1. Review the principles of body mechanics Review the principles of proper body mechanics, focusing on: Alignment Base of support Center of gravity Fulcrum and lever equilibrium

1. Review the principles of body mechanics The ten rules of proper body mechanics are: 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. Do not twist. Push or pull rather than lift.

2. Explain beginning and ending steps in care procedures The beginning steps of each care procedure are: Washing hands Identification of NA and resident Explanation of procedure while looking at resident Providing for privacy Adjusting bed and locking wheels

2. Explain beginning and ending steps in care procedures The ending steps of each care procedure are: Making resident comfortable Returning bed to proper position Placing call light within reach Washing hands Reporting changes Documenting procedure

3. Explain why position changes are important for bedbound residents and describe five basic positions Define the following terms: Positioning Supine Lateral Prone Fowler’s Sims’

3. Explain why position changes are important for bedbound residents and describe five basic positions Define the following terms (con’t.): Draw sheet Shearing Logrolling Dangle Trendelenburg position Reverse Trendelenburg position

3. Explain why position changes are important for bedbound residents and describe five basic positions Supine Position Resident lying flat on back Pillows under head and shoulders, arms, hands; heels should be “floating” Lateral Position Resident lying on either side Pillows support head, arm, and leg on upper side, back and head. Upper knee on pillow.

3. Explain why position changes are important for bedbound residents and describe five basic positions 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 and at flexed feet and under head

3. Explain why position changes are important for bedbound residents and describe five basic positions Sims’ Position Variation on lateral side position, left side-lying position Lower arm behind the back and upper knee flexed Pillows under head, arms, flexed knee, and foot

Transparency 10-1 Five Basic Positions

Locking arms with a resident and raising head and shoulders Wash your hands. Identify yourself by name. Identify the resident by name. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Provide for the resident’s privacy with curtain, screen, or door. 11

Locking arms with a resident and raising head and shoulders If the bed is adjustable, adjust bed to a safe level, usually waist high. Lock bed wheels. Place pillow at the head of bed against the headboard. Stand at the side of the bed. Face the head of bed. Gently slide one hand under the resident’s closest shoulder. Gently slide the other hand under the resident’s upper back. 12

Locking arms with a resident and raising head and shoulders 10. At the count of three, slowly raise the resident’s head and shoulders. Give necessary care (Fig. 10-10). Replace pillow under the resident’s head. Make resident comfortable. Make sure sheets are free from wrinkles and the bed free from crumbs. Return bed to appropriate position. Remove privacy measures. Fig. 10-10. 13

Locking arms with a resident and raising head and shoulders Before leaving, place call light within resident’s reach. Wash your hands. Report any changes in resident to the nurse. Document procedure using facility guidelines. 14

Assisting a resident to move up in bed Wash your hands. Identify yourself by name. Identify the resident by name. Explain the procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Provide for the resident’s privacy with curtain, screen, or door. If the bed is adjustable, adjust bed to a safe level, usually waist high. Lock bed wheels. 15

Assisting a resident to move up in bed 6. Lower the head of bed. Move pillow to head of the bed. Lower the side rail (if not already lowered) on side nearest you. Stand by bed with feet apart. Face the resident. Place one arm under the resident’s shoulder blades. Place the other arm under the resident’s thighs. 16

Assisting a resident to move up in bed Ask resident to bend knees, brace feet on mattress, and push feet on the count of three. On three, shift body weight. Move resident while resident pushes with her feet (Fig. 10-12). Place pillow under resident’s head. Make resident comfortable. Make sure sheets are free from wrinkles and the bed free from crumbs. Fig. 10-12. 17

Assisting a resident to move up in bed Return bed to appropriate position. Remove privacy measures. Before leaving, place call light within resident’s reach. Wash your hands. Report any changes in resident to the nurse. Document procedure using facility guidelines. 18

Identify yourself by name. Identify the resident by name. Assisting a resident to move up in bed with one assistant (using draw sheet) Equipment: draw sheet Wash your hands. Identify yourself by name. Identify the resident by name. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Provide for the resident’s privacy with a curtain, screen, or door. 19

