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Patient positioning can be pretty confusing, especially when a physician or clinical instructor quickly tells you to get the patient into orthopneic position and immediately walks away to get supplies.
“What position is that again… What do I do?”
Just describing that situation may provide enough fear and frustration to elicit a rise in your heart rate, respiratory rate, and systolic blood pressure.
Never fear, nursing students! We’ve created a great guide with pictures of the top patient positions, what they look like, when to use them, as well as nursing considerations. Take a look at this resource multiple times, commit it to memory, and think back to it when you’ve got to position a patient. You’ll look like you’ve been doing this for years, you experienced nurse you.
We’ve got you covered with a nicer looking version of the chart above that includes patient positioning pictures below (you can also download this image and use in clinical with the link below).
When referring to the document, remember that HOB means head of bed. Many hospital beds are equipped with something on the side that tells you the angle of the head of the bed. These are awesome to look at while positioning patients. For example, in the neuro ICU, we frequently had the HOB at 30 degrees because it optimized venous return and lowers ICP. Therefore, whenever I was finishing up repositioning a patient, I’d look at that little indicator to make sure I had the HOB at 30 before walking out of the room.
If you’ve got a chance to check these out on an empty bed in clinical – do it! Have a nurse bud hop in, change the level of the HOB, and switch! It’s helpful to really feel what 0, 10, 15, 30, or 45 degrees feels like. Sixty degrees doesn’t sound like much, but when you’re sitting in a hospital bed, 60 degrees feels like you’re sitting at 90 degrees! And 15 degrees feels like you’re completely flat, even though you’re not.
And finally, make sure you’re checking your patient’s orders. Many times the physician will order a patient's position or where they want the HOB, especially if they’re critically ill or had a procedure completed recently. So check out your nursing orders! Once the patient has been positioned appropriately, don’t forget to document!
Here is a text version of the above chart:
HOB 60-90° with the patient sitting up in bed
During episodes of respiratory distress, when inserting a nasogastric tube, during oral intake with feeding precautions
This may be uncomfortable to maintain for an extended period, a patient may slump over if they lack the strength to stay sitting upright, and must be repositioned within 2 hours to prevent skin breakdown if patient is unable to reposition themselves as High-Fowler’s places quite a bit of pressure on the coccyx
HOB 45-60° with the patient sitting up in bed. Patient lying on their back in bed, with HOB reclined
Facilitates chest expansion so it is helpful with patients who are having difficulty breathing, during tube feeding admininstation because it facilitates peristalsis while minimizing aspiration risk, simply a comfortable position, also used in the postpartum period to facilitate excretion of lochia
HOB 15-30° with patient lying on their back
Necessary in some neurological and cardiac conditions, after procedures or surgeries to facilitate hemostatis at the insertion site (like a cardiac cath with a femoral approach) or drainage from various drains
If a patient has continous tube feeding infusing or trouble managing secretions, aspiration is a risk with prolonged positioning
HOB flat, patient on back
Post procedures to maintain hemostatis at insertion site, frequent position for many surgeries
Many pressure points (including the top of toes from the sheet) therefore you must be diligent in turning patient, may be uncomfortable to maintain, increases apnea in OSA, avoid after 1st trimester due to the added pressure on vena cava and subsequent hypotension
HOB flat, patient on stomach with head to one side
Not used frequently; use as a therapeutic measure in advanced ARDS, during and after some surgeries
Not comfortable for long, difficult for full respiratory expansion, not easy to put a patient into this position (especially if they have multiple lines and tubes)
Flat on back, feet raised higher than head by 15-30°
During CVC (subclavian or IJ) placement, if an air embolism is suspected as it traps air in the right ventricle, when positioned this way with a Valsava it can convert supraventricular tachycardia, during various surgeries, respiratory distress to increase perfusion
Not ideal with increased ICP, uncomfortable, if patient is confused putting them in this position may increase fall risk,
Flat on back, head raised higher than feet by 15-30°
For some surgeries or procedures, pre-surgery intervention for some vascular surgeries, may be used to facilitate respirations in patients who need to lay flat post-procedure, reduces GERD symptoms
Somewhat uncomfortable, if patients are confused it might be difficult to maintain them safely in this position for long periods
Flat on back, knees bent, rotated outwards, feet flat on the bed (head/shoulders typically on a pillow)
During or after various surgeries, for comfort
On side, top knee and arm flexed and supported by pillows
Relieves pressure on sacrum, great for patients who are immobile as it is typically quite comfortable and provides good spine alignment, supporting and off-loading common pressure points
Halfway between lateral and prone
Occasionally used with unconscious patients as it facilitates drainage of oral secretions, pregnancy, during enemas, for patients who are paralyzed as it takes the pressure off of the hip and sacrum
Must remember to turn patient on the schedule
Sitting at the side of the bed, leaning over a table
Facilitates respiratory expansion, makes it easier to breath in patients with respiratory difficulty and used during a thoracentesis
Ensure patient can safely sit back in bed; don’t leave unattended if a fall risk and sitting at the side of the bed
Whether you’re reading a new physician order to place the patient in High-Fowler’s position, documenting the position the patient was in, or suggesting a patient position to the MD, after utilizing this resource, you’ll feel more comfortable and confident. While this is a basic aspect of nursing care, it can be confusing and difficult to remember, especially in a chaotic moment.
