BODY MECHANICS - describes the efficient, coordinated, and safe use of the body to move objects and carry out

the activities of daily living.

Major Purposes of Body Mechanics: To facilitate the safe and efficient use of appropriate muscle groups to maintain balance. To reduce the energy required. To reduce fatigue. To decrease the risk of injury.

Three Basic Elements of Body Mechanics: body alignment(posture) balance(stability) coordinated body movement

Body Alignment:- Geometric arrangement of body parts in relation to each other.- One criteria for assessing general health, physical fitness, and attractiveness.- reflects the mood, self-esteem, and personality of an individual.

Good Body Alignment Promotes: optimal balance and maximal body function Helps one to achieve balance without undue strain on the joints, muscles, tendons, or

ligaments. Enhances lung expansion and promotes efficient circulatory, renal, and gastrointestinal

functions.

Using Body Mechanics

1. INTRODUCTION

Some of the most common injuries sustained by members of the health care team are severe musculoskeletal strains. Many injuries can be avoided by the conscious use of proper body mechanics when performing physical labor.

2. DEFINITION

Body mechanics is the utilization of correct muscles to complete a task safely and efficiently, without undue strain on any muscle or joint.

3. PRINCIPLES OF GOOD BODY MECHANICS

Maintain a Stable Center of Gravity.

1. Keep your center of gravity low. 2. Keep your back straight. 3. Bend at the knees and hips.

Maintain a Wide Base of Support. This will provide you with maximum stability while lifting.

1. Keep your feet apart. 2. Place one foot slightly ahead of the other. 3. Flex your knees to absorb jolts. 4. Turn with your feet.

Maintain the Line of Gravity. The line should pass vertically through the base of support.

1. Keep your back straight. 2. Keep the object being lifted close to your body.

Maintain Proper Body Alignment.

1. Tuck in your buttocks. 2. Pull your abdomen in and up. 3. Keep your back flat. 4. Keep your head up. 5. Keep your chin in. 6. Keep your weight forward and supported on the outside of your feet.

4. TECHNIQUES OF BODY MECHANICS

Lifting.

1. Use the stronger leg muscles for lifting. 2. Bend at the knees and hips; keep your back straight. 3. Lift straight upward, in one smooth motion.

Reaching.

1. Stand directly in front of and close to the object. 2. Avoid twisting or stretching. 3. Use a stool or ladder for high objects. 4. Maintain a good balance and a firm base of support. 5. Before moving the object, be sure that it is not too large or too heavy.

Pivoting.

1. Place one foot slightly ahead of the other. 2. Turn both feet at the same time, pivoting on the heel of one foot and the toe of the other. 3. Maintain a good center of gravity while holding or carrying the object.

Avoid Stooping.

1. Squat (bending at the hips and knees). 2. Avoid stooping (bending at the waist). 3. Use your leg muscles to return to an upright position.

5. GENERAL CONSIDERATIONS FOR PERFORMING PHYSICAL TASKS

1. It is easier to pull, push, or roll an object than it is to lift it. 2. Movements should be smooth and coordinated rather than jerky. 3. Less energy or force is required to keep an object moving than it is to start and stop it. 4. Use the arm and leg muscles as much as possible, the back muscles as little as possible. 5. Keep the work as close as possible to your body. It puts less of a strain on your back, legs, and

arms. 6. Rock backward or forward on your feet to use your body weight as a pushing or pulling force. 7. Keep the work at a comfortable height to avoid excessive bending at the waist. 8. Keep your body in good physical condition to reduce the chance of injury.

6. REASONS FOR THE USE OF PROPER BODY MECHANICS

Use proper body mechanics in order to avoid the following:

1. Excessive fatigue. 2. Muscle strains or tears. 3. Skeletal injuries. 4. Injury to the patient. 5. Injury to assisting staff members.

7. STEPS INVOLVED IN PROPERLY MOVING AN OBJECT TO A NEW LOCATION

The following paragraph takes you through the process of moving (lifting, pivoting, squatting, and carrying) a heavy object. (The same rules would apply to moving a patient.) The object will be moved from a waist high area to a lower area five to ten feet away. The procedure will combine all the rules of body mechanics previously discussed.

Identify the object to be moved.

Adopt a stable base of support.

1. Your feet are separated. 2. One foot is behind the other. 3. Your back is straight.

Grasp the object at its approximate center of gravity.

Pull the object toward your body's center of gravity using your arm and leg muscles.

Re-establish your base of support and appropriate body alignment.

1. Your back is straight. 2. You have a stable base of support. 3. You are holding the object approximately at waist height and close to your body.

