Ma. Cristina P.

Mariano
Level 1 Clinical Instructor
 Overview
• Any position, correct or incorrect, can be detrimental if maintained for
a prolonged period. Positioning a client in good body alignment and
changing the position systematically and regularly every two hours
are essential aspects of nursing practice.
• The patient’s position of comfort is often the position of greatest
contracture risk. Attention to correct positioning and draping is
important in treatment and in the performance of nursing procedures.
• Positioning and draping are techniques which maximize patient
comfort and dignity. In this lesson, we will define key terms and
explore methods for proper positioning and draping.
 Learning Outcomes
At the end of the lesson, the students will be able to:
1. Define positioning and draping.
2. Describe the importance of positioning and draping.
3. Identify the different types of positioning and the types of correct
draping in each position.
4. Explain the indications and contraindications of various positioning
and draping techniques.
 Learning Outcome # 1:
Define Positioning and Draping
• Positioning is a deliberate placement of the patient or
body part/s to promote physiological and psychological
well-being.
• Draping is the manner of placing a paper or cloth covering
over a patient’s body during medical examination or
treatment designed to provide privacy or create a sterile
operative field.
 Learning Outcome # 2: Describe the
importance of positioning and draping
Importance of Effective Positioning
• Increases function
• Decreases edema
• Supports and facilitates stability to the patient’s trunks and extremities
• Ensures comfort/decreases pain
• Prevents pressure sores

Importance of Effective Draping

• Promotes privacy and modesty
• Prevents inadvertent soiling during bedside activity
 Learning Outcome # 3:
Identify the different types of positioning and
the types of correct draping in each position.

Learning Outcome # 4:
Explain the indications and contraindications
of various positioning and draping techniques.
 Materials for Positioning and Draping
• 3 bottom sheets
• 2 top sheets
• 4 regular-sized pillows
• 2 small pillows
• Leggings/stockinettes
• Gown
• Hair cap
• Clean gloves
 1. Erect Position
• Thehead and body is held in an
upright position

Indications:
A. For vaginal examination - to
determine the presence of
prolapsed uterus
B. For orthopedic condition
 1. Erect Position
Procedure:
a. Assist the patient to move to the side of the bed
b. Assist the patient to sit on the edge of the bed
c. Assist the patient to stand
d. Assist the patient to stand either with slippers or bare foot
on a piece of paper
e. Assist the patient to walk to check his gait
f. Untie the gown and leave the uppermost taped or secured.
g. Fold back the gown over both shoulders towards the front
when the physician is ready for examination of the back.
 2. Supine or Dorsal Position (Horizontal)
• Back lying position
• Similar to dorsal recumbent, but the head
and shoulders are not elevated.

Indications:
A. Examination of head, neck, axillae,
anterior thorax, lungs, abdomen, extremities,
and peripheral pulses
B. Provides comfort in general for the
patient’s recovery after some types of
surgeries
 2. Supine or Dorsal Position (Horizontal)
Procedure:
a. Replace the top sheet with a draping sheet.
b. Cover the patient from the shoulders to the
foot part with the sheet hanging loose at the
sides.
c. Assist the patient to lie flat on his/her back
with the legs together, extended or slightly flexed
d. Place one pillow under the head and one
smaller pillow under the knees.
e. Place the arms along the side of the body or
comfortably flexed on the sides.
f. Place back the draping sheet.
 3. Dorsal Recumbent Position
• Back lying position
• The head and shoulders are slightly
elevated on a small pillow.

Indications:
A. Provides comfort and facilitates healing
following certain surgeries
B. For vaginal examination, digital rectal
examination (DRE), pelvic examination,
and catheterization
 3. Dorsal Recumbent Position
Procedure:
a. Replace the top sheet with a draping
sheet
b. Assist the patient to lie flat on his/her
back.
c. Separate the legs and flex the knees so
that the soles of the feet are flat on the
bed
d. Place the arms either above the head or
flex with the hands on the chest
e. Place the pillow under the head.
 3. Dorsal Recumbent Position
f. Place the draping sheet diagonally on the
patient so that the opposite corners cover
the legs.
g. Fold back the top corner over the chest.
h. Wrap the corner on the right side around
the right foot.
i. Wrap the corner on the left side around
the left foot.
j. Fold the lower corner of the sheet back
on the abdomen to expose the part to be
examined when the doctor is ready.
 4. Lithotomy Position
• Back-lying position with feet supported in
stirrups: The hips should be in line with the
edge of the table.

