Body Mechanics
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 (WMSD).
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
When providing care, you will:
•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 WORK-RELATED INJURIES
OSHA recommends that:
•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:
•The resident’s dependence level
•The amount of assistance needed
•What procedure to use
•The equipment needed
Persons with dementia may:
•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
Some persons can move and turn in bed.
Those who are weak, unconscious, paralyzed, or in casts need help.
Protecting the skin
•Friction and shearing injure the skin.
•Friction and shearing cause infection and pressure ulcers.
Reduce friction and shearing when moving the person in bed by:
•Rolling the person
•Using a lift sheet (turning sheet)
•Using a turning pad, a large incontinence product, slide board, or slide sheet
Raising the person’s head and shoulders
•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
•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
•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:
•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.
Moving the person to the side of the bed
•One method involves moving the person in segments.
•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
The person is turned toward you or away from you.
After the person is turned, position him or her in good alignment.
Persons may:
•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.
•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)
Residents dangle for many reasons.
While dangling the legs, the person:
•Deep breathes and coughs
•Moves the legs back and forth in circles
Two staff members may be needed.
TRANSFERRING PERSONS
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:
•Support residents during transfers
•Reposition persons in chairs and wheelchairs
Bed to chair or wheelchair transfers
•Help the person out of bed on his or her strong side.
Chair or wheelchair to bed transfers
•If the person is weak on one side, transfer the person so that the strong side moves first.
Mechanical lifts
•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
•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
Stretchers (gurneys) are used for persons who:
•Cannot sit up
•Must stay in a lying position
•Are seriously ill
To transfer the person to the stretcher:
•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:
•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 WHEELCHAIR
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
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.
•The risk of falling increases with age.
•A history of falls increases the risk of falling again.
CAUSES AND RISK FACTORS FOR FALLS
Most falls occur in resident rooms and bathrooms.
Falls are most likely to occur:
•Between 1800 (6:00 PM) and 2100 (9:00 PM)
•During shift changes
FALL PREVENTION PROGRAMS
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
•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:
•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:
•At all times except when moving the bed
•When giving bedside care
•When you transfer a person to and from the bed
Wheelchair and stretcher wheels are locked during transfers.
TRANSFER/GAIT BELTS
A transfer belt (gait belt) is a device used to support a person who is unsteady or disabled.
•It helps prevent falls and other injuries.
The belt goes around the person’s waist.
•Grasp under the belt to support the person during the transfer or when assisting the person to walk.
THE FALLING PERSON
Falling may be caused by:
•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.
•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.
•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
A fall can seriously affect a person’s quality of life.
You must help prevent falls.
•You must not interfere with the person’s rights.
Key Terms
base of support