Transferring, log rolling and positioning of patient

By: Jay Vincent B. Medrano, RN

Body MechanicsProper Body Mechanics is using the right muscles to

do the job.Good body mechanics start with proper posture.Proper posture means that there is a balance

and body parts are in good alignment ( position )Good posture allows the body to function at its best in

all activities.Correct posture makes lifting, pulling, and pushing

easier

*10 BASIC RULES OF PROPER BODY MECHANICS1. Keep your back straight

2. Stay Balanced… Keep your feet separated ( 12 INCHES ) to provide a good base of support.

(see figure )

3. Bend from the hips and knees to get close to the object. Do not bend from the waist. (see figure )

4. Avoid lifting whenever possible. Often you can push, pull roll an object

5. Use the strongest muscles to do the job.

6. Avoid twisting your body as you work and bend for long periods of time. Try not to twist your body at the waist. Pivot the whole body.

7. Hold heavy objects close to your body. When lifting a patient, lean into the patient body,

8. Lift smoothly.

9. Always ask for help if you feel the

patient or object is too heavy

to move by yourself. (see figure )

10. Plan and think through your move. Before you begin the action, make sure you are applying proper body mechanics. Coordinate your movements by telling patients or other health workers when you are ready to move. count “ 1, 2, 3 ….. Lift “

Hand Grips

The wrist grip

The finger grip

The through arm grip

The double wrist grip

Lifting of Patients Nurses for their own safety should

always remember the key factor in lifting.

Head ErectChin tucked into help keepBack straight

Back Straightto protect joints& ligaments

Elbows Closeto sides to useMuscle force Efficiently

Feet Apartto give a stablebase

Handgripspartners forearm firmly

Knees Bent

to control thigh and buttock muscle

QUESTIONS???

COMPLICATIONS OF BEDRESTEVERY BODY SYSTEM

IS AFFECTEDCONTRACTURE

AN ABNORMAL SHORTENING OF THE MUSCLE DUE TO LACK OF USE

THE MUSCLE IS FIXED INTO POSITION, IS DEFORMED, AND CANNOT STRETCH.

ATROPHYATROPHY – A DECREASE IN SIZE OR A WASTING AWAY OF MUSCLE TISSUE.CAUSED BY LACK OF USE

DECUBITUS ULCER

A BREAKDOWN IN SKIN TISSUE THAT OCCURS WHEN BLOODFLOW TO AN AREA IS INTERRUPTED

MORE DECUBITI

BODY ALIGNMENTTHE TRUNK OF THE PERSON SHOULD BE

IN A STRAIGHT LINE WHEN THE PATIENT IS LYING DOWN

THE PATIENT IN A CHAIR SHOULD SIT UP STRAIGHT

HIS FEET SHOULD EITHER REST ON

THE FLOOR OR ON A STOOL

HIS LOWER BACK SHOULD REST

AGAINST THE BACK OF THE CHAIR

THE BACKS OF HIS KNEES SHOULD BE SLIGHTLY AWAY

FROM THE SEAT OF THE CHAIR

PROPER POSITIONING IN A CHAIR

•Fowler’s position is a semi sitting position.‑• The spine is kept straight.• The head is supported with a small pillow.• The arms are supported with pillows.

•The supine (dorsal recumbent) position is the back‑lying position.

• The bed is flat.• The head and shoulders are supported on a pillow.

• Arms and hands are at the sides.

•Prone position• The person lies on the abdomen with the head turned to one side.

• The bed is flat.• Small pillows are placed under the head, abdomen, and lower legs.

• Arms are flexed at the elbows with the hands near the head.

•Lateral position (side-lying)• A pillow is under the head and neck.• The upper leg, ankle, and thigh are supported with

pillows.

Jacknife PositionA modification of prone

positionPatient hips are

supportedon a pillow and the table are flexed at 90° angle, raising the hips and lowering head and body

A straps used over the thigh to prevent shearing and sliding

The head, face, shoulders, chest and feet are supported by soft pads or rolls to prevent bony pressure

Common position for hemorrhoidectomy or pilonidal sinus procedures

TURNING PATIENT FROM SUPINE TO LATERAL POSITIONDefinition:

A process of assisting the patient to assume a lateral position.

Purposes:1. Promotes blood circulation.2. Prevent deformities, contractures and

pressure sores.

