56. CCA Study Notes: Client Positioning and Repositioning in Beds, Chairs, and Wheelchairs

The Big Picture

Clients need safe, comfortable positions whether they are lying in bed or sitting in a chair. Regular position changes and good posture help support comfort, breathing, circulation, and general well-being.

Some clients move themselves. Others need reminders, help, or full assistance from the health care team.

Positioning also requires close attention to the care plan, skin changes, body alignment, comfort, privacy, and safety.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

Why Position Changes Matter

Regular changes in position and good body alignment support comfort and well-being. They also help breathing and circulation.

Proper positioning helps prevent complications such as pressure injuries and contractures.

Body alignment means the way the head, trunk, arms, and legs line up with one another. Another word for body alignment is posture.

The client must stay properly positioned at all times.

How Often Clients Need Repositioning

Clients in beds or chairs need repositioning at least every 2 hours. Some clients need position changes more often.

A physician may order a specific position or set limits on which positions the client uses.

Follow:

• your supervisor’s instructions
• the care plan
• the client’s repositioning schedule
• any ordered position limits

Safety and Comfort During Positioning

Every time you position a client:

• Check with your supervisor and the care plan ⓘ for the proper position.
• Follow the scheduled repositioning time.
• Use good body mechanics.
• Ask for help before starting when help is needed.
• Explain the procedure to the client.
• Move the client gently.
• Provide privacy.
• Leave the client in good body alignment.
• Use pillows as directed for comfort and support.
• Keep linens smooth and free of wrinkles.
• Straighten or change linens when needed.
• In facilities, place the call bell ⓘ within reach.

Report: Check the skin for redness, paleness, or discoloration each time you position the client. Report these observations immediately.

Fowler’s Positions

Fowler’s position places the client in a semi-sitting to upright sitting position in bed.

This position helps relax tense abdominal muscles and improve breathing. It also supports uterine drainage after delivery during the postpartum period.

Many clients feel more comfortable with slightly bent legs and pillows supporting their arms. Arm support also helps keep the client from slipping sideways.

Clients who remain in bed often use Fowler’s positions while:

• eating
• visiting
• taking medications
• reading
• watching television

There are three main Fowler’s positions.

Position	Head of Bed
low Fowler’s position	15 to 30 degrees
semi-Fowler’s position	30 to 45 degrees
high Fowler’s position	45 to 90 degrees

Low Fowler’s Position

For low Fowler’s position, raise the head of the bed to 15 to 30 degrees.

Extra pillows under the head and shoulders offer another supported method of raising the upper body.

Semi-Fowler’s Position

For semi-Fowler’s position:

1. Raise the head of the bed to 30 to 45 degrees.
2. Reposition the client’s head and shoulders on the pillow.

The knee portion of the bed might be raised to help stop the client from sliding downward.

Raising the knee portion can interfere with leg circulation. Some care plans direct workers to place a small pillow under the knees instead.

High Fowler’s Position

For high Fowler’s position:

1. Raise the head of the bed to 45 to 90 degrees.
2. Reposition the client’s head and shoulders on the pillow.

Clients usually do not sit above 60 degrees because higher positions often feel uncomfortable.

High Fowler’s is the best position for a client who needs to use a bedpan while remaining in bed.

Some clients who eat or drink in bed need an almost 90-degree sitting position, especially when they have difficulty swallowing. Follow the care plan or your supervisor’s directions for meal positioning.

People with heart or respiratory disorders often breathe better in high Fowler’s position.

Safety: Never leave a frail client unattended in an upright 90-degree position. The client might tip forward, fall sideways, or fall out of bed.

Supporting a Client in Fowler’s Position

Follow the care plan for all Fowler’s positioning.

When the care plan allows it:

• Raise the knees slightly with the hospital bed’s knee control.
• Use a small pillow under the lower calves when the bed does not adjust or the care plan directs this method.
• Support the client with a backrest, foam wedge pillow, or sofa pillows.
• When pillows provide support, make sure the headboard is sturdy or place the head of the bed against the wall.
• Keep the spine straight.
• Position the hips directly against the bend in the bed or supporting pillows.
• Place a small pillow behind the head and neck.
• Place small pillows under the arms and hands.
• Place pillows under the lower back, thighs, and ankles when your supervisor directs you to do so.

Slight knee flexion helps reduce back strain, limits sliding toward the foot of the bed, and reduces shearing around the coccyx.

Use the angle indicator built into the hospital bed frame to measure the head-of-bed angle. Do not rely only on personal judgment.

Supine Position

The supine position means lying on the back. Clients use this position for sleeping and resting.

To position a client in the supine position:

1. Flatten the bed. Lower the head when needed.
2. Place a small pillow under the head and shoulders.
3. Place the arms along the sides with the palms facing down.
4. Place a small pillow under the arms and hands.
5. Place a small pillow under the knees to keep them flexed. This helps reduce back strain.
6. Place small pillows or rolled towels under the lower back, thighs, and ankles when your supervisor directs you to do so.

