6 Module 6 – Lifting and Moving
Lifting and Moving
Learning Objectives
- Demonstrate understanding of the complications of inactivity
- Describe effective ways to move a person safely
- Demonstrate understanding of active and passive range of motion
- Demonstrate appropriate use of assistive devices
Complications of inactivity
Persons who require nursing care may be immobile for long periods of time. A person is immobile when their bodies cannot be active or can only perform very limited activity, such as when a person is on an order for bedrest. However, remaining active is an essential part of human health and wellness. When a person remains inactive for an extended period of time, it can have negative impacts on various different bodily systems[1].
- Eating and digestion: Activity is important for gastrointestinal health because it helps stir up an appetite and move waste through the intestines. Activity promotes healthy digestion, which promotes healthy elimination. Lack of activity can result in constipation, or inability or difficulty with regular elimination.
- Urination: Regular activity improves urinary elimination by helping a body to regulate its hydration and thirst; hydration and regular urinary elimination can help prevent UTIs. A result of inactivity thus may be increased UTIs as a result of inadequate hydration and thirst regulation.
- Skin wounds: Inactivity can result in integumentary pressure wounds, or pressure wounds on the skin that do not heal quickly. Activity improves the overall health of the skin; as a person remains inactive for a long period of time, their skin will break down, especially around the areas that remain in contact with the bed or chair.
- Circulation: Activity is important to healthy circulation, or the flow of blood through the body. When someone is inactive, it can produce blood clots. Humans should stay active to help keep their blood moving easily and normally.
- Breathing and respiratory health: Inactivity impacts a person’s respiratory system by making them more susceptible to respiratory infections like pneumonia. Activity helps us breathe more easily, increases our lung capacity, and helps us fight off infections in the lungs.
- Muscle health: Activity increases blood flow and improves the strength and conditioning of our muscles. Without activity, a person’s muscles can atrophy and develop contractures. This means that they weaken as they get smaller and softer. A contracture occurs when a muscle shortens and tightens, which can makes the muscle less effective.
- Mental and brain health: Activity is important for our nervous system because it makes us relaxed and sleepy afterward. A lack of activity and sleep can lead to mental health problems, compounded issues with sleep, and difficulty focusing.
- Hormonal balance: Activity is important for our endocrine system because it help our body keep its dietary hormones in balance. Without activity, the hormonal aspect of digestion and nutrient processing will be thrown out of balance. This can result in weight gain and diminished absorption of nutrients from food.
Allum, V. (2015, April 17). The complications of immobility [Video]. Youtube. https://www.youtube.com/watch?v=CAl0TH0MnPw
Assisting and moving a person safely
Body mechanics and safety
Always keep safety at the forefront of your mind while transporting, ambulating, or lifting a resident. Activity is essential, and getting injured by pulling muscles or spraining joints will only make both the NA and the residents they care for less active. NAs can protect themselves and residents by always thinking of good body mechanics, posture, and maintaining alignment[2].
NAs should never use their back when lifting and moving residents. Always use assistive devices and mechanical lifts whenever possible; if the movement cannot be completed with as assistive device, NAs should always lift with their legs and ask for help from their colleagues.
Protecting one’s back is an essential aspect to continuing to provide good care. Remember, good body mechanics are healthy ways of moving and lifting things; alignment refers to keeping a person’s back, and one’s own, straight and strong.
Determine the resident’s independence
Always determine the person’s the person’s level of independence while planning a movement or transfer[3]. Independence in this case refers to a resident’s ability to assist you during a movement or transfer, such as by pushing against the bed or chair to stand, or using their legs to help you help them to stand up.
Ask for help from another team member if a person’s level of independence does not allow them to participate helpfully in the moving and lifting.
Determining a person’s level of dependence is a necessary step in planning a transfer, or the movement of a person from one surface or place to another, such as a transfer from their bed to a wheelchair, or from their bed to a stretcher[4].
- Consider your own abilities; if you are the NA, it is important to consider how strong you’re feeling on that day, and how much practice you have performing the motion or transfer in question.
- Consider the size of the person being moved; a heavier person will require more staff members, or the use of an assistive device or mechanical lift to be moved safely. In addition to considering how many care staff will be required to move someone safely.
- Consider what sort of equipment will be most helpful in completing the task; for instance, does the move require a mechanical lift or would a transfer belt be more useful?
