Chapter 10
Positioning and Transferring People
GOALS
After reading this chapter, you will be able to:
- Help prevent pressure sores using good skin care and regular position changes.
- Assess situations before positioning or transferring people.
- Protect your safety and the person’s safety during positioning and transfers.
- Promote comfort during positioning and transfers, including teamwork with a co‑worker.
After practicing, you’ll be able to move a person in bed, place several positions, transfer bed↔chair (with/without mechanical lift), and reposition in a chair.
Key Terms
bony prominence
Bony area that sticks out; common pressure points.
coccyx
Tailbone at end of spine.
pressure ulcer
Bedsore from pressure/friction cutting off circulation.
drawsheet
Sheet under mid‑bed, used for moving/turning.
Fowler’s
Sitting with head of bed elevated (semi/standard/high).
lateral
Side‑lying position.
supine
Flat on back.
mobility
Ability to move.
Scenario: Mr. Rivera, with paralysis after a stroke, is at high risk of pressure ulcers. You turn him every 2 hours, use pillows for support, and report redness promptly.
Promoting Proper Body Alignment
- Support bones/joints; keep positions natural and comfortable.
- Float heels with towels under calves to relieve pressure.
- Support weak limbs to prevent contractures.
Preventing Pressure Ulcers
Pressure + friction can cause tissue death and ulcers. Common pressure points: ears, elbows, shoulders, hips, coccyx, knees, ankles, heels. Risks: dry skin, bedrest, poor circulation, paralysis, incontinence.
Table 10‑1 — Protecting Skin Integrity
| Issue | Do This… |
|---|---|
| Direct pressure | Reposition q2h; maintain alignment; use devices. |
| Friction | Lift with drawsheet; HOB ≤30°; avoid tubing under body. |
| Skin‑to‑skin | Separate with pillows; check under folds. |
| Moisture | Wash/rinse/dry; check incontinence q2h; prefer cotton. |
| Poor circulation | Elevate limbs; massage; frequent checks. |
Signs & Stages of Pressure Ulcers
- Stage I: Red area doesn’t fade; off‑load pressure; report.
- Stage II: Redness + blister/break; off‑load; report.
- Stage III: Full‑thickness skin loss; shallow crater; often drainage; report.
- Stage IV: Deep crater to muscle/bone; infection likely; report.
Repositioning Schedule
Common 2‑hour rotation:
| Time | Position |
|---|---|
| 6:00 A.M. | Left side |
| 8:00 A.M. | Semi‑Fowler’s |
| 10:00 A.M. | Right side |
| 12:00 P.M. | Supine → Semi‑Fowler’s |
| 2:00 P.M. | Left side |
| 4:00 P.M. | Prone* |
| 6:00 P.M. | Right side |
*Prone often needs doctor’s order.
Assess • Communicate • Complete
Assess
- Mobility, balance, cooperation, predictability.
- Environment, equipment, brakes locked, body mechanics.
- Other risks: nutrition, paralysis, incontinence.
Communicate
- Explain plan to resident/co‑worker; assign roles.
Complete
- Protect pressure points; support with pillows; smooth linens; check alignment; rails if needed; call‑light in reach.
Types of Positions & Transfers
- Side‑lying with support pillows.
- Bed↔chair transfer with belt or lift.
- Fowler’s: high (~90°), standard (~45°), semi (~30°).
- Supine: flat for rest or care.
- Lateral: side‑lying with support.
- Prone: stomach; relieves other pressure but less comfortable.
Wheelchair Transport
- Walk on right side; caution at doors/corners.
- Ramps: go backwards downhill.
- Elevators: enter/exit backwards.
- Always lock brakes when stopped.
- Check with nurse before leaving unattended.
End of Chapter 10 — Positioning and Transferring People