PCC CNA Unit 6

1. MobilityMobility
Unit 6Unit 6
 Turning andTurning and
PositioningPositioning
 Transferring theTransferring the
person to a chair orperson to a chair or
wheel chairwheel chair
 Helping a person toHelping a person to
walkwalk

2. ObjectivesObjectives
 Demonstrate correctDemonstrate correct
postural alignmentpostural alignment
 Discuss the importance ofDiscuss the importance of
body mechanics whenbody mechanics when
transferring a residenttransferring a resident
 Demonstrate the correctDemonstrate the correct
transfer techniques for atransfer techniques for a
patient with hemiplegiapatient with hemiplegia

3. ObjectivesObjectives
 Discuss bed mobilityDiscuss bed mobility
techniquestechniques
 Demonstrate how to position aDemonstrate how to position a
Resident in the supine, prone,Resident in the supine, prone,
and side-lying positionsand side-lying positions
 List considerations for theList considerations for the
correct fit for a resident in acorrect fit for a resident in a
wheelchairwheelchair

4. CNA’s role related to residentCNA’s role related to resident
mobilitymobility
 Encourage resident participation,Encourage resident participation,
control and confidencecontrol and confidence
 Prevent deterioration inPrevent deterioration in
condition(functional decline)condition(functional decline)
 Provide safetyProvide safety
 Follow resident care plan,Follow resident care plan,
including restorative activitiesincluding restorative activities..

5. Body MechanicsBody Mechanics
 Describes how to use the body correctlyDescribes how to use the body correctly
when moving residents and/or objects.when moving residents and/or objects.
 Using good body mechanics makes the bestUsing good body mechanics makes the best
use of strength, avoiding fatigue and injuryuse of strength, avoiding fatigue and injury
(back strain).(back strain).
 When the CNA uses good body mechanicsWhen the CNA uses good body mechanics
(along with proper lifting/moving devices)(along with proper lifting/moving devices)
the chance of injury to residents and selfthe chance of injury to residents and self
decreases.decreases.

6. Watch Your Posture!!!Watch Your Posture!!!
 Use proper posture asUse proper posture as
much as possible.much as possible.
 SittingSitting
 DrivingDriving
 Desk WorkDesk Work
 LiftingLifting
 LyingLying

7. The ResultsThe Results
 Healthier backHealthier back
 Stronger musclesStronger muscles
 Aging healthierAging healthier
 Reduced risk of injuriesReduced risk of injuries

8. Before Lifting or MovingBefore Lifting or Moving
 Assess the patient or item beingAssess the patient or item being
moved.moved.
 Ask for assistance if the lift isAsk for assistance if the lift is
heavy.heavy.
 DO NOT lift or move unsafely!!!DO NOT lift or move unsafely!!!
 DO NOT twist your back.DO NOT twist your back.
 Position the load for the bestPosition the load for the best
possible positioning of yourselfpossible positioning of yourself
and the load being moved.and the load being moved.

9. To lift safely…To lift safely…
 Use largest, strongest muscles toUse largest, strongest muscles to
do the job.do the job.
 When moving or picking up a heavy object useWhen moving or picking up a heavy object use
the large muscles of the legs instead of smaller,the large muscles of the legs instead of smaller,
weaker back muscles.weaker back muscles.
 Squat down, bending at knees. Keep your backSquat down, bending at knees. Keep your back
straight and raise up, using leg muscles.straight and raise up, using leg muscles.
 NEVER bend at waist or twist while lifting a heavyNEVER bend at waist or twist while lifting a heavy
objectobject
 Use both hands/arms rather than one to pick up aUse both hands/arms rather than one to pick up a
heavy objectheavy object..
 Stand erect, using good postureStand erect, using good posture
 Keep close to object or personKeep close to object or person
being lifted or moved.being lifted or moved.
 Don’t lift from a reaching position.Don’t lift from a reaching position.

