Use of Different Types of Comfort/Support Devices

Definition
Comfort devices are mechanical invented articles which would add comfort to the patient
when used in appropriate manner and helping to maintain correct alignment or posture of
body.

General Requirement

Any position support device should meet the following requirements.

(1) Promote good posture and conform to the part of the body being supported.

(2) Be firm enough to support the part, yet not cause undue pressure.

(3) Be of sufficient size to support a part along its entire length.

(4) Be clean and protected against moisture and body secretions.

Remember

Do not use special devices (that is., splints, traction) unless ordered. Ask physician if you do not know
what is allowed.

1- Medical Sandbags are filled with sands, made of durable vinyl reinforced material.

Figure: sandbags with different

sizes and weight
 While sandbags are often assumed to contain only sand, but some contain ferrous pellets or iron
oxides that add weight to the sandbag without increasing its size. Therefore, must make sure
before using it especially in MRI diagnostic procedure.

Sr.# Purposes
1

To immobilize the body parts.

To support body parts.

To proper align the skeleton bones during image techniques.

4

To help the femoral artery heal (hemostasis) after cardiac catheterization procedure.

Articles Required

 Sand Bag

Procedure

Sr. STEPS RATIONALE

#

1 Identify the patient. Provide the therapeutic intervention to the

right patient.
2 Explain the procedure to the patient. Make mentally and physical motivate and
ready patient to adapt the procedure.

3 Choose the correct size and weight of sandbag. Maintain required body posture and Prevent
from musculoskeletal injury.
4 Wrap the sandbag with extra linen sheet. Prevent from direct skin friction and
irritation.
5 Ask Patient for any skin allergy to vinyl fabric? Should be Hypoallergenic.

6 Check for durability and seaming. Tear and damage can cause sand leakage.

7 Should be Infection-resistant material. Prevent & control pt from infection i.e.

antifungal & antibacterial.

8 Use only sandbags that are labeled with MR The magnetic field generated by an MRI unit
 Safe and made of Non-magnetic, non will attract ferromagnetic objects with
conductive raw materials. considerable force during diagnostic
procedure.

9 Should adjust the sandbag at accurate angle Provide effective support and prevent
and required part of the body. muscles from extra pressure and fatigue.

10 Should be Stain and moisture free. Maintain the skin integrity.

11 Assist the client in holding, handling and Prevent from muscular injury, sprain or
changing site of sandbag. strain.

12 Document the procedure, used device, initial To evaluate the nursing interventions and
observation and instructions given to patient. outcome.

2- Comfort Pillow has multiple uses, but placement in relation to body curves is essential.
They are available as standard traditional pillows used for sleeping in different positions
and ergonomic designed pillows used for special purposes.

Types of Comfort Pillows

 Standard sleeping Pillows
 Ergonomic Designed Pillows

A- Standard Sleeping Pillows are padded with cotton fibers, available in different sizes and
thickness and covered with linen pillow case.

Purposes
1- Use to provide comfort and support to the body during sleep.
2- To reduce or control the pain in different pressure areas of body while lying.
3- To prevent from bedsores while bridging the body with pillows.
4- To prevent from decubitus pressure ulcers in immobilized patients.

B- Ergonomic Designed Pillows are made of polyester, foam or combination of both. They
have highly designed contour features that provide ergonomic comfort to the specific parts
of the body in different postures while sitting or lying etc.
Purposes
 Each specifically designed pillow is used for the relevant part of the body to treat the
underlying causing problems.

Key points

 Pillows come in even greater varieties of materials, shapes and sizes. Choose a pillow that
supports the spine in a neutral position while laying on side or back.
 The head, neck and spine should always be alignment in whatever position they are sleeping
in (see figure below).

Figure: pillows size and thickness matter a lot

Types of Ergonomic Designed Pillows

(i) Neck pillows are usually “U” shapede specially modified used to support the neck by
providing a deep area for the head to rest and a supportive area to keep the neck in
alignment with the spine while sleeping. These can also be known as cervical pillows.
Purposes
 To provide support and comfort to the neck during sleep.
  To prevent from the complications of aged related degenerative diseases such as
cervical spondylosis, cervical stenosis, cervical radiculopathy or myelopathy etc.
 To prevent from sleep apnea and snoring during sleep.

Figure: Neck Pillow

Sr.# STEPS RATIONALE

1 Explain the purpose of procedure to patient To motivate the patient for execution of
therapeutic procedure.
2 Observe the patient position on bed during To turn every 2 hr body position and
past few hours. prevent from postural discomfort.
3 Collect the relevant history from patient such To perform the right intervention for
as neck pain, stiffness, past neck surgery, patient with prompt indications or
sleep disturbance, history of fall and contraindications and to minimize the
degenerative disease of vertebral column. underlying causing problem.
4 Perform neck ROM and assess the muscular To improve the neck muscle tone and
strength, flexibility and pain level. surrounding blood circulation.
To reduce the neck pain.
5 Ask or assist patient to lie down in bed, and To support the neck vertebra and muscles.
place neck in”U” shaped pillow while the
lobes of pillow should face forward /outward.
6 Make sure that the back of patient’s shoulders To align the cervical vertebra (neck) and
and head should touch the surface of mattress lower vertebral column (shoulder,
being lying thoracolumbar) all in neutral position.

