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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

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.

Logrolling the Resident

Logrolling is a technique used to roll a resident onto their side without the resident helping, and while keeping the resident’s spine in a straight line. This is especially important for residents who have had spinal surgery or injury.

Feeding the Patient

Not all patients will need help feeding themselves. Some patients will only need assistance opening cartons or cutting their food. To promote independence, always let the patient do as much as he or she can before assisting. It is vitally important that the nurse’s aide verifies that the patient receives the correct meal tray. Patients may have special diets that play a critical role in their health (i.e., pureed diet, gluten-free diet, food allergies, etc.). Feeding the wrong food to the wrong patient could result in serious complications.

Perineal Care of the Male Resident

Perineal care should be performed during a bath, after using the bedpan, and/or after incontinence. Special care should be used when performing perineal care on an uncircumcised male. Failure to retract and wash the area under the foreskin can result in infection. Failure to return the foreskin to its normal position can result in paraphimosis.

Tympanic Membrane Temperature with Electronic Thermometer

A tympanic membrane thermometer uses an infrared sensor to measure the temperature of the tympanic membrane (ear drum). This type of thermometer is considered an accurate and reliable predictor of a patient’s core temperature because the tympanic membrane’s blood supply is sourced from the carotid artery, which is the same artery that carries blood to the hypothalamus in the brain.

Putting on Personal Protective Equipment

Personal protective equipment is worn to protect the mouth, nose, eyes, clothing, and skin from unwanted pathogens. In the health care setting, a patient’s condition often prompts the use of personal protective equipment; however, a health care worker is able to wear personal protective equipment whenever he or she deems it is necessary (e.g., during procedures with the potential for excessive contact with bodily fluids).

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