1. Chapter 15
Safe Patient Handling

2. Patient-Centered Care
Develop a mobility and activity plan with the patient.
Assess:
Knowledge.
Influence of culture and ethnicity.
Circumstances leading to loss of independent activity.
Discuss complications of immobility.
Individualize the plan of care to achieve a reasonable level of mobility and activity.

3. Safety
Conditions resulting in immobility or limitations imposed by treatment plans can cause:
Pressure ulcers.
Contractures.
Complications from improper positioning.
Risk of injury during transfer.
Goals
Assist patient to achieve optimal level of activity independence.
No injury occurs to the health care provider while providing care.

4. Skill 15.1 Using Safe and Effective Transfer Techniques
Transferring assists dependent patients or those with restricted mobility to regain optimal independence.
Promote the safety of the patient and nurse.
Assess the patient’s:
Physiological capacity and pain.
Weight-bearing status.
Cognitive and sensory status.
Need for special adaptive techniques.
Previous mode of transfer and amount of assistance.

5. Skill 15.1 Using Safe and Effective Transfer Techniques (cont’d)
Determine staff required for safe transfer.
Assist from supine to sitting position in bed.
Assist to sitting position on side of bed.
Raise head of bed to 30 degrees.
Provide nonskid shoes to patient.
Apply transfer belt if indicated.
Transfer from bed to chair.
Use slide or friction-reducing board for lateral transfer.
Place chair on strong side at 45-degree angle to bed.
Use mechanical lift device if indicated.

6. Procedural Guideline 15.1 Wheelchair Transfer Techniques
Use basic transfer principles to transfer patient from bed to wheelchair.
Include additional safety precautions.
Check wheelchair locks, foot plates, and wheels for proper function.
Lock wheelchair when performing transfers.
Raise foot plates during transfers.

7. Skill 15.2 Moving and Positioning Patients in Bed
Correct positioning in bed:
Maintains body alignment
Promotes comfort.
Prevents musculoskeletal and integumentary injury.
Provides sensory, motor, and cognitive stimulation.

8. Skill 15.2 Moving and Positioning Patients in Bed (cont’d)
Provide for safe positioning.
Assess for presence of tubes, incisions, and equipment.
Check orders for positioning contraindications.
Determine staff or equipment needed.
Support head, back, limbs, hands, and feet with pillows, folded bath blankets, or rolled towels.
Maintain individualized turning/repositioning schedule.

9. Chapter 16
Exercise & Mobility

10. Patient-Centered Care
Patients must understand the benefits of mobility and the risks of immobility.
Pain can limit motivation and lead to decreased range of motion.
Assess patient’s level of pain before activity.
Assess impact of culture and gender on pain.
Include family members in discussion so activity can be reinforced.

11. Safety Safe patient activity and handling includes:
Prevention of orthostatic hypotension.
Exercise calf muscles.
Sit on edge of bed for 1 minute before standing.
Use safe patient handling techniques.
Assess physical, cognitive, and medical status.
Work with other health care team members.
Use patient handling equipment and devices.
Educate patients about safe exercise practices:
Frequency, intensity, time and type, self-care

12. Procedural Guideline 16.1 Range of Motion
Encourage patients to be as independent as possible during range-of-motion (ROM) exercises.
Incorporate ROM into activities of daily living and during bathing and feeding.
Collaborate with the patient to schedule ROM.
Active—The patient performs independently.
Passive—Are performed for the patient by the caregiver.

13. Skill 16.1 Continuous Passive Motion Machine
Continuous passive motion (CPM) machines exercise joints and are routinely ordered for postoperative orthopedic surgery.
Discuss the purpose of CPM with the patient.
Prescribed flexion and extension degrees and speed
Align the extremity in the machine.
Observe two flexion and extension cycles.
Instruct the patient how/when to use the on/off switch.

14. Procedural Guideline 16.2 Applying Elastic Stockings and Sequential Compression Device
Risk factors contributing to deep vein thrombosis include hypercoagulability of blood, venous wall damage, and blood flow stasis.
Prevention includes administration of anticoagulant medications, compression stockings, and sequential compression devices.
Measure stockings and compression devices for proper fit.
Ensure proper alignment and no wrinkles.
Routinely remove devices to observe skin.

15. Skill 16.2 Assisting with Ambulation
Devices such as canes, crutches, and walkers help increase activity tolerance and balance.
Assess:
Patient’s most recent activity experience.
Assess for history or risk of orthostatic hypotension.
Best time for patient to ambulate.
Patient’s motivation and ability to cooperate.
Weight-bearing ability
Need for additional nursing assistive personnel (NAP).
Provide slippers with nonskid soles.

16. Skill 16.3 Teaching Use of Canes, Crutches, and Walkers
Devices assist patients with balance and weight bearing or decrease pain during weight bearing.
Collaborate with physical therapy for device selection and patient teaching.
Canes broaden base of support.
Crutches remove weight from one or both legs.
May be used temporarily or routinely and continuously
Walkers provide stability and security.
Height adjusted to patient; may have 2 or 4 wheels