1. Body Mechanics and Safety
Mobility, positioning, transfers, safety devices

2. Body Mechanics
The effective use of the body as a machine and as a means of locomotion

3. Concepts of Body Mechanics
Body alignment or posture – to avoid strain on joints, muscles, tendons, ligaments
Balance – center of gravity is closes to its base of support
Coordinated body movement - necessary to avoid musculoskeletal strain and injury
Postural reflexes - contractions of skeletal muscles to keep body in upright position against force of gravity
Concepts of Body Mechanics

4. Application of body mechanics
Develop habit of erect posture (back straight, head over shoulders, abd muscles contracted -upward pull, gluteal muscles contracted - downward pull)
Use longest, strongest muscles of arms & legs to provide power for strenuous activities
Use internal girdle and a long midriff to stabilize and to protect ABD viscera
Work closely to objects when moving or lifting them
Use body weight as a force when pushing or pulling objects by rocking
Application of body mechanics

5. Application of body mechanics(cont)
Slide, roll, push, pull objects rather than lift
Push rather than pull equipment
Use broad base of support
Ensure dry, smooth surface when moving objects
Flex knees
Break up heavier loads into smaller, lighter loads (NIOSH recommendation limit lift load of 51 lbs)
Application of body mechanics(cont)

6. Proper and Improper Way to Pick up an Object

7. Variables Leading to Back Injury
Uncoordinated lifts
Height-weight differential among lifters
Lifting when fatigued
Lifting after recent recovery from back injury
Lack of training in body mechanics
Standing for long periods of time
Transferring patients
Variables Leading to Back Injury

8. Mobility
Ability to move to fulfill basic human needs.

9. Factors Influencing Mobility
Developmental considerations
Physical health
Mental health
Lifestyle
Attitude and values
Fatigue and stress
External factors
Factors Influencing Mobility

10. Physical Assessment for Mobility
General ease of movement and gait
Alignment
Joint structure and function
Muscle mass, tone, and strength
Endurance
Physical Assessment for Mobility

11. Protective Positioning
Fowler’s position – HOB up degrees
Supine or dorsal recumbent position – flat on back
Side-lying or lateral position
Prone position – flat on abdomen
Protective Positioning

12. Bed Mobility and Positioning Patients
Pillows
Mattresses
Adjustable beds
Bed side rails
Trapeze bar
Additional equipment
Bed Mobility and Positioning Patients

13. Mechanical Aids for Walking
Walker
Cane
Braces
Crutches
Mechanical Aids for Walking

14. Crutch Gaits Four-point – weight bearing bilateral legs
Three-point – weight bearing one legs only
Two-point – weight bearing bilateral – faster than 4 point
Swing-to –no lower body weight bearing. crutches move ahead together and body weight is lifted by arms and swung to crutches
Swing-through – as with the swing to except the body is swung beyond the crutches
Crutch Gaits

15. The Tripod Position—Initial Crutch Stance

16. Safety
Promoting safety and preventing injury are dual responsibility of the nurse

17. Factors Affecting Safety
Developmental considerations
Lifestyle
Mobility
Sensory perception
Knowledge
Ability to communicate
Physical health state
Psychosocial health state
Factors Affecting Safety

18. Focus of Safety Assessments
The individual
The environment
Specific risk factors
Focus of Safety Assessments

19. Nursing History Assess for history of falls or accidents
Note assistive devices
Be alert to history of drug or alcohol abuse
Obtain knowledge of family support systems

20. Physical Examination Assess mobility status
Assess ability to communicate
Assess level of awareness or orientation
Assess sensory perception
Identify potential safety hazards
Recognize manifestations of domestic violence or neglect

21. Risk Factor Assessments
Falls
Fires
Poisoning
Suffocation and choking
Firearm injuries
Risk Factor Assessments

22. Factors That Contribute to Falls
Age >65
History of falls
Impaired vision or balance
Altered gait or posture, impaired mobility
Medication regimen
Postural hypotension
Slowed reaction time
Confusion or disorientation
Unfamiliar environment

