1. Body Mechanics and Safe Resident Handling, Positioning, and Transfers
Chapter 14
Body Mechanics and Safe Resident Handling, Positioning, and Transfers
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2. Body Mechanics
Body mechanics means using the body in an efficient and careful way.
It involves:
Good posture
Balance
Using your strongest and largest muscles for work
Fatigue, muscle strain and injury can result from the improper use and positioning of the body during activity or rest.
Focus on the person’s and your own body mechanics. Good body mechanics reduces the risk of injury.
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3. Principles of Body Mechanics
Body alignment (posture) is the way the head, trunk, arms, and legs are aligned with one another.
Base of support is the area on which an object rests.
A good base of support is needed for balance.
Use the muscles in your shoulders, upper arms, hips, and thighs to lift and move residents and heavy objects.
Good alignment lets the body move and function with strength and efficiency. Standing, sitting, and lying down require good alignment.
When standing, your feet are your base of support. Stand with your feet apart for a wider base of support and more balance. A good strong base is needed for balance (Fig on p. 201).
Your strongest and largest muscles are in the shoulders, upper arms, hips, and thighs. Use them to avoid placing strain and exertion on smaller and weaker muscles, which causes fatigue and injury. Back injuries are a major risk.
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4. Good Body Mechanics For good body mechanics:
Bend your knees and squat to lift a heavy object.
Do not bend from the waist; it causes strain on small back muscles.
Hold items close to your body and base of support.
All activities require good body mechanics.
Holding items close to your body and base of support involves upper arm and shoulder muscles (Fig on p. 201). Holding objects away from your body places strain on small muscles in your lower arms.
You must safely and efficiently handle and move persons and heavy objects.
Follow the rules in Box 14-1 on p. 202.
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5. Ergonomics
Ergonomics is the science of designing the job to fit the worker.
The goal is to eliminate a serious and disabling work-related musculoskeletal disorder (MSD).
MSDs are injuries and disorders of the muscles, tendons, ligaments, joints, and cartilage.
Risk factors for MSDs in nursing centers include:
Force
Repeating action
Awkward postures
MSDs are workplace health hazards.
Always report a work-related injury as soon as possible.
MSDs also can involve the nervous system. MSDs are caused or made worse by the work setting.
The arms and back are often affected. So are the hands, fingers, neck, wrists, legs, and shoulders. MSDs are painful and disabling. They can develop slowly over weeks, months, and years. Or they can occur from one event.
Early signs and symptoms include pain, limited joint movement, or soft tissue swelling. Time off work is often needed. According to the US Department of Labor, nursing assistants are at great risk.
Early attention can help prevent the problem from becoming worse. Also injuries are often less serious and less costly to treat if they receive early attention.
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6. OSHA Identified Risk Factors
The Occupational Safety and Health Administration (OSHA) has identified risk factors for MSDs in nursing team members.
The risk of an MSD increases if risk factors are combined.
Risk factors:
Force: the amount of physical effort needed to perform a task
Repeating action: performing the same motion or series of motions continually or frequently
Awkward postures: assuming positions that place stress on the body
Heavy lifting: manually lifting residents who cannot move themselves
Review the nursing tasks that are known to be high risks for MSDs listed in the textbook.
Lifting or transferring heavy residents, preventing falls, and unexpected or sudden motions are examples of force.
Re-positioning residents and transfers to and from beds, chairs, and commodes without adequate rest breaks are examples of repeating action.
Examples of awkward postures include reaching above shoulder height, kneeling, squatting, leaning over a bed, bending, or twisting the torso while lifting.
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7. Risk of Back Injuries Back injuries:
Are a major threat
Can occur from repeated activities or one event
Signs and symptoms of back injuries include:
Pain when trying to assume a normal posture
Decreased mobility
Pain when standing or rising from a seated position
Review the signs and symptoms of back injuries listed in the textbook.
Follow the rules for good body mechanics in Box 14-1 on p They help prevent back injuries.
See Promoting Safety and Comfort: Back Injuries on p. 203.
