10
Positioning, Transfers, and Ambulation
1. Review the principles of body mechanics
Define the following terms:
alignment
based on the word line; a body is in alignment when a
straight line could be drawn through the center of his body
and his center of gravity.
base of support
the foundation that supports an object.
center of gravity
the point in the body where the most weight is concentrated.
fulcrum and lever
a means of moving an object by resting it on a base of
support; a seesaw is an example of a fulcrum and lever.
10
Positioning, Transfers, and Ambulation
1. Review the principles of body mechanics
NAs should remember these guidelines for using proper body
mechanics:
• Assess the load.
• Think ahead, plan, and communicate the move.
• Check base of support. Have a firm footing.
• Face what you are lifting.
• Keep back straight.
• Begin in squatting position. Lift with legs.
• Tighten stomach muscles when beginning.
• Keep object close to the body.
• Push rather than lift.
10
Positioning, Transfers, and Ambulation
2. Explain positioning and describe how to safely position
residents
Define the following terms:
positioning
the act of helping people into positions that promote comfort
and health.
supine
body position in which a person lies flat on his back.
lateral
body position in which a person is lying on either side.
prone
body position in which a person is lying on his stomach, or
front side of the body.
10
Positioning, Transfers, and Ambulation
2. Explain positioning and describe how to safely position
residents
Define the following terms:
Fowler’s
a semi-sitting body position, in which a person’s head and
shoulders are elevated 45 to 60 degrees.
Sims’
body position in which a person is lying on his left side with
the upper knee flexed and raised toward the chest.
arm lock/lock arm
hold in which the caregiver places his arm under a person’s
arm, grasping the person’s shoulder, while the person grasps
the caregiver’s shoulder.
10
Positioning, Transfers, and Ambulation
2. Explain positioning and describe how to safely position
residents
Define the following terms:
draw sheet
an extra sheet placed on top of the bottom sheet; used for
moving residents.
shearing
rubbing or friction that results from the skin moving one way
and the bone underneath it remaining fixed or moving in the
opposite direction.
10
Positioning, Transfers, and Ambulation
2. Explain positioning and describe how to safely position
residents
Define the following terms:
logrolling
moving a person as a unit, without disturbing the alignment
of the body.
dangle
to sit up with the legs hanging over the side of the bed in
order to regain balance and stabilize blood pressure.
10 Positioning, Transfers, and Ambulation
Transparency 10-1: Five Basic Positions
10
Positioning, Transfers, and Ambulation
2. Explain positioning and describe how to safely position
residents
NAs should know the following facts about the five basic body
positions:
• Supine Position
• Resident lying flat on back
• Pillows under head and shoulders, arms, hands; heels
should not be touching the bed
• Lateral Position
• Resident lying on either side
• Pillows support head, arm, and leg on upper side, back
and head. Upper knee on pillow.
10
Positioning, Transfers, and Ambulation
2. Explain positioning and describe how to safely position
residents
Facts about the five basic body positions (cont’d):
• Prone Position
• Resident lying on stomach
• Small pillow under head and to keep feet off bed
• Fowler’s Position
• Semi-sitting, head and shoulders elevated
• Pillows at flexed knees, at flexed feet, and under head
• Sims’ Position
• Variation on lateral side position, left side-lying position
• Lower arm behind the back, upper knee flexed
• Pillows under head, arms, flexed knee, and foot
Helping a resident sit up using the arm lock
1.
Identify yourself by
name. Identify the
resident by name.
2.
Wash your hands.
3.
Explain procedure to the
resident. Speak clearly,
slowly, and directly.
Maintain face-to-face
contact whenever
possible.
4.
Provide for the resident’s
privacy with curtain,
screen, or door.
5.
Adjust bed to a safe
level, usually waist high.
Lock bed wheels.
Helping a resident sit up using the arm lock
6.
Move the pillow to the
head of the bed.
7.
Stand at the side of the
bed and face the head of
the bed. Spread feet
about 12 inches or
shoulder-width apart.
Bend your knees.
8.
Place your arm under
the resident’s arm and
grasp the resident’s
shoulder. Have the
resident grasp your
shoulder in the same
manner. This hold is
called the arm lock or
lock arm.
Helping a resident sit up using the arm lock
9.
Reach under the
resident’s head and
place your other hand on
the resident’s far
shoulder.
10. At the count of three,
rock yourself backward
and pull the resident to a
sitting position. Use
pillows or a bed rest to
support the resident in
the sitting position.
11. Check the resident for
dizziness or weakness. If
the resident is dizzy, you
can ease her back to the
supine position.
Helping a resident sit up using the arm lock
12. Put pillow back under
resident’s head. Make
resident comfortable.
13. Return bed to lowest
position. Remove privacy
measures.
14. Place call light within
resident’s reach.
15. Wash your hands.
16. Report any changes in
resident to the nurse.
Document procedure
using facility guidelines.
Moving a resident up in bed
Equipment: draw sheet
When the resident can
help you move her up in
bed, take the following
steps:
1.
Identify yourself by
name. Identify the
resident by name.
2.
Wash your hands.
3.
Explain procedure to the
resident. Speak clearly,
slowly, and directly.
Maintain face-to-face
contact whenever
possible.
4.
Provide for the resident’s
privacy with curtain,
screen, or door.
Moving a resident up in bed
5.
Adjust bed to a safe
level, usually waist high.
Lock bed wheels.
6.
Lower the head of bed to
make it flat. Move the
pillow to the head of the
bed.
7.
If the bed has side rails,
raise the rail on the far
side of the bed.
8.
Stand by bed with your
feet shoulder-width
apart, facing the
resident.
Moving a resident up in bed
9.
Place one arm under
resident’s shoulder
blades. Place the other
arm under resident’s
thighs. Use proper body
mechanics.
