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Sim’s Position

Written by Amanda R. McDaniel, MS, BSN, RN
Amanda is a BSN/RN with a MS in Physiology and a BA in English. She worked as a medical writer in the pharmaceutical industry for 11 years before pursuing a career in nursing. She now works as a nurse on a NeuroTelemetry unit and continues to write and edit on a freelance basis. Amanda’s LinkedIn

The position a patient is placed in is often ordered by the physician, or recommended by a speech, occupational, or physical therapist. The position dictates whether a patient is sitting, lying, standing; or if they are on their side, back, or prone (face-down). Positioning is also determined by the patient’s current needs, such as: Are they eating? Sleeping? Having surgery on their back? Are they receiving nutrition through a nasogastric tube?

Equally important to correct positioning is correct body alignment. Correct alignment prevents undue strain on any joints, bones, muscles, tendons, or ligaments. It also helps prevent pressure ulcers in patients who have limited mobility. For proper body alignment:

  • The head, neck, and spine should be in a straight line.
  • The hips should be in line with the back.
  • The arms and legs should be relaxed.

Sim’s position is comfortable for patients when they wish to sleep or relax while lying on their stomachs.

Achieving Sim’s Position

  1. Start with the patient lying supine (flat on their back) with the body in proper alignment.
  2. Stand on the side of the bed opposite the direction the patient will be facing and raise the bed to a comfortable working height. Lower the side rail. Move first the upper trunk (shoulders and chest), then the lower trunk (abdomen and hips) toward you. A draw sheet can be used for this movement. Raise the side rail.
  3. Walk to the other side of the bed (the one the patient will be facing). Lower the side rail.
  4. Bend the patient’s knee that will be on top once the patient is on their side.
  5. On the side that will be on top (away from the mattress), place one hand on the patient’s shoulder and the other hand on the hip and roll the patient toward you until they are lying partially on their abdomen.
  6. Slide the patient’s lower shoulder until it is not under the patient and move the lower arm to the patient’s side.
  7. Place a pillow under the patient’s head to maintain proper alignment.
  8. The patient’s upper arm should be slightly flexed with a pillow supporting it in line with that shoulder.
  9. Place a pillow behind the patient’s back to help them stay in position.
  10. Place a pillow under the slightly bent upper leg to maintain alignment with the hip.
  11. Ask the patient if they are comfortable. Make adjustments as necessary.
  12. Lower the bed back to the lowest position.
  13. Document the position per institutional or unit policy. Report any difficulty getting the patient into position, or maintaining position to the nurse per policy.

References

Activity and mobility. (2014). In A. G. Perry, P. A. Potter, and W. R. Ostendorf (Eds), Clinical nursing skills & techniques (8th ed., pp. 210-216). St. Louis, MO: Mosby Elsevier.

More Resources

Orthopneic Position

Patients with respiratory illnesses such as chronic obstructive pulmonary disease (COPD) find ways to help themselves breathe more easily. This can include sleeping with extra pillows to keep them propped up or leaning forward to ease the work of breathing. The orthopneic position is one forward-leaning position used to help patients breathe comfortably when they are having difficulty.

person wearing orange and white silicone band

Applying Restraints

Restraints have very strict guidelines for use due to the number of complications that can result. Use of restraints is associated with increased physical and psychosocial health issues. Restraints are only considered necessary when restraint-free alternatives have failed and the patient or others are at risk of harm without the restraints. It is illegal to use restraints for the staff’s convenience or to punish the patient.

Axillary Temperature with Electronic Thermometer

Compared to other temperature measurement methods, the axillary measurement is considered the least reliable. An axillary temperature measurement typically reads 0.5 to 1 degree Fahrenheit lower than an oral temperature reading [1]. For this reason, it is recommended to use this method only when other methods are contraindicated or when taking an axillary temperature is the safest method for the patient.

Measuring and Recording Output from a Urinary Drainage Bag

Accurate measurement of urination (aka, the output portion of intake and output) allows medical personnel to assess kidney and bladder function. Changes in output quantity or quality can reflect health status changes including new-onset infection or renal injury.

Moving the Resident to the Side of the Bed

Residents are usually kept in the center of the bed for safety reasons. However, moving a resident to the side of the bed is an important step to take before turning a resident onto his or her side. Performing this action allows the resident to end up side lying in the center of the bed and not smashed up against the side rail.

Making an Occupied Bed

If a patient is bedridden or on bedrest, the bed linens will need to be changed while the patient is in the bed. For safety reasons, the nurse’s aid should avoid making an occupied bed if the patient is able to get out of bed. Bed linens should be changed according to the facility’s policy or anytime they are wet or soiled.

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