 B od y M ec han i c s
Body mechanics means using the body in an efficient and careful way.
It involves:
•Good posture
•Balance
•Using your strongest and largest muscles for work
PRINCIPLES OF BODY MECHANICS
Body alignment (posture) is the way the head, trunk, arms, and legs are aligned with
one another.
Base of support is the area on which an object rests.
•A good base of support is needed for balance.
Use the muscles in your shoulders, upper arms, hips, and thighs to lift and move
residents and heavy objects.
For good body mechanics:
•Bend your knees and squat to lift a heavy object.
•Hold items close to your body and base of support.
All activities require good body mechanics.
ERGONOMICS
Ergonomics is the science of designing the job to fit the worker.
•The goal is to eliminate a serious and disabling work-related musculoskeletal disorder
(W MSD).
Risk factors for WMSDs in nursing centers include:
•Force
•Repeating action
•Awkward postures
WMSDs are workplace health hazards.
Always report a work-related injury as soon as possible.
Back injuries
•Are a major threat
•Can occur from repeated activities or from one event
Signs and symptoms of back injuries include:
•Pain when trying to assume a normal posture
•Decreased mobility
•Pain when standing or rising from a seated position
POSITIONING THE PERSON
Regular position changes and good alignment:
•Promote comfort and well-being
•Promote breathing
•Promote circulation
•Help prevent pressure ulcers and contractures
Residents may:
•Move and turn when in bed or a chair without assistance
•Need reminding to adjust their positions
•Need help with position changes
•Depend entirely on the nursing team for position changes
The person is repositioned at least every 2 hours.
Follow these guidelines to safely position a person:
•Use good body mechanics.
•Ask a co-worker to help you if needed.
•Explain the procedure to the person.
•Be gentle when moving the person.
•Provide for privacy.
•Use pillows as directed by the nurse for support and alignment.
•Provide for comfort after positioning.
•Place the signal light within reach after positioning.
•Complete a safety check before leaving the room.
Fowler’s position (a semi-sitting position)
•The head of the bed is raised between 45 and 60 degrees.
Supine position (dorsal recumbent position)
•This is the back-lying position.
Prone position
•The person lies on the abdomen with the head turned to one side.
Lateral position (side-lying position)
•The person lies on one side or the other.
Sims’ position (semi-prone side position)
•This is a left side-lying position.
Chair position
•Persons who sit in chairs must hold their upper bodies and heads erect.
•The nurse may ask you to put a small pillow between the person’s lower back and the
chair.
 A pillow is not used behind the back if restraints are used.
•Some people require postural supports to keep them in good alignment.
QUALITY OF LIFE
Proper body mechanics protects the person from injuries that could affect health and
ability to function.
 Safe Resident Handling, Moving, and Transfers
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Turn and reposition persons often
Move persons in bed
Transfer persons to and from beds, chairs, wheelchairs, stretchers,
and toilets
You must use your body correctly.
PREVENTING W ORK-RELATED INJURIES
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When providing care, you will:
OSHA recommends that:
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Manual lifting be minimized in all cases
Manual lifting be eliminated when possible
For safe resident handling, moving, and transfers, the nurse and health team
determine:
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The resident’s dependence level
The amount of assistance needed
What procedure to use
The equipment needed
Persons with dementia may:
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Not understand what you are doing
Resist your handling, moving, and transfer efforts
Shout at you, grab you, or try to hit you
 Always get a co-worker to help you.
 Do not force the person.
 Tell the nurse at once if you have problems.
MOVING PERSONS IN BED
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Some persons can move and turn in bed.
Those who are weak, unconscious, paralyzed, or in casts need help.
Protecting the skin
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Friction and shearing injure the skin.
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Reduce friction and shearing when moving the person in bed by:
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Using a lift sheet (turning sheet)
Using a turning pad, a large incontinence product, slide board, or slide
sheet
You can raise the person’s head and shoulders easily and safely by
locking arms with the person.
It is best to have help with older persons and with those who are heavy
or hard to move.
Moving the person up in bed
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Rolling the person
Raising the person’s head and shoulders
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Friction and shearing cause infection and pressure ulcers.
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The person is moved up in bed for good alignment and comfort.
You can sometimes move lightweight adults up in bed alone if they can
assist and use a trapeze.
Two or more staff members are needed to move heavy, weak, and
very old persons.
Always protect the person and yourself from injury.
Moving the person up in bed with an assist device
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Assist devices are used to move some persons up in bed.
With these devices, the person is moved more easily.
With these devices, shearing and friction are reduced.
The device is placed under the person from the head to above the
knees or lower.
At least two staff members are needed.
When moving the person up in bed, OSHA recommends the following:
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If the person weighs less than 200 pounds, two or three staff members
and a friction-reducing device are needed.
If the person weighs more than 200 pounds, at least three staff
members and a friction-reducing device are needed.
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Moving the person to the side of the bed
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Use a mechanical lift or the assist device method for:
 Tall or heavy persons
 Totally dependent persons
 Persons requiring extensive assistance
 Older persons
 Persons with arthritis
 Persons recovering from spinal cord injuries or spinal cord
surgery
TURNING PERSONS
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The person is turned toward you or away from you.
After the person is turned, position him or her in good alignment.
Persons may:
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Be able to turn and reposition themselves in bed
Need help
Totally depend on the nursing staff for care
Logrolling is turning the person as a unit, in alignment, with one motion.
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One method involves moving the person in segments.