10. Ask resident to bend her
knees, place her feet
firmly on the mattress,
and push her feet and
hands on the count of
three.
Moving a resident up in bed
11. On the count of three,
shift your body weight,
and help move resident
while she pushes with
her feet. As always,
allow the resident to do
all she can for herself.
12. Make resident
comfortable. Put pillow
back under resident’s
head and arrange the
blankets for her.
13. Return bed to lowest
position. Remove privacy
measures.
14. Place call light within
resident’s reach.
Moving a resident up in bed
15. Wash your hands.
16. Report any changes in
resident to the nurse.
Document procedure
using facility guidelines.
When the resident cannot
assist and there is no one
else around to help you
move her up in bed, take
the following steps:
1.
Follow steps 1 through 6
above.
2.
Stand behind the head
of the bed with your feet
shoulder-width apart and
one foot slightly in front
of the other.
Moving a resident up in bed
3.
Roll and grasp the top
edge of the draw sheet.
4.
Bend your knees and
keep your back straight.
Rock your weight from
the front foot to the back
foot in one smooth
motion, while pulling the
draw sheet and resident
toward the head of the
bed.
5.
Make resident
comfortable. Put pillow
back under resident’s
head and arrange the
blankets for her. Unroll
the draw sheet and
leave it in place for the
next repositioning.
Moving a resident up in bed
6.
Return bed to lowest
position. Remove privacy
measures.
7.
Place call light within
resident’s reach.
8.
Wash your hands.
9.
Report any changes in
resident to the nurse.
Document procedure
using facility guidelines.
When you have help from
another person, you can
modify the procedure as
follows:
1.
Follow steps 1 through 6
above.
Moving a resident up in bed
2.
Stand on the opposite
side of the bed from
your helper. Each of you
should be turned slightly
toward the head of the
bed. For each of you, the
foot that is closest to the
head of the bed should
be pointed in that
direction. Stand with
your feet about
shoulder-width apart.
Bend your knees. Keep
your back straight.
Moving a resident up in bed
3.
Roll the draw sheet up to
the resident’s side, and
have your helper do the
same on her side of the
bed. Grasp the sheet
with your palms up, and
have your helper do the
same.
Moving a resident up in bed
4.
Shift your weight to your
back foot (the foot closer
to the foot of the bed)
and have your helper do
the same. On the count
of three, you and your
helper both shift your
weight to your forward
foot. Slide the draw
sheet and resident
toward the head of the
bed.
Moving a resident up in bed
5.
Make resident
comfortable. Put pillow
back under resident’s
head and arrange the
blankets for her. Unroll
the draw sheet and
leave it in place for the
next repositioning.
Moving a resident up in bed
6.
Return bed to lowest
position. Remove privacy
measures.
7.
Place call light within
resident’s reach.
8.
Wash your hands.
9.
Report any changes in
resident to the nurse.
Document procedure
using facility guidelines.
Moving a resident to the side of the bed
Equipment: draw sheet
1.
Identify yourself by
name. Identify the
resident by name.
2.
Wash your hands.
3.
Explain procedure to the
resident. Speak clearly,
slowly, and directly.
Maintain face-to-face
contact whenever
possible.
4.
Provide for the resident’s
privacy with curtain,
screen, or door.
5.
Adjust bed to a safe
level, usually waist high.
Lock bed wheels.
6.
Lower the head of bed.
Moving a resident to the side of the bed
7.
Stand on the same side
of the bed to where you
are moving the resident.
Stand with feet
shoulder-width apart,
and bend your knees.
Moving a resident to the side of the bed
8.
With a draw sheet:
Roll the draw sheet up to
the resident’s side, and
grasp the sheet with
your palms up. One
hand should be at the
resident’s shoulders, the
other about level with
the resident’s hips.
Apply one knee against
the side of the bed, and
lean back with your
body. On the count of
three, slowly pull the
draw sheet and resident
toward you.
Moving a resident to the side of the bed
Without a draw sheet:
Gently slide your hands
under the head and
shoulders and move
toward you. Gently slide
your hands under her
midsection and move it
toward you. Gently slide
your hands under the
hips and legs and move
them toward you.
9.
Make resident
comfortable.
10. Return bed to lowest
position. Remove privacy
measures.
11. Place call light within
resident’s reach.
Moving a resident to the side of the bed
12. Wash your hands.
13. Report any changes in
resident to the nurse.
Document procedure
using facility guidelines.
Turning a resident
1.
Identify yourself by
name. Identify the
resident by name.
2.
Wash your hands.
3.
Explain procedure to the
resident. Speak clearly,
slowly, and directly.
Maintain face-to-face
contact whenever
possible.
4.
Provide for the resident’s
privacy with curtain,
screen, or door.
5.
Adjust bed to a safe
level, usually waist high.
Lock bed wheels.
6.
Lower the head of bed.
Turning a resident
7.
Stand on side of bed
opposite to where
resident will be turned.
If the bed has side rails,
raise the far side rail.
Lower side rail nearest
you if it is up.
8.
Move resident to side of
bed nearest you using
previous procedure.
9.
Turning resident away
from you:
a.
Cross resident’s arm
over her chest. Move
arm on side resident is
being turned to out of
the way. Cross the leg
nearest you over the far
leg.
Turning a resident
b.
Stand with feet
shoulder-width apart.
Bend your knees.
c.
Place one hand on the
resident’s shoulder.
Place the other hand on
the resident’s nearest
hip.
d.
Gently push the resident
onto side as one unit,
toward the other side of
bed (toward raised side
rail if present). Shift
your weight from your
back leg to your front
leg.
Turning a resident
Turning resident toward
you:
a.
Cross resident’s arm
over his chest. Move arm
on side resident is being
turned to out of the way.