Indications:
A. Examination of female genitals, rectum, and
female reproductive tract
B. For cystoscopic examination, vaginal delivery,
and operations and examinations on the
perineum, vagina, cervix, bladder, and rectum

Caution: May be uncomfortable and tiring for

elderly people and often embarrassing
 4. Lithotomy Position
Procedure:
a. Assist the patient to lie on his back at the
lower edge of the bed.
b. Insert leggings or stockinettes when
necessary.
c. Adjust the stirrups according to the size of the
patient.
d. Separate the legs and flex thighs deeply
towards the abdomen.
e. Elevate the lower legs and support them with
the stirrups.
f. Draw down the buttocks on the folding edge of
the table.
 4. Lithotomy Position
g. Raise the arms above the head or flex them with
the hands on the chest.
h. Place the draping sheet diagonally on the patient
so that the opposite corners cover the legs.
i. Fold back the top corner the chest.
j. Wrap the corner on the right side around the right
leg.
k. Wrap the corner on the left side around the left
leg.
l. Fold the lower corner on the sheet back on the
abdomen to expose the part to be examined when
the doctor is ready to do so.
 5. Sims Position

• The patient assumes a posture halfway

between lateral and prone position.
• The lower arm is positioned behind the
client and the upper arm is flexed at the
shoulder and the elbow.
• Both legs are flexed in front of the patient.
• The upper legs are more acutely flexed at
both the hip and the knee (compared with
the lower legs).
 5. Sims Position
Indications:
A. Unconscious patients – facilitates drainage from mouth
and prevents aspiration of fluids.
B. Paralyzed patients – reduces pressure over the sacrum
and greater trochanter of the hips.
C. Patients receiving enemas
D. Patients undergoing treatment and/or examination of
the perineal area
E. Pregnant women – comfortable for sleeping
i. Support proper body alignment in sims position by placing a
pillow underneath the patient’s head and under the upper arm
to prevent internal rotation
ii. Place another pillow between the legs
 5. Sims Position
Procedure:
a. Assist the patient to lie on either side, preferably
the left with the body inclined forward.
b. Extend the left arm behind the back and flex the
elbow of the right arm forward
c. Flex the right thigh towards the abdomen with the
knees drawn up higher than the left knee, which is
only slightly flexed.
d. Lay out the draping sheet in horizontal recumbent
position.
e. Fold back and/or gather a side of the sheet to
expose the area to be examined.
 6. Prone Position
• The patient lies on the abdomen with head turned to one side; the
hips are not flexed.
• To support a patient lying in prone, place a pillow under the head
and a small pillow or a towel roll under the abdomen.

Indications:
A. Allows full extension of the hip and knee joints
B. Promotes drainage from the mouth
C. Useful for patients who are unconscious or those who are
recovering from surgery of the mouth and throat
D. Should only be used when the patient’s back is correctly aligned
and for people with no evidence of spinal abnormalities
E. For examination of posterior thorax
 6. Prone Position
Procedure:
a. Help the patient assume the horizontal recumbent
position.
b. Assist the client to turn over onto the abdomen.
c. Turn the head on one side.
d. Place the arms at the sides or flex or extent
upwards.
e. Allow the feet to hang over the edge of the
mattress or support on a pillow high enough to keep
the toes from touching the bed.
f. Drape the patient horizontally.
 7. Fowlers Position

•A bed position wherein the head

and trunk are raised 15 to 90
degrees.
• Usingfootboard is recommended
to keep the patient feet in proper
alignment.
 7. Fowlers Position
Indications:
A. Difficulty of breathing (DOB) – because gravity pulls
the diaphragm downward allowing greater chest and lung
expansion

i. LOW FOWLERS – head and trunk are raised to 15 degrees

ii. SEMI FOWLERS POSITION – head and trunk are raised
to 45 degrees
iii. HIGH FOWLERS – head and trunk are raised to 90
degrees

B. Patients with cardiac, respiratory and neurological

problems
C. Patients with nasogastric tube (NGT) in place
D. Helps prevent footdrop
 7. Fowlers Position
Procedure:
a. Place the patient in a horizontal
recumbent.
b. Elevate the head of the bed
appropriately.
1. Low fowlers – 15°
2. Semi-fowlers – 45°
3. High fowlers – 90°
c. Flex the knees slightly and support them
with knee rolls.
d. Drape the patient appropriately.
 8. Trendelenburg Position (T-Position)

• Involves
lowering the head of the
bed and raising the foot of the
bed.