Pivot toward the desired direction of travel.

1. Turn on both feet at the same time. 2. Maintain a stable balance.

Re-establish a stable base of support and appropriate body alignment.

1. Your back is straight. 2. Your feet are apart, one slightly behind the other. 3. The object is at hip level, close to your body.

Squat and place the object onto the lower area.

1. Bend at the knees and hips. 2. Maintain a straight back. 3. Maintain a stable base of support. 4. Use your arm and leg muscles (as needed) for guidance. 5. Use your leg muscles to resume an upright position.

Maintaining Proper Body Alignment

It is important because it affects a person’s appearance, stamina, and ability to use the musculoskeletal system efficiently. Good posture, whether it is standing, sitting, or lying position, distributes gravity through the center of the body over a wide base of support. Good posture is both important for nurses and clients.

When a person performs work while using poor posture, muscle spasm (sudden, forceful, involuntary muscle constrictions) often result. They occur more often when muscles are strained and forced to work beyond their capacity.

Dangers of Inactivity

Muscular WeaknessDecreased tone/strengthDecreased Size (Atrophy)

Skeletal Poor PostureContracturesFoot Drop

Cardiovascular Impaired CirculationThrombus (Clot) FormationDependent Edema

Respiratory Pooling Of SecretionsShallow RespirationsAtelectasis (Collapsed Alveoli)

Urinary Oliguria (Scanty Urine)Gastrointestinal Urinary Tract Infections

Calculi (Stone) FormationInconsistence (Inability to control elimination)

Integumentary Pressure SoresEndocrine Decreased metabolic rate

Decreased hormonal secretions

Central Nervous Sleep pattern disturbancesPsychological changes

Gravity – force objects toward the center of the earth. Cause water to drain to the lowest part.Energy – Capacity to do work.Balance – Steady position with weight.Center Of Gravity – Point at which the mass of an object is centered.Line Of Gravity – Imaginary line that passes through the center of gravity.Base Of Support – Area of which an object rests.Alignment – Parts of an object being in proper relationship to one another.Neutral Position - The position of a limb that is turned neither toward or away the body’s midline.Anatomic Position – Frontal and back views with arms at side and palms forwardFunctional Position – Position in which an activity is performed properly and normally. In the hand, the wrists are slightly dorsiflexed between 20 and 35 degrees a proximal finger joints are flexed between 45 and 60 degrees, with thumb in opposition and alignment with the pads of the fingers.

Standing Position

To maintain good posture in a standing position: Keep the feet parallel, at right angles to the lower legs, and about 4 to 8 inches (10 to

20cm) apart. Distribute a weight equally on both feet to provide a broad base of support. Bend knees slightly to avoid straining the joints. Maintain the hips at an even level. Pull in the buttocks and hold the abdomen up and in to keep the spine properly

aligned. This position support the abdominal organs and reduces strains on both back and abdominal muscles.

Hold the chest up and slightly forward and extend or stretch the waist to give internal organs more space and maintain good alignment of the spine.

Keep the shoulders even and centered above the hips. Hold the head erect with the face forward and chin slightly tucked.

Sitting Position

In a good sitting position, the buttocks and upper thighs become base of support. Both feet rest on the floor The knees are bent, with the posterior of the knee free from the edge of the chair to avoid interfering with distal circulation.

Lying Position

Good posture in a lying position looks the same as in a standing position, except the person is horizontal. The head and neck muscles are in neutral position, centered between the shoulders. The shoulders are in level, whereas the arms, hips, and knees are slightly flexed with no compression of the arms or legs under the body. The trunk is straight, and the hips are in level. The legs are parallel to each other with the feet at right angles to the leg.

Coordinated Body Movements Complex mechanisms Proprioception

- Awareness of posture, movement, changes in equilibrium- Knowledge in position, weight, resistance of objects in relation to body

Exercise Is a type of physical activity Defined as planned, structured, or repetitive bodily movement Performed to improve or maintain one or more components of physical fitness

Types Of Exercise

Isotonic (Dynamic) Exercise

Muscles shortens to produce muscle contraction and active movement Increase muscle tone, mass, and strength Maintain joint flexibility and circulation HR and CO quicken increase Example of this exercise is pushing or pulling a stationary object

Isometric (Static or Setting) Exercise

Muscle contraction without moving the joint (muscle length does not change) Involve exerting pressure against a solid object Produce a mild increase in HR and CO No apparent increase in blood flow to other parts of the body Example of this exercise is squeezing a pillow or towel roll between the legs for 10

seconds.

