1. Review the principles of body mechanics

1
1. Review the principles of body mechanics

• Define the following terms
• alignment
• based on the word line a body is in alignment
  when a straight line could be drawn through the
  center of his body and his center of gravity.
• base of support
• the foundation that supports an object.
• center of gravity
• the point in the body where the most weight is
  concentrated.
• fulcrum and lever
• a means of moving an object by resting it on a
  base of support a seesaw is an example of a
  fulcrum and lever.

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1. Review the principles of body mechanics

• NAs should remember these guidelines for using
  proper body mechanics
• 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.
• Push rather than lift.

3
2. Explain positioning and describe how to safely
position residents

• Define the following terms
• positioning
• the act of helping people into positions that
  promote comfort and health.
• supine
• body position in which a person lies flat on his
  back.
• lateral
• body position in which a person is lying on
  either side.
• prone
• body position in which a person is lying on his
  stomach, or front side of the body.

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2. Explain positioning and describe how to safely
position residents

• Define the following terms
• Fowlers
• a semi-sitting body position, in which a persons
  head and shoulders are elevated 45 to 60 degrees.
• Sims
• body position in which a person is lying on his
  left side with the upper knee flexed and raised
  toward the chest.
• arm lock/lock arm
• hold in which the caregiver places his arm under
  a persons arm, grasping the persons shoulder,
  while the person grasps the caregivers shoulder.

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2. Explain positioning and describe how to safely
position residents

• Define the following terms
• draw sheet
• an extra sheet placed on top of the bottom sheet
  used for moving residents.
• shearing
• rubbing or friction that results from the skin
  moving one way and the bone underneath it
  remaining fixed or moving in the opposite
  direction.

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2. Explain positioning and describe how to safely
position residents

• Define the following terms
• logrolling
• moving a person as a unit, without disturbing the
  alignment of the body.
• dangle
• to sit up with the legs hanging over the side of
  the bed in order to regain balance and stabilize
  blood pressure.

7
Transparency 10-1 Five Basic Positions

8
2. Explain positioning and describe how to safely
position residents

• NAs should know the following facts about the
  five basic body positions
• Supine Position
• Resident lying flat on back
• Pillows under head and shoulders, arms, hands
  heels should not be touching the bed
• Lateral Position
• Resident lying on either side
• Pillows support head, arm, and leg on upper side,
  back and head. Upper knee on pillow.

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2. Explain positioning and describe how to safely
position residents

• Facts about the five basic body positions
  (contd)
• Prone Position
• Resident lying on stomach
• Small pillow under head and to keep feet off bed
• Fowlers Position
• Semi-sitting, head and shoulders elevated
• Pillows at flexed knees, at flexed feet, and
  under head
• Sims Position
• Variation on lateral side position, left
  side-lying position
• Lower arm behind the back, upper knee flexed
• Pillows under head, arms, flexed knee, and foot

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Helping a resident sit up using the arm lock

• 1. Identify yourself by name. Identify the
  resident by name.
• 2. Wash your hands.
• 3. Explain procedure to the resident. Speak
  clearly, slowly, and directly. Maintain
  face-to-face contact whenever possible.
• 4. Provide for the residents privacy with
  curtain, screen, or door.
• 5. Adjust bed to a safe level, usually waist
  high. Lock bed wheels.

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Helping a resident sit up using the arm lock

• 6. Move the pillow to the head of the bed.
• 7. Stand at the side of the bed and face the head
  of the bed. Spread feet about 12 inches or
  shoulder-width apart. Bend your knees.
• 8. Place your arm under the residents arm and
  grasp the residents shoulder. Have the resident
  grasp your shoulder in the same manner. This hold
  is called the arm lock or lock arm.

12
Helping a resident sit up using the arm lock

• 9. Reach under the residents head and place your
  other hand on the residents far shoulder.
• 10. At the count of three, rock yourself backward
  and pull the resident to a sitting position. Use
  pillows or a bed rest to support the resident in
  the sitting position.
• 11. Check the resident for dizziness or weakness.
  If the resident is dizzy, you can ease her back
  to the supine position.

13
Helping a resident sit up using the arm lock

• 12. Put pillow back under residents head. Make
  resident comfortable.
• 13. Return bed to lowest position. Remove privacy
  measures.
• 14. Place call light within residents reach.
• 15. Wash your hands.
• 16. Report any changes in resident to the nurse.
  Document procedure using facility guidelines.

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Moving a resident up in bed

• Equipment draw sheet
• When the resident can help you move her up in
  bed, take the following steps
• 1. Identify yourself by name. Identify the
  resident by name.
• 2. Wash your hands.
• 3. Explain procedure to the resident. Speak
  clearly, slowly, and directly. Maintain
  face-to-face contact whenever possible.
• 4. Provide for the residents privacy with
  curtain, screen, or door.

15
Moving a resident up in bed

• 5. Adjust bed to a safe level, usually waist
  high. Lock bed wheels.
• 6. Lower the head of bed to make it flat. Move
  the pillow to the head of the bed.
• 7. If the bed has side rails, raise the rail on
  the far side of the bed.
• 8. Stand by bed with your feet shoulder-width
  apart, facing the resident.

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Moving a resident up in bed

• 9. Place one arm under residents shoulder
  blades. Place the other arm under residents
  thighs. Use proper body mechanics.
• 10. Ask resident to bend her knees, place her
  feet firmly on the mattress, and push her feet
  and hands on the count of three.