10. Safe LiftingSafe Lifting
 Face the work area. Turn by pivoting feet or taking aFace the work area. Turn by pivoting feet or taking a
few small steps rather than by twisting at the waist.few small steps rather than by twisting at the waist.
 Use a broad base of support when lifting.Use a broad base of support when lifting.
 Use a space between feet approximately the width ofUse a space between feet approximately the width of
your shoulders, with one foot slightly ahead of theyour shoulders, with one foot slightly ahead of the
other (football player)other (football player)
 Wear sturdy, non-slip shoesWear sturdy, non-slip shoes
 Use your arms to support object being moved.Use your arms to support object being moved.
Leg muscles actually do the job of lifting,Leg muscles actually do the job of lifting,
not back muscles.not back muscles.
 Push, pull, slide or roll rather than lift a heavyPush, pull, slide or roll rather than lift a heavy
object, if possible. Use the weight of yourobject, if possible. Use the weight of your
body to aid in moving.body to aid in moving.

11. More Safe LiftingMore Safe Lifting
 Keep work at a comfortable height. Usually the mostKeep work at a comfortable height. Usually the most
comfortable working level for a bed is slightly abovecomfortable working level for a bed is slightly above
waist.waist.
 Use smooth, steady movements. Avoid jerking lifts.Use smooth, steady movements. Avoid jerking lifts.
 Back pain or trauma may result form repeatedBack pain or trauma may result form repeated
small injuries, not just from a single event.small injuries, not just from a single event.
 Keep your own muscles strong through fitnessKeep your own muscles strong through fitness
exercise.exercise.

12. General Principles for lifting andGeneral Principles for lifting and
moving a residentmoving a resident
 Understand how the resident may be moved, whatUnderstand how the resident may be moved, what
he/she can do to assist, and mobility goals.he/she can do to assist, and mobility goals.
 Check the care plan or ask the nurse.Check the care plan or ask the nurse.
 Terms such as “weight-bearing”, “limited assistance”,Terms such as “weight-bearing”, “limited assistance”,
“extensive assistance” will be used.“extensive assistance” will be used.
 Plan for help from other staff when you arePlan for help from other staff when you are
moving/lifting a resident.moving/lifting a resident.
 Use mechanical lifting devices or other devicesUse mechanical lifting devices or other devices
whenever possible. Some facilities may havewhenever possible. Some facilities may have
implemented “no lift”, “lift free” or “safe lift” policies.implemented “no lift”, “lift free” or “safe lift” policies.
 Know how to use devices safely. Approach theKnow how to use devices safely. Approach the
resident with confidence.resident with confidence.

13. Principles continuedPrinciples continued
 Work in coordination when lifting or moving aWork in coordination when lifting or moving a
resident with another person.resident with another person.
 Explain procedure to resident, give cues aboutExplain procedure to resident, give cues about
what the resident can do to help.what the resident can do to help.
 Protect all tubing and dressings when movingProtect all tubing and dressings when moving
resident.resident.
 Give most support to heaviest parts of body.Give most support to heaviest parts of body.
 Position resident so that gravity can help with thePosition resident so that gravity can help with the
move.move.
 TAKE TIME. Allow resident to maintain control.TAKE TIME. Allow resident to maintain control.
A resident may experience a period ofA resident may experience a period of
dizziness when changing position.dizziness when changing position.
 Observe and report resident ability to participate inObserve and report resident ability to participate in
activity, and response to activity.activity, and response to activity.

14. Body AlignmentBody Alignment
 Alignment is the correct positioning ofAlignment is the correct positioning of
the resident body.the resident body.
 Part are in an anatomically “straight”Part are in an anatomically “straight”
line.line.
 Correct positioning helps to preventCorrect positioning helps to prevent
contractures (shortening or tighteningcontractures (shortening or tightening
of muscle) and undue pressure onof muscle) and undue pressure on
tissue.tissue.

15. Posture Changes with agingPosture Changes with aging
 Osteoporosis and other conditionsOsteoporosis and other conditions
may contribute to changes in posturemay contribute to changes in posture

 Head and neck flexed slightly forward, causingHead and neck flexed slightly forward, causing
the res to look down.the res to look down.
 Spinal column shortened, perhaps more rigid,Spinal column shortened, perhaps more rigid,
flexed forward.flexed forward.
 Hips and knees slightly flexed to compensateHips and knees slightly flexed to compensate
for other changes.for other changes.
 Posture changes may cause the individual to havePosture changes may cause the individual to have
poor balance.poor balance.

16. Also…Also…
 Use a gait belt whenUse a gait belt when
needed.needed.
 Promptly report allPromptly report all
accidents/injuries.accidents/injuries.
 Make sure resident’s braceMake sure resident’s brace
fits properly.fits properly.
 Allow resident to do asAllow resident to do as
much as safely possible tomuch as safely possible to
reduce strain to yourselfreduce strain to yourself
and the resident.and the resident.

