Mobility - Lifting and Moving
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This document discusses nursing skills for lifting and moving patients. It outlines the purposes of lifting and moving patients which include encouraging mobility, promoting comfort, and transferring patients safely. Basic principles for lifting and moving patients safely are described, such as keeping weight close to the body and lifting with legs rather than back. Emergency moves are described for when there is immediate danger, including clothing drag, blanket drag, and bent arm drag techniques. Urgent moves are also outlined for situations requiring quicker movement. Finally, equipment for moving patients safely is mentioned, including wheeled stretchers.
Mobility - Lifting and Moving
- 1. Nursing Skills Lifting and Moving Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 1 An Urgent Move This used when the patient is suffering from an immediate threat to life. 1) A patient in an MVA must be quickly moved from the vehicle for emergency care and immediate transport 2) In this case, fully immobilizing the spine would take too much time. NURSING SKILLS Lifting and Moving A non-urgent Move 1) When there is no immediate threat to life, take Lecturer: Mark Fredderick R. Abejo R.N, M.A.N the time to choose the best equipment and positioning for moving the patient safely 2) The best way to move a patient is the easiest way that will not cause injury or pain LIFTING and MOVING 3) There are many ways to move patient’s, you are only limited by your imagination and the safety and comfort of the patient. Example: Crutch Method-patient leaning on PURPOSES OF LIFTING AND MOVING POSITION you while walking 4) Extremity lift is the most popular non-urgent • To encourage patient’s mobility move • To promote patient’s comfort • To promote blood circulation PRINCIPLES FOR MOVING PATIENTS • To maintain skin integrity • To transfer patient safely Emergency Moves • To avoid injury whenever a patient is moved. A patient should be moved immediately by an emergency • To practice using equipment. move only when there is an immediate danger to the patient or • To know that certain patient conditions call for special the EMTs including: techniques. Fire or danger of fire. Danger of explosives or other hazardous materials. BASIC PRINCIPLES OF LIFTING AND MOVING Inability to protect patient from other hazards at the PATIENTS scene. Inability to gain access to other patients who need 1) Keep the weight of the object as close to the body as lifesaving care. possible. Inability to provide care due to location or position. 2) To move a heavy object, contract your abdominal muscles and lift with the leg, hips, and gluteal Clothing Drag muscles. 1. Tie the patient's wrists together if you have something 3) When lifting, align your shoulders, hips and feet in a quickly available. If nothing is available, tuck the vertical line. hands into the waist band to prevent them from being 4) Reduce the height or distance through which the pulled upwards. object must be moved. 2. Clutch the patient's clothing on both sides of the neck to provide a support for the head. TYPE OF MOVES 3. Pull the patient towards you as you back up, watching . the patient at all times. The pulling force should be concentrated under the armpits and NOT the neck. Emergency moves This used when there is immediate danger to the Blanket Drag patient or to threscuer 1. Lay a blanket lengthwise beside the patient. 1. Top priority in emergency care is to maintain the 2. Kneel on the opposite side of the patient and roll the patient’s ABCs. Generally, you will control any life- patient toward you. threatening problems and stabilize the patient before 3. As the patient lies on their side while resting against moving you, reach across and grab the blanket. 2. If scene is unstable or unsafe and there is threat to the 4. Tightly tuck half of the blanket lengthwise under the life or well-being of the patient or of you, the above patient and leave the other half lying flat than gently priority changes. roll the patient onto their back. 3. Emergency moves are a last resort. Do only when you 5. Pull the tucked portion of the blanket out from under run out of options. the patient and wrap it around the body. 4. Three reasons to use an emergency move: 6. Grasp the blanket under the patient's head to form a support and means for pulling. There is an immediate environmental danger to 7. Pull while backing up and while observing the patient the patient or rescuer such as fire, exposure to at all times. explosives, toxic fumes, etc. You cannot gain access to other patients who Bent Arm Drag need life-saving care. 1. Reach under the patient's armpits from behind and You cannot render life-saving care due to the grasp the forearms or wrists. patient’s location or position. 2. Use your arms as a cradle for the patient's head and 5. Three types of emergency moves: keep the arms locked in a bent position by your grasp. i. Bent Arm Drag 3. Drag the patient towards you as you walks backwards, ii. Clothing Drag. observing the patient at all times. iii. Blanket Drag. Foundations of Nursing Abejo Lifting and Moving
