AFAMS Master Lesson Plan (MLP)
Nursing Program
Skills Lab #02B
Instructor
Serial/Semester
Location
Start/Finish Time
Date
LESSON OBJECTIVE
Performance: Apply transferring, ambulating, and ROM techniques to assist the patient.
Conditions:
Given a patient scenario, a simulated patient and necessary equipment in a practical
exercise environment, using the skills checklist.
Standard:
1.
You will demonstrate to the instructor using a hands-on approach the skills taught
in this lab.
TEACHING POINTS
1. Ambulate a patient.
2. Transfer a patient from a bed to a chair/litter.
3. Instruct a patient in the use of a cane or
walker.
4.
5.
6.
Instruct a patient on the use of crutches.
Use a wheelchair.
Perform active and passive range of motion
(ROM).
INSTRUCTIONAL STRATEGY
Demonstration-Performance and Simulation
Method:
Real Equipment and Instructor
Media:
Skills Lab
Environment:
OTHER LESSON SPECIFICATIONS
Skill Lesson
Type of Lesson:
1/10
Ratio:
Resources:
Supportive equipment (pillows, blankets, etc),
crutches, patient shoes/slippers, walker, cane,
chair/litter, wheelchair, hospital bed, gloves, and
mannequin.
Instructional Time: 190 Minutes
180 Minutes
Skills Lab Test:
End of Lesson Test: None
Reference(s):
Adult Health Nursing, 4th Edition 01 Jan 2003.
DEWIT, S. C. Fundamental Concepts and Skills for
Nursing, 1st Edition, W B Saunders. 01 Jan 2001
LESSON PLAN APPROVAL
Signature of Standards Officer
Date
AFAMS Master Lesson Plan (MLP)
Nursing Program
Skills Lab #02B
INTRODUCTION
Allocated Time:
Review:
5 Minutes
Transferring, ambulating, and ROM lectures.
Objective:
This lesson will provide you the information and skills to safely move and
transfer patients.
Importance:
It is important that you learn, demonstrate, and apply these skills as they will
be critical to the mobility and transfer of your patient.
Fit:
This Skills lab will teach you some basic nursing skills vital to the clinical
area.
Approach:
The class will be broken up into small groups. I will demonstrate then have
you practice each skill using your skills checklist.
Control Statement:
If you have any questions during the lesson please feel free to ask.
BODY
1. Teaching Point: Ambulate a patient.
40 Minutes
Allocated Time:
You are required to walk a patient. You will need a transfer belt and an
Introduction:
assistant.
Learner Participation:
Knowledge Lesson
Skill Lesson
Apply teaching points using hands-on approach.
Refer to Ambulate a Patient skills checklist. *Bolded sections are critical steps,
Learning Support:
if the student does not perform/observe these steps, student will fail and
require remedial training.
1
AFAMS Master Lesson Plan (MLP)
Nursing Program
Skills Lab #02B
Performance Steps
1. Identify the patient.
2. Explain the procedure to the patient/family.
3. Prepare for ambulation.
a. Wash your hands and follow standard precautions.
b. Make sure the patient is dressed to walk and has on shoes.
c. Assist the patient to sit on the edge of the bed.
d. Observe the patient for signs and symptoms of orthostatic hypotension.
(1) Dizziness.
(2) Lightheadedness.
(3) Increase in heart rate.
e. Consult the charge nurse before attempting to ambulate the patient if he or she is very weak and
unstable.
f. Apply a transfer belt. Make sure the belt is snug around the patient's waist and fastened
securely.
g. Assist the patient to a standing position and remain in that position until the patient feels secure
and steady.
4. Assist the patient to ambulate.
a. Encourage the patient to walk independently, but walk beside them.
b. Stay close to the patient at all times in case assistance is needed.
c. Walk on the patient's weaker side and interlock your forearm with theirs, if the patient seems
unstable.
d. Have an assistant follow behind you and the patient with a wheelchair if the patient is a high
risk for falls.
(1) After surgery.
(2) Prolonged immobility.
(3) Injury.
(4) Confused mental status.
e. Grasp the transfer belt of a high-risk patient and walk slightly behind and to one side of them.
5. Protect the patient who begins to fall while ambulating.
a. Assist the patient to a nearby chair and ask the patient to lower their head between their knees.
b. Stay with the patient.
c. Assist the patient back to the bed after the weakness subsides.
d. Assist the patient to a horizontal position on the floor if a chair is not available.