ASSESSMENT:1. Assistive devices that will be required to verify the

availability of the devices needed.2. Hindrances to movement3. Assistance required from other health care personnel

IMPLEMENTATION:1. Introduce self2. Verify the patient’s identity ( discreetly look at the

patient’s arm, check the ID band)3. Explain the procedure to the patient and significant

others to gain their cooperation and alleviate anxiety.4. Observe proper hand hygiene.

5. Provide for patient’s privacy by closing the curtain and applying proper drapes exposing

6. Lower side rail near you, leaving the other side raised.7. Move the patient closer to the side of the bed.

THE PERSON IS MOVED IN SEGMENTS

a) While standing on the side of the bed nearest the patient, place the patient’s near arm across chest.

b) Abduct the patient’s far shoulder slightly from the side of the body and externally rotate the shoulder

c) Place the patient’s near ankle and foot across the far ankle and foot

d) Raise the side rail next to the patient before going to the other side of the bed

e) Position yourself on the side of the bed toward which the patient will turn, directly in line with the patient’s waistline and as close to the bed as possible

8. Pull or roll the patient toward you to the lateral position

Assisting the patient to sit at the side of the bedDefinition:

A procedure supporting the patient to assume a sitting position before going out of bed to prevent postural hypotension and complications of prolonged confinement

Purposes:1. Promotes blood circulation2. Prevent deformities, contractures and

pressure sore3. Assumes a sitting position on the edge of the

bed, before walking, eating or transferring.

Assessment:The client physical abilities.Ability to understand instructions.Degree of comfort or discomfort when

moving.Presence of orthostatic hypotension.You own strength and ability to move the

client.

Implementation:

1-6.7. Raise the head of the bed slowly to its

highest position8. Lower the side rail near you, leaving the

other side raised9. Position the patient’s feet and lower legs at

the edge of the bed10.Stand beside the patient’s hips, and face the

far corner of the bottom of the bed.

10. Move the patient to a sitting position

QUESTIONS???

LOGROLLING A PATIENTDefinition:

Technique used to laterally move a patient who sustained spinal injury

Purposes:Uses to turn a patient whose body

must be kept in straight alignment at all times.

Keeps the spine in straight alignment to avoid further injury.

Assessment:Hindrances to movement of the

patientConsider patient’s height and weight

Prepare materials/ supplies:Turning sheetPillows

Members of health team:Without turning sheet, minimum of 3

membersWith turning sheet, 2 members

Implementation:1-6

1. Stand on the same side of the bed, and assume a broad stance, with one foot ahead of the other:

a) Place the patient’s arms across the chest 

b) Place your arms under the patient

7. Pull the patient to the side of the bed:

8. Move to the other side of the bed, and place supportive devices for the patient when turned

9. Roll and position the patient in proper alignment

USING A TURNING SHEET OR LIFTER10. Stand with another nurse on the same side of the bed. Assume a broad stance, with one foot forward, and grasp half of the fan folded or rolled edge of the turn sheet. On a signal, pull the patient toward both of you

11. Then, go to the other side of the bed. Reaching over the patient, grasp the far edges of the turn sheet, and roll the patient toward you.

11. Raise the side rails, and place the call bell within the patient’s arm reach12. Perform hand hygiene.

MOVING THE PATIENT UP IN BEDDefinition:

It is assisting patient in positioning himself up in bed.

Purposes:1. Maintains patient’s body alignment and comfort2. Prevent injury to musculoskeletal system3. Promotes blood circulation

•ASSESSMENT:1. The patient‘s physical abilities2. Hindrances to movement3. The patient‘s degree of comfort or discomfort when

moving. 4. The patient’s weight .

IMPLEMENTATION:1-56. Adjust the head of the bed to a flat

position or as low as the patient can tolerate

7. Raise the bed to the height of your center of gravity

8. Lock the wheels on the bed, and raise the rail on the side of the bed opposite you

9. Remove all pillows, then place one against the head of the bed

10.Lower side rail near you, leaving the other side raised up.

