MobilityMobilityUnit 6Unit 6

Turning and Turning and PositioningPositioning Transferring the Transferring the person to a chair or person to a chair or wheel chairwheel chair Helping a person Helping a person to walkto walk

ObjectivesObjectives Demonstrate correct Demonstrate correct

postural alignmentpostural alignment Discuss the importance of Discuss the importance of

body mechanics when body mechanics when transferring a residenttransferring a resident

Demonstrate the correct Demonstrate the correct transfer techniques for a transfer techniques for a patient with hemiplegiapatient with hemiplegia

ObjectivesObjectives Discuss bed mobility Discuss bed mobility

techniquestechniques Demonstrate how to Demonstrate how to

position a Resident in the position a Resident in the supine, prone, and side-supine, prone, and side-lying positionslying positions

List considerations for the List considerations for the correct fit for a resident in correct fit for a resident in a wheelchaira wheelchair

CNA’s role related to CNA’s role related to resident mobilityresident mobility

Encourage resident participation, Encourage resident participation, control and confidencecontrol and confidence

Prevent deterioration in Prevent deterioration in condition(functional decline) condition(functional decline)

Provide safetyProvide safety Follow resident care plan, Follow resident care plan,

including restorative activitiesincluding restorative activities..

Body MechanicsBody Mechanics Describes how to use the body correctly Describes how to use the body correctly

when moving residents and/or objects.when moving residents and/or objects. Using good body mechanics makes the Using good body mechanics makes the

best use of strength, avoiding fatigue best use of strength, avoiding fatigue and injury (back and injury (back

strain).strain). When the CNA uses good body When the CNA uses good body

mechanics (along with proper mechanics (along with proper lifting/moving devices) the chance of lifting/moving devices) the chance of injury to residents and self decreases.injury to residents and self decreases.

Watch Your Posture!!!Watch Your Posture!!! Use proper posture as Use proper posture as

much as possible.much as possible. SittingSitting DrivingDriving Desk WorkDesk Work LiftingLifting LyingLying

The ResultsThe Results Healthier backHealthier back

Stronger musclesStronger muscles

Aging healthierAging healthier

Reduced risk of injuriesReduced risk of injuries

Before Lifting or MovingBefore Lifting or Moving Assess the patient or item Assess the patient or item

being moved.being moved. Ask for assistance if the lift is Ask for assistance if the lift is

heavy.heavy. DO NOT lift or move DO NOT lift or move

unsafely!!!unsafely!!! DO NOT twist your back.DO NOT twist your back. Position the load for the best Position the load for the best

possible positioning of possible positioning of yourself and the load being yourself and the load being moved.moved.

To lift safely…To lift safely… Use largest, strongest muscles Use largest, strongest muscles

to do the job.to do the job. When moving or picking up a heavy object When moving or picking up a heavy object

use the large muscles of the legs instead of use the large muscles of the legs instead of smaller, weaker back muscles. smaller, weaker back muscles.

Squat down, bending at knees. Keep your Squat down, bending at knees. Keep your back straight and raise up, using leg muscles. back straight and raise up, using leg muscles.

NEVER bend at waist or twist while lifting a NEVER bend at waist or twist while lifting a heavy objectheavy object

Use both hands/arms rather than one to pick Use both hands/arms rather than one to pick up a heavy objectup a heavy object..

Stand erect, using good postureStand erect, using good posture Keep close to object or person Keep close to object or person

being lifted or moved.being lifted or moved. Don’t lift from a reaching Don’t lift from a reaching

position.position.

Safe LiftingSafe Lifting Face the work area. Turn by pivoting feet or taking a Face the work area. Turn by pivoting feet or taking a

few small steps rather than by twisting at the waist.few small steps rather than by twisting at the waist. Use a broad base of support when lifting. Use a broad base of support when lifting.

