CNA Skill: Positioning a Patient on their Side

During certain procedures, you may need to assist your patient in lying on their side.  This will be used during bed pan placement, linen changes, and in bed weight measures among other procedures.  Before you begin, you will need the assistance of a second person.  You should both wash your hands and put on a pair of gloves.  Greet your patient and explain that you are going to help the patient turn onto their side.  Then, follow these steps:

1. Raise the bed so that it is at a comfortable height to allow you to reach both sides of the bed.
2. Grasp the draw sheet, and pull the patient closer to the side of the bed opposite the side he or she will be laying.  Doing this will result in the patient remaining in the center of the bed, which can prevent falls.
3. Pull the draw sheet toward you and slightly upwards to roll the patient onto his or her side.
4. If your patient is able to, ask him or her to grasp the side rail of the bed as you turn him/her.  This will provide increased stability.
5. Place a pillow underneath the draw sheet, below the patient’s back for support.  Place a second pillow beneath the patient’s buttocks.  Another pillow should be placed between the patient’s knees for comfort and support.  If the patient desires, a pillow can be placed beneath the top arm as well.
6. Remove and dispose of gloves, and wash your hands.

For patients who are non ambulatory, turning the patient on a regular basis can prevent pooling of blood into certain areas which can lead to painful and dangerous bedsores.  With guidance from the nursing staff, you will want to reposition your patient several times throughout the day.  By using the steps above, you will be able to help your patient remain comfortable during procedures which require him or her to lie on the side.

Examiners Checklist For This Skill

1) Performed beginning tasks.
2) Raised side rail on unprotected side of bed (if applicable).
3) Positioned resident on side in the center of the bed in side-lying
position.
4) Placed appropriate padding.
a. Behind back.
b. Under head.
c. Between legs.
d. Supporting dependent arm.
5) Ensured resident is in good body alignment.
6) Raised side rails, if appropriate.
7) Performed completion tasks.

Expert Tip by Tanya Glover, CNA

Positioning a patient on their side can be one of the hardest skills to master. It is also one of those skills that tend to strike fear into the heart of students everywhere. The main reason for this is that there are so many steps to remember and when it comes to real life work, each patient will have different needs when it comes to positioning. For the purpose of your skills exam, simply memorize the steps you were taught and you can forget them once you hit the job. I am serious about that. What you are taught and what you actually need to know about this topic are two very different things. For instance, what you are taught will not help you position Mr. Joe when his body is so rigid that you need an extra person to pry his legs apart in order to insert a new pillow or wedge. You will not be taught how to handle a patient whose family want this particular pillow between their elbow and side at all times. These types of things will only come with experience and getting to know each patients individual needs.

The upside to this skill is that your partner feels your fear and will typically do everything they can to help you. They will not go limp or stiff on you and will help you move them around in a subtle way so your job is not so hard. Remember to return the favor! They need your help too. This is what I like to call the working together skill. You either learn it or sink at work. Trust me on this one!