- Consider the person’s own ability to assist the NA with the move or transfer. How cognitively present is the person? Would they be able to follow any instructions about the motion that the NA gives them? What are their physical limitations? Are they experiencing any physical limitations that would make the motion difficult or risky for them? Has the doctor ordered any restrictions on their movement, such as an order for bed rest or limiting their range of motion? The person’s cognitive capability, physical limitations, or any doctor or nurse ordered restrictions are all important considerations when planning a move or a transfer.
Common assistive devices
Transfer/gait belt
Transfer belts are a common piece of assistive technology in healthcare settings. Transfer belts are thick belts made of a strong material, usually canvas, with a metal buckle. Transfer belts are used in care facilities to help transfer residents from their bed to chairs, and to assist them with ambulation[5].
Transfer belts are applied around the person’s waist or under their arms. NAs should always apply transfer belts over the person’s clothing; transfer belts that are making direct contact with skin can cause chafing, rashes, and general discomfort.
The buckle on a transfer belt should always be on the person’s side, never on their front or back. The belt should be tight and secure, but loose enough for the NA to still fit their fingers between the belt and the person’s body. This is to maintain a stable grip while performing a transfer or assisting with ambulation.
Video by Allie Tiller is licensed under CC BY-NC 4.0
Bed and bedrails
Beds and bedrails are assistive devices because they can be used selectively and temporarily to help position a person for care, such as while making an occupied bed.
Bedrails are danger and pose the risk of entrapment. If left up the bedrails are considered a restraint, which may pose some legal or ethical problems if they are used improperly or thoughtlessly.
Always make sure that beds are in the lowest position unless someone is actively performing a care task. NAs should always return a bed to its lowest position when they are finished with the care task. Always check the care plan before using bedrails with a patient or resident.
Lifts
Facilities may have various types of lifts. A lift is a device designed to gently lift a person to aid in their transfer from one position to another. Lifts can be used to move someone in bed, such as moving them up in their bed or moving them to the side. Lifts are also used to reposition someone in a chair, and to lift them up from the floor if they have fallen.
There are some different kinds of lifts. For example, there is a difference between a manual lift and a mechanical lift. A manual lift is a lift that is powered by humans and will operate through a mechanism that doesn’t involve a motor or a battery. Mechanical lifts use a motor to assist in transferring residents.
The two most common kinds of mechanical lifts are the Hoyer lift and the ceiling lift. A Hoyer lift is a portable lift with two legs mounted on wheel for portability. A ceiling lift, by contrast, is embedded into the ceiling above the bed. Only operate lifts that you have been trained to use.
Assisted Home Health and Hospice. (2019, August 20). Hoyer lift [Video]. Youtube. https://www.youtube.com/watch?v=jLetizMjNHg
Ceiling lifts are often preferred to Hoyer lifts because they do not take up any floor space and thus do not present a physical obstacle to work around during transfers; Hoyer lifts can be preferred to ceiling lifts in situations where portability and the sharing of resources between patients is a necessity.
Transfers
Transfer refers to changing a person’s location from their bed to a chair, from a stretcher to a bed, from a chair to a different chair, from a chair to the tub, or any other purposeful assisted movement from one location to another.
- Never support the resident under their arms; this is not a safe way to move an adult, and lifting in this way can strain the NA’s back muscles and produce injury.
- The resident must never put their hands on the NA for support; instead, they can be given a solid object to hold onto for support, or can trust the care staff to perform the transfer; residents should never stabilize themselves upon another person during transfer, since this can throw people off balance and compromise the motion.
- Make sure any device’s wheels are locked during transfer, such as when transferring using a wheelchair or stretcher.
- If side rails or bed rails are required for care, they must be lowered once the care task is complete. When the guardrails need to be raised for a care task, the NA should always lower the rails on the side of the bed they are working; NAs should never lean over a guardrail to provide care[6].
- When transferring residents with a strong and weak side, it is important for the NA to work from the resident’s weak side, and to begin the motion with the person’s strong side by moving it first.
- Use a “stand and pivot” method where the person stands and the NA helps them pivot around until they either sit in the chair they are being transferred into, or take a seated upright position on the bed they are being transferred into. The stand and pivot method can only be used if the person’s legs are strong enough to bear some or all of their weight, the person is lucid and cooperative enough to follow directions closely, and the person is otherwise capable of assisting with the transfer. If these three conditions aren’t met, avoid using the stand and pivot method.
