Topic 2: Body mechanics

Learning objectives

By the end of this lesson, member should be able to:

v Describe the important of maintaining a good body mechanics.

v Describe how to maintain a good body mechanics.

v Describe the types of positions used in nursing, its advantages and disadvantages.

v Describe essential techniques when assisting a client move up in bed,

repositioning a helpless client, assisting a client to a sitting position, and

transferring a client from a bed to a chair.

Training materials needed:

1. A bed, preferable a hospital bed with 2 - 3 crane and side rails

2. A wheelchair or a chair

3. Pillow with pillow case

4. Drawsheet

2. BODY MECHANICS

The positions used in nursing vary with the needs of the client. Although each procedure

for positioning has specific guidelines, there are some universal steps the nurse should

follow for clients who require positioning assistance.

Body mechanics for health care workers:

1. Use mechanical aids if help is unavailable. E.g. lifting crane.

2. Encourage client to assist as much as possible.

3. Keep back, neck, pelvis and feet aligned. Avoid twisting of back.

4. Flex knees and keep feet wide apart.

5. Position yourself close to client during lifting.

6. Use arms and legs instead of back during lifting.

7. Slide the client toward yourself using a drawsheet.

8. Set (tighten) abdominal and thigh muscles in preparation for move.

9. Person (nurse) with the heaviest load will coordinated the efforts of them involved

by counting of three.

The nurse is normally at the risk of injury to lumbar muscles when lifting, transferring, or

positioning the client. Therefore proper body mechanics is important to the nurse and

client. It affects their levels of wellness. Correct body mechanics is necessary for health

promotion and prevention of disability.

Bed rest is an intervention (action) in which the client is restricted to bed for therapeutic

reasons. The duration of bed rest depends on the illness of injury and the client’s state of

health.

The general objectives of bed rest are:

1. Reducing physical activity and the oxygen needs of the body.

2. Reducing pain; allowing ill client to rest and regain strength.

3. Allow exhausted clients to have uninterrupted rest.

Figure 1: Key factors in lifting

2.1 Positions used in nursing

5 common positions used in nursing the client

1) Supported Fowler’s position

v The head of the bed is elevated to 45 to 60 degree & client’s knees are

slightly elevated without pressure to restrict circulation in the lower legs.

v The angle of head & knee elevation & the length of time that the client

should remain in the Fowler’s position are influenced by the client’s

illness & overall condition.

v Purposes : Improves breathing capacity

Prevents aspiration

Promotes comfort

v Common trouble areas:

ü Increased cervical flexion because the pillow at the head is too

thick & the head thrust forward.

ü Extensions of the knees, allowing the client to slide down the bed.

ü Pressure on the posterior aspect for the knee, decreasing circulation

to the feet.

ü Arms hanging unsupported at the client’s sides.

ü Unsupported feet & pressure points at the sacrum & heels.

Figure 2: Supported Fowler’s position

2) Supine position (dorsal recumbent position)

v Client rest on the back (is also called dorsal recumbent position).

v The relationship of the body parts is essentially the same as in good

standing alignment except that the body is in horizontal plane.

v The mattress should be firm enough to support the cervical, thoracic &

lumbar vertebrae.

v Shoulders are supported & the elbows are slightly flexed to control

shoulder rotation.

v A foot support is used to prevent foot drop & maintain proper alignment.

v Purposes : Prevents bending at crucial areas, such as groin or spine.

Figure 3: Supine Position

v Common trouble areas:

ü Pillow at the head is too thick, increasing cervical flexion.

ü Elbows extended.

ü Hips externally rotated.

ü Unsupported feet & pressure points at the occiput region of the

head, lumbar vertebrae, elbows & heels.

3) Prone position

v Lying face down. The pillow under the head should be thinks enough

to prevent cervical flexion or extension & maintain alignment of the

lumbar spine.

v Placing a pillow under the lower legs permits dorsi- flexion of the

ankles & some knee flexion, which promotes relaxation.

v If a pillow is unavailable, the ankle should be in dorsi- flexion over the

end of the mattress.

v Purpose : Serves as positioning alternative in turning procedure

for immobilized client.

Figure 4: Prone position

v Common trouble areas:

ü Neck hyperextension

ü Hyperextension of the lumbar spine

ü Plantar flexion of the ankles

ü Unprotected pressure points at the chin, elbows, hops, knees &

toes.

4) Lateral position (side-lying)

v In the lateral (side- lying) position the client is resting on the side, with

the major portion of the body weight on the dependent hop &

shoulder.

v Either on the left or right side of the client, arms in the front & legs

slightly flexed.

v Purpose : Serves as position for some procedures and alternative

position for turning procedure.

Figure 5: Lateral position

v Common trouble areas:

ü Lateral flexion of the neck

ü Spinal curves out of normal alignment

ü Shoulder & hip joints internally rotated at the ear, adducted or

unsupported.

ü Lack of support for feet.

ü Lack of protection for pressure points at the ear, ilium, knee &

ankles.

5) Sim’s position (recovery)

v The Sims’ position is differs from the side- lying position in the

distribution of the client’s weight.

v In the Sims’ position the weight is placed anterior ilium, humerus &

clavicle.

v Purpose : Serves as position for some procedures and alternative

position for turning procedure.