Isokinetic (Resistive) Exercise

Muscles Contraction or tension against resistance Can be either isotonic or isometric Person moves (Isotonic) or tenses (Isometric) against resistance An increase in blood pressure and blood flow to muscles occurs Example of this exercises build up muscle groups

Aerobic Exercise

Activity during which the amount of oxygen taken in the body is greater that used to perform the activity

Improve cardiovascular conditioning and physical fitness

Anaerobic Exercise

Activity in which the muscles cannot draw enough oxygen from the bloodstream Anaerobic pathways are used to provide additional energy for a short time

Effects on Musculoskeletal System

Exercise- Maintain size, shape, tone, and strength of muscles- Nourish joints- Increase joint flexibility, stability, and ROM- Maintain bone density and strength

Immobility- Disuse osteoporosis- Disuse atrophy- Contractures- Stiffness or pain in the joints

Effects on the Cardiovascular System

Exercise- Increase HR, strength of contraction, and blood supply to the heart and muscles- Meditates harmful effects of stress

Immobility- Diminished cardiac reserve- Increase use of the valsalva maneuver- Orthostatic hypotension- Venous vasodilation and stasis- Dependent edema- Thrombus formation

Effects on the Respiratory System

Exercise- Increase ventilation and oxygen intake improving gas exchange- Prevents pooling of secretions in the bronchi and bronchioles

Immobility- Decreased respiratory movement- Pooling of respiratory secretions- Atelectasis- Hypostatic pneumonia

Effects on the Metabolic/Endocrine System

Exercise- elevates the metabolic rate- Decrease serum triglycerides and cholesterol- Stabilizes blood sugar and make cells more responsive to insulin

Immobility- Decreased metabolic rate- Negative nitrogen balance- Anorexia- Negative calcium balance

Effects on the GI System

Exercise- Improves the appetite- Increases GI tract tone- Facilitates peristalisis

Immobility- Constipation

Effects on the Urinary System

Exercise- Promotes blood flow to the kidneys causing body wastes to be excreted more effectively- Prevents stasis (stagnation) of urine in the bladder

Immobility- Urinary stasis- Renal calculi- Urinary retention- Urinary infection

Effects on the Immune System

Exercise- Pumps lymph fluids from tissues into lymph capillaries and vessels- Increases circulation through lymph nodes- Strenuous exercise may reduce immune function

Effects on the Psychoneurologic System

Exercise- Elevates mood- Relieves stress and anxiety- Improves quality of sleep for most individuals

Immobility- Decline in mood elevating substance- Perception of time intervals deteriorates- Problem-solving and Decision-making abilities ma deteriorate- Loss of over events can cause anxiety

Effects on the Cognitive System

Exercise- Positive effects on decision-making and problem-solving processes, planning, and paying attention- Induces cells in brain to strengthen and build neuronal connections

Other Effects of Exercise and Immobility

Evidence that certain types of exercise increase spiritual health Immobility causes reduced skin turgor and skin breakdown

Moving and turning the clients

When a nurse assists a person to move, correct body mechanics need to be employed so that the nurse is not injured. Correct body alignment for the client must also be maintained so that undue stress is not placed on the musculoskeletal system.

Turning to prone position

In the prone position, the client lies on the abdomen with the head turned to one side. The hips are not flexed. Both children and adults often sleep in this position, sometimes with one or both arms flexed over their heads. It is the only bed position that allows full extension of the hip and knee joints.

Advantages:

When used periodically, the prone position helps to prevent flexion contractures of the hips and knees, thereby counteracting a problem caused by all other bed position.

The prone position also promotes drainage from the mouth. Useful for unconscious clients or those clients recovering from

surgery of the mouth or throat.

Disadvantages:

The pull of gravity on the trunk produces a marked lordosis in most people, and the neck is rotated laterally to a significant degree.

The prone position may not be recommended for people with problems of the cervical or lumbar spine.

This position also causes plantar flexion. Some clients with cardiac or respiratory problems find the prone

position confining and suffocating because chest expansion is inhibited during respirations.

The prone position should be used only when the client’s back is correctly aligned, only for short periods, and only for people with no evidence of spinal abnormalities.

Unsupported position

Problem to be prevented

Corrective measure

Head is turned to side and neck is slightly flexed

Flexion or hyperextension of the neck.

Small pillow under head unless contraindicated

because of promotion of mucous drainage from mouth.

Body lies flat on abdomen accentuating lumbar curvature

Hyperextension of lumbar curvature; difficulty in breathing; pressure on breasts(women); pressure on genitals(men)

Small pillow or roll under abdomen just below the diaphragm.