Always remember when you’re changing a patient’s position to use proper support, lifts, and ergonomics to prevent injury to yourself. Nurses can really hurt themselves when they’re trying to quickly move a patient. Don’t do it! Always ensure your safety first.
Hopefully, the pictures of the positions make it easier for you to remember.
And don’t forget to share it with your nursing school buds!
4 Simple Steps to Talk to Physicians
One would think that communicating with physicians would be black and white… that it would be very fluid and easy, and come naturally to a nurse… however that could not be farther from the truth.
I want to give you some practical tips about how to talk to physicians that you can apply in your next clinical.
(Now, when I say “how to talk to physicians,” I mean when communicating about your patients. I don’t mean to insinuate that physicians are this different breed of people that you must speak to in a certain calculated way every time you interact. This is specifically about when you need to communicate with physicians about patient needs.)
1. Identify when you need to speak with the physician
Not every scenario that presents itself requires notifying the MD. You may have various policies, procedures, and protocols that may address your issue without having to contact the physician. If you’re calling about an abnormal, like vital signs that are out of range or a critically high or low lab value, make sure that this abnormal is accurate first. Grab a manual blood pressure, or make sure the blood specimen that you sent down to the lab wasn’t hemolyzed or diluted. Verify that you do indeed need to notify them.
2. Be prepared for the callback
Remember, if you page them… they’re going to call you back! You must be ready for this. This includes making sure you have pertinent information near you. Most likely it will include having a chart open in front of you so that you can answer any questions they may have, or having a fresh set of vitals, or knowing any unit policy regarding any potential orders (like the order set that you use for administering blood products, or what set of orders need to be implemented for getting a central line placed, and so forth). They may call you back while driving or in OR so they can’t necessarily look up things as they think of them.
3. Be confident
It can be hard to be confident when talking to physicians sometimes… it can be a very intimidating situation. I know I was pretty intimidated at the beginning, but the more comfortable I got talking with physicians, the more confident I became. Therefore, I really encourage you to introduce yourself to physicians and kind of break down that awkward first meeting communication barrier. Say hello, shake their hand, and introduce yourself.
It’s also common to feel this pressure to know absolutely everything when talking to a physician – please know that’s not the expectation. You must be knowledgeable about your patient, but you don’t have to know every little thing.
4. Remember, they’re just people
It’s hard not to get caught up in the omg they’re a doctor mentality, especially when you’re new to the medical field. At the end of the day, physicians are just people… they are members of the health care team. Just as we expect them to treat us with respect, we need to treat them with respect. If a physician is speaking to you in a demeaning tone, stand up for yourself… just as you would if anyone else was speaking to you that way. Just because someone is a physician does not mean they can speak to people disrespectfully.
I hope you find these tips helpful. If you’re not sure what kind of situations necessitate notifying a physician, I recommend checking out our awesome resource called NURSING.com. We have courses on med-surg, mental health, EKG’s, cardiac, peds, OB, just to name a few… as well as an NCLEX simulator and NCLEX practice questions.