1. Obtain comfortable bedding. Allow some of patient's own possessions (such as a pillow or afghan) when possible.

2. Change the bed position (head and knee).

3. Reduce the noise and light in the patient's room.

4. Check for mechanical reasons for discomfort:

   • Bed linens or Chux® which are gathered and wrinkled under the patient.

   • Plastic mattress covers that wrinkle and cause pressure.

   • Top covers which may be pulled too tightly over the feet and legs.

   • The patient lying on tubes, drains, syringe caps, or other equipment.

   • Soiled dressings, urine, and feces causing the bed to be wet.

   • Nonfunctioning equipment, to include alarms sounding without cause.

If a patient is restless, having difficulty getting comfortable, or not sleeping well, consider the following steps. As always, be sure you have a physician's order for the patient to be turned when necessary.

1. Wash your hands.

2. Approach and identify the patient (by checking the ID band) and explain the procedure (using simple terms and pointing out the benefits).

3. Perform practical nursing care to promote relaxation.

   • Straighten or change the linens.

   • Give the patient a back massage.

   • Provide oral hygiene.

   • Administer hair care.

   • Administer a sponge bath and get fresh pajamas.

4. Position the patient in the preferred position for rest if possible. Follow the physician's order for turning if specified.

5. Modify the position for support and comfort. Use aids for the patient's positioning as indicated.

6. Check for the position and function of tubes and drains.

7. Check the bed linens for comfort.

   • Wrinkles in linens.

   • Wrinkles in mattress cover.

   • Tightness over the feet and lower extremities.

8. Tell the patient when you plan to return.

9. Position the call light and bedside table within easy reach. NOTE: To keep the call light within the patient's reach, secure it to the bed linen with a safety pin, if necessary.

10. Provide for quiet in the area when possible.

    • Close the doors.

    • Turn off any radios or TVs.

    • Ask unnecessary visitors and personnel to leave the area.

11. Avoid interrupting the patient once he falls asleep.

    • Schedule medications for times when the patient is being turned.

    • Keep nursing care treatments and procedures to a minimum during sleep hours.

12. Report and record significant nursing observations.

1. Preserve or improve muscle tone.

2. Improve circulation, particularly in the lower extremities.

3. Preserve pulmonary tissue and airway function.

4. Preserve muscle and joint mobility.

1. Reassure the patient of his personal safety against injury and over-exertion.

2. If necessary, get additional help to assist you in ambulating the patient.

3. Support the affected side or extremities of the patient when ambulating or moving.

4. Do not overtire the patient; increase time up in the chair and ambulation gradually.

5. Lock all wheelchair or litter wheels before transferring the patient from the bed.

6. Stabilize the footstool, when it is utilized.

7. Place a signal cord or call-light button within easy reach of the patient while he is up.

8. Check on the patient frequently.

1. Review the patient's medical record for an authorizing physician's order.

2. Review the patient's nursing care plan for information regarding the following:

   • Physical limitations.

   • Mechanical equipment being utilized; that is, IV infusion pumps, chest drainage set, urinary drainage sets.

   • Distance patient is to ambulate.

   • Length of time patient is to be out of bed.

   • Frequency patient is to get out of bed.

3. Review the Nurse's Notes to identify the patient's previous tolerance of the activity specified.

4. Explain the rationale for getting out of bed to the patient.

5. Pre-medicate for pain prior to getting out of bed, if necessary.

6. Ensure that the patient is appropriately clothed, including footwear.

1. Assist the patient to sit on the side of the bed (dangling).

2. Assist the patient to stand.

3. Assist the patient to move to a chair, or to ambulate.

The Patient Who Collapses.

1. Assume a broad stance with one foot slightly forward, grasp the patient's body firmly at the waist or under the axilla, and allow him to slide down against your leg.

2. Ease the patient slowly to the floor using your body as an incline.

3. Lower your body along with the patient, if necessary.

4. Utilize proper body mechanics.

The Patient Who Loses Balance.

1. Attempt to stabilize the patient by bracing him against you.

2. Guide the patient to the bedside or chair, if possible.

3. If a fall begins to occur, guide him slowly toward the floor.

The physiological and psychological benefits of repositioning, being out of bed, and sitting up or ambulating should not be under-emphasized. Basic nursing care activity such as this, although not always pleasant for the patient, does make a significant difference in the recovery and return to health of the patient.

Continue with Exercises