Toes rest on bed surface ;feet are in plantar flexion

Plantar flexion(foot drop) Allow feet to fall naturally over end of mattress, or support lower legs on a pillow

TURNING A CLIENT TO A LATERAL POSITION IN

BED

Definition:

Movement to a lateral (side-lying position may be necessary when placing a bedpan

beneath the client, when changing client’s bed linen, or when repositioning the client.

Purpose:

1. Placing a bedpan beneath the client

2. Changing client’s bed linen

3. Repositioning the client

Special Considerations:

1. Turn a client in the prone position to the lateral or supine position before pulling

the client across the bed.

2. Assess the client’s capabilities and limitations for movement.

3. Assess your own skill and physical strength.

4. Use correct body mechanics.

5. Encourage the client to assist as much as possible.

6. Give explicit instructions to the client about what to do to help.

7. Obtain assistance of another health care worker to move helpless or heavy

clients.

8. Coordinate you efforts with those of the client and/or other health care workers.

9. Use side rails as needed to prevent falls.

PROCEDURE RATIONALE

1. Before moving a client to lateral position,

move the client closer to the side of the

bed opposite the side of the client will

face when turned.

This ensures that the client will be positioned

safely in the center of the bed after turning.

2. While standing on the side of the bed

nearest of the client, place the client’s

near arm across his or her chest. Abduct

the client’s far shoulder slightly from the

side of the body.

Placing the one arm forward facilitates the

turning motion. Placing the other arm away

from the body prevents that arm from being

caught beneath the client’s body during roll.

3. Place the client’s near ankle and foot

across the far ankle and foot. Raise the

side rail next to the client before going to

the other side of the bed.

Placing the near ankle and foot forward

facilitates the turning motion. Making these

preparations on the side of the bed closest to

the client helps the nurse prevent

unnecessary reaching. The raised side rail

prevents the client who is close to the edge

of the mattress from falling out of bed.

PROCEDURE RATIONALE

4. Position yourself on the side of the bed

toward which the client will turn, directly

in line with the client’s waistline and as

close as to the bed as possible.

Spinal twisting is avoided when the nurse’s

center of gravity and when the direction of

movement is squarely faced.

5. Incline your trunk forward from the hips.

Flex your hips, knees, and ankles.

Assume a broad stance with one foot

forward and the weight placed upon this

foot forward.

The broad stance provides balance. Flexing

the joints of the lower extremities lowers the

center f gravity, increasing stability, and

ensures use of the large leg muscles during

movement.

6. Place one hand on the client’s far hip and

the other hand on the client’s far

shoulder.

This position of the hands supports the client

at the two heaviest parts of the body,

providing greater control in movement

during the roll.

7. Tighten your gluteal, abdominal, leg and

arm muscles.

Isometric contraction of stabilizing muscles

helps to prevent musculoskeletal strain and

injury.

8. Rock backward, shifting your weight from

the forward to the backward foot, and roll

the client onto the side to face you.

Pulling requires less energy than lifting.

Rocking backwards uses the nurse’s body

weight to assist the pull. The enlarged base

of support enhances stability. Pulling the

client’s upper body directly toward the

center of gravity requires less force and

prevents spinal twisting

Moving a Client Up in Bed

Clients who have slid down in bed from fowler’s position or been pulled down by traction need assistance to move up in bed. The clients should be encouraged to accomplish this movement independently whenever health permits.

1. Adjust the bed and client’s position.• adjust the head of the bed to a flat position or as low as the client can tolerate. • raise the bed to the height of your center of gravity.• lock the wheels on the bed and raise the rail on the side of the bed opposite you.• remove all pillows, then place one against the head of the bed.

2. Elicit the client’s help in lessening your workload.• ask the client to flex the hips and knees and position the feet so that they can be used effectively for pushing.• ask the client to:

a. Grasp the head of the bed with both hands and pull during the move.b. Raise the upper part of the body on the elbows and push with the hands and

forearms during the move.c. Grasp the overhead trapeze with both hands and lift and pull during the

move.3. Position yourself appropriately, and move the client.

• face the direction of the movement and then assume a broad stance, with the foot nearest the bed behind the forward foot and weight on the forward foot. Incline your trunk forward from the hips. Flex hips, knees and ankles.• place your near arm under the client’s thighs. Push down on the mattress with the far arm.• tighten your gluteal, abdominal, leg and arms muscles, and rock from the back leg to the front leg and back again. Then shift the weight to the front leg as the client pushes the heels and pulls with the arms, moving the client toward the head of the bed.

4. Ensure client comfort.• Elevate the head of the bed and provide appropriate support devices for the client’s new postion.

