0811-1446-777 
The lying position of a patient is a critical aspect that must be carefully considered during the care process. There are various types of patient lying positions.
To select the most appropriate position for a patient, several factors need to be considered, such as age, weight, and past medical history, including respiratory or circulatory disorders.
One type of patient lying position is the Fowler position. Let’s explore the definition, purpose, benefits, and variations of the Fowler position below.
What is the Fowler Position?
The Fowler position is a position where the patient is placed in a semi-sitting position on a bed that is partially raised, typically between 45 to 60 degrees. This position is commonly used for patients to rest comfortably, whether in inpatient wards or emergency units.
This position is also usually used for neurosurgery and shoulder surgery. Additionally, the Fowler position is employed for patients experiencing breathing difficulties, as this position allows gravity to pull the diaphragm downward, facilitating greater chest and lung expansion.
When is the Fowler Position Used?
The purpose of using this position can vary depending on its type. Based on the degree of inclination, the Fowler position is divided into standard, high, and semi-Fowler positions. Each of these variations is used in different circumstances according to its purpose, such as:
- The standard position is usually used for head, shoulder, and chest surgeries, as well as for patients with respiratory distress syndrome.
- The high position is often used after abdominal or lung surgery when fluid drainage into a container is required, when the patient is about to eat, or during an X-ray examination.
- The semi-Fowler position is used when someone has difficulty breathing, is using a feeding tube, is experiencing gastroesophageal reflux disease (GERD), or is in labor.
Variations of the Fowler Position
The Fowler position has three variations based on the angle of the bed used for the patient to lie down and sit at the same time. Here are the definitions, purposes, and steps to perform each variation.
Also Read: Home Personal Care for You
Standard Fowler Position
The standard Fowler position, also known as the sitting position, has a bed angle between 45 and 60 degrees at the head section. In this position, the patient can have their knees straight or slightly bent.
In addition to the uses mentioned above for head, shoulder, and chest surgeries, this position is frequently used to manage respiratory distress syndrome. Due to the angle of the bed, the standard Fowler position allows better chest expansion, thus improving breathing by facilitating oxygenation.
Other benefits of this position include improved drainage of blood and cerebrospinal fluid, as well as enhanced hemostasis, the body’s natural mechanism for maintaining blood circulation.
High Fowler Position
The high Fowler position, also known as the full Fowler, is a supine position where the patient lies on their back with the head of the bed elevated to 60 to 90 degrees, and the legs can be positioned straight or bent at the knees. For comfort, a pillow can be placed under the calves for support.
This position is recommended for post-operative management, patient feeding, bedside X-ray examinations, and during respiratory therapy.
Moreover, this position is usually used for elderly patients as it helps facilitate digestion and assists patients in managing respiratory issues. However, prolonged rest in the high Fowler position can lead to discomfort and increase the risk of developing pressure ulcers.
Semi-Fowler Position
The semi-Fowler position, or low Fowler’s, is a supine position where a person lies on a bed with the head of the bed elevated at an angle of 30-45 degrees. Like the other positions, the patient’s legs can be positioned straight or bent at the knees.
This position is commonly used when a patient is having difficulty breathing or undergoing respiratory therapy, is undergoing drainage after an abdominoplasty procedure, is fitted with a feeding tube, or is a mother in labor.
This position is also applied to patients experiencing gastroesophageal reflux disease (GERD) as it can reduce nausea compared to lying flat.
Contraindications for the Fowler Position
There are several conditions where the use of this position is contraindicated. One such condition is anatomical exposure during surgical procedures.
If a patient cannot tolerate sitting well, such as those with pressure ulcers on the lower back or buttocks, position adjustments are necessary. For example, reducing pressure and contact between the injured area and hard surfaces can be done using extra padding, angle adjustments, or tilting to relieve pressure on the lateral injured areas.
Additionally, this position is not recommended for patients who have undergone spinal surgery as they may have limited range of motion. Doctors or nurses must assess the patient’s ability to tolerate this position and any other intrinsic factors that may pose additional risks to the patient.
Important Considerations When Using the Fowler Position
Here are some important considerations when using the Fowler position:
- This position can be practiced in various ways other than using a bed. For example, using the original parts of a general surgical table or by adding surgical table accessories and positioning aids.
- Surgical table accessories and positioning aids can be used when applying the Fowler position, such as positioning beach chairs or foam body positioners. Beach chairs are often used for nose surgeries, abdominoplasty, and breast reduction surgery.
- When positioning the patient in the Fowler position, healthcare providers must minimize the elevation degree of the patient’s head and always keep the head in a neutral position. The patient’s arms should be flexed and secured along the body, the buttocks should be cushioned, and the knees positioned at an angle of about 30 degrees.
- In the Fowler position, patients are at high risk of developing air embolism, skin injuries due to friction and shear, and blood clots in the veins of the lower limbs.
- In this position, patients have an increased risk of pressure on the shoulder blades, sacrum, tailbone, ischium (part of the pelvic bone), the back of the knees, and heels.
Always communicate with the healthcare professionals managing your condition about anything you are experiencing so that they can determine the most appropriate lying position for you.
If you need home care assistance, Kavacare’s trusted medical staff are ready to help. Contact us at 0811-1446-777 to receive home care services from trusted and experienced professional nurses.
Sources:
- Anatomy, Patient Positioning – StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK513320/
- Semi-Fowler Position: What Is It, Difference from Fowler, and More | Osmosis. https://www.osmosis.org/answers/semi-fowler-position.
- High Fowler Position: What Is It, Its Uses, and How It Helps Breathing | Osmosis. https://www.osmosis.org/answers/high-fowler-position.
- Fowler’s Position Guide | STERIS. https://www.steris.com/healthcare/knowledge-center/surgical-equipment/fowlers-position-guide.
