Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Principles of Body Movement for Nurses One of the most common injuries in health care workers is lower back strain ! Get help whenever possible; ask patient to help if able.  Two nurses moving a patient divides the work.  It is better to wait for help than to risk injury. Use your leg muscles; bend and flex your knees.  Bend at the knees, not at the waist. (Cont’d…)

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Principles of Body Movement for Nurses (…Cont’d) Use the greatest number of muscles possible. Use thigh, arm, or leg muscles rather than back muscles, and use a wide base of support. Keep feet approximately shoulders’ width apart. Use smooth, coordinated movements; avoid jerking or sudden pulling movements.

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Moving and Lifting Patients Keep elbows close and work close to your body; work at the same level or height as the object to be moved. Keep the load near your center of gravity. Pulling actions require less effort than pushing or lifting. Face in the direction of the movement. Use arms as levers when pulling the patient toward you. Lock the elbows and rock back on your heels, using the weight of your body to move the patient.

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Body Movement and Alignment for Patients Two basic principles 1.Maintain correct anatomic position. 2.Change position frequently. Hazards of improper alignment Interference with circulation, which may lead to pressure ulcers Muscle cramps and possible contractures Fluid collection in the lungs

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Pressure Ulcers Also known as decubitus ulcers, or bedsores Occur when pressure on the skin causes an area of local tissue necrosis Occur most often between a bony prominence and an external surface May be caused by shearing as force is applied downward and forward on tissue beneath the skin (as when a patient slides down in a chair)

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Goals and Expected Outcomes Patient will experience no musculoskeletal injury. Former level of mobility will be reattained within 6 months. Skin integrity will remain intact while patient is on bed rest. Patient will not experience injury while ambulating. Patient should have full range of motion exercise actively or passively performed several times a day.

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. PositioningPositioning Accomplishes four objectives: 1.Positioning provides comfort. 2.Positioning relieves pressure on bony prominences and other parts decreasing the patient’s risk of developing bedsores. 3.Positioning prevents contractures, deformities, and respiratory problems. 4.Positioning improves circulation.

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Common Positions and Variations Supine  Patient lying on his or her back Fowler’s  Supine with the HOB elevated 60 to 90 degrees Semi-Fowler  Supine with the HOB elevated 30 to 60 degrees Low Fowler’s  Supine with the HOB elevated 15 to 30 degrees

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. High-Fowlers or Orthopneic

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Fowlers versus Trendelenberg

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Semi-Fowler’s

Common Positions and Variations (…Cont’d) Dorsal recumbent  Supine with knees flexed and feet flat on the bed; used for procedures and examinations Side-lying/lateral  Patient lying on his or her side; alleviates pressure on the bony prominences of the back Sims’  A variation of side-lying used for examinations or insertions of tubes or suppositories (Cont’d…)

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Sim’s

Left & Right Lateral Recumbent

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Dorsal recumbent

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Common Positions and Variations (…Cont’d) Prone  Patient lying face down  Often used for patients with spinal cord injury  Not generally well tolerated Knee-chest  Face down, with chest, knees, and elbows resting on the bed  Used for rectal examinations

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Prone & Supine

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Common Positioning Devices Pillows  Used to support the body or extremities Boots or splints  Maintain dorsiflexion Footboards, high-top sneakers  Maintain dorsiflexion Trochanter rolls  Prevent external rotation of the leg (Cont’d…)

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. The Need for Good Alignment

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. A well-aligned resident

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Common Positioning Devices (…Cont’d) Sandbags  Used to immobilize an extremity, provide support, and maintain body alignment Hand rolls  Help prevent contractures and prevent dorsiflexion of the wrist Trapeze bars, side rails, bed boards  Enhance patient mobility, provide patient safety, and support patient’s back

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Overhead trapeze bar

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Moving the Patient in Bed Using a lift sheet  Requires at least two people standing on opposite sides of the bed  Both face the bed and use the sheet to move the patient up in the bed  Moving the patient is performed as a coordinated effort  Patient is lifted and moved, not dragged

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. LogrollingLogrolling Turning the patient as a single unit Body alignment maintained at all times Used to change bed linen, can be performed with or without a lift sheet Requires two people if patient cannot turn himself or herself Leave a pillow under the patient’s head

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Logrolling

Lifting and Transferring Patients may transfer independently or may require different levels of assistance. Always dangle a patient at bedside before transferring to a wheelchair, and observe for dizziness or nausea. Remember to lock the wheels on wheelchairs or gurneys before attempting to transfer a patient.

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Bed to Wheelchair

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Bed To Stretcher

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Things to Remember Determine how much help you will need to move or transfer the patient. Get help whenever possible. Make sure wheels on beds, wheelchairs, and gurneys are locked. Use a transfer device when possible. Dangle the patient before ambulating. Use a gait belt when ambulating patients.

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Transfer Devices Pull sheets Mechanical lifts Roller boards Slide boards Transfer or gait belts

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Gait Belt

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Hoyer Lift

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Standing Lift

Elsevier items and derived items © 2005, 2001 by Elsevier Inc. Slide Board