17
Moving a resident up in bed

• 11. On the count of three, shift your body
  weight, and help move resident while she pushes
  with her feet. As always, allow the resident to
  do all she can for herself.
• 12. Make resident comfortable. Put pillow back
  under residents head and arrange the blankets
  for her.
• 13. Return bed to lowest position. Remove privacy
  measures.
• 14. Place call light within residents reach.

18
Moving a resident up in bed

• Wash your hands.
• 16. Report any changes in resident to the nurse.
  Document procedure using facility guidelines.
• When the resident cannot assist and there is no
  one else around to help you move her up in bed,
  take the following steps
• 1. Follow steps 1 through 6 above.
• 2. Stand behind the head of the bed with your
  feet shoulder-width apart and one foot slightly
  in front of the other.

19
Moving a resident up in bed

• 3. Roll and grasp the top edge of the draw sheet.
• 4. Bend your knees and keep your back straight.
  Rock your weight from the front foot to the back
  foot in one smooth motion, while pulling the draw
  sheet and resident toward the head of the bed.
• 5. Make resident comfortable. Put pillow back
  under residents head and arrange the blankets
  for her. Unroll the draw sheet and leave it in
  place for the next repositioning.

20
Moving a resident up in bed

• 6. Return bed to lowest position. Remove privacy
  measures.
• 7. Place call light within residents reach.
• 8. Wash your hands.
• 9. Report any changes in resident to the nurse.
  Document procedure using facility guidelines.
• When you have help from another person, you can
  modify the procedure as follows
• 1. Follow steps 1 through 6 above.

21
Moving a resident up in bed

• 2. 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 in that direction. Stand
  with your feet about shoulder-width apart. Bend
  your knees. Keep your back straight.

22
Moving a resident up in bed

• 3. Roll the draw sheet up to the residents side,
  and have your helper do the same on her side of
  the bed. Grasp the sheet with your palms up, and
  have your helper do the same.

23
Moving a resident up in bed

1. Shift your weight to your back foot (the foot
   closer to the foot of the bed) and have your
   helper do the same. On the count of three, you
   and your helper both shift your weight to your
   forward foot. Slide the draw sheet and resident
   toward the head of the bed.

24
Moving a resident up in bed

• 5. Make resident comfortable. Put pillow back
  under residents head and arrange the blankets
  for her. Unroll the draw sheet and leave it in
  place for the next repositioning.

25
Moving a resident up in bed

• 6. Return bed to lowest position. Remove privacy
  measures.
• 7. Place call light within residents reach.
• 8. Wash your hands.
• 9. Report any changes in resident to the nurse.
  Document procedure using facility guidelines.

26
Moving a resident to the side of the bed

• Equipment draw sheet
• 1. Identify yourself by name. Identify the
  resident by name.
• 2. Wash your hands.
• 3. Explain procedure to the resident. Speak
  clearly, slowly, and directly. Maintain
  face-to-face contact whenever possible.
• 4. Provide for the residents privacy with
  curtain, screen, or door.
• 5. Adjust bed to a safe level, usually waist
  high. Lock bed wheels.
• 6. Lower the head of bed.

27
Moving a resident to the side of the bed

• 7. Stand on the same side of the bed to where you
  are moving the resident. Stand with feet
  shoulder-width apart, and bend your knees.

28
Moving a resident to the side of the bed

• 8. With a draw sheet Roll the draw sheet up to
  the residents side, and grasp the sheet with
  your palms up. One hand should be at the
  residents shoulders, the other about level with
  the residents hips. Apply one knee against the
  side of the bed, and lean back with your body. On
  the count of three, slowly pull the draw sheet
  and resident toward you.

29
Moving a resident to the side of the bed

• Without a draw sheet Gently slide your hands
  under the head and shoulders and move toward you.
  Gently slide your hands under her midsection and
  move it toward you. Gently slide your hands under
  the hips and legs and move them toward you.
• 9. Make resident comfortable.
• 10. Return bed to lowest position. Remove privacy
  measures.
• 11. Place call light within residents reach.

30
Moving a resident to the side of the bed

• 12. Wash your hands.
• 13. Report any changes in resident to the nurse.
  Document procedure using facility guidelines.

31
Turning a resident

• 1. Identify yourself by name. Identify the
  resident by name.
• 2. Wash your hands.
• 3. Explain procedure to the resident. Speak
  clearly, slowly, and directly. Maintain
  face-to-face contact whenever possible.
• 4. Provide for the residents privacy with
  curtain, screen, or door.
• 5. Adjust bed to a safe level, usually waist
  high. Lock bed wheels.
• 6. Lower the head of bed.

32
Turning a resident

• 7. Stand on side of bed opposite to where
  resident will be turned. If the bed has side
  rails, raise the far side rail. Lower side rail
  nearest you if it is up.
• 8. Move resident to side of bed nearest you using
  previous procedure.
• 9. Turning resident away from you
• a. Cross residents arm over her chest. Move arm
  on side resident is being turned to out of the
  way. Cross the leg nearest you over the far leg.

33
Turning a resident

• b. Stand with feet shoulder-width apart. Bend
  your knees.
• c. Place one hand on the residents shoulder.
  Place the other hand on the residents nearest
  hip.
• d. Gently push the resident onto side as one
  unit, toward the other side of bed (toward raised
  side rail if present). Shift your weight from
  your back leg to your front leg.

