Patient Positioning

A position is therapeutic only if it achieves its purpose without creating a new injury. The patient may appear comfortable while pressure, shear, nerve compression, or restricted chest movement is already damaging tissue. Pressure injuries develop when external force compresses soft tissue between a support surface and bone. Blood flow through the compressed tissue falls; if the force persists, cells become ischaemic and injured. The sacrum, heels, occiput, scapulae, elbows, trochanters, knees, and malleoli are common danger points because little tissue separates skin from bone. Shear is different from direct pressure. It occurs when the skin stays against the bed while deeper tissue slides downward, such as when a patient gradually slips toward the foot of an elevated bed. The surface may look intact at first, but deeper tissue can be distorted. Use repositioning equipment and enough assistance to lift or move the patient rather than dragging them across the linens. Experienced nurses look first for the patient who cannot move or cannot reliably report discomfort: an unconscious patient, someone with impaired sensation, severe weakness, sedation, delirium, pain, or medical...