Change Position to Supported Side-Lying

Care Plan: Change the position of a resident who is lying on his/her back to a side-lying position. The resident requires support to remain on his/her side.


Click on each question below to view the answer…

Why aren’t side-rails used in this skill?

Side-rails may not be present in every setting.  Patients in home settings, assisted living settings and nursing homes will not have side-rails on their beds in most cases.  It is vital that students are able to perform skills in any setting and retain the ability to protect patient safety. By learning how to perform this skill without the use of side-rails, patient safety can be maintained.

Why do we have to use a privacy blanket when we have already closed the privacy curtain?

Although privacy curtain does provide some privacy, we should consider this skill from the patient’s point of view. Patients are often clothed in nothing more than a hospital gown while lying in bed. Once the sheet is been removed from the bed, this patient may feel exposed, even though you are the only one in the area. Remember, you are active, and the temperature in the room will feel much warmer to you. Since the patient is lying in bed, the temperature is going to feel much colder. Therefore a privacy blanket should be used to limit the patient’s exposure and to keep the patient warm.

Why does it matter which side the patient is positioned onto?

Patients will be repositioned every two hours onto a different side to evenly distribute pressure throughout the day.  By making sure the patient adheres to a turning schedule, we can ensure that no one side is under pressure longer than the others, increasing the chance of pressure sore formation.  Patients will be positioned in the following manner, every two hours (or as directed by the care plan):  back, right, back, left, back, right, etc.

Do I have to position the patient exactly like it is demonstrated?

Each step in this skill is important.  The pillow behind the back keeps the patient on their side by preventing gravity from pulling them back onto their back.  The pillow between the legs helps protect the bony areas of the knees and ankles from rubbing together, causing sores.  The pillow under the upper arm keeps the neck and shoulder in proper alignment, reducing headaches, muscle spasms and contractures.  And the pillow under the head should be adjusted so that it supports only the head and neck.

Does it really matter where the call light is placed at the end of the skill?

Since this skill is performed on an immobile patient, they will not be able to reach out for the call light.  It must be placed in their hand at the end of the skill.  There are many other devices that immobile patients can use to summon help, based on their level of ability.  You will use whatever device the care plan calls for and make sure to place it within easy use of the patient.  The standard call light is used for the exam.

Do I need to wear gloves for this skill?

If there is a chance that you will come into contact with blood or body fluids, non-intact skin or personal skin, you should wear gloves.  Since this patient is completely dressed, continent (able to control his bowels/bladder) and has no sores or incisions, gloves are not necessary.  They are not required for the exam.