10 Positioning Transfers and Ambulation 1 Review the

10 Positioning, Transfers, and Ambulation 1. Review the principles of body mechanics Define the following terms: alignment based on the word line; a body is in alignment when a straight line could be drawn through the center of his body and his center of gravity. base of support the foundation that supports an object. center of gravity the point in the body where the most weight is concentrated. fulcrum and lever a means of moving an object by resting it on a base of support; a seesaw is an example of a fulcrum and lever.

10 Positioning, Transfers, and Ambulation 1. Review the principles of body mechanics NAs should remember these guidelines for using proper body mechanics: • Assess the load. • Think ahead, plan, and communicate the move. • Check base of support. Have a firm footing. • Face what you are lifting. • Keep back straight. • Begin in squatting position. Lift with legs. • Tighten stomach muscles when beginning. • Keep object close to the body. • Push rather than lift.

10 Positioning, Transfers, and Ambulation 2. Explain positioning and describe how to safely position residents Define the following terms: positioning the act of helping people into positions that promote comfort and health. supine body position in which a person lies flat on his back. lateral body position in which a person is lying on either side. prone body position in which a person is lying on his stomach, or front side of the body.

10 Positioning, Transfers, and Ambulation 2. Explain positioning and describe how to safely position residents Define the following terms: Fowler’s a semi-sitting body position, in which a person’s head and shoulders are elevated 45 to 60 degrees. Sims’ body position in which a person is lying on his left side with the upper knee flexed and raised toward the chest. arm lock/lock arm hold in which the caregiver places his arm under a person’s arm, grasping the person’s shoulder, while the person grasps the caregiver’s shoulder.

10 Positioning, Transfers, and Ambulation 2. Explain positioning and describe how to safely position residents Define the following terms: draw sheet an extra sheet placed on top of the bottom sheet; used for moving residents. shearing rubbing or friction that results from the skin moving one way and the bone underneath it remaining fixed or moving in the opposite direction.

10 Positioning, Transfers, and Ambulation 2. Explain positioning and describe how to safely position residents Define the following terms: logrolling moving a person as a unit, without disturbing the alignment of the body. dangle to sit up with the legs hanging over the side of the bed in order to regain balance and stabilize blood pressure.

10 Positioning, Transfers, and Ambulation Transparency 10 -1: Five Basic Positions

10 Positioning, Transfers, and Ambulation 2. Explain positioning and describe how to safely position residents NAs should know the following facts about the five basic body positions: • Supine Position • Resident lying flat on back • Pillows under head and shoulders, arms, hands; heels should not be touching the bed • Lateral Position • Resident lying on either side • Pillows support head, arm, and leg on upper side, back and head. Upper knee on pillow.

10 Positioning, Transfers, and Ambulation 2. Explain positioning and describe how to safely position residents Facts about the five basic body positions (cont’d): • Prone Position • Resident lying on stomach • Small pillow under head and to keep feet off bed • Fowler’s Position • Semi-sitting, head and shoulders elevated • Pillows at flexed knees, at flexed feet, and under head • Sims’ Position • Variation on lateral side position, left side-lying position • Lower arm behind the back, upper knee flexed • Pillows under head, arms, flexed knee, and foot

Helping a resident sit up using the arm lock 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with curtain, screen, or door. 5. Adjust bed to a safe level, usually waist high. Lock bed wheels.

Helping a resident sit up using the arm lock 6. Move the pillow to the head of the bed. 7. Stand at the side of the bed and face the head of the bed. Spread feet about 12 inches or shoulder-width apart. Bend your knees. 8. Place your arm under the resident’s arm and grasp the resident’s shoulder. Have the resident grasp your shoulder in the same manner. This hold is called the arm lock or lock arm.

Helping a resident sit up using the arm lock 9. Reach under the resident’s head and place your other hand on the resident’s far shoulder. 10. At the count of three, rock yourself backward and pull the resident to a sitting position. Use pillows or a bed rest to support the resident in the sitting position. 11. Check the resident for dizziness or weakness. If the resident is dizzy, you can ease her back to the supine position.

Helping a resident sit up using the arm lock 12. Put pillow back under resident’s head. Make resident comfortable. 13. Return bed to lowest position. Remove privacy measures. 14. Place call light within resident’s reach. 15. Wash your hands. 16. Report any changes in resident to the nurse. Document procedure using facility guidelines.

Moving a resident up in bed Equipment: draw sheet When the resident can help you move her up in bed, take the following steps: 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with curtain, screen, or door.

Moving a resident up in bed 5. Adjust bed to a safe level, usually waist high. Lock bed wheels. 6. Lower the head of bed to make it flat. Move the pillow to the head of the bed. 7. If the bed has side rails, raise the rail on the far side of the bed. 8. Stand by bed with your feet shoulder-width apart, facing the resident.

Moving a resident up in bed 9. Place one arm under resident’s shoulder blades. Place the other arm under resident’s thighs. Use proper body mechanics. 10. Ask resident to bend her knees, place her feet firmly on the mattress, and push her feet and hands on the count of three.

