Key Takeaways
- Use proper body mechanics: bend at knees, keep load close, use leg muscles
- Reposition bedridden patients at least every 2 hours to prevent pressure injuries
- Gait belts provide a secure handhold during transfers—never use as a lifting handle
- If a patient starts to fall, ease them to the floor and protect their head—do not try to catch them
- Range of motion exercises maintain joint flexibility—stop if patient reports pain
Positioning, Transfers, and Mobility
Safe positioning and transfer techniques protect both patients and CNAs from injury. Proper body mechanics, equipment use, and understanding patient abilities are essential for safe mobility assistance.
Body Mechanics Principles
Body mechanics are techniques that use the body efficiently to prevent injury when lifting, moving, or positioning patients.
| Principle | How to Apply |
|---|---|
| Wide base of support | Keep feet shoulder-width apart |
| Bend at knees, not waist | Lower body by bending knees, keep back straight |
| Keep load close | Hold patient/object close to your body |
| Avoid twisting | Turn your whole body, not just your torso |
| Use leg muscles | Legs are stronger than back |
| Push, don't pull | Pushing uses larger muscle groups |
| Get help | Ask for assistance when needed |
Common Bed Positions
| Position | Description | Uses |
|---|---|---|
| Supine | Flat on back | Rest, sleeping, some procedures |
| Lateral | On side | Sleeping, prevention of pressure injuries |
| Prone | Face down | Back care, some respiratory conditions |
| Fowler's | Head elevated 45-60° | Eating, breathing difficulty, post-surgery |
| Semi-Fowler's | Head elevated 30-45° | Comfort, mild respiratory difficulty |
| Trendelenburg | Head lower than feet | Shock (not commonly used now) |
| Reverse Trendelenburg | Feet lower than head | Prevent aspiration after feeding |
| Sims' (semi-prone) | Side-lying, slightly forward | Rectal procedures, enemas |
Pressure Injury Prevention
Pressure injuries (formerly "bedsores") develop when pressure cuts off blood supply to tissue. Repositioning is the primary prevention.
High-Risk Areas:
- Heels
- Sacrum (tailbone)
- Shoulder blades
- Elbows
- Ears
- Back of head
Prevention Strategies:
| Strategy | Frequency/Method |
|---|---|
| Reposition | Every 2 hours minimum |
| Floating heels | Pillow under calves, heels off bed |
| Support devices | Pillows, foam wedges, heel protectors |
| Keep skin dry | Change wet linens promptly |
| Nutrition | Adequate protein and hydration |
| Report changes | Any redness that doesn't blanch |
Transfer Techniques
Gait Belt Use: The gait belt is a safety device that provides a secure handhold for transfers.
Gait Belt Rules:
- Apply over clothing, at waist
- Snug fit (two fingers should fit underneath)
- Never use on recent abdominal surgery, pregnancy, or ostomy
- Never use handles on back of belt for lifting
Bed to Chair Transfer (with one assistant):
- Explain procedure
- Lock bed and wheelchair/chair
- Position chair at 45° angle to bed
- Apply gait belt
- Assist patient to sit at edge of bed (dangle)
- Allow patient to rest (check for dizziness)
- Place your feet blocking patient's feet
- On count of three, assist to stand
- Pivot toward chair
- Lower to sitting position
- Position comfortably, remove gait belt
Mechanical Lift Use: Mechanical lifts are used for patients who cannot bear weight or are too heavy to transfer manually.
Types of Lifts:
- Full-body (Hoyer) lift - For non-weight-bearing patients
- Sit-to-stand lift - For patients with some weight-bearing ability
- Ceiling lifts - Permanent installation
Lift Safety:
- Follow manufacturer instructions
- Check weight capacity
- Inspect slings and equipment
- Two-person operation usually required
- Never leave patient unattended in lift
Ambulation (Walking) Assistance
Before Ambulating:
- Check care plan for weight-bearing status
- Apply non-skid footwear
- Use gait belt
- Clear pathway of obstacles
- Know patient's ambulatory aids (cane, walker)
Assisting with Walking:
- Apply gait belt
- Stand at patient's weaker side
- Hold gait belt with one hand, support arm with other
- Walk slightly behind and to the side
- Watch for signs of fatigue or dizziness
- If patient starts to fall: ease them to floor, protect head
What to Do If Patient Falls:
- Stay with patient
- Do NOT try to catch a falling patient (you may get injured)
- Help ease patient to floor
- Call for help
- Check for injuries before moving
- Complete incident report
Range of Motion (ROM) Exercises
ROM exercises maintain joint flexibility for patients with limited mobility.
Types:
| Type | Who Does Movement | When Used |
|---|---|---|
| Active ROM | Patient does movement | Able to move independently |
| Passive ROM | CNA does movement | Patient cannot move limb |
| Active-Assisted ROM | Patient + CNA together | Patient has some ability |
General ROM Principles:
- Support the limb above and below the joint
- Move joints gently and slowly
- Stop if patient reports pain
- Perform each movement 3-5 times
- Follow care plan for specific exercises
How often should a bedridden patient be repositioned to prevent pressure injuries?
When using proper body mechanics, you should lift using which muscle group?
What should you do if a patient starts to fall during ambulation?