From the diary of an in-home hospice nurse…
Patients who are bedbound should be turned every two hours. This keeps blood flowing to their skin, prevents bedsores and will absolutely keep them more comfortable over the course of the day (and night). I’ve attended to many patients who would rather just stay put because – in that moment – nothing hurts and they’d rather just be left alone. They will, however, feel better in the long run if you keep up this two hour schedule.
The Golden Rule of turning a patient in bed is: Never lift more than you can handle
Step 1: Create a base of support: stand with your feet shoulder width apart and place one foot a half-step ahead of the other. Use your legs not your back when lifting.
Step 2: Prepare the patient:
- Explain what is going to happen and encourage them to help if possible.
- Move the patient to the center of the bed, making sure the rails are up on the side you are turning the patient towards. The patient’s bottom arm should be stretched towards you.
- Place the patient’s top arm across their chest. Cross the patient’s upper ankle over the bottom ankle.
Remember the Golden Rule: Never lift more than you can handle
Step 3: Steps for the caregiver:
- Raise the bed to a level that reduces back strain for you and make the bed flat (lowering the head and/or foot of the bed).
- Get as close to the patient as you can.
- Place one of your hands on the patient’s shoulder and your other hand on their hip.
- Shift your weight to your front foot as you gently pull the patient’s shoulder toward you. Then shift your weight to your back foot as you gently pull their hip toward you. Make sure the patient’s ankles, knees and elbows are not resting on top of each other.
- Make sure their head and neck are in line with their spine.
- Return the bed to a comfortable position with the side rails up. Use pillows as needed.
- In two hours, return patient to back, and repeat with the other side at next turn.
I’ve found with my parapligic patient that crossing the ankles is very painful for her, so i modified this technique (i thought i came up with it) to have her pull her sholders in the turn (using her head rail), while i using one arm to roll her hips and my other arm to lift her leg over above the ankle she has stoped bruising her toes and back. (Like she did before i joined the staff where i work) I’ve also noticed where i work nobody understands bed ergodynamics and i’m finding very often that instead of people being positioned so their hips are in the center of hospital beds that they are being placed with their hips where their thighs should be. I don’t know if this is a problem with your service, but where i work i have to redo the positioning on about half of our patients with hospital beds. An article on ergodynamics and what they do to the patients body (explaining why it’s so important) would in my company be needed (wishing i wasn’t just a worker bee here). So, i’m just leaving a suggestion here to help your employees realize what i wish i could get my coworkers to understand. Also with (most) hospital bed patients using 2 more flat pillows, one with the bottom in the middle of the sholders and the other with the bottom behind the nape of the neck seems to keep most of them able to sleep pain free at night. Just a couple suggestions from a caregiver. Thanks for verifying my technique as appropiate!