1. Slide 1 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Textbook For Nursing Assistants Chapter 11 - Positioning, Lifting, and Transferring Patients and Residents

2. Slide 2 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Positioning Patients and Residents

3. Slide 3 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Changing positions helps us stay comfortable and prevents complications resulting from spending long periods of time in the same position In a health care setting, a person may need to get into a certain position to have a procedure done, or to recover from one Positioning Patients and Residents

4. Slide 4 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. During repositioning, some patients or residents need help Helping people who must stay in bed or a wheelchair to reposition themselves is an important responsibility of the nursing assistant Positioning Patients and Residents

5. Slide 5 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A person may be unable to shift positions without help because of: Surgery A body cast Traction Total or partial paralysis Unconsciousness or coma Weakness from disease or disability Immobility – Reasons for Immobility

6. Slide 6 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. The most serious complications affect the skin, bones and muscles, lungs, and heart. Some of the complications are: Pressure ulcers (skin) Contractures (bones and muscles) Pneumonia (lungs) Blood clots (heart) Immobility – Complications Due to Immobility

7. Slide 7 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Immobility – Complications Due to Immobility

8. Slide 8 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Proper positioning is necessary for good body alignment and may help relieve some of the discomfort associated with a person’s medical condition A person in proper body alignment is positioned so that his or her spine is not twisted or crooked Basic Positions – Body Alignment

9. Slide 9 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. To check for alignment, imagine a line that connects nose, breastbone, and pubic bone, and continues between the knees and ankles Basic Positions – Body Alignment The line should be straight whether the person is lying on his or her back, side, or abdomen

10. Slide 10 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Basic Positions – Supportive Devices Supportive devices are needed to keep the person in proper body alignment Learning to position these supports correctly is essential Proper use of supportive devices helps to keep your patients or residents both safe and comfortable

11. Slide 11 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Basic Positions – Supportive Devices Supportive devices include Pillows Rolled sheets Rolled towels Rolled blankets Devices designed specifically for the purpose of offering support

12. Slide 12 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Basic Positions There are several basic positions that are used when a person must stay in bed or seated for long periods of time A doctor may order restrictions on positions for a person after a surgery or diagnosis

13. Slide 13 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Basic Positions Basic positions that are used when a person must stay in bed or seated for long periods of time include: Supine (dorsal recumbent) position Fowler’s position Lateral position Prone position Sims’ position Sitting position

14. Slide 14 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Basic Positions

15. Slide 15 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Repositioning a Person Each time you reposition a person, you should be alert to signs and symptoms of complications related to immobility People who are being moved in bed are particularly at risk for shearing and friction injuries if they are not moved properly

16. Slide 16 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Repositioning a Person – Shearing Shearing is caused by pulling a person across a sheet or other surface that offers resistance In shearing the skin is dragged in a direction opposite that of the underlying tissues and muscles, injuring the blood vessels and connective tissue under the skin and resulting in skin breakdown

17. Slide 17 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Repositioning a Person – Friction Friction occurs when two surfaces, such as a sheet and the person’s skin, rub against each other The rubbing action can injure the skin and contribute to skin breakdown

18. Slide 18 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Repositioning a Person The risk of shearing and friction can be minimized by rolling or lifting, instead of pulling or dragging, a person who needs to be moved

19. Slide 19 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Repositioning a Person Procedures for repositioning a person include Moving a person to the side of the bed Helping a person to move up in bed Raising a person’s head and shoulders Turning a person onto his or her side Logrolling a person

20. Slide 20 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Guidelines for Repositioning a Person Before attempting to reposition a person, plan how you will go about it and get help from others if necessary. Make sure you are aware of any limitations or restrictions concerning the movement or positioning of a person. Explain the procedure to the person, even if he or she is unconscious. Make sure that you allow the person to assist in the repositioning to the full extent of his or her ability. Provide for the person’s modesty by keeping his or her body covered.

