The 5 Smiles technique


The 5 Smiles technique

When repositioning or turning an immobile person, the carer should complete five skin tension-relieving tasks to avoid shear and skin injury;

  • A pillow used when lying down may not be as comfortable when sitting up. When a user is sitting up in bed, remove the pillow, shake it, and replace it. This of course also applies when changing position from sitting to lying down.
  • Put on the MultiGlide Glove and place the gloved hand on the shoulders and move the hand slowly down the back to the buttocks.
  • Move the hand under the buttocks and slowly down the leg to the feet.

Repeat on the opposite side of the user.




Using the MultiGlide Glove

The low-friction MultiGlide Glove is an excellent aid for skin tension relief over bony prominences. The glove makes it easier to place the hand between the user and the surface and straighten out the skin on the back side of the user and the wrinkles on the sheet to avoid skin injury.

See the instructions to learn how, when lying or sitting in bed.


Bony prominences 

In the text above, you will find examples of skin areas that are at risk of pressure injuries. It is important to keep in mind that there are many more exposed skin areas to be attentive to. 

Relieving skin tension is relevant for all areas at risk of a localized injury because of pressure, or pressure in combination with shear 

The examples should only be regarded as a principal guideline and do not substitute the need for individual assessments, performed by competent carers for each individual user/patient. 


EPUAP Guideline

As part of good practice, the European Pressure Ulcer Advisory Panel recommends using manual handling techniques and equipment that reduce friction and shear when repositioning individuals with limited mobility.

When using the 5 Smiles technique we strive to relieve skin tension over bony prominences; e.g., on the back of the head, shoulders, and buttocks.

The Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline may be purchased from NPIAP here.