Storage (care)

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In nursing and medicine, the targeted positioning of a person in need of care or a patient in a specific, favorable posture is referred to as positioning (also patient positioning or position support ) . The aim of the positioning can differ, but it is usually used to relieve pressure and avoid consequential damage, support therapeutic measures , relieve pain or is part of a specific medical treatment or first aid measure.

term

In professional care, the term “storage” is controversial, as it is perceived passively from the perspective of the person being cared for and does not support the person in need of care to actively participate in the change in situation. Newer publications, for example the expert standard pressure ulcer prophylaxis , therefore use the term “position support” or “position support measures”.

Storage types

Breath-relieving positions

For those in need of care who have difficulty breathing, positions are used that specifically ventilate individual sections of the lungs or generally make breathing easier. At the same time, these positions are part of the prophylaxis for pneumonia and atelectasis . The simplest positioning in this area is the upper body elevation , which at the same time prevents aspiration , other positions are the so-called VATI positions (V- / A- / T- / I-position), the torsional stretch position, crescent position and the coachman's seat . In intensive care, the complete and incomplete prone position is often carried out, which means that bronchial secretions can flow better and the dorsobasal lung sections are better ventilated. For secretion loosening are drainage bearings, for example, applied the angioneurotic hanging position. The breathing situation is either assessed by nursing staff as part of the nursing diagnosis and the necessary positioning is planned or is carried out on a doctor's order. The implementation is carried out by nursing staff.

Pressure relief positions

A focus of applied positioning is the pressure relief and the prophylaxis of pressure sores and the relief of already existing skin lesions, which arise from a lack of movement of the person in need of care. Applied positions are, for example, the 30 ° side position, 5-cushion hollow position, position on the inclined plane and the 135 ° position, and in the case of particular danger also soft or super-soft position on anti-decubitus or alternating pressure mattresses. The hazardous situation is recorded by nursing staff as part of the nursing history and the measures to relieve pressure are planned. As a rule of thumb, a storage interval of two hours applies, but the storage frequency can be increased or decreased as required. The implementation is carried out by nursing staff or can be delegated to nursing assistants or nursing assistants .

Micro storage

Micro-positioning mimics the physiological movement pattern of healthy people who perform up to 40 micro-movements per hour. The method is used as one of several interventions in the context of pressure ulcer prophylaxis. For example, a small pillow (or a folded towel) is pushed from the side under the hip joint and then changed to another part of the body (e.g. the shoulder) after about 15 minutes. In this way it is possible to bring about the smallest changes in position and thus a slight, selective pressure reduction in a sleeping person without waking him up. This method is also suitable for patients who react to major changes in position with severe discomfort or expressions of pain.

Contraction prophylactic positioning

Relief and painful postures as well as incorrect positioning, various underlying diseases or sedative therapies for individual limbs can result in flexion or extension contractures in the person in need of care . These should be avoided by positioning in the physiological middle position , positioning the adductor contracture and using a bed arch to prevent equinus foot prophylaxis. In particular, attention to the alternating flexion and extension of the various joints when performing the positioning and avoiding factors that trigger spasticity can prevent position-related contractures. Planning and implementation is the responsibility of the nursing staff, in some cases special positioning techniques are necessary for special illnesses, for example positioning according to Bobath or tetraplegic positioning . In the case of immobilization such as positioning splints, plaster casts or extensions, physiotherapeutic measures are usually necessary; positioning is carried out on the order of the doctor.

First aid bearings

Stable side position

Bearings are used in the context of emergency life-saving measures in first aid. These positions include the stable lateral position , the shock position (Trendelenburg position) and the upper body position.

Surgical positioning

→ Main article: Surgical positioning

Surgical positions are used to ensure the surgeon the best possible access to the operating area during an operation and at the same time to avoid positional damage such as pressure sores or contractures of the patient by using suitable positions and positioning aids. To the operation bearings include for example the lithotomy position , the lateral position, the anti-Trendelenburg position, the Jackson-storage, Killian storage, Overholt storage and prone position. These positions are carried out by a specialist nurse in the operation department or by a specialist for operation positions on the order of the surgeon . The anesthetist is responsible for positioning the arms and head .

Therapeutic positions

Positioning can be used to support therapeutic measures, for example to relieve a wound area after surgery , to support the drainage of secretion, to achieve pain relief or to enable a diagnostic or therapeutic intervention.

