14
section
safety and infection Control
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Ergonomics are the factors or qualities in an object’s design and/or use that contribute to comfort, safety, efficiency, and ease of use.
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Using good body mechanics when positioning and moving clients promotes safety for the client as well as for health care providers.
Before attempting to position or move a client, the nurse should perform a mobility assessment. Begin this assessment with the easiest movements (range of motion) and progress as long as the client tolerates it (balance, gait, and exercise).
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Body mechanics is the proper use of muscles to maintain balance, posture, and body alignment when performing a physical task. Nurses use body mechanics when providing care to clients by lifting, bending, and carrying out the activities of daily living.
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The risk of injury to the client and the nurse is reduced with the use of good body mechanics. Whenever possible, mechanical lift devices should be used to lift and transfer clients. Many health care agencies have “no manual lift” and “no solo lift” policies.
Center of gravity
View media supplement: ergonomic Principles (video)
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The center of gravity is the center of a mass.
Weight is a quantity of matter acted on by the force of gravity.
To lift an object, the nurse must overcome the weight of the object and know the center of gravity of the object.
When the human body is in the upright position, the center of gravity is the pelvis.
When an individual moves, the center of gravity shifts.
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● ergonomiC PrinCiPles
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The closer the line of gravity is to the center of the base of support, the more stable the individual is.
To lower the center of gravity, bend the hips and knees.
Lifting
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Use the major muscle groups to prevent back strain, and tighten the abdominal muscles to increase support to the back muscles.
Distribute the weight between the large muscles of the arms and legs to decrease the strain on any one muscle group and avoid strain on smaller muscles.
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When lifting an object from the floor, flex the hips, knees, and back. Get the object to thigh level, keeping the knees bent and the back straightened. Stand up while holding the object as close as possible to the body, bringing the load to the center of gravity to increase stability and decrease back strain.
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Use assistive devices whenever possible, and seek assistance whenever it is needed.
When pushing or pulling a load:
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Widen the base of support.
When opportunity allows, pull objects toward the center of gravity rather than pushing away.
If pushing, move the front foot forward, and if pulling, move the rear leg back to promote stability.
Face the direction of movement when moving a client.
Use own body as a counterweight when pushing or pulling to make the movement easier.
Sliding, rolling, and pushing require less energy than lifting and offer less risk for injury.
Avoid twisting the thoracic spine and bending the back while the hips and knees are straight.
Guidelines to Prevent Injury
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Know your agency’s policies regarding lifting.
Plan ahead for activities that require lifting, transfer, or ambulation of a client, and ask others to be ready to assist at the planned time.
Be aware that the safest way to lift a client may be with the use of assistive equipment.
Rest between heavy activities to decrease muscle fatigue.
Maintain good posture and exercise regularly to increase the strength of arm, leg, back, and abdominal muscles, so these activities will require less energy.
Use smooth movements when lifting and moving clients to prevent injury through sudden or jerky muscle movements.
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ergonomiC PrinCiPles
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When standing for long periods of time, flex the hip and knee through use of a foot rest. When sitting for long periods of time, keep the knees slightly higher than the hips.
Avoid repetitive movements of the hands, wrists, and shoulders. Take a break every 15 to 20 min to flex and stretch joints and muscles.
Maintain good posture (head and neck in straight line with pelvis) to avoid neck flexion and hunched shoulders, which can cause impingement of nerves in the neck.
Avoid twisting the spine or bending at the waist (flexion) to minimize the risk for injury.
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The nurse is responsible for positioning clients so that good body alignment is maintained.
Many clients are able to reposition themselves when they are uncomfortable. It is especially important for the nurse to ensure proper positioning of clients who are unable to move themselves due to disability or injury.
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Transfers and Use of Assistive Devices
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Assess the client’s ability to help with transfers (balance, muscle strength, endurance).
Determine the need for additional personnel or assistive devices (transfer belt, hydraulic lift, sliding board).
Assess and monitor the client’s proper use of mobility aids (canes, walkers, crutches).
Include assistance or mobility aids needed for safe transfers and ambulation in the plan of care.
PosItIoN semi-Fowler’s position
Fowler’s position dEscRIPtIoN
• the client lies supine with the head of the bed elevated approximately 30°, and his knees may be slightly elevated
(about 15°).
• this position is frequently used to prevent regurgitation of tube feedings and aspiration in clients with difficulty swallowing.
• the client lies supine with the head of the bed elevated approximately 45°, and his knees may be slightly elevated
(about 15°).
• this position is frequently used during procedures such as nasogastric tube insertion and suctioning. it also allows for better chest expansion and ventilation, as well as better dependent drainage, after abdominal surgeries.
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PosItIoN
High-Fowler’s position supine or dorsal recumbent position
Prone position lateral or side-lying position sims’ or semi-prone position orthopneic position trendelenburg position reverse trendelenburg ergonomiC PrinCiPles dEscRIPtIoN
• the client lies supine with the head of the bed elevated approximately 90°, and his knees may or may not be elevated.
