Procedure: Turning the Patient in Bed

1. Explain the procedure to the patient.
2. Wash and dry hands. Put on gloves as needed.
3. Position yourself on the side of the bed that the patient will be turned to. Adjust the bed to waist height. Lock bed brakes. Lower the head of the bed. This allows gravity to work with, instead of against you. Lower the side rail closest to you. Use proper body mechanics.
4. Provide privacy and warmth for the patient. Keep them covered with a blanket.
5. Ensure safety of the patient while turning. Watch position of the patient’s head and extremities (arms and legs). Never let a patient’s head roll backward or arms and legs to get caught in side rails.
6. Lifting the patient toward the head of the bed: Before turning or positioning a patient, and when patients slide down in bed, Home Health Aides/Personal Care Aides may have to lift them further up toward the head of the bed.
7. For a patient who can assist: Put the head of the bed flat and move any pillows that will be in the path you are moving toward. Lower the side rail on the side you are standing. Use proper body mechanics: stand with your feet hip width apart and slightly bend your knees. Face the patient. The foot closest to where you are moving should be slightly forward and your rear leg slightly backward. Place one arm under the patient’s shoulders and the other under the patient’s thighs. Instruct the patient to bend their knees and push down against the mattress with their feet and hands. You should rock back and forth to begin your motion and start to count. On the count of three, shift your weight to your front leg, and assist the patient to move up in bed, while they push down on the mattress with their hands and feet.
8. Using a draw sheet/bed pad to lift the patient with two people: Put the head of the bed flat and move any pillows that will be in the path you are moving toward. Lower the side rails. Use proper body mechanics: stand with your feet hip width apart and slightly bend your knees. Point the foot closest to the head of the bed in that direction. Your other leg should be slightly behind you. Face the patient. Each person should roll the bed pad on their side and grasp it in their hands. Each of you should shift your weight from front to back legs by rocking back and forth and then shift your weight toward your front foot (the direction to which you are going) and on the count of three, slide the patient and draw sheet toward the head of the bed.
9. Using a draw sheet/bed pad to lift the patient with a one person assist: Put the head of the bed flat and move any pillows that will be in the path you are moving toward. Stand behind the head of the bed. Use proper body mechanics: stand with your feet hip width apart and slightly bend your knees. One foot should be slightly in front of the other. Roll and grasp the top of the draw sheet/bed pad on either side of the patient’s shoulders. While pulling the draw sheet up toward you, rock your weight from your front to your back foot. On the count of three, pull the bed pad up toward the head of the bed. If possible, ask the patient to assist by pushing down on the bed with their feet while you lift up.
10. Moving the patient to the side of the bed: Before turning a patient, and when performing procedures such as a bed bath or mouth care, you should position the patient closest to the side of the bed you are on. This prevents you from having to extend your reach, which reduces your personal injury risk. Moving the patient to the side of the bed before turning them also ensures that they will not end up too far on the edge of the other side of the bed, which increases their chance of falling off the bed.
11. Moving the patient in segments: To move the patient in segments, you will first move the upper part of the body, and then the trunk area, and finally the legs and feet. To move the upper part of the body, place the hand closest to the patient underneath their neck and grasp their far shoulder (the shoulder furthest from you) from underneath their body. With your other arm, place your hand under the middle of their back, near their waist area. Gently move their upper body toward you. While moving the patient, watch for proper body mechanics. Rock backward and shift your weight to your back leg. To move their torso, place one arm under their waist and one under their thigh. Rock backward, shift your weight to your rear leg, and move them toward you. To move their legs and feet, place your arms under their thighs and calves. Rock backward and shift your weight to your rear leg. Take care not to let their feet drag or get caught underneath them.
12. Moving the patient with a draw sheet/bed pad with a 2 person assist: To move the patient using a draw sheet/bed pad, roll up the draw sheet/bed pad on the side closest to you. This provides you with a grip with which to move the patient. Another worker should do the same on the other side. On the count of three, rock backward, placing your weight on your rear leg, and pull the patient toward you, lifting slightly so the patient does not drag across the bed.
13. Moving the patient with a draw sheet/bed pad with one person: To move the patient using a draw sheet/bed pad, roll up the draw sheet/bed pad on the side closest to you. This provides you with a grip with which to move the patient. One hand should have the draw sheet/bed pad near the patient’s shoulders, with the other hand grasping the draw sheet near the patient’s hips. On the count of three, rock backward, placing your weight on your rear leg, and pull the patient toward you, using the draw sheet/bed pad to move the patient.
14. To turn the patient toward you: Stand on the side of the bed to which you want to move the patient. Ensure the side rail is up on the side to which the patient is turning from. Lower the side rail on the side closest to you. Cross the patient’s arms over their chest and bend/cross the patient’s leg nearest you over the farthest leg. Stand with your feet about 12 inches apart, bend at the knees, and place one hand on the patient’s shoulder and one on the patient’s hip. Rock backward and shift your weight to your rear leg. Roll the patient toward you.
15. To turn the patient away from you: Stand on the side of the bed opposite of the side you want to move the patient. Ensure the side rail is up on the side to which the patient will be turning. Cross the patient’s arms over their chest. Cross and slightly bend the patient’s leg furthest from you over their lower leg. Stand with your feet about 12 inches apart, bend at the knees, and place one hand on the patient’s shoulder with the other on their hip. Roll the patient in one smooth motion so that their entire body rolls as one. As you roll them, shift your weight from your back to your front leg. You can also use the bed pad to turn the patient toward you by gripping the bed pad near the patient’s shoulder and hip and rolling the patient. Keep the patient in good alignment at all times.
16. Place the patient’s head, arms, and legs correctly. The top knee should be flexed with a pillow between the legs. The ankle and foot should be supported. Support arms and legs as necessary with pillows or rolled towels or blankets. Ensure the patient is not lying on their arm by adjusting their shoulder. Position pillows underneath all bony prominences to prevent pressure ulcer development. A pillow should be placed at the small of their back to prevent them from rolling onto their back.
17. Adjust pillows and head height for comfort. Ensure the patient’s body is properly aligned.
18. Ensure that the patient’s mouth, face, and nose are not obstructed by pillows so they can properly breathe.
19. Return bed to proper safe height (lowest position). Ensure side rails are up for patient safety.
20. Remove your gloves. Wash and dry your hands.
21. Document completion of task and record any changes in condition or behavior. Report and record any observations made about skin condition.

