Today we shall discuss how to safely turn someone in bed. Usually, a person who needs turning in bed is someone who is either weak or unable to move on their own, or it may be someone who is bedridden due to some sort of paralysis. Persons who are bedridden should be on a turning schedule and ideally turned every 2 hours. This is important to avoid the formation of bedsores – a condition caused by pressure exerted over a bony prominence for extended periods. Check out our blog http://niceusgeriatric.com/2021/11/14/how-to-prevent-pressure-ulcer-sores/ to learn more about Pressure Ulcers.
Turning someone in bed is somewhat of a technique, not just to turn the person safely but also the science behind it helps the caregiver turn the person without harm to themselves. Body mechanics is essential for avoiding injury while turning a person in bed. We will look at it a bit closer and then look at the steps to turn a person safely in bed.
Body mechanics describe the way we move on a daily basis. It is a combination of posture, balance, and motion, all of which influence coordinated movement and stress placed on the body. Incorporating proper body mechanics will safeguard you from injury during lifting and turning persons. Here are some rules to remember:
- Never attempt to lift or move someone alone if they seem too heavy
- If you experience any strain in your back, stop the transfer and get help
- Spread your feet to shoulder-width apart to maintain a good stance of support with one foot slightly in front of the other
- Push or pull heavy objects instead of lifting them when possible
- Bend your knees instead of bending over at the waist
- Lift using the strongest muscles of your legs and arms
- Ask someone to help when possible, it’s always safer to have 2 people to transfer an individual
- Always keep your back as straight as possible
- Keep the person’s weight as close to your body as possible
- Contracting or tightening your abdominal muscles can decrease back strain
- It’s a good idea to stretch your muscles before doing any type of transferring or moving
- Keep your back, trunk, and feet aligned properly at all times and avoid twisting
- To change directions, shift your feet and take smalls steps while keeping your back and neck straight
- Never allow the person you are assisting to put his/her arms around your neck during a transfer (it could pull you forward causing you to lose your balance).
Turning a person in bed
When turning a person in bed, it is critical to be prepared. Firstly, know the reason why you are turning them. Did they ask to be turned? Are they on a turning schedule? Is it necessary to bathe/tidy them? The reason you want to know the purpose of the turn is so you can properly prepare to do everything you are supposed to when they turn, so you reduce the number of times turning them. You see, for a person with limited or no mobility, turning may be a chore and for some, it may even be painful. So you wouldn’t want them to turn unnecessarily. For example, if you are doing a bed bath and you know when they turn you have to apply lotion on their back, have the lotion close by to apply when they turn.
ALWAYS get consent to turn them before you start the turn. They must be prepared mentally to turn; sometimes turning for them may activate a past fear of falling and they need that emotional support before the turn starts. We must have empathy for their concerns as it is very real for them and with consent, you will get their co-operation, which makes turning them easier. A person resisting your efforts to turn them will put a strain on your back.
Safety is very important when turning someone in bed, for both you and the bed-bound person. Ensure bed rails are in an up position BEFORE you turn the person and only put down the rail on the side you are closest to accommodate the turn. ALWAYS put the bed rail back in an up position when you leave the bedside.
It is critical, for your back, to adjust the bed to waist height BEFORE turning the person. When the bed is in this position, there is no need to bend ‘down-and-over’ to turn the person, which will put a strain on your back and cause damage over time. If the bed cannot adjust, then squat down, feet shoulder-width apart, and then attempt the turn, keeping the back straight and core tight as best as you can. It may take some time to get accustomed to this posture but it is IMPORTANT to protect your back. Always remember to return the bed to a low position when you are finished.
If the bed has wheels, make sure to lock the wheels of the bed BEFORE you start the turn. Turning will involve moving forces, it is unsafe to turn on a bed that can roll and shifts during the turn, because they may fall off the bed, and you may strain your back with a sudden shifting of the bed.
Footwear is very important during turning. A shoe with a flat, non-slid base is ideal to avoid sudden movement or slips and to protect your back from strain. This type of shoe will place your feet in a flat position, which will better “root” you while you turn the person. A solid base will give proper support for the turn.
Encourage as much independence during the turn to boost the person’s self-esteem and self-worth. Congratulate them on improvements on moving for themselves; let them know they are doing a good job. Humans thrive when motivated, and this will make the turn easier for you.
When the person turns, that is a good time to inspect the side they were lying on for any irregularities or objects they may have been lying on. Look for cuts, bruises, phones, other devices, and anything that may cause concerns. It is also a great opportunity to give a massage when you turn them during a bath; it will soothe the area.
Steps for safe turning
- Place your hand on the shoulder and hips furthest from you (alternatively, you can put your hand on their upper back or on the back of their knees if the shoulder or hips are not practical)
- Instruct them to cross their hands on their chest if possible. If not, try to cross it for them, placing the hand furthest from you on top.
- Cross their legs, putting the leg furthest from you on top
- DO NOT dig your nails/fingers into their skin. The force should come from the palms, with the fingers just anchoring on their body.
- Ensure that before you turn them, if they have any tubes in situ (eg. catheters to drain urine, nasogastric tubes to feed through the nose etc) place the attached bag for the tube closer to the side they are turning on, so when they turn, it will not pull and detach.
- Do a count down towards the actual turn – “Ok are you ready? (wait for confirmation) On three – one, two, three” and move them on three
- Pull them towards you with enough force to turn them but not so much force to topple them off the bed.
- Be efficient with the activity when they turn, if they have to hold on to the rail while you do what you have to do, remember they are under strain so you don’t want to linger nor waste time.
- If they are to remain in the new turned position, place a small pillow or a rolled towel mid-back to anchor them so they would not rollback. You can also check the blog on how to prevent bedsores http://niceusgeriatric.com/2021/11/14/how-to-prevent-pressure-ulcer-sores/ and implement them one time.
- To turn them back, place your hands on their shoulder and hip, the same hand placement, but this time gently pushing them back into position.
Turning Aide – The Draw Sheet
You can use what we call a “draw sheet” to assist with turning. This will move the person by their lower torso and uses the momentum of their body weight to move them. It must be placed below the person, so it can be placed before they go on the bed, or it can be applied while they are on the bed. This draw sheet can be a re-purposed sheet or pillowcase (for smaller persons) and it usually measures one-third of the bed length – and is laid in the middle of the bed. It is placed below the person’s hips/buttocks and may extend from their waist to mid-thigh. This sheet can be folded into thirds lengthwise. It is laid in a horizontal position on the bed, the ends draping the sides of the bed.
To place this draw sheet when the person is still lying in bed, take the sheet aside and roll it inwards up to the middle. Put the rolled side to the person’s back, line it up to be under the waist to mid-thigh, and tuck it in as far as possible under the person. Using the tips to turn as above, turn the person, pull out the tucked sheet on the other side, and unroll. Either let the ends drape the sides of the bed or tuck the ends into the side of the bed. Now for future turns, you can use the draw sheet.
When using the draw sheet, you would not have to handle the person by their shoulder and hips. Instead, grab the ends of the draw sheet furthest from you and simply pull the sheet towards you. The sheet will cause the pelvis to rotate, making the person turn.
Well, that’s it on safely turning a person in bed. Please share this blog with someone who may need to see it. Also, check out the other blogs we have up already, we have some great information here for you. Thank you for taking the time out to read our blogs and do enjoy your day!