Use good body mechanics to protect yourself from injury. Do not work alone. Avoid lifting whenever possible.
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8. Positioning the Person
Regular position changes and good alignment:
Promote comfort and well-being
Promote breathing
Promote circulation
Help prevent pressure ulcers and contractures
Residents may:
Move and turn when in bed or a chair without assistance
Need reminding to adjust their positions
Need help with position changes
Depend entirely on the nursing team for position changes
The person must be properly positioned at all times.
Review Focus on Communication: Positioning the Person on p. 204.
Review Delegation Guidelines: Positioning the Person on p. 204.
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9. Turning and Re-positioning
The person is repositioned at least every 2 hours.
Follow these guidelines to safely position a person:
Use good body mechanics.
Ask a co-worker to help you if needed.
Explain the procedure to the person.
Be gentle when moving the person.
Provide for privacy.
Use pillows as directed by the nurse for support and alignment.
Provide for comfort after positioning.
Place the signal light within reach after positioning.
Complete a safety check before leaving the room.
You must follow the nurse’s instructions and the care plan.
You must make sure you are not causing the person pain.
See Promoting Safety and Comfort: Positioning the Person on p. 204.
See Focus on Communication: Positioning the Person on p. 204.
See Delegation Guidelines: Positioning the Person on p. 204.
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10. Positions Fowler’s position (a semi-sitting position)
The head of the bed is raised between 45 and 60 degrees.
Supine position (dorsal recumbent position)
This is the back-lying position.
Prone position
The person lies on the abdomen with the head turned to one side.
Lateral position (side-lying position)
The person lies on one side or the other.
Review Figure 14-4 on p. 204 and the list of factors for good alignment in Fowler’s position.
Review the list of factors for good alignment in the supine position on pp and see Figure 14-5 on p. 204.
Review the list of factors for good alignment in the prone position on p. 204 and see Figures 14-6 and 14-7 on p. 205.
Review the list of factors for good alignment in the lateral position on p. 205 and see Figure 14-8 on p. 205.
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11. Positions (Cont’d) Sims’ position (semi-prone side position)
This is a left side-lying position.
Chair position
Persons who sit in chairs must hold their upper bodies and heads erect.
The nurse may ask you to put a small pillow between the person’s lower back and the chair.
A pillow is not used behind the back if restraints are used.
Some people require postural supports to keep them in good alignment.
Review the list of factors for good alignment in the Sims’ position on p. 205 and see Figure 14-9.
Review the list of factors for good alignment in a chair position on p. 205 and see Figure
Ask the nurse about the proper use of positioners and postural supports Figures and
The health team selects the best product for the person’s needs. The person’s safety, dignity, and function are considered.
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12. Proper Body Mechanics When providing care, you will:
Turn and reposition persons often
Move persons in bed
Transfer persons to and from beds, chairs, wheelchairs, stretchers, and toilets
You must use your body correctly.
To transfer a person means moving the person from one place to another.
Using your body correctly protects you and the person from injury.
Review Focus on Communication: Safe Resident Handling, Moving, and Transfers on p. 207.
Review Promoting Safety and Comfort: Safe Resident Handling, Moving, and Transfers on p. 207.
Review Teamwork and Time Management: Safe Resident Handling, Moving, and Transfers on p. 207
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13. Preventing Work-Related Injuries
OSHA recommends that:
Manual lifting be minimized in all cases
Manual lifting be eliminated when possible
For safe resident handling, moving, and transfers, the nurse and health team determine:
The resident’s dependence level
The amount of assistance needed
What procedure to use
The equipment needed
Review the guidelines for preventing work-related injuries listed in Box 14-2 on pp
Review the dependence level descriptions in Box 14-3 on p. 209.
Review Residents with Dementia: Preventing Work Related Injuries on p. 210.
Review Teamwork and Time Management: Preventing Work-Related Injuries on p. 210.
Review Delegation Guidelines: Preventing Work-Related Injuries on p. 210.
Review Promoting Safety and Comfort: Preventing Work-Related Injuries on p. 211.