The procedure is used to turn:
 Older persons with arthritic spines or knees
 Persons recovering from hip fractures
 Persons with spinal cord injuries
 Persons recovering from spinal surgery
The spine is kept straight all times.
SITTING ON THE SIDE OF THE BED (DANGLING)
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Residents dangle for many reasons.
While dangling the legs, the person:
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Deep breathes and coughs
Moves the legs back and forth in circles
Two staff members may be needed.
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TRANSFERRING PERSONS
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Residents are moved to and from beds, chairs, wheelchairs, shower chairs,
commodes, toilets, and stretchers.
The amount of help needed and the method used vary with the person’s
dependency level.
Transfer belts (gait belts) are used to:
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Reposition persons in chairs and wheelchairs
Bed to chair or wheelchair transfers
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Help the person out of bed on his or her strong side.
Chair or wheelchair to bed transfers
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If the person is weak on one side, transfer the person so that the
strong side moves first.
Mechanical lifts
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Support residents during transfers
Mechanical lifts are used to transfer persons who::
 Cannot help themselves
 Are too heavy for the staff to transfer
The type of sling used depends on the person’s size, condition, and
other needs.
Before using a mechanical lift:
 You must be trained in its use.
 It must work.
 The sling, straps, hooks, and chains must be in good repair.
 The person’s weight must not exceed the lift’s capacity.
 At least two staff members are needed.
 Always follow the manufacturer’s instructions.
Transferring the person to and from the toilet
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Sometimes mechanical lifts are used.
A slide board may be used if:
 The wheelchair armrests are removable
 The person has upper body strength
 The person has good sitting balance
 There is enough room to position the wheelchair next to the
toilet
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Cannot sit up
Must stay in a lying position
Are seriously ill
To transfer the person to the stretcher:
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A drawsheet, turning pad, large incontinence product, slide sheet, or
slide board is used.
At least two or three staff members are needed.
When the person is on the stretcher:
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Safety straps are used.
The stretcher side rails are kept up during the transport.
The stretcher is moved feet first.
Never leave a person on a stretcher alone.
REPOSITIONING IN A CHAIR OR W HEELCHAIR
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Stretchers (gurneys) are used for persons who:
For good alignment and safety, the person’s back and buttocks must be
against the back of the chair.
Follow the nurse’s directions and the care plan for the best way to reposition
the person.
QUALITY OF LIFE
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You must protect the right to privacy at all times.
The person’s rights also are protected by allowing personal choice whenever
possible.
The person has the right to be free from restraint.
Exercise and Activity
Being active is important for physical and mental well-being.
Illness, surgery, injury, pain, and aging cause weakness and some activity limits.
Inactivity, whether mild or severe:
•Affects every body system
•Affects mental well-being
Deconditioning is the loss of muscle strength from inactivity.
To help promote exercise and activity, you need to understand:
•Bedrest
•How to prevent complications from bedrest
•How to help with exercise
BEDREST
Generally bedrest is ordered to:
•Reduce physical activity
•Reduce pain
•Encourage rest
•Regain strength
•Promote healing
These types of bedrest are common:
•Strict bedrest
•Bedrest
•Bedrest with commode privileges
•Bedrest with bathroom privileges (bedrest with BRP)
The person’s care plan and your assignment sheet tell you the activities allowed.
Complications of bedrest involve every system and include:
•Pressure ulcers
•Constipation and fecal impaction
•Urinary tract infections and renal calculi
•Blood clots (thrombi)
•Pneumonia
•Contractures
•Muscle atrophy
•Orthostatic hypotension (postural hypotension)
Good nursing care prevents complications from bedrest.
•The care plan includes:
Good alignment
Range-of-motion exercises
Frequent position changes
Supportive devices are often used.
•Bed boards
•Foot boards
•Trochanter rolls
•Hip abduction wedges
•Hand rolls or handgrips
•Splints
•Bed cradles
Exercise helps prevent:
•Contractures
•Muscle atrophy
•Other complications of bedrest
A trapeze is used for exercises to strengthen arm muscles.
•The trapeze is also used to move up and turn in bed.
RANGE-OF-MOTION EXERCISES
Active range-of-motion exercises are done by the person.
With passive range-of-motion exercises, someone moves the joints through their
range of motion.
With active-assistive range-of-motion exercises, the person does the exercises with
some help.
OBRA requires an assessment and care planning process to prevent unnecessary
loss in a person’s range of motion.
AMBULATION
Some people need help walking.
•Some become strong enough to walk alone.
•Others will always need help.
After bedrest, activity increases slowly and in steps.
To achieve the goal of walking:
•Contractures and muscle atrophy must be prevented.
•Proper positioning and exercises are needed during bedrest.
When helping the person to walk:
•Follow the care plan.
•Use a gait (transfer) belt if the person is weak or unsteady.
•The person uses hand rails along the wall.
•Check the person for orthostatic hypotension.
Walking aids support the body.
•The need may be temporary or permanent.
•The type ordered depends on:
The person’s condition
The amount of support needed
The type of disability
•Crutches are used when the person cannot use one leg or when one or both legs
need to gain strength.
•Follow these safety measures when crutches are used:
Check the crutch tips.
Check crutches for flaws.
Tighten all bolts.
Street shoes are worn.
Clothes must fit well.
Practice safety rules to prevent falls.
Keep crutches within the person’s reach.
Know which crutch gait the person uses.
•Canes are used for weakness on one side of the body.
They help provide balance and support.