17. Your ResponsibilityYour Responsibility
 Say NO to lifting more thanSay NO to lifting more than
is safe.is safe.
 When others ask for help,When others ask for help,
we must all work as a teamwe must all work as a team
to safely and effectivelyto safely and effectively
move patients and objects.move patients and objects.
 Make safety your priority!Make safety your priority!

18. Just a side note…Just a side note…
 Nobody PLANS to injureNobody PLANS to injure
their backs…yet…their backs…yet…
 There are thousands ofThere are thousands of
spinal injuries each yearspinal injuries each year
 Other area are injured byOther area are injured by
poor lifting, such aspoor lifting, such as
shoulders, hips, and evenshoulders, hips, and even
hernias can result in workhernias can result in work
related injuriesrelated injuries
 Don’t let it happen to you!!!Don’t let it happen to you!!!

19. PositionPosition
ss
 Supine and semi-supineSupine and semi-supine
 Prone and semi-proneProne and semi-prone
 Sims(left semi-prone)Sims(left semi-prone)
 Fowlers(semi-sitting)Fowlers(semi-sitting)
 Chair (w/c)Chair (w/c)

20. Devices forDevices for
positioningpositioning
 PillowsPillows
 Foam wedges(or otherFoam wedges(or other
shapes)shapes)
 Trochanter rollTrochanter roll
 Abduction splintAbduction splint
 Palmar splint (hand-Palmar splint (hand-
wrist)wrist)
 Hand rollHand roll
 Foot boardFoot board

21. PositioningPositioning
 Use common senseUse common sense
 Get help if neededGet help if needed
 Always ask resident ifAlways ask resident if
she/he is comfortableshe/he is comfortable
 Make sure resident isMake sure resident is
safe before leaving thesafe before leaving the
roomroom

22. Slide BoardsSlide Boards
 Are most useful withAre most useful with
patients who cannot standpatients who cannot stand
to pivotto pivot
 Allows increasedAllows increased
independenceindependence
 Must be taught how toMust be taught how to
properly perform transferproperly perform transfer

23. AmbulationAmbulation
 Check for res ambulationCheck for res ambulation
goals(restorative activity)goals(restorative activity)
 Check device before usingCheck device before using
to see that it is safe.to see that it is safe.
 ALL devices should haveALL devices should have
slip-proof tips that are notslip-proof tips that are not
cracked or torncracked or torn

24. AmbulationAmbulation
 Res should wearRes should wear
non-slip shoes.non-slip shoes.
 Observe andObserve and
report res activityreport res activity
and any signs ofand any signs of
illness.illness.
 EncourageEncourage
res to walk tores to walk to
activities, evenactivities, even
if it would beif it would be
faster to takefaster to take
the res in athe res in a
w/c.w/c.
 Encourage the res toEncourage the res to
walk with good posture.walk with good posture.
 head uphead up
 looking forwardlooking forward
CNA may place a handCNA may place a hand
in front of res shoulderin front of res shoulder
to encourage goodto encourage good
postureposture..

25. Devices forDevices for
AmbulatingAmbulating
 WalkerWalker
 CaneCane
 CrutchesCrutches

26. WheelchairWheelchair
ss
 Understand mobility goal forUnderstand mobility goal for
residents, enabling individual toresidents, enabling individual to
participate as much as possible.participate as much as possible.
 PositioningPositioning
 Alignment devices may be used toAlignment devices may be used to
help maintain proper positioninghelp maintain proper positioning
 Resident’s feet are placed securelyResident’s feet are placed securely
on foot rests.on foot rests.
 Know where resident’s feet areKnow where resident’s feet are
positioned while w/c is moving.positioned while w/c is moving.
 Resident’s arms and elbows areResident’s arms and elbows are
positioned inside arm rests.positioned inside arm rests.
 Lap blanket provides warmth andLap blanket provides warmth and
protects modesty. Tuck ends firmlyprotects modesty. Tuck ends firmly
around resident to prevent themaround resident to prevent them
from tangling in wheels.from tangling in wheels.