34
Turning a resident

• Turning resident toward you
• a. Cross residents arm over his chest. Move arm
  on side resident is being turned to out of the
  way. Cross the leg furthest from you over the
  near leg.
• b. Stand with feet shoulder-width apart. Bend
  your knees.
• c. Place one hand on the residents far shoulder.
  Place the other hand on the far hip.

35
Turning a resident

• Gently roll the resident toward you. Your body
  will block resident and prevent him from rolling
  out of bed.
• 10. Position the resident properly, comfortably,
  and in good alignment. Proper positioning
  includes the following
• Head supported by pillow
• Shoulder adjusted so resident is not lying on
  arm
• Top arm supported by pillow

36
Turning a resident

• Back supported by supportive device
• Top knee flexed
• Supportive device between legs with top knee
  flexed knee and ankle supported
• 11. Return bed to lowest position. Remove privacy
  measures.
• 12. Place call light within residents reach.
• 13. Wash your hands.
• 14. Report any changes in resident to the nurse.
  Document procedure using facility guidelines.

37
Logrolling a resident

• Equipment draw sheet, co-worker
• 1. Identify yourself by name. Identify the
  resident by name.
• 2. Wash your hands.
• 3. Explain procedure to the resident. Speak
  clearly, slowly, and directly. Maintain
  face-to-face contact whenever possible.
• 4. Provide for the residents privacy with
  curtain, screen, or door.
• 5. Adjust bed to a safe level, usually waist
  high. Lock bed wheels.

38
Logrolling a resident

• 6. Lower the head of the bed.
• 7. Both people stand on the same side of the bed.
  One person stands at the residents head and
  shoulders. The other stands near the residents
  midsection.
• 8. Place the residents arms across his chest.
  Place a pillow between the knees.
• 9. Stand with your feet shoulder-width apart.
  Bend your knees.
• 10. Grasp the draw sheet on the far side.

39
Logrolling a resident

• On the count of three, gently roll the resident
  toward you. Turn the resident as a unit. Your
  bodies will block the resident and prevent him
  from rolling out of bed.
• 12. Make resident comfortable. Arrange pillows
  and covers for comfort.
• 13. Return bed to lowest position. Remove privacy
  measures.
• 14. Place call light within residents reach.
• 15. Wash your hands.

40
Logrolling a resident

• 16. Report any changes in resident to the nurse.
  Document procedure using facility guidelines.

41
Assisting a resident to sit up on side of bed
dangling

• 1. Identify yourself by name. Identify the
  resident by name.
• 2. Wash your hands.
• 3. Explain procedure to the resident. Speak
  clearly, slowly, and directly. Maintain
  face-to-face contact whenever possible.
• 4. Provide for the residents privacy with
  curtain, screen, or door.
• 5. Adjust bed to lowest position. Lock bed wheels.

42
Assisting a resident to sit up on side of bed
dangling

• 6. Raise the head of bed to sitting position.
  Fanfold (fold into pleats) the top covers to the
  foot of the bed. Ask the resident to turn onto
  his side, facing you. Assist as needed (see
  earlier procedure).
• 7. Tell the resident to reach across his chest
  with his top arm and place his hand on the edge
  of the bed near his opposite shoulder. Ask him to
  push down on that hand to raise his shoulders up
  while swinging his legs over the side of the bed.

43
Assisting a resident to sit up on side of bed
dangling

• 8. Always allow the resident to do all he can for
  himself. However, if the resident needs
  assistance, follow these steps
• a. Stand with your legs shoulder-width apart.
  Bend your knees.
• Place one arm under the residents shoulder
  blades. Place the other arm under the residents
  thighs.

44
Assisting a resident to sit up on side of bed
dangling

1. On the count of three, slowly turn resident into
   sitting position with legs dangling over side of
   bed. The weight of the residents legs hanging
   down from the bed helps the resident sit up.
2. 9. Ask resident to hold onto the edge of mattress
   with both hands. Assist resident to put on
   non-skid shoes or slippers.

45
Assisting a resident to sit up on side of bed
dangling

• 10. Have resident dangle as long as ordered. The
  care plan may direct you to allow the resident to
  dangle for several minutes and then return him to
  lying down, or it may direct you to allow the
  resident to dangle in preparation for walking or
  a transfer. Follow the care plan. Do not leave
  the resident alone. If the resident is dizzy for
  more than a minute, have him lie down again and
  report to the nurse.

46
Assisting a resident to sit up on side of bed
dangling

• 11. Take vital signs as ordered (you will learn
  how to take vital signs in Chapter 14).
• 12. Remove slippers or shoes.
• 13. Gently assist resident back into bed. Place
  one arm around residents shoulders and the other
  arm under the residents knees. Slowly swing
  residents legs onto bed.
• 14. Make resident comfortable.
• 15. Leave bed in lowest position. Remove privacy
  measures.

47
Assisting a resident to sit up on side of bed
dangling

• 16. Place call light within residents reach.
• 17. Wash your hands.
• 18. Report any changes in resident to the nurse.
  Document procedure using facility guidelines.

48
3. Describe how to safely transfer residents

• Define the following terms
• ergonomics
• the science of designing equipment, areas, and
  work tasks to make them safer and to suit the
  workers abilities.
• transfer/gait belt
• a belt made of canvas or other heavy material
  that is used to help people who are weak,
  unsteady, or uncoordinated to stand, sit, or
  walk.
• slide board
• a wooden board that helps transfer people who are
  unable to bear weight on their legs also called
  a transfer board.