7 Make sure neck pillow should support without To maintain the neutral spinal position.
head tilting forward or backward if patient is a
back sleeper dominant.
8 See neck is supported and nose should be in To maintain the neutral spinal position and
line with the center of body if patient is a side avoid from posture discomfort.
sleeper dominant.
9 Educate patient that give time to settle Ideally need neck muscles and vertebra 10-
himself while lying on bed in any desirable 15 minutes to relax and settle on pillow.
posture. 
10 Ask to stay in one position to see if that's best To change position frequently will reduce
for him. If not, move into a different position the postural discomfort.
until finds one in which your neck can relax.

11 Inform patient that consider the turning over To check and maintain the “Bottoming out”
pillow after every few weeks. quality of neck pillow and prevent from
sagging, denting to one side.

12 Counsel patient that give himself at least one To evaluate the nursing interventions and
week of sleeping on a neck pillow to figure out outcome.
as it is the right one for him. If the pillow still To refer the patient for further next level of
treatment such as chiropractor, orthopedic
isn't comfortable after a week then come for
surgeon or pharmacological management
the follow up physician advice. such as pain killer.

(ii) Wedge Pillow is a triangle-shaped pillow that gives a slope for placing the body in a
diagonal position. It can be used in an upright or downright position.

Purposes

1- Mainly used to relieve the symptoms of acid reflux and gastroesophageal reflux
disease (GERD) during sleep.
2- Used to support the shoulders in case of pain by shoulder frozen and rotator cuff
injury etc.

Figure: Wedge Pillow

(iii) Lumbar pillow half-moon shaped pillow used at the lower back.
Purposes

 To comfort and relieve back pain such as lumbago and sciatica pain.
 To keep a correct sitting-down position on chair.
 To support normal vertebral curvatures and prevent from lordosis or scoliosis
complications.

Figure: Lumbar Pillow

(iv) Air Filled Doughnut are either made of durable, puncture free rubber or synthetic
flannel, inflatable and doughnut shaped with a space in the middle to alleviate pressure
on the tailbone area while sitting.
 Purposes
 Distributes body weight evenly without putting pressure on the perineum to help
relieve pelvic, perineal, and anal pain.

Nursing Alert!

 Do not use a rubber air ring or any kind of doughnut for a longer period of time because they
can create a lot of unnecessary pressure where it is undesired and block the flow of blood to skin
inside the ring.
 They are not ergonomically fit for obese patient.

Point of Care

 Air may leak or inflatable ring can break any time. Therefore, check properly inflatable valve and
rubber before use for patient.
 Examine the perineum area of patient for any kind of pressure sores, skin erythema or bruises after
use.

(v)- Coccyx cushion is designed specifically for the tailbone, made of polyurethane memory
foam and cooling gel pad with a V or U shaped cutout at the back to relieve pressure on the
tailbone, spine and pelvic floor.

Purposes

 To provide comfort support to the pelvic floor and tail bone.

 To reduce the pain at tail bone also called coccydynia.
 To alleviate the underlying cause of pain produced by prostate disorder, pilonidal cyst,
hemorrhoids(piles) and degenerative bone diseases.
 Figure: U- Shaped Coccyx Cushion

Key Points

When place it on a chair or car seat, the “U” shape cutout should be facing the back because that’s
where coccyx will go. Also make sure that the cushion is placed in the center of whatever surface put
it on.  Ideally knees and hips should be at about 90-degree angles while seated. Use the coccyx
cushion in a chair with a back that will give you extra support. The cushion naturally helps improve
body posture by slightly elevating hips, and sitting in a chair with a back will help sit up straight and
eliminate pressure on spine and pelvis. The placement of the cushion on the seat can either be flat or
slightly slopping. This is most people’s preference.
Point of Care (POC)

Bridging Pillow Technique is the use of multiple pillows to support the pressure points area of body
especially to prevent bedsores in patients with paralysis, hemiplegia, paraplegia after stoke.
 When lying on your affected side, use 1 or 2 pillows for your head. Your affected shoulder
should be positioned comfortably. Place your unaffected leg forward on 1 or 2 pillows. Place
more pillows in front and behind you. This is an important position, as it increases awareness of
your affected side as you are lying on the bed. It also leaves your unaffected side available for
tasks.

