AFAMS Master Lesson Plan (MLP)
Nursing Program
Lifting and Positioning
Instructor
Serial/Semester
Location
Start/Finish Time
Date
LESSON OBJECTIVE
Performance: To gain an understanding of lifting and positioning.
Conditions:
The student will be presented a powerpoint presentation by the instructor and will have
all necessary references made available to him/her.
Standard:
1.
Given the five elements of the nursing care process and a scenario of a patient
requiring help with positioning by correctly responding to written, oral, and
experiential assessment measures
TEACHING POINTS
1. Definition of Terms.
6.
2.
State the principles of body mechanics.
7.
3.
Identify the hazards of improper alignment
and positioning.
Describe assistive devices used for proper
positioning.
Describe patient teaching topics related to
mobility.
8
4.
5.
9.
State the nursing interventions used to prevent
complications of immobility.
Demonstrate the correct lifting, carrying,
pivoting and stooping
Demonstrate placing a patient in various
positions using common positioning devices.
Demonstrate turning a patient in bed.
10.
INSTRUCTIONAL STRATEGY
Interactive Lecture
Method:
Instructor
Media:
Classroom
Environment:
OTHER LESSON SPECIFICATIONS
Knowledge Lesson
Type of Lesson:
1/50
Ratio:
Resources:
.
End of Lesson Test: None
Minutes
Instructional Time: 156
Reference(s):
DEWIT, S. C. (2)
Fundamental Concepts and Skills for Nursing, 1st
Edition, W B Saunders (ISBN: 0721669239)
01 Jan 2001
ISBN 0-323-01727-4
Foundations of Nursing, 4th Edition
01 Jan 2003
LESSON PLAN APPROVAL
Signature of Standards Officer
Date
AFAMS Master Lesson Plan (MLP)
Nursing Program
Lifting and Positioning
INTRODUCTION
Allocated Time:
Review:
5 Minutes
You have had previous anatomy and physiology lectures in your combat medic
training, this lecture will build upon prior instruction.
Objective:
To discuss/describe topics related to the nursing process.
Importance:
Nurses work in various health care settings so it is important to gain an
understanding of this subject as it will apply to your clinical practice.
Fit:
Knowing how to lift objects properly and position patients will help prevent
injury to yourself and the patient. Proper positioning of a patient can prevent
long-term disabilities to the patient.
Approach:
You will be presented the subject in lecture format and will be tested using a
written exam at a later date.
Control Statement:
If you have any questions during the lesson please feel free to ask.
BODY
1. Teaching Point: Definition of Terms.
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
a. Abduction- Movement of an extremity away from the midline of the body.
b. Adduction- Movement of an extremity toward the midline of the body.
c. Alignment- Relationship of various body parts to one another.
d. Contractures- Abnormal, usually permanent condition of a joint characterized by flexion and fixation
and caused by atrophy.
e. Dorsal recumbent- Supine position with patient lying on back, head and shoulders with extremities
moderately flexed and legs extended.
f. Extension- Movement of joint that increases the angle between two adjoining bones.
g. Fowler's position- A position arranged by elevating the head of the bed 60-90 degrees.
h. Hyperextension- Extension of a limb or part beyond the normal limit.
i. Later position- When patient is resting on his/her side.
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Lifting and Positioning
j. Lithotomy- Patient lying supine with the hips and knees flexed and the thighs abducted and rotated
externally.
k. Logroll- Technique used to turn a patient in bed as a single unit while maintaining straight body
alignment.
l. Necrosis- Local death of tissue from disease or injury.
m. Orthopneic- the ability to breathe only in the upright position.
n. Pivot- Turn or change of direction with your feet while remaining in a fixed place.
o. Pressure ulcer- An ulcer that forms from a local interference with circulation.
p. Pronation- Palm of the hand turned down.
q. Prone position- When the patient is lying face down.
r. Range of motion- Normal movement that any given joint is capable of making. Any body action
involving the muscles, joints and natural directional movement.
s. Semi-Fowler's position- Position arranged by elevating the head of the bed 30-60 degrees and raising
the knees up to 15 degrees.
t. Shearing force- An applied force that causes a downward and forward pressure on the tissues beneath
the skin.
u. Sim's position- Side-lying position in which the weight is distributed over the anterior ilium, humerus
and clavicle.
v. Supination- The act of turning the palm of the hand forward or upward.
w. Supine position- Resting on back.
x. Trendelenburg- A position in which the patient is lying supine with the head lower than the body with
the body and legs elevated and on an incline
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
What is the difference between extension and hyperextension?
