The bed

The problem

Moving someone in bed by sheer force, pulling on the arms or the clothing, hurts the person's skin and the caregiver's back. The tool that changes everything is a slide sheet.

What is happening underneath

The skin of someone who spends many hours in bed is fragile. Dragging them creates friction and shear (when the skin stays still while the bones move underneath), and that opens pressure sores. The slide sheet lets the body move without scraping. And a bed at the right height keeps the caregiver from working bent over.

Step by step

1. If it is a crank or electric bed, raise it until the person is at the height of your hip, so you do not bend your back. If it has wheels, lock them.
2. Place a slide sheet, or a folded regular sheet (a draw sheet), under the person, from the shoulders to the thighs. This is what you will use to turn and to boost them.
3. Get to know the side rails: they help some people turn or feel secure, but in someone who is confused they can be a danger of entrapment or of falling when trying to climb them. Use them or not as the professional advises.
4. Before any movement, tell the person what you are going to do and ask them to help if they can.

The problem

When someone spends most of the day and night in bed, an ordinary mattress concentrates the weight on the same points every time. A pressure-relief mattress spreads or shifts that pressure and helps prevent wounds.

What is happening underneath

Lying down, the weight lands on the sacrum, the heels, the hips, and the shoulder blades. A prevention mattress spreads that weight over more surface. There are two main types: special good-density foam, which always cushions, and alternating-air ones, which have cells that inflate and deflate in turns with a pump, so the area that was under pressure for a while is relieved on the next cycle. But one thing is certain and applies to all: no mattress replaces the changes of position. It reduces them, it does not eliminate them.

Step by step

1. If the person spends many hours in bed, cannot move on their own, or already has skin at risk, ask the professional (doctor, nurse, physiotherapist, or therapist) which type of mattress suits them. The higher the risk, the better the surface: good-density foam is the minimum, and alternating air is reserved for those who barely move or already have wounds.
2. If it is alternating air, check that the pump is plugged in, on, and working. An air mattress that is off does not protect.
3. Do not put thick layers on top (several sheets, plastic covers, or tight pads): they cancel out the mattress's effect. Use the minimum, well stretched out.
4. Even with the mattress, keep turning the person and checking the skin every 2 hours (see card B6).
5. Keep the skin clean and dry. Moisture, especially from urine leaks, harms the skin just like pressure.

The problem

Lying on the back seems the most comfortable position, but done badly it loads the sacrum and the heels, exactly where pressure sores appear.

What is happening underneath

Lying on the back, the weight falls on the sacrum (the base of the spine) and the heels. If the head of the bed is raised too high, the person slides toward the feet and loads the sacrum even more. The key is to align the body and to lift the heels off.

Step by step

1. Lay the person straight: head, shoulders, hips, and legs in line, not twisted.
2. If the head of the bed needs to be raised, keep it no more than about 30 degrees, unless the doctor indicates more for breathing or swallowing.
3. Place a thin pillow under the head and, if it helps, one under the arms.
4. Lift the heels off: place a pillow lengthwise under the calves so the heels float, not touching the mattress.
5. Change the position every 2 hours and check the skin of the sacrum and the heels.

The problem

Being on the side relieves the sacrum, but if the person rests right on the hip bone, you simply trade one pressure point for another.

What is happening underneath

The position that protects the skin is not fully on the side, but tilted about 30 degrees, with the back supported by a pillow. That way the weight is shared between the hip and the back, and does not land on the bone. A pillow between the knees keeps one leg from pressing on the other.

Step by step

1. Turn the person to one side (see card B6).
2. Do not leave them fully on their side on the hip: tilt them about 30 degrees back and support the back with a wedge pillow.
3. Place a pillow between the knees and the ankles, so the legs do not rest bone against bone.
4. Bring the lower arm forward so it is not crushed, and rest the upper arm on a pillow.
5. Alternate sides at each change, every 2 hours.

The problem

Raising the head of the bed helps with breathing, eating, or staying awake, but it makes the person slide toward the feet and end up slumped on the sacrum.

What is happening underneath

When only the head is raised, the body slides down and the skin of the sacrum wrinkles and stretches (shear). To avoid this, first raise the knee area a little and then the head, so the person is propped and does not slide.

Step by step

1. Before raising the head of the bed, raise the knee section a little (if the bed allows it) or place a pillow under the thighs.
2. Only then raise the head of the bed to where the person is comfortable, without overdoing it.
3. Make sure the hips sit in the fold of the bed, not further forward.
4. Rest the arms on pillows and check that they are not twisted.
5. If they slide toward the feet, do not leave them like that: boost them toward the head of the bed (card B7) instead of pulling from above.

The problem

You have to change sides every 2 hours so the skin can rest, but turning someone by pulling badly hurts you both.

What is happening underneath

Turning is not flipping them over by force: it is rolling them as one unit, moving the shoulder and hip together, using the slide sheet. The force comes from your legs, not your back. It is almost always safer with two people.

Step by step

1. Raise the bed to the height of your hip and lock the wheels.
2. Lower the side rail on the side you are turning them toward; leave the one on the other side up.
3. Cross the person's arm and ankle toward the side they will turn to.
4. Take the slide sheet at the shoulder and the hip. Give warning, and on the count of three, roll the person toward you as one unit, without twisting their back.
5. Settle them tilted about 30 degrees with pillows (card B4). The caregiver: feet apart, knees bent, back straight.

The problem

Over the hours, the person slips toward the foot of the bed. The reflex is to boost them by pulling on the armpits, and that hurts their shoulders and your back.

What is happening underneath

You do not "lift" them, you slide them up with the sheet, while they push with their feet if they can. It is almost always with two people, one on each side. The skin is never dragged.

Step by step

1. Lower the head of the bed flat, if the person tolerates it. Raise the bed to your height and lock the wheels.
2. Take the pillow from under the head and place it against the headboard so they do not bump it.
3. Ask the person to bend their knees, plant their feet, and, if they can, lift their head a little.
4. Each caregiver takes the slide sheet at the shoulder and the hip. On the count of three, they slide them toward the head of the bed while the person pushes with their feet.
5. Do it in several short moves instead of one big one. Make sure the heels do not drag.

The problem

Sitting on the edge is the step before standing or moving to the chair, and it is where many people get dizzy or fall to one side.

What is happening underneath

The safe way is not to pull the person straight up from the front, but to roll them onto their side and use the weight of their legs coming down as a counterbalance to raise the trunk. Sitting up suddenly can drop the blood pressure and cause dizziness, so it is done slowly and with a pause.

Step by step

1. Turn the person onto their side, facing the edge where they will sit (card B6).
2. Pass one arm under their shoulders and the other over their knees or shins.
3. As you lower their legs off the bed, raise their trunk toward the side. The weight of the legs helps raise the body.
4. Leave them sitting with their feet flat on the floor and their hands at their sides. Stay in front, supporting them.
5. Wait a few seconds to make sure they are not dizzy before continuing. If they are going to stand or move to the chair, see the Transfers chapter.