Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Support Surface Considerations

The client indicates intensity of pain on a 10cm line marked from "no pain" at one end to "pain as bad as it could possibly be" at the other end.

Compiled by L. Norton (2006)

When choosing a support surface for a client, the clinician should consider not only its pressure management characteristics but also:

  • the impact on the client (comfort, bed mobility, transfers, functional activities such as dressing in bed, etc.)
  • the impact on the caregiver (skill required to properly set up and maintain the device, impact on caregiver burden)
  • the environment (Where will the surface be used? Is it compatible with the bed or space within the room?)
  • the product (fail safety, need for a power supply, need for specialized linens, etc.)
Category Clinical considerations in addition to interface pressure
Standard (hospital bed or client's regular bed at home)
  • Client does not have to accomodate to a new surface
  • No additional cost incurred
Foam overlay (4 inch egg-crate or concoluted foam)
  • May require frequent replacement (who will do this and when?)
  • Deteriorates when exposed to moisture
  • Can be warm
Foam Mattress (replaces the standard hospital mattress)
  • Can often be adapted with foam or gel in high risk areas
  • May be less expensive than active support surfaces
  • Generally do not impact transfers or bed mobility
Static Flotation (air cells, gell, fluid overlays/mattresses)
  • May be less expensive than active support surfaces
  • May require less maintenance (gel, fluid)
  • Air mattresses/overlays may require some maintenance
Alternating Air (large air bolsters alternately over inflate and under-inflate in sequence)
  • Noise of the pump and movement of the mattress may be disturbing
  • Can decrease bed mobility and make transfers more difficult
Low Air Loss (air constantly escapes through the bladders, reducing surface tension)
  • Noise of the pump and movement of the mattress may be disturbing
  • Can decrease bed mobility and make transfers more difficult
  • Low air loss mattresses may be better able to manage excessive moisture, but the client' s fluid balance should be monitored
  • Motion of the bed can disrupt sleep
  • Client may not be well positioned after the turn related to position on surface, contracture, etc.
Turning/ Rotation (assists the client to change position)
  • Noise, ease of transfers, and bed mobility remain issues
  • Client may find the gradual turning on the mattress more comfortable and less disruptive than being turned by caregivers
Air Fluidized (client is "floating" in silicone beads)
  • Client is unable to transfer/ decreased independence with bed mobility
  • Care is more difficult
  • Usually requires a hospital admission

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