Figure 6: Recovery position

v Common trouble areas:

ü Lateral flexion of the neck

ü Internal rotation, adduction or lack of support to shoulders &

hips.

ü Lack of support for feet.

ü Lack of protection for pressure points at the ear, ilium, knees &

ankles.

Frequently a client needs to be turned, moved, lifted or carried while he/ she was given

nursing care. Apply nursing process while carrying out such a procedure.

Nursing process

Assessment:

ü Assess client’s comfort level, activity tolerance, muscle strength and mobility.

Planning

ü Determine the type position to turn the client.

ü Prepare necessary aids. E.g. extra helper & pillows.

ü Raise the level of bed to comfortable working height.

Implementation

ü Explain the procedure to client to reduce his/her anxiety

ü Ensure privacy.

ü Wash hand.

ü Level the bed and lock the bed.

Evaluation

ü Wash hand.

ü Lower the level of bed.

ü Report if client uncooperative.

ü Record the procedure in the nurses’ notes, including position assumed, frequency

of turning, condition of skin, joint movement, use of supports or splints,

and client’s ability to assist with moving and positioning.

2.2 Turning, lifting & transferring techniques

Turning the client on bed

1) Turning of the client towards the nurse, from a supine to prone or lateral

position.

Procedure Rationale

1. Move the client near the edge of the bed first So that the client will not be too close to the edge of the bed after the turning. 2. The nurse will stands on the side of the bed to Client will be rolled toward which the client is to be turned. Place the the nurse so speed & amount client’s near arm on the bed, palm up next to of roll can be controlled. The body. The opposite arm should be placed next arm placement will minimize to client’s body, with palm facing thigh torque on arm when client is (Figure 7). wrolled.

Figure 7 3. Cross client’s far leg over near leg This method will facilitate movement of far leg during roll. 4. Turn the client’s head away, not facing you. This will prevent client from rolling onto the face. 5. Place your hands on the client’s far shoulder Provides turning force at area & hip, hold client’s far arm next to the body of greatest weight. Avoids with your wrist. Torque on client’s joint.

Figure 8 6. Assume a broad stance (feet shoulder width This stance provides a stable apart) with one foot next to the bed, the other base of support during foot about 2 feets from the bed. Knees should shifting of nurse’s weight to be slightly flexed with weight on leg nearest move the client. the bed (Figure 8). 7. Shift your weight to your other leg (shaded) Shifting your weight provides rolled client toward you as you move (Figure additional force of your 9). weight, decreasing work of muscle.

Figure 9 8. Support the extremities in proper alignment Client will be in the center of for lateral position. the bed after the turning. Continue rolling the client if a prone position The hand position will is desired. Shift your hand position to the front control the speed and force of of the shoulder & hip. 9. After the client is on his side, raises the bedside rail so that there is no danger of that client falling from the bed. 10. Lower the bed & place the call bed near the client.

2) Assisting the client to sitting position at the edge of the bed

Procedure Rationale

1. Instruct of move the client to the edge of the Keep the client’s weight bed for easy turning. close to nurse’s center of gravity. 2. Raise the head of the bed 60 to 80 degrees. Conserve client’s and nurse’s energy. 3. Stand facing the side of bed next to the client’s Facilitate using strong muscle hips. Assume a broad stance with knees flexed, of legs, not back muscles, as back straight. Most of the weight should be on client is moved. the leg nearest the bed. 4. Place one arm under the client’s shoulders Support the client near the with the hand in the farthest axilla & place center of gravity. The other arm under the client’s knees 5. All movements must be slow & gentle. Allow the client to adjust to each shift. 6. Pivot the client toward the edge of the bed by Movement of the nurse’s simultaneously swinging the client’s leg over body in the direction the the side of the bed and pushing client’s upper client is to be moved & the body to face side of the bed. Facilitate the use of the leverage created by client’s pivot by stepping backward with your pushing off the bed will non-weight bearing leg, shift your weight to the reduce muscular energy leg as your step, & pushing against the edge of expended. the bed with your other thigh at the same time. ( Figure 10)

Figure 10

7. Extra pillow or backrest may be used to make the client’s comfortable in the sitting position.

Lifting the client on bed

1) The Orthodox Lift (cradling method)

This technique is suitable for weak, lightweight clients.

1. Discuss the procedure with the client. This is to gain cooperation and reduce anxiety level of the client. 2. Raise the bed to nurse’s mid-thigh level, The height facilitates use of lower near side rail, and lock wheels of the bed. major muscles of the limbs. 3. If client cannot assist in move, fold client’s This will reduce friction from arm across client’s chest. client’s arms and legs being pulled across sheets as she moved. 4. Slide one arm under the client’s shoulder, the Provides support for weak other under the client’s back (Figure 11). clients unable to tolerate pressure on shoulder girdle.

Figure 11 5. Face head of bed. Assume broad stance with Broad stance increases base legs slightly flexed. Outside foot is forward. of support. Flexion allows Weight is on inside leg (shaded) (Figure 12). smooth weight shift, with force exerted by arms and legs, not back.