Single-tip and four-point (quad) canes are common.
A cane is held on the strong side of the body.
•A walker is a four-point walking aid.
It gives more support than a cane.
There are many kinds of walkers.
Baskets, pouches, and trays attach to the walker.
•Braces support weak body parts.
They prevent or correct deformities or prevent joint movement.
They are applied over the ankle, knee, or back.
You need to keep the skin and bony points under braces clean and dry.
You need to report redness, signs of skin breakdown, and complaints of pain or
discomfort at once.
RECREATIONAL ACTIVITIES
OBRA requires activity programs for residents.
A good activity program improves a person’s quality of life.
Activities must meet each person’s interests and physical, mental, and psychosocial
needs.
QUALITY OF LIFE
You assist residents with exercise and activity.
You must protect the rights to privacy and personal choice.
•The person’s body is not exposed.
•Choices are allowed whenever safe and possible.
 Preventing Falls
 Falls are the most common accidents in nursing centers.
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The risk of falling increases with age.
A history of falls increases the risk of falling again.
CAUSES AND RISK FACTORS FOR FALLS
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Most falls occur in resident rooms and bathrooms.
Falls are most likely to occur:
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Between 1800 (6:00 PM) and 2100 (9:00 PM)
During shift changes
FALL PREVENTION PROGRAMS
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Nursing centers have fall prevention programs.
Common sense and simple measures can prevent many falls.
The goal is to prevent falls without decreasing the person’s quality of life.
Bed rails
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The nurse and care plan tell you when to raise bed rails.
If a person needs bed rails, keep them up at all times except when
giving bedside nursing care.
Bed rails present hazards.
Entrapment is a risk.
Bed rails are considered restraints by OBRA and the Centers for
Medicare & Medicaid Services (CMS).
Accrediting agency standards and state laws affect bed rail use.
If a person uses bed rails:
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Check the person often.
Report to the nurse that you checked the person.
If you are allowed to chart, record when you checked the person and
your observations.
Hand rails are in hallways and stairways.
Grab bars are in bathrooms and in shower/tub rooms.
Bed wheels are locked:
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When giving bedside care
When you transfer a person to and from the bed
Wheelchair and stretcher wheels are locked during transfers.
A transfer belt (gait belt) is a device used to support a person who is
unsteady or disabled.
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It helps prevent falls and other injuries.
The belt goes around the person’s waist.
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Grasp under the belt to support the person during the transfer or when
assisting the person to walk.
THE FALLING PERSON
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At all times except when moving the bed
TRANSFER/GAIT BELTS
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Falling may be caused by:
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Weakness, lightheadedness, or dizziness
Fainting
Slipping or sliding on spills, waxed floors, throw rugs, or improper
shoes
Do not try to prevent the fall.
If a person starts to fall, ease him or her to the floor.
Do not let the person move or get up before the nurse checks for injuries.
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An incident report is completed after all falls.
A confused person may not understand why you do not want him or her to
move or get up after a fall.
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You may need to let the person move for his or her safety or your own.
Never use force to hold a person down.
Stay calm and call for help.
QUALITY OF LIFE
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A fall can seriously affect a person’s quality of life.
You must help prevent falls.
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You must not interfere with the person’s rights.
Key Terms
base of support
body alignment
body mechanics
dorsal recumbent position
ergonomics
Fowler’s position
lateral position
posture
prone position
semi-prone side position
side-lying position
Sims’ position
supine position
Outline and Classroom Activities
I.
INTRODUCTION
A. Body mechanics means using the body in an efficient and careful way.
1. It involves:
a. Good posture
b. Balance
c. Using your strongest and largest muscles for work
B. Fatigue, muscle strain, and injury can result from improper use and positioning of the
body during activity or rest.
II.
PRINCIPLES OF BODY MECHANICS
A. Body alignment (posture) is the way the head, trunk, arms, and legs are aligned with one
another.
1. Good alignment lets the body move and function with strength and efficiency.
B. Base of support is the area on which an object rests.
1. A good base of support is needed for balance.
2. When standing, your feet are your base of support.
a. Stand with your feet apart for a wider base of support and more balance.
C. Use the muscles in your shoulders, upper arms, hips, and thighs to lift and move residents
and heavy objects.
1. Otherwise, you place strain and exertion on smaller and weaker muscles.
a. This causes fatigue and injury.
b. Back injuries are a major risk.
D. For good body mechanics:
1. Bend your knees and squat to lift a heavy object.
a. Bending from the waist places strain on small back muscles.
2. Hold items close to your body and base of support.
a. Holding objects away from your body places strain on small muscles in your
lower arms.
E. All activities require good body mechanics.
III.
ERGONOMICS
A. Ergonomics is the science of designing the job to fit the worker.
1. It involves changing the task, work station, equipment, and tools to help reduce stress
on the worker’s body.
2. The goal is to eliminate a serious and disabling work-related musculoskeletal
disorder (WMSD).
a. WMSDs:
(1) Are injuries and disorders of the muscles, tendons, ligaments, joints, and
cartilage
(2) Can involve the nervous system
(3) Are painful and disabling
(4) Can develop slowly over weeks, months, and years
(5) Can occur from one event
3. Risk factors for WMSDs in nursing centers include:
a. Force
(1) The amount of physical effort needed to perform a task
b. Repeating action
(1) Performing the same motion or series of motions continually or frequently
c. Awkward postures
(1) Assuming positions that place stress on the body
4. WMSDs are workplace health hazards.
a. Time off work is often needed.
b. Nursing assistants are at great risk.