Procedure: Positioning the Patient

Patients who are bedbound or who are unable to turn themselves must be turned and repositioned every two hours. This helps to prevent pressure ulcers development. There are a variety of positions Home Health Aides/Personal Care Aides can choose to rotate the patient to.

On Back (Supine position)

1. Explain the procedure to the patient.
2. Wash your hands and apply gloves as needed.
3. Assemble equipment (pillows, clean pillow cases, towels)
4. Center the patient in the middle of the bed.
5. Turn the patient onto their back.
6. Ensure the patient’s body is in proper alignment.
7. Replace soiled or damp pillow cases with clean ones.
8. Place a pillow underneath the back of the patient’s head.
9. Place a pillow underneath the small of the patient’s back if they prefer.
10. Place a pillow underneath each bony prominence of the patient’s hips. To do this, slightly turn the patient to one side and slide a pillow lengthwise along their hips. The pillow will be partly under their back and partly sticking out from their sides. The top of the pillow should be near their lower back, with the bottom of the pillow underneath their buttocks. This will ensure that the bony prominences of their hips are not pressing against the bed, creating a possible pressure ulcer. Repeat on the other side of the patient’s hips.
11. Place one pillow underneath each leg of the patient. One pillow should be used per leg. Pillows should be placed lengthwise. Make sure that the patient’s heels are not pressing against the pillow or mattress. You may slightly tuck the end of the pillow closest to the patient’s feet by slightly rolling it under. This ensures that the patient’s heels are floated (free from pressing against surfaces).
12. Ensure that the patient is comfortable and appropriately covered for warmth and privacy.
13. Remove your gloves. Wash your hands.
14. Record time of procedure and any observations or changes in behavior or condition. Also record and inform a supervisor of any changes in skin condition or observations of skin breakdown or pressure ulcers.
15. Remember to turn and position the patient every two hours to prevent pressure sore formation.