Figure 12

6. Ask client to raise head. If client can assist, ask Lifting head can reduces him to push with the arm and legs on signals. weight and friction. 7. Contract your pelvic muscles. On signals, shift Shifting weight provides your weight to your forward leg, keeping your additional force of your body back straight, moving the client toward the weight, decreasing work of head of the bed. Repeat if necessary (Figure 13). Muscles.

Figure 13 8. Replace pillows and other positioning aids and raise up side rails.

2) The Australian Lift (Shoulder Lift)

1. Two nurses stand facing slightly towards the head of the bed.

2. The arm nearest the client is passed under the client’s thighs & both hands

will grip together (Figure 14).

3. The client is asked to place arms over those nurses, forearms under them

& grasp client’s hands in front of the client (Figure 15).

4. The nurses bend their hips & knees, and fit their shoulder into the client’s

axilla while the other hand will supports the client’s back.

5. The nurses straighten their hips & knees and at the same time the client is

lifted off the bed as the trunk is raised (Figure 16).

Figure 15 Figure 16

Figure 14

3) Lifting the client by a blanket or draw sheet

1. Discuss the procedure with client. This is to gain cooperation from the client. 2. Raise the bed to the nurse’s mid-thight level, This height facilitates use of lower near side rail, and lock wheels of the bed. major muscles of the limbs. 3. Fold draw sheet in half lengthwise, place under Sheet will support bulk of client so it extends from shoulder to hips. client’s weight for moving & positioning & reduce friction. 4. Ask client to fold arms across the chest & flex To prevent squeezing client’s knees. limbs between draw sheet. 5. Roll sheet so that the edges are close to client’s Maximizes control during body and grasp firmly next to client’s shoulder movement, improves and hips (Figure 17). leverage.

Figure 17 6. Face head of bed. Assume broad stance with Broad stance increases base legs slightly flexed. Outside foot is forward. of support. Flexion allows Weight is on inside leg (shaded) (Figure 18). smooth weight shift, with force exerted by arms and legs, not back.

Figure 18

7. Contract your pelvic muscles. On signal, shift Shifting weight provides your weight to your forward leg, keeping your additional force of your body back straight, moving your arms and the client weight, decreasing work of toward the head of bed. Repeat if necessary. muscle (Figure 19).

Figure 19 8. Replace pillows and other positioning aids. Raise up side rails.

Transferring the client out the bed

1) Helping the client out of bed into a chair/ a wheelchair (1 person)

1. Place the chair or wheelchair adjacent to client’s stronger (pivot) leg. If

wheelchair is use, reposition leg supports to provide leg room for you and

client during pivot. Secure brakes and swing front casters forward for

maximum stability (Figure 20).

2. Lower the bed so that the client’s feet are firmly planted on the floor with the

knees slightly lower than the hips. Client’s lower legs should be angled back

slightly towards the bed. Angled of the legs keeps base of support directly

below client’s center of gravity (Figure 21).

3. The nurse will gives herself a wide base of support by putting one foot inside

the client’s pivot foot and one foot outside the client’s knee. Both of your

knees should be slightly flexed, and keep your back straight (Figure 22).

Figure 20 Figure 21 Figure 22

4. Ask the client to place one hand on your shoulder or on the arm of the

wheelchair nearest the bed in preparation for standing. Grasp the transfer belt

at the client’s hips (Figure 23). If no transfer belt is available, reach under the

client’s arms and place your hands on the client’s scapula. Client may push

him/herself up from the bed and reach for the arm of the chair (Figure 24).

Figure 23 Figure 24

5. On signal, client stands while the nurse assists by straightening own legs and

shifting weight to back leg.

6. The nurse and the client’s pivot toward chair simultaneously (Figure 25).

Figure 25 Figure 26

7. Ask client to reach back for arms of chair and sit down. Nurse will assists by

flexing own knees, not back, to lower client to a sitting position (Figure 26).

Rationale:

It is important that the client be prevent from placing the arms around the

nurse’s neck. This will pull nurse toward client, moving the center of

gravity outside the base of support, thereby increasing risk

of falling and backstrain.

2) Helping the client out of bed into a chair/ a wheelchair (2 person)

1. Place the chair or wheelchair parallel to the bed in a convience place & lock

the wheels of the bed and wheelchair.

2. Adjust the height of bed so it is even with arms of the chair. This is because

more energy would be required to lift the client over the arms of the chair than

to lower client to the chair seat from the height of the chair arms.

3. Bring the client to the side of the bed & assist her to a sitting position.

4. One nurse will place her arm under client’s axillary area & lean forward.

While the client will folds the arms across the chest, the nurse grasps client’s

left forearm with the right hand, and the client’s right forearm with the left

hand (Figure 27).

Figure 27 Figure 28

5. The other nurse will flexed her knees and reaches under the client’s thighs just

above the knees, locking hands. The client’s knees should be flexed also

(Figure 28).

Rationale:

This will protect the nurses’ back muscles by using stronger arm and leg

muscles to move client. Flexing back rather than knees to seat client may

stain nurse’s back.