Turning a Bedridden Patient: Step by Step

Why turning matters

• Pressure sores form over bony areas such as the tailbone, hips, heels, ankles, shoulder blades, elbows and the back of the head. Early damage looks like redness that does not fade after pressure is removed. Later it breaks into an open sore. See pressure ulcers: stages and care and preventing bedsores at home.
• Chest infection: lying flat on the back allows secretions to pool in the lungs. Changing position and sitting up when allowed lowers the risk; see pneumonia prevention and recovery in seniors.
• Stiff joints and contractures: staying in one posture shortens muscles; gentle positioning and movement help.
• Comfort and dignity: relief from pain and numbness, and a chance to wash, dry and check the skin.
• Circulation: movement reduces swelling and the risk of clots, though the doctor must advise on specific risks.

How often?

A common schedule for a person who cannot change position alone is about every two hours, day and night. Some people need more frequent turns, for example with very fragile skin, poor nutrition, incontinence or a standard foam mattress. Others on a pressure-relieving air mattress may turn less often. A person who can shift weight themselves may need only reminders. The nurse or doctor sets the schedule from an assessment, and may change it after reviewing the skin. Keep a turning chart with the time, the position (left, back, right), the skin check and who did it; see care diary and handover notes. Night turns are hard on carers; share them and ask about a mattress that allows longer intervals; see air mattress for pressure sores and night-time caregiving.

What you will need

• A bed that is at a comfortable working height; a hospital-style bed that raises and lowers helps your back; see hospital bed at home guide and setting up a hospital bed at home.
• A pressure-relieving mattress or overlay as advised by the nurse; see choosing an anti-bedsore mattress.
• Pillows and wedges: at least three to five firm and soft pillows or foam wedges.
• A draw sheet or slide sheet, a folded cotton sheet placed under the person from shoulders to thighs, which lets you move them without dragging.
• Clean, wrinkle-free bedding and soft, absorbent underpads where needed; see incontinence in older adults explained.
• Gloves, wipes, a basin, moisturiser as advised and a chart.
• A helper, ideally trained.

Preparing

1. Wash your hands and explain to the person what you are about to do, even if they seem unaware. 2. Raise the bed to about waist height and lower the head of the bed flat if it is allowed. If the person is on a hospital bed with rails, check with the nurse how to use them; see bed rails guide. 3. Check tubes, bags and lines (catheter, feeding tube, oxygen) so that they will not pull or kink. 4. Remove pillows and loose items. 5. Lock the bed wheels. 6. Check your own body and plan your moves; see how to lift and transfer safely. 7. Agree a signal with your helper: "ready, steady, turn".

Turning from back to side: one person (for a lighter person who can help a little)

This is a general outline; ask for a demonstration first.

1. Stand on the side of the bed to which the person will turn away from you, or follow the nurse's instruction for your parent. Many carers find it safer to stand on the side the person will face, with the bed rail down. 2. Bring the person gently towards your side of the bed using the slide sheet, not by dragging the body. Do this by supporting shoulders and hips with your hands flat, and moving the sheet or the person in small steps. 3. Cross the person's far arm over the chest and bend the far knee, with the foot flat on the bed. This makes the body easier to roll. 4. Place one hand on the far shoulder and one on the far hip. 5. On your signal, roll the person towards you in one smooth motion, keeping the spine in a straight line, so that shoulders and hips turn together. Do not twist the upper body alone. 6. Check that the person is not lying on an arm, ear or tube.

Turning with two people (preferred for heavier or very frail people)

1. One helper stands on each side of the bed. 2. Use the draw sheet: each helper rolls the edge of the sheet close to the person's body and grasps it firmly. 3. On the signal, both helpers lift the sheet slightly and slide the person to one side of the bed, then pause. 4. The helper on the side the person will face turns the person using the draw sheet while the other helper supports the back and positions the pillows. 5. Lower slowly, and straighten the sheet.

Moving up the bed uses a similar method with the head slightly lowered; do not pull the person up by the arms or under the armpits.

Positioning in bed

On the side (side-lying) at about 30 degrees. Avoid lying flat on the side, which puts the full weight on the hip bone. Use pillows or wedges behind the back so that the person rests on the fleshy part of the buttock and thigh rather than directly on the hip bone. Place a pillow between the knees and ankles. Support the upper arm on a pillow. Bring the lower shoulder forward slightly so that the person is not lying on it. Keep the head supported in line with the spine.

On the back. Place a small pillow under the head and neck and one under the calves so that the heels float off the mattress. Keep knees slightly bent, not locked. Avoid raising the head of the bed more than about 30 degrees unless needed for eating, breathing or reflux, because sitting up makes the person slide down and raises pressure on the tailbone; use a pillow under the knees to stop sliding; see backrests for sitting up in bed.

On the stomach (prone). Not suitable for most older people; use only if the doctor advises.

Hands and feet. Place hands open on a pillow, or hold a rolled towel to prevent clenched fingers. Keep feet at a right angle, supported with a pillow or footboard, to prevent drop foot.

See positioning a bedridden parent.

Check the skin every turn

At each turn, look at the pressure areas: tailbone, hips, heels, ankles, knees, elbows, shoulder blades, spine, back of the head and ears, plus skin folds. Look for redness that does not fade within a few minutes, dark or purple patches, blisters, broken skin, warmth, swelling or new pain. Keep skin clean and dry; pat, do not rub; do not massage red areas. Change wet pads and clothes promptly. Moisturise dry skin only as the nurse advises. Report any change; see pressure ulcers: stages and care and wound care at home for older adults.

Comfort, breathing and mind

• Pain: turning may hurt. Tell the doctor; pain relief must come from them, and the timing may be matched to turns.
• Breathing: if the person becomes breathless or turns blue when moved, stop and seek help.
• Cognition: talk gently, explain and ask for cooperation; with dementia, keep calm and touch with care.
• Dignity: keep the person covered, close doors and curtains and be gentle in tone; see dignity and consent in care.
• Mouth care, eating and drinking when upright are part of the routine; see feeding someone who cannot feed themselves.
• Exercises: a physiotherapist may teach passive range-of-motion movements to do during care.

Protecting yourself

Use the bed at the right height, a slide sheet and a second person; keep close, bend your knees and avoid twisting. Do not struggle alone with a heavy person. Rotate who does night turns. See caregiver burnout signs and prevention.

Warning signs

Call the doctor the same day for: new open sores, blisters or black skin; spreading redness, pus or bad smell; fever; new swelling in a leg; the person crying out in pain on turning; poor urine output; or new breathlessness. Call 112 for severe breathlessness, blue lips, collapse, chest pain, unresponsiveness or heavy bleeding.

When to ask a professional

A nurse or physiotherapist should demonstrate turning on your parent's own bed and set the schedule. A doctor assesses skin, pain, nutrition and mattress needs. A dietician helps with food that supports healing. An occupational therapist advises on equipment. In an emergency, call 112.