Extension is the movement of a joint through a normal range of motion;
hyperextension is the extension beyond the normal range of motion.
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
2. Teaching Point: State the principles of body mechanics.
Minutes
Allocated Time:
Introduction:
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Lifting and Positioning
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
a. Maintain proper body alignment, also known as good body alignment.
(1) Keep head up and eyes straight forward.
(2) Neck straight.
(3) Chest out.
(4) Back straight.
(5) Abdominal muscles tucked in.
(6) Arms relaxed at side.
(7) Knees slightly flexed.
(8) Feet straight, toes forward.
b. Get help whenever possible.
(1) Encourage patient to assist when transferring or moving if possible.
(2) When lifting objects or moving patients get another staff member to help, this reduces the workload
by 50%.
c. Use leg muscles.
(1) When picking up objects do not bend at waist, squat down to pick up the item to prevent straining
your back.
(2) When turning a patient in bed, flex your knees and use the muscles in your legs as well as the
muscles in your arms.
d. Provide stability of movement by keeping your feet shoulder width apart. This provides a wide base
of support and provides stability for movement.
(1) Base should be 1.5 times the length of the nurse's shoes
e. Use smooth, coordinated movements instead of sudden or jerky motions. When moving, lifting or
pulling with others coordinate movement on a three count.
f. Keep loads close to body and near center of gravity.
(1) Keep elbows close to body.
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Lifting and Positioning
(2) When changing linen or moving a patient in bed, raise bed to waist height to keep the work near
your center of gravity.
g. Pull and pivot.
(1) Pulling requires less effort than pushing or lifting. When ever possible use a pulling motion.
(2) Face the direction of movement. It is easier to move an object if facing it. Do not twist; this can
cause back injuries. Pivot to change direction.
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
What takes less effort, pulling or pushing?
Pulling.
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
3. Teaching Point: Identifty the hazards of improper alignment and positioning.
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
a. Body movement and alignment are also important for the patient. Many are unable to change position
by themselves. As nurses we must remember two basic principles for the patient.
(1) Maintain correct anatomic position.
(2) Change position frequently.
b. Hazards of improper alignment and positioning.
(1) Pressure ulcers or decubitus ulcers.
(a) These ulcers form from pressure on the skin, which causes local tissue necrosis.
(b) Most often form over bony prominence.
(2) Shearing force injuries occur due to downward and forward pressure on the tissues beneath the
skin. These happen when a patient slides down in a chair or when sheets are pulled out from under the
patient.
(3) Contractured joints are frozen because muscles pull them into a fixed position. Nurses need to
perform range of motion exercises with the immobile patient to help prevent contractures. Proper
positioning of the patient will help prevent contractures.
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Lifting and Positioning
(4) The immobile patient is unable to effectively clear secretions in the lungs. Fluid collecting in the
lungs will occur if patient's position is not changed.
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
What are decubitus ulcers?
Ulcers that form from pressure on the skin, which causes local tissue necrosis.
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
4. Teaching Point: Describe assistive devices used for proper positioning.
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
a. Pillows provide support of body or extremities; elevate body parts; splint incisional sites when
coughing or moving to reduce pain. When placed between legs of side lying patient, pillows can prevent
pressure points.
b. Foot boots, high top sneakers and footboards help prevent foot drop and maintain feet in the
anatomically correct position.
c. Trochanter rolls made out of blankets prevent external rotation of the legs of the patient lying in the
supine position.
d. Sandbags provide support and shape to body contours; immobilizes extremities; and maintains specific
body alignment.
e. Hand rolls made with gauze rolls or washcloths maintain thumb slightly adducted and in opposition to
fingers, with fingers slightly flexed to maintain hand in position of function.
f. Splints used on upper and lower extremities help maintain an anatomically correct position.
g. Trapeze bars and side rails help patients who are weak or have compromised mobility to move in bed.
Trapeze bars also allow patients to transfer themselves from bed to chair.
h. Wedge pillows placed between the legs of patients maintain legs in the abducted position.
i. Bed boards add additional support to the mattress and improve vertebral alignment.
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Lifting and Positioning
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
What can be used to prevent foot drop?
Foot boots, footboards and high top sneakers.