Lateral Position

The lateral position means lying on one side.

Most clients lie on either side, but the care plan might contain restrictions. A pressure sore on the hip area is one example given for a positioning restriction.

Check the client often for:

• pain
• numbness
• discomfort

To position a client laterally:

1. Flatten the bed. Lower the head when needed.
2. Position the client on the side.
3. Bend the upper leg at the knee and place it in front of the lower leg.
4. Place a small pillow under the head and neck.
5. Place small pillows under the upper leg and thigh.
6. Place small pillows under the upper hand and arm.
7. Place a small pillow against the client’s back.

Sims’ Position

Sims’ position places the client on the left side, partly toward the abdomen.

The right leg bends sharply so it does not rest on the left leg. The left arm lies along the client’s back.

This position supports certain procedures, including enemas, because it places the intestines in a position that supports enema absorption. A client also uses this position for rest when comfortable.

Older clients often find Sims’ position uncomfortable. Check with your supervisor before positioning an older client this way. Use plenty of pillows for support.

Check the lower arm and hand frequently for comfort and circulation.

To position a client in Sims’ position:

1. Flatten the bed. Lower the head when needed.
2. Position the client on the left side.
3. Bend the upper right leg so it does not rest on the lower left leg.
4. Bend the upper right arm and place the hand near the head with the palm down.
5. Place the lower left arm behind the client with the palm facing up. Move it to a more comfortable position if the client does not tolerate this placement.
6. Place a small pillow under the head and neck. Keep the pillow away from the face so the client breathes freely.
7. Place small pillows under the upper arm and hand and under the upper leg.

Prone Position

The prone position means lying on the abdomen with the head turned to one side.

Many clients do not tolerate this position, especially clients with limited neck movement. When used, it usually lasts only a short time.

The prone position mainly helps prevent shortening, or contractures, of the thigh muscle in clients who have had leg amputations and spend long periods sitting in a wheelchair. This position keeps the thigh muscles of the amputated leg stretched.

Follow the care plan: Use the prone position only when the care plan calls for it.

To position a client prone:

1. Flatten the bed. Lower the head when needed.
2. Remove the pillows. Turn the client carefully onto the side, then onto the abdomen.
3. Turn the client’s head to one side.
4. Bend the arms at the elbows and place the hands near the head.
5. Place small pillows under the head, abdomen, and lower legs. If the feet hang over the end of the mattress, do not place a pillow under the lower legs.

Sitting Position in a Chair or Wheelchair

A client sitting in a chair or wheelchair needs an erect head and upper body for good alignment.

Clients who do not maintain this position need postural supports. The health care team selects the support based on the client’s needs, dignity, independence, individualized care, preferences, privacy, and safety.

Assist with postural supports as needed.

This type of postural support can be considered a restraint, so use the same care required for a client in a restraint.

To position a client in a chair or wheelchair:

1. Place the client’s back and buttocks against the back of the chair.
2. Keep the back straight and prevent leaning to either side.
3. Place the feet flat on the floor or on the wheelchair footrests.
4. Keep the backs of the knees and calves slightly away from the seat edge.
5. Support affected or paralyzed arms on pillows. Follow the care plan.
6. Position the wrists at a slightly flexed angle.
7. Place a small pillow between the lower back and chair when your supervisor directs you to do so.

Some clients use special foam positioners.

Ask your supervisor about the proper use of special foam positioners.

Must not: Never apply these positioners unless the care plan includes them. Most agencies consider them restraints.

Elevated wheelchair armrests suit some clients who tend to lean toward an affected side.

Repositioning a Client in a Chair or Wheelchair

Clients sometimes slide downward in their chairs. Reposition them so their backs and buttocks rest against the backs of their chairs.

A transfer belt is a strong strap secured around the client’s waist or hips. It supports the client during standing, sitting, or walking and comes off after the activity.

Transfer belts often help with chair repositioning, although some agencies do not supply them. Check whether this safety equipment is available in your workplace.

Use the following method only when the client:

• is alert
• is cooperative
• follows instructions
• has enough strength to help

Repositioning Steps

1. Lock the wheelchair wheels.
2. Stand in front of the client. Block the client’s knees and feet with your own knees and feet.
3. Place your knees in front of the client’s knees.
4. Apply a transfer belt when your agency uses one.
5. Place the client’s feet flat on the floor. Swing wheelchair foot pedals out of the way when present.
6. Position the client’s arms on the armrests.
7. Hold the transfer belt on both sides behind the client’s armpits while the client leans forward. Without a transfer belt, place your arms under the client’s arms and your hands around the shoulder blades.
8. On the count of three, ask the client to push with the feet and arms.
9. On the count of three, lift the client back into the chair. Keep your back in its natural curve to avoid back injury.
10. As the client pushes with the feet and arms, push the client’s knees with your knees. This movement brings the client back into position in the wheelchair.