49
3. Describe how to safely transfer residents

• REMEMBER
• Many facilities have adopted no-lift, zero-lift,
  or lift-free policies. It is important that NAs
  follow facility policy carefully.

50
3. Describe how to safely transfer residents

• REMEMBER
• When assisting residents NAs must know which side
  is stronger and which is weaker and move the
  stronger side first. NAs should never refer to a
  bad side or a bad leg or arm.

51
3. Describe how to safely transfer residents

• REMEMBER
• Transfer belts must be applies over the clothing
  and not on bare skin. It is important to check
  and ensure no skin is caught in the belt.

52
Applying a transfer belt

• Equipment transfer belt, non-skid footwear
• 1. Identify yourself by name. Identify the
  resident by name.
• 2. Wash your hands.
• 3. Explain procedure to the resident. Speak
  clearly, slowly, and directly. Maintain
  face-to-face contact whenever possible.
• 4. Provide for the residents privacy with
  curtain, screen, or door.
• 5. Adjust bed to lowest position. Lock bed wheels.

53
Applying a transfer belt

• 6. Assist the resident to a sitting position with
  feet flat on the floor.
• 7. Put non-skid footwear on resident and make
  sure laces are tied.
• 8. Place the belt over the residents clothing
  and around the waist. Do not put it over bare
  skin.
• 9. Tighten the buckle until it is snug. Leave
  enough room to insert flat fingers/hand
  comfortably under the belt.

54
Applying a transfer belt

• 10. Check to make sure that skin or skin folds
  (for example, breasts) are not caught under the
  belt.
• 11. Position the buckle slightly off-center in
  the front or back for comfort.

55
3. Describe how to safely transfer residents

• NAs should know the following guidelines for
  wheelchairs
• Know how to use brake, armrests, and footrests.
• Lock before transfer unlock after.
• Open by pulling on both sides. Close by lifting
  center of seat.
• Remove armrests by releasing lock.
• Remove footrests by pulling back on lever and
  swinging out toward side of chair.
• Lift or lower footrest by squeezing lever and
  pulling up or pushing down.
• Resident must use side of body that can bear
  weight and lift side that cannot.

56
3. Describe how to safely transfer residents

• Guidelines for wheelchairs (contd)
• Resident must be wearing non-skid footwear before
  transferring.
• Keep resident safe and comfortable during
  transfers.
• Assist resident as needed by having chair close
  and wheels locked. Use transfer belt and check
  alignment in chair.
• To move resident to back of chair, stand behind
  resident with arms under residents arms
  resident pushes, NA pulls gently. Reposition
  resident at least every hour.

57
3. Describe how to safely transfer residents

• When a resident starts to fall, the NA should
  respond in this way
• Widen stance.
• Bring residents body close.
• Bend knees and support resident.
• Lower resident to floor.
• Do not try to stop the fall.
• Call for help.
• Do not attempt to get resident up.

58
3. Describe how to safely transfer residents

• NAs should know these guidelines for using
  stretchers
• Lock wheels before transferring.
• Keep safety belts fastened while in stretcher.
• Raise safety rails.
• Keep resident covered.
• Keep wheels locked except when moving stretcher.
• Get help.

59
3. Describe how to safely transfer residents

• Guidelines for stretchers (contd)
• Move slowly and carefully.
• Push stretcher from head end.
• Go through doorways by opening door, entering
  first, and pulling stretcher through.
• Do not hit walls or doorways.
• Be cautious while going down sloping areas.
• Stay with resident at all times.

60
3. Describe how to safely transfer residents

• NAs should know these guidelines for mechanical
  lifts
• Safer for two people to transfer with these
  lifts.
• Keep chair or wheelchair close to bed to only
  move resident a short distance.
• Make sure valves are working.
• Check sling and straps for tears or fraying. Do
  not use mechanical lift if there are tears or
  holes.
• Open legs of stand to widest position before
  helping resident into lift.
• Pump up lift only to the point where the
  residents body clears the bed or chair.

61
Transferring a resident from bed to wheelchair

• Equipment wheelchair, transfer belt, non-skid
  footwear, and lap robe or folded blanket
• 1. Identify yourself by name. Identify the
  resident by name.
• 2. Wash your hands.
• 3. Explain procedure to the resident. Speak
  clearly, slowly, and directly. Maintain
  face-to-face contact whenever possible.
• 4. Provide for the residents privacy with
  curtain, screen, or door. Check the area to be
  certain it is uncluttered and safe.

62
Transferring a resident from bed to wheelchair

• 5. Remove both wheelchair footrests close to the
  bed.
• 6. Place wheelchair near the head of the bed with
  arm of the wheelchair almost touching the bed.
  Wheelchair should be facing the foot of the bed.
  The wheelchair should be placed on residents
  stronger, or unaffected, side.
• 7. Lock wheelchair wheels.
• 8. Raise the head of the bed. Adjust bed to
  lowest position. Lock bed wheels.

63
Transferring a resident from bed to wheelchair

• 9. Assist resident to sitting position with feet
  flat on the floor. Let resident sit for a few
  minutes to adjust to the change in position.
• 10. Put non-skid footwear on resident and fasten
  securely.
• 11. Stand in front of resident with your feet
  about shoulder-width apart. Bend your knees.
• 12. Place the transfer belt around residents
  waist over clothing (not on bare skin). Grasp
  belt securely on both sides.