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14. Preventing Work-Related Injuries (Cont’d)
Persons with dementia may:
Not understand what you are doing
Resist your handling, moving, and transfer efforts
Shout at you, grab you, or try to hit you
Measures to provide safe care for persons with dementia include:
Always get a co-worker to help you.
Do not force the person.
Proceed slowly and use a calm, pleasant voice.
Divert the person’s attention.
Tell the nurse at once if you have problems handling, moving, or transferring the person.
The person’s care plan also has measures for providing safe care.
Review Residents with Dementia: Preventing Work-Related Injuries on p The rules and guidelines in Box 14-3 on p The person’s care plan also has measures for providing safe care.
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15. Moving Persons in Bed Some persons can move and turn in bed.
Those who are weak, unconscious, paralyzed, or in casts need help.
If the person has a dependence level of Code 3: Extensive Assistance or Code 4: Total Dependence, use a mechanical lift or friction-reducing device. At least two staff members are needed.
If the person weighs less than 200 pounds, two to three staff members and a friction-reducing device are needed.
If the person weighs more than 200 lbs, at least three staff members and a friction-reducing device are needed.
Sometimes two or three people and a mechanical lift or a friction-reducing device are needed.
See Delegation Guidelines: Moving Persons in Bed on p. 211.
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16. Avoiding Friction and Shear
Protecting the skin
Friction and shearing injure the skin.
Friction and shearing cause infection and pressure ulcers.
Reduce friction and shearing when moving the person in bed by:
Rolling the person
Using a lift sheet (turning sheet)
Using a turning pad, a large incontinence product, board, or sheet
Older persons have fragile skin that is easily damaged.
Friction is the rubbing of one surface against another. When moved in bed, the person’s skin rubs against the sheet.
Shearing is when the skin sticks to a surface while muscles slide in the direction the body is moving (Fig on p. 211). It occurs when the person slides down in bed or is moved in bed.
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17. Re-positioning Raising the person’s head and shoulders
You can raise the person’s head and shoulders easily and safely by locking arms with the person.
It is best to have help with older persons and with those who are heavy or hard to move.
Moving the person up in bed
The person is moved up in bed for good alignment and comfort.
You can sometimes move lightweight adults up in bed alone if they can assist and use a trapeze.
Two or more staff members are needed to move heavy, weak, and very old persons.
Always protect the person and yourself from injury.
Do not pull on the person’s arm or shoulder.
Review the Raising the Person’s Head and Shoulders procedure on pp
When the head of the bed is raised, it is easy to slide down toward the middle and foot of the bed (Fig ).
It is best to have help and to use an assist device—lift sheet, large incontinence product, slide sheet.
Review Promoting Safety and Comfort: Moving the Person Up in Bed on p. 213.
Review the Moving the Person Up in Bed procedure on pp
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18. Using an Assist Device for Re-positioning
Moving the person up in bed with an assist device
Assist devices are used to move some persons up in bed.
With these devices, the person is moved more easily and more evenly.
With these devices, shearing and friction are reduced, helping to prevent pain and skin damage.
These devices also help prevent injury to bones, joints, and the spinal cord.
The device is placed under the person from the head to above the knees or lower.
At least two staff members are needed.
Such assist devices include a drawsheet (lift sheet), flat sheet folded in half, turning pad (Fig ), sheet (Fig ), and large incontinence product.
Review Promoting Safety and Comfort: Moving the Person Up in Bed with an Assist Device on p. 215.
Review the Moving the Person Up in Bed with an Assist Device procedure on p. 215.
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19. OSHA Recommendations
When moving the person up in bed, OSHA recommends the following:
If the person weighs less than 200 pounds, two or three staff members and a friction-reducing device are needed.
If the person weighs more than 200 pounds, at least three staff members and a friction-reducing device are needed.
Recall that getting the needed assistance to move persons in bed is safer for the resident and for you!
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20. Positioning to the Side of the Bed
Moving the person to the side of the bed
One method involves moving the person in segments.
Use a mechanical lift or the assist device method for:
Tall or heavy persons
Totally dependent persons
Persons requiring extensive assistance
Older persons
Persons with arthritis
Persons recovering from spinal cord injuries or spinal cord surgery
Re-positioning and care procedures require moving the person to the side of the bed.
