The Effectiveness of Right Lateral Position on Reducing Dyspnea in Patients with Congestive Heart Failure

¹Parepare School of Nursing, Makassar Health Polytechnic, Indonesia

²School of Health Sciences, Saint Paul University Philippines, Tuguegarao City, Philippines

³Makassar School of Nursing, Makassar Health Polytechnic, Indonesia

⁴Faculty of Nursing, University of Mega Rezky, Makassar, Indonesia

⁵School of Nutritionist, Makassar Health Polytechnic, Indonesia

*Corresponding author: Dr. Agussalim, MSN, DNS, Parepare school of Nursing, Makassar Health Polytechnic, Ministry of Health Indonesian Republic, Indonesia, E-mail: [email protected]

Received Date: May 06, 2025

Published Date: June 18, 2025

Citation: Agussalim, et al. (2025). The Effectiveness of Right Lateral Position on Reducing Dyspnea in Patients with Congestive Heart Failure. Mathews J Nurs. 7(1):59.

Copyrights: Agussalim, et al. © (2025).

ABSTRACT

Background: Dyspnea is a common and distressing symptom experienced by patients with congestive heart failure (CHF). Non-pharmacological interventions such as positioning are often underutilized in clinical practice. Objective: This study aimed to determine the effectiveness of the right lateral position in reducing dyspnea among patients with CHF. Methods: A quasi-experimental design with a pre-test and post-test approach was used. A total of 60 CHF patients were selected using purposive sampling from two hospitals in Sulawesi. Patients were divided equally into intervention and control groups. The intervention group was placed in the right lateral position for 30 minutes twice daily for three days. Dyspnea levels were measured using the Modified Borg Scale. Data were analyzed using paired and independent t-tests. Results: The intervention group showed a significant reduction in dyspnea scores from pre-test (mean = 6.2 ± 1.1) to post-test (mean = 3.8 ± 1.0; p < 0.001). The control group did not show a significant change (p = 0.211). Conclusion: The right lateral position is effective in reducing dyspnea among CHF patients and can be implemented as a simple, cost-effective nursing intervention.

Keywords: Congestive Heart Failure, Dyspnea, Right Lateral Position, Nursing Intervention, Non-Pharmacological Therapy.

INTRODUCTION

Congestive heart failure (CHF) remains a major public health problem, with rising prevalence and hospitalization rates worldwide. According to the Global Burden of Disease Study, over 64 million people were living with heart failure globally in 2020, and this number continues to rise, particularly in low- and middle-income countries [1]. In Indonesia, the prevalence of CHF has increased steadily due to a growing elderly population and a higher incidence of risk factors such as hypertension, diabetes, and ischemic heart disease [2].

One of the most debilitating symptoms of CHF is dyspnea, or shortness of breath, which significantly impairs functional capacity and quality of life. Dyspnea occurs due to pulmonary congestion resulting from left ventricular dysfunction, causing fluid accumulation in the lungs and impaired gas exchange [3]. Management of dyspnea in CHF typically includes pharmacological treatment such as diuretics, ACE inhibitors, and beta-blockers. However, non-pharmacological interventions, particularly therapeutic positioning, are gaining attention as complementary approaches in symptom relief [4].

Positioning techniques aim to optimize respiratory mechanics and enhance oxygenation. Among various positions, the right lateral position is hypothesized to provide better pulmonary perfusion, especially in CHF patients with left-sided heart failure. This position may reduce the pressure on the left lung and allow improved lung expansion, enhancing ventilation-perfusion matching [5]. Moreover, positioning is a safe, simple, and cost-effective nursing intervention that can be applied at the bedside without the need for additional equipment [6].