5. Always report a work-related injury as soon as possible.
a. Early attention can help prevent the problem from becoming worse.
6. The following nursing tasks are known to be high risk for WMSDs:
a. Transfers
b. Weighing a person
c. Moving a person up in bed
d. Repositioning a person in a bed or in a chair
e. Changing an incontinence product
f. Making beds
g. Dressing and undressing a person
h. Feeding a person in bed
i. Giving a bed bath
j. Applying anti-embolism stockings
B. Back injuries:
1. Are a major threat
2. Can occur from repeated activities or from one event
3. Signs and symptoms include:
a. Pain when trying to assume a normal posture
b. Decreased mobility
c. Pain when standing or rising from a seated position
4. According to OSHA, these factors can lead to back disorders:
a. Reaching while lifting
b. Poor posture when sitting or standing
c. Staying in one position too long
d. Poor body mechanics when lifting, pushing, pulling, or carrying objects
e. Poor physical condition
f. Repeated lifting of awkward items, equipment, or persons
g. Shifting weight when a resident loses balance or strength while moving
h. Twisting while lifting
i. Bending while lifting
j. Maintaining a bent posture such as leaning over a bed
k. Working in a confined, crowded, or cluttered area
l. Fatigue
m. Poor footing such as on slippery floors
n. Lifting with forceful movement
5. You can help prevent back injuries by:
a. Following the rules in Box 14-1 on p. 204 in the textbook
b. Being extra careful when performing tasks that are associated with back injuries
IV.
POSITIONING THE PERSON
A. The person must be properly positioned at all times.
1. Regular position changes and good alignment:
a. Promote comfort and well-being
b. Promote breathing
c. Promote circulation
d. Help prevent pressure ulcers and contractures
B. Residents may:
1. Move and turn when in bed or a chair without assistance
2. Need reminding to adjust their positions
3. Need help with position changes
4. Depend entirely on the nursing team for position changes
C. The person is repositioned at least every 2 hours.
1. Some people are repositioned more often.
a. Follow the nurse’s instructions and the care plan.
D. Follow these guidelines to safely position a person:
1. Use good body mechanics.
2. Ask a co-worker to help you if needed.
3. Explain the procedure to the person.
4. Be gentle when moving the person.
5. Provide for privacy.
6. Use pillows as directed by the nurse for support and alignment.
7. Provide for comfort after positioning.
a. See the inside of the front textbook cover.
8. Place the signal light within reach after positioning.
9. Complete a safety check before leaving the room.
a. See the inside of the front textbook cover.
E. Fowler’s position is a semi-sitting position
1. The head of the bed is raised between 45 and 60 degrees.
2. For good alignment:
a. Keep the spine straight.
b. Support the head with a small pillow.
c. Support the arms with pillows.
d. The nurse may ask you to place small pillows under the lower back, thighs, and
ankles.
F. Supine position (dorsal recumbent position)
1. This is the back-lying position.
2. For good alignment:
a. The bed is flat.
b. The head and shoulders are supported on a pillow.
c. Arms and hands are at the sides.
(1) You can:
(a) Support the arms with regular pillows.
(b) Support the hands on small pillows with the palms down.
d. The nurse may ask you to place:
(1) A folded or rolled towel under the lower back and a small pillow under the
thighs
(2) A pillow under the lower legs to lift the heels off of the bed
G. Prone position
1. The person lies on the abdomen with the head turned to one side.
2. For good alignment:
a. The bed is flat.
b. Small pillows are placed under the head, abdomen, and lower legs.
c. Arms are flexed at the elbows with the hands near the head.
(1) You also can position a person with the feet hanging over the end of the
mattress.
3. Most older persons do not tolerate the prone position.
a. Check with the nurse before placing any person in the prone position.
H. Lateral position (side-lying position)
1. The person lies on one side or the other.
a. The bed is flat.
b. A pillow is under the head and neck.
c. The upper leg is in front of the lower leg.
(1) Or, the upper leg is behind the lower leg, not on top of it.
d. The ankle, upper leg, and thigh are supported with pillows.
e. A small pillow is positioned against the person’s back.
(1) The person’s back is at a 45-degree angle with the mattress.
f. A small pillow is under the upper hand and arm.
I. Sims’ position (semi-prone side position)
1. This is a left side-lying position.
a. The upper leg (right leg) is sharply flexed so that it is not on the lower leg (left
leg).
b. The lower arm (left arm) is behind the person.
2. For good alignment:
a. The bed is flat.
b. Place a pillow under the person’s head and shoulder.
c. Support the upper leg with a pillow.
d. Place a pillow under the upper arm and hand.
3. This position usually is not comfortable for older persons.
a. Check with the nurse before placing a person in Sims’ position.
J. Chair position
1. Persons who sit in chairs must hold their upper bodies and heads erect.
2. For good alignment:
a. The person’s back and buttocks are against the back of the chair.
b. Feet are flat on the floor or wheelchair footplates.
(1) Never leave feet unsupported.
c. The backs of the knees and calves are slightly away from the edge of the seat.
3. The nurse may ask you to put a small pillow between the person’s lower back and the
chair.
a. A pillow is not used behind the back if restraints are used (Chapter 12).
4. Paralyzed arms are supported on pillows.
a. Some residents have positioners.
b. Wrists are positioned at a slight upward angle.