Figure: Lying on Affected Side

 When lying on your unaffected side, use 1 or 2 pillows for your head. Your affected shoulder
should be forward with your arm supported on another pillow. Place your affected leg
backward on 1 or 2 more pillows. Place a pillow behind you. This position can let you practice
doing tasks with your affected side, if possible.

Figure: Lying on Unaffected Side

 (vi)- Hip Abduction Pillows are wedge-shaped sponge rubber with lateral indentations for
the patient’s thighs and straps that wrap around the thighs to maintain a proper position and
body alignment.

Figure: Abduction Pillow

Purpose

 It helps to prevent internal hip rotation after a femoral fracture, hip fracture or surgery.  
 It may also be used after surgery such as an open reduction and internal fixation (ORIF) or a
hip arthroplasty. Patient may need to use a hip abduction pillow for several weeks.

Articles Required

 Abduction pillow
 Hip Abduction Brace
 Extra Pillow (Head)

Procedure
Sr.# STEPS RATIONALE
1 Explain the proper procedure to the patient. Mentally, physically relax and ready the patient
for application of procedure.
2 Ask patient to lie flat/supine on bed. Legs are properly aligned.
3 Place the pillow between thighs. The Pillow Prevent the hip/legs from internal rotation.
 should touch each leg from thigh to ankles.
4 Attach the pillow to thighs and ankles. Full support to both legs from hip to the ankle.
5 Wrap the straps around thighs and ankles and Provide extra support to legs and prevent from
attach to the pillow. unnecessary outward/inward movement.
6 Tighten the straps to prevent legs from moving
outward.

Nursing Alert!

Encourage patients to avoid bending at the hip past 90°, twisting their leg in or out, and crossing their
legs. Hip precautions focus on limiting the internal rotation, external rotation, adduction, and flexion
of the hip .

(vii)- Hand Roll can be improvised by using a rolled washcloth that is secured with roller
gauze and an adhesive tape.

Figure: Hand Roll

Articles Required
 Guaze Roll
 Crepe Bandage
 Adhesive Tape

Purposes

1- These devices are used to prevent hand contractures and are available in hard and soft
materials.
Procedure

Sr.# STEPS RATIONALE

1 Explain the purpose of procedure to the patient. To build trust with the patient.
2 Examine the affected hand and wrist thoroughly. Check for muscular strength, ROM of hand,
finger’s capillary refill, bruises and swelling etc.
3 Clean the hand of patient and dry with towel if To prevent to hand from germ growth.
dirty.
4 Place the affected hand on a hard surface of To prevent fingers from hyper flexion,
table, pad the palm side of hand with guaze roll contracture and further rigidity.
and cover the hand roll with crepe bandage and
secure it with an adhesive tape finally.
5 Check and ask patient for any kind of pain and To prevent from suspected complications in
over tightness in hand, wrist and fingers etc. long term.
6 Document the initial observations related to Record of pre observations and post
procedure in the nursing notes. procedural outcome.

Nursing Alert!
Teach patient if any kind of complication such as dull pain, swelling, nails pinning, and poor
circulation occurs then must report to the physician.
(viii)- Bed Cradle is a frame of tubular metal whose lower frame slides underneath the
mattress, securing the cradle to the bed, while the upper frame is positioned horizontally over
the lower limbs.

Figure: Bed Cradle

Purposes

A bed cradle is a frame of metal that is installed at the foot of the bed to keep sheets/blankets
off legs/feet. This helps with air circulation, sensitive skin and keeping skin dry, especially if the
patient is lying in bed for long periods of time.

1- To help with air circulation to feet and to keep skin dry.

2- To prevent hyper sensitive skin from irritation, rubbing and itching of top linens or
blanket.
3- To create a room/space between the top linen and the skin surface for circulation of
warm or cold blowing air.
4- To prevent burn skin from further shearing and rubbing friction of top linens or blanket.

Articles Required

(1) Bed cradle, standard model or field (collapsible)

(2) Roller bandage

(3) Usual allowance of bed linen, plus one additional sheet and blanket.

Procedure
Sr.# STEPS RATIONALE
1 Explain the purpose of procedure to the patient. To establish a trust with the patient.

2 Examine the patient’s body skin for any kind of burn, To arrange the bed cradle with linens
allergy, hyper sensitivity, wound and pressure ulcers according to the need.
etc.
3 Place the cradle in position over the patient, with no To prevent the skin from irritation,
part in contact with a body part. Secure the cradle in itching and rubbing sensation.
place with bandage loops tied to the bed frame.
4 Place the top covers to provide adequate covering for
the shoulders, then drag these ends over the head-
end of the cradle.
5 Place the additional blanket and covering sheet To maintain the normal body
crosswise over the cradle, overlapping the top covers temperature.
with the surplus toward the foot of the bed.
6 Tuck the surplus edges of the cradle covering under To prevent body skin from the friction
the foot of the mattress. Miter corners, arranging the of bottom sheet.
top folds to hang free. Fold back the overlapped
covers as required for access to the body part
protected by the cradle.
7 Document procedure, device used, condition of To evaluate the outcome of nursing
patient’ skin, comfort level, body posture and interventions.
instructions given to patient.
(ix)- Footboards also called foot rest are usually made up of wood. A padded board, a firm
pillow, or a blanket roll is braced between the end of the bed and the patient’s feet.