Stretcher
When transferring a person to or from a stretcher, the stretcher should be covered with a folded flat sheet or a bath blanket to minimize shearing and friction.
A lateral (side-direction) transfer device along with a slide board is used, or something similar to it such as a drawsheet, turning pad, or slide sheet, to move the person to the stretcher. When performing a transfer to a stretcher, at least two or three staff members must be present for safety.
Once the person has been safely transferred, and only with the nurse’s permission, raise the head of the stretcher so the person is in Fowler’s or a semi-Fowler’s position so the person is as comfortable as possible.
Wheelchair
When transferring people into or out of a wheelchair always make sure the wheels on the chair are locked in place.
Adjust the height of the chair appropriately for the person who will be transferred to it, and that any straps, cushions, and rails are all positioned to make the transfer as smooth as possible. Make sure the person is securely seated all the way back in the chair.
(Re)Positioning
It is important for people who spend a lot of time in bed to move around in their bed to maintain comfort; moving in bed and adopting different positions to maintain comfort can help prevent bed sores and other pressure injuries[7]. Moving in bed is also necessary for a person to maintain good bodily alignment. Some people will be able to reposition themselves in their own bed, however others will need assistance.
People who are weak, unconscious, paralyzed, in casts, or otherwise have their movement inhibited in some way will need help moving in bed. If the person weighs less than 200 pounds they will likely need 2 – 3 staff members and the use of a friction reducing device, such as a draw sheet. Depending on the person’s mobility and ability a mechanical lift may be necessary. However if the person weighs more than 200 pounds at least 3 staff members should assist with the move while using a lift or friction reducing device.
Always communicate with the person being repositioned throughout the whole repositioning process. This helps to put them at ease and keep their body relaxed, which is an important part of moving a person safely. It is also an important dimension of person-centered care, because the person should know what is being done to/for them before it happens. Communication is important to creating a sense of agency for the person receiving care.
Friction and shearing
When moving someone in bed, minimize friction and shearing as much as possible. Friction occurs when two surfaces rub against one another, such as skin on a sheet. Shearing occurs when one’s skin moves while their bone either stays in place or moves in the opposite direction, or when the skin is stationary and the bones and muscles move, and can happen when someone slides down or is moved up in bed. Shearing can be painful and may cause skin damage. Both friction and shearing cause skin infection and pressure ulcers.
- To reduce or eliminate friction and shearing, use friction-reducing devices such as a lift sheet, a cotton draw-sheet, sliding boards, and slide sheets.
- To prevent shearing and friction, always use a lift sheet or a mechanical lift with two people to move someone in bed.
- The angle of the bed should be kept at less than 30 degrees unless the patient is eating; a less steep bed angle can help prevent the person from sliding down. While moving the person, the angle of their bed should be zero, or flat.
- Another way to prevent friction and shearing is to have the person lift their legs during the move if they are able.
Video by Allie Tiller is licensed under CC BY-NC 4.0
Positioning
A person needs to be repositioned at minimum once every two hours, or when they become uncomfortable. NAs must always remember to chart when they have moved a person so the rest of the staff are up-to-date on the person’s positioning.
When repositioning people some essential things to keep in mind are their comfort, skin health, and their alignment. NAs should always reposition people in a way that minimizes friction and shearing, and maintains the person’s healthy alignment through the moving process. Use pillows and other supports to prop up a person in a way that is comfortable and maintains their alignment.
People may need to be moved into various positions such as Supine or Fowler’s, covered in Module 5. Turning is one common form of repositioning. Some people can reposition themselves in bed, while others need help to do so safely.
Turning and logrolling
Sometimes a person will be turned onto their sides. This lateral positioning can help prevent complications from bedrest or may be the best position for recovery. A resident may require a specific repositioning procedure depending on their condition; always check the care plan or check with the nurse to see how a person needs to be moved.
A lift sheet should be used to put the person on one side of the bed before they are turned. Once a person has been turned onto their side pillows and other supportive devices can be used to prop them up to maintain their position comfortably.