5. Some people require postural supports to keep them in good alignment.
a. The health team selects the best product for the person’s needs.
(1) The person’s safety, dignity, and function are considered.
V.
QUALITY OF LIFE
A. Proper body mechanics protects the person from injuries that could affect health and
ability to function.
Key Terms positioning
friction
logrolling
shearing
transfer
Procedures
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II.
Raising the Person’s Head and Shoulders
Moving the Person Up in Bed
Moving the Person Up in Bed With an Assist Device
Moving the Person to the Side of the Bed
Turning and Repositioning the Person
Logrolling the Person
Sitting on the Side of the Bed (Dangling)
Transferring the Person to a Chair or Wheelchair
Transferring the Person From a Chair or Wheelchair to Bed
Transferring the Person Using a Mechanical Lift
Transferring the Person To and From the Toilet
Moving the Person To a Stretcher
A. When providing care, you will:
1. Turn and reposition persons often.
2. Move persons in bed.
3. Transfer persons to and from beds, chairs, wheelchairs, stretchers, and toilets.
a. To transfer a person means moving the person from one place to another.
B. You must use your body correctly.
1. This protects you and the person from injury.
PREVENTING WORK-RELATED INJURIES
OSHA recommends that:
1. Manual lifting be minimized in all cases.
2. Manual lifting be eliminated when possible.
For safe resident handling, moving, and transfers, the nurse and health team determine:
3. The resident’s dependence level.
a. Dependence levels relate to the ability to move without help.
b. You need to know the person’s dependence level before you handle, move, or
transfer a person.
(1) See Box 15-2 on p. 216 in the textbook.
4. The amount of assistance needed
a. This will depend on the person’s height, weight, cognitive function, and
dependence level.
5. What procedure to use
a. The nurse and care plan tell you what procedure to use.
6. The equipment needed
a. Assist equipment and devices are useful to handle, move, and transfer residents
safely.
(1) The nurse and care plan tell you what to use.
(2) Follow the manufacturer’s instructions.
(3) Ask for any needed training to use the equipment and devices safely.
B. Residents with dementia
1. Persons with dementia may:
a. Not understand what you are doing
b. Resist your handling, moving, and transfer efforts
c. Shout at you, grab you, or try to hit you
2. Always get a co-worker to help you.
a. Do not force the person.
3. You need to:
a. Follow the rules and guidelines in Box 15-1 on p. 214 and 215 in the textbook.
b. Follow the person’s care plan.
c. Tell the nurse at once if you have problems handling, moving, or transferring the
person.
III.
MOVING PERSONS IN BED
A. Some persons can move and turn in bed.
B. Those who are weak, unconscious, paralyzed, or in casts need help.
1. Sometimes two or three people or a mechanical lift is needed.
C. Protecting the skin
1. Older persons have fragile skin that tears easily.
2. Friction and shearing injure the skin.
a. Both cause infection and pressure ulcers (Chapter 32).
3. Friction is the rubbing of one surface against another.
4. Shearing is when the skin sticks to a surface while muscles slide in the direction the
body is moving.
a. It occurs when the person slides down in bed or is moved in bed.
5. Reduce friction and shearing when moving the person in bed by:
a. Rolling the person
b. Using a lift sheet (turning sheet)
c. Using a turning pad, a large incontinence product, slide board, or slide sheet
D. Raising the person’s head and shoulders
1. You can raise the person’s head and shoulders easily and safely by locking arms with
the person.
a. It is best to have help with older persons and with those who are heavy or hard to
move.
2. Raising the Person’s Head and Shoulders
E. Moving the person up in bed
1. The person is moved up in bed for good alignment and comfort.
2. You can sometimes move lightweight adults up in bed alone if they can assist and use
a trapeze.
a. It is best to have help and to use an assist device.
3. Two or more staff members are needed to move heavy, weak, and very old persons.
4. Always protect the person and yourself from injury.
5. Moving the Person Up in Bed
F. Moving the person up in bed with an assist device
1. Assist devices are used to move some persons up in bed.
a. Such assist devices include a:
(1) Drawsheet (lift sheet)
(2) Flat sheet folded in half
(3) Turning pad Slide sheet
(4) Large incontinence product
b. With these devices:
(1) The person is moved more evenly.
(2) Shearing and friction are reduced.
c. The device is placed under the person from the head to above the knees or lower.
d. At least 2 staff members are needed.
2. OSHA recommends the following:
a. If the person weighs less than 200 pounds:
(1) 2 to 3 staff members and a friction-reducing device are needed
b. If the person weighs more than 200 pounds:
(1) At least 3 staff members and a friction-reducing device are needed
3. This procedure is used for persons:
a. With a dependence level of Code 4:
(1) Total dependence
b. With a dependence level of Code 3:
(1) Extensive assistance
(a) Such persons cannot move up in bed themselves.
c. Recovering from spinal cord surgery or spinal cord injuries
4. Moving the Person Up in Bed With an Assist Device
G. Moving the person to the side of the bed
1. Person is moved to the side of the bed:
a. For repositioning and care procedures
b. Before turning
(1) Otherwise, after turning, the person lies on the side of the bed.
c. To limit the need to reach over the person
2. One method involves moving the person in segments.
3. Use a mechanical lift or the assist device method for:
a. Tall or heavy persons
b. Persons with Code 4 (total dependence) or Code 3 (extensive assistance)
c. Older persons
d. Persons with arthritis
e. Persons recovering from spinal cord injuries or spinal cord surgery
4. Using an assist device helps prevent:
a. Pain and skin damage
b. Injury to the bones, joints, and spinal cord.