Moving a resident up in bed 11. On the count of three, shift your body weight, and help move resident while she pushes with her feet. As always, allow the resident to do all she can for herself. 12. Make resident comfortable. Put pillow back under resident’s head and arrange the blankets for her. 13. Return bed to lowest position. Remove privacy measures. 14. Place call light within resident’s reach.

Moving a resident up in bed 1. Wash your hands. 16. Report any changes in resident to the nurse. Document procedure using facility guidelines. When the resident cannot assist and there is no one else around to help you move her up in bed, take the following steps: 1. Follow steps 1 through 6 above. 2. Stand behind the head of the bed with your feet shoulder-width apart and one foot slightly in front of the other.

Moving a resident up in bed 3. Roll and grasp the top edge of the draw sheet. 4. Bend your knees and keep your back straight. Rock your weight from the front foot to the back foot in one smooth motion, while pulling the draw sheet and resident toward the head of the bed. 5. Make resident comfortable. Put pillow back under resident’s head and arrange the blankets for her. Unroll the draw sheet and leave it in place for the next repositioning.

Moving a resident up in bed 6. Return bed to lowest position. Remove privacy measures. 7. Place call light within resident’s reach. 8. Wash your hands. 9. Report any changes in resident to the nurse. Document procedure using facility guidelines. When you have help from another person, you can modify the procedure as follows: 1. Follow steps 1 through 6 above.

Moving a resident up in bed 2. Stand on the opposite side of the bed from your helper. Each of you should be turned slightly toward the head of the bed. For each of you, the foot that is closest to the head of the bed should be pointed in that direction. Stand with your feet about shoulder -width apart. Bend your knees. Keep your back straight.

Moving a resident up in bed 3. Roll the draw sheet up to the resident’s side, and have your helper do the same on her side of the bed. Grasp the sheet with your palms up, and have your helper do the same.

Moving a resident up in bed 1. Shift your weight to your back foot (the foot closer to the foot of the bed) and have your helper do the same. On the count of three, you and your helper both shift your weight to your forward foot. Slide the draw sheet and resident toward the head of the bed.

Moving a resident up in bed 5. Make resident comfortable. Put pillow back under resident’s head and arrange the blankets for her. Unroll the draw sheet and leave it in place for the next repositioning.

Moving a resident up in bed 6. Return bed to lowest position. Remove privacy measures. 7. Place call light within resident’s reach. 8. Wash your hands. 9. Report any changes in resident to the nurse. Document procedure using facility guidelines.

Moving a resident to the side of the bed Equipment: draw sheet 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with curtain, screen, or door. 5. Adjust bed to a safe level, usually waist high. Lock bed wheels. 6. Lower the head of bed.

Moving a resident to the side of the bed 7. Stand on the same side of the bed to where you are moving the resident. Stand with feet shoulder -width apart, and bend your knees.

Moving a resident to the side of the bed 8. With a draw sheet: Roll the draw sheet up to the resident’s side, and grasp the sheet with your palms up. One hand should be at the resident’s shoulders, the other about level with the resident’s hips. Apply one knee against the side of the bed, and lean back with your body. On the count of three, slowly pull the draw sheet and resident toward you.

Moving a resident to the side of the bed Without a draw sheet: Gently slide your hands under the head and shoulders and move toward you. Gently slide your hands under her midsection and move it toward you. Gently slide your hands under the hips and legs and move them toward you. 9. Make resident comfortable. 10. Return bed to lowest position. Remove privacy measures. 11. Place call light within resident’s reach.

Moving a resident to the side of the bed 12. Wash your hands. 13. Report any changes in resident to the nurse. Document procedure using facility guidelines.

Turning a resident 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with curtain, screen, or door. 5. Adjust bed to a safe level, usually waist high. Lock bed wheels. 6. Lower the head of bed.

Turning a resident 7. Stand on side of bed opposite to where resident will be turned. If the bed has side rails, raise the far side rail. Lower side rail nearest you if it is up. 8. Move resident to side of bed nearest you using previous procedure. 9. Turning resident away from you: a. Cross resident’s arm over her chest. Move arm on side resident is being turned to out of the way. Cross the leg nearest you over the far leg.

Turning a resident b. Stand with feet shoulder -width apart. Bend your knees. c. Place one hand on the resident’s shoulder. Place the other hand on the resident’s nearest hip. d. Gently push the resident onto side as one unit, toward the other side of bed (toward raised side rail if present). Shift your weight from your back leg to your front leg.

Turning a resident Turning resident toward you: a. Cross resident’s arm over his chest. Move arm on side resident is being turned to out of the way. Cross the leg furthest from you over the near leg. b. Stand with feet shoulder -width apart. Bend your knees. c. Place one hand on the resident’s far shoulder. Place the other hand on the far hip.

Turning a resident 1. Gently roll the resident toward you. Your body will block resident and prevent him from rolling out of bed. 10. Position the resident properly, comfortably, and in good alignment. Proper positioning includes the following: • Head supported by pillow • Shoulder adjusted so resident is not lying on arm • Top arm supported by pillow

Turning a resident • Back supported by supportive device • Top knee flexed • Supportive device between legs with top knee flexed; knee and ankle supported 11. Return bed to lowest position. Remove privacy measures. 12. Place call light within resident’s reach. 13. Wash your hands. 14. Report any changes in resident to the nurse. Document procedure using facility guidelines.