Cross the leg furthest
from you over the near
leg.
b.
Stand with feet
shoulder-width apart.
Bend your knees.
c.
Place one hand on the
resident’s far shoulder.
Place the other hand on
the far hip.
Turning a resident
d.
Gently roll the resident
toward you. Your body
will block resident and
prevent him from rolling
out of bed.
10. Position the resident
properly, comfortably,
and in good alignment.
Proper positioning
includes the following:
•
Head supported by
pillow
•
Shoulder adjusted so
resident is not lying on
arm
•
Top arm supported by
pillow
Turning a resident
•
Back supported by
supportive device
•
Top knee flexed
•
Supportive device
between legs with top
knee flexed; knee and
ankle supported
11. Return bed to lowest
position. Remove privacy
measures.
12. Place call light within
resident’s reach.
13. Wash your hands.
14. Report any changes in
resident to the nurse.
Document procedure
using facility guidelines.
Logrolling a resident
Equipment: draw sheet, coworker
1.
Identify yourself by
name. Identify the
resident by name.
2.
Wash your hands.
3.
Explain procedure to the
resident. Speak clearly,
slowly, and directly.
Maintain face-to-face
contact whenever
possible.
4.
Provide for the resident’s
privacy with curtain,
screen, or door.
5.
Adjust bed to a safe
level, usually waist high.
Lock bed wheels.
Logrolling a resident
6.
Lower the head of the
bed.
7.
Both people stand on the
same side of the bed.
One person stands at the
resident’s head and
shoulders. The other
stands near the
resident’s midsection.
8.
Place the resident’s arms
across his chest. Place a
pillow between the
knees.
9.
Stand with your feet
shoulder-width apart.
Bend your knees.
10. Grasp the draw sheet on
the far side.
Logrolling a resident
11. On the count of three,
gently roll the resident
toward you. Turn the
resident as a unit. Your
bodies will block the
resident and prevent him
from rolling out of bed.
12. Make resident
comfortable. Arrange
pillows and covers for
comfort.
13. Return bed to lowest
position. Remove privacy
measures.
14. Place call light within
resident’s reach.
15. Wash your hands.
Logrolling a resident
16. Report any changes in
resident to the nurse.
Document procedure
using facility guidelines.
Assisting a resident to sit up on side of bed: dangling
1.
Identify yourself by
name. Identify the
resident by name.
2.
Wash your hands.
3.
Explain procedure to the
resident. Speak clearly,
slowly, and directly.
Maintain face-to-face
contact whenever
possible.
4.
Provide for the resident’s
privacy with curtain,
screen, or door.
5.
Adjust bed to lowest
position. Lock bed
wheels.
Assisting a resident to sit up on side of bed: dangling
6.
Raise the head of bed to
sitting position. Fanfold
(fold into pleats) the top
covers to the foot of the
bed. Ask the resident to
turn onto his side, facing
you. Assist as needed
(see earlier procedure).
7.
Tell the resident to reach
across his chest with his
top arm and place his
hand on the edge of the
bed near his opposite
shoulder. Ask him to
push down on that hand
to raise his shoulders up
while swinging his legs
over the side of the bed.
Assisting a resident to sit up on side of bed: dangling
8.
Always allow the
resident to do all he can
for himself. However, if
the resident needs
assistance, follow these
steps:
a.
Stand with your legs
shoulder-width apart.
Bend your knees.
b.
Place one arm under the
resident’s shoulder
blades. Place the other
arm under the resident’s
thighs.
Assisting a resident to sit up on side of bed: dangling
c.
On the count of three,
slowly turn resident into
sitting position with legs
dangling over side of
bed. The weight of the
resident’s legs hanging
down from the bed helps
the resident sit up.
d.
9. Ask resident to hold
onto the edge of
mattress with both
hands. Assist resident to
put on non-skid shoes or
slippers.
Assisting a resident to sit up on side of bed: dangling
10. Have resident dangle as
long as ordered. The
care plan may direct you
to allow the resident to
dangle for several
minutes and then return
him to lying down, or it
may direct you to allow
the resident to dangle in
preparation for walking
or a transfer. Follow the
care plan. Do not leave
the resident alone. If the
resident is dizzy for
more than a minute,
have him lie down again
and report to the nurse.
Assisting a resident to sit up on side of bed: dangling
11. Take vital signs as
ordered (you will learn
how to take vital signs in
Chapter 14).
12. Remove slippers or
shoes.
13. Gently assist resident
back into bed. Place one
arm around resident’s
shoulders and the other
arm under the resident’s
knees. Slowly swing
resident’s legs onto bed.
14. Make resident
comfortable.
15. Leave bed in lowest
position. Remove privacy
measures.
Assisting a resident to sit up on side of bed: dangling
16. Place call light within
resident’s reach.
17. Wash your hands.
18. Report any changes in
resident to the nurse.
Document procedure
using facility guidelines.
10
Positioning, Transfers, and Ambulation
3. Describe how to safely transfer residents
Define the following terms:
ergonomics
the science of designing equipment, areas, and work tasks to
make them safer and to suit the worker’s abilities.
transfer/gait belt
a belt made of canvas or other heavy material that is used to
help people who are weak, unsteady, or uncoordinated to
stand, sit, or walk.
slide board
a wooden board that helps transfer people who are unable to
bear weight on their legs; also called a transfer board.
10
Positioning, Transfers, and Ambulation
3. Describe how to safely transfer residents
REMEMBER:
Many facilities have adopted no-lift, zero-lift, or lift-free policies.
It is important that NAs follow facility policy carefully.
10
Positioning, Transfers, and Ambulation
3. Describe how to safely transfer residents
REMEMBER:
When assisting residents NAs must know which side is stronger
and which is weaker and move the stronger side first. NAs should
never refer to a “bad side” or a “bad” leg or arm.