5. Moving the Person To the Side of the Bed
IV.
TURNING PERSONS
A. Persons are turned onto their sides:
1. To help prevent complications from bedrest (Chapter 24)
2. For certain procedures and care measures
B. The person is turned toward you or away from you.
1. The direction depends on the person’s condition and the situation.
C. After the person is turned, position him or her in good alignment.
1. Use pillows for support as needed.
D. Persons may:
1. Be able to turn and reposition themselves in bed
2. Need help
3. Totally depend on the nursing staff for care
E. Logrolling is preferred for persons with arthritis in their spines, hips, and knees.
F. Turning and Repositioning the Person (NNAAP™)
G. Logrolling
1. Logrolling is turning the person as a unit, in alignment, with one motion.
a. The spine is kept straight.
2. The procedure is used to turn:
a. Older persons with arthritic spines
b. Persons recovering from hip fractures
c. Persons with spinal cord injuries
(1) The spine is kept straight at all times.
d. Persons recovering from spinal surgery
(1) The spine is kept straight all times.
3. Logrolling the Person
V.
SITTING ON THE SIDE OF THE BED (DANGLING)
A. Residents dangle for many reasons.
1. Many older persons become dizzy or faint when getting out of bed too fast.
2. Some persons increase activity in stages.
B. While dangling the legs, the person:
1. Deep breathes and coughs
2. Moves the legs back and forth in circles
a. This stimulates circulation.
C. Two staff members may be needed.
1. If dizziness or fainting occurs, lay the person down.
D. Sitting On the Side of the Bed (Dangling)

 TRANSFERRING PERSONS
E. Residents are moved to and from beds, chairs, wheelchairs, shower chairs, commodes,
toilets, and stretchers.
1. The amount of help needed and the method used vary with the person’s dependency
level.
a. See Box 15-2 on p. 216 in the textbook.
F. For a safe transfer you need to:
1. Follow the rules of body mechanics (Chapter 14).
2. Follow the guidelines in Box 15-1 on pp. 214 and 215 in the textbook.
3. Arrange the room so that there is enough space.
4. Place the chair, wheelchair, or other device correctly.
G. Transfer belts
1. Also called gait belts, they are used to:
a. Support residents during transfers.
b. Reposition persons in chairs and wheelchairs.
H. Bed to chair or wheelchair transfers
1. Help the person out of bed on his or her strong side.
a. In transferring, the strong side moves first.
(1) It pulls the weaker side along.
b. Transfers from the weak side are awkward and unsafe.
2. The following stand and pivot transfers are used if:
a. The person’s legs are strong enough to bear some or all of his or her weight.
b. The person is cooperative and able to follow directions.
c. The person can assist with the transfer.
3. Transferring a Person to a Chair or Wheelchair (NNAAP™)
I. Chair or wheelchair to bed transfers
1. Chair or wheelchair to bed transfers have the same rules as bed to chair transfers.
a. If the person is weak on one side, transfer the person so that the strong side moves
first.
2. Transferring the Person From a Chair or Wheelchair to Bed
J. Mechanical lifts
1. Mechanical lifts are used to transfer persons who:
a. Cannot help themselves
b. Are too heavy for the staff to transfer
2. Slings
a. The type used depends on the person’s size, condition, and other needs.
b. Slings are padded, unpadded, or made of mesh.
c. Types include:
(1) Standard full sling
(a) Used for normal transfers
(2) Extended length sling
(a) Used for persons with extra large thighs
(3) Bathing sling
(a) Used to transfer the person directly from the bed or chair into a bathtub
(b) The sling is left in place and attached to the lift during the bath.
(4) Toileting sling
(a) The sling bottom is open.
(b) For infection control:
(i) Each person should have his or her own toileting sling.
(ii) If the sling becomes contaminated, it is washed following the
manufacturer’s instructions.
(5) Amputee sling
(a) Used for the person who has had both legs amputated (double amputee)
d. Follow center policy for:
(1) Washing slings
(2) Handling contaminated slings
(a) A sling is considered contaminated when the sling:
(i) Has any visible sign of blood, body fluids, secretions, or excretions
(ii) Is used on a person’s bare skin
(iii)Is used to bathe a person
3. Using a mechanical lift
a. Before using a lift:
(1) You must be trained in its use.
(2) It must work.
(3) The sling, straps, hooks, and chains must be in good repair.
(4) The person’s weight must not exceed the lift’s capacity.
(5) At least two staff members are needed.
b. Always follow the manufacturer’s instructions.
(1) The procedure on p. 239 in the textbook is used as a guide.
c. Transferring the Person Using a Mechanical Lift
K. Transferring the person to and from the toilet
1. Using the bathroom for elimination:
a. Promotes dignity, self-esteem, and independence
b. Is more private than using a bedpan, urinal, or bedside commode
2. Transfers involving wheelchairs and toilets are often hard.
a. Falls and work-related injuries are risks.
3. Sometimes mechanical lifts are used.
4. A slide board may be used if:
a. The wheelchair armrests are removable.
b. The person has upper body strength.
c. The person has good sitting balance.
d. There is enough room to position the wheelchair next to the toilet.