Figure: plantar flexion without foot board support

Purposes

1- Use to prevent plantar flexion. Extended periods of plantar flexion can lead to foot drop.
2- To maintain the normal position of feet.
3-  To promote comfort.
4-  To prevent foot drop.

Figure: A padded footboard is placed at the foot of the bed

Articles Required

 Footboard
 Bath Towel
 Procedure

Sr.# STEPS RATIONALE

1 Explain the purpose of procedure to the patient. To make ready patient mentally and
physically adaptable to the procedure.
2 Observe the patient position during the past hours. Position should be changed every 2 hr to
prevent from discomfort.
3 Examine the alignment of both feet on bed. The feet normal angle should be at
perpendicular (90 0) to legs or dorsi flexed.
4 Collect history of patient any foot dystrophy, pain, To provide the comfort support device with
past surgery, history of fall, abnormal gait etc. proper need.
To prevent from risk of fall.
5 If patient is unable to place feet in dorsi flexion or To prevent from plantar flexion.
plantar flexion is continuous then provide a foot
board.
6 Cover footboard with a bath blanket. To protect feet and heel from rough
surfaces and friction.
7 Place footboard on bed in a place where client’s To prevent body torso from sliding down in
feet can firmly rest on it. bed.
8 Observe legs to ensure that they are not in a flexed To maintain the proper alignment of leg
position when feet are against the board. and feet.
9 Tuck top linen under mattress at foot of bed, and
bring linen up over the footboard to the top of the
bed. Do not drape top linen over footboard as it
can easily be pulled off the bed.
10 Put feet and ankles through range-of-motion To improve blood circulation in the lower
exercises every 4 hours for clients on prolonged limbs.
bed rest. To increase the muscular strength, tone and
tensile.
11 Observe heels and ankles frequently for signs of
Break down.
12 Place pillow under client’s calves (not under heels) To prevent feet from progressive pressure
allowing heels to be off mattress if skin breakdown sore.
is assessed.
13 Document procedure, device used, condition of To evaluate the outcome of nursing
patient’ skin, comfort level, body posture and interventions.
instructions given to patient.

Note:
Clients are encouraged to wear high-top sneakers while on bed rest, along with the footboard.
 (x)- Trochanter Roll is a wedge usually made of a rolled towel/blanket, placed from the crest
of the ilium to mid thigh to prevent external rotation of the hip when the patient is in a
recumbent position.

Figure: Trochanter Roll

Purposes

1. To keep a patient’s hips/legs properly aligned when the body is unable to support itself
without causing further injury.
2. To use in situations where a patient is receiving surgery or becomes immobilized due to
an injury.
3. To use for individuals that are dealing with muscle weakness, hip dislocation or
paralysis.
4. To alleviate the pain level in comfort position such as greater trochanter pain syndrome.

Articles Required

 Bath blanket
 Towel Roll(optional)

Procedure

Sr.# STEPS RATIONALE

1 Explain the purpose of procedure to patient. To make patient compliance with the
steps of procedure.
2 Collect history of patient any lower limbs pain, weakness, To provide the comfort support
past surgery, history of fall, hip fracture, hip dislocation device with proper need.
and abnormal gait etc. To prevent from risk of fall.
3 Place folded bath blanket on both sides of patient’s hip
while lying supine on bed.
4 Extend blanket from greater trochanter to thigh or knee. To prevent external rotation of the
head of the femur in the acetabulum.
5 Place blanket edge under legs and buttocks to anchor.
6 Roll bath blanket toward client by rolling it under.
7 Allow affected leg to rest against trochanter roll. Hip To prevent from muscular or
should be in normal alignment, not internally or externally ligament injury further.
rotated.
8 Hip should be in normal alignment, not internally or To prevent the surrounding
externally rotated. Patella should be facing upward if ligaments, blood vessels, muscles and
client in supine position. nerves from torsion damage.
9 The arms rest alongside the body. They can also rest on To provide fully body comfortable
the chest or stomach.  Also, make sure the neck and head position.
are properly supported
10 Document the patient’s chief complain, initial To evaluate the nursing interventions
observations, device used, lower limbs mobility, and outcome.
instructions given to patient at end.

Nursing Alert!

Instruct the patient not to move the legs across or move outward during lying.