10
Positioning, Transfers, and Ambulation
3. Describe how to safely transfer residents
REMEMBER:
Transfer belts must be applies over the clothing and not on bare
skin. It is important to check and ensure no skin is caught in the
belt.
Applying a transfer belt
Equipment: transfer belt,
non-skid footwear
1.
Identify yourself by
name. Identify the
resident by name.
2.
Wash your hands.
3.
Explain procedure to the
resident. Speak clearly,
slowly, and directly.
Maintain face-to-face
contact whenever
possible.
4.
Provide for the resident’s
privacy with curtain,
screen, or door.
5.
Adjust bed to lowest
position. Lock bed
wheels.
Applying a transfer belt
6.
Assist the resident to a
sitting position with feet
flat on the floor.
7.
Put non-skid footwear on
resident and make sure
laces are tied.
8.
Place the belt over the
resident’s clothing and
around the waist. Do not
put it over bare skin.
9.
Tighten the buckle until
it is snug. Leave enough
room to insert flat
fingers/hand comfortably
under the belt.
Applying a transfer belt
10. Check to make sure that
skin or skin folds (for
example, breasts) are
not caught under the
belt.
11. Position the buckle
slightly off-center in the
front or back for
comfort.
10
Positioning, Transfers, and Ambulation
3. Describe how to safely transfer residents
NAs should know the following guidelines for wheelchairs:
• Know how to use brake, armrests, and footrests.
• Lock before transfer; unlock after.
• Open by pulling on both sides. Close by lifting center of seat.
• Remove armrests by releasing lock.
• Remove footrests by pulling back on lever and swinging out
toward side of chair.
• Lift or lower footrest by squeezing lever and pulling up or
pushing down.
• Resident must use side of body that can bear weight and lift
side that cannot.
10
Positioning, Transfers, and Ambulation
3. Describe how to safely transfer residents
Guidelines for wheelchairs (cont’d):
• Resident must be wearing non-skid footwear before
transferring.
• Keep resident safe and comfortable during transfers.
• Assist resident as needed by having chair close and wheels
locked. Use transfer belt and check alignment in chair.
• To move resident to back of chair, stand behind resident with
arms under resident’s arms; resident pushes, NA pulls gently.
Reposition resident at least every hour.
10
Positioning, Transfers, and Ambulation
3. Describe how to safely transfer residents
When a resident starts to fall, the NA should respond in this way:
• Widen stance.
• Bring resident’s body close.
• Bend knees and support resident.
• Lower resident to floor.
• Do not try to stop the fall.
• Call for help.
• Do not attempt to get resident up.
10
Positioning, Transfers, and Ambulation
3. Describe how to safely transfer residents
NAs should know these guidelines for using stretchers:
• Lock wheels before transferring.
• Keep safety belts fastened while in stretcher.
• Raise safety rails.
• Keep resident covered.
• Keep wheels locked except when moving stretcher.
• Get help.
10
Positioning, Transfers, and Ambulation
3. Describe how to safely transfer residents
Guidelines for stretchers (cont’d):
• Move slowly and carefully.
• Push stretcher from head end.
• Go through doorways by opening door, entering first, and
pulling stretcher through.
• Do not hit walls or doorways.
• Be cautious while going down sloping areas.
• Stay with resident at all times.
10
Positioning, Transfers, and Ambulation
3. Describe how to safely transfer residents
NAs should know these guidelines for mechanical lifts:
• Safer for two people to transfer with these lifts.
• Keep chair or wheelchair close to bed to only move resident a
short distance.
• Make sure valves are working.
• Check sling and straps for tears or fraying. Do not use
mechanical lift if there are tears or holes.
• Open legs of stand to widest position before helping resident
into lift.
• Pump up lift only to the point where the resident’s body clears
the bed or chair.
Transferring a resident from bed to wheelchair
Equipment: wheelchair, transfer
belt, non-skid footwear, and lap
robe or folded blanket
1.
Identify yourself by name.
Identify the resident by
name.
2.
Wash your hands.
3.
Explain procedure to the
resident. Speak clearly,
slowly, and directly.
Maintain face-to-face
contact whenever possible.
4.
Provide for the resident’s
privacy with curtain,
screen, or door. Check the
area to be certain it is
uncluttered and safe.
Transferring a resident from bed to wheelchair
5.
Remove both wheelchair
footrests close to the
bed.
6.
Place wheelchair near
the head of the bed with
arm of the wheelchair
almost touching the bed.
Wheelchair should be
facing the foot of the
bed. The wheelchair
should be placed on
resident’s stronger, or
unaffected, side.
7.
Lock wheelchair wheels.
8.
Raise the head of the
bed. Adjust bed to
lowest position. Lock bed
wheels.
Transferring a resident from bed to wheelchair
9.
Assist resident to sitting
position with feet flat on
the floor. Let resident sit
for a few minutes to
adjust to the change in
position.
10. Put non-skid footwear on
resident and fasten
securely.
11. Stand in front of resident
with your feet about
shoulder-width apart.
Bend your knees.
12. Place the transfer belt
around resident’s waist
over clothing (not on
bare skin). Grasp belt
securely on both sides.
Transferring a resident from bed to wheelchair
13. Provide instructions to
allow resident to help
with transfer.
Instructions may
include: “When you start
to stand, push with your
hands against the bed.”
“Once standing, if you’re
able, you can take small
steps in the direction of
the chair.” “Once
standing, reach for the
chair with your stronger
hand.”
Transferring a resident from bed to wheelchair
14. With your legs, brace
(support) resident’s
lower legs to prevent
slipping. This can be
done by placing one or
both of your knees in
front of the resident’s
knees.
15. Count to three to alert
resident. On three, with
hands still grasping the
transfer belt on both
sides and moving
upward, slowly help
resident to stand.