The person is moved to the side of the bed before turning. Otherwise, after turning, the person lies on the side of the bed—not in the middle. One method involves moving the person in segments (see Fig ).
Review Promoting Safety and Comfort: Moving the Person to the Side of the Bed on p. 216.
Review the Moving the Person to the Side of the Bed procedure on p. 217.
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21. Turning Persons onto Their Side
Turning persons onto their sides helps prevent complications from bedrest. Certain procedures and care measures also require the side-lying position. The direction of turning depends on the person’s condition and the situation.
The person is turned toward you or away from you.
After the person is turned, position him or her in good alignment.
Persons may:
Be able to turn and reposition themselves in bed
Need help
Totally depend on the nursing staff for care
After the person is turned, use pillows to support the person in the side-lying position. Make sure the person’s face, nose, and mouth are not obstructed by a pillow or other device.
Review Delegation Guidelines: Turning Persons on p. 218.
Review Promoting Safety and Comfort: Turning Persons on p. 218.
Review the Turning and Re-positioning the Person procedure on pp
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22. Logrolling
Logrolling is turning the person as a unit, in alignment, with one motion.
The procedure is used to turn:
Older persons with arthritic spines or knees
Persons recovering from hip fractures
Persons with spinal cord injuries
Persons recovering from spinal surgery
The spine is kept straight at all times.
Many older persons suffer from arthritis in their spines, hips, and knees. When turning these persons, logrolling is preferred. Logrolling may be less painful for these persons.
Review Promoting Safety and Comfort: Logrolling on p. 219.
Review the Logrolling the Person procedure on p. 220.
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23. Sitting on the Side of the Bed (Dangling)
Residents dangle for many reasons.
Many older persons become dizzy or faint when getting out of bed too fast.
They may need to sit on the side of the bed for 1 to 5 minutes before walking or transferring.
While dangling the legs, the person:
Deep breathes and coughs
Moves the legs back and forth in circles
Two staff members may be needed to help the person sit on the side of the bed.
Some persons increase activity in stages—from bedrest to sitting on the side of the bed, and then to sitting in a chair. Walking is the next step.
Persons with balance and coordination problems need support. If dizziness or fainting occurs, lay the person down.
Review Delegation Guidelines: Dangling on p. 221.
Review Promoting Safety and Comfort: Dangling on p. 221.
Review the Sitting on the Side of the Bed (Dangling) procedure on p. 222.
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24. Transferring Persons
Residents are moved to and from beds, chairs, wheelchairs, shower chairs, commodes, toilets, and stretchers.
The amount of help needed and the method used vary with the person’s dependency level.
Arrange the room so there is enough space for a safe transfer. Correct placement of the chair, wheelchair, or other device also is needed for a safe transfer.
Transfer belts (gait belts) are used to:
Support residents during transfers
Reposition persons in chairs and wheelchairs
Bed to chair or wheelchair transfers
Help the person out of bed on his or her strong side.
The amount of help needed and method used vary with the person’s dependency level (See Box 14-3).
The rules of body mechanics apply to transfers. So do guidelines in Box 14-2.
Review Delegation Guidelines: Transferring Persons on p. 223.
Review Promoting Safety and Comfort: Transferring Persons on p. 223.
Review Teamwork and Time Management: Transferring Persons on p. 224.
Review the Transferring the Person to a Chair or Wheelchair procedure on pp
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25. Transfers and Lifts Chair or wheelchair to bed transfers
If the person is weak on one side, transfer the person so that the strong side moves first.
Mechanical lifts
Mechanical lifts are used
To transfer persons who
Cannot help themselves.
Are too heavy for the staff to transfer.
For transfers to and from beds, chairs, stretchers, tubs, shower chairs, toilets, commodes, whirlpools, or vehicles
The type of sling used depends on the person’s size, condition, and other needs.
Slings are padded, unpadded, or made of mesh.
Chair or wheelchair to bed transfers have the same rules as bed to chair transfers.