Logrolling a resident Equipment: draw sheet, coworker 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with curtain, screen, or door. 5. Adjust bed to a safe level, usually waist high. Lock bed wheels.

Logrolling a resident 6. Lower the head of the bed. 7. Both people stand on the same side of the bed. One person stands at the resident’s head and shoulders. The other stands near the resident’s midsection. 8. Place the resident’s arms across his chest. Place a pillow between the knees. 9. Stand with your feet shoulder-width apart. Bend your knees. 10. Grasp the draw sheet on the far side.

Logrolling a resident 1. On the count of three, gently roll the resident toward you. Turn the resident as a unit. Your bodies will block the resident and prevent him from rolling out of bed. 12. Make resident comfortable. Arrange pillows and covers for comfort. 13. Return bed to lowest position. Remove privacy measures. 14. Place call light within resident’s reach. 15. Wash your hands.

Logrolling a resident 16. Report any changes in resident to the nurse. Document procedure using facility guidelines.

Assisting a resident to sit up on side of bed: dangling 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with curtain, screen, or door. 5. Adjust bed to lowest position. Lock bed wheels.

Assisting a resident to sit up on side of bed: dangling 6. Raise the head of bed to sitting position. Fanfold (fold into pleats) the top covers to the foot of the bed. Ask the resident to turn onto his side, facing you. Assist as needed (see earlier procedure). 7. Tell the resident to reach across his chest with his top arm and place his hand on the edge of the bed near his opposite shoulder. Ask him to push down on that hand to raise his shoulders up while swinging his legs over the side of the bed.

Assisting a resident to sit up on side of bed: dangling 8. Always allow the resident to do all he can for himself. However, if the resident needs assistance, follow these steps: a. Stand with your legs shoulder-width apart. Bend your knees. 1. Place one arm under the resident’s shoulder blades. Place the other arm under the resident’s thighs.

Assisting a resident to sit up on side of bed: dangling 1. On the count of three, slowly turn resident into sitting position with legs dangling over side of bed. The weight of the resident’s legs hanging down from the bed helps the resident sit up. 2. 9. Ask resident to hold onto the edge of mattress with both hands. Assist resident to put on non-skid shoes or slippers.

Assisting a resident to sit up on side of bed: dangling 10. Have resident dangle as long as ordered. The care plan may direct you to allow the resident to dangle for several minutes and then return him to lying down, or it may direct you to allow the resident to dangle in preparation for walking or a transfer. Follow the care plan. Do not leave the resident alone. If the resident is dizzy for more than a minute, have him lie down again and report to the nurse.

Assisting a resident to sit up on side of bed: dangling 11. Take vital signs as ordered (you will learn how to take vital signs in Chapter 14). 12. Remove slippers or shoes. 13. Gently assist resident back into bed. Place one arm around resident’s shoulders and the other arm under the resident’s knees. Slowly swing resident’s legs onto bed. 14. Make resident comfortable. 15. Leave bed in lowest position. Remove privacy measures.

Assisting a resident to sit up on side of bed: dangling 16. Place call light within resident’s reach. 17. Wash your hands. 18. Report any changes in resident to the nurse. Document procedure using facility guidelines.

10 Positioning, Transfers, and Ambulation 3. Describe how to safely transfer residents Define the following terms: ergonomics the science of designing equipment, areas, and work tasks to make them safer and to suit the worker’s abilities. transfer/gait belt a belt made of canvas or other heavy material that is used to help people who are weak, unsteady, or uncoordinated to stand, sit, or walk. slide board a wooden board that helps transfer people who are unable to bear weight on their legs; also called a transfer board.

10 Positioning, Transfers, and Ambulation 3. Describe how to safely transfer residents REMEMBER: Many facilities have adopted no-lift, zero-lift, or lift-free policies. It is important that NAs follow facility policy carefully.

10 Positioning, Transfers, and Ambulation 3. Describe how to safely transfer residents REMEMBER: When assisting residents NAs must know which side is stronger and which is weaker and move the stronger side first. NAs should never refer to a “bad side” or a “bad” leg or arm.

10 Positioning, Transfers, and Ambulation 3. Describe how to safely transfer residents REMEMBER: Transfer belts must be applies over the clothing and not on bare skin. It is important to check and ensure no skin is caught in the belt.

Applying a transfer belt Equipment: transfer belt, non -skid footwear 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with curtain, screen, or door. 5. Adjust bed to lowest position. Lock bed wheels.

Applying a transfer belt 6. Assist the resident to a sitting position with feet flat on the floor. 7. Put non-skid footwear on resident and make sure laces are tied. 8. Place the belt over the resident’s clothing and around the waist. Do not put it over bare skin. 9. Tighten the buckle until it is snug. Leave enough room to insert flat fingers/hand comfortably under the belt.