(1) Assume a broad stance with one foot in front of the other.
(2) Bring the patient backward so that your body supports them.
(3) Allow the patient to slide down your leg, and lower the person gently to the floor, making
sure the patient does not hit their head.
e. Stay with the patient until the weakness resolves, and then assist them back to bed.
f. Check local policy for requirements to report the incident on an unusual occurrence form.
6. Report unexpected outcomes to the charge nurse.
7. Document the procedure.
a. How far the patient ambulated and how he or she tolerated the procedure.
b. How much assistance was required?
c. Any unexpected outcomes.
2
AFAMS Master Lesson Plan (MLP)
Nursing Program
Skills Lab #02B
2. Teaching Point: Transfer a patient from a bed to a chair/litter
50 Minutes
Allocated Time:
You are required to move a patient from a bed to a chair or litter. You will
Introduction:
need an assistant, transfer belt, sliding belt, robe, footwear, chair, wheelchair,
stretcher, or litter.
Learner Participation:
Knowledge Lesson
Skill Lesson
Apply teaching points using hands-on approach.
Refer to Patient Transfer skills checklist. *Bolded sections are critical steps, if
Learning Support:
the student does not perform/observe these steps, student will fail and require
remedial training.
Performance Steps
1. Prepare for transferring patient.
a. Identify the patient.
b. Explain procedure to patient/family.
c. Remove obstacles from the transfer path.
d. Wash hands and follow standard precautions.
e. Provide patient privacy.
2. Transfer the patient.
a. Bed to chair.
(1) Lower the bed.
(2) Place a chair parallel to the bed as close as possible.
(3) Assist the patient to a sitting position on the side of the bed.
(4) Evaluate the patient for signs and symptoms of orthostatic hypotension.
(5) Assist the patient in putting on a robe, appropriate footwear, etc.
(6) Place a transfer belt snugly around the patient's waist, if necessary.
(7) Move the patient to the edge of the bed.
(8) Lean forward and place one foot between the patient's legs and put the other leg forward,
being sure to bend with your legs and not with your back.
(9) Have the patient put his or her hands on your shoulders.
(10) Grasp the patient's waist with your arms, grasping the transfer belt at the patient's back.
(11) Assist the patient to a standing position and pivot towards the chair.
(12) Assist the patient to a sitting position, having the patient hold the arms of the chair with
his or her arms.
(13) Ensure that the patient is sitting back in the seat.
(14) Apply a seat belt if available.
b. Bed to litter.
(1) Assess the patient to determine the number of staff needed to perform a safe transfer. This
procedure requires a minimum of two persons.
(2) Lower the head of the bed to the flat position.
(3) Raise the bed so it is slightly higher than the litter.
(4) Make sure the wheels on the bed are locked.
(5) Pull the draw sheet out from the bed.
(6) Move the patient to the edge of the bed, next to the litter.
(7) Roll the draw sheet in as close to the patient's sides as possible.
(8) Make sure the litter's wheels are locked.
(9) Grasp the draw sheet in unison with other staff members.
(10) Count to three and pull the sheet in unison directly towards the litter. Pull if you are
3
AFAMS Master Lesson Plan (MLP)
Nursing Program
Skills Lab #02B
bringing the patient towards you, lifting and move forward, if the patient is moving away
from you.
(11) Make sure the patient is comfortable.
(12) Move the litter away from the bed and put the side rails up.
(13) Cover the patient with a blanket.
3. Report unexpected outcomes to the charge nurse.
4. Document the nursing activity.
a. That the patient was safely transferred.
b. How the patient tolerated the procedure.
3. Teaching Point: Instruct a patient in the use of a cane or walker.
40 Minutes
Allocated Time:
You have a patient who requires the use of an assistive device to ambulate.
Introduction:
You must assess the patient and determine the appropriate device such as a
cane or walker and instruct the patient in its proper use.
Learner Participation:
Knowledge Lesson
Skill Lesson
Apply teaching points using hands-on approach.
Refer to Assist Patient – Use a Cane skills checklist. *Bolded sections are
Learning Support:
critical steps, if the student does not perform/observe these steps, student will
fail and require remedial training.
Performance Steps
1. Assess the patient's physical strength.
a. Ability to bear body weight.
b. Ability to maintain balance.
c. Ability to hold body erect.
