1. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 4: Ambulation Purposes of Ambulation Keeps the resident more active Improves muscle tone in legs; improves strength Provides sense of accomplishment Allows resident to maintain greater independence Slows loss of bone mass and density related to osteoporosis Increases peristalsis Improves circulation

2. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 4: Ambulation Reasons Why Residents May Need Assistance with Ambulation Decreased muscle strength Changes of the center of gravity and posture Decreased sensory perception Changes from aging may cause: Impaired balance Confusion Drugs that the resident is receiving Distractions

3. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 4: Ambulation Nurse Assistant’s Responsibilities in Ambulating Residents Be aware of safety considerations – Make sure objects and other residents are out of the way and that there are no slippery floors or shoes. Ensure that there are rubber tips on all canes and nonrolling walkers. NOTE: Always use a gait belt! Use good body mechanics. Dress resident appropriately. Resident should wear stockings or socks and nonskid shoes to prevent falls. Observe resident’s ambulation and response to ambulation (e.g., steadiness of gait, balance, and endurance). Ambulate resident in an uncluttered area. Have a chair ready for the resident at the other end or at a resting point along the way.

4. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 4: Ambulation Nurse Assistant’s Responsibilities in Ambulating Residents Most of the time, you ambulate at the resident’s side, with your arm/hand for support, standing on the resident’s weaker side and slightly behind him/her. If the resident is encouraged to use a weak leg, stand on the weak side. Allow resident to sit on side of bed before ambulating to allow time for resident to gain balance. As you walk with the resident, observe for signs of fatigue such as difficult breathing, sweating, dizziness, and rapid heart beat. If these occur, allow the resident to rest. If resident loses weight-bearing ability, pull the resident’s body into close alignment with your hip/thigh area by using the gait belt and lower to floor using large muscles of your legs.

5. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 4: Ambulation Equipment Used for Ambulation Transfer or gait belt Grasp the belt with both hands and use it to guide the resident. Walk slowly and allow the resident to set the pace. Walk with the resident by placing one hand around the back of the gait belt with palms up and the other hand under the front of the gait belt. (See Figure 4.1.) Walk on the weaker side and encourage resident to hold handrail, if available, with strong arm. Figure 4.1 – Using a Gait Belt

6. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 4: Ambulation Equipment Used for Ambulation Walkers (See Figures 4.2, 4.3, and 4.4.) It is used for the resident who requires some support when walking due to imbalance or weakness. Resident may be able to bear weight on one foot, remain balanced in an upright position, and have use of hands and arms. When walker without wheels is being moved, the resident’s feet should not be moving. It should never be slid along the floor or ground. Always instruct the resident to move the walker forward by lifting it up. The height of the walker should be adjusted so that the resident is standing straight with elbows slightly flexed (approximately at hip height).

7. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 4: Ambulation Figure 4.2 – Types of Walkers

8. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 4: Ambulation Figure 4.3 – Assisting the Resident Who Is Weak to Stand With a Walker Figure 4.4 – Assisting the Resident Who Is Weak to Sit With A Walker

9. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 4: Ambulation Equipment Used for Ambulation Cane (See Figures 4.5 and 4.6.) It is used for residents who have weakness or paralysis on one side of the body. It should be used on resident’s stronger side to balance his/her weight between the cane and his/her weaker side. The height of the cane should be such that the resident holds it with his/her elbow slightly bent when walking. Three-point and four-point canes give more support than single tip canes but may be harder to move. The flat side of cane should be against the side of the leg, and extended cane legs should be away from the resident’s legs. The tip of the cane should be about 6 to 10 inches to the side of the foot. The bottom of the cane should be covered with a rubber tip to prevent sliding.

10. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 4: Ambulation Figure 4.5 – Assisting the Resident Who Is Hemiplegic to Sit With a Cane

11. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 4: Ambulation Figure 4.6 – Types of Canes

12. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 4: Ambulation Equipment Used for Ambulation Brace It is used for the resident who needs specific support for weakened muscles/joints or to provide immobilization of an injured part. Check for loose screws/bolts of brace. Report loose screws or bolts to charge nurse. Check skin where brace is applied for any signs of breakdown; report to charge nurse. Prop brace when not in use. Never lay it flat because it could warp. Refer to the care plan for information regarding use of a brace.

13. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 4: Ambulation Equipment Used for Ambulation Prosthesis – artificial limb It is used for the resident who is missing an arm/leg. Observe skin stump for any signs of breakdown. Record and report. Encourage resident to wear prosthesis as much as possible. If needed, help resident put on prosthetic according to care plan.

14. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 4: Ambulation Conclusion By helping residents with ambulation, the nurse assistant also provides an opportunity for residents to achieve a greater sense of independence while increasing muscle tone and circulation.

15. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 4: Ambulation Steps of Procedure for Ambulating Resident Using a Gait Belt 2.Identify and greet resident. Identify self. 3.Explain what you are going to do. 4.Lower bed to lowest level; assist resident to sit on edge of bed. 5.Pause and allow resident to sit on edge of bed a few moments to regain balance. 1.Wash your hands. 6.Assist the resident in putting on nonskid shoes and socks. 7.Put gait belt around resident’s waist. 8.Stand in position of good body mechanics. 9.Assist the resident to a standing position.

16. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 4: Ambulation Steps of Procedure for Ambulating Resident Using a Gait Belt 11.Pause to allow resident to regain balance. 12.Walk with the resident by placing one hand on gait belt in front of his/her waist and your hand in back under the gait belt. Walk on the weaker side and encourage resident to hold handrail, if available, with strong arm. 10.Assist resident to stand by straightening legs as you lift with gait belt as resident pushes down with hands on the mattress. 13.Walk in the same pattern as the resident (both step with left foot at the same time). Assist resident to step forward with strong foot first. 14.Walk resident the distance instructed by charge nurse as indicated by care plan.

17. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 4: Ambulation Steps of Procedure for Ambulating Resident Using a Gait Belt 15.Return resident to bed/chair. 16.Make sure resident is comfortable; place call signal within reach. NOTE: If resident loses weight-bearing ability, pull the resident’s body into close alignment with your hip/thigh area by using the gait belt and lower to floor using large muscles of your legs. Notify the charge nurse while the resident is still on the floor. He/she will assess the resident for injury. 17.Remove gait belt. 18.Wash your hands. 19.Record observations.

18. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 4: Ambulation Steps of Procedure for Ambulating Resident with a Walker 2.Identify and greet resident. Identify self. 3.Explain what you are going to do. 4.Lower bed to lowest level; assist resident to sit on edge of bed. 5.Pause and allow resident to sit on edge of bed a few moments to regain balance. 1.Wash your hands. 6.Assist the resident in putting on nonskid shoes and socks. 7.Apply gait belt. 8.Stand in position of good body mechanics. 9.Assist the resident to a standing position.

19. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 4: Ambulation Steps of Procedure for Ambulating Resident with a Walker 11.Instruct resident to move walker forward by lifting it up, moving it forward, and setting it down. 12.Instruct resident to take a step forward with the weak leg. 10.Instruct resident to position body within the frame of the walker. 13.Instruct resident to move strong leg forward. 14.Instruct resident to take short steps and keep head up and eyes looking forward. 15.Walk resident the distance instructed by charge nurse as indicated in the care plan. 16.Return resident to bed or chair. To ambulate backward, resident steps back with strong foot, takes a step back with weak foot, then walker is moved back. Have resident feel for arm of chair or top of mattress with his/her hand.

20. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 4: Ambulation Steps of Procedure for Ambulating Resident with a Walker 18.Wash your hands. 19.Record observations. 17.Make sure resident is comfortable; place call signal within reach.

21. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 4: Ambulation Steps of Procedure for Ambulating Resident with a Cane 2.Identify and greet resident. Identify self. 3.Explain what you are going to do. 4.Lower bed to lowest level; assist resident to sit on edge of bed. 5.Pause and allow resident to sit on edge of bed a few moments to regain balance. 1.Wash your hands. 6.Assist the resident in putting on nonskid shoes and socks. 7.Apply gait belt. 8.Stand in position of good body mechanics. 9.Assist the resident to a standing position.

22. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 4: Ambulation Steps of Procedure for Ambulating Resident with a Cane 11.Instruct resident to move cane forward and a little out to the side of the strong leg. Resident should use cane on his/her stronger side. 12.Instruct resident to move weak extremity forward to line up evenly with tip of cane just after cane is placed. 10.Instruct resident to take short steps and keep head up and eyes looking forward. 13.Instruct resident to put weight on cane and weak foot while swinging strong foot forward, taking a step. 14.Walk in the same pattern as the resident (both step with left foot at the same time). 15.Walk resident the distance instructed by the charge nurse as indicated in the care plan.

23. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 4: Ambulation Steps of Procedure for Ambulating Resident with a Cane 17.Make sure resident is comfortable; place call signal within reach. 18.Wash your hands. 16.Return resident to bed/chair. 19.Record observations.