LESSON 8 ADL’S: POSITIONING, TURNING,

TRANSFERS

Objectives

1. Student able to explain principles of good body mechanics

2. Student able to demonstrate importance of proper positioning and good body alignment

3. Student able to correctly demonstrate how to use following positions:Supine, Lateral, Fowler’s, Semi-Fowler’s

4. Student able to correctly demonstrate how to perform the following transfer techniques: Assist to HOB, Sit on edge of bed, Transfer to chair, Transfer to w/c, Using a gait belt to assist with ambulation, Walking, Assist with walker, Assist with cane

Body Mechanics

Define the following terms: alignment

refers to being in a straight line; shoulders directly above hips, head/neck straight, arms/legs in natural position.

base of support the foundation that supports an object.

center of gravitythe point in the body where the most weight is

concentrated.

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.

PositioningDefine the following terms:positioning

the act of helping people into positions that promote comfort and health.

supinebody position in which a person lies flat on his back.

lateralbody position in which a person is lying on either side.

pronebody position in which a person is lying on his stomach, or front side of the body.

PositioningDefine the following terms:Fowler’s

a semi-sitting body position, in which a person’s 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.

draw sheetan extra sheet placed on top of the bottom sheet; used for moving residents.

shearingrubbing or friction that results from the skin moving one way and the bone underneath it remaining fixed or moving in the opposite direction.

PositioningDefine the following terms:logrolling

moving a person as a unit, without disturbing the alignment of the body.

dangleto sit up with the legs hanging over the side of the bed in order to regain balance and stabilize blood pressure.

Semi-Fowler’s Position

Left Side Only

Left or right Side

Others:

PositionsNAs should know the following facts about the four basic body positions:• Supine Position

• Resident lying flat on back • Pillow under head and shoulders• Pillows under arms, hands, legs are optional

• Lateral Position • Resident lying on either side • Pillows support head, upper arm, back and between the legs

laterally (between knees and ankles)• Fowler’s Position

• Semi-sitting, head and shoulders elevated 45-60º• Pillows as necessary • Increases pressure to coccyx

• Semi-Fowler’s Position • Semi-sitting, head and shoulders elevated 30-45º• Pillows as necessary • Reduces pressure to coccyx and promotes breathing

Other Positions• Prone Position

• Resident lying on stomach • Small pillow under head and to keep feet off bed • May be patient/resident preference but not a standard

position we use• Sims’ Position

• Left side-lying position • Lower arm behind the back (sometimes may still be in

front of body), upper knee flexed • Pillows under head, arms, flexed knee, and foot• Often used for rectal exams/procedures done by nurses

and physicians

TransferringDefine the following terms:ergonomics

the science of designing equipment, areas, and work tasks to make them safer and to suit the worker’s abilities.

transfer/gait belta 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 boarda wooden board that helps transfer people who are unable to bear weight on their legs; also called a transfer board.

Transferring

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

If resident is full weight bearing, they will need to be transferred/lifted using a mechanical lift

Transferring

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.

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

Transfer to Wheelchair• 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.• 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 resident’s arms; resident pushes, NA pulls gently. Reposition resident at least every hour.

Falls & Body Mechanics:

When a resident starts to fall, the NA should respond in this way:• Widen stance. • Bring resident’s 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.

Transferring

2 Person Transfer- resident able to bear weight, but too much weight for one staff member to lift on his or her own

(50-75 lbs per person as a guide)

*** Instructor Demonstration***

*Note-this is not the same as a 2 person lift (later discussed)

TransferringDefine the following terms:ambulation

walking.ambulatory

capable of walking.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.

Transferring Using Walker/Cane

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.

Assisting Visually Impaired

NA should walk beside and slightly ahead of resident to guide him/her

Still stand on residents affected side

The NA should warn the resident when approaching corners or steps or any oncoming traffic/equipment

LESSON 9 ADL’S: DEVICES USED FOR TRANSFERS

Objectives

1.Student able to explain how to safely use a mechanical lift

2.Student able to explain how to safely transfer a resident to a stretcher or shower bed

3.Student able to explain how and when to use a two-person lift (not transfer)

Devices for TransfersDefine the following terms:Mechanical Lift

Hydraulic or electrical device used to transfer or weigh dependent and obese residents.

StretcherDevice for transporting residents unable to walk or use a wheelchair; a means of transporting a severely ill or immobile person. (AKA gurney)

Shower BedDevice for transporting and giving residents a shower when unable to walk or use a wheelchair or shower chair

Mechanical Lift

Stretcher

Shower Bed

Devices for Transfers

NAs should know these guidelines for using stretchers/shower beds:• 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.

Devices for Transfers

Guidelines for stretchers/shower beds (cont’d):• 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.

Devices for Transfers

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 resident’s

body clears the bed or chair.

Devices for TransfersNAs 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.

Mechanical Lifts

When using a mechanical lift, you must be 18 years to operate

You can assist an adult employee if trained (however for CNA class purposes we do not use or assist at all if under 18= you can simply only watch)

Always follow manufacturers guidelines and do not use any lifts unless you are properly trained

Westminster Lifts Maxi Move (full mechanical lift)

Used for dependent residents unable to bear any weight and/or those unable to understand direction

Always inspect slings before and afterLocking wheels is not required and not advised when assisting

into a chairMust always have plastic stakes in sling while moving residentsLegs should be in closed positions when moving residentsAlways use the designated colored sling ordered by therapy Always remove the sling from under the resident after

transferring to designated area Stand to the residents side while using the remote to ensure safety

2 trained staff members, must be 18

Westminster Lifts SARA 3000 (Stand Lift)

Used only for resident able to follow directions and able to bear weight

Stand to the residents side while using the remote to ensure safety

Wheels must be locked when assisting the resident to the standing position then can be unlocked

Be sure to fasten the leg straps to ensure safety, but use caution when unfastening

Do not lock the wheels when lowering the resident into a chairLegs should be in closed positions when moving residentsAlways use the designated colored sling ordered by therapy Always remove the sling from under the resident after transferring

to designated area

2 trained staff members, must be 18