Posture and positioning for wellbeing

Postural support is critical to maintaining physical health, safety and comfort. This is especially pertinent to people who have underlying respiratory, digestive or musculoskeletal conditions, or eating, drinking or swallowing difficulties. Posture and positioning can also have an impact on the way that we feel and on our emotional wellbeing. For example, ‘shoulders back and stand tall’ is a well-known stance that can give an instant boost to self-esteem. We may not always be consciously aware of the impact our posture has on our emotions and on how connected we feel to what is going on around us.

Do we consider where and how we position people who are reliant on us to determine where they are to sit, lay or stand for the purposes of their emotional wellbeing as well as their physical needs?

This guidance will help you to discover ways in which you can become more consciously aware of the importance of posture and positioning for emotional wellbeing, and what actions you can take to assist in providing optimum positioning and posture for emotional health.

What you need

An awareness of postural care for maintaining and preserving body shape and muscle tone.
An awareness of any physical conditions or difficulties the person you are supporting may have. For example, does the person have a respiratory condition that affects their breathing, and so need to be in an upright position for maximum air flow capacity, or any external equipment that you need to be aware of (enteral feeding site, indwelling catheter etc).
An awareness of optimal positioning to prevent or manage reflux, aid safe swallowing and good digestion.
An awareness of any sensory difficulties such as visual, hearing or sensory processing difficulties (e.g. sensitivity to light, sounds, loud noise).
A willingness to observe and tune into how the person communicates comfort or discomfort.
A willingness to reflect on positive or negative responses so as to inform future support.

Guidance and instructions

Firstly, to better appreciate the impact of posture on feelings, you are invited to try this short exercise yourself.

Hunch over, rounding your shoulders over and drop your chin to your chest so that you are looking down towards your lap if sitting or to your feet if standing. Take a moment to notice how you feel. Then, when you are ready slowly, straighten up, sit or stand tall, lift your chest and your chin and slightly pull back your shoulders, without exerting any force or doing anything that is uncomfortable. Lift your head slightly and allow your gaze to look outwards. Now notice how you feel.

Most people will report that they feel more confident, more optimistic, more alert and more positive in this posture compared to that of being rounded over.

Some postures and positions and their associations with feelings

Being collapsed or slouched over – associated with depression and more negative thoughts.
Foetal position – associated with comfort, self-protection and self-soothing.
Being upright with head up – can instil feelings of confidence, self-worth and presence.
Lying down on back – can be a relaxing position, but may also be a vulnerable position, depending on how safe and secure a person feels and on their head position. If the head is facing the ceiling, then there is decreased ability to see what is going on in the environment. Lying on the floor, or low-level plinth may also make a person feel vulnerable.
Back to door – not knowing who is entering and increased risk of becoming startled or surprised. May also give a feeling of exclusion if others are looking towards the door when somebody enters.
Facing the door – sense of calm and expectancy, can see who is entering and approaching.
Being approached from behind – increases risk of becoming startled or anxious.
Low level lying – can induce feelings of vulnerability as at a lower height to others in the room.

In addition to physical and safety considerations for positioning, when assisting in choosing a position and supporting posture, consider:

What is visible at eye level?
If vision is impaired, what can be heard from this position? (Particularly important if vision or hearing is impaired).
What stimuli can be heard, seen or felt in this position? Could this become overbearing, for example in front of moving sensory lighting or next to a radio?
Orientation – What can be seen? Can what is going on be seen and heard? Is it possible to join in?
Stimulation – what stimuli has the person been exposed to in this position and for how long? Is a change of scenery, activity or experience needed?
What is the temperature like, is there a cool draft, or heat from a radiator?
Is there space surrounding a person to allow room for people to walk around them. If, for example wheelchairs are placed in awkward positions in a room, such as in front of a door or in a tight space, they may need to be moved to allow access.
Busyness – Is this position in the centre of what is happening, or away from the social hub of the room? What would be preferred?
What size is the room? The size of the room will impact on the way in which the room can be used to include everybody within it. Larger rooms may require people to gather in a central area to be able to fully participate in what is going on. Allocation of a quiet corner may allow for peace and quiet for people when they need it.
Comfort – is seating correct, are clothes rolled up or too tight and uncomfortable? Is the lap strap or table top too tight or loose, are there clothing labels rubbing or digging in? Being uncomfortable without being able to say it can be extremely distressing and harmful to our emotional state. It can also distract us from feeling any other sensation until the discomfort has gone.
External aids – If there are attached aids such as a catheter or enteral feeding tubing, are these clear and unobstructed and not causing discomfort?
Posture – If I am lying down, am I well supported.
Timing – If I am unable to shift in my seat, have I been in this position for long? Do I need a change of position?

Where a person may feel most at ease and like to be located might depend on:

Whether other people are in the room.
Who is present and where they are.
Whether the space is small or open, light or dark?
How stimulating the environment is.
How noisy or peaceful the space is.
The temperature and ventilation of the room.
The atmosphere in the room.
When they last had any food or drink.

What to observe, assess and record

Facial expressions, body language and all signs and signals that may tell you whether the person is content and comfortable?
Continue to assess my facial and body language for signs of comfort and pleasure or discomfort and tension.
Details of what worked best in supporting my posture and positioning. Where did I seem most comfortable and content? Where did I seem uncomfortable or tense?

Contributors

Senior Enhanced Nurse, Intensive Interaction Practitioner/Trainer

Cork, Ireland

Email: [email protected]

and

Julie Calveley, PhD, BSc(Hons) Psychology, Registered Nurse Learning Disabilities, NAC Director

Email: [email protected]

Created January 2022