Transferring a resident from bed to wheelchair
16. Tell the resident to take
small steps in the
direction of the chair
while turning his back
toward the chair. Or, if
more assistance is
needed, help the
resident pivot (turn) to
stand in front of
wheelchair with back of
resident’s legs against
wheelchair.
Transferring a resident from bed to wheelchair
17. Ask the resident to put
hands on wheelchair arm
rests if able. When the
chair is touching the
back of the resident’s
legs, help the resident
lower himself into the
chair.
18. Reposition resident so
that his hips touch the
back of the wheelchair
seat. Remove transfer
belt if used.
Transferring a resident from bed to wheelchair
19. Attach footrests and
place the resident’s feet
on the footrests. Check
that the resident is in
proper alignment. Make
resident comfortable.
Place a lap robe or
folded blanket over the
resident’s lap as
appropriate.
20. Remove privacy
measures.
21. Place call light within
resident’s reach.
22. Wash your hands.
Transferring a resident from bed to wheelchair
23. Report any changes in
resident to the nurse.
Document procedure
using facility guidelines.
When transferring back to
bed from a wheelchair, the
height of the bed should be
equal to or slightly lower than
the chair. Help the resident
pivot to the bed. When the
resident feels the bed with
the back of his legs, help him
sit down slowly.
Transferring a resident from bed to stretcher
Equipment: stretcher,
blanket, draw sheet
1.
Identify yourself by
name. Identify the
resident by name.
2.
Wash your hands.
3.
Explain procedure to the
resident. Speak clearly,
slowly, and directly.
Maintain face-to-face
contact whenever
possible.
4.
Provide for the resident’s
privacy with curtain,
screen, or door.
5.
Lower the head of bed
so that it is flat. Lock
bed wheels.
Transferring a resident from bed to stretcher
6.
Fold linens to the foot of
the bed. Cover resident
with a blanket.
7.
Move the resident to the
side of the bed. Have
your co-workers help
you do this. Refer to the
procedure Moving a
resident to the side of
the bed earlier in this
chapter.
8.
Place stretcher solidly
against the bed, and lock
stretcher wheels. Bed
height should be equal
to or slightly above the
height of the stretcher.
Move stretcher safety
belts out of the way.
Transferring a resident from bed to stretcher
9.
Two workers should be
on one side of the bed
opposite the stretcher.
Two more workers
should be on the other
side of the stretcher.
10. Each worker should roll
up the sides of the draw
sheet and prepare to
move the resident.
Protect the resident’s
arms and legs during the
transfer.
Transferring a resident from bed to stretcher
11. On the count of three,
the workers lift and
move the resident to the
stretcher. All should
move at once. Make sure
the resident is centered
on the stretcher.
12. Place a pillow under the
resident’s head. Make
sure resident is still
covered with the
blanket.
13. Place the safety straps
across the resident.
Raise side rails on
stretcher.
Transferring a resident from bed to stretcher
14. Unlock stretcher’s
wheels. Move resident to
proper place, staying
with him until another
staff member takes
over.
15. Wash your hands.
16. Report any changes in
resident to the nurse.
Document procedure
using facility guidelines.
To return the resident to bed,
the bed height should be
equal to or slightly below the
stretcher.
Transferring a resident using a mechanical lift
Equipment: wheelchair or
chair, co-worker (if available),
mechanical or hydraulic lift
The following is a basic
procedure for transferring
using a mechanical lift. Ask
someone to help you before
starting.
1.
Identify yourself by
name. Identify the
resident by name.
2.
Wash your hands.
3.
Explain procedure to the
resident. Speak clearly,
slowly, and directly.
Maintain face-to-face
contact whenever
possible.
Transferring a resident using a mechanical lift
4.
Provide for the resident’s
privacy with curtain,
screen, or door.
5.
Lock bed wheels.
6.
Position wheelchair next
to bed. Lock brakes.
Transferring a resident using a mechanical lift
7.
Help the resident turn to
one side of the bed.
Position the sling under
the resident, with the
edge next to the
resident’s back,
fanfolding if necessary.
Adjust the bottom of the
sling so that it is even
with the resident’s
knees. Help the resident
roll back to the middle of
the bed, and then spread
out the fanfolded edge of
the sling.
Transferring a resident using a mechanical lift
8.
Roll the mechanical lift
to bedside. Make sure
the base is opened to its
widest point. Push the
base of the lift under the
bed.
9.
Position the overhead
bar directly over the
resident.
Transferring a resident using a mechanical lift
10. With the resident lying
on his back, attach one
set of straps to each side
of the sling. Attach one
set of straps to the
overhead bar. If
available, have a coworker support the
resident at the head,
shoulders, and knees
while being lifted. The
resident’s arms should
be folded across his
chest. If the device has
S hooks, they should
face away from resident.
Make sure all straps are
connected properly and
are smooth and straight.
Transferring a resident using a mechanical lift
11. Following manufacturer’s
instructions, raise the
resident two inches
above the bed. Pause a
moment for the resident
to gain balance.
12. If available, a lifting
partner can help support
and guide the resident’s
body while you roll the
lift so that the resident is
positioned over the chair
or wheelchair.
Transferring a resident using a mechanical lift
13. Slowly lower the resident
into the chair or
wheelchair. Push down
gently on the resident’s
knees to help the
resident into a sitting,
rather than reclining,
position.
14. Undo the straps from the
overhead bar to the
sling. Remove sling or
leave in place for
transfer back to bed.
15. Be sure the resident is
seated comfortably and
correctly in the chair or
wheelchair. Remove
privacy measures.
Transferring a resident using a mechanical lift
16. Place call light within
resident’s reach.
17. Wash your hands.
18. Report any changes in
resident to the nurse.
