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Fowler’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

Fowler’s position is used when a patient is eating, is having difficulty breathing, or is ordered by a doctor. This position is easily recognized because the patient will be sitting äóìstraight up.äó Semi-Fowlers is sitting äóìhalf-way up,äó and is used when patients cannot be laid flat, but wishes to be in a more relaxed position than Fowler’s. This position is often used for patients who are receiving feedings from a nasogastric tube to prevent aspiration while they sleep.

Achieving Fowler’s Position (aka, High Fowler’s)

  1. Start with the patient lying supine (flat on their back) with the body in proper alignment.
  2. Gently raise the head of the bed to 90 degrees.
  3. Place a small pillow behind the patient’s head and one at the lower back. These are not to make the patient lean forward, but to help support and keep the body aligned.
  4. Place a small pillow under the thighs. Place pillows lengthwise under the calves, but leave the heels unsupported. This helps prevent pressure injury to the heels.
  5. If the patient has difficulty moving their hands or arms, support the hands and arms with pillows.
  6. Ask the patient if they are comfortable. Make adjustments as necessary.
  7. Document the position per institutional or unit policy. Report any difficulty getting the patient into position or maintaining position to the nurse per policy.

Achieving Semi-Fowler’s Position

  1. Start by ensuring the patient has proper body alignment.
  2. Gently adjust the head of the bed to 45 to 60 degrees.
  3. Follow steps three through seven above.

References

Activity and mobility. (2014). In A. G. Perry, P. A. Potter, and W. R. Ostendorf (Eds), Clinical nursing skills & techniques (8th ed., pp. 210-213). St. Louis, MO: Mosby Elsevier.

More Resources

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.

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.

Using a Gait / Transfer Belt to Assist the Resident to Ambulate

Walking (aka, ambulating) helps residents maintain mobility and independence, and prevents complications. However, ambulation must be done safely so that the resident does not have a fall or injury. A gait or transfer belt, when properly used, can increase resident safety. Gait belts can vary between facilities, so make sure you know how to use the one in your facility.

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.

Performing Ostomy Care

Residents who have had a portion of their intestines removed due to illness or trauma may have a temporary or permanent ostomy, which is an opening in the abdomen that is created for the elimination of urine or feces. The portion of the intestine that is connected to the abdominal wall and is visible is called the stoma. A pouch is placed over the stoma to collect feces.

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.

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