One technique for turning a person while maintaining their alignment is logrolling. Logrolling involves two people (or more) using an assistive device like a lift sheet to turn someone on their side while keeping the back and legs perfectly straight. One might use logrolling when the person’s spine needs to be kept straight at all times, such as after a back injury or while recovering from spinal surgery[8].
Dangling
Another common positioning technique is called dangling and involves residents sitting on the side of the bed with their legs dangling. Dangling is used for many reasons; perhaps somebody is becoming uncomfortable lying down and wants spend some time upright without moving out of bed.
Dangling is also used as an intermediary step between lying down and standing up. In this case, dangling is used to help someone maintain balance and prevent dizziness; dangling helps to equalize blood flow and stabilize blood pressure, which can help a person keep their bearings when moving from lying down to standing up. Dangling is an important posture for residents who are prone to lightheadedness.
When a person is dangling, have them cough and breath deeply, and move their legs back and forth in a circular motion. These activities contribute to good blood flow and the regulation of blood pressure that helps prevent dizziness and lightheadedness.
Multiple staff members may be necessary when helping a person dangle. For instance, if the person has any issues with balance or coordination, they may need additional support to prevent a fall or accident. If any dizziness or fainting does occur, the person should lay back down until it subsides.
Reporting and recording
Report and record carefully when repositioning residents, helping them with care tasks, and observe for any changes in their condition. If the NA repositions someone it should be charted; if they transfer them to a chair this should be chart; if the person uses the bathroom and the NA assists them with perineal care before or after, this should be charted. Always chart care provided, and any relevant observations about the resident’s condition or symptoms. Always chart carefully and thoroughly.
Bed rest
Sometimes a doctor will order bedrest for an elderly person when they are recovering from an injury or surgery. Bedrest can be useful, though it is also associated with declines in a person’s body’s muscle mass, immune health, cardiac and respiratory systems, and general ability to perform the tasks of daily living[9].
People on bedrest are susceptible to dysphagia; to help prevent dysphagia, make sure that persons are angled highly enough in bed while eating to offset some of the difficulty of swallowing in Fowler’s position.
There are three different kinds of orders of bed rest.
- The strictest prescription is “strict bed rest,” where the person is not allowed out of bed at all. The NAs and other nursing staff assist them with all of their ADLs, including bathing and elimination.
- The next is bed rest with commode privileges, when the person remains in bed except to use the commode, which is a kind of free-standing device into which a person eliminates. Commodes are easier to transfer onto than toilets, and can be moved so they are right next to someone’s bed.
- The third is bed rest with bathroom privileges, when a person remains in bed except to get up and use the bathroom.
Bed rest can be beneficial for somebody who needs a substantial amount of rest or needs to recover from a major medical event, like a fall or surgery. Bed rest can help a person control their pain, regain their strength, and lets their body devote all of its energy to healing.
Complications
Bed rest has a deleterious effect on almost all bodily systems, and can result in muscle atrophy. Not only can bed rest result in serious medical complication, it reduces social interactions and ability to meet one’s self actualization needs, and has a broadly negative impact on a person’s mental health.
Some complications from bed rest include:
- Bed sores, pressure ulcers, and other forms of skin breakdown
- Constipation and fecal impaction
- UTIs
- Thrombus
- Orthostatic hypotension
Complications resulting from bed rest can make a person’s recovery extremely difficult; the good news is that effective nursing care can prevent the complications that may follow periods of bed rest.
Some of the most important things to include in a person’s bed rest care plan are maintaining good alignment and performing frequent position changes. Range of motion exercises help a person maintain muscle capabilities and mobility.
Assistive devices
Various assistive devices may be used to help people maintain their health while on bed rest. For example, a bed board is a hard surface placed under the person’s mattress to make it further and to prevent the mattress from sagging.
- A foot board is a padded board used to keep a person’s feet in place and in alignment.
- Trochanter rolls are similar to foot boards in being a padded object intended for alignment, except trochanter rolls are usually a set of rolled bath towels that keep a person’s hips aligned. Abduction wedges (hip wedges) also keep hips in place, usually following a surgery, to promote proper healing.
- Hand rolls/grips and orthotic splints help keep a person’s hands in place and in a natural position. Splints are useful in preventing contractures and other complications of underuse.
- Bed cradles and foot cradles are used to minimize the amount of time a person’s legs and feet spend in direct contact with bedding.
