1. Review the principles of body mechanics

1. 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.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. Transparency 10-1: Five Basic Positions

8. 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.

9. 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

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.

18. Moving a resident up in bed • 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.

19. 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.

20. 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.

21. 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.

22. 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.

23. Moving a resident up in bed • 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.

24. 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.

25. 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.

26. 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.

27. 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.

28. 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.

29. 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.

30. 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.

31. 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.

32. 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.

33. 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.

34. 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.

35. Turning a resident • 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

36. 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.

37. Logrolling a resident • Equipment: draw sheet, co-worker 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.

38. 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.

39. Logrolling a resident • 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.

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

41. 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.

42. 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.

43. 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. • Place one arm under the resident’s shoulder blades. Place the other arm under the resident’s thighs.

44. Assisting a resident to sit up on side of bed: dangling • 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. • 9. Ask resident to hold onto the edge of mattress with both hands. Assist resident to put on non-skid shoes or slippers.

45. 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.

46. 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.

47. 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.

48. 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.

49. 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.

50. 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.