1. Fundamentals of Nursing
Body Mechanics
PNU 145
Cheryl Proffitt RN, MSN
September, 2015
Chapter 23
ATI REVIEW-Chapters 14,40

2. Body Mechanics
Learning Objectives
Identify characteristics of good posture in a standing, sitting or lying position
Describe three principles of correct body mechanics.
Explain the purpose of ergonomics.
Give at least two examples of ergonomics recommendations in the workplace.
Describe at least 10 signs or symptoms associated with disuse syndrome
Describe six common client positions

3. Discuss four types of transfer devices
Body Mechanics
Learning Objectives Cont’d
Explain the purpose of five different positioning device used for safety and comfort
Name one advantage for each of three different pressure relieving devices
Discuss four types of transfer devices
Give at least five general guidelines that apply to transferring clients

4. Body Mechanics
Introduction- Dangers of inactivity
Inactivity leads to deterioration of health. Multiple complications can occur among people with limited activity and movement. (table 23-1)
For example- As we get older our co- ordination, endurance and muscle strength declines. This caused limitation in mobility.
Inactivity leads to disuse syndrome (signs and symptoms that occurs from inactivity)

5. Body Mechanics
What are some activities that can be done to reduce Disuse syndrome
Positioning
Moving the client.
Nurses should use good posture when performing these activities.
See table 23-1 for dangers of inactivity and fig 23-1 for good posture

6. Dangers of Inactivity

7. Maintaining Good Posture
What is posture ? (fig 23-1)
Posture is the position of the body, or the way in which it is held, that affects the person’s appearance, how the person stands, and their ability to use the musculoskeletal system effectively.
Good posture distributes gravity through the center of the body over a wide base for clients and staff.
Poor Posture causes muscle spasms ( which are sudden, forceful, and involuntary muscle contraction). This occurs because muscles are strained and are forced to work harder

8. Maintaining Good Posture (cont’d)

9. Standing Posture

10. Another way to maintain good posture is standing. (fig 23-3)
Body Mechanics
Correct Standing Position
Another way to maintain good posture is standing. (fig 23-3)
Most effective, when feet are parallel, with weight equally distributed on both feet to provide a broad base of support. (fig 23-2), bend knees slightly, chest up and slightly forward, shoulders ,even and centered above hip, hold head erect, face forward and chin slightly tucked

11. Sitting Posture Correct sitting posture
Buttocks and thighs base of support
Both feet rest on floor
Knees bent and clear of chair edge
(Figure 23-3 in the textbook.)

12. Lying-Down Posture Good lying-down posture - horizontal
Head, neck centered between shoulders
Shoulders level; arms, hips, knees slightly flexed
Trunk straight; hips level; legs parallel; feet at right angles to legs (Figure 23-4)

13. Body Mechanics
Proper body mechanics (the effective use of the musculoskeletal system) will
Increase muscle effectiveness
Reduce fatigue
Avoids repetitive strain injuries (disorders that results from cumulative trauma to musculoskeletal structures).

14. Nursing Guidelines (23-1)
Using Good body Mechanics (nursing guidelines)
Use the longest and strongest muscles of arms and legs
When lifting a heavy load, center is over feet.
Hold objects close to the body
Bend the knees
Contract the abdominal muscles and make a long midriff
Push, pull or roll objects whenever possible rather than lifting them.
Use body weight as a lever to assist with pushing or pulling an object
See 23-1for more.

15. Ergonomics
Definition: special field of engineering science devoted to the promotion of comfort, performance of health in the workplace. Helps in the design of health in the work environment .
Example: using assistive devices to lift or transport heavy items or clients; using alternative equipment for task that require repetitive motions e.g. headsets or automatic staples.