2. Determine the type of ambulatory assistive device appropriate for the patient. The privileged
provider or physical therapist may specify the device to be used.
3. Inspect the equipment to ensure it is in proper working order.
a. Hand grips clean and intact.
b. Rubber tips in place and intact.
c. Wheels in place and operating correctly.
d. Adjusted to proper fit for the patient.
4. Identify the patient and provide privacy.
5. Explain the procedure to the patient/family.
6. Wash your hands and follow standard precautions.
7. Instruct the patient on how to use the ambulatory assistance device.
NOTE: A nurse or physical therapist must instruct a patient in the use of assistive devices. Once the
patient demonstrates adequate skill in ambulating with the equipment, unlicensed personnel may assist the
patient with ambulation.
a. Using a cane.
(1) Maximum support.
(a) Ask the patient to hold the cane on the stronger side of the body.
(b) Position the tip of the cane 6 inches to the side and front of the near foot. If a multitipped cane is used, the tip nearest the foot is placed 6 inches to the side and front of
the foot.
(c) Check to confirm the elbow is slightly flexed.
4
AFAMS Master Lesson Plan (MLP)
Nursing Program
Skills Lab #02B
(d) Keep the body weight on both legs and move the cane forward to a position of
comfort for the patient. This distance should not exceed 1 foot.
(e) Ask the patient to bring the affected leg forward to the cane while transferring the
body's weight onto the cane and the strongest leg.
(f) Instruct the patient to bring the unaffected leg forward past the cane as the body’s
weight is supported by the cane and affected leg.
(2) Minimum support.
(a) Instruct the patient to transfer the body's weight to the strongest leg; then move the
cane and the weaker leg forward at the same time.
(b) Ask the patient to transfer the body's weight to the cane and weaker leg; then bring
the strongest leg forward.
b. Using a walker.
(1) Maximum support.
(a) Ask the patient to move the walker forward about 6 inches with the body's weight
supported by both legs.
(b) Instruct the patient to move the right leg up while supporting the body's weight on the
left leg and both arms.
(2) Minimum support.
(a) Move the walker and the weak leg forward together while the body's weight is on the
stronger leg.
(b) Move the stronger leg forward with the body's weight supported by the weaker leg
and both arms.
8. Ensure patient safety.
a. Walk beside the patient on the affected side.
b. Ambulate the patient as tolerated or as indicated in the plan of care.
c. Prevent patient injury in the event of loss of balance or fall by supporting the patient as needed.
9. Report unexpected outcomes to the charge nurse.
10. Document the activity in the patient's record.
a. Assistive device used.
b. Patient tolerance.
c. Problems encountered.
d. Distance ambulated.
e. Patient progress.
4. Teaching Point: Instruct a patient on the use of crutches.
40 Minutes
Allocated Time:
You have a patient who requires the use of crutches to ambulate. You must
Introduction:
assess the patient and instruct the patient in the use of crutches.
Learner Participation:
Knowledge Lesson
Skill Lesson
Apply teaching points using hands-on approach.
Refer to Assist a Patient – Use Crutches skills checklist. *Bolded sections are
Learning Support:
critical steps, if the student does not perform/observe these steps, student will
fail and require remedial training.
Performance Steps
1. Identify the patient and provide privacy.
2. Wash your hands and follow standard precautions.
3. Perform a physical assessment.
5
AFAMS Master Lesson Plan (MLP)
Nursing Program
Skills Lab #02B
a. Strength of the lower extremities, arms, and hands.
b. Ability to bear the body's weight.
c. Ability to maintain balance.
d. Ability to hold the body erect.
4. Explain the procedure to the patient/family.
NOTE: Due to the extent of knowledge required, teaching the patient to use crutches must be done by a
nurse or physical therapist. Once a patient demonstrates adequate skill, unlicensed personnel may assist a
patient in ambulating with crutches.
5. Assist or request the patient to put on the shoes to be used during crutch walking.
6. Inspect the crutches to ensure the handles, grips, and tips are in safe working condition.
7. Measure the distance from the patient's axilla to a point 6 to 8 inches out from the heel.
NOTE: A waist belt should be used on all patients receiving initial instruction in the use of crutches. Use
a waist belt on all patients at risk for falls. When ambulating a patient, stand slightly behind and to the
affected side. A patient is most likely to fall toward the affected side.
