Learning Supplement
Body Mechanics, Moving and Transferring, Positioning, and
Ambulating a Patient
Introduction
Mobility is the ability to move freely, easily, and purposefully in the environment.
Individuals must move to protect themselves from trauma and to meet their basic
needs. Mobility is vital to independence.
NURSING DIAGNOSIS
Some common nursing diagnoses related to the individual who is experiencing a
problem with physical mobility that will guide nursing care include:
1. Impaired physical mobility related to:
2. Risk for injury related to:
3. Activity intolerance related to:
GOALS
The patient will:
1.
2.
3.
INTERVENTIONS
Body Mechanics
Definition
Body mechanics is the use of the body in movement (lifting, bending, moving)
and at rest. It is the efficient, coordinated, and safe effort of the musculoskeletal
and nervous systems.
Why Use
Healthcare workers use proper body mechanics to:
1. reduce fatigue.
2. prevent injury.
3. maintain balance.
4. conserve energy.
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Components of Body Mechanics
1. Center of Gravity – located in the pelvis, it is the point where the body’s mass is
centered.
2. Line of Gravity – passes through the base of support or center of gravity. (The
base of support includes the feet and the distance between the feet.)
Both of these assists the body to maintain optimal balance and alignment. Without
this balance, the center of gravity is displaced creating a risk for falling and receiving
an injury.
Principles of Body Mechanics
1. Size up your load to determine whether you need help. Know your abilities and
limitations when lifting or moving. Get help or find an alternative method to
move the patient.
2. Push, pull, or roll object rather than lift. Since gravity exerts a downward force, it
is easier to push or pull an object than to lift it.
3. Pulling is easier than pushing. So pull patients toward you rather than push.
4. The wider the base of support and the lower the center of gravity, the greater the
stability.
 You can lower your center of gravity by bending your knees.
 You can widen the base of support by moving your feet apart.
5. Objects that are close to the center of gravity, the more effective and stable that
force is, and are moved with less effort.
 When moving patients keep them close to your body.
 When carrying an object, carry close to your body.
6. The amount of work required to move an object is directly related to the amount
of resistance and gravitational pull. Friction is a resistive force between two
objects.
 Keep sheets wrinkle free to decrease friction.
 Lower the head of the bed to move a patient up in bed.
7. Use the longest and strongest muscles of the legs and arms rather than the
weaker muscles of the back. It is less fatiguing and safer.
8. Move your body as a unit – avoid twisting, stretching, or stooping
 Keep your back straight.
 Turn the feet, not the back if a change of direction is required. Twisting
the back causes a shift in balance and can strain the structures in the low
back area.
 Face in the direction you are moving.
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Complications of Poor Body Mechanics
A major complication of poor body mechanics is lower back injury. Two
movements to avoid because of their potential for causing back injury are:
1. twisting (rotation) of the thoracolumbar spine.
2. acute flexion of the back with hips and knees straight (stooping).
To protect the back - Squarely facing the direction of movement, whether
pushing, pulling, or sliding, and moving the object directly toward or away from
one’s center of gravity can prevent undesirable twisting of the back.
Moving and Transferring a Patient
Moving and transferring a patient requires good planning to avoid injury to the
patient and the nurse. When moving and transferring a patient, the nurse needs to
consider the patient’s ability to assist with the transfer. If the patient is unable to
provide any assistance or is large, the nurse may need help to perform the transfer
safely.
Assessment Prior to Moving / Transferring
1.
Note conditions that impair the patient’s activity and mobility.
2.
Observe the patient’s position in bed, alignment.
3.
Identify the patient level of consciousness and capacity for following
directions.
4.
Determine the patient’s strength and ability to assist with moving.
5.
Estimate the effort required to move the patient in relation to his size,
weight.
Basic Guidelines for Moving and Transferring a Patient
1.
As a rule, a patient’s position is changed at least every 2 hours. Patient’s
condition may indicate otherwise.
