Nursing & Healthcare Programs

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

Applying Elastic Support Hose

Elastic stockings are worn to prevent deep vein thrombosis (DVT) and reduce the pooling of blood in vessels. Many hospitals and care facilities use elastic stockings in patients with reduced mobility, such as surgical patients and/or the elderly. There are a few risks in wearing elastic stockings; however, these risks can be prevented with proper application and care.

Applying a Condom Catheter

Condom catheters are used for men who are incontinent. These catheters are external and are meant to be used short-term and changed daily.

Removing Personal Protective Equipment

It is important to follow the correct procedure while removing personal protective equipment to avoid contaminating your skin or clothing. The most common source of contamination in this process stems from improper removal of gloves. Gloves are often the most soiled piece of equipment. To avoid contaminating your skin or the other equipment worn, gloves should always be removed first. Then remove the goggles, gown, and mask, in that order.

Collecting a Stool Specimen

Stool specimens are collected to test for a variety of disorders from colon cancer to parasites. While it is not the most pleasant job, it is important that the collection is done correctly for accurate results.

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.

Offering the Bedpan

When a resident is bed-bound, they must use a bedpan to urinate and defecate. This can be embarrassing for the resident, so it should be done with sensitivity to the resident’s privacy and dignity. There are two types of bedpans. A regular bedpan is the deeper and more rounded of the two. A fracture pan has a relatively flat upper end with a trough at the lower end. Fracture pans are used for residents who have difficulty, or restrictions against, moving their hips and/or backs.