23. RACE R – Rescue anyone in immediate danger
A – Activate the fire code and notify appropriate person
C – Confine the fire by closing doors and windows
E – Evacuate patients and other people to safe area

24. Decreasing Equipment-Related Accidents
Use only for intended use and be familiar with equipment
Handle equipment with care so as not to damage it
Use three-prong plugs
Do not twist or bend electric cords
Be alert to signs that equipment is faulty
Be alert to wet surfaces

25. JCAHO Safety Goals Improve patient identification
Improve communication among caregivers
Improve safety of high-alert medications
Eliminate wrong site, wrong patient, wrong procedure, and wrong surgery
Improve safety using infusion pumps
Improve effectiveness of clinical alarm systems
Reduce risk of healthcare acquired infections
JCAHO Safety Goals

26. Abuse and Neglect Abuse:
purposely causing physical, mental, or emotional pain or injury to someone.
Active neglect:
purposely harming a person physically, mentally, or emotionally by failing to provide needed care.
Financial abuse:
stealing, taking advantage of, or improperly using the money, property, or other assets of another.
Abuse and Neglect

27. Types of abuse and neglect
A nurse is legally required to report any observed or suspected abuse of residents and assist residents who wish to make a complaint of abuse in every way possible. Staff cannot retaliate in any way against a resident who makes a complaint.
Types of abuse and neglect include:
Physical abuse,
Psychological abuse,
Sexual abuse,
Financial abuse
Active and passive neglect, etc.
Types of abuse and neglect

28. Recognize signs and symptoms of abuse and neglect
All care team members are considered mandated reporters and must assess for signs of abuse and report them.
Residents are vulnerable and there are many ways for caregivers to help and protect them.
Recognize signs and symptoms of abuse and neglect

29. Suspicious Injuries
Transparency 1-4

30. The steps to take if abuse is suspected.
The patient is immediately removed from the abusive situation (Patient safety is first).
The alleged abuser is asked to leave immediately pending a investigation.
Report allegations as per facility protocols.
An investigation will be performed.
If abuse is found to have occurred, the HCW is placed on the abuse registry in addition to other possible penalties. Employers check this registry before hiring HGW.
The steps to take if abuse is suspected.

31. Types of Restraints Used for Adults and Children

32. Restraints Determine the need for restraint
Secure physician order or validate order that has been ordered within the past 24 hours as per agency policy
Perform hand hygiene
Identify the patient
Follow manufactures directions when applying restraint
Use least restrictive type of restraint
Pad bony prominences
Wrap restraint with softest part next to the skin
Maintain restrained extremity in normal anatomic position
Restraints

33. Use quick release knot to secure, tie to bed frame not side rail
Assess patient according to agency policy at least every hour, include placement of restraint, neurovascular assessment and skin integrity on restrained limb, signs & symptoms of sensory deprivation (e.g. increased sleeping, daydreaming, anxiety, panic, and hallucinations)
Restraints (cont)

34. Remove restraint according to agency policy, at least every two hours
Remove restraint according to agency policy, at least every two hours. Perform ROM.
Evaluate need for continued use of restraint. Reapply only if continued need is evident and order is still valid.
Reassure patient at regular intervals. Provide explanation of need for restraint and reorient as needed. Keep call light within reach.
Restraints (cont)

35. Physiologic Hazards Associated With Restraints
Suffocation from entrapment
Impaired circulation
Altered skin integrity — pressure ulcers
Diminished muscle and bone mass
Fractures
Altered nutrition and hydration
Aspiration and breathing difficulties
Incontinence
Changes in mental status
Physiologic Hazards Associated With Restraints

36. Skills Applying an Extremity Restraint
Assisting a patient with turning in bed.
Moving a patient up in bed with the assistance of another nurse
Transfering a patient from bed to stretcher
Transferring a patient from bed to chair
Skills