Use a space between feet approximately the width Use a space between feet approximately the width of your shoulders, with one foot slightly ahead of the of your shoulders, with one foot slightly ahead of the

other (football player) other (football player) Wear sturdy, non-slip shoesWear sturdy, non-slip shoes

Use your arms to support object being moved. Use your arms to support object being moved. Leg muscles actually do the job of lifting, Leg muscles actually do the job of lifting,

not back muscles.not back muscles. Push, pull, slide or roll rather than lift a heavyPush, pull, slide or roll rather than lift a heavy

object, if possible. Use the weight of your object, if possible. Use the weight of your body to aid in moving.body to aid in moving.

More Safe LiftingMore Safe Lifting Keep work at a comfortable height. Usually Keep work at a comfortable height. Usually

the most comfortable working level for a bed the most comfortable working level for a bed is slightly above waist.is slightly above waist.

Use smooth, steady movements. Avoid jerking Use smooth, steady movements. Avoid jerking lifts.lifts.

Back pain or trauma may result form Back pain or trauma may result form repeated repeated small injuries, not just small injuries, not just from a single event.from a single event.

Keep your own muscles strong through Keep your own muscles strong through fitness fitness exercise.exercise.

General Principles for lifting General Principles for lifting and moving a residentand moving a resident

Understand how the resident may be moved, what Understand how the resident may be moved, what he/she can do to assist, and mobility goals.he/she can do to assist, and mobility goals.

Check the care plan or ask the nurse.Check the care plan or ask the nurse. Terms such as “weight-bearing”, “limited Terms such as “weight-bearing”, “limited

assistance”, “extensive assistance” will be used.assistance”, “extensive assistance” will be used. Plan for help from other staff when you are Plan for help from other staff when you are

moving/lifting a resident.moving/lifting a resident. Use mechanical lifting devices or other devices Use mechanical lifting devices or other devices

whenever possible. Some facilities may have whenever possible. Some facilities may have implemented “no lift”, “lift free” or “safe lift” implemented “no lift”, “lift free” or “safe lift” policies.policies.

Know how to use devices safely. Approach the Know how to use devices safely. Approach the resident with confidence.resident with confidence.

Principles continuedPrinciples continued Work in coordination when lifting or moving a Work in coordination when lifting or moving a

resident with another person.resident with another person. Explain procedure to resident, give cues about Explain procedure to resident, give cues about

what the resident can do to help.what the resident can do to help. Protect all tubing and dressings when moving Protect all tubing and dressings when moving

resident.resident. Give most support to heaviest parts of body.Give most support to heaviest parts of body.

Position resident so that gravity can help with Position resident so that gravity can help with the move. the move.

TAKE TIME. Allow resident to maintain control. TAKE TIME. Allow resident to maintain control. A resident may experience a period of A resident may experience a period of

dizziness when changing position.dizziness when changing position. Observe and report resident ability to Observe and report resident ability to

participate in activity, and response to activity.participate in activity, and response to activity.

Body AlignmentBody Alignment Alignment is the correct Alignment is the correct

positioning of the resident body.positioning of the resident body. Part are in an anatomically Part are in an anatomically

“straight” line.“straight” line. Correct positioning helps to Correct positioning helps to

prevent contractures (shortening prevent contractures (shortening or tightening of muscle) and or tightening of muscle) and undue pressure on tissue.undue pressure on tissue.

Posture Changes with agingPosture Changes with aging Osteoporosis and other conditions Osteoporosis and other conditions

may contribute to changes in posturemay contribute to changes in posture

Head and neck flexed slightly forward, Head and neck flexed slightly forward, causing the res to look down.causing the res to look down.

Spinal column shortened, Spinal column shortened, perhaps more rigid, flexed forward.perhaps more rigid, flexed forward.

Hips and knees slightly flexed to compensate Hips and knees slightly flexed to compensate for other changes.for other changes.

Posture changes may cause the individual to have Posture changes may cause the individual to have poor balance.poor balance.

Also…Also… Use a gait belt when Use a gait belt when

needed.needed. Promptly report all Promptly report all

accidents/injuries.accidents/injuries. Make sure resident’s Make sure resident’s

brace fits properly.brace fits properly. Allow resident to do as Allow resident to do as

much as safely possible much as safely possible to reduce strain to to reduce strain to yourself and the resident.yourself and the resident.

