Patient Positioning Frustrations

systoly · Nov 3, 2011

Trapeze? PT eval/tx?

You told the pt, "I don't think I like caring for people" ???

CharmedJ7 · Nov 3, 2011

Trapeze? PT eval/tx?
You told the pt, "I don't think I like caring for people" ???

Not the pt, one of the residents (docs) I'm friends with. I love the PTs and they're great when they're there, but they can't be there all the time and they often put the pt in the chair and then we have to get them back to bed. I like trapezes too unfortunately I don't think they're not an option for most of my patients d/t upper extremity weakness, though I confess I'm not all that familiar with their indications.

Double-Helix, BSN, RN · Nov 3, 2011

1. When the patient says "I'm uncomfortable" here's what I do:

a. Look at them. Are they aligned properly? Is a limb bent awkwardly? Is there something on/in the bed that might be irritating them? How high is the head of the bed? Are they sitting up high enough? Are the blankets wrinkled or bunched?

b. Stay with the simple things- straighten the blankets, remove any objects that don't belong, align their limbs, bend the knees slighly or elevate with pillows. Boost them up if needed, adjust the pillow under their head, make sure their shirt/johnny and pant legs aren't bunched up, make sure the head of the bed is in a good position for whatever they are trying to do (sleep, watch tv, read, eat, etc.)

2. Pulling only causes back injury if you reach/bend your back when pulling. Draw sheets help a lot with this and you should have one under every patient for boosting/rolling. A cloth chux or a folded flat sheet works great. If you stand close to the bed, gather the draw sheet in your hands and pull smoothly in towards your core. As long as you aren't jerking the sheet, you should be fine. If the patient is small enough, you can also pull with one hand while gently guiding the patient on their side with the other hand. If you have two people, one should pull while the other helps turn the patient on their side.

3. If the patient says that you are being too rough and hurting them, then you need to stop. I understand that you're busy and no, going slowly isn't easier, but if the patient complains you are hurting them and you continue in the same manner, you could be help liable. If they are alert and oriented and they say stop, then stop. Try to move them more slowly. Just like above, steadily turning or moving the patient works a lot better than jerking, fast movements.

4. There isn't really any way around this, although I agree that it's really frustrating to have to round up and wait for help. If the patient has a toileting schedule, let people know ahead of time when you will need them, and remind them 10 minutes in advance. This doesn't work so well when you need someone without notice.

bsnanat2 · Nov 3, 2011

For some reason when folks come into the hospital they become totally helpless. Unless there is some medical reason they cannot, I "coach" them while they move themselves in bed. Ortho pts are taught to do as much as they can even with one "good" usable limb. No amount of patient complaining or discomfort is worth your back. Talk to the PT/OT dept about teaching you some good body mechanics and always use a gait belt or draw sheet. If no one is available to help you move a large patient and they cannot move themselves, they will simply have to wait. If the patient is in a dangerous position, push the call light and make someone come to help. Patient care does not mean sacrifice of your health. Again, in most cases, patients need to be reminded that they can do this themselves. Of course, how you deliver this message is key.

JollyGreenGiant · Nov 3, 2011

How about when you just spent 10 minutes getting a patient repositioned just the way they wanted, all snug underneath their blankets, everything all set and your ready to walk out the door and you here..."I got to use the bed pan"

tokidoki7, ASN, RN · Nov 4, 2011

If I have a patient who needs repositioned and I can't find anyone to help, here's what I do: If the patient is able to turn side to side, I put the patient in Trendelenburg position. Then I ask the patient to turn to each side while I staighten out the linens underneath them. By the time they're done doing that they have managed to repositiong themselves to the top. Most of the time it works, but only if the patient is able to turn him or herself and doesn't have any other issues that make it unsafe.

RNnbakes · Nov 4, 2011

Let the pt do as much repositioning as they can for themselves.

Straighten out their sheet, I know I cannot sleep under a rumpled sheet.

Use draw sheets.

If you need help, let the pt know that you that you have to wait for another staff member.

Please be careful and gentle, you don't want a bad reputation.

However don't injure you back for any patients.

carolmaccas66, BSN, RN · Nov 4, 2011

In Oz we do not strain our backs for anything. If someone is falling to the floor, you can guide them but u let them fall. That is part of our training. Too many nurses were hurting their backs, usually permanently, by stopping falls.

Use a slip sheet to re-position people. If they aren't comfy ask them how do THEY think you could get them comfy. Hospital beds aren't made for comfort.

Encourage them to help as much as possible, by digging heels in, wiggling their behind - get them to be active in their care. Tell them they have to roll every 2 hours and re-position themselves (if poss of course).

Use lots of pillows - if u can find any.

And I always say to patients: I can't lift u due to federal laws - we are not allowed as I will hurt my back. DO NOT LIFT. No one will thank you if u get a sore back, & the managers will have you out that door quicker than a bullet from a gun. I will not lift or push/pull if I think I will hurt my back. I never have back pain & want it to stay that way, thank you.