Lower the head of bed. Move pillow to head of the bed. Assisting a resident to move up in bed with assistance (using draw sheet) If the bed is adjustable, adjust bed to a safe level, usually waist high. Lock the bed wheels. Lower the head of bed. Move pillow to head of the bed. 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 that direction. 20

(con’t.) Stand with feet about 12 inches apart. Bend your knees. Assisting a resident to move up in bed with assistance (using draw sheet) (con’t.) Stand with feet about 12 inches apart. Bend your knees. Roll the draw sheet up to the resident’s side. Have your helper do the same on his side of the bed. Grasp the sheet with your palms up. Have your helper do the same. Shift your weight to your back foot (the foot closer to the foot of the bed). Have your helper do the same (Fig. 10-13). Fig. 10-13. 21

Return bed to appropriate position. Remove privacy measures. Assisting a resident to move up in bed with assistance (using draw sheet) 9. (con't.) On the count of three, both shift your weight to your forward feet. Slide the resident toward the head of the bed (Fig. 10-14). Make resident comfortable. Make sure sheets are free from wrinkles and the bed free from crumbs. Unroll the draw sheet. Leave it in place for the next repositioning. Return bed to appropriate position. Remove privacy measures. Fig. 10-14. 22

Before leaving, place call light within resident’s reach. Assisting a resident to move up in bed with assistance (using draw sheet) Before leaving, place call light within resident’s reach. Wash your hands. Report any changes in resident to the nurse. Document procedure using facility guidelines. 23

Moving a resident to the side of the bed Wash your hands. Identify yourself by name. Identify the resident by name. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Provide for the resident’s privacy with curtain, screen, or door. If the bed is adjustable, adjust bed to a safe level, usually waist high. Lock bed wheels. 24

Moving a resident to the side of the bed Lower the head of bed. Gently slide your hands under the resident’s head and shoulders and move toward you (Fig. 10-15). Fig. 10-15. 25

Moving a resident to the side of the bed (con’t.) Gently slide your hands under midsection and move toward you. Gently slide your hands under hips and legs and move toward you (Fig. 10-16). Make resident comfortable. Make sure sheets are free from wrinkles and the bed free from crumbs. 9. Return bed to appropriate position. Remove privacy measures. Fig. 10-16. 26

Moving a resident to the side of the bed Before leaving, place call light within resident’s reach. Wash your hands. Report any changes in resident to the nurse. Document procedure using facility guidelines. 27

Identify yourself by name. Identify the resident by name. Turning a resident Wash your hands. Identify yourself by name. Identify the resident by name. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Provide for the resident’s privacy with curtain, screen, or door. If the bed is adjustable, adjust bed to a safe level, usually waist high. Lock the bed wheels. 28

Lower side rail nearest you. Turning a resident Lower the head of bed. Stand on side of bed opposite to where person will be turned. The far side rail should be raised Lower side rail nearest you. Move resident to side of bed nearest you using previous procedure. 29

Turning resident away from you Turning a resident Turning resident away from you Cross resident’s arm over his or her chest. Cross the leg nearest you over the far leg. Stand with feet about 12 inches apart. Bend your knees. Place one hand on the resident’s shoulder. Place the other hand on the resident’s nearest hip. 30

Turning resident away from you (con’t.) Turning a resident Turning resident away from you (con’t.) Gently push the resident toward the other side of the bed. Shift your weight from your back leg to your front leg (Fig. 10-17). Turning resident toward you: Cross resident’s arm over his or her chest. Cross the leg farthest from you over the near leg. Fig. 10-17. 31

Turning resident toward you (con’t.): Raise both side rails. Turning a resident Turning resident toward you (con’t.): Raise both side rails. Stand with feet about 12 inches apart. Bend your knees. Place one hand on the resident’s far shoulder. Place the other hand on the resident’s far hip. Gently roll the resident toward you (Fig. 10-18) Fig. 10-18. 32

11. Position resident properly. Use proper body alignment: Turning a resident 11. Position resident properly. Use proper body alignment: Head supported by pillow Shoulder adjusted so resident is not lying on arm Top arm supported by pillow Back supported by supportive device Top knee flexed Top leg supported by supportive device with hip in proper alignment (Fig. 10-19) Fig. 10-19. 33