- 2. Nursing Skills Lifting and Moving Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 2 Urgent Moves 4. The EMT's raises to a crouching position, then Sometimes a patient must be moved more quickly than usual simultaneously stand and move with the patient to the due to reasons of an urgent nature. Weather conditions, hostile stretcher. bystanders, uncontrolled traffic, and rapidly rising flood waters are some examples of situations requiring an urgent move. EQUIPMENT FOR MOVING PATIENTS Procedure for Rapid Extrication One EMT should be stationed behind the patient. Wheeled Stretcher Place one hand on each side of the patient's head to stabilize the neck in a neutral position. It is done as you begin evaluation of the airway. The second EMT quickly applies a cervical spine immobilization device while doing a rapid primary survey. A third EMT simultaneously places the long backboard onto the seat and, if possible, slightly under the patient's buttocks. The second EMT supports the chest and back as the third EMT frees the patient's legs from the pedals and floor panel. The patient is rotated in several short coordinated Two basic types of stretchers are used: the two-person moves until the patient's back is in the open doorway and the one-person. The two-person requires two EMTs to lift and feet are on the backboard. and load in the ambulance, whereas, the one-person stretcher has Another EMT supports the patient's head until the first special loading wheels at the head that allows one EMT to load EMT gets out and takes control of the cervical spine it into the ambulance. Stretchers are usually adjustable to immobilization device from outside the vehicle. different heights and different angles. Some can be adjusted to The EMT team lowers the patient and slides the elevate the legs (Trendelenberg position). Additional equipment patient onto the board in short coordinated may be attached to the stretchers including oxygen, IV lines, and movements. Straighten the patient's legs and make cardiac monitors or defibrillators. sure the neck and back do not bend. Secure patient to backboard after the patient is brought back to the Stair Chair ambulance. Non-urgent Moves This is the most frequent type of move and the best way to make the move depends on the illness or injury, factors at the scene, and equipment and personnel resources available. Direct Ground Lift 1. 2-3 EMTs line up on the same side of a supine patient. 2. The EMTs all kneel on one knee. 3. Cross the patient's arms on the chest if injuries don't These are designed for patients that can sit up while prevent it. being carried. They are useful for taking patients up or down 4. The EMT at the head places one arm under the stairs, or through narrow passageways. The patient must be patient's head and shoulders, cradling the head. The transferred to the stretcher once back at the ambulance. other arm is placed under the patient's lower back. The extremity lift is used to place the patient in the stair chair. All belts and straps must be secured before moving patient. The 5. The second EMT places one arm directly below the patients wrists may be loosely tied to prevent grabbing onto first EMT's arm in the small of the patient's back. The fixtures and causing loss of balance when moving them. The second arm is placed under the patient's knees. chair is tilted slightly backwards to allow movement with the 6. The third EMT (if available) slides both arms under wheels on the chair. the patient's waist. The other EMTs adjust their arms accordingly. 7. On signal, the EMTs lift the patient to their knees and Short Backboard roll the patient in toward their chests. 8. On signal, the EMTs stand and move the patient to the This is used when a spinal injury is suspected and the stretcher. patient is in a seated position. They made be made from wood, 9. On signal, the patient is lowered onto the stretcher, aluminum, or plastic. A vest type is also used when a patient is which has been positioned at waist level. found inside a small car or place. It wraps around the patient and has all the straps attached or enclosed. Extremity Lift This is only used when a spinal injury is not suspected. It is best used for short distances. Scoop (Orthopedic) Stretcher 1. One EMT kneels at the patient's head and the other EMT kneels at the patient's side by the knees. This is designed to easily lift supine patients. The 2. The EMT at the head reaches under the patient arms at stretcher is made of a rectangular aluminum tube with V-shaped the shoulders and grasps the patient's wrists. If the lifts to "scoop" patients from the floor or ground without patient is unresponsive or uncooperative, the other changing their position. Its greatest advantage is that it can be EMT may assist by lifting the patient's wrists to within used in confined spaces where other stretchers cannot fit. the reach of the partner. To improve stability, the patient's left wrist may be grasped by your right hand and their right wrist by your left hand. This crosses the Flexible Stretcher patient's arms over their chest creating a more secure Do not use the flexible, or "pole" stretcher if spine injury is hold with less give. suspected. It is designed for limited access space, on stairs or 3. The second EMT reaches under both knees with one around cramped corners, or when other equipment is not arm and under the buttocks with the other arm. available Foundations of Nursing Abejo Lifting and Moving