64
Transferring a resident from bed to wheelchair

• 13. 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 youre able,
  you can take small steps in the direction of the
  chair. Once standing, reach for the chair with
  your stronger hand.

65
Transferring a resident from bed to wheelchair

• 14. With your legs, brace (support) residents
  lower legs to prevent slipping. This can be done
  by placing one or both of your knees in front of
  the residents knees.
• Count to three to alert resident. On three, with
  hands still grasping the transfer belt on both
  sides and moving upward, slowly help resident to
  stand.

66
Transferring a resident from bed to wheelchair

1. Tell the resident to take small steps in the
   direction of the chair while turning his back
   toward the chair. Or, if more assistance is
   needed, help the resident pivot (turn) to stand
   in front of wheelchair with back of residents
   legs against wheelchair.

67
Transferring a resident from bed to wheelchair

• 17. Ask the resident to put hands on wheelchair
  arm rests if able. When the chair is touching the
  back of the residents legs, help the resident
  lower himself into the chair.
• 18. Reposition resident so that his hips touch
  the back of the wheelchair seat. Remove transfer
  belt if used.

68
Transferring a resident from bed to wheelchair

• 19. Attach footrests and place the residents
  feet on the footrests. Check that the resident is
  in proper alignment. Make resident comfortable.
  Place a lap robe or folded blanket over the
  residents lap as appropriate.
• 20. Remove privacy measures.
• 21. Place call light within residents reach.
• 22. Wash your hands.

69
Transferring a resident from bed to wheelchair

• 23. Report any changes in resident to the nurse.
  Document procedure using facility guidelines.
• When transferring back to bed from a wheelchair,
  the height of the bed should be equal to or
  slightly lower than the chair. Help the resident
  pivot to the bed. When the resident feels the bed
  with the back of his legs, help him sit down
  slowly.

70
Transferring a resident from bed to stretcher

• Equipment stretcher, blanket, draw sheet
• 1. Identify yourself by name. Identify the
  resident by name.
• 2. Wash your hands.
• 3. Explain procedure to the resident. Speak
  clearly, slowly, and directly. Maintain
  face-to-face contact whenever possible.
• 4. Provide for the residents privacy with
  curtain, screen, or door.
• 5. Lower the head of bed so that it is flat. Lock
  bed wheels.

71
Transferring a resident from bed to stretcher

• 6. Fold linens to the foot of the bed. Cover
  resident with a blanket.
• 7. 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.
• 8. Place stretcher solidly against the bed, and
  lock stretcher wheels. Bed height should be equal
  to or slightly above the height of the stretcher.
  Move stretcher safety belts out of the way.

72
Transferring a resident from bed to stretcher

• 9. Two workers should be on one side of the bed
  opposite the stretcher. Two more workers should
  be on the other side of the stretcher.
• Each worker should roll up the sides of the draw
  sheet and prepare to move the resident. Protect
  the residents arms and legs during the transfer.

73
Transferring a resident from bed to stretcher

• On the count of three, the workers lift and move
  the resident to the stretcher. All should move at
  once. Make sure the resident is centered on the
  stretcher.
• 12. Place a pillow under the residents head.
  Make sure resident is still covered with the
  blanket.
• 13. Place the safety straps across the resident.
  Raise side rails on stretcher.

74
Transferring a resident from bed to stretcher

• 14. Unlock stretchers wheels. Move resident to
  proper place, staying with him until another
  staff member takes over.
• 15. Wash your hands.
• 16. Report any changes in resident to the nurse.
  Document procedure using facility guidelines.
• To return the resident to bed, the bed height
  should be equal to or slightly below the
  stretcher.

75
Transferring a resident using a mechanical lift

• Equipment wheelchair or chair, co-worker (if
  available), mechanical or hydraulic lift
• The following is a basic procedure for
  transferring using a mechanical lift. Ask someone
  to help you before starting.
• 1. Identify yourself by name. Identify the
  resident by name.
• 2. Wash your hands.
• 3. Explain procedure to the resident. Speak
  clearly, slowly, and directly. Maintain
  face-to-face contact whenever possible.

76
Transferring a resident using a mechanical lift

• 4. Provide for the residents privacy with
  curtain, screen, or door.
• 5. Lock bed wheels.
• 6. Position wheelchair next to bed. Lock brakes.

77
Transferring a resident using a mechanical lift

• 7. Help the resident turn to one side of the bed.
  Position the sling under the resident, with the
  edge next to the residents back, fanfolding if
  necessary. Adjust the bottom of the sling so that
  it is even with the residents knees. Help the
  resident roll back to the middle of the bed, and
  then spread out the fanfolded edge of the sling.

78
Transferring a resident using a mechanical lift

• 8. 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.
• Position the overhead bar directly over the
  resident.

79
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. If
  available, have a co-worker support the resident
  at the head, shoulders, and knees while being
  lifted. The residents arms should be folded
  across his chest. If the device has S hooks, they
  should face away from resident. Make sure all
  straps are connected properly and are smooth and
  straight.

80
Transferring a resident using a mechanical lift

• 11. Following manufacturers instructions, raise
  the resident two inches above the bed. Pause a
  moment for the resident to gain balance.
• If available, a lifting partner can help support
  and guide the residents body while you roll the
  lift so that the resident is positioned over the
  chair or wheelchair.