Your ResponsibilityYour Responsibility Say NO to lifting more Say NO to lifting more

than is safe.than is safe. When others ask for When others ask for

help, we must all work help, we must all work as a team to safely and as a team to safely and effectively move effectively move patients and objects.patients and objects.

Make safety your Make safety your priority!priority!

Just a side note…Just a side note… Nobody PLANS to injure Nobody PLANS to injure

their backs…yet…their backs…yet… There are thousands of There are thousands of

spinal injuries each yearspinal injuries each year Other area are injured by Other area are injured by

poor lifting, such as poor lifting, such as shoulders, hips, and even shoulders, hips, and even hernias can result in work hernias can result in work related injuriesrelated injuries

Don’t let it happen to Don’t let it happen to you!!!you!!!

PositionPositionss

Supine and semi-Supine and semi-supinesupine

Prone and semi-proneProne and semi-prone Sims(left semi-prone)Sims(left semi-prone) Fowlers(semi-sitting)Fowlers(semi-sitting) Chair (w/c)Chair (w/c)

Devices Devices for for

positioninpositioningg

PillowsPillows Foam wedges(or Foam wedges(or

other shapes)other shapes) Trochanter rollTrochanter roll Abduction splintAbduction splint Palmar splint (hand-Palmar splint (hand-

wrist)wrist) Hand rollHand roll Foot boardFoot board

PositioninPositioningg

Use common senseUse common sense Get help if neededGet help if needed Always ask resident if Always ask resident if

she/he is comfortable she/he is comfortable Make sure resident is Make sure resident is

safe before leaving safe before leaving the roomthe room

Slide BoardsSlide Boards Are most useful with Are most useful with

patients who cannot patients who cannot stand to pivotstand to pivot

Allows increased Allows increased independenceindependence

Must be taught how to Must be taught how to properly perform properly perform transfertransfer

AmbulationAmbulation Check for res ambulation Check for res ambulation

goals(restorative activity)goals(restorative activity) Check device before using Check device before using

to see that it is safe.to see that it is safe. ALL devices should have slip-ALL devices should have slip-

proof tips that are not proof tips that are not cracked or torncracked or torn

AmbulationAmbulation Res should wear Res should wear

non-slip shoes.non-slip shoes. Observe and Observe and

report res report res activity and any activity and any signs of illness.signs of illness. Encourage Encourage

res to walk res to walk to activities, to activities,

even even if it would be if it would be faster to takefaster to take

the res in athe res in a w/c.w/c.

Encourage the res to Encourage the res to walk with good posture.walk with good posture. head uphead up looking forward looking forward

CNA may place a hand CNA may place a hand in front of res in front of res shoulder to shoulder to encourage good encourage good postureposture..

Devices Devices for for

AmbulatinAmbulatingg

WalkerWalker

CaneCane

CrutchesCrutches

WheelchaiWheelchairsrs

Understand mobility goal for Understand mobility goal for residents, enabling individual residents, enabling individual to participate as much as to participate as much as possible.possible.

Positioning Positioning Alignment devices may be used to Alignment devices may be used to

help maintain proper positioninghelp maintain proper positioning Resident’s feet are placed Resident’s feet are placed

securely on foot rests.securely on foot rests. Know where resident’s feet are Know where resident’s feet are

positioned while w/c is moving.positioned while w/c is moving. Resident’s arms and elbows are Resident’s arms and elbows are

positioned inside arm rests.positioned inside arm rests. Lap blanket provides warmth and Lap blanket provides warmth and

protects modesty. Tuck ends protects modesty. Tuck ends firmly around resident to prevent firmly around resident to prevent them from tangling in wheels.them from tangling in wheels.

WheelchaiWheelchairsrs

MovingMoving Usually move w/c forward by Usually move w/c forward by

pushing from behind.pushing from behind. Back w/c into elevator when Back w/c into elevator when

entering, enabling res to face entering, enabling res to face elevator opening.elevator opening.