2.
You do not need a doctor’s order to turn the patient, but the doctor should
write an activity order.
3.
The aim of moving a patient is to put the least possible stress on his/her
joints and skin.
4.
Use a lift pad / draw sheet to reduce shearing force on the patient’s skin.
5.
If a patient is in proper body alignment, he will remain functional and
unstressed.
6.
If you feel a patient is too large or too weak for you to safely move, get
assistance.
7.
Falls are the most common hazard to a patient being transferred.
8.
Have the patient put on shoes or slippers with firm soles, if they have them.
A patient should not get out of bed without foot cover.
9.
Always get your patient to assist you with any activity.
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10.
When you are moving a patient up in bed, have them bend their knees and
place the soles of the feet firmly on the surface of the bed. This reduces the
drag.
11.
Be sure that everyone involved in a transfer/move know what is expected of
them, including the patient. Communicate your intentions clearly.
12.
Be sure that restraint devices will not interfere with moving/transfer of
patient. They may need to be removed and replaced after the move.
13.
Be sure that locks are “on” all moveable equipment.
14.
Be sure to document you patient’s activity and tolerance of the activity in
the chart as soon as you are finished with the patient.
Positioning
Positioning a patient in good alignment and changing the position regularly and
systematically are essential aspects of nursing care. Any position, correct or
incorrect, can be detrimental if maintained for a prolonged period. Frequent change
of position helps to prevent muscle discomfort, undue pressure resulting in pressure
ulcers, damage to superficial nerves and blood vessels, and contractures.
When positioning patients in bed to ensure proper alignment and comfort, the nurse
should:
1. Make sure the mattress is firm and level.
2. Ensure that the bed is clean and dry, wrinkle free.
3. Place support devices in specified areas according to the patient’s position.
Examples of some support devices are:
a. pillows: rolled or folded linen
b. mattresses
c. bed boards
d. trapeze bar
e. boots, splints, wedges
4. Avoid placing one body part, particularly one with bony prominence, directly
on top of another body part.
5. Always ask the patient which position is most comfortable and appropriate.
Types
1.
2.
3.
of Positions
Supine – back-lying with head and shoulders, forearms on pillow.
Prone – lies on abdomen with the head turned to one side.
Fowlers, semi-fowlers, high-fowlers - fowlers- semi-sitting 45° - 90°
Semi-fowlers- 15-45 degrees, and high fowlers is when the head and chest
are raised 90 degrees.
4. Lateral – side-lying where the patient lies on one side of the body. Flexing
the top hip and knee and placing this leg in front of the body creating a wider
base of support and greater stability.
5. Sims position – semiprone position. The patient is halfway between lateral
and prone.
Ambulation
Ambulation is the act of walking. Patients who have been immobilized for a few
days become weak, unsteady, and shaky when first getting out of bed and may need
help with ambulation. The amount of assistance will depend on the patient’s
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condition, including age, health status, and length of inactivity. Assistance may
mean walking along side the patient while providing physical support or providing
instruction to the patient about the use of assistive devices.
Assessment of the Patient Prior to Ambulation
1. Determine the patient’s most recent activity level to evaluate ambulatory
ability.
2. Assess the patient’s current condition, including fatigue, pain, dizziness and
medications that may affect ambulation.
3. Evaluate the patient’s environment for safety.
4. Assess need for any ambulation equipment.
5. Assess the patient’s shoes to be sure they are safe to walk in and that he has
adequate covering for warmth and privacy.
Protecting the Safety of the Patient during a Fall
A complication that can occur with ambulation is a fall. It is the nurses’
responsibility to protect the patient who begins to fall. The nurse should ease the
patient to the floor while supporting and protecting the patient’s head. Position
yourself next to and slightly behind the ambulating patient this being able to step
behind the patient and safely ease the patient to the floor. Ask another person to
assist you in returning the patient to bed.
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