Active and Passive Range of Motion (ROM)
Exercise is important for a person to maintain a high quality of life; this goes double for older adults whose muscles are at risk of atrophy and contracture if they do not perform their exercise regularly.
NAs can help residents incorporate muscle-maintaining movements into their ADLs, or encourage residents to engage in exercise together in the form of walking together and taking an aerobics class, stretching class, or another activity offered by the facility. Increased strength, endurance, and balance are some improvements that a person may see in their condition that goes beyond the simple maintenance of ability; a stronger muscular system can help protect a person’s alignment and spinal health.
Range of motion refers to the full scope of a person’s joint movement; range of motion is another dimension of mobility that suffers when a person remains on bed rest for an extended period of time.
Range-of-motion (ROM) exercises involve moving the person’s joints through their complete range of motion, and are usually done at least two times per day for those who need them.
People who are on bedrest should practice ROM exercises more frequently. ROM exercises should not be painful; rather, the point is to move the joint to the extent possible without causing pain while gradually working to extend the person’s ROM in the targeted area.
The three different kinds of ROM are active range of motion (AROM), active assisted range of motion (AAROM), and passive range of motion (PROM)[10].
- AROM exercises are when a person moves their joint through its full range of motion unassisted by the care team member.
- AAROM exercises are done with assistance from but still involve active participation from the person. This allows them to move the joint beyond the point at which they would have to stop on their own.
- PROM exercises are movements the staff member puts a joint through without help or active involvement from the person. The patient remains relaxed and lets the NA, nurse, or therapist move their joint for them. PROM exercises are usually ordered when a person is immobilized.
ROM exercises
ROM exercises can be incorporated into ADLs and other activities. For example, range of motion exercises could be incorporated in a short dance-party, folding laundry, or hygiene activities like brushing one’s teeth.
When NAs assist someone with their ROM exercises, it is important to avoid causing hyperextension, or the extension of a joint beyond its capabilities. NAs must always follow the care plan on ROMS regarding which joints need to be exercised, how many repetitions of a given exercise are required, how regularly they should be performed, and which specific motions are ordered.
- Abduction: moving a body part away from the body’s midline, such as to swing one’s leg to the side
- Adduction: moving a body part towards the body’s midline, such as swinging the aforementioned leg back into place
- Extension and flexion: straightening a body part, such as straightening a bent elbow, and flexion such as bending the elbow again. Dorsiflexion is bending a body part backwards, such as flexing one’s wrist so the hand points up and back toward the person.
- Pronation and supination: turning downward and upward respectively, such as turning one’s hand so their palm is facing down, and then turning it to face upward.
Wings Healthcare Training. (2015, September 30). Range of motion exercises [Video]. Youtube. https://www.youtube.com/watch?v=t6hE_ntz4Ho
ROM exercise are one excellent opportunity for NAs to provide holistic care by talking with residents, assessing their orientation, and giving residents a chance to talk about whatever they want to. NAs should be encouraging and positive when assisting a person with their ROM exercises.
Muscles and joints
In order to correctly interpret instructions for assisting residents with ROM exercises, NAs need to know some basics about the different types of muscles and joints in a person’s body.
Muscles are a tissue group that allows us to move our bodies through contracting and relaxing motions. When a person moves their arm, it is because some muscles in one area are tightening and others become loose. The result is a movement coordinated by the nervous system. The muscles that do this are called voluntary muscles, or skeletal muscles.
Muscles also provide protection for organs and other internal tissues, and help a body remain supported and upright. Smooth muscles, or involuntary muscles, are muscles that line the walls of our organs; a person does not consciously control these muscles. For example, our diaphragm is an involuntary muscle that is essential for our breathing; though it can be activated purposely, is usually is not.
The third kind of muscles are cardiac muscles; these muscles are found only in the heart and perform the movements necessary for the contracting of the heart required for blood-flow.
A joint is any point at which two bones come together; joints are either immovable or movable. An immovable joint would be the cranium. Movable joints, by contrast, are joints that permit movement, for example the elbow and knee joints, or the point where the arm meets the scapula in the shoulder.
There are four basic types of joints NAs should know about.
- Ball and socket joints are joints where one joint ends in a ball that fits into the cup-like receptacle of another bone. Hips and shoulder joints are both examples of ball and socket joints. Ball and socket joints usually have a wide range of motion and can move in a variety of different ways – think of all the ways a healthy person can swing their arms. This is possible because of their ball and socket joints.