11.Ask the patient to flex hips and knees and to position feet so that they can be used effectively for pushing

12.Ask the patient to grasp the head of the bed with both hands, and pull during the move or raise the upper part of the body on the elbows, and push with the hands and forearms during the move

13. Position yourself appropriately:• Face the direction of the movement, and assume a

broad stance• Place your near arm under the patient’s thighs. Push

down on the mattress with the far arm• Shift your weight to the front leg as the patient

pushes with his heels and pulls with his arms so that the patient moves toward the head of the bed

14. Elevate the head of the bed, and provide appropriate support devices for the patient’s new position

MOVING A PATIENT WHO HAS LIMITED STRENGTH IN THE UPPER EXTREMITIES15.Assist the patient to flex the hips and knees as in step

11. Place the patient’s arm across the chest. Ask the patient to flex the neck during the move, and keep head off the bed surface

16.Position yourself as in step 13, and place one arm under the client’s back and shoulders and the other arm under the patient’s thighs. Shift your weight, as in step 13

TWO NURSES USING A TURN SHEET/ LIFTER17.Both individual grasp the sheet close to the shoulders

and buttocks of the patient. Follow the method moving clients with limited upper extremity strength, as describe earlier

18.Assist the patient in a comfortable position19.Raise side rail near you20.Perform hand hygiene

TRANSFERRING PATIENT FROM BED TO CHAIR/ WHEEL CHAIRDefinition: It is a process of assisting

patient to move from bed to chair/ wheel chair using proper body mechanics.

Purposes:1. Promotes movement and blood circulation.2. Provides patient’s comfort during nursing care

activities.

ASSESSMENT:3. Range of motion to determine if transfer is applicable4. Presence of injury to determine if transfer is

applicable5. Weakness or paralysis6. Age and physical appearance of the patient (height,

weight and contractures)7. Presence of contraptions

Prepare materials/supplies:1. Transfer belt as necessary2. Chair/ wheel chair

Safety Measures with Wheelchairs

o ALWAYS LOCK THE BRAKES WHEN TRANSFERRINGo CLEAN THE WHEELCHAIR ON A REGULAR BASISo MOVE THE FOOTRESTS OUT OF THE WAY WHEN TRANSFERRING

IMPLEMENTATION:1 – 56. Place the bed on a low position.7. Have chair/ wheel chair in position at 45-degree angle

to the bed and to the strong side of the patient. 8. Lock the wheel chair to prevent movement during

transfer.

9. Assist patient to sitting position on side of bed.10.Apply transfer belt or other transfer aids as necessary11.Instruct the patient to place strong leg forward, with

weak foot back.12.Place the patient’s hand on bed surface or on your

shoulder

13.Grasp transfer belt at patient’s side14.Rock patient up to standing position on count of three

while straightening hips and legs and keeping knees slightly flexed.

15.Pivot on foot farther from chair/ wheel chair

22.Flex hips and knees while lowering patient into chair/ wheel chair

23.Assess patient for proper alignment for sitting position.

24.Praise patient’s progress, effort and performance.25.After care of materials26.Perform hand hygiene

BACK DOWN A RAMP WITH A WHEELCHAIR

BACK INTO THE ELEVATOR SO THE PATIENT FACES THE

FRONT

TRANSFERRING PATIENT FROM BED TO STRETCHER/BED Definition:

A technique used to transfer patient from bed to stretcher because of inability to perform the activity.

Purpose:1. Uses to transfer weak, dependent, sedated

and related type of patients condition from bed to stretcher.

ASSESSMENT:1. Patient’s body size to determine the number of

staff needed to accomplish the transfer safely2. The patient’s ability to follow instructions

3. The patient’s activity tolerance and level of comfort

Prepare materials/supplies/equipment:1. Lifter/ drawsheet2. Stretcher3. Body strapMembers of health team4. Minimum of 2

IMPLEMENTATION:1. Implement pain relief measures as prescribed by the

physician.2. Stand by stretcher within reach to save time and

effort, prevents overreaching and facilitate transfer.3. Introduce yourself.4. Verify the patient’s identity ( discreetly look at the

patient’s arm, check the ID band).

5. Explain the procedure to the patient and significant others to gain their cooperation and alleviate anxiety.

6. Observe proper hand hygiene.7. Lower side rail near you, leaving the other side raised.8. Provide privacy by applying proper draping.9. Adjust the patient’s bed in preparation for the transfer.

10.If the patient is unable to move/slide, loosen the drawsheet to be used as a lifter.

11.Move the patient to the edge of the bed, and position the stretcher parallel to the bed.

12.Lift the patient securely to the stretcher.

13.Make the patient comfortable and maintain privacy by fixing the drapes.

14.Immediately raise the stretcher side rails and or fasten the body straps across the patient

15.Unlock the stretcher wheels, and move the stretcher away from the bed to the appropriate area.

16.Perform hand hygiene

TRANSFER THE PATIENT FEET FIRST DOWN A RAMP

ENTER THE ELEVATOR HEAD FIRST

THANK YOU!!!