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1. Safety; Basic Body Mechanics; Moving & Positioning Nursing 125

7. A safe environment is one in which basic needs are met, physical hazards are reduced or eliminated, transmission of organisms is reduced and sanitary measures are carried out.

15. “ In 1990, Canadian hospitals reported 30,487 time loss injuries. Fifty-three percent were sustained by nurses. Almost half (of the injuries) were back injuries. Back injury is now recognized as one of the major reasons for ill-health retirement from nursing. Not only is it the most frequent injury sustained by nurses, it is the most debilitating”

16. Action Rationale A broad base of support increases stability. The force is minimized. 10 lbs at waist height close to the body is equal to 100 lbs at arms’ length. Flex knees; keep feet wide apart. Position self close to client (or object being lifted). Reduces risk of injury to lumbar vertebrae & muscle groups. Twisting increases risk of injury. Keep back, neck, pelvis and feet aligned. Avoid twisting. This promotes the client’s abilities & strength while minimizing workload. Encourage client to assist as much as possible. Two workers lifting together divide the workload by 50%. When planning to move a client, arrange for adequate help. Use mechanical aids if help is unavailable.

17. Action Rationale Simultaneous lifting minimizes the load by any one lifter. Person with the heaviest load coordinates efforts of team involved by counting to three. Preparing muscles for the load minimizes strain. Set (tighten) abdominal & gluteal muscles in preparation for move. Sliding requires less effort than lifting. Pull sheet minimizes shearing forces, which can damage client’s skin. Slide client toward yourself using a pull sheet. The leg muscles are stronger, larger muscles capable of greater work without injury. Use arms and legs (not back)

39. Nursing 125 LAB Safety; Basic Body Mechanics; Moving & Positioning

40. Moving the patient: up in bed Patient bends knees, feet firmly on bed, 1 st nurse at HOB arms under head & shoulders, face foot of bed, 2 nd nurse under hips facing foot of bed, on same side – count to 3. Up in bed (2 nurses) (heavy patient or one who cannot help) Encourage independence & foster self-esteem. Patient bends knees, feet firmly on the bed – grasps side rail @ shoulder level. Nurse positions hand & arms under patients hips, back straight, bend knees, feet apart, count to 3. Nurse pulls patient up in bed & pt pulls arms & pushes feet up into bed. Up in bed (1 nurse) (Patient alert & cooperative) Back straight, knees bent, one foot forward (broad base of support) Move close to the side of the bed

41. Moving the patient: lifter Do not lift, always slide One nurse on each side of the bed, firmly grasp the lifter in both hands, ask the patient to lift their head. Slide the patient up in bed on the count of 3. Benefit: 1. movement b/w 2 layers of cloth has less friction than skin on cloth. 2. Much easier to grasp sheet firmly than it is to hold a patient’s body. 3. Lifter supports the entire body (except the head) making it easier to keep the patient straight. Up in bed using the pull sheet/lifter (2 nurses)

42. Moving the patient: lateral Move the patient to the side of the bed, so the patient will be in the center when complete. Raise rail, move to other side of bed, roll patient toward you far ankle over near ankle, far knee over near knee . Place one hand on client’s hip and one hand on his/her shoulder and roll pt. onto side toward you. Place pillow under head & neck, bring shoulder blade forward, position both arms in slightly flexed positions (protects joints). Upper arm supported by pillow. Place pillow behind patient’s back & pillow under semi flexed upper leg Assess need to support feet (footboard, high top sneakers). From the back to the side (lateral) position

43. Moving the patient: prone Move to the extreme edge of the bed, raise rail on that side, move to other side. Pillow for support under abdomen, near arm over head, turn face away, roll as above, check arm & face, continue rolling. Prone - infrequently used because respirations can be compromised Good position for pressure sores on hips/buttocks. Important to turn head to the side, no pillow b/c it hyper extends the neck – can use small towel, small folded towel under each shoulder to prevent slumping, flat pillow at abdomen (esp. women with large breasts) Arms at either sides or flexed by head, hand rolls, feet in dorsiflexion – sandbags under ankles. From the back to the abdomen (prone)