Long-Term Care

Trainer’s tip: Good chair positioning begins with the feet!

LTC Nursing Assistant Trainer, November 17, 2011

Most nurses are surprised to learn that good chair positioning is determined by the placement of the feet. Sliding occurs when the feet:

  • Are dangling
  • Are not properly supported
  • Slip off the footrests

Sliding causes pressure on the spine, scapula, hips, and elbows. It is a primary cause of skin damage and shearing. After the resident has been transferred into the chair, the first step is to stabilize the feet. To accomplish this, you may have to adjust the leg rest length, seat the resident on a low profile cushion, or use a footrest extender/elevator cushion. The feet should be positioned so the knees are lower than the hips. If the knees are higher, the leg rests need to be lengthened, or the resident needs a wheelchair with a higher seat. If the feet dangle, shorten the leg rests or add a footrest elevator to the chair.

By beginning with the feet and using the 90-90-90 position, the body will be supported in good alignment, improving structural function and reducing discomfort. This will also reduce the need for restraints and redistribute pressure, reducing the risk of skin breakdown.

This is an excerpt from the HCPro book, The Long-Term Care Nursing Desk Reference, Second Edition, by Barbara Acello, MS, RN.

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