81
Transferring a resident using a mechanical lift

• 13. Slowly lower the resident into the chair or
  wheelchair. Push down gently on the residents
  knees to help the resident into a sitting, rather
  than reclining, position.
• 14. Undo the straps from the overhead bar to the
  sling. Remove sling or leave in place for
  transfer back to bed.
• 15. Be sure the resident is seated comfortably
  and correctly in the chair or wheelchair. Remove
  privacy measures.

82
Transferring a resident using a mechanical lift

• 16. Place call light within residents reach.
• 17. Wash your hands.
• 18. Report any changes in resident to the nurse.
  Document procedure using facility guidelines.

83
Transferring a resident onto and off of a toilet

• Equipment 2 pairs of gloves, toilet paper or
  disposable wipes, wheelchair
• 1. Identify yourself by name. Identify the
  resident by name.
• 2. Wash your hands.
• 3. Explain procedure to the resident. Speak
  clearly, slowly, and directly. Maintain
  face-to-face contact whenever possible. Make sure
  resident is wearing non-skid shoes.
• 4. Provide for the residents privacy with
  curtain, screen, or door.

84
Transferring a resident onto and off of a toilet

• 5. Position wheelchair at a right angle to the
  toilet to face the hand bar/wall rail. Place
  wheelchair on the residents stronger side.
• 6. Remove wheelchair footrests. Lock wheels.
• 7. Put on gloves.
• 8. Apply a transfer belt around the residents
  waist over clothing (not on bare skin). Grasp
  belt securely on both sides.

85
Transferring a resident onto and off of a toilet

1. Ask resident to push against the armrests of the
   wheelchair and stand, reaching for and grasping
   the hand bar. Move wheelchair out of the way.

86
Transferring a resident onto and off of a toilet

• 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.
• 11. Help resident to pull down pants and
  underwear. You may need to keep one hand on the
  transfer belt while helping to remove clothing.

87
Transferring a resident onto and off of a toilet

• 12. Help resident slowly sit down onto the
  toilet. Ask resident to pull on the emergency
  cord if she needs help. Remove and discard
  gloves. Wash your hands. Leave bathroom and close
  door.
• 13. When called, return and don clean gloves.
  Assist with perineal care as necessary (see
  Chapter 13). Ask her to stand and reach for the
  hand bar.

88
Transferring a resident onto and off of a toilet

• 14. Use toilet paper or disposable wipes to clean
  the resident. Make sure she is clean and dry
  before pulling up clothing. Remove and discard
  gloves.
• 15. Help resident to the sink to wash hands.
• 16. Wash your hands.
• 17. Help resident back into wheelchair. Be sure
  the resident is seated comfortably and correctly
  in the wheelchair. Replace footrests.

89
Transferring a resident onto and off of a toilet

• 18. Help resident to leave the bathroom. Make
  sure resident is comfortable. Remove privacy
  measures.
• 19. Place call light within residents reach.
• 20. Wash your hands again.
• 21. Report any changes in resident to the nurse.
  Document procedure using facility guidelines.

90
Transferring a resident into a vehicle

• Equipment wheelchair
• 1. Identify yourself by name. Identify the
  resident by name.
• 2. Wash your hands.
• 3. Explain procedure to the resident. Speak
  clearly, slowly, and directly. Maintain
  face-to-face contact whenever possible.
• 4. Place wheelchair close to the vehicle at a
  45-degree angle. Open the door on the residents
  stronger side.
• 5. Lock wheelchair.

91
Transferring a resident into a vehicle

• 6. Ask the resident to push against the arm rests
  of the wheelchair and stand.
• 7. Ask the resident to stand, grasp the vehicle,
  and pivot his foot so the side of the seat
  touches the back of the legs.
• 8. The resident should then sit in the seat and
  lift one leg, and then the other, into the
  vehicle.

92
Transferring a resident into a vehicle

• 9. Carefully position the resident comfortably in
  the vehicle. Help fasten seat belt.
• 10. Safely shut the door.
• 11. Return the wheelchair to the appropriate
  place for cleaning.
• 12. Wash your hands.
• 13. Document procedure using facility guidelines.

93
3. Describe how to safely transfer residents

• NAs should know these guidelines for stand-up
  lifts
• Used when resident can bear some weight on his
  legs but has poor leg strength and/or balance
• Resident must be able to stand and have some arm
  strength.
• Manual and battery-powered lifts are different
  types.
• Brakes must be locked before using.
• Resident in sitting position, with feet on foot
  plate and knees against knee pads
• Resident grasps support bar and pulls himself up.
• Lower sides of seat into position, adjust straps,
  and resident lowers himself into seat while
  holding bars.

94
Handout 10-1 Transferring a Resident to Bed from
Wheelchair

• Transferring a resident to bed from wheelchair
• 1. Identify yourself by name. Identify the
  resident by name.
• 2. Wash your hands.
• 3. Explain procedure to the resident. Speak
  clearly, slowly, and directly. Maintain
  face-to-face contact whenever possible.
• 4. Provide for the residents privacy with
  curtain, screen, or door. Check the area to be
  certain it is uncluttered and safe.
• 5. Remove both wheelchair footrests close to the
  bed.
• 6. Place wheelchair near the head of the bed
  with arm of the wheelchair almost touching the
  bed. Wheelchair should be facing the foot of the
  bed. The wheelchair should be placed on
  residents stronger, or unaffected, side.
• 7. Lock wheelchair wheels.
• 8. Adjust bed level. The height of the bed
  should be equal to or slightly lower than the
  chair. Lock bed wheels.
• 9. Stand in front of resident with your feet
  about shoulder-width apart. Bend your knees.
• 10. Place the transfer belt around residents
  waist over clothing (not on bare skin). Grasp
  belt securely on both sides.
• 11. Provide instructions to allow resident to
  help with transfer.