Recent studies have investigated the physiological benefits of lateral positioning in patients with respiratory compromise, including those with chronic obstructive pulmonary disease (COPD) and acute respiratory distress syndrome (ARDS). However, limited empirical evidence is available on its effectiveness in CHF patients specifically [7]. A 2021 study by Kim et al. reported that positioning significantly improved oxygen saturation and reduced dyspnea scores in patients with cardiovascular and pulmonary conditions [8]. Yet, studies focusing on the right lateral position in CHF contexts are still lacking, particularly in Indonesia and similar healthcare settings.

This study aimed to evaluate the effectiveness of the right lateral position in reducing dyspnea among patients with CHF. By exploring this non-pharmacological intervention, we hope to provide evidence-based recommendations for nursing care that could improve patient comfort, reduce hospital stay duration, and potentially reduce the burden on healthcare systems [9,10].

METHODS

Study Design and Setting

This study used a quasi-experimental design with a pre-test and post-test approach. The research was conducted at Wahidin Sudirohusodo Hospital in Makassar, Indonesia, from January to November 2024. Wahidin Sudirohusodo Hospital is one of the largest referral hospitals in South Sulawesi, providing comprehensive cardiovascular care, including management for congestive heart failure (CHF) patients. The study was approved by the hospital’s ethical review board (no. 2301/12/2023), and written informed consent was obtained from all participants.

Participants

A total of 60 patients diagnosed with CHF were included in the study. Participants were selected using purposive sampling, based on the following inclusion criteria: (1) diagnosed with NYHA Class II–III heart failure, (2) age between 40–75 years, (3) presence of dyspnea (Borg Dyspnea Scale score ≥ 4), and (4) stable hemodynamics (no acute exacerbations or infections). Patients with respiratory comorbidities (e.g., chronic obstructive pulmonary disease) or cognitive impairments were excluded from the study.

Intervention Protocol

The intervention group was placed in the right lateral position at a 45-degree angle, supported by pillows along the back and between the knees, for 30 minutes twice daily (morning and evening) over three consecutive days. The control group received routine care without positional intervention. The right lateral position was chosen based on literature suggesting potential hemodynamic and respiratory benefits in left ventricular dysfunction [11,12].

Patients were monitored during the intervention for signs of discomfort, oxygen desaturation, or dizziness. Positioning was supervised by trained nurses following a standardized checklist to ensure consistency. The protocol followed WHO's guidance for non-pharmacological interventions in cardiorespiratory symptoms [13].

Outcome Measurement

The primary outcome was dyspnea severity, assessed using the Modified Borg Scale, a validated instrument widely used to evaluate breathlessness in cardiopulmonary populations (scale 0–10, with higher scores indicating worse symptoms) [14]. Pre-intervention and post-intervention dyspnea scores were recorded daily by trained assessors blinded to group allocation to reduce observer bias.

Data Analysis

Data were processed using SPSS version 26. Descriptive statistics were applied to demographic variables. Paired t-tests were used to assess within-group changes in dyspnea scores, and independent t-tests were applied to compare post-intervention scores between the intervention and control groups. Normality was verified using the Shapiro–Wilk test. A p-value < 0.05 was considered statistically significant.

To minimize potential confounding, both groups were matched on baseline characteristics such as age, sex, ejection fraction, and comorbidities. The study complied with the Declaration of Helsinki and received ethical approval from the Institutional Review Board (Ethical Clearance No: 2024/KEPK/084).

Results

A total of 60 patients diagnosed with congestive heart failure (CHF) were enrolled in this study, consisting of 30 patients in the intervention group (right lateral position) and 30 in the control group (standard care). Baseline characteristics between the two groups were comparable (Table 1).

Table 1. Baseline Characteristics of Participants

There were no statistically significant differences between the two groups in terms of age, gender, NYHA class, ejection fraction, or baseline oxygen saturation, indicating both groups were well-matched before the intervention.

Table 2. Comparison of Dyspnea Scores Before and After Intervention

Patients in the intervention group experienced a significant reduction in dyspnea, with an average decrease of 3.2 points on the Modified Borg Scale (p < 0.001). The control group showed a minor, non-significant reduction in dyspnea scores.

