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Mempersiapkan Tempat Tidur Agar Siap Pakai B.memberikan Kenyamanan Dan Keamanan Bagi Pasien
Mempersiapkan Tempat Tidur Agar Siap Pakai B.memberikan Kenyamanan Dan Keamanan Bagi Pasien
patient positioning
Glynis Collis Pellatt
P
roviding a comfortable bed and positioning a patient them. Table 1 describes making an unoccupied and occupied
to prevent pressure ulcers or to assist breathing are bed. It is more time efficient (and safer for the patient when
important ways that nurses can promote comfort. making an occupied bed) to do this task in pairs (Gowin,
These are fundamental nursing skills that require 2001). The need for changing of bed linen should be assessed
practical ability and are vital in enhancing a patient’s physical, and linen changed when necessary rather than as a daily
social and psychological wellbeing. In this article the procedure ritual (Westfall and Burrow, 1997).
for bedmaking will be described. Positioning patients in bed
and in chairs to promote optimum function will be discussed. Patient positioning
Moving and handling issues will be considered in relation to Correct therapeutic positioning of patients is essential to
repositioning patients. maximize their physiological functioning and recovery.
Poor positioning can compromise a patient’s airway, cause
Bedmaking joint dislocations, displacement of fractures, peripheral nerve
Bedmaking is a daily routine in nursing but for a patient who damage, spasm and pressure ulcers (Hawkins et al, 1999;
is in bed for all or part of the day, a comfortable bed and Jarrett, 2004; Griffiths and Gallimore, 2005).
appropriate bedding are essential (Burrows and Baillie, 2005).
Bedmaking is an example of how nursing is a combination Basic positions in bed
of the practical (the procedure) and the technical (the n The supine position
promotion of patient comfort and the prevention of cross In the supine position the patient is placed on his back with
infection) (Gowin, 2001). However, there is very little the spinal column in a straight line and legs parallel to the bed
research-based literature about this fundamental skill. (Jacobs, 1994a; Griffiths and Gallimore, 2005). See Figure 1
Remove the soiled sheet and then pull the clean sheet taut. n Other accessories (Stewart, 2003),
If the patient is unable to be rolled on his side, the clean sheet can be put in from In normal sitting the pelvis is positioned in a slight anterior
the head of the bed in a similar way. In this case the patient will be asked to move (forward) tilt and the body weight is taken evenly through both
down the bed while the soiled sheet is rolled toward their back and the clean one ischial tuberosities.The hips are flexed to 90 degrees.The knees
inserted. The patient will then be asked to move back up the bed on to the clean and ankles are flexed to 90 degrees allowing us to place our feet
area while the soiled sheet is removed and the clean one pulled taut. flat on the floor. A large portion of the body weight is shared
If the patient is not able to do this himself then appropriate equipment will need to between both thighs (Collins, 1999, 2002). A chair that is too
be used.
low will not only be difficult to get out of but will also produce
At the end of the bed making make sure the patient is comfortable and can reach
his locker, call bell, etc.
pressure on the pelvis rather than distributing it evenly along
Adapted from Ambrose and Quinless (2004) the thighs (Stewart, 2003). If the seat is too high the person’s
feet will not touch the floor and will cause pressure under the
thighs with the potential for swollen feet. If the person needs
Positioning patients in chairs a higher chair to enable them to stand up it is important to
Healthy human beings are able to stand and sit to carry out provide a foot stool to support the feet (Broadbent, 2002).
daily living activities (Collins, 1999). However, some immobile Alternatively a better option might be to provide a seat riser
patients are unable to stand and they spend long periods of unit or even a riser/recliner chair which would enable the
time sitting, often in the same position, unable to reposition person to alter their position independently (Rush, 2004). The
themselves. The National Institute for Health and Clinical seat needs to be deep enough to support the full length of the
thighs and wide enough to enable the person to easily get into
the seat, but not so wide that it does not provide support or that
the person cannot reach the armrests (Stewart, 2003).
Patients who have hemiplegia following a stroke should
have their affected arm supported. The shoulder joint should
be correctly aligned and the weight of the arm supported
with an arm support or a pillow (Dowswell et al, 2000;
Goulding et al, 2004).
Patients who do spend substantial amounts of time in a
chair or wheelchair should be provided with a pressure-
redistributing device (EPUAP, 1998). It must be remembered
that a cushion placed on top of a seat will alter the chair’s
dimensions (Collins, 1999).
Conclusion
Nurses have an important role to play in providing a bed that
has clean, unwrinkled bed linen, covers that are not too hot,
too heavy or too cold and enough supporting pillows. They
also have a major role in positioning patients so that they are
able to be as independent as possible and avoid the discomfort
and range of complications that are associated with poor
positioning. These are fundamental nursing skills that are Essat Z (2005) Prone positioning in patients with acute respiratory distress
syndrome. Nurs Stand 20(9): 52–5
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patient comfort and wellbeing. BJN prevention of pressure ulcers from the European Pressure Ulcer Advisory
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Skin tears
Skeletal deformities
Back and neck pain
Dysphagia KEY POINTS
Impaired respiration and digestion n Profiling beds provide comfort and safety for patients
Contractures
and nurses.
Discomfort
Inability to self propel the wheelchair n Bed making by nurses is more time efficient and safer for
Visual impairment patients if carried out in pairs.
Incontinence n Poor positioning can cause a range of problems both
Social isolation
physical and psychosocial.
Unsafe transfers
Sources: Samuelsson et al (2001), Aissaoui et al (2002), n Before moving and positioning a patient an ergonomic
Gavin-Dreschnack (2005) risk assessment must be undertaken.