Applying a transfer belt 10. Check to make sure that skin or skin folds (for example, breasts) are not caught under the belt. 11. Position the buckle slightly off-center in the front or back for comfort.

10 Positioning, Transfers, and Ambulation 3. Describe how to safely transfer residents NAs should know the following guidelines for wheelchairs: • Know how to use brake, armrests, and footrests. • Lock before transfer; unlock after. • Open by pulling on both sides. Close by lifting center of seat. • Remove armrests by releasing lock. • Remove footrests by pulling back on lever and swinging out toward side of chair. • Lift or lower footrest by squeezing lever and pulling up or pushing down. • Resident must use side of body that can bear weight and lift side that cannot.

10 Positioning, Transfers, and Ambulation 3. Describe how to safely transfer residents Guidelines for wheelchairs (cont’d): • Resident must be wearing non-skid footwear before transferring. • Keep resident safe and comfortable during transfers. • Assist resident as needed by having chair close and wheels locked. Use transfer belt and check alignment in chair. • To move resident to back of chair, stand behind resident with arms under resident’s arms; resident pushes, NA pulls gently. Reposition resident at least every hour.

10 Positioning, Transfers, and Ambulation 3. Describe how to safely transfer residents When a resident starts to fall, the NA should respond in this way: • Widen stance. • Bring resident’s body close. • Bend knees and support resident. • Lower resident to floor. • Do not try to stop the fall. • Call for help. • Do not attempt to get resident up.

10 Positioning, Transfers, and Ambulation 3. Describe how to safely transfer residents NAs should know these guidelines for using stretchers: • Lock wheels before transferring. • Keep safety belts fastened while in stretcher. • Raise safety rails. • Keep resident covered. • Keep wheels locked except when moving stretcher. • Get help.

10 Positioning, Transfers, and Ambulation 3. Describe how to safely transfer residents Guidelines for stretchers (cont’d): • Move slowly and carefully. • Push stretcher from head end. • Go through doorways by opening door, entering first, and pulling stretcher through. • Do not hit walls or doorways. • Be cautious while going down sloping areas. • Stay with resident at all times.

10 Positioning, Transfers, and Ambulation 3. Describe how to safely transfer residents NAs should know these guidelines for mechanical lifts: • Safer for two people to transfer with these lifts. • Keep chair or wheelchair close to bed to only move resident a short distance. • Make sure valves are working. • Check sling and straps for tears or fraying. Do not use mechanical lift if there are tears or holes. • Open legs of stand to widest position before helping resident into lift. • Pump up lift only to the point where the resident’s body clears the bed or chair.

Transferring a resident from bed to wheelchair Equipment: wheelchair, transfer belt, non-skid footwear, and lap robe or folded blanket 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with curtain, screen, or door. Check the area to be certain it is uncluttered and safe.

Transferring a resident from bed to wheelchair 5. Remove both wheelchair footrests close to the bed. 6. Place wheelchair near the head of the bed with arm of the wheelchair almost touching the bed. Wheelchair should be facing the foot of the bed. The wheelchair should be placed on resident’s stronger, or unaffected, side. 7. Lock wheelchair wheels. 8. Raise the head of the bed. Adjust bed to lowest position. Lock bed wheels.

Transferring a resident from bed to wheelchair 9. Assist resident to sitting position with feet flat on the floor. Let resident sit for a few minutes to adjust to the change in position. 10. Put non-skid footwear on resident and fasten securely. 11. Stand in front of resident with your feet about shoulder-width apart. Bend your knees. 12. Place the transfer belt around resident’s waist over clothing (not on bare skin). Grasp belt securely on both sides.

Transferring a resident from bed to wheelchair 13. Provide instructions to allow resident to help with transfer. Instructions may include: “When you start to stand, push with your hands against the bed. ” “Once standing, if you’re able, you can take small steps in the direction of the chair. ” “Once standing, reach for the chair with your stronger hand. ”

Transferring a resident from bed to wheelchair 14. With your legs, brace (support) resident’s lower legs to prevent slipping. This can be done by placing one or both of your knees in front of the resident’s knees. 1. Count to three to alert resident. On three, with hands still grasping the transfer belt on both sides and moving upward, slowly help resident to stand.

Transferring a resident from bed to wheelchair 1. Tell the resident to take small steps in the direction of the chair while turning his back toward the chair. Or, if more assistance is needed, help the resident pivot (turn) to stand in front of wheelchair with back of resident’s legs against wheelchair.

Transferring a resident from bed to wheelchair 17. Ask the resident to put hands on wheelchair arm rests if able. When the chair is touching the back of the resident’s legs, help the resident lower himself into the chair. 18. Reposition resident so that his hips touch the back of the wheelchair seat. Remove transfer belt if used.

Transferring a resident from bed to wheelchair 19. Attach footrests and place the resident’s feet on the footrests. Check that the resident is in proper alignment. Make resident comfortable. Place a lap robe or folded blanket over the resident’s lap as appropriate. 20. Remove privacy measures. 21. Place call light within resident’s reach. 22. Wash your hands.

