What technique is most effective when communicating with a client who is positioned in bed?

Patients in health care settings often spend extended periods in bed with limited mobility. An important part of nursing care consists of helping your patients keep their bodies as comfortable and safe as possible, specifically through thoughtful patient positioning.

Understanding different types of patient positioning, what they look like, when you might use them, and the impact they can have on health are important aspects of becoming a nurse. 

We will explore the basic patient positions and what you should know as an aspiring nurse about these different positions.

What is Patient Positioning?

Patient positioning refers to the techniques nurses use with their patients to maintain a neutral body alignment.

Proper patient positions help to:

• Protect the patient from potential problems related to immobility and injuries.
• Promote the overall health of the patient.
• Keep the patient safe during procedures, such as in operating rooms or in recovery.

As a nurse, you’ll need to consider many details when choosing your patient’s position. 

For example, you should consider the position of any medical devices, such as catheters, or any risk factors of this patient, such as incision sites. Patient safety should be one of your top concerns.

Why is patient positioning important in nursing?

Patient positioning plays an important role in helping to promote the comfort and safety of your patient throughout their hospital stay.

Specified positions are designed to do several things, including:

• Promote clear airways
• Encourage circulation throughout the body
• Help keep the patient comfortable while confined to a bed
• Minimize patient exposure during surgery or wound care
• Help patients feel their privacy is respected when vulnerable, such as during the perioperative phase.

In addition to benefiting patients, these positions can also help the health care team. Proper positioning can ensure maximum visibility when needing access to a particular area of the body. 

Visibility is needed to properly administer medications, like anesthetics, and gain intraoperative surgical access to begin a procedure and work as effectively as possible.

13 Basic Patient Positions 

As a nurse, you’ll need to learn a variety of patient positions, each with particular situations in which they’ll work best. There are a few things you’ll want to keep in mind before moving your patient into a new position:

• Discuss with the patient how you plan to position them and why so they can fully understand what is happening.
• Request assistance from the patient as much as possible, as well as other health care team members, whenever you may need it.
• Patients left in a single position for too long may start to experience health problems, even if nothing is wrong with the position itself.
• Frequent repositioning changes play an important role in proper patient positioning.

Now, we will explore some of the most significant patient positions and surgical positions you will need to know.

1. Supine Position

What the supine position looks like:

In the supine position, a patient lies flat on their back. Nurses can use different variations of this position. For example, depending on your patient’s condition, you might place your legs out straight, extended, or slightly bent. Your arms may be up or down.

When the supine position is used:

The supine position is one of the most commonly used positions in nursing examinations and assessments. 

Nurses can also use this if a procedure needs to be done on the anterior side of the body, such as the abdomen or thoracic area – or if you want to help your patient maintain blood flow in situations such as heat stroke. 

Patients will also need to stay flat after certain procedures, such as a cerebral angiography using the femoral artery.

What to watch out for when using the supine position:

Nurses must be careful that patients do not develop pressure ulcers or nerve damage from excessive time in this position. They will want to check for skin problems and pad bony prominences. 

You should also note if there are any reasons patients should not have a pillow in this position, such as if an anesthesiologist used spinal anesthesia.

2. Fowler’s Position

What the Fowler’s position looks like:

The Fowler’s position is often referred to as the semi-sitting position, with the head of the bed elevated like a beach chair. 

The standard elevation for the Fowler’s position is between 45 and 60 degrees, although low Fowler’s and semi-Fowler’s each use slightly smaller angles. Meanwhile, a high Fowler’s position elevates the bed even higher until your patient nearly sits upright.

When the Fowler’s position is used:

This position helps patients breathe easier. Nurses can use high Fowlers for patients experiencing high blood pressure. 

Patients who are preparing to walk again might start using this position more, as it gives nurses the chance to watch for signs of dizziness. It can also be used for neurosurgery.

What to watch out for when using the Fowler’s position:

When your patients use this position, you want to encourage them to spend a few hours a day resting without a headrest or pillow. This helps the neck fully stretch and helps the patient avoid neck flexion contractures. 

With this position, you should also watch for signs of deep vein thrombosis (DVT) in the lower extremities.

3. Orthopneic Position

What the orthopneic position looks like:

The orthopneic (or tripod position) has the patient in a sitting position. It uses a table with ample pillows in front of the patient so the patient can lean forward and rest on them.

When the orthopneic position is used:

This position allows for maximum lung expansion and can help patients with trouble exhaling. They can use the edge of the table to press on their chest to help them exhale successfully. This position is used often on patients being treated for COPD.

What to watch out for when using the orthopneic position:

Like most positions, too much time in the orthopneic position can lead to muscle strain, fatigue, sores, or bruising. Regular repositioning is necessary for patient health.

4. Prone Position

What the prone position looks like:

In the prone position, the patient lies on their stomach. The head is in a neutral position and turned to one side. Nurses can place pillows under the abdomen or in other areas to increase comfort.

When the prone position is used:

This position is useful because it allows the hip and knee joints to extend fully. It also helps with patients who are unconscious to promote drainage from the mouth. For pediatric patients, the prone position helps with gastroesophageal reflux disease. 

This position can work for vascular surgeries, neurosurgeries, and neck surgeries, among others.

What to watch out for when using the prone position:

You should not use this position for patients with spinal injuries as it creates a forward curve in the spine. You also want to watch for potential complications, such as compartment syndrome.

5. Lateral Position

What the lateral position looks like:

In the lateral position, your patient is placed on either their left or right side. Often, a pillow will be placed under the head to promote proper spinal alignment and greater comfort. 

A safety restraint may be needed across your patient’s hips depending on the reason for this positioning.