27. WheelchairWheelchair
ss
 MovingMoving
 Usually move w/c forward byUsually move w/c forward by
pushing from behind.pushing from behind.
 Back w/c into elevator whenBack w/c into elevator when
entering, enabling res to faceentering, enabling res to face
elevator opening.elevator opening.
 When traveling down a steepWhen traveling down a steep
ramp, move w/c backwards.ramp, move w/c backwards.
This will allow operator toThis will allow operator to
maintain control of w/cmaintain control of w/c
movement.movement.
 Move carefully when goingMove carefully when going
through swinging doors orthrough swinging doors or
around corners.around corners.
 Brakes-when moving into orBrakes-when moving into or
out of chair.out of chair.

28. WheelchairWheelchair
ss
 Pressure relief(preventingPressure relief(preventing
pressure injury)pressure injury)
 Show res how to changeShow res how to change
position to relieve prolongedposition to relieve prolonged
pressure on buttocks, hips andpressure on buttocks, hips and
coccyxcoccyx
 w/c push-upsw/c push-ups
 Change pressure from oneChange pressure from one
hip to the other by leaninghip to the other by leaning
to side.to side.
Cushions that distributeCushions that distribute
pressure may be used onpressure may be used on
the chair seat.the chair seat.

29. Mechanical LiftsMechanical Lifts
 Use extreme caution!Use extreme caution!
 Can be helpfulCan be helpful
 Can also be dangerousCan also be dangerous
 Always have two staff whenAlways have two staff when
using a liftusing a lift
 Watch for tipping, weightWatch for tipping, weight
limits, and positioninglimits, and positioning
 Don’t injure patient with theDon’t injure patient with the
sling or hooks!sling or hooks!

30. MechanicalMechanical
LiftsLifts
 For safely moving aFor safely moving a
resident who cannotresident who cannot
assist, cannot maintainassist, cannot maintain
balance, or is heavy.balance, or is heavy.
 To standing position (sit-To standing position (sit-
to-stand lift)to-stand lift)
 To chair or w/c (total-bodyTo chair or w/c (total-body
lift)lift)
 To facilitate other activity,To facilitate other activity,
such as ambulation,such as ambulation,
moving into whirlpool tubmoving into whirlpool tub
or weighingor weighing

31. MechanicalMechanical
LiftsLifts
 To protect CNATo protect CNA
 To comply with aTo comply with a
facilities no-lift/safe liftfacilities no-lift/safe lift
policy.policy.

32. MechanicalMechanical
LiftsLifts
 Lift MechanicsLift Mechanics
 Hydraulic-a hand-pumpedHydraulic-a hand-pumped
“jack” or crank powers the“jack” or crank powers the
lift.lift.
 Battery-powered orBattery-powered or
electric liftelectric lift

33. MechanicalMechanical
LiftLift
 Follow facility policy regardingFollow facility policy regarding
number of staff required for safe lift.number of staff required for safe lift.
Many times safe operation willMany times safe operation will
require two of more TRAINED staff.require two of more TRAINED staff.
 Understand how to use lift. FollowUnderstand how to use lift. Follow
operating instructions. Practice withoperating instructions. Practice with
it before attempting to move ait before attempting to move a
resident. Check for operationalresident. Check for operational
safety before attempting to movesafety before attempting to move
resident.resident.
 Consider resident response to beingConsider resident response to being
lifted.lifted.
 Provide for privacyProvide for privacy
 Lessen res anxiety by showingLessen res anxiety by showing
competence and confidence in use of lift,competence and confidence in use of lift,
and by showing res how to participate inand by showing res how to participate in
lift.lift.
 Use brakes appropriatelyUse brakes appropriately
 Position lifting sling and/or straps inPosition lifting sling and/or straps in
correct manner for type of lift.correct manner for type of lift.

34. SafetySafety
 Consider the resident’sConsider the resident’s
abilities and disabilitiesabilities and disabilities
 NEVER leave a residentNEVER leave a resident
unattended on lift!!!!!!!!!unattended on lift!!!!!!!!!
 Gait belts!!!Gait belts!!!
 Talk to your resident aboutTalk to your resident about
what the plan is to performwhat the plan is to perform
the task and what isthe task and what is
expected of her/him.expected of her/him.

35. SafetySafety
 Make sure brakes are on!!!Make sure brakes are on!!!
 Use the resourcesUse the resources
available to help youavailable to help you
 Think about the ‘what ifs”Think about the ‘what ifs”
 Make sure you are notMake sure you are not
asking the resident to doasking the resident to do
something she/he cannotsomething she/he cannot
do safelydo safely