Transferring a resident from bed to wheelchair 23. Report any changes in resident to the nurse. Document procedure using facility guidelines. When transferring back to bed from a wheelchair, the height of the bed should be equal to or slightly lower than the chair. Help the resident pivot to the bed. When the resident feels the bed with the back of his legs, help him sit down slowly.

Transferring a resident from bed to stretcher Equipment: stretcher, blanket, draw sheet 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with curtain, screen, or door. 5. Lower the head of bed so that it is flat. Lock bed wheels.

Transferring a resident from bed to stretcher 6. Fold linens to the foot of the bed. Cover resident with a blanket. 7. Move the resident to the side of the bed. Have your co-workers help you do this. Refer to the procedure Moving a resident to the side of the bed earlier in this chapter. 8. Place stretcher solidly against the bed, and lock stretcher wheels. Bed height should be equal to or slightly above the height of the stretcher. Move stretcher safety belts out of the way.

Transferring a resident from bed to stretcher 9. Two workers should be on one side of the bed opposite the stretcher. Two more workers should be on the other side of the stretcher. 1. Each worker should roll up the sides of the draw sheet and prepare to move the resident. Protect the resident’s arms and legs during the transfer.

Transferring a resident from bed to stretcher 1. On the count of three, the workers lift and move the resident to the stretcher. All should move at once. Make sure the resident is centered on the stretcher. 12. Place a pillow under the resident’s head. Make sure resident is still covered with the blanket. 13. Place the safety straps across the resident. Raise side rails on stretcher.

Transferring a resident from bed to stretcher 14. Unlock stretcher’s wheels. Move resident to proper place, staying with him until another staff member takes over. 15. Wash your hands. 16. Report any changes in resident to the nurse. Document procedure using facility guidelines. To return the resident to bed, the bed height should be equal to or slightly below the stretcher.

Transferring a resident using a mechanical lift Equipment: wheelchair or chair, co-worker (if available), mechanical or hydraulic lift The following is a basic procedure for transferring using a mechanical lift. Ask someone to help you before starting. 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

Transferring a resident using a mechanical lift 4. Provide for the resident’s privacy with curtain, screen, or door. 5. Lock bed wheels. 6. Position wheelchair next to bed. Lock brakes.

Transferring a resident using a mechanical lift 7. Help the resident turn to one side of the bed. Position the sling under the resident, with the edge next to the resident’s back, fanfolding if necessary. Adjust the bottom of the sling so that it is even with the resident’s knees. Help the resident roll back to the middle of the bed, and then spread out the fanfolded edge of the sling.

Transferring a resident using a mechanical lift 8. Roll the mechanical lift to bedside. Make sure the base is opened to its widest point. Push the base of the lift under the bed. 1. Position the overhead bar directly over the resident.

Transferring a resident using a mechanical lift 10. With the resident lying on his back, attach one set of straps to each side of the sling. Attach one set of straps to the overhead bar. If available, have a coworker support the resident at the head, shoulders, and knees while being lifted. The resident’s arms should be folded across his chest. If the device has S hooks, they should face away from resident. Make sure all straps are connected properly and are smooth and straight.

Transferring a resident using a mechanical lift 11. Following manufacturer’s instructions, raise the resident two inches above the bed. Pause a moment for the resident to gain balance. 1. If available, a lifting partner can help support and guide the resident’s body while you roll the lift so that the resident is positioned over the chair or wheelchair.

Transferring a resident using a mechanical lift 13. Slowly lower the resident into the chair or wheelchair. Push down gently on the resident’s knees to help the resident into a sitting, rather than reclining, position. 14. Undo the straps from the overhead bar to the sling. Remove sling or leave in place for transfer back to bed. 15. Be sure the resident is seated comfortably and correctly in the chair or wheelchair. Remove privacy measures.

Transferring a resident using a mechanical lift 16. Place call light within resident’s reach. 17. Wash your hands. 18. Report any changes in resident to the nurse. Document procedure using facility guidelines.

Transferring a resident onto and off of a toilet Equipment: 2 pairs of gloves, toilet paper or disposable wipes, wheelchair 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Make sure resident is wearing nonskid shoes. 4. Provide for the resident’s privacy with curtain, screen, or door.

Transferring a resident onto and off of a toilet 5. Position wheelchair at a right angle to the toilet to face the hand bar/wall rail. Place wheelchair on the resident’s stronger side. 6. Remove wheelchair footrests. Lock wheels. 7. Put on gloves. 8. Apply a transfer belt around the resident’s waist over clothing (not on bare skin). Grasp belt securely on both sides.

Transferring a resident onto and off of a toilet 1. Ask resident to push against the armrests of the wheelchair and stand, reaching for and grasping the hand bar. Move wheelchair out of the way.

Transferring a resident onto and off of a toilet 1. Ask resident to pivot her foot and back up so that she can feel the front of the toilet with the back of her legs. 11. Help resident to pull down pants and underwear. You may need to keep one hand on the transfer belt while helping to remove clothing.

Transferring a resident onto and off of a toilet 12. Help resident slowly sit down onto the toilet. Ask resident to pull on the emergency cord if she needs help. Remove and discard gloves. Wash your hands. Leave bathroom and close door. 13. When called, return and don clean gloves. Assist with perineal care as necessary (see Chapter 13). Ask her to stand reach for the hand bar.