These overlays the lateral positioning the infant with include plagiocephaly , the ventilation in the prone position , the Douglas storage (Beck depth storage), the storage drain according gable, storage at thoracic drainage , Lungenresektionslagerung, Cardiac storage, extension bearings Nestchenlagerung, storage in the slide bed or stages bed as well as storage for Insertion of a nasogastric tube and positioning for bone marrow aspiration. These types of storage are carried out by nurses on medical order.

Storage aids

All aids used for position support are referred to as positioning aids . Various criteria are taken into account when making the selection. On the one hand, the aids introduced should be user-friendly from the point of view of the well-groomed, that is, they should be comfortable, skin-friendly, pressure-relieving and low-noise, as well as wick away moisture and ensure air circulation. On the other hand, the aids should meet the needs of care workers, that is, they should be easy to handle or operate, be easy to control and, in the case of technical aids, have easy-to-reach customer service. They have to meet hygienic requirements; Reusable materials must be boil-proof, disinfectable or sterilizable. Another aspect is economic efficiency: low purchase prices, compatibility with existing aids, durable materials and easy disposal all play a role.

Typical positioning aids are, for example, microfiber pillows, polystyrene pillows in various sizes, U-pillows (nursing pillows), blankets, plastic-coated foam wedges, blocks and rolls. Towels and small pillows can be used for micro and hollow storage. There are also special storage aids such as gel cushions and pads. For those in need of care who are particularly at risk and who are mostly bedridden, special mattresses are used for soft and super-soft positioning, for example perforated mattresses, anti-decubitus mattresses or alternating pressure mattresses. Air or water-filled seat rings, perforated pads, skins made of synthetic materials and various heel and elbow pads are not recommended by the National Expert Standard on Pressure Ulcer Prevention in Care .

literature

  • German network for quality development in nursing (ed.): Expert standard pressure ulcer prophylaxis in nursing . 2. Update including commentary and literature review. German Network for Quality Development in Nursing, Osnabrück 2017, ISBN 978-3-00-009033-2 .
  • Waltraud Steigele: Movement, mobilization and positioning in nursing. Practical tips for movement exercises and changing positions. Springer-Verlag, Berlin / Heidelberg 2016, ISBN 978-3-662-47270-5 .

Individual evidence

  1. ^ Roche Lexicon Medicine . 5th edition. Elsevier, Urban & FischerVerlag, 2003, ISBN 3-437-15150-9 , pp. 1068 , col. 1 .
  2. ↑ Heike Lubatsch: Pressure Ulcer Management on the basis of the National expert standards . Schlütersche, 2004, ISBN 3-89993-121-1 , 7. The 2nd criterion of the expert standard, p. 143-144 .
  3. ↑ Martina Lauster, Anna-Marie Seitz, Anke Drescher, Karin Kühnel, Nicole Menche (eds.): Pflege Heute: Textbook for nurses . 7th edition. Elsevier GmbH, Germany, Munich 2019, ISBN 978-3-437-26778-9 , pp. 48 .
  4. ↑ Mechthild Seel, Elke Hurling: The care of people in old age: Resource-oriented support according to the AEDL . Schlütersche, 2005, ISBN 3-89993-419-9 , 3.2.6 Nursing measures to support breathing and to prevent pneumonia and atelectasis, p. 232-236 .
  5. ↑ Kerstin Menker: Nursing theory and practice . 2nd Edition. Elsevier, Urban & FischerVerlag, 2006, ISBN 3-437-47930-X , 7.5.2 Nursing therapy, p. 383-392 .
  6. ↑ Nursing Science Tips on dekubitus.de ; accessed on December 21, 2018
  7. ^ Ina Pfitzer, Maren Asmussen-Clausen : Care techniques today: Understanding care activities step by step . Ed .: Ina Pfitzer. Elsevier, Urban & FischerVerlag, 2006, ISBN 3-437-27090-7 , 37.1 Contracture prophylaxis , p. 331-364 .
  8. ^ Ina Pfitzer, Maren Asmussen-Clausen: First aid in nursing: based on the first aid guidelines of the DRK and taking into account the recommendations of the German advisory board for first aid and resuscitation at the German Medical Association . Ed .: Ina Pfitzer. 4th edition. Elsevier, Urban & FischerVerlag, 1996, ISBN 3-87706-449-3 , 9. Positioning of injured persons, p. 102-104 .
  9. ↑ a b Mechthild Seel: The care of people . Schlütersche, 2003, ISBN 3-87706-996-7 , 4.4.6.2 Storage aids, p. 354-355 .