Indication: For hypotension –

promotes venous return.
 8. Trendelenburg Position (T-Position)
Procedure:
a. Assist the patient to a horizontal
recumbent position.
b. Elevate the foot of the bed so
that the lower trunk is higher than
the bed and the shoulders.
c. Support the shoulders and the
knees.
 9. Reverse Trendelenburg Position
(Reverse T-Position)
• Opposite of Trendelenburg
Position
• The head of the bed is elevated
with the foot of the bed down

Indication:
• This is often a position of
choice for patients with
gastrointestinal problem to
minimize esophageal reflux.
 10. Genupectoral (Knee-chest) Position
• A prone posture resting on the knees and
upper part of the chest.
• For gynecologic or rectal examination.
• Position the patient’s knees so that the
weight of the body is supported by the
knees and chest with buttocks raised.
• The head is turned to one side and the
arms are flexed so that the upper part of
the body can be supported in part by the
elbows.
 10. Genupectoral (Knee-chest) Position
Indications:
A. Displacement of a prolapsed
fundus
B. Dislodgement of the imparted head
of a fetus
C. Management of transverse
presentation
D. Replacement of a retroverted
uterus or displaced ovary
 10. Genupectoral (Knee-chest) Position
Procedure:
a. Place the patient on a prone position.
b. Assist him to kneel with the knees slightly
separated.
c. Bend forward so that the chest is resting on
the bed and the thighs are perpendicular to
the legs.
d. Turn the head to one side.
e. Place the arms either above head or flex at
the elbow and rest along the side of the head.
f. Drape the patient diagonally so that only the
area to be examined is exposed.
 11. Lateral Position (Side-lying)
• The patient lies on one side of the body
with the top leg in front of the bottom leg
and the top hip and knee flexed.
• Flexing the top hip and knee and placing
this leg in front of the body creates a
wider, triangular base of stability.
• The greater the flexion of the top hip and
knee, the greater the stability and balance
in this position.
• In lateral position, most of the body
weight is distributed to the lateral aspect
of the lower scapula, the lateral aspect of
the ilium, and the greater trochanter of
the femur.
 11. Lateral Position (Side-lying)
Indications:
A. Reduces lordosis
B. Promotes good back alignment
C. Helps relieve pressure on the
sacrum and heels in people who
sit for much of the day or confined
to bed rest in fowlers or dorsal
recumbent.
 12. Orthopneic or Tripod Position
• Placethe patient in a sitting position
or on the side of the bed with an
overbed table in front to lean on and
several pillows on the table to rest on

Indication:
• Forpatients who are having difficulty
breathing (DOB) because it allows
maximum expansion of the chest.
 Draping
Reasons for Draping:
• Toprovide privacy and to
promote modesty and dignity
• For warmth
• For hygienic purposes
 Guidelines for Draping
 Ifyou need to change the patient’s gown, leave the room, then knock before
reentering.
 Ifthe patient needs assistance, suggest it, then ask permission before helping
them.
 Only the area being treated is exposed, the rest of the patient is covered with
a gown, blanket, sheet, or towel.
 The patient’s comfort is the key to working on difficult areas.
 Be sure you keep legal considerations in mind (door closed/slightly open;
curtains drawn).
 Inappropriate comments or touch mean different things to difficult people.
 Protect yourself by being professional at all times.
 KEY POINTS
• Positioning is the deliberate placement of the patient or body part/s to promote
physiological and psychological well-being.
• Draping is the manner of placing a paper or cloth covering over a patient’s body during
medical examination or treatment designed to provide privacy or create a sterile operative
field.
• Positioning and draping are techniques which maximize the patient’s comfort and dignity.
• In positioning, the most comfortable position for the patient may not be the best
for them.
• Considerations with positioning should be employed for the elderly, those unable to change
their own position, those with decreased sensation, and those who may be unable to
communicate their discomfort.
• We change the patient’s position according to the medical standard: “Change every two
hours.”
• Standard positions include: Supine, prone, side-lying, semi-fowlers, and sitting/erect.
Thank you!