Document procedure
using facility guidelines.
Transferring a resident onto and off of a toilet
Equipment: 2 pairs of gloves,
toilet paper or disposable
wipes, wheelchair
1.
Identify yourself by
name. Identify the
resident by name.
2.
Wash your hands.
3.
Explain procedure to the
resident. Speak clearly,
slowly, and directly.
Maintain face-to-face
contact whenever
possible. Make sure
resident is wearing nonskid shoes.
4.
Provide for the resident’s
privacy with curtain,
screen, or door.
Transferring a resident onto and off of a toilet
5.
Position wheelchair at a
right angle to the toilet
to face the hand bar/wall
rail. Place wheelchair on
the resident’s stronger
side.
6.
Remove wheelchair
footrests. Lock wheels.
7.
Put on gloves.
8.
Apply a transfer belt
around the resident’s
waist over clothing (not
on bare skin). Grasp belt
securely on both sides.
Transferring a resident onto and off of a toilet
9.
Ask resident to push
against the armrests of
the wheelchair and
stand, reaching for and
grasping the hand bar.
Move wheelchair out of
the way.
Transferring a resident onto and off of a toilet
10. Ask resident to pivot her
foot and back up so that
she can feel the front of
the toilet with the back
of her legs.
11. Help resident to pull
down pants and
underwear. You may
need to keep one hand
on the transfer belt while
helping to remove
clothing.
Transferring a resident onto and off of a toilet
12. Help resident slowly sit
down onto the toilet. Ask
resident to pull on the
emergency cord if she
needs help. Remove and
discard gloves. Wash
your hands. Leave
bathroom and close
door.
13. When called, return and
don clean gloves. Assist
with perineal care as
necessary (see Chapter
13). Ask her to stand
and reach for the hand
bar.
Transferring a resident onto and off of a toilet
14. Use toilet paper or
disposable wipes to
clean the resident. Make
sure she is clean and dry
before pulling up
clothing. Remove and
discard gloves.
15. Help resident to the sink
to wash hands.
16. Wash your hands.
17. Help resident back into
wheelchair. Be sure the
resident is seated
comfortably and
correctly in the
wheelchair. Replace
footrests.
Transferring a resident onto and off of a toilet
18. Help resident to leave
the bathroom. Make sure
resident is comfortable.
Remove privacy
measures.
19. Place call light within
resident’s reach.
20. Wash your hands again.
21. Report any changes in
resident to the nurse.
Document procedure
using facility guidelines.
Transferring a resident into a vehicle
Equipment: wheelchair
1.
Identify yourself by
name. Identify the
resident by name.
2.
Wash your hands.
3.
Explain procedure to the
resident. Speak clearly,
slowly, and directly.
Maintain face-to-face
contact whenever
possible.
4.
Place wheelchair close to
the vehicle at a 45degree angle. Open the
door on the resident’s
stronger side.
5.
Lock wheelchair.
Transferring a resident into a vehicle
6.
Ask the resident to push
against the arm rests of
the wheelchair and
stand.
7.
Ask the resident to
stand, grasp the vehicle,
and pivot his foot so the
side of the seat touches
the back of the legs.
8.
The resident should then
sit in the seat and lift
one leg, and then the
other, into the vehicle.
Transferring a resident into a vehicle
9.
Carefully position the
resident comfortably in
the vehicle. Help fasten
seat belt.
10. Safely shut the door.
11. Return the wheelchair to
the appropriate place for
cleaning.
12. Wash your hands.
13. Document procedure
using facility guidelines.
10
Positioning, Transfers, and Ambulation
3. Describe how to safely transfer residents
NAs should know these guidelines for stand-up lifts:
• Used when resident can bear some weight on his legs but has
poor leg strength and/or balance
• Resident must be able to stand and have some arm strength.
• Manual and battery-powered lifts are different types.
• Brakes must be locked before using.
• Resident in sitting position, with feet on foot plate and knees
against knee pads
• Resident grasps support bar and pulls himself up.
• Lower sides of seat into position, adjust straps, and resident
lowers himself into seat while holding bars.
10 Positioning, Transfers, and Ambulation
Handout 10-1: Transferring a Resident to Bed from Wheelchair
Transferring a resident to bed from wheelchair
1.
Identify yourself by name. Identify the resident by name.
2.
Wash your hands.
3.
Explain procedure to the resident. Speak clearly, slowly, and directly.
Maintain face-to-face contact whenever possible.
4.
Provide for the resident’s privacy with curtain, screen, or door. Check the
area to be certain it is uncluttered and safe.
5.
Remove both wheelchair footrests close to the bed.
6.
Place wheelchair near the head of the bed with arm of the wheelchair almost
touching the bed. Wheelchair should be facing the foot of the bed. The
wheelchair should be placed on resident’s stronger, or unaffected, side.
7.
Lock wheelchair wheels.
8.
Adjust bed level. The height of the bed should be equal to or slightly lower
than the chair. Lock bed wheels.
9.
Stand in front of resident with your feet about shoulder-width apart. Bend
your knees.
10. Place the transfer belt around resident’s waist over clothing (not on bare
skin). Grasp belt securely on both sides.
11. Provide instructions to allow resident to help with transfer.
10 Positioning, Transfers, and Ambulation
Handout 10-1: Transferring a Resident to Bed from Wheelchair (cont’d.)
12. With your legs, brace resident’s lower legs to prevent slipping. This can be
done by placing one or both of your knees in front of the resident’s knees.
13. Count to three to alert resident. On three, with hands still grasping the
transfer belt on both sides and moving upward, slowly help resident stand.
14. Tell the resident to take small steps in the direction of the bed while turning
his back toward the bed. Or, if more assistance is needed, help the resident
pivot to stand in front of bed with back of resident’s legs against bed. When
he feels the bed, help him sit down on the side of the bed.