When traveling down a steep When traveling down a steep ramp, move w/c backwards. ramp, move w/c backwards. This will allow operator to This will allow operator to maintain control of w/c maintain control of w/c movement.movement.

Move carefully when going Move carefully when going through swinging doors or through swinging doors or around corners.around corners.

Brakes-when moving into or Brakes-when moving into or out of chair.out of chair.

WheelchaiWheelchairsrs

Pressure relief(preventing Pressure relief(preventing pressure injury)pressure injury) Show res how to change Show res how to change

position to relieve position to relieve prolonged pressure on prolonged pressure on buttocks, hips and coccyxbuttocks, hips and coccyx

w/c push-upsw/c push-ups Change pressure from Change pressure from

one hip to the other by one hip to the other by leaning to side.leaning to side.

Cushions that distributeCushions that distributepressure may be used onpressure may be used onthe chair seat.the chair seat.

Mechanical LiftsMechanical Lifts Use extreme caution!Use extreme caution! Can be helpfulCan be helpful Can also be dangerousCan also be dangerous Always have two staff Always have two staff

when using a lift when using a lift Watch for tipping, weight Watch for tipping, weight

limits, and positioninglimits, and positioning Don’t injure patient with Don’t injure patient with

the sling or hooks!the sling or hooks!

MechanicaMechanical Liftsl Lifts

For safely moving a For safely moving a resident who cannot resident who cannot assist, cannot maintain assist, cannot maintain balance, or is heavy.balance, or is heavy. To standing position (sit-To standing position (sit-

to-stand lift)to-stand lift) To chair or w/c (total-To chair or w/c (total-

body lift)body lift) To facilitate other To facilitate other

activity, such as activity, such as ambulation, moving into ambulation, moving into whirlpool tub or weighingwhirlpool tub or weighing

MechanicaMechanical Liftsl Lifts

To protect CNATo protect CNA

To comply with a To comply with a facilities no-lift/safe facilities no-lift/safe lift policy.lift policy.

MechanicaMechanical Liftsl Lifts

Lift MechanicsLift Mechanics

Hydraulic-a hand-Hydraulic-a hand-pumped “jack” or pumped “jack” or crank powers the lift.crank powers the lift.

Battery-powered or Battery-powered or electric liftelectric lift

MechanicaMechanical Liftl Lift

Follow facility policy regarding Follow facility policy regarding number of staff required for safe number of staff required for safe lift. Many times safe operation will lift. Many times safe operation will require two of more TRAINED require two of more TRAINED staff.staff.

Understand how to use lift. Follow Understand how to use lift. Follow operating instructions. Practice operating instructions. Practice with it before attempting to move with it before attempting to move a resident. Check for operational a resident. Check for operational safety before attempting to move safety before attempting to move resident.resident.

Consider resident response to Consider resident response to being lifted.being lifted.

Provide for privacyProvide for privacy Lessen res anxiety by showing Lessen res anxiety by showing

competence and confidence in use of competence and confidence in use of lift, and by showing res how to lift, and by showing res how to participate in lift.participate in lift.

Use brakes appropriatelyUse brakes appropriately Position lifting sling and/or straps in Position lifting sling and/or straps in

correct manner for type of lift.correct manner for type of lift.

SafetySafety Consider the resident’s Consider the resident’s

abilities and disabilitiesabilities and disabilities NEVER leave a resident NEVER leave a resident

unattended on lift!!!!!!!!!unattended on lift!!!!!!!!! Gait belts!!!Gait belts!!! Talk to your resident Talk to your resident

about what the plan is to about what the plan is to perform the task and what perform the task and what is expected of her/him.is expected of her/him.

SafetySafety Make sure brakes are Make sure brakes are

on!!!on!!! Use the resources Use the resources

available to help youavailable to help you Think about the ‘what ifs”Think about the ‘what ifs” Make sure you are not Make sure you are not

asking the resident to do asking the resident to do something she/he cannot something she/he cannot do safelydo safely