Transferring a resident onto and off of a toilet 14. Use toilet paper or disposable wipes to clean the resident. Make sure she is clean and dry before pulling up clothing. Remove and discard gloves. 15. Help resident to the sink to wash hands. 16. Wash your hands. 17. Help resident back into wheelchair. Be sure the resident is seated comfortably and correctly in the wheelchair. Replace footrests.

Transferring a resident onto and off of a toilet 18. Help resident to leave the bathroom. Make sure resident is comfortable. Remove privacy measures. 19. Place call light within resident’s reach. 20. Wash your hands again. 21. Report any changes in resident to the nurse. Document procedure using facility guidelines.

Transferring a resident into a vehicle Equipment: wheelchair 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Place wheelchair close to the vehicle at a 45 degree angle. Open the door on the resident’s stronger side. 5. Lock wheelchair.

Transferring a resident into a vehicle 6. Ask the resident to push against the arm rests of the wheelchair and stand. 7. Ask the resident to stand, grasp the vehicle, and pivot his foot so the side of the seat touches the back of the legs. 8. The resident should then sit in the seat and lift one leg, and then the other, into the vehicle.

Transferring a resident into a vehicle 9. Carefully position the resident comfortably in the vehicle. Help fasten seat belt. 10. Safely shut the door. 11. Return the wheelchair to the appropriate place for cleaning. 12. Wash your hands. 13. Document procedure using facility guidelines.

10 Positioning, Transfers, and Ambulation 3. Describe how to safely transfer residents NAs should know these guidelines for stand-up lifts: • Used when resident can bear some weight on his legs but has poor leg strength and/or balance • Resident must be able to stand have some arm strength. • Manual and battery-powered lifts are different types. • Brakes must be locked before using. • Resident in sitting position, with feet on foot plate and knees against knee pads • Resident grasps support bar and pulls himself up. • Lower sides of seat into position, adjust straps, and resident lowers himself into seat while holding bars.

10 Positioning, Transfers, and Ambulation Handout 10 -1: Transferring a Resident to Bed from Wheelchair Transferring a resident to bed from wheelchair 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with curtain, screen, or door. Check the area to be certain it is uncluttered and safe. 5. Remove both wheelchair footrests close to the bed. 6. Place wheelchair near the head of the bed with arm of the wheelchair almost touching the bed. Wheelchair should be facing the foot of the bed. The wheelchair should be placed on resident’s stronger, or unaffected, side. 7. Lock wheelchair wheels. 8. Adjust bed level. The height of the bed should be equal to or slightly lower than the chair. Lock bed wheels. 9. Stand in front of resident with your feet about shoulder-width apart. Bend your knees. 10. Place the transfer belt around resident’s waist over clothing (not on bare skin). Grasp belt securely on both sides. 11. Provide instructions to allow resident to help with transfer.

10 Positioning, Transfers, and Ambulation Handout 10 -1: Transferring a Resident to Bed from Wheelchair (cont’d. ) 12. With your legs, brace resident’s lower legs to prevent slipping. This can be done by placing one or both of your knees in front of the resident’s knees. 13. Count to three to alert resident. On three, with hands still grasping the transfer belt on both sides and moving upward, slowly help resident stand. 14. Tell the resident to take small steps in the direction of the bed while turning his back toward the bed. Or, if more assistance is needed, help the resident pivot to stand in front of bed with back of resident’s legs against bed. When he feels the bed, help him sit down on the side of the bed. 15. Make resident comfortable. Remove transfer belt. 16. Return bed to lowest position. Remove privacy measures. 17. Place call light within resident’s reach. 18. Wash your hands. 19. Report any changes in resident to the nurse. Document procedure using facility guidelines.

10 Positioning, Transfers, and Ambulation 4. Discuss how to safely ambulate residents Define the following terms: ambulation walking. ambulatory capable of walking.

10 Positioning, Transfers, and Ambulation 4. Discuss how to safely ambulate residents REMEMBER: NAs should check the care plan before helping a resident to ambulate and must always keep the resident’s limitations in mind.

Assisting a resident to ambulate Equipment: gait belt, nonskid shoes 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for resident’s privacy with curtain, screen, or door.

Assisting a resident to ambulate 5. Adjust bed to lowest position so that the feet are flat on the floor. Lock bed wheels. 6. Before ambulating, put non-skid footwear on the resident and securely fasten. 7. Stand in front of the resident, facing the resident, with your feet about shoulder-width apart. 8. Place gait belt around resident’s waist over clothing (not on bare skin). Grasp belt securely on both sides.

Assisting a resident to ambulate 1. Always allow resident to do whatever he is able to do for himself. If the resident is unable to stand without help, brace (support) the resident’s lower extremities. Bend your knees. If the resident has a weak knee, brace it against your knee.

Assisting a resident to ambulate 10. Hold the resident close to your center of gravity. Provide instructions to allow resident to help with standing. Tell the resident to lean forward, push down on the bed with his hands, and stand on the count of three. On three, with hands still grasping the gait belt on both sides and moving upward, slowly help resident to stand.