When the lateral position is used:

Nurses use this position in many different surgeries, particularly those involving the back or hips. Patients will also often need arm boards to keep them positioned correctly for different procedures.

What to watch out for when using the lateral position:

Keep an eye on pressure building along the half of the body lying against the surface. You’ll also want to watch for signs of DVT.

6. Sim’s Position

What the Sims’ position looks like:

The Sims’ position is very similar to the lateral position described above. The main difference is that bodily restraints and padding are used to keep the patient in a better position. 

The patient will be on their left side in this position, with a straightened left leg and a slightly bent right leg.

When the Sims’ position is used:

Like the lateral position, this position is often used for certain types of surgeries. This position is also used for certain examinations, such as rectal or vaginal wall prolapse.

What to watch out for when using the Sims’ position:

Keep an eye out for pressure injuries on the side of the body lying on the surface and for DVT.

7. Lithotomy Position

What the lithotomy position looks like:

In the lithotomy position, patients keep their backs flat against the surface while their legs are raised. Some type of leg holder or stirrups is generally used to help the patient keep their legs in the proper position.

When the lithotomy position is used:

As a nurse, you will most often use this position when your patient needs an examination or surgery related to the pelvic or colorectal area.

What to watch out for when using the lithotomy position:

This position places a considerable amount of pressure on the back. Nurses — like you — have to keep an eye on potential fractures or nerve injuries. Concerns also include pressure injuries and diminished lung capacity.

8. Trendelenburg’s Position

What the Trendelenburg’s position looks like:

With the Trendelenburg position, your patient will lie down on the bed, which will then shift so the head is lower than the rest of the body. Since your patient ends up nearly upside-down, they will need safety restraints so they do not fall off the surface.

When the Trendelenburg’s position is used:

This position can be useful in situations where your patient needs certain surgical procedures, such as those involving the colorectal area. Raising the foot off the bed can be helpful if there are problems with certain nerves, such as the peroneal nerve. 

This position also helps promote venous return for patients with hypotension and can help if a patient develops an air embolism.

What to watch out for when using the Trendelenburg’s position:

Do not use this position with obese patients or with those who have problems with their lung capacity. You’ll also need to watch for signs of venous pooling around the patient’s head.

9. Reverse Trendelenburg’s Position

What the reverse Trendelenburg’s position looks like:

The reverse Trendelenburg position flips what we described for the original Trendelenburg’s position. Here, the patient is flat but the table is moved so the head is higher than the legs. 

Similar to the Trendelenburg position, patients will need restraints to keep them from sliding off the table. Padded footboards can also be used.

When the reverse Trendelenburg’s position is used:

This position can be useful for certain types of surgeries, such as those involving the head and neck or laparoscopic procedures.

What to watch out for when using the reverse Trendelenburg’s position:

As a nurse, you will want to watch for signs of deep vein thrombosis or nerve damage in this position.

10. Knee-Chest Position

What the knee-chest position looks like:

The knee-chest position can serve as a variation of either the lateral or the prone positions. In a lateral variation, your patient will be on their side with the legs bent and the knees pulled up toward the chest. 

In the prone variation, your patient will kneel with the chest and face on the surface.

When the knee-chest position is used:

Nurses often use the lateral variation for spine surgeries, while the prone variation can help with rectal examinations.

What to watch out for when using the knee-chest position:

This position, particularly the prone variation, can be very uncomfortable or embarrassing for patients. Reassurance and communication can help keep your patient calm and comfortable.

11. Kraske Position

What the Kraske position looks like:

The Kraske position can also be called the jackknife position, which requires your patient to kneel. Since they will need to kneel for an extended period, ensure that your patient has adequate padding to prevent discomfort.

When the Kraske position is used:

This position can help if your patient needs a colorectal procedure.

What to watch out for when using the Kraske position:

It’s important to note that this position can have cardiovascular effects and can decrease venous return to the heart. This can increase the risk for deep vein thrombosis, so be aware of the signs.

12. Kidney Position

What the kidney position looks like:

The kidney position also has similarities to the lateral position. The main difference is that a lift is placed underneath the patient’s abdomen. 

Again, to promote patient comfort and safety, you will need to use cushions and security belts to keep the patient positioned correctly.

When the kidney position is used:

This position can help the health care team better access the retroperitoneal space, or lower back abdominal cavity.

What to watch out for when using the kidney position:

Like the lateral position, you’ll want to watch out for signs of pressure causing issues on the bed-down side of the body — as well as DVT.

13. Dorsal Recumbent Position

What the dorsal recumbent position looks like:

The term “dorsal” refers to the back (or spine), and “recumbent” refers to a lying or reclining position. 

In the dorsal recumbent position, the patient is lying on their back, their knees flexed, and their feet flat on the bed. The knees are extended and directed upward and outward, The body is lying down with the arms nearby. 

When the dorsal recumbent position is used:

This position allows a large range of motion without causing discomfort or pain, which makes it ideal for patients with limited mobility. This position also allows nurses and other medical staff to examine the hips more easily. 

Additionally, when a patient is placed in the dorsal recumbent, their body will naturally align itself with gravity, which helps to reduce swelling in limbs and joints.

What to watch out for when using the dorsal recumbent position:

As a nurse, you should take note of any discomfort the patient may be experiencing, especially in the abdomen area.

Take the Next Step in Your Nursing Career with Us

Learning these different patient positions can help you prepare for your nursing exams and — later — for your career as a nurse. Knowing when to use the different positions, and the potential risks involved, can help you improve patient care.

As you prepare for your nursing exams, it’s important to have the resources you need to study confidently and effectively. SimpleNursing offers the resources you need to prepare for your exams. 

Our exam prep will help you review all the information you need to know, so you feel ready on testing day. 

Prepare for your nursing career starting with a free trial today.

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