95
Handout 10-1 Transferring a Resident to Bed from
Wheelchair (contd.)

• 12. With your legs, brace residents lower legs
  to prevent slipping. This can be done by placing
  one or both of your knees in front of the
  residents knees.
• 13. Count to three to alert resident. On three,
  with hands still grasping the transfer belt on
  both sides and moving upward, slowly help
  resident stand.
• 14. Tell the resident to take small steps in the
  direction of the bed while turning his back
  toward the bed. Or, if more assistance is needed,
  help the resident pivot to stand in front of bed
  with back of residents legs against bed. When he
  feels the bed, help him sit down on the side of
  the bed.
• 15. Make resident comfortable. Remove transfer
  belt.
• 16. Return bed to lowest position. Remove privacy
  measures.
• 17. Place call light within residents reach.
• 18. Wash your hands.
• 19. Report any changes in resident to the nurse.
  Document procedure using facility guidelines.

96
4. Discuss how to safely ambulate residents

• Define the following terms
• ambulation
• walking.
• ambulatory
• capable of walking.

97
4. Discuss how to safely ambulate residents

• REMEMBER
• NAs should check the care plan before helping a
  resident to ambulate and must always keep the
  residents limitations in mind.

98
Assisting a resident to ambulate

• Equipment gait belt, non-skid shoes
• 1. Identify yourself by name. Identify the
  resident by name.
• 2. Wash your hands.
• 3. Explain procedure to resident. Speak clearly,
  slowly, and directly. Maintain face-to-face
  contact whenever possible.
• 4. Provide for residents privacy with curtain,
  screen, or door.

99
Assisting a resident to ambulate

• 5. Adjust bed to lowest position so that the feet
  are flat on the floor. Lock bed wheels.
• 6. Before ambulating, put non-skid footwear on
  the resident and securely fasten.
• 7. Stand in front of the resident, facing the
  resident, with your feet about shoulder-width
  apart.
• 8. Place gait belt around residents waist over
  clothing (not on bare skin). Grasp belt securely
  on both sides.

100
Assisting a resident to ambulate

1. Always allow resident to do whatever he is able
   to do for himself. If the resident is unable to
   stand without help, brace (support) the
   residents lower extremities. Bend your knees. If
   the resident has a weak knee, brace it against
   your knee.

101
Assisting a resident to ambulate

• 10. Hold the resident close to your center of
  gravity. Provide instructions to allow resident
  to help with standing. Tell the resident to lean
  forward, push down on the bed with his hands, and
  stand on the count of three. On three, with hands
  still grasping the gait belt on both sides and
  moving upward, slowly help resident to stand.

102
Assisting a resident to ambulate

• 11. Walk slightly behind and to one side of
  resident for the full ordered distance, while
  holding onto the gait belt. If the resident has a
  weaker side, stand on the weaker side. Use the
  hand that is not holding the belt to offer
  support on the weak side. Ask resident to look
  forward, not down at the floor, during ambulation.

103
Assisting a resident to ambulate

• 12. Observe the residents strength while you
  walk together. Provide a chair if the resident
  becomes dizzy or tired.
• 13. After ambulation, remove gait belt. Help
  resident to the bed or chair and check that the
  resident is in proper alignment. Make resident
  comfortable.
• 14. Leave bed in lowest position. Remove privacy
  measures.
• 15. Place call light within residents reach.

104
Assisting a resident to ambulate

• 16. Wash your hands.
• 17. Report any changes in resident to nurse.
  Document procedure using facility guidelines.

105
4. Discuss how to safely ambulate residents

• REMEMBER
• When an NA assists a visually-impaired resident
  with ambulation, the resident should walk beside
  and slightly behind him. The NA should warm the
  resident when approaching corners or steps.

106
4. Discuss how to safely ambulate residents

• Define the following terms
• C cane
• a straight cane with a curved handle at the top.
• functional grip cane
• cane that has a straight grip handle.
• quad cane
• cane that has four rubber-tipped feet and a
  rectangular base.
• walker
• adaptive equipment used for people who are
  unsteady or who lack balance usually has four
  rubber-tipped feet and/or wheels.

107
4. Discuss how to safely ambulate residents

• NAs should remember the following guidelines for
  cane or walker use
• Make sure cane or walker is in good condition.
• Make sure resident is wearing securely fastened
  non-skid footwear.
• Resident should place cane on stronger side.
• Resident should place both hands on the walker,
  and walker should be placed no more than six
  inches in front of resident.
• Stay near resident on weaker side.
• Do not hang purses or clothing on walker.
• Report to nurse if cane or walker seems to be the
  wrong height.

108
Assisting with ambulation for a resident using a
cane, walker, or crutches

• Equipment gait belt, non-skid shoes, cane,
  walker, or crutches
• 1. Identify yourself by name. Identify resident
  by name.
• 2. Wash your hands.
• 3. Explain procedure to resident. Speak clearly,
  slowly, and directly. Maintain face-to-face
  contact whenever possible.
• 4. Provide for residents privacy with curtain,
  screen, or door.