15. Make resident comfortable. Remove transfer belt.
16. Return bed to lowest position. Remove privacy measures.
17. Place call light within resident’s reach.
18. Wash your hands.
19. Report any changes in resident to the nurse. Document procedure using
facility guidelines.
10
Positioning, Transfers, and Ambulation
4. Discuss how to safely ambulate residents
Define the following terms:
ambulation
walking.
ambulatory
capable of walking.
10
Positioning, Transfers, and Ambulation
4. Discuss how to safely ambulate residents
REMEMBER:
NAs should check the care plan before helping a resident to
ambulate and must always keep the resident’s limitations in
mind.
Assisting a resident to ambulate
Equipment: gait belt, nonskid shoes
1.
Identify yourself by
name. Identify the
resident by name.
2.
Wash your hands.
3.
Explain procedure to
resident. Speak clearly,
slowly, and directly.
Maintain face-to-face
contact whenever
possible.
4.
Provide for resident’s
privacy with curtain,
screen, or door.
Assisting a resident to ambulate
5.
Adjust bed to lowest
position so that the feet
are flat on the floor.
Lock bed wheels.
6.
Before ambulating, put
non-skid footwear on the
resident and securely
fasten.
7.
Stand in front of the
resident, facing the
resident, with your feet
about shoulder-width
apart.
8.
Place gait belt around
resident’s waist over
clothing (not on bare
skin). Grasp belt
securely on both sides.
Assisting a resident to ambulate
9.
Always allow resident to
do whatever he is able
to do for himself. If the
resident is unable to
stand without help,
brace (support) the
resident’s lower
extremities. Bend your
knees. If the resident
has a weak knee, brace
it against your knee.
Assisting a resident to ambulate
10. Hold the resident close
to your center of gravity.
Provide instructions to
allow resident to help
with standing. Tell the
resident to lean forward,
push down on the bed
with his hands, and
stand on the count of
three. On three, with
hands still grasping the
gait belt on both sides
and moving upward,
slowly help resident to
stand.
Assisting a resident to ambulate
11. Walk slightly behind and
to one side of resident
for the full ordered
distance, while holding
onto the gait belt. If the
resident has a weaker
side, stand on the
weaker side. Use the
hand that is not holding
the belt to offer support
on the weak side. Ask
resident to look forward,
not down at the floor,
during ambulation.
Assisting a resident to ambulate
12. Observe the resident’s
strength while you walk
together. Provide a chair
if the resident becomes
dizzy or tired.
13. After ambulation,
remove gait belt. Help
resident to the bed or
chair and check that the
resident is in proper
alignment. Make
resident comfortable.
14. Leave bed in lowest
position. Remove privacy
measures.
15. Place call light within
resident’s reach.
Assisting a resident to ambulate
16. Wash your hands.
17. Report any changes in
resident to nurse.
Document procedure
using facility guidelines.
10
Positioning, Transfers, and Ambulation
4. Discuss how to safely ambulate residents
REMEMBER:
When an NA assists a visually-impaired resident with ambulation,
the resident should walk beside and slightly behind him. The NA
should warm the resident when approaching corners or steps.
10
Positioning, Transfers, and Ambulation
4. Discuss how to safely ambulate residents
Define the following terms:
C cane
a straight cane with a curved handle at the top.
functional grip cane
cane that has a straight grip handle.
quad cane
cane that has four rubber-tipped feet and a rectangular base.
walker
adaptive equipment used for people who are unsteady or who
lack balance; usually has four rubber-tipped feet and/or
wheels.
10
Positioning, Transfers, and Ambulation
4. Discuss how to safely ambulate residents
NAs should remember the following guidelines for cane or walker
use:
• Make sure cane or walker is in good condition.
• Make sure resident is wearing securely fastened non-skid
footwear.
• Resident should place cane on stronger side.
• Resident should place both hands on the walker, and walker
should be placed no more than six inches in front of resident.
• Stay near resident on weaker side.
• Do not hang purses or clothing on walker.
• Report to nurse if cane or walker seems to be the wrong
height.
Assisting with ambulation for a resident using a cane, walker, or crutches
Equipment: gait belt, nonskid shoes, cane, walker, or
crutches
1.
Identify yourself by
name. Identify resident
by name.
2.
Wash your hands.
3.
Explain procedure to
resident. Speak clearly,
slowly, and directly.
Maintain face-to-face
contact whenever
possible.
4.
Provide for resident’s
privacy with curtain,
screen, or door.
Assisting with ambulation for a resident using a cane, walker, or crutches
5.
Adjust bed to lowest
position so that the feet
are flat on the floor.
Lock bed wheels.
6.
Before ambulating, put
non-skid footwear on the
resident and securely
fasten.
7.
Stand in front of the
resident, facing the
resident, with your feet
about shoulder-width
apart.
8.
Place gait belt around
resident’s waist over
clothing (not on bare
skin). Grasp belt
securely on both sides.
Assisting with ambulation for a resident using a cane, walker, or crutches
9.
If the resident is unable
to stand without help,
brace (support) the
resident’s lower
extremities. Bend your
knees. If the resident
has a weak knee, brace
it against your knee.
Help the resident to
stand as described in the
previous procedure.
Assisting with ambulation for a resident using a cane, walker, or crutches
10. Help as needed with
ambulation.
a.
Cane: Resident places
cane about six inches, or
a comfortable distance,
in front of his stronger
leg. He brings weaker
leg even with cane. He
then brings stronger leg
forward slightly ahead of
cane. Repeat.
Assisting with ambulation for a resident using a cane, walker, or crutches
b.
Walker: Resident picks
up or rolls the walker
and places it about six
inches, or a comfortable
distance, in front of him.