Return bed to appropriate position. Remove privacy measures. Turning a resident Make resident comfortable. Make sure sheets are free from wrinkles and the bed free from crumbs. Return bed to appropriate position. Remove privacy measures. Before leaving, place call light within resident’s reach. Wash your hands. 34

Report any changes in resident to the nurse. Turning a resident Report any changes in resident to the nurse. Document procedure using facility guidelines. 35

Logrolling a resident with one assistant Equipment: draw sheet Wash your hands. Identify yourself by name. Identify the resident by name. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Provide for the resident’s privacy with curtain, screen, or door. 36

Logrolling a resident with one assistant If the bed is adjustable, adjust bed to a safe level, usually waist high. Lock the bed wheels. Lower the head of bed. Lower the side rail on side nearest you. Both co-workers 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. 37

Logrolling a resident with one assistant 9. Place the resident’s arms across his or her chest. Place a pillow between the knees. Stand with feet about 12 inches apart. Bend your knees. Grasp the draw sheet on the far side (Fig. 10-20). Fig. 10-20. 38

Logrolling a resident with one assistant 12. On the count of three, gently roll the resident toward you. Turn the resident as a unit (Fig. 10-21). Make resident comfortable. Make sure sheets are free from wrinkles and the bed free from crumbs. Return bed to appropriate position. Remove privacy measures. Fig. 10-21. 39

Logrolling a resident with one assistant 15. Before leaving, place call light within resident’s reach. Wash your hands. Report any changes in the resident to the nurse. Document procedure using facility guidelines. 40

Assisting a resident to sit up on side of bed: dangling Wash your hands. Identify yourself by name. Identify the resident by name. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Provide for the resident’s privacy with curtain, screen, or door. Adjust bed height to lowest position. Lock the bed wheels. 41

Assisting a resident to sit up on side of bed: dangling Raise the head of bed to sitting position. Place one arm under resident’s shoulder blades. Place the other arm under resident’s thighs (Fig. 10-22). Fig. 10-22. 42

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 (Fig. 10-23). Ask resident to hold onto edge of mattress with both hands. Assist resident to put on nonskid shoes or slippers. Fig. 10-23. 43

Assisting a resident to sit up on side of bed: dangling Have resident dangle as long as ordered. Stay with the resident at all times. Check for dizziness. If resident feels dizzy or faint, help her lie down again. Tell the nurse at once. Take vital signs as ordered. Remove slippers or shoes. 44

Assisting a resident to sit up on side of bed: dangling 13. Gently assist resident back into bed. Place one arm around resident’s shoulders. Place the other arm under resident’s knees. Slowly swing resident’s legs onto bed. Make sure resident is comfortable. Remove privacy measures. Before leaving, place call light within resident’s reach. 45

Assisting a resident to sit up on side of bed: dangling Wash your hands. Report any changes in the resident to the nurse. Document procedure using facility guidelines. 46

4. Describe how to safely transfer residents Define the following terms: Ergonomics Transfer belt Gait belt You must know which side of the resident’s body is strong and which is weaker. Move the stronger side first. Do not use the term “bad side.” Use the terms “affected” or “involved” side instead.

Applying a transfer belt Equipment: transfer belt Wash your hands. Identify yourself by name. Identify the resident by name. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Provide for the resident’s privacy with curtain, screen, or door. 48

Applying a transfer belt Assist the resident to a sitting position. Place the belt over the resident’s clothing and around the waist. Do not put it over bare skin. Tighten the buckle until it is snug. Leave enough room to insert two fingers into the belt. The fingers should fit comfortably under the belt. 49

Applying a transfer belt 8. Check to make sure that a female’s breasts are not caught under the belt. 9. For comfort, place the buckle off-center in the front or back (Fig. 10-24) Fig. 10-24. 50

4. Describe how to safely transfer residents The guidelines for wheelchairs/geriatric chairs are: Know how to use the brake and foot rests. Lock before transfer; unlock after. Open by pulling on both sides. Close by lifting center of seat. Remove armrests by pressing a button. Attach armrests by lining up the button. Remove footrests by pulling back on lever and off knob. Attach footrests by lining up knobs. Squeeze lever to adjust footrests.