- 3. Nursing Skills Lifting and Moving Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 3 GUIDELINES FOR LIFTING AND MOVING Keep the patient secured with belts at all times while on stretcher even if the stretcher is not being moved Guidelines for Safe Lifting Consider the weight of the patient together with the weight of the stretcher or other equipment being COMPONENT SKILL FOR MOVING AND LIFTING carried and determine if additional help is needed. Know your physical ability and limitations. Know A. MOVING TO THE SIDE OF THE BED your combined ability with your partner. If absolutely necessary, you can ask bystanders to help. You or your partner must be in charge and give the orders, not 1. Stand facing patient at the side of the bed. the bystander. 2. Assume a broad stance, one leg forward of the other Lift without twisting. Avoid any kind of swinging with knees and hips flexed, bring arms to the level of motion when lifting as well. the bed. Position your feet shoulder width apart with one foot 3. Place one arm under shoulders and neck of patient and slightly in front of the other. Wear proper boots that another arm under small of patient’s back. go above the ankle to protect your feet and help keep a 4. Shift body weight from front to back foot, rock firm footing. Boots should have nonskid soles. backward to a crouch position, bringing patients towards his side. Nurse’s hips come downwards as he Communicate clearly and frequently with your rocks backwards. Patient should be pulled. partner. Decide ahead of time how you will move the patient and what verbal commands will be used. Also, tell the patient what you will be doing ahead of time. B. HELPING THE PATIENT TURN ON HIS SIDE A startled patient may reach out or grab something and cause a loss of balance. 1. Stand at the side of the bed towards which patient is to be turned. Place patient’s far arm across his chest and Guidelines for Lifting Cots and Stretchers far leg over near leg, near arm is lateral to and away Most back injuries to EMTs can be avoided by following the from his body. following guidelines: 2. Stand opposite to the patient’s waist and face side of Know or find out the weight to be lifted. the bed with one foot a step in front of the other. Use a minimum of two people to lift, even if a one- 3. Place one hand on patient’s far shoulder and one hand person stretcher is being used. on his far hip. Use an even number of people to maintain balance 4. Shift weight from forwarded leg to rear leg, patient is during the lift. turned towards the nurse hips come downward. Know the weight limitations of the equipment you 5. Patient is stopped by nurse’s elbows, which come to use. Know what to do if the patient exceeds the weight rest on mattress at the edge of the bed. limitations of the equipment. Use the power lift or squat lift position. Feet are C. RAISING SHOULDERS OF THE HELPLESS shoulder width apart. Back is tight and the abdominal PATIENT muscles lock the lower back in a slight inward curve. Distribute weight to the balls of the feet. Keep both 1. Stand at side of the side of the bed and face patient feet in full contact with floor or ground. While head. standing, keep the back locked in, as the upper body 2. Assume a wide stance with foot next to bed behind the comes up before the hips. other foot. Use a power grip to get maximum force from the 3. Pass arm over the patient’s near shoulders and rest hands. Hands should be at least 10 inches apart. Palms hand between patient’s shoulder blades. face up and fingers in complete contact with the 4. Rock backward, shift weight from forwarded foot to stretcher bar. rear foot, hips coming straight down. Lift while keeping your back in the locked-in position. When lowering the cot or stretcher, reverse the steps. D. RAISING THE SHOULDERS OF TH SEMI Avoid bending at the waist. HELPLESS PATIENT Avoid twisting. "Feed" the stretcher into the ambulance while face across the patient. 1. Stand at one side of the bed facing the head of the patient. Foot next to bed is to rear and the other foot Guidelines for Moving Stretchers forward. Provide wide base of support. Stretchers should be handled by two EMTs with both 2. Bend knees to bring arm next to bed down to a level hands on the stretcher. Other personnel or bystanders with a surface of the bed. may be asked to help carry additional equipment if 3. With elbow on the patient‘s bed grasps the nurse’s necessary. arm in the same manner. Never leave the patient alone on the stretcher. 4. Rock forward, shift weight from forwarded foot to Load the stretcher with the foot end first or going rear foot to bring hips downward. Elbow remains on upstairs. bed, which serves as fulcrum. Position one EMT at the foot and one EMT at the head of the stretcher when rolling it. The EMT at the foot E. MOVING THE HELPLESS PATIENT UP IN BED should pull while the EMT at the head should push. Always maintain a firm grip on the stretcher when 1. Stand at the side of the bed and face the far corner of rolling to prevent a tipover. the foot of the bed. Lower the stretcher and carry end to end if the ground 2. Flex knees so that arms are leveled with the bed. Put is to rough to roll the stretcher safely. arm under patient, one arm under patient’s head and Use four EMTs, one at each corner, when moving a shoulders, one hand under small of his back. stretcher across extremely rough terrain. 3. Rock forward. Shift weight from forwarded foot to rear foot, hips coming downward. Patient will slide Turn corners slowly and squarely, avoiding sideways diagonally across the bed towards the head and side of movements that might make the patient dizzy. the bed. Lift the stretcher over rugs, grates, door jams, and 4. Repeat from tuck and legs of patient. other such obstacles on the ground or floor. Foundations of Nursing Abejo Lifting and Moving