Lateral Position (also called a side-lying position)

1. Explain the procedure to the patient.
2. Wash your hands and apply gloves as needed.
3. Assemble equipment (pillows, clean pillow cases, towels).
4. Center the patient in the middle of the bed.
5. Safely turn the patient to one side using one fluid motion to move their entire body. This helps to keep their body in alignment.
6. Once turned to their side, ensure that the patient’s body is in proper alignment.
7. Place a pillow under the patient’s head and neck.
8. Place a pillow between the patient’s legs so that the knees are not pressing against each other, causing a possible pressure ulcer.
9. Place a pillow underneath the arm that is on top of the patient’s hip.
10. Place a pillow underneath the patient’s feet to float the heels.
11. Place a pillow at the small of the patient’s back to provide support so they do not roll over. To do this, place the pillow lengthwise and then slightly roll it to tuck the ends under.
12. Ensure that the patient is comfortable and appropriately covered for warmth and privacy.
13. Remove your gloves. Wash your hands.
14. Record the time of procedure and any observations or changes in behavior or condition. Also record and inform a supervisor of any changes in skin condition or observations of skin breakdown or pressure ulcers.
15. Remember to turn and position the patient every two hours to prevent pressure sore formation.

Prone position (on Abdomen)

1. Explain the procedure to the patient.
2. Wash your hands and apply gloves as needed.
3. Assemble equipment (pillows, clean pillow cases, towels).
4. Move the patient to the side of the bed.
5. Gently turn/assist the patient onto their abdomen (stomach).

little girl in prone position on the floor 6. Ensure the patient’s body is in proper alignment.

7. Turn the patient’s head to the side and ensure it is in proper alignment. Place a pillow under the patient’s head.
8. Position the patient’s arms for comfort by gently bending them upward on either side of the patient so that their palms are facing down on the bed. Ensure that arms are not tucked under their body. Place pillows under the patient’s arms for comfort.
9. Place a pillow underneath the patient’s lower legs to elevate their heels.
10. Ensure that the patient is comfortable and appropriately covered for warmth and privacy.
11. Remove your gloves. Wash your hands.
12. Record the time of procedure and any observations or changes in behavior or condition. Record and inform a supervisor of any changes in skin condition or observations of skin breakdown or pressure ulcers.
13. Remember to turn and position the patient every two hours to prevent pressure sore formation.

Overview: Assisting Patients to Transfer to and from Different Positions

Patients may require assistance moving among positions. They may need assistance moving from a lying down to a sitting position and from a sitting upright position to moving to the edge of the bed. If the patient would like to get out of bed, the Home Health Aide/Personal Care Aide should assist them to a sitting position and allow them to sit at the edge of the bed for a few minutes prior to standing. This helps their bodies adjust to changes in blood pressure and helps prevent falls.

This section provides instruction for how to assist patients move from a lying down to a sitting position, from a sitting upright position to the edge of the bed, and finally to a standing position. Assisting with walking (ambulation) is also discussed. This is an important skill for the Home Health Aide/Personal Care Aide. Patients benefit from exercise in order to maintain and improve muscle and bone strength. Instruction is also provided for assisting patients transfer to a wheelchair, chair, toilet, commode, and shower.

Proper positioning of a patient while in a wheelchair is also discussed. Patients who spend a great deal of time in wheelchairs are at risk for pressure ulcers. They should be encouraged or assisted to turn and position every two hours. Pillows may be used to relieve pressure points.

Procedure: Transfer to the Sitting Position in Bed

Patients may require instruction or assistance with sitting up in bed. Sitting up in bed allows a patient to eat, engage in visits with loved ones, or participate in other activities. Some patients may become dizzy or feel faint if they sit up too quickly. Home Health Aides/Personal Care Aides should always watch their patient for signs of dizziness and inquire as to whether they feel faint when changing positions from a lying down to a sitting position. If dizziness or faintness persists once the patient is in a sitting (Fowler’s) position Home Health Aides/Personal Care Aides should , assist them back into a lying down (supine) position and inform their supervisor.