8. Have the patient assume the tripod position. Ask the patient to stand with the crutches under the
arms. Instruct the patient to place the crutches 6 inches in front and 6 inches out from the feet.
9. Adjust the hand bars on the crutches so that the patient's elbows are always slightly flexed at 30
degrees. This allows the body's weight to be borne by the forearms and crutch handles.
10. Ensure proper fit of the crutches. You should be able to place two fingers between the crutch arm
rest and the axilla.
11. Demonstrate and explain each gait before allowing the patient to attempt ambulation.
12. Provide instruction in crutch ambulation.
a. Four-point gait. This is the safest gait allowing three points of support at all times.
(1) Move the right crutch forward 4 to 6 inches.
(2) Move the left foot forward to the level of the crutch.
(3) Move the left crutch forward 4 to 6 inches.
(4) Move the right foot forward.
b. Three-point gait. The patient must be able to bear the body's entire weight on one leg.
(1) Move both crutches forward with the weaker leg.
(2) Move the stronger leg forward.
c. Two-point gait. This gait requires balance and the ability to bear at least partial weight on both
legs.
(1) Move the left crutch and right foot forward together.
(2) Move the right crutch and left foot forward together.
d. Swing to gait. This gait is used for those with paralysis of the legs and hips.
(1) Move both crutches forward together.
(2) Lift the body's weight with the arms and swing to the crutches.
e. Swing through gait. This gait requires considerable strength, balance, and coordination.
(1) Move both crutches forward together.
(2) Lift the body's weight by the arms and swing through and beyond the crutches.
13. Provide instruction in using a chair with crutches.
a. Getting into a chair.
(1) Ensure the chair has an armrest and is secure against a wall.
(2) Ask the patient to stand with the back of the unaffected leg centered against the chair.
(3) Transfer the crutches to the hand on the affected side, and then grasp the armrest with the
hand on the unaffected side.
(4) Lean slightly forward with knees flexed, and then lower the body into the chair.
b. Getting out of a chair.
6
AFAMS Master Lesson Plan (MLP)
Nursing Program
Skills Lab #02B
(1) Have the patient move forward to the edge of the chair.
(2) Have the patient place the unaffected leg slightly under the edge of the chair.
(3) Instruct the patient to grasp the crutch handles with the hand on the affected side, and then
grasp the arm of the chair with the hand on the unaffected side.
(4) Push down on the crutch handles and armrest while raising the body out of the chair.
(5) Ask the patient to assume the tripod position before attempting to move.
14. Using stairs with crutches.
a. Going upstairs.
(1) Have the patient assume the tripod position at the base of the stairs.
(2) Stand behind the patient and to the affected side.
(3) Instruct the patient to transfer the body's weight to the crutches, and then place the
unaffected leg on the step.
(4) Have the patient transfer the body's weight to the unaffected leg and move the crutches
and affected leg up to the step.
NOTE: The crutches always support the affected leg.
b. Going down stairs.
(1) Ask the patient to assume the tripod position at the top of the stairs.
(2) Instruct the patient to shift the body's weight to the unaffected leg, and then move the
crutches and affected leg down onto the step.
(3) Have the patient transfer the body's weight to the crutches, and then bring the unaffected
leg down to the step.
15. Provide patient education related to using crutches.
a. Be aware of slippery floors.
b. Loose objects.
c. Unfastened rugs.
d. Recommend use of nonskid strips on stairs.
16. Report unexpected outcomes to the charge nurse.
17. Document the nursing activity.
a. Patient's ability.
b. Observed progress.
c. Education provided.
8. Teaching Point: Use a wheelchair.
15 Minutes
Allocated Time:
Introduction:
Given a patient scenario, a simulated patient and necessary equipment in a
practical exercise environment.
Learner Participation:
Knowledge Lesson
Skill Lesson
Apply teaching points using hands-on approach.
Refer to Use a Wheelchair skills checklist. *Bolded sections are critical steps,
Learning Support:
if the student does not perform/observe these steps, student will fail and
require remedial training.
Performance Steps
a. Place wheelchair in position and set brakes.
b. When patient seated, place feet correctly on footrests.
7
AFAMS Master Lesson Plan (MLP)
Nursing Program
Skills Lab #02B
c. Ensure clothing or lap robe tucked safely away from wheels.
d. Put shoes, slippers or bed socks on patient to protect feet.
e. Keep patient in wheelchair away from stairwells, elevators and doorways.
f. Push wheelchair in smooth, slow and safe manner- no tilting back. Watch for and maneuver
around obstacles.
g. Always lock brakes when chair not in motion.