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
5. Teaching Point: Describe patient teaching topics related to mobility.
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
a. Assess ability and motivation of patient, family members, and primary caregivers to participate in
moving and positioning patient in bed. Encourage participation in positioning and moving patient. Teach
patient ways to assist with positioning.
(1) Administer pain medication be fore activity or moving
b. Assess home or care environment to determine the compatibility of environment with assistive devices
such as hospital bed, overhead trapeze, or Hoyer lifts.
c. Teach patient and caregivers to assess the home environment for fall hazards such as loose throw rugs,
stairs without slip guards, or loose extension cords.
d. Teach family members/caregivers how to position and maintain alignment. Explain use of appropriate
devices; demonstrate how to use each device. Explain importance of maintaining proper body alignment.
Provide opportunity for return demonstration.
e. Teach patients and family members to perform range of motion exercises. Have family members and
patients assist with range of motion exercises during hospital stay.
f. Teach patients and family that full range of motion exercises must be done on geriatric or bedridden
patients to prevent complications of immobility. Emphasize importance of active range of motion
exercises.
(1) Range of motion for the patient a joint should be moved through ROM tothe point of resistance or
pain.
g. Teach family to avoid injury to joints, avoid jerking motions.
h. Teach patient and family members signs and symptoms of skin impairment and contractures. Teach
caregiver and family members to always assess skin condition for breakdown or pressure points and the
importance of maintaining skin integrity.
(1) Frequent turning every 2 hours
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Lifting and Positioning
i. Teach patient to avoid prolonged sitting. Frequent stretching decreases joint and muscle contractures.
j. Explain importance of rising slowly from lying to sitting, from sitting to standing and after stooping
over to prevent orthostatic hypotension.
k. Include family in explanation, especially when caring for infant, young child or disoriented or
unconscious patient. Provide time for questions and answers.
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
Why should a patient rise slowly?
Prevent orthostatic hyoptension.
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
6. Teaching Point: State the nursing interventions used to prevent complications of immobility.
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
a. Reposition at least every two hours to prevent skin breakdown.
b. Provide adequate intake, encourage fluids, to prevent constipation, urinary tract infections, and renal
calculi.
c. Encourage a well-balanced diet to prevent constipation or anorexia.
d. Prevent deformities by performing range of motion exercises or using footboards to prevent foot drop.
(1) Complete each exercise 5 times
e. Handle and transfer patients carefully; maintain proper body alignment.
(1) use a transfer belt.
f. Position lower extremities properly.
g. Ambulate patients early whenever possible.
h. Use antiembolism measures such as thromboembolic hose/decompression boots.
i. Progressive ambulation:
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Lifting and Positioning
(1) Raise head of bed.
(2) Dangle over side of bed.
(3) Stand.
(4) Take a few steps.
(5) Sit in chair.
(6) Up to bathroom.
(7) Up in room.
(8) Up and around ward or in the hallway.
(9) Up as desired.
j. Schedule 2 hours of activity into short periods throughtout the day to prevent long periods of inactivity
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
Click here to enter the question.
Click here to enter the answer.
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
7. Teaching Point: Demonstrate the correct lifting, carrying, pivoting and stooping
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
a. Stooping
(1) Place feet shoulder width apart.
(2) Lower body by bending at knees, keeping back straight and erect.
b. Pivoting- place feet shoulder width apart and turn as in making a facing movement in marching.
c. Lifting and carrying
(1) Get assistance whenever possible.
(2) Stoop to level of object to be lifted.
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Lifting and Positioning
(3) Grasp object and bring close to body approximately waist level.
(4) When carrying object keep elbows and object close to body.
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
Why should feet be placed shoulder width apart?
To provide a stable base.
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
8. Teaching Point: Demonstrate placing a patient in various positions using common positioning
devices.
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
a. Supine position.
(1) Place patient on back with bed flat if not contraindicated.
(2) Place a pillow under the patient's head, neck and upper shoulders.
(3) If needed, place sandbag or trochanter roll parallel to the lateral aspect of the thigh.
(4) Use heel pads or a small pillow or rolled towel under the ankles to protect the heels.
(5) Maintain upper arms parallel with body and pillows under pronated forearms.
(6) Place hand rolls or towels in patient's hands if necessary.
b. Fowler's and Semi-Fowler's.