1. Explain the procedure to the patient.
2. Wash your hands and don gloves as needed.
3. Ensure that the locks of the bed are on.
4. Raise the height of the bed to a safe working height. Raise the head of the bed. This makes it easier for the patient to rise into a sitting position.
5. Remove any pillows that are placed underneath the patient’s body. Fold back the top covers.
6. Face the head of the bed. Place your outer foot forward. Your feet should be about 12 inches apart. Keep your hips aligned and slightly bend at the knee.
7. For an independent patient who can sit up without assistance: Ask them to bend their knees. Instruct the patient to push down on the mattress with their hands, while also pushing down on the bed with their feet, as they boost themselves up in bed into a sitting position. Provide support and assistance as needed.
8. For the patient who requires assistance to sit up: Place one arm (the arm closest to the patient) behind the patient’s shoulders. If it is a particularly frail patient or one who cannot control their neck or head, rest your forearm and hand behind their head. This prevents their head from rolling back. Place your other arm underneath the patient’s thighs.
9. Do not hold the patient underneath their axilla (armpit) and do not pull against their clothing or other body part. You could cause them injury if you do so.
10. Use a gentle rocking motion to assist the patient to propel forward and up into a sitting position. On the count of 3 (count aloud so the patient knows when they will be moving), help to move the patient to the sitting position by slowly pushing them up. Rock forward and then backward, keeping your back aligned, and shifting your weight from your front to your rear leg. This provides a firm base of support and balance while assisting the patient into a sitting position.
11. Place a pillow or two behind the patient’s back and head to keep them in an upright position. Position and cover the patient for comfort.
12. Check for any changes in the patient’s condition such as dizziness, weakness, or shortness of breath. Make sure to record and report any conditions observed or statements made the patient to indicate this. If the patient remains dizzy or continues to report feeling weak, return them to a lying down position. Immediately inform a supervisor.
13. Remove gloves if wearing, and wash your hands.
14. Place the bed back into its lowest level and ensure side rails are raised.
15. Document the procedure and any observations or changes in condition.

Procedure: Helping the Patient to Sit at the Side of the Bed

It is helpful when transferring a patient or assisting with ambulation to first assist a patient from a lying down to a sitting position. Care Plans may provide instructions for Home Health Aides/Personal Care Aides to assist patients to dangle (sit at the edge of the bed) for a certain amount of time per day. Care Plans may also instruct Home Health Aides/Personal Care Aides to allow their patient to dangle at the edge of the bed prior to standing or transfer. They should always watch their patient for signs of dizziness and inquire as to whether they feel faint when changing positions from a lying down to a sitting position. If dizziness or faintness persists once the patient is in a sitting position, assist them back into a lying down position and inform a supervisor.

1. Explain the procedure to the patient.
2. Wash your hands and don gloves as needed.
3. Face the head of the bed. Place your outer foot forward. Your feet should be about 12 inches apart. Keep your hips aligned and slightly bend at the knee.
4. Make sure the bed is in its locked position.
5. For an independent patient who can sit up without assistance: Ask the patient to roll onto their side toward the side of the bed that they will be sitting on. Ask them to bend their knees and turn onto their side, facing you. Instruct the patient to grasp the mattress with their lower arm (the arm closest to the edge of the bed) and to use their other hand to push themselves up by reaching across their chest and reaching down to the mattress. Instruct them to push down on the mattress while swinging their legs over the side of the bed. They may also use a side rail for support while sitting up. Provide support and assistance as needed.
6. For the patient who requires assistance to sit up: Place one arm (the arm closest to the patient) behind the patient’s shoulders. If it is a particularly frail patient or one who cannot control their neck or head, rest your forearm and hand behind their head. This prevents their head from rolling back. Place your other arm underneath the patient’s thighs.
7. Do not hold them underneath their axilla (armpit) and do not pull against their clothing or other body part. You could cause them injury if you do so.
8. Use a gentle rocking motion to assist the patient to propel forward and up into a sitting position. On the count of 3 (count aloud so the patient knows when they will be moving), help to move the patient to the sitting position by slowly turning them up and toward you. Rock forward and then backward, keeping your back aligned, and put your weight onto your rear foot to provide a firm base of support and balance while you assist the patient into a sitting position. Help position the patient’s legs over the edge of the bed.
9. Place a pillow or two behind the patient’s back to keep them in an upright position. Position and cover the patient for comfort.
10. Check for any changes in the patient’s condition such as dizziness, weakness, or shortness of breath. Make sure to record and report any conditions observed or statements made by the patient to indicate this. If the patient remains dizzy or continues to report feeling weak, return them to a lying down position. Immediately inform a supervisor.
11. Remove gloves if wearing and wash your hands.
12. Place the bed back into its lowest level and ensure side rails are raised.
13. The Care Plan may provide instructions for assisting a patient to dangle their legs for a specific length of time before returning them to a lying down position. Or, it may instruct the HHA/PCA to allow the patient several minutes to dangle at the side of the bed prior to standing or transfer. Follow the Care Plan accordingly.
14. Document the procedure and any observations or changes in condition.