21. Slide 21 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Guidelines for Repositioning a Person Take care to protect any tubes or drains from being pulled out while the person is being moved. Follow safety precautions and use good body mechanics when helping to reposition a person. Use a lift sheet to reposition the person whenever possible. Avoid moving or lifting someone by holding onto his arm or leg. After repositioning a person, make sure that the bed linens are free of wrinkles, and that the person’s clothing is not twisted or wrinkled up underneath the person. Gently move the person’s clothing aside to check the person’s skin.

22. Slide 22 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Transferring Patients and Residents

23. Slide 23 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A nursing assistant will assist people with transfers many times each day The assistance offered will vary from just providing a steadying hand to totally lifting a person from one place to another The assistance required will depend on the person’s ability to bear weight (stand on one or both legs) Transferring Patients and Residents

24. Slide 24 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A transfer belt is a webbed or woven belt with a buckle that is used to assist a weak or unsteady person with standing, walking, or transferring Many health care facilities require nursing assistants to use a transfer belt when helping people to stand, walk, or transfer The transfer belt is applied around the person’s waist, giving the nursing assistant a place to grasp and support the person Transferring Patients and Residents – Transfer Belts

25. Slide 25 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Precautions to be taken when using a transfer belt: Some patients or residents may have medical conditions that make it dangerous to use a transfer belt on them. Check the nursing care plan or ask the nurse for specific directions. A transfer belt is only an assist device and should never be used to “lift” a person who is unable to bear weight. Transferring Patients and Residents – Transfer Belts

26. Slide 26 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Advance planning includes: Asking the nurse or physical therapist about any specific limitations of the patient or resident and the recommended method of transfer Gathering the necessary equipment (e.g., a mechanical lift or wheelchair) and making sure that the equipment is in good working condition If necessary, moving the furniture in the room to make space for a safe transfer Finally, asking others for help as necessary Transferring Patients and Residents – Planning

27. Slide 27 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. A person who needs your assistance during a transfer may feel weak and shaky The person may be frightened or embarrassed about having to rely on others to help her do things that seemed so easy previously Always explain the transfer procedure to the person, and make certain she understands how she is expected to help Transferring Patients and Residents

28. Slide 28 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Encouragement and reassurance along with firm, steady assistance will help the patient or resident gain confidence in her own abilities and learn to trust that a nursing assistant will be there to offer help as necessary Transferring Patients and Residents

29. Slide 29 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Accidents are common during the act of transferring It is important that safe transfer techniques are followed for both the nursing assistant and the person being transferred Safe Transferring Techniques

30. Slide 30 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Procedures for transferring patients and residents include: Transferring a person to and from a wheelchair or chair Transferring a person to and from a stretcher Transferring a person using a mechanical lift Assisting a person with walking (ambulating) Transferring Patients and Residents - Procedures

31. Slide 31 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Check to make sure that:  There are no broken or missing parts  The wheels turn smoothly and any safety straps are secure  The brakes hold well The transfer can be done with one assistant or two Transferring Patients and Residents - Wheelchair

32. Slide 32 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Stretchers are used to transport people to other parts of the facility for surgery or diagnostic testing. Critically ill and comatose people are also transported on stretchers. Transferring Patients and Residents - Stretcher

33. Slide 33 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Transferring a person using a mechanical lift: A mechanical lift is used to move people who are helpless or very heavy Before using a mechanical lift, make sure the person you need to transfer weighs less than the weight limit specified on the lift Transferring Patients and Residents – Mechanical Lift

34. Slide 34 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Transferring Patients and Residents – Ambulating Assisting a person with walking (ambulating) Frequent ambulation helps to preserve mobility, improves heart and lung function, and promote digestion Walking helps the person to remain as independent as possible for as long as possible A person who feels weak or unsteady benefits, both physically and emotionally, from being encouraged to walk with assistance

35. Slide 35 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Dangling: “Dangling” is the first step for someone who is going to get out of bed and walk When a person has been resting in bed, especially for a long time, sitting up and then standing causes blood to flow to the legs and away from the head, causing dizziness and fainting Dangling allows time for the heart and blood vessels to make up for the change in position Transferring Patients and Residents – Ambulating

36. Slide 36 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. Devices that can help people walk include: Walker Canes Crutches Transferring Patients and Residents – Ambulating

37. Slide 37 Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants. End of Presentation