(1) Fowler's elevate head of bed to 60-90 degrees. Semi-Fowler's elevate head of bed to 30-60
degrees.
(2) Place head and neck against small pillow on bed.
(3) Support arms and hands with pillows if needed.
(4) Place small pillow or towel roll under thighs.
(5) Protect heels by using a small pillow, rolled towel, or heel pads under patient's ankles.
c. Side-lying position.
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Lifting and Positioning
(1) Place patient on flat bed, if not contraindicated, or as low as patient can tolerate.
(2) Stand on side of bed to which you will turn the patient.
(3) Ask patient to raise arm above head. Place one hand on patient's far shoulder and the other hand on
patient's far hip and roll on side or use a draw sheet to smoothly turn patient onto side.
(4) Place small pillow under head and neck; be sure ear is flat against pillow.
(5) Roll blanket lengthwise and place against back. Place lengthwise pillow between the flexed knees
from knee to foot.
d. Side-lying oblique position.
(1) Move shoulder blades next to bed forward toward you.
(2) Flex the arm next to the mattress; raise hand so that it is in front of face and even with top of
patient's head.
(3) Support upper arm with pillow so that it is level with the shoulder.
(4) Reach under hip area and pull the hip slightly forward.
(5) Slightly flex knees and support upper leg from thigh to the ankle with lengthwise placed pillow.
e. Sim's.
(1) Position patient in complete side-lying position, but move farther to the side of the bed. Partially
roll patient forward partly on abdomen.
(2) Slightly flex arm next to mattress behind patient.
(3) Support flexed uppermost arm with pillow so that it is level with the shoulder.
f. Prone position.
(1) Lower head of bed to a flat position; place patient in supine position; and move to opposite side
bed.
(2) Put a small pillow on the patient's abdomen, distal to the diaphragm.
(3) Place arms close to the body with elbow extended and hand under hip.
(4) Roll patient toward you (pillow is between patient's abdomen and the bed).
(5) Place a small pillow under patient's head; turn head to one side, and be sure ear is flat against the
pillow.
(6) Support flexed arms at shoulder level.
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Lifting and Positioning
(7) Place pillow under the lower legs.
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
How high does the nurse elevate the head of the bed in Fowler's position?
60-90 degrees.
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
9. Teaching Point: Demonstrate turning a patient in bed.
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
a. Obtain assistance.
b. Lower head of bed.
c. Place a pillow between patient's legs. Use of a draw sheet placed between shoulders and knees can
facilitate turning.
d. Extend the patient's arm over the patient's head unless shoulder movement is restricted. If shoulder
movement is restricted, keep arm in extension next to body.
e. With both nurses on the same side of bed, one nurse places one hand on the patient's shoulder and the
other on the hip while the other nurse places one hand to support the back and the other behind the knees.
If a draw sheet is used, hands are placed alternately to provide even support for the length of the sheet and
to distribute weight evenly.
f. On a count of three, turn the patient with a continuous, smooth, and coordinated effect, maintaining
proper body alignment.
g. Support the patient with pillows as discussed earlier in the lesson.
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
Where should you place the patient's arm if shoulder movement is restricted?
Place arm extended next to body.
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Lifting and Positioning
END OF LESSON TEST
Allocated Time:
Instructions:
Test Questions or
Performance
Expected:
Test Key:
0 Minutes
You will be tested on this subject at a later date.
You will be expected to review and study the material taught in this session in
order to pass the associated written test. If you have difficulty with the material
please see me so we can review together.
None.
CONCLUSION
Allocated Time:
Summary:
5 Minutes
Review and re-emphasize the difficult Teaching Points below.
1.
2.
3.
4.
5.
6.
7.
8
9.
10.
Definition of Terms.
State the principles of body mechanics.
Identifty the hazards of improper alignment and positioning.
Describe assistive devices used for proper positioning.
Describe patient teaching topics related to mobility.
State the nursing interventions used to prevent complications of
immobility.
Demonstrate the correct lifting, carrying, pivoting and stooping
Demonstrate placing a patient in various positions using common
positioning devices.
Demonstrate turning a patient in bed.
Closing Statement:
Nurses work in various health care settings so it is important to gain an
understanding of this subject as it will apply to your clinical practice.
Re-motivating
Statement:
Knowing how to lift objects properly and position patients will help prevent
injury to yourself and the patient. Proper positioning of a patient can prevent
long-term disabilities to the patient.
12