- Gliding joint, or a plane joint, are two smooth bone surfaces that “glide” over one another. Gliding joints are mostly found in the ankles, wrist, and in the spine.
- Hinge joint allows for flexion and extension, but unlike a ball and socket joint it can bend along only one plane. For example, the knee is a hinge joint because it allows for bending in a forward and back motion, but it can’t move side to side.
- Pivot joints, also called rotary joints, allow for rotation in a specific area and are composed of a rotating bone within a ring formed by the second bone. An example of a pivot joint would be the vertebrae that allow a person to turn their head from side to side.
Ambulation
Ambulation is moving or walking. A person who does not need any assistive devices ambulates in the way that most other people walk, while a person who uses a cane or a wheelchair ambulates with the assistance of a cane or a wheelchair. Ambulation, then, is an umbrella term for many different kinds of motion and movement, though it usually refers to walking[11].
A person is ambulatory if they are capable of getting out of bed and moving or walking. Practicing ambulation is important, and maintaining the capability of ambulation is a necessary dimension of sustaining independence, preventing medical problems like blood clots, and managing one’s own holistic health.
Ambulation has many benefits, including:
- skin health
- circulation
- appetite
- elimination
- sleep
- overall energy and zest for life
After somebody has been on bedrest, ambulation should be taken slowly and over short distances, with gradual increases as the person regains their strength. Always consult the care plan, and ask a nurse if unsure. Image is Public Domain
Helping a resident ambulate
NAs should help residents ambulate if they need it; because ambulation is so important to overall health and wellbeing, and is particularly important for preventing deconditioning in older adults, residents should ambulate as much as they can. Many of them will need assistance and close monitoring in order to ambulate safely.
When helping a resident to ambulate, NAs will use a transfer belt or another safe and prescribed assistive device. When using a transfer/gait belt, NAs should walk slightly behind the resident while holding on to the gait belt; if the resident has a weaker side, that is the side that the NA should stand on.
To perform ambulation safely:
- Make sure that the pathway is clear of any obstructing objects and that the room or hallway is well-lit. Both the NA and the resident must be wearing proper footwear, meaning close-toed non-skid shoes.
- Make sure to know the person you are helping ambulate, especially in terms of any medical conditions the person experiences that might make ambulation riskier. For example, if the person is is prone to orthostatic hypotension, or experiences dizziness and pain, these considerations may be relevant to helping with ambulation.
Video by Allie Tiller is licensed under CC BY-NC 4.0
- Always ask for help if you think you may need it. It is always better to have one too many people available to assist than it is to have too few people than is necessary to complete a task safely.
- Make sure to chart the person’s ambulation – when it occurred, how far they went, their capabilities during the ambulation – when finished assisting them.
Always follow the care plan when it comes to increasing a person’s activity levels; going from bed rest to ambulation usually involves a couple steps in between, such as moving into a dangle, then getting out of bed and into a bedside chair, and then once they are able the person will ambulate in their room and then finally in the facility hallways. Always follow the care plan.
Falling and fall prevention
Ambulation can increase the risk of a resident falling, especially if they experience weakness or dizziness. If a resident is falling, NAs must not try to completely stop the fall, as this could result in injury to both parties. Instead, the NA should brace the falling person with their body and gently lower them to the floor. The person who fell should not be allowed to move or get up before the nurse checks them for injuries. An incident report form is always completed after a fall.
Video by Allie Tiller is licensed under CC BY-NC 4.0
Fall prevention programs are required when somebody is at risk of falling. The prevention program will be included in the person’s care plan. Fall prevention programs include steps the care staff must take to minimize the risk of falls, such as keeping a tidy space and having the person equipped with proper footwear. When a fall prevention program is included in someone’s care plan it must be used at all times.
Some patients who are at risk of falling will be prescribed assistive devices. NAs should always check the care plan to make sure they know whether someone needs to use an assistive device, and which kind of assistive device they need to use.
- Crutches are used when someone has reliable upper-body strength, but requires support on both sides for their lower body movements.
- Canes are used for people with weakness on one side of their body, operated on a person’s strong side and used in unison with the weak side. For instance, if a person’s strong side is their right, then then cane will be used by their right arm in time with their left side’s gait to provide extra support.
