POSITIONS USED IN NURSING

INTRODUCTION:
Positions in nursing are procedure that involves maintaining a patient body alignment by preventing hyperextension and extreme lateral rotation to prevent complications of immobility and injury. Positioning of patient is an essential aspect of nursing and it is the responsibility of nurses (registered nurse precisely).

REASONS FOR CHANGING PATIENT POSITION
1. To prevent deformities
2. To align the body
3. To aid relaxation
4. To aid comfortability of the patient
5. To prevent pressure
6. To stimulate circulation
7. It keeps the skin healthy and prevent bed sores.
8. To prevent immobility and injury.

PRINCIPLES OF POSITIONING OF PATIENTS
1.Maintain good patient body alignment. Think of the patient in bed as though he were standing.
2. Maintain the patient’s safety.
3. Reassure the patient to promote comfort and cooperation.
4. Properly handle the patient’s body to prevent pain or injury.
5. Keep in mind proper body mechanics for the practical nurse.
6. Obtain assistance, if needed, to move heavy or helpless patients.
7.Follow specific physician’s orders. A physician’s order, such as one of the following, is needed for the patient to be out of bed.
“Up ad lib.”
“Up as desired.”
“OOB” (out of bed).
8. Do not use special devices (that is., splints, traction) unless ordered. Ask if you do not know what is allowed.

TYPE OF POSITIONS AND INDICATION
1. Supine or Dorsal Recumbent Position
Supine position, or dorsal recumbent, is wherein the patient lies flat on the back with head and shoulders slightly elevated using a pillow unless contraindicated (e.g., spinal anesthesia, spinal surgery.

Indication
Most commonly used position. Supine position is used for general examination or physical assessment.

2. Fowler’s Position
Fowler’s position, also known as semi-sitting position, is a bed position wherein the head of the bed is elevated 45 to 60 degrees. Variations of Fowler’s position include: low Fowler’s (15 to 30 degrees), semi-Fowler’s (30 to 45 degrees), and high Fowler’s (nearly vertical).
Indication
-Promotes lung expansion. Fowler’s position is used for patients who have difficulty breathing because in this position, gravity pulls the diaphragm downward allowing greater chest and lung expansion.
– Useful for NGT. Fowler’s position is useful for patients who have cardiac, respiratory, or neurological problems and is often optimal for patients who have nasogastric tube in place.

3. Orthopneic or Tripod Position
Orthopneic or tripod position places the patient in a sitting position or on the side of the bed with an overbed table in front to lean on and several pillows on the table to rest on.
Indication
– Maximum lung expansion. Patients who are having difficulty breathing are often placed in this position because it allows maximum expansion of the chest.
– Helps in exhaling. Orthopneic position is particularly helpful to patients who have problems exhaling because they can press the lower part of the chest against the edge of the overbed table.

4. Prone Position
In prone position, the patient lies on the abdomen with head turned to one side and the hips are not flexed.
Indication
– Extension of hips and knee joints. Prone position is the only bed position that allows full extension of the hip and knee joints. It also helps to prevent flexion contractures of the hips and knees.
– Contraindicated for spine problems. The pull of gravity on the trunk when the patient lies prone produces marked lordosis or forward curvature of the spine thus contraindicated for patients with spinal problems. Prone position should only be used when the client’s back is correctly aligned.
– Drainage of secretions. Prone position also promotes drainage from the mouth and useful for clients who are unconscious or those recover from surgery of the mouth or throat.

5.Lateral Position
In lateral or side-lying position, the patient lies on one side of the body with the top leg in front of the bottom leg and the hip and knee flexed. Flexing the top hip and knee and placing this leg in front of the body creates a wider, triangular base of support and achieves greater stability. Increase in flexion of the top hip and knee provides greater stability and balance. This flexion reduces lordosis and promotes good back alignment.
Indication
– Relieves pressure on the sacrum and heels. Lateral position helps relieve pressure on the sacrum and heels especially for people who sit or are confined to bed rest in supine or Fowler’s position.

6. Sims’ Position
Sims’ position or semiprone position is when the patient assumes a posture halfway between the lateral and the prone positions. The lower arm is positioned behind the client, and the upper arm is flexed at the shoulder and the elbow. The upper leg is more acutely flexed at both the hip and the knee, than is the lower one.
Indication
– Prevents aspiration of fluids. Sims’ may be used for unconscious clients because it facilitates drainage from the mouth and prevents aspiration of fluids.
-Reduces lower body pressure. It is also used for paralyzed clients because it reduces pressure over the sacrum and greater trochanter of the hip.
– Pregnant women comfort. Pregnant women may find the Sims position comfortable for sleeping.

7. Lithotomy Position
Lithotomy is a patient position in which the patient is on their back with hips and knees flexed and thighs apart.
Indication
– Lithotomy position is commonly used for vaginal examinations and childbirth.

8. Trendelenburg’s Position
Trendelenburg’s position involves lowering the head of the bed and raising the foot of the bed of the patient. The patient’s arms should be tucked at their sides.
Indication
– Promotes venous return. Hypotensive patients can benefit from this position because it promotes venous return.
– Postural drainage. Trendelenburg’s position is used to provide postural drainage of the basal lung lobes.

9. Knee-Chest Position
Knee-chest position, can be in lateral or prone position. In lateral knee-chest position, the patient lies on their side, torso lies diagonally across the table, hips and knees are flexed. In prone knee-chest position, the patient kneels on the table and lower shoulders on to the table so chest and face rests on the table.
Indication
-Gynecologic and rectal examinations. Knee-chest position is assumed for a gynecologic or rectal examination.

10. Jackknife Position
Jackknife position, also known as Kraske, is wherein the patient’s abdomen lies flat on the bed. The bed is scissored so the hip is lifted and the legs and head are low.
Indication
– In surgery. Jackknife position is frequently used for surgeries involving the anus, rectum, coccyx, certain back surgeries, and adrenal surgery.

11. Kidney Position
In kidney position, the patient assumes a modified lateral position wherein the abdomen is placed over a lift in the operating table that bends the body. Patient is turned on their contralateral side with their back placed on the edge of the table. Contralateral kidney is placed over the break in the table or over the kidney body elevator (if attachment is available). The uppermost arm is placed in a gutter rest at no more than 90º abduction or flexion.
Indication
– Kidney positions allows access and visualization of the retroperitoneal area. A kidney rest is placed under the patient at the location of the lift.

CONCLUSION
In surgery,specimen collection, or other treatments, proper patient positioning provides optimal exposure of the surgical/treatment site and maintenance of the patient’s dignity by controlling unnecessary exposure. In most settings, positioning patients provide airway management and ventilation, maintaining body alignment, and provide physiologic safety.
Patient positioning is vital to a safe and effective surgical procedure. Proper patient positioning depends on the type and length of procedure, anesthesia access to the patient, devices required and other factors. Safely positioning the patient is a team effort. All members of the surgical team play a significant role in the process and share responsibility for establishing and maintaining the correct patient positions.