16. Ergonomics Examples Cont’d
Positioning equipment – to avoid reaching and twisting at the hip
Promoting stability by keeping feet apart
Use strong muscles to improve balance by bending knees and keeping the back straight
Avoid twisting and stretching muscles
Rest between periods of exertion.
Some nurses are prone to injury in the work during lifting patients, twisting while lifting, reaching and lifting with loads far from the body

17. Positioning Clients General principles for positioning
Changing inactive clients position to relieve pressure & improve Functional mobility (alignment that maintains the potential for movement & ambulation)
Change the inactive client’s position at least every 2 hours
Enlist the assistance of at least one other caregiver
Remove pillows and positioning devices

18. Positioning Clients Cont’d
Unfasten Drainage from the bed linen.
Use Low friction fabric or gel filled plastic sheet, repositioning sling to slide/ do not drag the client
Turn client as a complete unit ( avoid injury to spine)
Place the client in good alignment with joints slightly flexed
Replace pillows and positioning devices
Support limbs in a functional position
Use elevation to relieve swelling
Provide skin care after repositioning

19. Positioning Clients (cont’d)
Common positions for bed ridden clients, supine, lateral oblique, prone, sim’s, and Fowler’s ( Fig 23-6)
Supine position: client lies on back.
Concerns-prolonged pressure & skin breakdown. Foot drop: permanent dysfunctional position caused by shortening of the calf muscles and lengthening of the opposing muscles on the anterior leg.

20. Foot Drop

21. Positioning Clients (cont’d)
Lateral position- Side lying position
Lateral Oblique- variation of side lying position
Prone position-client lies on abdomen
provides drainage from bronchioles
Alternate position for client’s with ulcers
A challenge for nursing care.
Sim’s position- a semi prone position. Used for rectal and vaginal procedures.
Fowler’s position- semi-sitting position. Lowers abdominal organs from diaphragm , making breathing easier. Three types.

22. Common Positions

23. Positioning Clients (cont’d)
Positioning devices
Adjustable bed
Mattress
Bed board (rigid structure placed under a mattress)
Pillows
Roller sheets

24. Adjustable Bed

25. Positioning Clients (cont’d)
Turning and moving clients
Assistive devices and additional caregivers are needed when turning or moving a client who cannot change from one position to another independently

26. Trochanter Rolls -Prevents legs from turning outwards

27. Hand Rolls- prevents contractures, helps clients functional mobility to grasp objects

28. Foot Boards, Boots, and Foot Splints

29. Trapeze- triangular, over the bed, helps client to lift the body and move

30. Protective/Pressure-Relieving Devices
Side rails- aids in changing position
Mattress overlays- reduces pressure
Foam and gel mattresses- redistributes pressure
Static air mattress-distributes pressure
Alternating air mattress-relieves pressure
Water mattress –equalizes pressure

31. Protective devices

32. Protective/Pressure-Relieving Devices (cont’d)
Cradle: metal frame secured to or placed on top of the mattress to protect feet and lower legs from bed linens
Specialty beds
Low air loss
Air fluidized
Oscillating support
Circular bed

33. Oscillating Bed
It Slowly, continuously rocks from side to side in 124-degree arc
Relieves skin pressure
Helps mobilize respiratory secretions
Prevents skin shearing (force exerted against skin surface and layers causes tissues slide in opposite direction)
(Refer to Figure in the textbook.)

34. Circular Bed-supports & maintains mobility during position change

35. Transferring Clients
Transfers –moving client from one place to the next, from bed to chair/toilet or stretcher/back to bed.
Examples of transferring aids
Transfer handle- active /independent
Transfer belt – gripping/support for client
Transfer boards – bed to stretcher
Mechanical lift- raise/transfer, obese/helpless

36. Examples of transfer aids

37. Nursing Implications Nursing diagnoses for inactive clients
Impaired physical mobility
Risk for injury
Risk for disuse syndrome
Impaired bed mobility

38. General Gerontologic Considerations
Older adults
Need to maintain as much mobility as possible to prevent disability
Require extra time and assistance during positioning, transferring, and ambulating
Instructions should be given using clear, simple words; make one request at a time

39. Reference
Timby, B. (2009). Fundamental nursing skills and concepts (10th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Google pictures. (2015, August 10). Retrieved from