- Walkers are used by people who have general weakness in the upper and lower body, but are not yet at the point of requiring a wheelchair. When a person uses a walker, they should remain close to the walker to remain as aligned as possible.
- Various braces, such as leg and ankle braces, can also help people walk when they otherwise may not be able to do so comfortably. Braces work to keep body parts in place and to provide extra support to a person’s musculoskeletal system.
Key Takeaways
- Inactivity comes with the risk for a variety of different complications. It can negatively impact one’s overall physical and mental health, and generates problems with blood flow, eating and drinking, and muscle conditioning.
- Always practice good body mechanics for both oneself and the resident when moving or transferring. Make sure there are enough care team members to do the task safely, and never avoid asking for help. Speak to the resident throughout the whole process to create a secure and respectful environment, and to help the process go smoothly.
- Active range of motion (AROM) refers to the range of motion through which a person can move their joint on their own, which passive range of motion (PROM) refers to a joint’s available range of motion when a member of the care team moves the joint through the range of motion while the resident remains relaxed. When assisting someone with range of motion exercises, never extend a joint past its capabilities, and keep talking throughout the process. Always check the care plan for details on when, how, and how many ROM exercises a given resident needs.
- Assistive devices are an essential component of practicing safe caregiving. Assistive devices are used to make moving and transferring safer for both care team members, and patients and residents. Always use assistive devices such as lifts, drawsheets, and transfer belts to make moving someone as risk-free as possible. Other assistive devices may be used to prevent pressure injuries while on bed rest, such as a foot board, and to help minimize residents’ risk of falling, such as canes and walkers.
Comprehension Questions
1) How often should a resident on bed rest be repositioned? How often should a resident in a chair or wheelchair be repositioned?
a. Every 3 hours; every ½ hour
b. Every 1- 2 hours; every hour
c. Twice per day; three times per day
d. Whenever they ask for it
2) The complications of inactivity include …
a. Skin wounds
b. Issues with circulation
c. Communication challenges
d. Musculoskeletal complications
e. Problems with vision
3) Which of the following is true about body mechanics?
a. Assistive devices and mechanical lifts should only be used as a last resort
b. Protecting one’s own back is an important part of assuring quality care
c. Good body mechanics refers to lifting weights so you can move residents easily
4) Respond to the following sentences with T (true) or F (false).
____ Transfer belts work best when applied directly over a person’s skin.
____ Bedrails are an entrapment risk when not used properly. They should be lowered when not actively necessary for a care task.
____ Lifts are used to transport people around a facility.
____ Mechanical lifts should be used whenever possible to make a safe transfer from a bed to a chair.
____ Safety is less important during transfers than it is during ambulation.
5) Which of the following is true of transfers from a bed to a wheelchair?
a. The wheels of the wheelchair should be left unlocked.
b. The height of the chair is not adjustable, so the bed will need to be adjusted accordingly.
c. The person should be seated securely at the back of the chair.
d. Residents can use a transfer belt to assist themselves with transfers.
6) What elements are necessary for a safe repositioning movement? Select all that apply.
a. A friction-reducing device
b. At least 2 – 3 staff members
c. A working television
d. Excellent communication
7) What are some strategies NAs can use to limit friction and shearing? Select all that apply.
a. Oil the bed so it is slippery
b. Use a friction reducing device
c. Make the bed flat during repositioning, and less than a 30-degree angle at other times
d. Have the resident assist if they are able
8) What is it called when NAs have a resident sit up in bed for a minute to allow their blood pressure to equalize before continuing with a transfer?
a. Sitting up
b. Calibrating
c. Dangling
d. Aligning
9) Respond to the following sentences with T (true) or F (false).
____ A resident is under orders of “strict bed rest” when they can only get up to use a portable commode.
____ Bed rest can allow a person the opportunity to focus all of their energy on healing after an injury or major medical intervention such as a surgery.
____ Complications from bed rest include skin breakdown, UTIs, constipation, and circulatory issues.
____ Someone on bed rest will be unable to perform range-of-motion exercises.
____ Range-of-motion exercises can be incorporated into ADLs, such as by working on wrist and hand mobility while a resident brushes their teeth.
