Moving a patient to the Fowler’s position

Authors: V.Rednenko 

Editor: V.Rednenko 

Equipment for the practical skill:

• simulated patient (patient manikin)
• hospital bed with bedding
• chair
• foot support
• pillows
• rollers
• anti-decubitus circles

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. Place the patient to the Fowler’s 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.
• 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 and make sure the wheels on the bed are locked.
• 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:

• stand as close to the patient as possible
• make sure the patient is lying on their back in the middle of the bed
• remove the pillows
• raise the head of the bed at an angle of 45-60°
• remove the blanket and put it on a chair
• place the patient's head, neck and shoulders on a low pillow
• place an anti-decubitus circle under the patient's buttocks
• place pillows under the patient’s forearms, put small rollers in the hands of each hand
• place small pillows under the patient's hips, place rollers under the knee joints
• spread the patient's legs (slightly bent at the knee and hip joints)
• place anti-decubitus circles under the patient's heels
• place the patient's footrest at a 90° angle

Final stage:

• Ensure the person’s comfort and good body alignment.
• Adjust equipment for safety: Lower the bed to the level specifi ed in the person’s care plan. Make sure the wheels on the bed are locked. Place the person’s method of calling for help within reach. Lower or raise the side rails according to the person’s care plan.
• Clean up your work area.
• Remove gloves
• Wash your hands.