4. Describe how to safely transfer residents The guidelines for wheelchairs/geriatric chairs are (con’t.): Go backwards down ramps. Turn chair around before entering elevators. To move resident to back of chair, stand behind resident with arms under resident’s arms, resident pushes, you pull. Be careful when using tray tables on geri-chairs. Put on non-skid footwear first.

4. Describe how to safely transfer residents If a resident starts to fall: Widen your stance. Bring resident’s body close to you. Bend knees and support resident. Lower resident to floor. Do not try to stop the fall. Call for help. Do not get resident up.

Transferring a resident from bed to wheelchair Equipment: wheelchair, transfer belt, non-skid footwear Wash your hands. Identify yourself by name. Identify the resident by name. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Provide for the resident’s privacy with curtain, screen, or door. 54

Transferring a resident from bed to wheelchair Place wheelchair near the head of the bed with arm almost touching the bed. Wheelchair should be placed on resident’s stronger, or unaffected, side. Remove wheelchair footrests. Lock wheelchair wheels. Lower the head of the bed to make it flat. Adjust bed level. The height of the bed should be equal to or slightly higher than the chair. Lock bed wheels. 55

Transferring a resident from bed to wheelchair Help resident to sitting position with feet flat on the floor. Put non-skid footwear on resident and securely fasten. 56

Transferring a resident from bed to wheelchair 10. With transfer (gait) belt: Stand in front of resident. Stand with feet about 12 inches apart. Bend your knees. Place belt around resident’s waist. Grasp belt securely on both sides. 57

Transferring a resident from bed to wheelchair Without transfer belt: Stand in front of resident. Stand with feet about 12 inches apart. Bend your knees. Place your arms around resident’s torso under the arms. Ask resident to place his hands on your shoulders if possible. 58

Transferring a resident from bed to wheelchair 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.” 59

Transferring a resident from bed to wheelchair With your legs, brace resident’s lower legs to prevent slipping (Fig. 10-27). Count to three to alert resident. On three, slowly help resident to stand. Help resident to pivot to front of wheelchair with back of resident’s legs against wheelchair Lower resident into wheelchair. Fig. 10-27. 60

Transferring a resident from bed to wheelchair Reposition resident with hips touching back of wheelchair. Remove transfer belt, if used. Place resident’s feet on footrests. Make resident comfortable. Remove privacy measures. Before leaving, place call light within resident’s reach. Wash your hands. 61

Transferring a resident from bed to wheelchair Report any changes in resident to the nurse. Document procedure using facility guidelines. 62

Transferring a resident from bed to stretcher Equipment: stretcher, bath blanket Wash your hands. Identify yourself by name. Identify the resident by name. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Provide for the resident’s privacy with curtain, screen, or door. 63

Transferring a resident from bed to stretcher Lower the head of bed so that it is flat. Lock bed wheels. Lower the side rail on side to which you will move resident. 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. 64

Transferring a resident from bed to stretcher Lower the side rail on the other side of the bed. Keep a hand on the resident at all times. Place stretcher solidly against the bed. Lock stretcher wheels. Bed height should be equal to the height of the stretcher. Move stretcher safety belts. Two workers should be on one side of resident. Two workers should be standing behind the stretcher. 65

Transferring a resident from bed to stretcher Each worker should roll up the sides of the draw sheet and prepare to move the resident (Fig. 10-28). Protect the resident’s arms and legs during the transfer. Fig. 10-28. 66

Transferring a resident from bed to stretcher On the count of three, the workers should lift and move the resident to the stretcher. All should move at once. Make sure the resident is centered on the stretcher (Fig. 10-29). Place a pillow under the resident’s head if allowed. Cover resident. Place safety straps across the resident. Raise side rails on stretcher. Fig. 10-29. 67

Transferring a resident from bed to stretcher Unlock stretcher’s wheels. Take resident to appropriate site. Stay with the resident until another team member takes over. Wash your hands. Report any changes in the resident to the nurse. Document procedure using facility guidelines. To return the resident to bed, reverse the above procedure. 68

Transferring a resident using a mechanical lift Equipment: wheelchair or chair, co-worker, mechanical or hydraulic lift Wash your hands. Identify yourself by name. Identify the resident by name. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 69

