Here's a detailed step-by-step guide for each key topic in Positioning and Draping, ensuring

that no steps are skipped.

DRAPING (COVERING THE PATIENT PROPERLY)

Draping is used to maintain patient modesty, warmth, and cleanliness while exposing only the
area that needs treatment.

1. Use Clean Linens

 Always use fresh, clean, and unused linens before starting.

 Do not reuse linens that have been used for another patient.

 If linens become soiled with sweat, lubricants, or fluids, replace them immediately.

 Avoid using the patient’s personal clothing as a drape.

2. Ensure Modesty

 Cover the body fully, leaving only the treated area exposed.

 Be extra careful when draping:

o Female patients: Cover the chest and perineum (genital area).

o Male patients: Cover the perineum (genital area).

 Be aware of cultural and personal preferences regarding modesty.

 Explain the draping procedure to the patient before starting.

3. Adjust Draping If Needed

 Regularly check that the drape remains secure.

 Readjust the linen if the patient moves or if exposure increases.

 Ensure that the drape does not restrict the patient’s movement.

4. Remove Wrinkles

 Smooth out any folds or wrinkles under the patient.

 Wrinkles can cause uneven pressure and skin irritation.

 If the drape is creased, lift and reposition it instead of pulling.

5. Use Disposable Linens

  Dispose of any linen that touches sensitive areas (e.g., perineum, gluteal cleft).

 Never reuse soiled linen on the same or another patient.

 If a patient sweats a lot, replace damp linens promptly.

6. Explain to the Patient

 Tell the patient why draping is necessary.

 Obtain permission before removing any clothing.

 Reassure the patient that their modesty will be respected.

POSITIONING (PLACING THE PATIENT COMFORTABLY)

Positioning is important to prevent discomfort, pressure sores, and contractures. Different

positions are used based on treatment needs.

1. Supine (Lying on Back)

 Step 1: Place a small pillow or cervical roll under the head for support.

 Step 2: Avoid excessive neck flexion (too much bending) or scapular abduction
(shoulders rounding forward).

 Step 3: Put a small pillow or rolled towel under the knees to reduce lower back strain.

 Step 4: If necessary, place a small lumbar roll under the lower back for extra support.

 Step 5: Position a small rolled towel or bolster under the ankles to reduce heel
pressure.

 Step 6: Ensure that arms are in a comfortable position:

o By the patient’s side.

o In a reverse “T” position.

o Folded across the chest.

 Step 7: Ensure no body part is hanging off the bed or table.

 Step 8: Protect areas that experience the most pressure, such as:

o Occipital tuberosity (back of the head)

o Shoulder blades
 o Spine

o Sacrum

o Heels

2. Prone (Lying on Stomach)

 Step 1: Place a small pillow or towel roll under the head or turn the head to the side.

 Step 2: Use a face cutout table if available for comfort.

 Step 3: Place a pillow under the abdomen to reduce excessive lower back arching.

 Step 4: Place a rolled towel under the shoulders to relieve stress on the scapulae.

 Step 5: Support the ankles with a pillow or towel roll to prevent foot strain.

 Step 6: Position arms in a comfortable way:

o At the sides.

o In a “T” position.

o Hands under the head.

3. Side-Lying Position

 Step 1: Position the patient in the center of the bed or mat.

 Step 2: Align the head, trunk, and pelvis in a straight line.

 Step 3: Flex both knees and hips slightly.

 Step 4: Place a pillow between the knees to prevent pressure on bony areas.

 Step 5: Place a pillow under the head for neck support.

 Step 6: Place a pillow at the chest to support the upper arm.

 Step 7: Place a pillow at the back to prevent rolling backward.

 Step 8: If needed, place a small towel roll under the bottom ankle to relieve pressure.

 Step 9: If the patient is unstable, use a safety strap or foam bolster.

4. Sitting Position

 Step 1: Ensure the patient sits with good back support (pillows, straps, chair back).

 Step 2: Feet should be flat on the floor, footrest, or stool.

 Step 3: Make sure the thighs are fully supported on the seat.

 Step 4: Position arms in a comfortable way:

o On armrests.

o On a lap pillow.

o Leaning forward on a table with pillows.

 Step 5: If leaning back, place a pillow behind the patient.

 Step 6: If necessary, use a belt or strap to secure stability.

PREVENTIVE POSITIONING (AVOIDING COMPLICATIONS)

Patients with certain conditions require special positioning to prevent contractures or

complications.

1. Amputees (Leg Amputation)

 Avoid prolonged hip/knee flexion.

 Do not elevate the leg on a pillow for more than a few minutes per hour.

 Limit sitting to 40 minutes per hour to prevent joint stiffness.

 When lying, keep the leg flat and straight.

 Lying prone (on the stomach) is recommended.

2. Stroke Patients (Hemiplegia)

 For the affected arm:

o Avoid shoulder adduction (pulling in) and internal rotation.

o Avoid elbow flexion and forearm pronation/supination.

o Keep wrist and fingers slightly extended.

  For the affected leg:

o Avoid prolonged hip/knee flexion.

o Avoid ankle plantar flexion (foot pointing downward).

o Position leg in hip/knee extension and neutral foot position.

 Change positions frequently to prevent stiffness.

RATIONALE FOR PROPER POSITIONING

Proper positioning is important because it:

1. Prevents soft-tissue injury, pressure, and joint contractures.

2. Provides patient comfort.

3. Supports and stabilizes the trunk and extremities.

4. Gives access to areas for treatment.

5. Promotes proper body function.

6. Reduces prolonged pressure on soft tissues and nerves.

PRECAUTIONS FOR POSITIONING

 Avoid folds in clothing or linen under the patient.

 Check skin color over bony areas before, during, and after treatment.

