What Is High Fowler’s Position?

Content reviewed by Megan Andrews, MSN, APRN, ANP-C. 

High Fowler’s position is a common patient position used in healthcare settings, particularly in hospitals and clinics. It involves positioning the patient in a semi-sitting posture, with the head of the bed elevated between 60 and 90 degrees. This position is utilized for various medical purposes, which we explore here. 

What is High Fowler’s position used for?

High Fowler’s position is employed in various clinical situations to address specific patient needs. Some of the primary uses include: 

1. Respiratory distress: Elevating the head of the bed helps patients with respiratory issues — such as chronic obstructive pulmonary disease (COPD), asthma, or pneumonia — to breathe more easily. This position promotes lung expansion and reduces pressure on the diaphragm. 
2. Feeding and swallowing difficulties: Patients with dysphagia or other swallowing disorders benefit from High Fowler’s position as it allows gravity to assist with the passage of food/liquids and reduces the risk of aspiration. 
3. Postoperative care: After certain surgical procedures, patients are positioned in High Fowler’s position to facilitate breathing, prevent aspiration, and promote comfort. 
4. Cardiac conditions: Patients with congestive heart failure or other cardiac conditions may find relief in High Fowler’s position as it helps decrease venous return and reduces the workload on the heart. 
5. Comfort and mobility: High Fowler’s position is often used to enhance patient comfort, particularly for those who are uncomfortable lying flat.  

Benefits of High Fowler’s position 

The benefits of High Fowler’s position are numerous and can significantly improve patient outcomes. These benefits include: 

1. Improved respiratory function: By elevating the upper body, High Fowler’s position promotes better ventilation and oxygenation, making it easier for patients to breathe. 
2. Reduced risk of aspiration: For patients with swallowing difficulties, this position helps ensure that food and liquids move safely through the esophagus. 
3. Enhanced cardiac output: High Fowler’s position can reduce the workload on the heart by decreasing venous return, which is beneficial for patients with heart failure or other cardiac issues. 
4. Increased comfort: Patients who experience discomfort when lying flat often find relief in High Fowler’s position, as it can alleviate pressure on certain body parts and improve overall comfort. 
5. Facilitation of certain medical procedures: High Fowler’s position provides better access and visibility for healthcare providers during procedures such as nasogastric tube insertion, respiratory therapy, and certain types of examinations. 

How to position a patient in High Fowler’s position 

Properly positioning a patient in High Fowler’s position is crucial for maximizing its benefits. Here are the steps to ensure correct positioning: 

1. Explain the procedure to the patient: Inform the patient about the need for High Fowler’s position and what to expect.  
2. Adjust the bed: Elevate the head of the bed to an angle between 60 and 90 degrees. Most hospital beds have controls that allow for easy adjustment. 
3. Support the patient: Ensure the patient is well-supported by adjusting pillows behind their back and under their head for added comfort. Additional pillows may be placed under the arms and knees to prevent strain. 
4. Check for alignment: Ensure that the patient’s body is properly aligned and that there is no undue pressure on any part of the body. This helps prevent discomfort and pressure sores. 
5. Monitor the patient: Regularly check the patient’s position and adjust as needed to maintain comfort and effectiveness.  

Potential complications and precautions 

While High Fowler’s position offers many benefits, it is important to be aware of potential complications and take necessary precautions: 

1. Pressure ulcers: Prolonged time in High Fowler’s position can increase the risk of pressure ulcers, particularly on the sacrum and heels. Regular repositioning and the use of pressure-relieving devices can help mitigate this risk. 
2. Orthostatic hypotension: Sudden changes in position can lead to orthostatic hypotension, causing dizziness or fainting. Ensure that position changes are made gradually and monitor the patient’s blood pressure closely. 
3. Musculoskeletal discomfort: Patients may experience discomfort or strain in the neck, back, or shoulders if not properly supported. Use pillows and other support devices to maintain proper alignment and comfort. 

High Fowler’s position is helpful for patient numerous patient care scenarios. By understanding how to properly position patients and recognizing its applications, healthcare professionals can optimize patient care and improve outcomes.