Palliative Positioning in Hospice Care

palliative positioning

By Cindy Spence

Tips for Getting Clients Comfortable in Bed at the End of Life

Palliative positioning has the power to reduce a pain score dramatically, and it’s a skill that anyone can learn. As a massage therapist working in hospice care, I’ve learned that most of what I do to help people is very simple. It starts with taking the work out of lying down.

Tip #1. Start by noticing whether your client looks comfortable. If a client is verbal, of course, we can ask about their comfort, though people will often say they are “fine” when observation suggests otherwise. My assessment of comfort includes nonverbal signs of effort or strain, including facial expression, respirations faster than 20 per minute, and fidgeting.

Tip #2. Check the hips. Clients often slip toward the foot of the bed, causing the bend of the bed to occur in the middle of the spine. If this is the case, have the client scoot toward the head of the bed if they’re able, so that the hips are aligned with the bend. Seek help from family or care staff as needed.

Tip #3. If you suspect the client is still not comfortable, invite them to try something different. My script for this: “I’m noticing X, would you be willing to try Y to see if we can get you more comfortable?” The X might be “I’m noticing that your arms don’t have a place to rest,” and the Y might be “Would you be willing to try pillows under your arms to see if you like that better?”

I place the items, and then I ask, “Is this better or worse?” Keeping our language neutral allows each client to be the expert in his or her own comfort. If the client is nonverbal, I use this same script, watching for nonverbal indications of improvement (softening of the face, slowed respirations, stillness of the body).

Tip #4. Use available materials to fill empty space. Every body part should have a soft surface to rest on. Dangling arms are often more comfortable with a pillow under each elbow. The knees, ankles and low back may feel better with a pillow under each leg.

I use pillows of different sizes, borrowing small decorative pillows when needed (these can be covered in a pillowcase for protection). Towels can be folded or rolled to create padding that is customized to size, and rolled washcloths can fill tiny spaces such as the back of the neck or curve of the fingers.

Tip #5. Stay open to learning as you improve your palliative positioning skills. I am constantly learning new tricks from clients, family caregivers, home health aides, restorative yoga teachers, and other massage therapists. Chapter 4 of Palliative Touch: Massage for People at the End of Life describes palliative positioning for people in recliners, wheelchairs, hospital beds, and other furniture. Visit www.finaltouchtraining.com for more information.

Author

Cindy Spence and Susan Gee teach Palliative Massage for People at the End of Life, a three-day course for massage therapists, end-of-life doulas, and other healthcare professionals. Last year, Cindy conducted a very informative webinar for Lifespan Doulas on Comfort Massage at End of Life. Check it out to get a flavor of her teaching.

Photo copyright Final Touch Training © 2024

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Patty Brennan

Patty is the owner and visionary force behind Lifespan Doulas. For 40+ years, she has been a doula, midwife, educator, author, nonprofit executive, and entrepreneur. Patty has personally trained over 3,000 people to become doulas. She is the author of The Doula Business Guide: How to Succeed as a Birth, Postpartum or End-of-Life Doula, 4th Edition, and accompanying Workbook.