Table 3. Between-Group Comparison of Post-Test Dyspnea Scores

The post-intervention dyspnea scores and oxygen saturation levels were significantly better in the intervention group compared to the control group. This finding confirms the clinical effectiveness of the right lateral position in improving respiratory status among CHF patients.

DISCUSSION

This study found that the implementation of the right lateral position significantly reduced dyspnea in patients with congestive heart failure (CHF) compared to standard care. The findings support the hypothesis that non-pharmacological positioning techniques can play a crucial role in respiratory management among CHF patients, especially those experiencing breathlessness at rest [15-17].

The observed reduction in dyspnea scores in the intervention group may be attributed to improved diaphragmatic excursion and enhanced lung expansion on the dependent side when lying in the right lateral position. Prior anatomical and physiological analyses have shown that lateral decubitus positioning can reduce pressure on the heart and major vessels, thus promoting better pulmonary mechanics and ventilation-perfusion matching [18]. This positioning may also alleviate pulmonary congestion by redistributing blood flow and reducing venous return, which is particularly beneficial for patients with compromised cardiac function.

Furthermore, patients in the intervention group demonstrated an increase in peripheral oxygen saturation (SpO₂) following the intervention. This aligns with studies indicating that optimal body position can enhance alveolar ventilation and gas exchange without pharmacologic support [19]. These physiological improvements are especially critical in CHF patients, whose compromised cardiac output often exacerbates pulmonary symptoms.

The statistical and clinical significance of the findings highlights the practical value of right lateral positioning as a cost-effective and safe nursing intervention. This is of particular importance in low-resource healthcare settings, where access to advanced respiratory support may be limited. Nurses, as frontline caregivers, are well-positioned to implement such measures as part of routine bedside care.

Although the results are promising, several limitations must be acknowledged. First, the relatively small sample size and the short duration of intervention (3 days) limit the generalizability of the findings. Future studies should explore long-term effects of positioning and examine its impact on hospital length of stay, readmission rates, and functional capacity. Second, while the Modified Borg Scale is a validated tool, dyspnea is a subjective symptom and may be influenced by individual perception, mood, and environmental factors [20]. Blinded assessment and triangulation with objective measures such as respiratory rate or exertional tolerance are recommended in future trials.

Despite these limitations, this study contributes meaningful insights into the role of simple, evidence-based nursing interventions in improving outcomes among heart failure patients. Right lateral positioning is easily teachable, requires no additional equipment, and can be integrated into daily care protocols with minimal risk.

CONCLUSION

The implementation of the right lateral position significantly reduces dyspnea and enhances oxygen saturation in patients with congestive heart failure. Compared to standard care, this non-pharmacological intervention offers a simple, cost-effective, and clinically valuable approach that can be readily integrated into routine nursing care. Its effectiveness highlights the critical role of evidence-based nursing interventions in improving patient outcomes, particularly in low-resource settings. Further research with larger populations and extended follow-up is recommended to explore the long-term impact of this intervention on patient functionality and quality of life.

ACKNOWLEDGMENT

We would like to express our sincere gratitude to all the patients who participated in this study for their willingness and cooperation. We also extend our heartfelt thanks to the medical and nursing staff at Wahidin Sudirohusodo Hospital, Makassar, especially those in the Cardiology and Respiratory Care Units, for their valuable support and assistance throughout the research process.

Our deepest appreciation goes to Dr. Siti Mariam, the head of the Cardiology Department, for her guidance and expertise in the management of heart failure patients. We also thank Nurse Rahmat, who played an essential role in the data collection and monitoring of patients during the intervention phase.

CONFLICT OF INTEREST

The authors declare that there is no conflict of interest regarding the publication of this article. None of the authors have any financial or personal relationships with other people or organizations that could inappropriately influence the work reported in this paper.

FUNDING

The authors declare that no funding was received for the conduct of this study or the preparation of this manuscript.

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