Variations: A Client who has limited strength of the Upper Extremities • Assist the client to flex the hips and knees as above. Place the client’s arms across the chest. Ask the client to flex the neck during the move and keep the head off the bed surface. •Position yourself properly and place one arm under the client’s back and shoulders and the other arm under the client’s thighs. Shift your weight as above.

Variation: Pulling a client up in bed

This method emphasizes pulling the client up toward the head of the bed rather than lifting the client. It is designed to create less back strain for the nurse than a method that utilizes lifting. The steps are as follows:

• After lowering the head of the bed and removing all pillows, move the client to the edge of the bed closest to your body. • ask the client to assist or if the client has limited strength of the upper extremities, place the client’s arms across the chest and ask the client to flex the neck during the move. • Stand toward the head of the bed, and face the foot of the bed. Position yourself appropriately, and place both hands together beneath the client’s coccyx. Align your body so that it is directly in line with you hands. Your elbow closest to the client will be beneath the client’s upper back. Both elbows should rest on the surface of the bed. • Coordinating your efforts with those of the client, rock backward and shift weight from the forward to the backward foot, pulling the client directly toward you while the client pushes with the heels and pulls with the arms. The hip closest to the bed should slide along the side of the mattress. Your elbows should slide along the bed surface. • Raise the side rail and move to the opposite side of the bed. Move or pull the client as above, and move again to the opposite side of the bed. Move or pull the client back to the center of the bed. Raise the trade rail.

Variation: Two nurses using a hand-forearm interclock

Two people are required to move the clients who are unable to assist because of their condition or weight. Using the technique described in step 3, with the second burse on the opposite side of the bed, both of you interlock your forearms under the clients thighs and shoulders and lift the client up in bed.

Variation: Two nurses using a turn sheet

• Place a drawsheet or a full sheet folded in half under the client, extending from shoulders to thighs. Each of you rolls up or fanfolds the turn sheet close to the client’s body on either side. • Both of you then grasp the sheet close to the shoulders and buttocks of the client. Then follow the method of moving clients with limited upper extremity strength, described earlier.

ASSISTING THE CLIENT TO A SITTING POSITION IN BED/ MOVING THE CLIENT WITH ASSISTANCE

Procedure

1. Ask the client to place arms at the sides with the palms of the hands against the surface of the bed. The client can push against the bed surface to assist the nurse.

2. Facing the head of the bed, stand at the side of the bed and opposite the client’s buttocks. Assume a broad stance with the foot nearest the bed behind the other foot. Facing the head of the bed prevents twisting of the nurse’s body in the motion that follows. A broad stance enhances balance.

3. The nurse places the hand nearest the client over the client’s far shoulder to rest at a point between the shoulder blades. Place the hand of your free arm on the bed surface. This hand placement is designed to lift the client’s upper trunk evenly. The hand on the bed provides balance and leverage.

4. Raise the client to a sitting position by shifting your weight back to the leg. At the same time, have the client who can assist push with arms and hands. The nurse’s body weight counteracts the client’s weight.

Moving and Turning the Client in Bed

Actions and Rationales applicable to moving and lifting a client include this:

- Before moving a client, assess the degree of exertion permitted, the client physical abilities and ability to assist with the nurse, ability to understand instructions, degree of comfort or discomfort when moving, clients weight, presence of orthostatic hypotension, and your own strength and ability to move the client.

- If indicated, use pain relief modalities or medications prior to moving the client

- Prepare any needed assistive devices and supportive equipments

- Plan around encumbrances to movement such as an IV or heavy cast

- Be alert to the effects of any medications the client takes that may impair alertness, balance, strength, or mobility

- Obtain required assistance from other persons

- Explain the procedure to the client and listen to any suggestions the client or support people have

- Provide privacy

- Wash hands

- Raise the height of the bed to bring the client close to your center of gravity

- Lock the wheels on the bed, and raise the rail on the side of the bed opposite you to ensure client safety

- Face to the direction of the movement to prevent spinal twisting

- Assume a broad stance to increase stability and provide balance

- Lean your trunk forward, and flex your hips, knees, and ankles to lower your center of gravity, increase stability, and ensure large muscle groups during movements

- Tighten your gluteal, abdominal, leg, and arm muscles t prepare them for action and prevent injury

- Rock from the front leg to the back leg when pulling or from back leg to front leg when pushing to overcome inertia, counteract the clients weight, and help attain a balanced, smooth motion

- After moving the client, determine and document the clients comfort, body alignment, tolerance of the activity, ability to assist, use of support devices , and safety precautions required

Assisting the client to sit on the side of the bed (Dangling)

1) Rapport establishment. Information giving to the patient.

2) Perform hand hygiene and infection control procedures.