Assisting a resident to ambulate 11. Walk slightly behind and to one side of resident for the full ordered distance, while holding onto the gait belt. If the resident has a weaker side, stand on the weaker side. Use the hand that is not holding the belt to offer support on the weak side. Ask resident to look forward, not down at the floor, during ambulation.

Assisting a resident to ambulate 12. Observe the resident’s strength while you walk together. Provide a chair if the resident becomes dizzy or tired. 13. After ambulation, remove gait belt. Help resident to the bed or chair and check that the resident is in proper alignment. Make resident comfortable. 14. Leave bed in lowest position. Remove privacy measures. 15. Place call light within resident’s reach.

Assisting a resident to ambulate 16. Wash your hands. 17. Report any changes in resident to nurse. Document procedure using facility guidelines.

10 Positioning, Transfers, and Ambulation 4. Discuss how to safely ambulate residents REMEMBER: When an NA assists a visually-impaired resident with ambulation, the resident should walk beside and slightly behind him. The NA should warm the resident when approaching corners or steps.

10 Positioning, Transfers, and Ambulation 4. Discuss how to safely ambulate residents Define the following terms: C cane a straight cane with a curved handle at the top. functional grip cane that has a straight grip handle. quad cane that has four rubber-tipped feet and a rectangular base. walker adaptive equipment used for people who are unsteady or who lack balance; usually has four rubber-tipped feet and/or wheels.

10 Positioning, Transfers, and Ambulation 4. Discuss how to safely ambulate residents NAs should remember the following guidelines for cane or walker use: • Make sure cane or walker is in good condition. • Make sure resident is wearing securely fastened non-skid footwear. • Resident should place cane on stronger side. • Resident should place both hands on the walker, and walker should be placed no more than six inches in front of resident. • Stay near resident on weaker side. • Do not hang purses or clothing on walker. • Report to nurse if cane or walker seems to be the wrong height.

Assisting with ambulation for a resident using a cane, walker, or crutches Equipment: gait belt, nonskid shoes, cane, walker, or crutches 1. Identify yourself by name. Identify resident by name. 2. Wash your hands. 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for resident’s privacy with curtain, screen, or door.

Assisting with ambulation for a resident using a cane, walker, or crutches 5. Adjust bed to lowest position so that the feet are flat on the floor. Lock bed wheels. 6. Before ambulating, put non-skid footwear on the resident and securely fasten. 7. Stand in front of the resident, facing the resident, with your feet about shoulder-width apart. 8. Place gait belt around resident’s waist over clothing (not on bare skin). Grasp belt securely on both sides.

Assisting with ambulation for a resident using a cane, walker, or crutches 9. If the resident is unable to stand without help, brace (support) the resident’s lower extremities. Bend your knees. If the resident has a weak knee, brace it against your knee. Help the resident to stand as described in the previous procedure.

Assisting with ambulation for a resident using a cane, walker, or crutches 10. Help as needed with ambulation. a. Cane: Resident places cane about six inches, or a comfortable distance, in front of his stronger leg. He brings weaker leg even with cane. He then brings stronger leg forward slightly ahead of cane. Repeat.

Assisting with ambulation for a resident using a cane, walker, or crutches b. Walker: Resident picks up or rolls the walker and places it about six inches, or a comfortable distance, in front of him. All four feet or wheels of the walker should be on the ground before resident steps forward to the walker. The walker should not be moved again until the resident has moved both feet forward and is in a steady position. The resident should never put his feet ahead of the walker.

Assisting with ambulation for a resident using a cane, walker, or crutches 1. Crutches: Resident should be fitted for crutches and taught to use them correctly by a physical therapist or nurse. The resident may use the crutches several different ways, depending on what his weakness is. No matter how they are used, weight should be on the hands and arms. Weight should not be on the underarm area.

Assisting with ambulation for a resident using a cane, walker, or crutches 11. Walk slightly behind and to one side of resident. Stay on the weaker side if resident has one. Hold the gait belt if one is used. 12. Watch for obstacles in the resident’s path. Ask resident to look forward, not down at the floor, during ambulation. 13. Encourage the resident to rest if he is tired. When a person is tired, it increases the chance of a fall. Let the resident set the pace. Discuss how far he plans to go based on the care plan.

Assisting with ambulation for a resident using a cane, walker, or crutches 14. After ambulation, remove gait belt. Help resident to the bed or chair and check that the resident is in proper alignment. Make resident comfortable. 15. Leave bed in lowest position. Remove privacy measures. 16. Place call light within resident’s reach. 17. Wash your hands. 18. Report any changes in resident to nurse. Document procedure using facility guidelines.

10 Positioning, Transfers, and Ambulation Exam Multiple Choice. Choose the correct answer. 1. Which of the following is part of using proper body mechanics? (A) The nursing assistant should twist her back when carrying objects. (B) The nursing assistant should push when possible, rather than lifting. (C) The nursing assistant should use a narrow base of support. (D) The nursing assistant should lift with her back, not her legs. 2. Which of the following statements is true of positioning? (A) Residents will not need help getting into comfortable positions or changing positions. (B) Constant pressure on an area helps prevent skin problems. (C) NAs should check residents’ skin each time they are repositioned. (D) Bed-bound residents should be repositioned every three hours.