With pulling, get up on the bed. This is an excellent way to negate back strain. I've seen so many people leaning way over beds to do transfers, & they end up with back pain or are off for a week to recover.

Always use lots of people. If everyone's walked out & the patient is STILL complaining, tell them they will have to wait till everyone is free again. It sounds like ur being manipulated to a certain extent, and not being assertive enough. Demanding people will NEVER be happy with anything you do - no-one is ever good enough for them.

You can also try distraction techniques. Say something like: well if you're uncomfortable I'll just put the head of the bed up, and then we'll get u a nice cup of tea - or something like that?

Just look after yourself. Look it doesn't matter what position you will put people in, they will always complain, just don't run around too much like an idiot cos they will play you.

carolmaccas66, BSN, RN · Nov 4, 2011

For some reason when folks come into the hospital they become totally helpless. Unless there is some medical reason they cannot, I "coach" them while they move themselves in bed. Ortho pts are taught to do as much as they can even with one "good" usable limb. No amount of patient complaining or discomfort is worth your back. Talk to the PT/OT dept about teaching you some good body mechanics and always use a gait belt or draw sheet. If no one is available to help you move a large patient and they cannot move themselves, they will simply have to wait. If the patient is in a dangerous position, push the call light and make someone come to help. Patient care does not mean sacrifice of your health. Again, in most cases, patients need to be reminded that they can do this themselves. Of course, how you deliver this message is key.

I've often wondered why people become helpless. Is it cos they have someone who can now run around after them? It's not like people say to patients: don't move ever again or help us! And it's not just old people either.

It's a mystery....

canigraduate · Nov 4, 2011

i'm going to try to avoid this being a rant, but my apologies if i fail. i find patient positioning and mobilization to be the worst part of my job. we have lift equipment, and i will say it is helpful with getting patients out of bed more safely, but it doesn't help much in the moment to moment repositioning requests. any words of wisdom for dealing with the following complaints/issues?
1) pt: i'm uncomfortable
nurse: ok, how can i help you?
pt: i don't know, just do something. i'm uncomfortable!
i just don't know where to start. if they've slid down low in the bed i may help boost them up, but really, i can't read minds and i'm not going to play goldilocks with them until i hit 'just right,' it's not feasible.
i tell the patients that i can't help them if they can't tell me what they need and i tell them to call me when they figure out something to try. then i hand them the call light and walk out. if there's something obviously wrong, though, i take care of that before i leave.
2) pt: just pull me over! no pushing that hurts!
my understanding is pulling=back injury. using my entire body helps a bit, but it's not sustainable and none of the equipment is made to help with that.
in this case, you should have a draw sheet and/or a partner. pushing doesn't hurt any more than pulling when it's on a sheet. just make sure you use a smooth motion. if you absolutely have to pull, lower the bed as much as you can and put at least one knee, if not both, on it to move your center of gravity closer to the center of the bed. this will help to keep you from hurting anything.
3) pt: you're being too rough/going too fast!
i've tried explaining to people that going slowly is often not possible (why not?) and/or will not make anything better/easier, and sometimes they get it sometimes they don't. stopping midway through though and/or letting them retract and then starting over is too much strain on staff both physically and time-wise. also, lift equipment and friction reducers still require a lot of side-to-side turning.
you really shouldn't be rough or go fast. especially with older people, who will get skin tears. if it takes too long, so be it.
4) large pt who requires at least 2-4 people to move them who is probably also incontinent and/or on contact isolation but rounding up people to help is a constant struggle.
i just get so frustrated with it. people on my floor are generally helpful but it's draining to have a heavy patient who you constantly need to be recruiting people to come in because even if they will come it's always "in a couple minutes" which is maybe ok if you only need one but god forbid you need >1 and need to coordinate all those "in a couple minutes".
been there, done that, and it really sucks. we had a +7 assist on our unit a couple of months ago. not fun at all. my hospital came up with a solution called a "code assist" where members of the security team, housekeeping, and cnas/rns from other units came to assist. it's called over the intercom like a code blue. also, like the other poster said, make an appointment to meet your team members in the room and remind them a few minutes ahead of time.
i sort of feel bad because i imagine it must suck to be unable to reposition yourself and be uncomfortable and/or sitting in your own excrement, but it's not worth a back injury and i'm not able to regularly spend large amounts of time in any given room to deal with it. i've had little old ladies threaten to hit me because i'm "too rough" (who subsequently forgave me) and i've had 400lb women yell at me for making them uncomfortable and demanding i "put them back how they were" after all the help has already left (who i walked out on after telling them yelling at me wasn't helping anything). i've walked out of rooms and when the resident asked what's wrong said "i don't think i like caring for people." i just don't know if it's a lack of training or technique or it's just one of the realities of the job and either you care so much you don't mind or you just get hard and tell patients they're fine and just to suck it up.

hope some of that helped!

Anna Flaxis, BSN, RN · Nov 4, 2011

It never ceases to amaze me how many people WALK into the ED lobby from their car, WALK back to the room from the lobby, and then once their butt hits the stretcher, suddenly become incapable of doing anything for themselves.

OP, what kind of unit are you working on?