3) Provide for client privacy.

4) Position yourself and the client appropriately before performing the move

- Assist the client to a lateral position facing you.

- Raise the head of the bed slowly to its highest position. This decreases the distance that the client needs to move to sit up on the side of the bed.

- Position the client’s feet and lower legs at the edge of the bed. This enables the client’s feet to move easily off the bed during the movement and the client is aided by gravity into a sitting position.

5) Moving the client to sitting position

- Place one arm around the client’s shoulders and other arm beneath both of the client’s thighs near the knees. Supporting the client’s shoulders prevents client from falling backward during the movement. Supporting the client’s thighs reduces friction of the thighs against the bed surface during the move and increases the force of the movement.

- Tighten your gluteal, abdominal, leg and arm muscles

- Life the client’s thighs slightly. This reduces friction of the client’s thighs and the nurse’s arm against the bed surface.

-Pivot the balls of your feet in the desired direction facing the foot of the while pulling the client and legs off the bed. Pivoting prevents twisting of the nurse’s spine. The weight of the client’s legs swinging downward increases downward movement of the lower body and helps make the client’s lower body and helps make the client’s upper body vertical.

- Keep supporting the client until the client is well-balanced and comfortable. This movement may cause some clients to faint. Assess vital signs as indicated by the client’s health status.

- Push up with the arms as the heels and legs slide over the mattress edge.

- Maintain the sitting position by pushing both fists into the mattress behind and to the sides of the buttocks

6) Document relevant information.

Evaluation:

- Client who has had recent abdominal surgery or has great abdominal pain can be thought to sit up on the side of the bed/assume a dangle position without assistance. Ask the patient to roll to the side and lift the far lef over the near leg then grasp the mattress edge with the lower arm and push the fist of the upper arm into the mattress

- Check skin integrity for pressure areas.- Check for proper alignment after the position change. Do a visual check and

conform to the client.- Determine all required safety precautions.- Determine client’s tolerance to activity (vital signs before and after dangling)

particularly the first time the client changes position.

Transferring Between Bed and Chair

If your patient is too weak to transfer himself, use this technique to get him from his bed into a sturdy chair or wheelchair.

DON'T

* Don't let the patient wear slippers or shoes without nonslip soles.

* Don't leave the wheelchair's footrests down because they'll interfere with the transfer.

* Don't change the patient's position quickly because his cardiovascular system may not have time to adjust to postural changes.

* Don't stretch your back at any time during the transfer.

The patient starts to fall, help ease him to the nearest surface. Otherwise, you could lose your balance, fall, or strain a muscle.

DO

* Explain the procedure to the patient, demonstrate his role, and lock the wheels on his bed.

* Place the chair or wheelchair so that it's facing the foot of the bed and it's parallel to or at a 45-degree angle to the bed. If you're using a wheelchair, lock the wheels.

* Help the patient into a side-lying position, facing the chair. Make sure the bed is in its lowest position.

* Lower the side rails and raise the head of the bed slowly as high as the patient can tolerate.

* With one arm under the patient's shoulder and the other arm over his thighs, swing his legs over the side of the bed and help lift his trunk and shoulders.

* Put your arms around the patient's torso and ask him to move toward the edge of the bed. If possible, have him place his feet flat on the floor.

* With your arms around his torso, block his toes with your feet and his knees with your legs. Slightly bend your knees and ask him to put his hands on the edge of the bed.

* Tell him to push himself off the bed, supporting as much of his own weight as possible. At the same time, straighten your knees and hips, raising him as you straighten your body. Keep your back as straight as possible throughout the transfer.

* Pivot toward the wheelchair, keeping your knees against his. Tell the patient to grasp the chair's armrests for support when he feels the chair against the back of his legs. Flexing your hips and knees and keeping your back straight, help him lower himself into the chair.

* If he can't position himself correctly, help him move his buttocks against the back of the chair. Make sure the ischial tuberosity, not the sacrum, is providing the support base. If necessary, properly position his feet on the footrests and his arms on the armrests.

Wheelchair Safety Always lock the brakes on both wheels of the wheelchair when the client transfers in or

out of it. Raise the footplates before transferring the client into the wheelchair. Lower the footplates after the transfer, and place the client’s feet on them. Ensure the client is positioned well back in the seat of the wheelchair. Use seatbelts that fasten behind the wheelchair to protect confused clients from falls. Back the wheelchair into or out of an elevator, rear large wheels first.

