Fundamentals of Nursing Practice

RLE/Skills Lab
STUDENT ACTIVITY SHEET BS NURSING / FIRST YEAR
Session #02

LESSON TITLE: BODY MECHANICS, MOVING &

POSITIONING – BASIC BODY MECHANICS Materials:
LEARNING TARGETS: Book, pen and notebook
Upon completion of this lesson, the nursing student: References:
1. Has full understanding regarding body mechanics.
Potter, P. A., Perry, A. G., Hall, A., & Stockert,
2. Can identify factors that affect body mechanics. P. A. (2017). Fundamentals of nursing. Mosby
Elsevier.
3. Distinguish pathological influences on mobility
4. Understand & utilize principles of body mechanics when Taylor, C. (2011). Fundamentals of nursing: the
appropriate. art and science of nursing care. Wolters Kluwer
Health/Lippincott Williams & Wilkins.

LESSON REVIEW/PREVIEW (5 minutes)

A brief summary of the previous lesson will be provided and will state this lesson’s learning targets.
Pretest:
In a sheet of paper, write a principle of body mechanics and give an example. A student will be randomly called to read
out his answer then ask will be asked to call on a classmate who’ll read his answers next. This will be done until 3-5
students have shared their answers or if different perceptions are given. This will gauge if you have read today’s topic.
MAIN LESSON (90 minutes)
The following topics are the focus of today’s discussion. Fill out the needed information in your SAS as you go with your
lesson.
BASIC BODY MECHANICS
Movement is a complex process that requires coordination between the musculoskeletal and nervous systems. As a
nurse you will consider how a patient's physical and psychological condition affects body movement. Body mechanics is
a term that describes the coordinated efforts of the musculoskeletal and nervous systems. Knowing how patients initiate
movement and understanding your own movements requires a basic understanding of the physics surrounding body
mechanics. The body mechanics applied in the lifting techniques historically used in nursing practice often because
debilitating injuries to nurses and other health care staff (Burnfield et al., 2013; Griffis, 2012). Today nurses use evidence-
based information about body alignment, balance, gravity, and friction when implementing nursing interventions such
as positioning patients, determining the risk of patient falls, and selecting the safest way to move or transfer patients
(Healey and Darowski, 2012).
Alignment and Balance
 The terms body alignment and posture – similar and refer to the positioning of the joints, tendons, ligaments, and
muscles while standing, sitting, and lying.
 Body alignment means that an individual's center of gravity is stable.
 Correct body alignment reduces strain on musculoskeletal structures, aids in maintaining adequate muscle tone,
promotes comfort, and contributes to balance and conservation of energy.
 Without balance control the center of gravity is displaced.
Individuals require balance for maintaining a static position (e.g., sitting) and moving (e.g., walking).
 Disease, injury, pain, physical development (e.g., age), and life changes (e.g., pregnancy) compromise the ability
to remain balanced.

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Gravity and Friction
 Weight is the force exerted on a body by gravity. The force of weight is always directed downward, which is why
an unbalanced object falls. Unsteady patients fall if their center of gravity becomes unbalanced because of the
gravitational pull on their weight.
 To lift safely the lifter has to overcome the weight of the object and know its center of gravity. In symmetrical
inanimate objects the center of gravity is at the exact center of the object. However, people are not geometrically
perfect; their centers of gravity are usually at 55% to 57% of standing height and are in the midline, which is why
only using principles of body mechanics in lifting patients often leads to injury of a nurse or other health care
professional.
 Friction is a force that occurs in a direction to oppose movement. The greater the surface area of the object that
is moved, the greater is the friction. A larger object produces greater resistance to movement.
 In addition, the force exerted against the skin while the skin remains stationary and the bony structures move is
called shear. Unfortunately a common example is when the head of a hospital bed is elevated beyond 60
degrees and gravity pulls a patient so that the bony skeleton moves toward the foot of the bed while the skin
remains against the sheets. The blood vessels in the underlying tissue are stretched and damaged, resulting in
impeded blood flow to the deep tissues.

Skeletal System
The skeletal system provides attachments for muscles
and ligaments and the leverage necessary for mobility.
Thus the skeleton is the supporting framework of the
body and is made up of four types of bones: long, short,
flat, and irregular. Bones are important for mobilization
because they are firm, rigid, and elastic. The aging
process changes the components of bone, which
impacts mobility.
The skeletal system has several functions. It protects
vital organs (e.g., the skull around the brain and the ribs
around the heart and lungs) and aids in calcium
regulation. Bones store calcium and release it into the
 Joints -
 Ligaments –
 Tendons –
 Cartilage –
circulation as needed. Patients who have decreased
calcium regulation and metabolism and who are
immobile are at risk for developing osteoporosis and
pathological fractures (fractures caused by weakened
bone tissue).
In addition, the internal structure of long bones contains
bone marrow, participates in red blood cell (RBC)
production, and acts as a reservoir for blood. Patients
with altered bone marrow function or diminished RBC
production tire easily because of reduced hemoglobin
and oxygen-carrying ability. This fatigue decreases their
mobility and increases the risk for falling.

