitize your hands, put on gloves
• Prepare the patient bed:
• fasten the bed brakes
• remove the bed side rails 
• adjust the bed to a horizontal position
• adjust the height of the bed (the patient lying on the bed should be at the level of the mid-thigh of the healthcare worker, which will reduce the effort required when moving the patient)

Main stage:

• Position yourself as close to the patient's bed as possible

• Remove the pillow from under the patient's head, remove the blanket, make sure that nothing is in the way to move the patient

• Move the patient to the side of the bed  (see skill Moving the Patient to the side of the bed by one nurse)

• Go to the other side of the bed
• Straighten the patient's arm closest to you at the elbow joint, place it along the body and place the patient's hand under the thigh

• Bend the patient's farthest leg at the knee joint, placing the foot under the popliteal cavity of the other leg

• Grab the patient's farthest shoulder and hip with your hands.

• Turn the patient towards you

• Move the patient to the prone position

• Place a low pillow under the patient's head, neck and shoulders, turn the patient's head to the side

• Bend the upper arm of the patient at the elbow and shoulder joints and place it next to the face (on the pillow or next to the pillow)

• Place the other hand in one of the positions: next to the head on a pillow or along the body

• Place small pads on the patient's hands

• Put anti-decubitus circles under the knee joints

• Place pillows under the patient's shins so that the toes do not touch the bed

• Make sure the patient is comfortable
• Straighten wrinkles in the patient's bed linen and clothing (if necessary)
• Cover the patient with a blanket
• Return the bed side rails to their initial position.

Final stage:

• Remove gloves, place in appropriate container for disinfection
• Perform hygienic hand washing