IMPLEMENTATION

Preparation Plan what to do and how to do it. Obtain essential equipment before starting and check that it is functioning correctly. Remove obstacles from the area used for the transfer

Performance1. Prior to performing the procedure, introduce self and verify the client’s identity using

protocol. Explain the transfer process to the client. During transfer, explain step by step what the client should do, for example “Move your right foot forward”.

2. Perform hand hygiene and observe other appropriate infection control procedures.3. Provide for client privacy. 4. Position the equipment appropriately5. Prepare and assess the client.6. Give explicit instructions.

Ask the client to:

Move forward and sit on the edge of the bed. Lean forward slightly from the hips Place the foot of the stronger leg beneath the edge of the bed and put other foot

forward. Place client’s hands on the bed surface or on your shoulders so that the client

can push while standing.7. Position yourself correctly.

Stand directly in front of the client. Lean the trunk forward from the hips. Flex the hips, knees, and ankles. Assume a broad stance, placing one foot forward and one back. Mirror the placement of the client’s feet, if possible.

Encircle the client’s waist with your arms, and gasp the transfer belt at the client’s back with thumbs pointing downward.

Tighten your gluteal, abdominal, leg, and arm muscles.8. Assist the client to stand, and then move together toward the wheelchair.9. Assist the client to sit.

Ask client to:a. Back up to the wheelchair and place the legs against the seat.b. Place the foot of the stronger leg slightly behind the other.c. Keep the other foot forward.d. Place both hands on the wheelchair arms or on your shoulders.

Stand directly in front of the client. Place one foor forward and one back. Tighten your grasp on the transfer belt. Have the client shift the body weight by rocking to the back foot. Lower the body

onto the edge of the wheelchair seat by flexing the joints of the legs and arms.10. Ensure client safety.

Ask the client to push back into the wheelchair seat. Lower the footplates, and place the client’s feet on them. Apply a seat belt as required.

VARIATION: Angling the Wheelchair For clients who have difficulty walking, place the wheelchair at a 45-degree angle to the

bed.

VARIATION: Transferring Without a Belt For clients who need minimal assistance, place the hands against the sides of the

client’s chest during the transfer. For clients who require more assistance, reach through the client’s axillae and place the hands on the client’s scapulae during the transfer. Avoid placing hands or pressure on the axillae, especially for clients who have upper extremity paralysis or paresis.

VARIATION: Transferring with a belt and two nurses When the client is able to stand, position yourselves on both sides of the client, facing

the same direction as the client. Flex your hips, knees, and ankle. Grasp the client’s transfer belt with the hand closest to the client, and with the other hand support to the client’s elbows.

Coordinating your efforts, all three of you stand simultaneously, pivot, and move to the wheelchair. Reverse the process to lower the client onto the wheelchair seat.

VARIATION: Using a Sliding Board

For clients who cannot stand, use a sliding board to help them move without nursing assistance. This method not only promotes client’s sense of independence but also preserves your energy.

11. Document relevant information: Client’s ability to bear weight and pivot. Number of staff needed for transfer Length of time up in chair Client response to transfer and being up in chair or wheelchair

Logrolling a Client

Logrolling is a technique used to turn a client whose body must at all times be kept in straight alignment. An example is the client with a spinal injury. Considerable care must be taken to prevent additional injury. This technique requires two nurses or if the client is large, three nurses. For the client who has a cervical injury, one nurse must maintain the client’s head and neck alignment.

PERFORMANCE1. Prior to performing the procedure, introduce self and verify the client’s identity using

agency protocol. Explain the client what you are going to do, why is it necessary, and how he or she can cooperate.

2. Perform hand hygiene and observe other appropriate infection control procedures.3. Provide client privacy.4. Position yourselves and the client appropriately before the move.

Stand on the same side of the bed, and assume a broad stance with one foot ahead of the other.

Place the client’s arms across the chest. Lean your trunk, and flex your hips, knees and ankles. Place your arms under the client.

5. Pull the client to the side of the bed. One nurse counts: One two three go. Then, at the same time, all staff members

pull the client to the side of the bed by shifting their weight to the back foot. Elevate the side rail on this side of the bed.

6. Move to the other side of the bed, and place supportive devices for the client when turned.

Place a pillow where it will support the client’s head after the turn. Place one or two pillows between the client’s legs to support the upper leg when

the client is turned.7. Roll and position the client in proper alignment.

All nurses flex their hips, knees and ankles and assume a braod stance with one foot forward.

All nurses reach over the client. One nurse counts: 1, 2, 3, go. Then, at the same times, all nurses roll the client

to a lateral position. Support the client’s head, back, and upper and lower extremities with pillows.

Raise the side rails and place the call bell within the client’s reach.

