ASSISTING PATIENT (SITTING ON THE SIDE OF DANGLING BED)

• To position means?


  A way in which someone or something is placed or arranged, related to position or posture.
• Positioning


  • Lies within the broader context of manual handling, which incorporates, 'transporting or supporting a load (including lifting, putting down, pushing, pulling, carrying or moving) by hand or bodily force'
• Patients with artificial airways


  • It is important to maintain neutral head and neck alignment within the movement plane
  • Have one member of staff in sole charge of looking after the patient's artificial airway to avoid risks or trauma, dislodgement and occlusion and, if ventilated prolonged disconnection from oxygen source
  • Changing position will also alter the neck musculature so it is important to ensure the tracheostomy tapes are tied securely before and after moving the patient
  • With newly formed tracheostomies there is an increased risk of dislodgement 7 – 10 days following the procedure as the surrounding fascia and muscle need to repair to form the tract
• Positioning a patient in bed


  • Important for maintaining alignment and for preventing bed sores (pressure ulcers), foot drop, and contractures
  • Vital for providing comfort for patients who are bedridden or have decreased mobility related to a medical condition or treatment
  • Supportive devices such as pillows, rolls, and blankets, along with repositioning, can aid in providing comfort and safety

  
• Assisting patient to sit on side of the bed (dangling)

  1. Determine assistive devices, encumbrances, medications, assistance required

  2. Introduce self, verify identity, explain procedure

  3. Perform hand hygiene, provide privacy, position appropriately

  4. Assist client to lateral position, raise bed, position feet

  5. Stand beside client, assume broad stance, lean forward

  6. Move client to sitting position, support shoulders and thighs

  7. Pivot on balls of feet, pull legs off bed

  8. Support client until balanced, document findings

  9. Check skin integrity, alignment, safety precautions, tolerance

  
• This skill describes the process to use for clients who is able to perform the task independently and only needs stand by assistance in steadying, or a client who requires minimum assistance in which the client can perform the task with or without friction-reducing assistive devise and the health care worker provides 25% of the work
• Transporting or supporting a load

  Lifting, putting down, pushing, pulling, carrying or moving) by hand or bodily force'
• Some patients, whether unconscious or not, may not be able to maintain a 'safe' airway and therefore and therefore may require an artificial airway to support the respiratory system. Patients may have a particular airway depending upon their individual need and presentation.
• The client assumes a sitting position on the edge of the bed before walking, moving to chair or wheelchair, eating or performing other activities.

  Purpose
• Determine:

  •Assistive devices that will be required

  •Encumbrances (hindrances) movement such as an IV urinary catheter.

  •Medications the client is receiving, because certain medications may hamper movement or alertness of the client.

  •Assistance required from other health care personnel
• Rationale of: Prior to performing the procedure, introduce self and verify the client's identity using agency protocol.


  Allay anxiety
• Rationale of: Perform hand hygiene and observe other appropriate infection prevention procedures.

  Decrease microorganisms transfer.
• Rationale of: Provide for client privacy 


  Increase sense of security.
• Rationale of: Position yourself and the client appropriately before performing the move.

  Efficient movement
• Rationale of: Assist the client to a lateral position facing you, using an assistive device depending on client assistance needs.


  This decreases the distance that the client needs to move to sit up on the side of bed
• Rationale of: Raise the head of the bed slowly to its highest position.

  Position the clients feet and lower legs at the edge of the bed.


  This enables the clients feet to move easily off the bed during the movement, and the client is aided by gravity into a sitting position.
• Rationale of: Stand beside the client's hips and face the far corner of the bottom of the bed (the angle in which occur). movement will

  Assume a broad distance, placing the foot nearest the client and head of the bed forward.

  Lean your trunk forward from the hips. Flex your hips, knees and ankles.

  Proper body mechanics
• Rationale of: Stand beside the client's hips and face the far corner of the bottom of the bed (the angle in which occur). movement will

  Assume a broad distance, placing the foot nearest the client and head of the bed forward.

  Lean your trunk forward from the hips. Flex your hips, knees and ankles.

  Proper body mechanics
• Rationale of: Move the client to a sitting position using an assistive devise.


  Depending on needs. clients assistance.
• Rationale: Place the arm nearest to the head of the bed under the clients shoulders and the other arm over both of the clients thighs near the knees.


  Supporting the clients shoulders prevents the client from falling backward during the movement.
• Rationale of: Tighten your gluteal, abdominal, leg and arm muscles.

  Supporting the clients thighs reduces friction of the thighs against the bed surface during the move and increases the force of the movement. In preparation for pivoting.
• Rationale of: Pivot on the balls of your feet in the desired direction facing the foot of the bed while pulling the clients feet and legs off the bed.

  Pivoting prevents twisting of the nurses spine. The weight of the clients legs swinging downward increases downward movement of the lower body and helps make the clients upper body vertical.
• Rationale of: Keep supporting the client until the client is well balanced and comfortable.


  This movement may cause some clients to become light headed or dizzy.
• Rationale of: Document relevant information.

  •Ability of the client to assist in moving and turning

  •Type of assistive device, if one was used.


  Response of the client to moving and turning (like anxiety, discomfort and dizziness)
• Rationale of


  1. Check the skin integrity of the pressure areas from the previous position

  2. Relate findings to assessment data if available

  3. Conduct follow up assessment for previous and/or new skin breakdown areas
• Rationale of


  1. Check for proper alignment after the position change

  2. Do a visual check

  3. Ask the client for a comfort assessment
• This skill describes the process to use for

  • Clients who is able to perform the task independently and only needs stand by assistance in steadying
  • Clients who requires minimum assistance in which the client can perform the task with or without friction-reducing assistive devise and the health care worker provides 25% of the work
• Determine that all required safety precautions (like side rails) in place. Determine client's tolerance of the activity (like vital signs before and after dangling) particularly the first time the client changes position. Report significant changes to the primary care practitioner.