5. The procedure on p. 241 in the textbook can be used if the person is able to stand and
pivot from the wheelchair to the toilet.
a. Transferring the Person To and From a Toilet
L. Moving the person to a stretcher
1. Stretchers (gurneys) are used for persons who:
a. Cannot sit up
b. Must stay in a lying position
c. Are seriously ill
2. The stretcher is covered with a folded flat sheet or bath blanket.
3. A pillow and extra blankets are on hand.
4. With the nurse’s permission, raise the head of the stretcher to a Fowler’s or semiFowler’s position (Chapter 16).
5. To transfer the person to the stretcher:
a. A drawsheet, turning pad, large incontinence underpad, slide sheet, or slide board
is used.
b. At least 2 or 3 staff members are needed.
c. OSHA recommends the following:
(1) If the person weighs less than 100 pounds, use a lateral sliding aid and 2 staff
members.
(2) If the person weighs 100 to 200 pounds, use a lateral sliding aid or a frictionreducing device and 2 staff members.
(3) If the person weighs more than 200 pounds, use one of the following:
(a) A lateral sliding aid and 3 staff members
(b) A friction-reducing device or lateral transfer device and 2 staff members
(c) A mechanical lateral transfer device with a built-in slide board
6. When the person is on the stretcher:
a. Safety straps are used.
b. The stretcher side rails are kept up during the transport.
c. The stretcher is moved feet first.
(1) The staff member at the head of the stretcher can watch the person’s breathing
and color during the transport.
d. Never leave a person on a stretcher alone.
7. Moving the Person To a Stretcher
VI.
REPOSITIONING IN A CHAIR OR WHEELCHAIR
A. For good alignment and safety, the person’s back and buttocks must be against the back
of the chair.
B. Follow the nurse’s directions and the care plan for the best way to reposition a person in a
chair or wheelchair.
1. Some persons can help.
2. Others need help.
3. If the person cannot help, a mechanical lift is needed.
4. If the person’s chair reclines, do the following:
a. Ask a co-worker to help you.
b. Recline the chair.
c. Position a friction-reducing device under the person.
d. Use the device to move the person up.
C. The following method can be used if the person is alert and cooperative, is able to follow
directions, and has the strength to help.
1. Lock the wheelchair wheels.
2. Remove or swing the front rigging out of the way.
3. Position the person’s feet flat on the floor.
4. Apply a transfer belt.
5. Position the person’s arms on the armrests.
6. Stand in front of the person.
a. Block his or her knees and feet with your knees and feet.
7. Grasp the transfer belt on each side while the person leans forward.
8. Ask the person to push with his or her feet and arms on the count of “3.”
9. Move the person back into the chair on the count of “3” as the person pushes with his
or her feet and arms.
VII.
QUALITY OF LIFE
A. You must protect the right to privacy at all times.
1. Screen the person properly.
2. Expose only the body part involved in the procedure.
3. Close window coverings as needed.
B. The person’s rights also are protected by allowing personal choice whenever possible.
1. Always check with the nurse and the care plan to make sure that the person’s choices
are safe.
2. Let the person help with lifting, moving, and transferring to the extent possible.
C. The person has the right to be free from restraint.
1. Bed rails are used only with the person’s consent.
a. Always check with the nurse and the care plan about using bed rails.
2. If the person does not use bed rails and you need to raise the bed, you need to have a
co-worker help you.
3. When you use bed rails, always explain to the person why you are using them.
TEST YOUR KNOWLEDGE
Match each term with the correct definition.
A. Body mechanics
B. Base of support
C. Body alignment
D. Sims’ position
E. Fowler’s position
F. Prone position
1.
2.
3.
4.
5.
6.
7.
_____ A left side-lying position in which the upper leg is sharply flexed so that it is not
on the lower leg and the lower arm is behind the person
_____ Lying on the abdomen with the head turned to one side
_____ A semi-sitting position; the head of the bed is raised between 45 and 60 degrees
_____ Using the body in an efficient and careful way
_____ The way the head, trunk, arms, and legs are aligned with one another; posture
_____ The area on which an object rests
Fill in the Blanks
8.
For good body mechanics, you need to
A. Keep your body in good alignment with a __________________________ base of
support.
B. Keep objects _________________________ to your body when you lift, move, or carry
them.
C. _________________________________________ your work area. This prevents
unnecessary __________________________________.
D. __________________, __________________, or __________________ heavy objects
whenever you can rather than lifting them.
E. Bend your _______________ and _______________ to lift heavy objects from the floor.
9.
The goal of ergonomics is to
_________________________________________________
_________________________________________________.
10.
Early signs and symptoms of work-related musculoskeletal disorders (WMSDs) include:
A. _______________________________________________
B. _______________________________________________
C. _______________________________________________
11.
_______________________, _______________________, and
___________________________ help prevent contractures.
12.
True or False
Mark T for true or F for false.
13._____ Good body mechanics reduces the risk of injury.
14_____ The muscles in the lower back are used to lift heavy objects from the floor.
15_____ Bending from the waist places strain on small back muscles.
16_____ Proper positioning helps prevent pressure ulcers and contractures.
17_____ Report a work-related injury only if you feel pain.
Multiple Choice
Circle the BEST answer.
18. These statements are about ergonomics. Which is correct?
a. It is the science of making the worker fit the job.
b. It involves changing the task, work station, equipment, and tools to help reduce
stress on the worker’s body.
c. Only those working in the maintenance department need to be aware of
ergonomics.
d. Nursing assistants are at low risk for musculoskeletal injuries.
