1. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 2: Using Body Mechanics to Lift and Move Residents Introduction As a nurse assistant, one of your major duties is moving residents. You must know how to do this without straining your back and causing an injury to yourself or the resident. This lesson covers ways to reduce strain and fatigue. Remember your feet are your base of support. Your strongest and largest muscles are in the shoulders, upper arms, hips, and thighs. These are the muscles that we use to lift and move heavy objects. Residents often need help when moving in the bed. You must observe your resident carefully to determine if you can move him/her by yourself or if you will need help. If the procedure requires two persons because the resident is “dead weight,” very heavy, or has very fragile skin, use a pull/lift sheet. This prevents friction and irritation to the skin. Keep in mind the principles of body mechanics any time you are moving the resident.

2. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 2: Using Body Mechanics to Lift and Move Residents Introduction Proper positioning of the resident in the bed is necessary to maintain normal body function, prevent contractures, ensure comfort, and prevent pressure on one area of the body. Body alignment is the proper relationship of body parts to each other to avoid unnecessary strain/injury. Always look at the resident when positioning him/her to see if the body is straight and looks comfortable. Check to make sure no bony areas are pressing/rubbing on the mattress. The following procedures illustrate the steps to take for turning a resident on his/her side and to the prone position (in which the resident is lying on his/her abdomen). This latter position extends the body more than any other position. This can help prevent flexion contractures of the hip. Pillows are used to position the resident. If you do not have enough pillows, a rolled bath blanket may be used.

3. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 2: Using Body Mechanics to Lift and Move Residents Term and Definition Body Mechanics – using correct techniques in performing certain functions in a manner that does not add undue strain to the body

4. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 2: Using Body Mechanics to Lift and Move Residents Importance of Body Mechanics Protects you from injury by aligning body segments to each other. By standing straight, the main parts of your body (head, chest, and pelvis) are properly aligned one over the other to maintain good balance. Reduces fatigue to prevent strain on the spine Makes the spine work with you and for you to maximize body strength Makes lifting, transferring, and moving objects easier and minimizes fatigue Provides balance and stability

5. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 2: Using Body Mechanics to Lift and Move Residents Key Points of Body Mechanics When moving residents, be sure they know when they are going to be lifted, how you plan to do it, and where you are going to lift them. Use verbal cues. (See Figure 2.1.) Determine what has to be done and if you will need help. Never attempt to lift a resident alone if you think that you cannot do so safely. (See Figure 2.2.) Figure 2.1 – Informing the Resident Figure 2.2 – Determine Procedure Needs

6. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 2: Using Body Mechanics to Lift and Move Residents Place feet apart (about 18 inches) with one foot slightly ahead of the other. Feet should be shoulder-width apart to give you a broad base of support. (See Figure 2.3.) Key Points of Body Mechanics Get close to whatever is being lifted instead of reaching for it. Move in and hold the object close to your body. (See Figure 2.4.) Figure 2.3 – Supportive Stance Figure 2.4 – Lifting Position

7. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 2: Using Body Mechanics to Lift and Move Residents Keep your back straight; bend at the hip and knees. (See Figure 2.5.) Key Points of Body Mechanics Figure 2.5 – Lifting Posture Straighten you legs and use you upper arm and leg muscles to lift. (See Figure 2.6.) Figure 2.6 – Proper Lifting

8. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 2: Using Body Mechanics to Lift and Move Residents Key Points of Body Mechanics Lift smoothly to avoid strain produced by jerky movements. Use verbal cues to signal your coworker when it is time to lift; e.g., count, “one, two, three, LIFT!” (See Figure 2.7.) To turn, pivot with your feet – never twist your body. (See Figure 2.8.) Figure 2.7 – Lifting as a Team Figure 2.8 – Pivot by Turning Feet

9. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 2: Using Body Mechanics to Lift and Move Residents Key Points of Body Mechanics Push, pull, slide, and roll objects (not people) whenever possible, rather than lift. (See Figure 2.9.) Figure 2.9 – Push Objects When Possible Remind coworkers to used good body mechanics. (See Figure 2.10.) Figure 2.10 – Remind Coworkers to Use Techniques

10. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 2: Using Body Mechanics to Lift and Move Residents Additional Points Always look for any obstacles or hazards before moving a resident. When an action requires physical effort, try to use as many muscles as possible. For example, use both hands rather than one hand to pick up a heavy piece of equipment. When you life an object or pick something up off the floor, squatting down rather than bending over reduces strain on the spine.

11. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 2: Using Body Mechanics to Lift and Move Residents Principles to Remember When Lifting and Moving a Resident The nurse assistant’s movements should be slow and steady. Explain to the resident what you are going to do so that he/she will have confidence in you. Allowing a resident to stay in a fetal position (curled-up position) can lead to pressure ulcers (decubiti), pneumonia, contractures, blood clots, and constipation. Change the resident’s position at least every 2 hours or more often according to the care plan. Always use a lift sheet to move the resident. NEVER slide his/her skin over the sheets. A lift sheet can be used to help lift the resident, which helps prevent friction on the skin. Sliding causes the resident’s skin to rub against the sheets, which can scratch and injure the skin.

12. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 2: Using Body Mechanics to Lift and Move Residents Principles to Remember When Lifting and Moving a Resident Handle the resident gently. Remember, skin is easily bruised and bones are easily broken. Safely moving the resident usually requires two people. Change of position (lying to sitting, sitting to standing) may cause the resident to become dizzy. Protect all tubing when moving a resident. If the resident is able to assist with moving, give the resident instructions about what to do and when to do it. For example, a nurse assistant instructs the resident to bend knees and place feet firmly on bed. On the count of three, the resident pushes with his/her feet as two nurse assistants move the resident up in the bed. When working with another nurse assistant to move/lift a resident, the nurse assistants work on opposite sides of the bed. Movements should be synchronized as the resident is moved/lifted.

13. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 2: Using Body Mechanics to Lift and Move Residents Principles to Remember When Lifting and Moving a Resident Roll the resident toward you rather than away from you whenever possible. Do not allow resident to hold you around your neck when moving him/her.

14. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 2: Using Body Mechanics to Lift and Move Residents Conclusion The importance of understanding and using proper body mechanics cannot be overemphasized. Serious injury to either or both the nurse assistant and resident may occur as a result of improper lifting or moving techniques.

15. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 2: Using Body Mechanics to Lift and Move Residents Steps of Procedure for Moving Resident to Head of Bed (Two-Person Assist) 1.Wash your hands. 2.Ask another nurse assistant to work with you. 3.Identify and greet resident. Identify self and other nurse assistant. 4.Explain what you are going to do. 5.Provide privacy. 6.Raise bed to a comfortable working height; lock wheels on bed. Lower the head of the bed; lower side rail on side at which you are working. 7.If the resident has any tubing coming from his/her body and it is pinned to the bedding, unfasten the tubing so that it will move freely with the resident. 8.Move pillow to headboard so resident does not hit his/her head when moving up.

16. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 2: Using Body Mechanics to Lift and Move Residents Steps of Procedure for Moving Resident to Head of Bed (Two-Person Assist) 9.Nurse assistants should stand on opposite sides of the bed. 10.Position a lift sheet/folded regular sheet under shoulders and hip area. Each nurse assistant should roll edges of sheet toward resident’s body and grasp rolled sheet with his/her hands (with palms up) at the resident’s shoulders and at the mid-hip area. (See Figure 2.11,) Figure 2.11 – Using a Lift Sheet11.Point your feet in the direction you are moving the resident; bend knees, keep back straight. 12.On the count of three, each nurse assistant lifts the resident up off the surface of the bed and toward the head of the bed while shifting weight from back foot to front foot.

17. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 2: Using Body Mechanics to Lift and Move Residents Steps of Procedure for Moving Resident to Head of Bed (Two-Person Assist) 13.Replace pillow. 14.Adjust backrest for comfort. 15.Lower bed to a position of safety; raise side rails where ordered per the care plan. 16.Make the resident comfortable; place call signal within reach. Fasten tubing if unpinned while moving resident; adjust bedding. 17.Wash your hands.

18. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 2: Using Body Mechanics to Lift and Move Residents Steps of Procedure for Turing Resident to Side (3/4 Turn) 1.Wash your hands. 2.Identify and greet resident. Identify self. 3.Explain what you re going to do. 4.Provide privacy. 5.Raise bed to a comfortable working height; lock wheels on bed. Lower backrest; lower side rail on side from which you are working. 6.If the resident has any tubing coming from his/her body and it is pinned to the bedding, unfasten the tubing so that it moves freely with the resident. 7.Loosen the top sheets without exposing the resident. Remove pillow.

19. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 2: Using Body Mechanics to Lift and Move Residents Steps of Procedure for Turing Resident to Side (3/4 Turn) 8.Cross the resident’s arms over his/her chest. 9.Cross the leg farthest from you over the leg closest to you. 10.Reach across the resident and put one hand behind his/her far shoulder. 11.Place your other hand behind his/her far hip and gently roll him/her toward you. (See Figure 2.12.) Figure 2.12 – Turning the Resident Toward You

20. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 2: Using Body Mechanics to Lift and Move Residents Steps of Procedure for Turing Resident to Side (3/4 Turn) 13.Support the resident’s head with the palm of one hand and slide a pillow under his/her head and neck with the other hand. 14.Position resident’s knees slightly flexed, upper leg more than the lower leg. Support upper leg on pillow. (See Figure 2.13.) Figure 2.13 – Lateral Position 12.Fold a pillow lengthwise and place it against the resident’s back for support. As you face the resident, pull the side of the lift sheet that is closest to you slightly toward you.

21. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 2: Using Body Mechanics to Lift and Move Residents Steps of Procedure for Turing Resident to Side (3/4 Turn) 16.Rotate lower shoulder slightly toward you so that pressure is not on the bone. 17.Place hand roll or rolled washcloth in clean, dry hand with thumb in opposition to fingers (per care plan). 18.Make the resident comfortable, place call signal within reach, fasten tubing if unpinned while moving resident, and adjust bedding. 19.Lower bed to a position of safety, raise side rails per care plan. 20.Wash your hands. 15.Support upper arm on pillow.