10) Which of the following statements is true of ambulation? Select all that apply.
a. The benefits of ambulation are primarily psychological, rather than physical.
b. Ambulation is an important aspect of promoting independence.
c. Ambulation helps prevent blood clots.
d. Ambulation can be risky, especially if residents are weak, confused, or imbalanced.
e. There aren’t any good assistive devices available to help someone ambulate.
11) What infection control measures are especially necessary when somebody is on bed rest? Why?
12) You are helping a resident ambulate with a gait belt. They are doing better than they usually do, so you let them walk on their own. However, they slip on an unmarked spill and begin to fall. You reach out to catch them and try to stop their fall, but in the process, you pull a muscle in your back and the resident ends up hitting the floor hard. What are the things you could have done differently to practice better safety measures and avoid injury?
- Nursing Assistant Chapter 9 by Chippewa Valley Technical College is licensed under a Creative Commons Attribution 4.0 International License ↵
- 3.2: Body Mechanics is shared under a CC BY 4.0 license and was authored, remixed, and/or curated by Glynda Rees Doyle and Jodie Anita McCutcheon (BC Campus) via source content that was edited to the style and standards of the LibreTexts platform; ↵
- Dugan, D. (2020). Nursing assisting: A foundation in caregiving (5th ed.), Chapter 11. Hartman. ↵
- For more information on the steps and tools NAs can use in ascertaining a person’s level of independence, check out this video: https://vimeo.com/73688818 ↵
- 3.2: Body Mechanics is shared under a CC BY 4.0 license and was authored, remixed, and/or curated by Glynda Rees Doyle and Jodie Anita McCutcheon (BC Campus) via source content that was edited to the style and standards of the LibreTexts platform ↵
- View this video for information on how to safely move residents, especially when they are experiencing dementia or another form of disorientation: https://youtu.be/2gQ_vKJE7yU ↵
- National Clinical Guideline Centre (UK). The Prevention and Management of Pressure Ulcers in Primary and Secondary Care. London: National Institute for Health and Care Excellence (NICE); 2014 Apr. (NICE Clinical Guidelines, No. 179.) 9, Repositioning. Available from: https://www.ncbi.nlm.nih.gov/books/NBK333122/ ↵
- Check out this video for more information on the processes going into transfers, movements, and logrolling: https://youtu.be/H68Sa04s_1s ↵
- Wick, J. (2011). Bedrest; Implications for the aging population. Pharmacy Times, 77(1). https://www.pharmacytimes.com/view/featurebedrest-0111 ↵
- CNA Training Institute. (2022, August 20). CNA Skill Series: Performing Range of Motion Exercises. https://cnatraininginstitute.org/performing-range-of-motion-exercises.html ↵
- Nursing Assistant, Chapter 8 by Chippewa Valley Technical College is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted. ↵
When a person cannot perform most or any of their daily tasks, particularly ones that require being upright.
Remaining in bed 100% of the time
Inability to or difficulty with defecation
Weakening, shrinkage, and loss of ability
Shortening of a muscle
How different parts of someone's body work together
When someone's body is in a line. This is a healthy and supported position.
A mechanical device designed to help move and transfer residents out of their bed, chair, or bath
A thick belt made of a strong material that nursing staff use to assist residents with transfers, while maintaining good body mechanics. Called a gait belt when used for assisting with ambulation.
Metal or plastic rails on hospital beds that can be put up or taken down
Moving to a new living space within a facility, or moving to a new facility
A narrow bed on wheels used to transport patients who cannot sit in a wheelchair
When a person's skin moves against a person's bone. Shearing is uncomfortable, and can cause pressure wounds.
Skin rubbing against an external surface. Friction can cause discomfort and pressure wounds.
Skin breakdown caused by pressure, shearing, and friction
Laying on one's side
A sheet designed specifically for helping someone move in bed.
Positioning technique in which the resident sits upright in bed with their legs hanging over the side
Difficulty swallowing
A blood clot that impedes the flow of blood in the blood vessel
Low blood pressure that comes when moving into a standing position
The full scope of a person's mobility. Range of motion exercises are ordered to regain or improve a patient's mobility and capacity for movement.
Tissue that allows for movement by contracting and relaxing.
Walking and other kinds of motion propelled by one's body
Able to ambulate, with or without assistance
Weakening muscles, increased fatigue, and lack of independence caused by diminished musculoskeletal capabilities
Individualized plans for residents to minimize their risk of falling