• this position promotes lung expansion by lowering the diaphragm and is used for clients experiencing severe dyspnea.
• the client lies on his back with his head and shoulders elevated on a pillow. the client’s forearms may be placed on pillows or placed at the side. a foot support prevents footdrop and maintains proper alignment.
• the client lies flat on his abdomen with his head to one side.
• this position promotes drainage from the mouth for clients following throat or oral surgery, but inhibits chest expansion.
• the client lies on his side with most of his weight on the dependent hip and shoulder. His arms should be flexed in front of the body. a pillow is placed under his head and neck, the upper arm, and under the leg and thigh to maintain body alignment.
• this is a good sleeping position, but the client must be turned regularly to prevent development of pressure ulcers on the dependent areas. a 30° lateral position is recommended for clients at risk for pressure ulcers.
• the client is on his side halfway between lateral and prone positions. (weight is on the anterior ileum, humerus, and clavicle.) the lower arm is behind the client while the upper arm is in front. both legs are flexed, but the upper leg is flexed at a greater angle than the lower leg at the hip as well as at the knee.
• this is a comfortable sleeping position for many clients, and it promotes oral drainage.
• the client sits in the bed or at the bedside. a pillow is placed on the over-bed table, which is placed across the client’s lap. the client rests his arms on the over-bed table.
• this position allows for chest expansion and is especially beneficial to clients with CoPd.
• the entire bed is tilted with the head of the bed lower than the foot of the bed.
• this position is used during postural drainage, and it facilitates venous return.
• the entire bed is tilted with the foot of the bed lower than the head of the bed. this position promotes gastric emptying and prevents esophageal reflux.
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ergonomiC PrinCiPles
1. A nurse is caring for a female client who has been placed in skeletal traction to treat a tibial fracture from a motor vehicle crash. Which of the following factors may place the client at risk for complications related to immobility?
A. The client exercised regularly prior to her injury.
B. The client has a head injury and is disoriented.
C. The client has been taking a multivitamin daily.
D. The client’s 24-hr fluid intake is 2,000 mL.
2. A nurse is caring for a postoperative client who has an order for semi-Fowler’s position. The nurse should recognize that
A. the head of the bed should be raised 30°.
B. the head of the bed should be raised 45°.
C. the client should be placed in a side-lying position.
D. a pillow should be placed between the client’s knees.
3. Place the following steps of a mobility assessment in the correct sequence.
Exercise tolerance
Moving from supine to sitting on the side of the bed
Gait
Range of motion
4. Which of the following positions promotes drainage from the mouth for clients with throat or oral surgery but inhibits chest expansion?
A. Fowler’s position
B. Semi-Fowler’s position
C. Prone position
D. Reverse Trendelenburg
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ERGONOMIC PRINCIPLES
1. A nurse is caring for a female client who has been placed in skeletal traction to treat a tibial fracture from a motor vehicle crash. Which of the following factors may place the client at risk for complications related to immobility?
A. The client exercised regularly prior to her injury.
B. The client has a head injury and is disoriented.
C. The client has been taking a multivitamin daily.
D. The client’s 24-hr fluid intake is 2,000 mL.
Clients who have sensory impairment such as disorientation are at greater risk for complications due to immobility. The client’s exercise program and intake of a multivitamin contribute to overall good health. A daily fluid intake of 2,000 mL is adequate.
NCLEX ® Connection: Basic Care and Comfort: Mobility/ Immobility
2. A nurse is caring for a postoperative client who has an order for semi-Fowler’s position. The nurse should recognize that
A. the head of the bed should be raised to 30°.
B. the head of the bed should be raised 45°.
C. the client should be placed in a side-lying position.
D. a pillow should be placed between the client’s knees.
In the semi-Fowler’s position, the client lies flat on his back. The head of the bed is raised
30°. He does not lie on his side and a pillow is not placed between his knees.
NCLEX ® Connection: Safety and Infection Control: Ergonomic Principles
3. Place the following steps of a mobility assessment in the correct sequence.
4 Exercise tolerance
2 Moving from supine to sitting on the side of the bed
3 Gait
1 Range of motion
NCLEX ® Connection: Basic Care and Comfort: Mobility/ Immobility
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ergonomiC PrinCiPles
4. Which of the following positions promotes drainage from the mouth for clients with throat or oral surgery but inhibits chest expansion?
A. Fowler’s position
B. Semi-Fowler’s position
C. Prone position
D. Reverse Trendelenburg
The prone position promotes drainage from the mouth for clients with throat or oral surgery, but it inhibits chest expansion. Fowler’s and semi-Fowler’s positions promote chest expansion. Reverse Trendelenburg promotes gastric emptying and prevents esophageal reflux.
NCLEX ® Connection: Basic Care and Comfort: Mobility/ Immobility
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