Transferring a resident using a mechanical lift Provide for the resident’s privacy with curtain, screen, or door. Lock bed wheels. Position wheelchair next to bed. Lock brakes. 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. Fanfold if necessary. Fanfolding means folding several times into pleats. 70

Transferring a resident using a mechanical lift (con’t.) Make the bottom of the sling even with the resident’s knees. Help the resident roll back to the middle of the bed. Spread out the fanfolded edge of the sling. 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. Place the overhead bar directly over the resident (Fig. 10-31). Fig. 10-31. 71

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 (Fig. 10-32). If available, have a co- worker support the resident at the head, shoulders, and knees while being lifted. Fig. 10-32. 72

Transferring a resident using a mechanical lift 10. (con’t.) The resident’s arms should be folded across his chest (Fig. 10-33). If the device has “S” hooks, they should face away from resident (Fig. 10-34). Make sure all straps are connected properly. Fig. 10-33. Fig. 10-34. 73

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. 12. If available, a lifting partner can help support and guide the resident’s body. You can then move the lift so that the resident is positioned over the chair or wheelchair. 74

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 position. Undo the straps from the overhead bar. Leave the sling in place for transfer back to bed. Be sure the resident is seated comfortably and correctly in the chair or wheelchair. Remove privacy measures. 75

Transferring a resident using a mechanical lift Before leaving, place call light within resident’s reach. Wash your hands. Report any changes in the resident to the nurse. Document procedure using facility guidelines. 76

Transferring a resident onto and off a toilet Equipment: disposable gloves, toilet tissue, wheelchair, transfer belt, non- skid shoes Wash your hands. Identify yourself by name. Identify the resident by name. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Provide for the resident’s privacy with curtain, screen, or door. 77

Transferring a resident onto and off a toilet Position wheelchair at a right angle to the toilet to face the hand bar/wall rail. Remove wheelchair footrests. Lock wheels. Apply a transfer belt around the resident’s waist. Grasp the belt. Put one of your hands toward the resident’s back and one toward the resident’s front. 78

Transferring a resident onto and off a toilet 8. Ask resident to push against the armrests of the wheelchair and stand, reaching for and grasping the hand bar (Fig. 10-35). Fig. 10-35. 79

Transferring a resident onto and off a toilet 9. 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 (Fig. 10-36). Help resident to pull down underwear and pants. You may need to keep one hand on the transfer belt while helping to remove clothing. Help resident to slowly sit down onto the toilet. Allow privacy unless resident cannot be left alone. Fig. 10-36. 80

Transferring a resident onto and off a toilet When the resident is finished, apply gloves. Assist with perineal care as necessary (see Chapter 13). Ask her to stand and reach for the hand bar. Use toilet tissue or damp cloth to clean the resident. Make sure he or she is clean and dry before pulling up clothing. Remove and dispose of gloves. Pull up resident’s clothing. Help resident to the sink to wash hands. 81

Transferring a resident onto and off a toilet Help resident back into wheelchair. Wash your hands. Help resident to leave the bathroom. Make sure resident is comfortable. Remove privacy measures. Before leaving, place call light within resident’s reach. Report any changes in the resident to the nurse. Document procedure using facility guidelines. 82

Transferring a resident into a car Equipment: car, wheelchair Wash your hands. Identify yourself by name. Identify the resident by name. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Place wheelchair close to the car at a 45-degree angle. Open the door on the resident’s stronger side. 83

Transferring a resident into a car Lock wheelchair. Ask the resident to push against the arm rests of the wheelchair and stand (Fig. 10-37). Fig. 10-37. 84

Transferring a resident into a car Ask the resident to stand, grasp the car or dashboard, and pivot his foot so the side of the car seat touches the back of the legs. The resident should then sit in the seat and lift one leg, and then the other, into the vehicle (Fig. 10-38). Carefully position the resident comfortably in the car. Help secure seat belt. Fig. 10-38. 85

Transferring a resident into a car See that door can be safely shut. Shut door. Return the wheelchair to the appropriate place for cleaning. Wash your hands. Document procedure using facility guidelines. 86