- 4. Nursing Skills Lifting and Moving Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 4 5. Go to the other side of the bed and repeat number 1 – J. TRANSFERRING PATIENT FROM BED TO 3. Continue this process until patient is satisfactorily STRETCHER positioned. 1. In preparation of the transfer, lower the head of the F. MOVING THE SEMI HELPLESS PATIENT UP IN BED bed until it is flat or as low as the patient can tolerate 2. Raise the bed so that it is slightly higher than the 1. Patient flexes knees, bringing heels up to his buttocks. stretcher. 2. Stand at the side of the bed, turn slightly towards 3. To transfer with client assistant: Ask the client o patient’s head. One foot is stepped in front of the other move feet, legs, buttocks and upper body to the foot closer to bed. Feet are directed towards the head stretcher, make sure that the client is in the center of of the bed. the stretcher. 3. Place one arm under patient’s shoulders, one arm 4. To transfer without client assistant: Make sure there under thighs. Flex knees to bring arms to the level of are two to three caregivers for this procedure, if there the surface of the bed. are two, one should stand on the side of the bed and 4. Patient places chin on his chest and pushes with his the other is on the side of the stretcher. If 3, two feet. Nurse shifts weight from rear foot to forwarded should stay at the side of the stretcher. foot. Patient grasps the head of the bed with his hands 5. Grasp pull sheet that support client’s head to mid- to pull on his own weight. thigh. 6. Roll pull sheet close to the body 7. Assist client to cross arms over the chest. G. HELPING THE SEMI HELPLESS: PATIENT RAISE 8. On the count of 3, slide the client towards the edge of HIS BUTTOCKS the bed. 9. Repeat and slide the patient towards the center of the 1. Patient flexes knees and brings heels towards the stretcher. buttocks. 10. Raise the side rails and head of the bed if not 2. Nurse faces the side of the bed and stands opposite to contraindicated the patient’s buttocks. Assume a board stance. 3. Flex knees to bring arms to the level of the bed, place one hand under sacral area of the patient. The elbow is K. LOGROLLING PATIENT resting firmly on the 3 bed. 4. As the patient raises his hips, the nurse comes to a Logrolling is a technique used to turn a patient whose body crouching position by bending his knees while his must at all times be kept in a straight alignment (like a log). arms act as a lever to help support the patient’s This technique is used for the patient who has a spinal buttocks. Nurse’s hips come straight down. While injury for the patient who must be turned in one movement, supporting patient in this position, free hand can place without twisting. Logrolling requires two people, or if the bedpan under the patient’s sacral area. patient is large, three people. The techniques involved are: H. ASSISTING THE PATIENT TO A SITING POSITION 1. Wash your hands and approach and identify the ON THE SIDE OF THE BED patient (by checking the identification band) and explain the procedure (using simple terms and 1. Patient is turned to the side towards the edge of the pointing out the benefits). bed. 2. Provide privacy. Position the bed should be in the flat 2. The nurse ensures that the patient does not fall out of position at a comfortable working height. Lower the the bed by raising the head of the bed. side rail on the side of the body at which you are 3. Face the far bottom corner of the bed, support the working. shoulders of the patient with one arm and the other 3. Position yourself with your feet apart and your knees arm helps patient extend lower legs over the side of flexed close to the side of the bed. the bed top the rear of the other foot. 4. Fold the patient's arms across his chest. Place your 4. Bring patient to a natural sitting position on the bed; arms under the patient so that a major portion of the support the patient’s shoulders and legs over the side patient's weight is centered between your arms. The of the bed. Pivot body to lower legs of the patient. arm of one nurse should support the patient's head and Patient’s legs are swung downward. Nurse’s weight is neck. shifted form front to rear leg. 5. On the count of three, move the patient to the side of the bed, rocking backward on your heels and keeping the patient's body in correct alignment. I. ASSISTING THE PATIENT TO GET OF BED AND INTO A CHAIR 6. Raise the side rail on that side of the bed and move to the other side of the bed. 7. Place a pillow under the patient's head and another 1. The patient assumes a suiting position on the edge of between his legs. the bed, put on shoes/slipper and gown. 8. Position the patient's near arm toward you. Grasp the 2. Place the chair at the side of the bed with back far side of the patient's body with your hands evenly towards foot of the bed. distributed from the shoulder to the thigh. 3. Stand facing patient with foot closer to the chair and a 9. On the count of three, roll the patient to a lateral step in front of the other to give the nurse a wide base position, rocking backward onto your heels. of support. 10. Place pillows in front of and behind the patient's trunk 4. Place patient’s hands on the nurses shoulders and the to support his alignment in the lateral position. nurse grasps patient’s waist. 11. Provide for the patient's comfort and safety which is 5. Patient steps on the floor and the nurse flexes her position the call bell and place personal items within knees, forwarded knee is against the patient knee. This reach. Also be sure the side rails are up and secure. provides patient’s knees bending involuntarily. 12. Report and record as appropriate. 6. Turn with the patient while maintaining a wide base of support. Bend knees as the patient sits on chair. Foundations of Nursing Abejo Lifting and Moving