Patient Positioning

Positioning is a physiologic intervention, not merely a comfort measure. Changing the angle of the torso or the distribution of weight can improve lung expansion, reduce aspiration risk, support alignment, and redistribute pressure. The same position can help one problem while worsening another: elevating the head may improve ventilation but cause the patient to slide, creating shear over the sacrum. Sustained pressure compresses tissue between a bony prominence and the bed or device. Shear occurs when the skeleton moves downward while the skin remains relatively fixed; this distorts small blood vessels and can injure deeper tissue even when the surface initially looks intact. Immobility, impaired sensation, poor perfusion, moisture, malnutrition, and inability to communicate pain all increase risk. For a US registered nurse, routine repositioning is generally part of nursing care. The RN assesses the patient, selects and implements the plan, evaluates the response, and modifies the plan when needed. Assistive personnel may help with a routine turn when permitted by state law, facility policy, and competency requirements, but the RN retains responsibility for assessment, clinical judgment, and evaluation. Orders...