Skeletal Muscle
Movement of bones and joints involves active processes that are carefully integrated to achieve coordination. Skeletal
muscles, because of their ability to contract and relax, are the working elements of movement. Anatomical structure and
attachment to the skeleton enhance contractile elements of the skeletal muscle.
Nervous System
The nervous system regulates movement and posture. The precentral gyrus, or motor strip, is the major voluntary motor
area and is in the cerebral cortex. A majority of motor fibers descend from the motor strip and cross at the level of the
medulla. Movement is impaired by disorders that alter neurotransmitter production, transfer of impulses from the nerve to
the muscle, or activation of muscle activity.

Pathological Influences on Mobility

Many pathological conditions affect mobility. Although a complete description of each is beyond
the scope of this chapter, an overview of four pathological influences is presented.
1. Postural Abnormalities
Congenital or acquired postural abnormalities affect the efficiency of the musculoskeletal system and body alignment,
balance, and appearance. During assessment observe body alignment and ROM. Postural abnormalities can cause pain,
impair alignment or mobility, or both. Knowledge about the characteristics, causes, and treatment of common postural
abnormalities is necessary for lifting, transfer, and positioning. Some postural abnormalities limit ROM.

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Postural Abnormalities
Abnormality Description
Torticollis
Lordosis
Kyphosis
Scoliosis
Congenital hip dysplasia
Knock-knee (genu valgum)
Bowlegs (genu varum)
Clubfoot
Footdrop
Pigeon toes
*Severity of condition and cause dictate treatment, which is individualized to the patient's needs.
2. Muscle Abnormalities
Injury and disease lead to numerous alterations in musculoskeletal function. For example, the muscular dystrophies are a
group of familial disorders that cause degeneration of skeletal muscle fibers.
3. Damage to the Central Nervous System
Damage to any component of the central nervous system that regulates voluntary movement results in impaired body
alignment, balance, and mobility. Trauma from a head injury, ischemia from a stroke (cerebrovascular accident [CVA]), or
bacterial infection such as meningitis can damage the cerebellum or the motor strip in the cerebral cortex. Damage to the
cerebellum causes problems with balance, and motor impairment is directly related to the amount of destruction of the
motor strip.
4. Direct Trauma to the Musculoskeletal System
Direct trauma to the musculoskeletal system results in bruises, contusions, sprains, and fractures. A fracture is a
disruption of bone tissue continuity. Fractures most commonly result from direct external trauma, but they also occur as a
consequence of some deformity of the bone (e.g., pathological fractures of osteoporosis, Paget's disease, or
osteogenesis imperfecta).
Normal Movement and Alignment / Elements of Body Mechanics:
The following concepts are an important part of normal movement and musculoskeletal functioning, and contribute
to a person’s overall well-being.
Body Alignment or Posture
Good posture, or good body alignment, is the alignment of body parts that
permits optimal musculoskeletal balance and operation and promotes healthy
physiologic functioning. A person in correct alignment is experiencing no
undue strain on the joints, muscles, tendons, or ligaments while balance is
maintained.

Balance
A body in correct alignment is balanced. An object is balanced when its center
of gravity is close to its base of support, the line of gravity goes through the
base of support, and the object has a wide base of support. The center of
gravity of an object is the point at which its mass is centered. In humans, the
center of gravity when standing is located in the center of the pelvis about
midway between the umbilicus and the symphysis pubis. The line of gravity is
a vertical line that passes through the center of gravity. The base of support is
the foundation that provides for an object’s stability. The wider the base of
support and the lower the center of gravity, the greater the stability of the
object will be.

Coordinated Body Movement

Using major muscle groups, rather than weaker ones, and taking advantage of
the body’s natural levers and fulcrums facilitates the actions of lifting, carrying,
pushing, pulling, and moving objects. Major muscle groups include the flexors, extensors, and abductors of the thighs;
flexors and extensors of the knees; and flexors and extensors of the upper and lower arms. Use of the arm bones as
levers and the elbows as fulcrums facilitates lifting a weight against resistance, the force of gravity—the lever and fulcrum
principle.