10 Positioning, Transfers, and Ambulation Exam 1. How often should bed-bound residents be repositioned? (A) At least every two hours (B) Once per shift (C) Twice a day (D) At least every three hours 2. How often should residents in wheelchairs be repositioned? (A) At least every hour (B) At least every two hours (C) At least every three hours (D) At least every four hours

10 Positioning, Transfers, and Ambulation Exam 1. A resident who is lying on either left or her right side is in the _______ position. (A) Supine (B) Lateral (C) Prone (D) Fowler’s 2. A resident who has her head and shoulders elevated and is in a semi-sitting position (45 to 60 degrees) is in the ____ position. (A) Sims’ (B) Fowler’s (C) Prone (D) Lateral

10 Positioning, Transfers, and Ambulation Exam 1. A resident who is lying on her stomach with her arms at her sides is in the ____ position. (A) Sims’ (B) Fowler’s (C) Prone (D) Lateral 2. A resident who is lying on her left side with her upper knee flexed and raised toward the chest is in the ____ position. (A) Sims’ (B) Fowler’s (C) Prone (D) Supine

10 Positioning, Transfers, and Ambulation Exam 1. A resident who is lying flat on his back with his head and shoulders supported by a pillow is in the ____ position. (A) Sims’ (B) Fowler’s (C) Prone (D) Supine 2. Dangling means (A) Sitting up with legs over side of bed (B) Sitting up in chair with feet on floor (C) Lying in bed with feet over side of bed (D) Hanging both arms over chair rests

10 Positioning, Transfers, and Ambulation Exam 1. When using (A) Place it (B) Place it (C) Place it (D) Place it 2. When transferring residents who have a strong side and a weak side, the NA should plan the move so that (A) The stronger side moves first (B) The weaker side moves first (C) Both feet move at the same time (D) The wheelchair moves first a transfer belt, the NA should underneath the resident’s clothing around the resident’s shoulders around a resident’s chest over the resident’s clothing

10 Positioning, Transfers, and Ambulation Exam 1. Which of the following is true of mechanical lifts? (A) Mechanical lifts prevent injury. (B) It is safer for the NA to lift residents without the use of a mechanical lift. (C) There is only one kind of mechanical lift. (D) When using a mechanical lift, the NA should pump it approximately five feet over the bed before moving the resident. 2. If a (A) (B) (C) (D) resident starts to fall, the best thing an NA can do is to Catch the resident under the arms to stop the fall Widen her stance and bring the resident’s body close to her Lock her knees Move out of the way

10 Positioning, Transfers, and Ambulation Exam 1. Which of the following canes has four rubber-tipped feet? (A) Quad cane (B) Functional grip cane (C) C cane (D) Crutch cane 2. When a resident can walk, he or she is (A) Ambulating (B) Accessorizing (C) Abducting (D) Adducting

10 Positioning, Transfers, and Ambulation Exam 1. How should a resident use a cane to aid ambulation? (A) Place the cane about six inches in front of his weaker leg. (B) Place the cane about six inches in front of his stronger leg. (C) Take the cane along in case he gets tired. (D) Allow the cane to drag about six inches behind him. 2. What should a nursing assistant do if a resident’s walker seems too short for the resident to use properly? (A) The NA should adjust the height of the walker for the resident. (B) The NA should inform the nurse. (C) The NA should see if the resident can adjust the height of the walker. (D) The NA should suggest to the resident that she needs a new one.

10 Positioning, Transfers, and Ambulation CHAPTER 10 PRACTICE 1. Dangling means (A) Sitting up with legs over side of bed (B) Sitting up in chair with feet on floor (C) Lying in bed with feet over side of bed (D) Hanging both arms over chair rests 2. How should a resident use a cane to aid ambulation? (A) Place the cane about six inches in front of his weaker leg. (B) Place the cane about six inches in front of his stronger leg. (C) Take the cane along in case he gets tired. (D) Allow the cane to drag about six inches behind him. 3. How often should residents in wheelchairs be repositioned? (A) At least every hour (B) At least every two hours (C) At least every three hours (D) At least every four hours 4. Which of the following is part of using proper body mechanics? (A) The nursing assistant should twist her back when carrying objects. (B) The nursing assistant should push when possible, rather than lifting. (C) The nursing assistant should use a narrow base of support. (D) The nursing assistant should lift with her back, not her legs.

10 Positioning, Transfers, and Ambulation CHAPTER 10 PRACTICE 1. 2. 3. 4. A- SITTING UP WITH LEGS OVER SIDE OF BED B- PLACE THE CANE ABOUT SIX INCHES IN FRONT OF HIS STRONGER LEG A- AT LEAST EVERY TWO HOURS B- THE NURSING ASSISTANT SHOULD PUSH WHEN POSSIBLE, RATHER THAN LIFTING