VARATION: Using a Turn or Lift Sheet Use a turn sheet to facilitate logrolling. First, stand with another nurse on the same side

of the bed. Assume a broad stance with one foot forward, and grasp half of the fanfolded or rolled edge of the turn sheet.

Before turning the client, place pillow supports for the head and legs. This helps maintain the client’s alignment when turning. Then go to the other side of the bed, and assume a stable stance. Reaching over the client, grasp the far edges of the turn sheet, and roll the client toward you. The second nurse helps turn the client and provides pillow supports to ensure good alignment in the lateral position.

USING A FOOTBOARD:

• FOOTBOARD:

- Device that prevent foot drop by keeping the feet in a functional position.- Some commercial footborads have supports that prevent outward rotation of the

foot and lower leg.- Some footboards are "L" shaped and some can be changed to fit your needs.

Another type has support strips to keep your feet from falling to the side.

• HOW TO USE A FOOTBOARD:

- When a person is in bed for a long time their toes or feet may start to droop down. Their feet also may fall to the side. A footboard will keep this from happening. Follow these steps to put the footboard on the bed:

1. Put the footboard at the end of the bed so it makes an "L" with the bed. Or follow the instructions that come with your footboard.

2. Move the footboard so that your feet rest against it when you are lying in bed. Use pillows and folded blankets as padding if the board cannot be moved close enough to support your feet.

3. Pad the footboard with a towel or a blanket if the board is bare.4. Put a rolled towel or a pillow next to each foot so that they do not fall to the

side.5. Put the top bedcovers over the board so that the covers do not put weight

on the feet. Tuck the top bedcovers under the mattress to keep them in place.• FOOTBOARD

TROCHANTER ROLLS:

- Prevent the legs from turning outward. - The trochanters are the bony protrusions at the head of the femur near the hip. - Placing the positioning device at the trochanters helps to prevent the leg from

rotating outward.

• HAND ROLLS:- Devices that preserve the client’s functional ability to grasp and pick-up objects. - Hand rolls prevent contractures (permanently shortened muscles that resist

stretching) of the fingers. - They keep the thumb positioned slightly away from the hand and at the moderate

angle to the fingers.- The fingers are kept in a slightly neutral position rather than a tight fist. - A rolled-up washcloth or a ball can be used as an alternative to commercial hand

rolls. - Hand rolls are removed regularly to facilitate movement and exercise.

• USING A TROCHANTER ROLL:1. Fold a sheet lengthwise in half or in thirds and place it under the client’s hips. The

sheet will anchor the body in correct position.2. Place a rolled-up bath blanket or two bath towels under each end of the sheet that

extends on either side of the client. This provides support to the trochanters.3. Roll the sheet around the blanket so that the end of the roll is underneath. This

action prevents unrolling.4. Secure the rolls next to each hip and thigh. The rolls prevent external rotation of the

hip. 5. Permit the leg to rest against the trochanter roll. This position allows normal

alignment of the hips, preventing internal or external rotation.

• PREVENT INNER HIP ROTATION • PREVENT EXTERNAL HIP ROTATION

• HAND ROLL • TROCHANTER ROLL

Actions and relations applicable to moving and lifting clients include these:

1. Before moving a client, assess the degree of exertion permitted, the client’s physical abilities (e.g., muscle strength, presence of paralysis) and ability to assist with the move, ability to understand instructions, degree of comfort or discomfort when moving, client’s weight, presence of orthostatic hypotension (particularly important when client will be standing), and your own strength and ability to move the client.

2. If indicated, use pain relief modalities or medication prior to moving the client.3. Prepare any needed assistive devices and supportive equipments (e.g.,

pillows, trochanter roll).4. Plan around encumbrances to movement such as an IV or heavy cast.5. Be alert to the effects of any medications the clients takes that may impair

alertness, balance, strength, or mobility,6. Obtain required assistance from other persons.7. Explain the procedure to the client and listen to any suggestions the client or

support people have.8. Provide privacy.9. Wash hands.10. Raise the height of the bed to bring the client close to your center of gravity.11. Lock the wheels on the bed, and raise the rails on the side of the bed

opposite you to ensure client safety.12. Face in the direction of the movement to prevent spinal twisting.13. Assume a broad stance to increase stability and provide balance.14. Lean your trunk forward, and flex your hips, knees, and ankles to lower your

center of gravity, increase stability and ensure use of large muscle groups during movements.

15. Tighten your gluteal, abdominal, leg and muscles to prepare them for action and prevent injury.

16. Rock from the front leg to the back leg when pulling or from the back leg to the front leg when pushing to overcome inertia, counteract the client’s weight, and help attain a balanced, smooth motion.