Turns q2h

nurseprnRN, BSN, RN · Aug 16, 2011

if it is a truly non-pressure mattress, then no, you don't need to turn for pressure relief. but you do need to turn for pulmonary toilet/aerating all lobes.

CVmursenary · Aug 16, 2011

The air mattresses i have seen don't appear to do all that much. I would turn the patient q2 if they were bedbound or especially at risk for skin breakdown. If they have good circulation and get up during the day type i would say q2 during the night is excessive in my opinion.

xtxrn, ASN, RN · Aug 16, 2011

The air mattresses i have seen don't appear to do all that much. I would turn the patient q2 if they were bedbound or especially at risk for skin breakdown. If they have good circulation and get up during the day type i would say q2 during the night is excessive in my opinion.

Yeah, the overlays are not true non-pressure mattresses. The air-flow beds (don't recall the name right now) have an actual cushion of air, and almost act like an air hockey table. :)

JDZ344 · Aug 16, 2011

We still have to turn them at our hospital. Lying in one position is uncomfortable, air mattress or not. I'm not a nurse, but we were told when I started that turnings also prevent the risk of chest infections/pneumonia (not sure how it works, though) and keeps the blood moving around.

As for nights: we turn less often at nights. Once as we do our night checks (around 10-11pm), in the middle of the night (around 2-3am) and in the morning- unless the patient is at huge risk or already has pressure sores, in which case we do the 2 hourly turns.

How I do it is I position the patient on one side at 10pm. Then around 2/3, I take the pillow out from under their back so they roll back naturally. I check for incontinence at the same time (we don't use briefs at night in our place, per policy). I only have to wake them at 6am, then, and that's when I do the vital signs anyway, so I turn/change them whilst I am in there.

evolvingrn, BSN, RN · Aug 16, 2011

We turn them every 4 hours

Long Term Care Columnist / Guide · Aug 16, 2011

I have had the unlovely experience of being turned Q 2 hrs., back when I had my first C-section and they didn't let you up until 24 hours after you delivered. I hated it---I usually only lie on my back, and the nurses insisted on turning me on my side where all I could do was stare at a window or the hallway for two hours. For some reason, my spinal took too long to wear off, and as a smoker with asthma, I was at higher risk for pneumonia than the average new mom. So they turned me, a helpless feeling if I ever had one......and to this day, I think about that whenever deciding if a patient/resident has to be turned.

Frankly, if their skin is intact and there is support for every surface without causing pressure, I usually forgo Q 2 hr. repositioning and let them sleep. If incontinence is an issue, they definitely need to be checked and changed frequently, but I don't like to use briefs at night AT ALL. Part of the reason there is so much skin breakdown in nursing facilities is the fact that the human body was never intended to be kept in hot plastic panties 24/7, yet most residents are kept in them night and day for convenience. It's enough to make my blood boil....unless there is a specific reason to do otherwise, it's usually better for one's skin to "go commando" in bed at night.

That's my story, and I'm stickin' to it. :)

ckh23, BSN, RN · Aug 16, 2011

An air mattress is more effective when you implement other interventions along with it. I did a research paper about this for school last year. The research pretty much said the best prevention was turning, nutrition, and the air matters. Although the matters turns the patient, it does not shift the weight enough to prevent pressure. For instance, I recently had a pt with a spinal cord injury that was on a rotarest bed. This bed keeps the spine immobilized and also turns the patient back a forth. The degree of turn is even a little steeper because the are strapped in. This particular patient still developed a stage 3 on her sacrum even with continous turning and nutrition.

When you turn patients you really need tp get that butt off the bed and you just don't get that with the air mattress rotation.

joanna73, BSN, RN · Aug 16, 2011

Realistically, with 30 people, we don't have time to turn q2h. It depends on the condition and the resident. Q3h is more the norm for high risk people. If someone is asleep and they are not high risk, I let them sleep. It depends. Some people are just more comfortable in a certain position.

Sehille4774 · Aug 16, 2011

Ha. At first I thought you meant one of those acute care mattresses that can turn the patient for you every 2 hours on a timer.

I used to at least take a peek in on everyone every 2 hours. Those A&O we would let sleep when possible...(if the were mobile, not Incontinent, good skin integ.) Sleep is a very important part of the healing process too.

I was also always taught that even a small shift in weight can make a very big difference.

SummitRN, BSN, RN · Aug 16, 2011

Someone was telling me about a study that showed that major repositions need only be done q4h and that q2h need only be minor shifts. I haven't searched for the study yet...

CBsMommy · Aug 16, 2011

I have had the unlovely experience of being turned Q 2 hrs., back when I had my first C-section and they didn't let you up until 24 hours after you delivered. I hated it---I usually only lie on my back, and the nurses insisted on turning me on my side where all I could do was stare at a window or the hallway for two hours. For some reason, my spinal took too long to wear off, and as a smoker with asthma, I was at higher risk for pneumonia than the average new mom. So they turned me, a helpless feeling if I ever had one......and to this day, I think about that whenever deciding if a patient/resident has to be turned.
Frankly, if their skin is intact and there is support for every surface without causing pressure, I usually forgo Q 2 hr. repositioning and let them sleep. If incontinence is an issue, they definitely need to be checked and changed frequently, but I don't like to use briefs at night AT ALL. Part of the reason there is so much skin breakdown in nursing facilities is the fact that the human body was never intended to be kept in hot plastic panties 24/7, yet most residents are kept in them night and day for convenience. It's enough to make my blood boil....unless there is a specific reason to do otherwise, it's usually better for one's skin to "go commando" in bed at night.
That's my story, and I'm stickin' to it. :)

Viva - That was my rationale too! Even though I've never been turned, I have been a patient in a hospital and sleep is hard to come by! Which doesn't make it any easier for our patients to heal.

Someone else said q4h turns, which wouldn't be bad at night since we can position with q4 vitals at night.

Thanks everybody for responding! I appreciate it! That question has been bugging me for a while now and I've asked some people and no one has ever had a good answer!