Nursing, Personal Care Attendant (PCA)

Moving clients up in bed or turning them

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Draw Sheet: Clients tend to slip down in the bed, especially if they are propped up or in Fowlers position. The simplest and safest way to pull the client up in bed is by using a draw sheet. The draw sheet covers about two thirds of the bottom sheet with the sides tucked under the mattress. It usually is beneath the client from her shoulders to about the knees. Flat sheets make serviceable draw sheets as long as there are no wrinkles. Remember to lower the bed to a flat position before trying to move a client.


How Draw Sheets are used: With a PCA on each side of the client, they each roll the draw sheet up to the sides of the client. Counting to three, they lift and move the client up in the bed using the draw sheet. If a draw sheet is not used, friction, or shearing can result from a client's skin rubbing against the bottom sheet as she is pulled. This can cause burns, rawness, skin tears, and complicate bedsores. If you do not have an assistant, you can still use the draw sheet to your advantage. Stand behind the head of the bed. Grasp the draw sheet with both hands, one on each side of the client's head. Pull the client up in bed with your back straight and knees bent.


Turning Clients in Bed: Always remember to tell your client what you are planning to do, and explain the procedure. Hand washing before and after any procedure should become automatic. Any client that cannot move around and change positions on their own should be turned and repositioned every two hours. This is critical for the maintenance of circulation to pressure points, avoid skin breakdown, and open ulcers. Remember to have an adjustable bed lying flat before you reposition your client.


Logrolling: Logrolling is a way of turning your client while keeping their spine, head, neck and legs in alignment during the process. Two PCAs make this procedure easier and safer for the client. One PCA should maintain the head, neck, shoulders, and upper back in the desired position, while the other PCA maintains the lower back, hips, and legs. Use of a draw sheet can make this process much easier. To turn a client on her side away from you, have her place her arms across her chest. Place the leg that will be in the upper position across the other leg as long as it is not painful for the client. Place a hand on the shoulder nearest you, and the other hand on the hip nearest you. Gently roll the client onto her side as you push on the shoulder and hip. Use the draw sheet to move the client back to the center of the bed if she is too close to the edge or the railing. To have the client turn to face you, follow the same procedure, pulling the shoulder and hip toward you. Flex the upper knee, and use a pillow as a cushion between the knees and legs.


5: Any white or purplish area over a bony prominence should be reported immediately.


6: A bony prominence is an area where there is not much tissue between the skin and a bone.


7: If a skin problem begins to develop, do not position the client in a way that puts pressure on that area.