6. Teaching Point: Perform active and passive ROM.
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson
Skill Lesson
Learning Support:
35 Minutes
You have a patient that requires range of motion exercises.
Apply teaching points using hands-on approach.
Refer to Range of Motion skills checklist. *Bolded sections are critical steps, if
the student does not perform/observe these steps, student will fail and require
remedial training.
Performance Steps
a. Introduce self. Identify patient. Explain procedure.
b. Wash hands and don gloves when appropriate.
c. Prepare patient.
(1) Provide privacy.
(2) Drape for procedure appropriately.
(3) Raise bed to safe, working level.
(4) Assist patient into comfortable position.
(5) Medicate patient as needed.
d. Support the body part above and below the joint by cradling the extremity or by using a cupped
hand to support the joing being exercised.
e. Begin by following exercises in sequence. Each movement should be repeated 5 times during
the exercise period. Discontinue exercise if patient c/o pain or there is resistance or muscle
spasms.
(1) Neck and cervical spine.
(a) Flexion.
8
AFAMS Master Lesson Plan (MLP)
Nursing Program
Skills Lab #02B
(b) Extension.
(c) Hyperextension.
(d) Lateral flexion.
(e) Rotation.
(2) Shoulder.
(a) Flexion.
(b) Extension.
(c) Hyperextension.
(d) Abduction.
(e) Adduction
(f) Internal rotation.
(g) External rotation
(h) Circumduction.
(3) Elbow.
(a) Flexion.
(b) Extension.
(c) Hyperextension.
(4) Forearm.
(a) Supination.
(b) Pronation.
(5) Wrist.
(a) Flexion.
(b) Extension.
(c) Hyperextension.
(d) Radial flexion.
9
AFAMS Master Lesson Plan (MLP)
Nursing Program
Skills Lab #02B
(e) Ulnar flexion.
(6) Fingers.
(a) Flexion.
(b) Extension.
(c) Hyperextension.
(d) Abduction.
(e) Adduction.
(7) Thumb.
(a) Flexion.
(b) Extension.
(c) Abduction.
(d) Adduction.
(e) Opposition.
(8) Hip.
(a) Flextion.
(b) Extension.
(c) Hyperextension.
(d) Abduction.
(e) Adduction.
(f) Internal rotation.
(g) External rotation.
(h) Circumduction.
(9) Knee.
(a) Flexion.
(b) Extension.
10
AFAMS Master Lesson Plan (MLP)
Nursing Program
Skills Lab #02B
(10) Ankle.
(a) Dorsiflexion.
(b) Plantar flexion.
(11) Foot.
(a) Inversion.
(b) Eversion.
(12) Toes
(a) Flexion
(b) Extension
(c) Abduction
(d) Adduction
f. Assist patient by putting each joint through full range of motion.
g. Position patient for comfort.
h. Adjust bed linen.
i. Remove and dispose of gloves and wash hands.
Knowledge Lesson:
Skill Lesson:
Check on Learning
In a knowledge lesson, pose questions to the class.
In a skill lesson, provide practice and watch students perform a skill.
END OF LESSON TEST
Allocated Time:
Instructions:
Test Questions or
Performance
Expected:
Test Key:
11
0 Minutes
There will be a performance check on these skills throughout the year.
You will be expected to correctly demonstrate these skills in a simulated skills
lab when tested.
Refer to the various separate skills checklists. *Bolded sections are critical
steps, if the student does not perform/observe these steps, student will fail and
require remedial training.
AFAMS Master Lesson Plan (MLP)
Nursing Program
Skills Lab #02B
CONCLUSION
Allocated Time:
Summary:
5 Minutes
Review and re-emphasize the difficult Teaching Points below.
1.
2.
3.
4.
5
6.
Ambulate a patient.
Transfer a patient from a bed to a chair/litter.
Instruct a patient in the use of a cane or walker.
Instruct a patient on the use of crutches.
Use a wheelchair.
Perform active and passive ROM.
Closing Statement:
This lesson concentrated on transferring, ambulating, and ROM which are
essential nursing skills that will assist the patient in most of their daily
activities or functions while hospitalized.
Re-motivating
Statement:
Now that you have practiced, you will be able to use these skills in the clinical
setting with assistance from the instructor.
12