All four feet or wheels of
the walker should be on
the ground before
resident steps forward to
the walker. The walker
should not be moved
again until the resident
has moved both feet
forward and is in a
steady position. The
resident should never
put his feet ahead of the
walker.
Assisting with ambulation for a resident using a cane, walker, or crutches
c.
Crutches: Resident
should be fitted for
crutches and taught to
use them correctly by a
physical therapist or
nurse. The resident may
use the crutches several
different ways,
depending on what his
weakness is. No matter
how they are used,
weight should be on the
hands and arms. Weight
should not be on the
underarm area.
Assisting with ambulation for a resident using a cane, walker, or crutches
11. Walk slightly behind and
to one side of resident.
Stay on the weaker side
if resident has one. Hold
the gait belt if one is
used.
12. Watch for obstacles in
the resident’s path. Ask
resident to look forward,
not down at the floor,
during ambulation.
13. Encourage the resident
to rest if he is tired.
When a person is tired,
it increases the chance
of a fall. Let the resident
set the pace. Discuss
how far he plans to go
based on the care plan.
Assisting with ambulation for a resident using a cane, walker, or crutches
14. After ambulation,
remove gait belt. Help
resident to the bed or
chair and check that the
resident is in proper
alignment. Make
resident comfortable.
15. Leave bed in lowest
position. Remove privacy
measures.
16. Place call light within
resident’s reach.
17. Wash your hands.
18. Report any changes in
resident to nurse.
Document procedure
using facility guidelines.
10
Positioning, Transfers, and Ambulation
Exam
Multiple Choice. Choose the correct answer.
1. Which of the following is part of using proper body mechanics?
(A) The nursing assistant should twist her back when carrying objects.
(B) The nursing assistant should push when possible, rather than lifting.
(C) The nursing assistant should use a narrow base of support.
(D) The nursing assistant should lift with her back, not her legs.
2.
Which of the following statements is true of positioning?
(A) Residents will not need help getting into comfortable positions or
changing positions.
(B) Constant pressure on an area helps prevent skin problems.
(C) NAs should check residents’ skin each time they are repositioned.
(D) Bed-bound residents should be repositioned every three hours.
10
Positioning, Transfers, and Ambulation
Exam
3.
How often should bed-bound residents be repositioned?
(A) At least every two hours
(B) Once per shift
(C) Twice a day
(D) At least every three hours
4.
How often should residents in wheelchairs be repositioned?
(A) At least every hour
(B) At least every two hours
(C) At least every three hours
(D) At least every four hours
10
Positioning, Transfers, and Ambulation
Exam
5.
A resident who is lying on either her left or her right side is in the _______
position.
(A) Supine
(B) Lateral
(C) Prone
(D) Fowler’s
6.
A resident who has her head and shoulders elevated and is in a semi-sitting
position (45 to 60 degrees) is in the ________ position.
(A) Sims’
(B) Fowler’s
(C) Prone
(D) Lateral
10
Positioning, Transfers, and Ambulation
Exam
7.
A resident who is lying on her stomach with her arms at her sides is in the
________ position.
(A) Sims’
(B) Fowler’s
(C) Prone
(D) Lateral
8.
A resident who is lying on her left side with her upper knee flexed and
raised toward the chest is in the ________ position.
(A) Sims’
(B) Fowler’s
(C) Prone
(D) Supine
10
Positioning, Transfers, and Ambulation
Exam
9.
A resident who is lying flat on his back with his head and shoulders
supported by a pillow is in the ________ position.
(A) Sims’
(B) Fowler’s
(C) Prone
(D) Supine
10. Dangling means
(A) Sitting up with legs over side of bed
(B) Sitting up in chair with feet on floor
(C) Lying in bed with feet over side of bed
(D) Hanging both arms over chair rests
10
Positioning, Transfers, and Ambulation
Exam
11. When using
(A) Place it
(B) Place it
(C) Place it
(D) Place it
a transfer belt, the NA should
underneath the resident’s clothing
around the resident’s shoulders
around a resident’s chest
over the resident’s clothing
12. When transferring residents who have a strong side and a weak side, the
NA should plan the move so that
(A) The stronger side moves first
(B) The weaker side moves first
(C) Both feet move at the same time
(D) The wheelchair moves first
10
Positioning, Transfers, and Ambulation
Exam
13. Which of the following is true of mechanical lifts?
(A) Mechanical lifts prevent injury.
(B) It is safer for the NA to lift residents without the use of a mechanical
lift.
(C) There is only one kind of mechanical lift.
(D) When using a mechanical lift, the NA should pump it approximately five
feet over the bed before moving the resident.
14. If a
(A)
(B)
(C)
(D)
resident starts to fall, the best thing an NA can do is to
Catch the resident under the arms to stop the fall
Widen her stance and bring the resident’s body close to her
Lock her knees
Move out of the way
10
Positioning, Transfers, and Ambulation
Exam
15. Which of the following canes has four rubber-tipped feet?
(A) Quad cane
(B) Functional grip cane
(C) C cane
(D) Crutch cane
16. When a resident can walk, he or she is
(A) Ambulating
(B) Accessorizing
(C) Abducting
(D) Adducting
10
Positioning, Transfers, and Ambulation
Exam
17. How should a resident use a cane to aid ambulation?
(A) Place the cane about six inches in front of his weaker leg.
(B) Place the cane about six inches in front of his stronger leg.
(C) Take the cane along in case he gets tired.
(D) Allow the cane to drag about six inches behind him.
18. What should a nursing assistant do if a resident’s walker seems too short
for the resident to use properly?
(A) The NA should adjust the height of the walker for the resident.
(B) The NA should inform the nurse.
(C) The NA should see if the resident can adjust the height of the walker.
(D) The NA should suggest to the resident that she needs a new one.