 Protect bony areas from excessive pressure.

 Do not let arms or legs dangle beyond the support surface.

 Avoid prolonged pressure on soft tissues and nerves.

 Be extra careful with patients who are elderly, paralyzed, unconscious, or have poor
circulation.
Here is a detailed step-by-step guide for Transfers, covering bed to wheelchair, wheelchair to
bed, and floor transfers without skipping any steps.

TRANSFERS (MOVING A PATIENT SAFELY)

1. Independent Standing Transfer (Wheelchair ↔ Bed/Chair)

Used for patients who can stand and move independently.

Bed to Wheelchair Transfer (Independent)

Step 1: Prepare the Wheelchair

 Position the wheelchair at a 45-degree angle to the bed.

 Lock the wheelchair wheels to prevent movement.

 Ensure caster wheels face forward for stability.

 Remove armrest and footrests on the side closest to the bed.

Step 2: Prepare the Patient

 Help the patient sit at the edge of the bed.

 Make sure both feet are flat on the floor.

 Check for dizziness before proceeding.

Step 3: Stand Up

 Have the patient place hands on the bed and push up to stand.

 If needed, they can use a walker or a stable surface for balance.

Step 4: Pivot and Sit in the Wheelchair

 The patient turns toward the wheelchair using small steps.

 The stronger leg should take most of the weight.

 Once positioned, sit down slowly, using the wheelchair armrest for support.

Wheelchair to Bed Transfer (Independent)

Step 1: Prepare the Wheelchair

  Position the wheelchair at a 45-degree angle to the bed.

 Lock the wheels and move footrests out of the way.

Step 2: Standing Up

 The patient moves to the front of the wheelchair.

 Push up from the armrests or a stable surface.

Step 3: Pivot and Sit on the Bed

 Turn toward the bed using small steps.

 Sit down slowly and safely.

 Adjust position to the center of the bed.

2. Standing, Assisted Pivot Transfer (With Caregiver Help)

Used for patients with some strength but need assistance.

Step 1: Position the Wheelchair

 Place it at a 45-degree angle to the bed.

 Lock wheels and move footrests aside.

Step 2: Prepare the Patient

 Move the patient to the edge of the bed.

 Place both feet flat on the floor.

 Put on a gait belt for support.

Step 3: Assist with Standing

 Stand in front of the patient with knees slightly bent.

 Place your hands on the gait belt (not underarms).

 Have the patient push up from the bed.

Step 4: Pivot to the Wheelchair

 Guide the patient in small side steps toward the wheelchair.

 Make sure their stronger leg supports most of the weight.

Step 5: Assist with Sitting

 Lower them gently into the chair using the gait belt.

 Ensure a safe, stable position before removing the belt.

3. Dependent Transfer (For Weak or Paralyzed Patients)

Used for patients who cannot assist themselves.

One-Person Dependent Lift

Step 1: Prepare the Wheelchair

 Position the wheelchair parallel to the bed.

 Lock the wheels and remove armrests and footrests.

Step 2: Prepare the Patient

 Put a safety belt or use a transfer sling.

 Move the patient to the edge of the bed.

 Cross the patient’s arms over their chest.

Step 3: Lift the Patient

 Place your feet outside their feet for stability.

 Squat down and grasp the belt or sling firmly.

 Lift the patient with your legs, not your back.

Step 4: Pivot and Lower

 Turn toward the wheelchair in one smooth motion.

 Gently lower the patient into the wheelchair seat.

 Adjust their position for safety.

4. Transfer Using a Transfer Board (For Patients Who Cannot Stand)

Used for patients with limited leg strength.

Bed to Wheelchair (Transfer Board)

Step 1: Prepare the Wheelchair

 Position it parallel to the bed.

 Lock wheels and remove armrests.

Step 2: Place the Transfer Board

 Place one end under the patient’s thigh.

 The other end should rest on the wheelchair seat.

Step 3: Move Across the Board

 The patient places hands on the board.

 They push up and slide over in small movements.

 Move slowly and safely until seated in the wheelchair.

Step 4: Adjust and Remove the Board

 Ensure the patient is fully seated.

 Carefully remove the board.

5. Floor to Wheelchair Transfer

For patients who have fallen and need to get back into a wheelchair.

Method 1: Strong Right Side (Hemiplegia)

Step 1: Prepare for Transfer

 Position the wheelchair close and lock the wheels.

 Have the patient sit on their strong side.

Step 2: Move into a Kneeling Position

 The patient pushes up on their right hand.

 Moves to a half-kneeling position with the right leg forward.

Step 3: Push Up into Standing

 The patient uses their right leg to stand.

 Holds onto the wheelchair armrest for balance.

Step 4: Sit in the Wheelchair

 The patient turns and slowly lowers into the seat.

 Adjusts position for comfort and safety.

6. Transfer from Wheelchair to Car

For patients needing to get into a car from a wheelchair.

Step 1: Prepare the Car and Wheelchair

 Position the wheelchair close to the car seat.

 Lock the wheelchair brakes.

 Move footrests aside.

Step 2: Assist with Standing

 Apply a gait belt for safety.

 Have the patient push up from the armrests.

Step 3: Pivot and Sit in the Car

 Help them turn slowly toward the car seat.

 Lower them gently onto the seat.

 Guide legs into the car.

Step 4: Adjust for Comfort

 Secure seatbelt.

 Make sure they are properly positioned.

KEY POINTS TO REMEMBER

✅ Always lock the wheelchair wheels before a transfer.

✅ Position the stronger side closest to the transfer surface.
✅ Use a gait belt for safety (if necessary).
✅ Never pull on a patient’s arms or shoulders.
✅ Encourage the patient to assist as much as possible.
✅ Use proper body mechanics to avoid injury.