109
Assisting with ambulation for a resident using a
cane, walker, or crutches

• 5. Adjust bed to lowest position so that the feet
  are flat on the floor. Lock bed wheels.
• 6. Before ambulating, put non-skid footwear on
  the resident and securely fasten.
• 7. Stand in front of the resident, facing the
  resident, with your feet about shoulder-width
  apart.
• 8. Place gait belt around residents waist over
  clothing (not on bare skin). Grasp belt securely
  on both sides.

110
Assisting with ambulation for a resident using a
cane, walker, or crutches

• 9. If the resident is unable to stand without
  help, brace (support) the residents lower
  extremities. Bend your knees. If the resident has
  a weak knee, brace it against your knee. Help the
  resident to stand as described in the previous
  procedure.

111
Assisting with ambulation for a resident using a
cane, walker, or crutches

• 10. Help as needed with ambulation.
• a. Cane Resident places cane about six inches,
  or a comfortable distance, in front of his
  stronger leg. He brings weaker leg even with
  cane. He then brings stronger leg forward
  slightly ahead of cane. Repeat.

112
Assisting with ambulation for a resident using a
cane, walker, or crutches

• b. Walker Resident picks up or rolls the walker
  and places it about six inches, or a comfortable
  distance, in front of him. All four feet or
  wheels of the walker should be on the ground
  before resident steps forward to the walker. The
  walker should not be moved again until the
  resident has moved both feet forward and is in a
  steady position. The resident should never put
  his feet ahead of the walker.

113
Assisting with ambulation for a resident using a
cane, walker, or crutches

1. Crutches Resident should be fitted for crutches
   and taught to use them correctly by a physical
   therapist or nurse. The resident may use the
   crutches several different ways, depending on
   what his weakness is. No matter how they are
   used, weight should be on the hands and arms.
   Weight should not be on the underarm area.

114
Assisting with ambulation for a resident using a
cane, walker, or crutches

• 11. Walk slightly behind and to one side of
  resident. Stay on the weaker side if resident has
  one. Hold the gait belt if one is used.
• 12. Watch for obstacles in the residents path.
  Ask resident to look forward, not down at the
  floor, during ambulation.
• 13. Encourage the resident to rest if he is
  tired. When a person is tired, it increases the
  chance of a fall. Let the resident set the pace.
  Discuss how far he plans to go based on the care
  plan.

115
Assisting with ambulation for a resident using a
cane, walker, or crutches

• 14. After ambulation, remove gait belt. Help
  resident to the bed or chair and check that the
  resident is in proper alignment. Make resident
  comfortable.
• 15. Leave bed in lowest position. Remove privacy
  measures.
• 16. Place call light within residents reach.
• 17. Wash your hands.
• 18. Report any changes in resident to nurse.
  Document procedure using facility guidelines.

116
Exam

• Multiple Choice. Choose the correct answer.
• Which of the following is part of using proper
  body mechanics?
• (A) The nursing assistant should twist her back
  when carrying objects.
• (B) The nursing assistant should push when
  possible, rather than lifting.
• (C) The nursing assistant should use a narrow
  base of support.
• (D) The nursing assistant should lift with her
  back, not her legs.
• Which of the following statements is true of
  positioning?
• (A) Residents will not need help getting into
  comfortable positions or changing positions.
• (B) Constant pressure on an area helps prevent
  skin problems.
• (C) NAs should check residents skin each time
  they are repositioned.
• (D) Bed-bound residents should be repositioned
  every three hours.

117
Exam

• How often should bed-bound residents be
  repositioned?
• (A) At least every two hours
• (B) Once per shift
• (C) Twice a day
• (D) At least every three hours
• How often should residents in wheelchairs be
  repositioned?
• (A) At least every hour
• (B) At least every two hours
• (C) At least every three hours
• (D) At least every four hours

118
Exam

• A resident who is lying on either her left or her
  right side is in the _______ position.
• (A) Supine
• (B) Lateral
• (C) Prone
• (D) Fowlers
• A resident who has her head and shoulders
  elevated and is in a semi-sitting position (45 to
  60 degrees) is in the ________ position.
• (A) Sims
• (B) Fowlers
• (C) Prone
• (D) Lateral

119
Exam

• A resident who is lying on her stomach with her
  arms at her sides is in the ________ position.
• (A) Sims
• (B) Fowlers
• (C) Prone
• (D) Lateral
• A resident who is lying on her left side with her
  upper knee flexed and raised toward the chest is
  in the ________ position.
• (A) Sims
• (B) Fowlers
• (C) Prone
• (D) Supine

120
Exam

• A resident who is lying flat on his back with his
  head and shoulders supported by a pillow is in
  the ________ position.
• (A) Sims
• (B) Fowlers
• (C) Prone
• (D) Supine
• Dangling means
• (A) Sitting up with legs over side of bed
• (B) Sitting up in chair with feet on floor
• (C) Lying in bed with feet over side of bed
• (D) Hanging both arms over chair rests

121
Exam

• When using a transfer belt, the NA should
• (A) Place it underneath the residents clothing
• (B) Place it around the residents shoulders
• (C) Place it around a residents chest
• (D) Place it over the residents clothing
• When transferring residents who have a strong
  side and a weak side, the NA should plan the move
  so that
• (A)