Ambulation, Patient
transfer, Restraints, ROM
PN 1 Nursing Skill Labs
Before you ambulate the
pt……….
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assess pt capabilities
administer pain med if needed
plan what you are going to do and make
sure you have the right number of
helpers, the right equipment etc.
explain to patient what is going to
happen and what their role is
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make sure the area is free of obstacles
elevate bed, lock wheels etc.
watch body mechanics of both you and
your patient
protect patient from harm if dependent
avoid friction on patients skin
move smoothly using a rhythmic motion
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use mechanical devices as indicated but
make sure you know how to use them
safely !!!!
be realistic about what you can do safely
and without injury
dangle patient prior to standing to avoid
incidents related to postural hypotension
Ambulating with one nurse……...
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always dangle before you get pt up
stand patient and remind to stand erect
start with short walk if first time up
if patient starts to faint, have wide base
of support, encircle pt under arms and
gently lower to floor
if wearing belt use it to lean pt back and
to floor
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stand at patients side and place both
hands at patients waist if not using belt
place belt securely on patient and grasp
at back
walk behind and slightly to side of patient
if pt weak on one side, stand on that side
and put arm around waist
support weak arm with other arm
Ambulating with two
nurses……..
Two methods:
 1. Each nurse stands at pts side and
grasps interior aspect of pts upper arm
holding pts lower arm or hand with other
hand
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2. Nurses place arms under pts axillae
and grasp each others forearms behind
pt while patient puts arms over nurses
shoulders and nurse grasps pt hand with
free hand - all three must be same
height
Transferring from bed to chair one nurse
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place bed in low position
prepare patient
if patient not impaired, place chair close
to bed facing foot of bed
if patient impaired, place chair facing
head of bed
lock wheels!!!!!!
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get foot pedals out of the way
raise head of bed to highest position
assist pt to sit on side of bed
assist pt to stand (may use belts for this)
face patient and brace his feet and
knees with yours
place your hands around the pts waist
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pivot the patient into position in front of
the chair with legs up against back of
chair
have patient place one arm on chair to
steady self while lowering to chair while
you continue bracing feet and knees with
yours
position for comfort, call bell, blanket
Transferring from bed to chair two nurses
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prepare equipment and patient
move pt to side of bed and cross pts
arms across chest
lock wheels on bed
put chair next to bed with back of chair
parallel to head of bed
lock wheels on chair
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adjust bed to comfortable level for nurses
first nurse stands behind chair and slips arms
under pts axillae grasping pts wrists securely
second nurse faces wheelchair and supports
pts knees by placing arms under them
on prearranged signal, lift together
Transferring from bed to
stretcher
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prepare patient and room
raise bed to same height as stretcher
place draw sheet under pt and use it to
move patient to side of bed
position stretcher parallel to bed
lock wheels on bed and stretcher
nurse 1 kneels on bed on far side of pt at
upper torso and grasps draw sheet
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nurse 2 reaches across stretcher and grasps
draw sheet securely at head and chest area
nurse 3 reaches across stretcher and grasps
draw sheet at waist and thigh area
have patient hold arms across chest
on count of three, move patient
put up siderails and cover patient
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transfer boards are sometimes used for
this purpose and they make it much
easier as you simply slide the patient on
a draw sheet over to the stretcher
a three carrier lift may also be used
Therapeutic mobility techniques
- SMART MOVES
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Concepts: discal load, COM, leverage,
friction reduction, normal movements
Equipment needed: velcro belts, beds,
drawsheets, garbage bags, towels,
w.chair,stretcher board
Harness the principles
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Safer patient moves & transfers by staff
with:
1.COM-centre of mass
2.leverage
3.friction reduction
vs. muscle mass & strength
Safety Strategies for
Transferring patients
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plan ahead
equipment set up
communications
consistency
symmetrical movements
don’t block pt. knee, cradle them
transfer belts/slider bags
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use center of mass and leverage to
move patient (shift your weight)
place your knee on bed to assist with
movement - this will save your back!!!
keep a wide stance and your knees bent
Range of Motion positions
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Head - flexion, extension, lateral flextion
Neck - rotation
Shoulder - flexion, extension, abduction,
adduction, internal and external rotation
Elbow - flexion, extension
Forearm - supination, pronation
Wrist - flexion, extension,
hyperextension
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Fingers - flexion, extension, abduction,
adduction, opposition of thumb to fingers
Hip - flexion, extension, abduction,
adduction, internal rotation, external
rotation
Knee - flexion, extension
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Ankle - dorsiflexion, plantar flexion,
inversion, eversion
Toes - flexion, extension, abduction,
adduction
Restraints………..
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anything that limits movement - tables,
bed rails, towels, jackets etc.
must have MD order
must have pt. permission
least restraint policy
how can restraints cause harm?
restraints don’t guarantee safety and
probably do more harm than good!!!
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check patient at least once an hour
remove restraints, massage area, check
for skin breakdown or redness, perform
ROM, reapply only if necessary
pad bony prominences under restraint
should allow two fingers under restraint
use least restrictive form of restraint
possible
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maintain restrained extremity in normal
anatomical position
use appropriate tie
fasten to bed frame not side rail
reassure patient frequently
DOCUMENT reason for restraint, alternate
measures tried, date and time of application,
type of restraint, times when removed and
ongoing assessment
If absolutely necessary to use
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R espond to the present, not the past
e valuate the potential for injury
s peak with family members/caregivers
t ry alternative measures
r easses need for restraints frequently
a lert physician and family
I ndividualize restraint use
n ote important information in chart
t ime the use of restraints