19. Risk factors for WMSDs include the following except
e. Performing the same motion continuously or frequently
f. Assuming positions that place stress on the body
g. Lifting or transferring heavy residents
h. Turning your whole body when changing the direction of your movement
20. Which of the following can lead to back disorders?
i. Twisting while lifting
j. Working with smooth, even movements
k. Widening your base of support when pushing or pulling
l. Getting help from a co-worker to move heavy objects
21. The back-lying position is the
m. Sims’ position
n. Semi-Fowler’s position
o. Dorsal recumbent position
p. Prone position
22. A person is positioned in a chair. Which is correct?
q. The back and buttocks are against the chair.
r. Feet are three to four inches off the floor.
s. The back of the legs and calves fit snugly against the edge of the seat.
t. A pillow is used behind the back if restraints are used.
Fill in the Blanks
23. Why are beds raised horizontally to move persons in bed?
___________________________________________________
___________________________________________________
24. You must perform tasks safety. The _______________________
____________________________________________ and
____________________________________ tell you how many staff members are needed to
complete a task.
25. ___________________________________ is the rubbing of one surface against another.
26. To use a gait/transfer belt correctly, you need to avoid bending, reaching, or twisting
when:
a. ______________________________________________
b. ______________________________________________
c. ______________________________________________
27. Why should you move down the center of the hallway when transporting a resident in a
wheelchair?
____________________________________________________
____________________________________________________
28. Moving the person up in bed is best done with at least two staff members. Perform this
procedure alone only if:
a. ______________________________________________
b. ______________________________________________
c. ______________________________________________
d. ______________________________________________
e. ______________________________________________
f. ______________________________________________
g. ______________________________________________
29. List three methods used to move persons to the side of the bed.
a. ______________________________________________
b. ______________________________________________
c. ______________________________________________
30. A mechanical lift or the assist device method is used to move the following persons in
bed:
a. ______________________________________________
b. ______________________________________________
c. ______________________________________________
d. ______________________________________________
e. ______________________________________________
31. Logrolling is _________________________________________
____________________________________________________
32. The nurse asks you to dangle a resident. What information do you need from the nurse
and the care plan before you begin?
a. ______________________________________________
b. ______________________________________________
c. ______________________________________________
d.
e.
f.
g.
h.
i.
j.
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
33. Why is it important for the person to wear non-skid footwear for transfers?
____________________________________________________
____________________________________________________
____________________________________________________
34. What is the purpose of a transfer belt?
____________________________________________________
____________________________________________________
____________________________________________________
35. You are transferring Mr. Lane from the bed to a wheelchair. Mr. Lane must not put his
arms around your neck because
____________________________________________________
____________________________________________________
____________________________________________________.
36. Before using a mechanical lift, the following must occur:
a. ____________________________________________________
b. ____________________________________________________
c. ____________________________________________________
d. ____________________________________________________
e. ____________________________________________________
True or False
Mark T for true or F for false.
37._____ To prevent work-related injuries, wear shoes that provide good traction.
38._____ To prevent injuries when transferring a resident from the floor, use a mechanical lift if
possible.
39._____ The bed is in the lowest horizontal position to give care.
40._____ Using an assist device to move a person up in bed reduces shearing and friction.
41._____ When transferring a person, the weak side moves first.
42_____ When transporting a person on a stretcher, the person is moved feet first.
43._____ Safety straps are used when a resident is on a stretcher.
44._____ All incontinence products can be used as assist devices.
Multiple Choice
Circle the BEST answer.
45. You are helping Mr. Jones transfer from the bed to the chair. Which is false?
A.
B.
C.
D.
Mr. Jones wears shoes or slippers with non-skid soles.
Mr. Jones is helped out of bed on his strong side.
The bed is in the highest horizontal position.
Help him to dangle. Make sure that his feet touch the floor.
46. When logrolling a person, you must
a.
b.
c.
d.
Make sure the bed is in the Fowler’s position
Lower the bed to the lowest level
Make sure both bed rails are up
Turn the person as a unit, in alignment, with one motion
47. These statements are about mechanical lifts. Which is false?
a.
b.
c.
d.
Do not use the lift if the person’s weight exceeds the lift’s capacity.
If you know how to use one lift, you know how to use them all.
Always follow the manufacturer’s instructions.
Make sure that the sling, straps, hooks, and chains are in good repair.
48. You are transferring Miss Mary Adams from the wheelchair to the toilet. Which is false?
a.
b.
c.
d.
Make sure that she has an elevated toilet seat.
Do not transfer her if the grab bars by the toilet are not secure.
Miss Adams should wear soft, warm, and comfortable bedroom slippers.
Lock the wheelchair wheels.
49. You need to transfer a resident to a stretcher. Which is correct?
a.
b.
c.
d.
Ask one co-worker to help you.
Lower the bed to its lowest level.
Use a friction-reducing device.
Make sure bed rails are up
50. To prevent injuries during a stand-pivot transfer, you need to
a. Keep your feet at least at shoulder width apart
b. Raise the bed to waist level
c. Have the person move his or her weak side first
d. Ask a co-worker to assist you
51. When delegated the dangling procedure, you need the following information from the
nurse and the care plan except
a.
b.
c.
d.
Areas of weakness
How tall the person is
The amount of help the person needs
How long the person needs to sit on the side of the bed
52. To reposition a resident in a wheelchair, do all of the following except
a.
b.
c.
d.
Lock the wheelchair wheels
Remove or swing the front rigging out of the way
Position the person’s feet on the footplates
Apply a transfer belt