Review the Transferring the Person from a Chair or Wheelchair to Bed on pp
Mechanical lifts are used for transfers to and from beds, chairs, stretchers, tubs, shower chairs, toilets, commodes, whirlpools, or vehicles.
There are manual, battery-operated, and electric lifts. Some are mounted on the ceiling.
Review the descriptions of and uses for types of slings on pp
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26. Mechanical Lift Before using a mechanical lift:
You must be trained in its use.
It must work.
The sling, straps, hooks, and chains must be in good repair.
The person’s weight must not exceed the lift’s capacity.
At least two staff members are needed.
Always follow the manufacturer’s instructions.
Review Delegation Guidelines: Using a Mechanical Lift on p. 229.
Review Promoting Safety and Comfort: Using a Mechanical Lift on p. 229.
Review the Transferring the Person Using a Mechanical Lift procedure on pp
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27. Toileting Transfers Using the bathroom for elimination
promotes dignity, self-esteem, and independence.
is more private than using a bedpan, urinal, or bedside commode.
Transferring the person to and from the toilet
Sometimes mechanical lifts are used.
A board may be used if:
The wheelchair armrests are removable.
The person has upper body strength.
The person has good sitting balance.
There is enough room to position the wheelchair next to the toilet.
Getting to the toilet is hard for persons who use wheelchairs.
Bathrooms are often small. There is little room for you or a wheelchair. A board may be used
Transfers involving wheelchairs and toilets are often hard. Falls and work-related injuries are risks.
Review Promoting Safety and Comfort: Transferring the Person to and from the Toilet on p. 231.
Review the Transferring the Person to and from the Toilet procedure on pp
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28. Stretchers Stretchers (gurneys) are used for persons who:
Cannot sit up.
Must stay in a lying position.
Are seriously ill.
To transfer the person to the stretcher:
A drawsheet, turning pad, large incontinence product, sheet, or board is used.
At least two or three staff members are needed.
The stretcher is covered with a folded flat sheet or bath blanket. A pillow and extra blankets are on hand.
With the nurse’s permission, raise the head of the stretcher to Fowler’s or semi-Fowler’s position. This increases the person’s comfort.
Review OSHA’s recommendations for moving persons to a stretcher in the text.
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29. Stretcher Safety When the person is on the stretcher:
Safety straps are used.
The stretcher side rails are kept up during the transport.
The stretcher is moved feet first.
Never leave a person on a stretcher alone.
The stretcher is moved feet first so the staff member at the head of the stretcher can watch the person’s breathing and color during the transport. Never leave a person on a stretcher alone.
Review Promoting Safety and Comfort: Moving the Person to a Stretcher on p. 233.
Review the Moving the Person to a Stretcher procedure on pp
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30. Re-positioning in a Chair or Wheelchair
For good alignment and safety, the person’s back and buttocks must be against the back of the chair.
Follow the nurse’s directions and the care plan for the best way to reposition the person.
If the person cannot help, a mechanical lift is needed to re-position the person.
The person can slide down into the chair.
Do not pull the person from behind the chair or wheelchair.
If the person’s chair reclines, do the following: Ask a co-worker to help you.
Lock the wheels.
Recline the chair.
Position a friction-reducing device (drawsheet or sheet) under the person.
Use the device to move the person up.
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31. Quality of Life You must protect the right to privacy at all times.
The person’s rights also are protected by allowing personal choice whenever possible.
The person has the right to be free from restraint.
Promote independence to the extent possible.
Proper body mechanics protect the person from injury.
Always check with the nurse and the care plan to make sure the person’s choices are safe.
Protect the person’s right to privacy at all times. For example, a person is wearing a gown that is open in the back. Apply a robe or another gown to cover that person’s backside.
Promote independence by focusing on the person’s abilities, encouraging the person, letting the person help as much as safely possible, and telling the person when you notice even small improvements.
Promoting independence can improve self-esteem and aid in healing.
Talk with the person while moving him or her. Ask about his or her preferences. Doing so promotes comfort, independence, and social interaction.
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