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COORDINATED BODY MOVEMENT: Relationship of skeletal muscles to bones. (A) Skeletal muscles produce
movements by pulling on bones. (B) Bones serve as levers, and joints act as fulcrums for the levers. The lever and
fulcrum principle is illustrated by the movement of the forearm lifting a weight.
Postural Reflexes
Integrated functioning of the musculoskeletal and nervous systems is essential for body alignment and balance. Postural
tonus, the sustained contraction of select skeletal muscles that keeps the human body in an upright position against
the force of gravity, depends on the functioning of several postural reflexes:
• Labyrinthine sense: This sense of position and movement is provided by the sensory organs in the inner ear, which
are stimulated by body movement (changes in head position) and transmit these impulses to the cerebellum.
• Proprioceptor or kinesthetic sense: This informs the brain of the location of a limb or body part as a result of joint
movements stimulating special nerve endings in muscles, tendons, and fascia.
• Visual or optic reflexes: Visual impressions contribute to posture by alerting the person to spatial relationships with the
environment (nearness of ceilings, walls, furniture, condition of floor, etc.).
• Extensor or stretch reflexes: When extensor muscles are stretched beyond a certain point (e.g., when knees buckle
under), their stimulation causes a reflex contraction that aids a person to reestablish erect posture (e.g., straighten the
knee).
Body Mechanics
Body mechanics is the application of mechanical laws to the human body, specifically in regard to structure, function, and
position of the body (VISN 8 Patient Safety Center, 2005). It includes proper body movement in daily activities, the
prevention and correction of problems associated with posture, and the enhancement of coordination and endurance. It is
important to use the principles of body mechanics during activity and during rest periods, to prevent injury and to prevent
sore muscles and joints. The principles of body mechanics are also used to assess and maintain the alignment of
patients. The correct use of body mechanics is a part of illness prevention and health promotion. Many activities in which
the nurse engages, from as simple an activity as moving a chair, repositioning the medication cart, or reaching to silence
a monitor alarm, require understanding and using these principles. Nurses who consciously develop good habits can
demonstrate to others proper ways of using the musculoskeletal system.
Principles of body mechanics:
1. Weight is balanced best when the center of gravity is directly above the base of support.

2. Enlarging the base of support increases the stability of the body.

3. A person or an object is more stable if the center of gravity is close to the base of support.

4. Enlarging the base of support in the direction of the force to be applied increases the amount of force that
can be applied.

5. Tightening the abdominal muscles upward and the gluteal muscles downward before undertaking any
activity decreases the chance of strain or injury to ligaments and muscles of the back.

6.

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 7. Facing in the direction of the task to be performed and turning the entire body in one place (rather than
twisting) lessens the susceptibility of the back to injury.

8. Lifting is better undertaken by bending the legs and not using the back muscles. Because muscles tire
less quickly than small muscles, you should use the large gluteal and femoral muscles rather than
smaller muscles of the back.

9. It is easier to move on a level surface than to move it up a slanted surface against the force of gravity.

10. Less energy is required to move an object when friction between the object and surface in which it rests
is minimized.

11. It takes less energy to hold an object close to the body that at a distance from the body; it is also easier
to move an object that is close. Muscles are strongest when contracted and weakest when stretched.

12. The weight of the body can be used to assist in lifting or moving.

13. Smooth rhythmical movements at moderate speed require less energy than rapid, jerky ones.

14. When an object is pushed, it absorbs part of the force being exerted, leaving only part of the force
available to do the moving.

15. It takes less energy to work on a surface at an appropriate height (usually waist level) than it does to
stoop or stretch to reach the surface.

CHECK FOR UNDERSTANDING (20 minutes)

This serves as your quiz. Encircle the correct letter. 1 point is given to each correct answer and another point is also given
to correct rationales. Superimpositions & erasure are not allowed Students are given 20 minutes to answer.
Multiple Choice

RATIONALIZATION ACTIVITY (DURING THE FACE TO FACE INTERACTION WITH THE STUDENTS)
After the prescribed time, the correct answers and their respective rationale will be provided. You are encouraged to ask
questions if there are any.
1. It is described as the coordinated efforts of the musculoskeletal and nervous systems.
A. Body balance C. Body posture
B. Body alignment D. Body mechanics
Rationale: _______________________________________________________________________________________
_________________________________________________________________________________________________
2. This refers to the positioning of the joints, tendons, ligaments, and muscles while standing, sitting, and lying.
A. Body alignment C. A & B
B. Posture D. None of the above
Rationale: _______________________________________________________________________________________
_________________________________________________________________________________________________
3. These are white, shiny, flexible bands of fibrous tissue that bind joints together, connect bones and cartilages,
and aid joint flexibility and support.
A. Joints C. Tendons
B. Ligaments D. Cartilage

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Rationale: _______________________________________________________________________________________
_________________________________________________________________________________________________
4. These are nonvascular (without blood vessels) supporting connective tissue located chiefly in the joints and
thorax, trachea, larynx, nose, and ear.
1. Joints 3. Tendons
2. Ligaments 4. Cartilage
Rationale: _______________________________________________________________________________________
_________________________________________________________________________________________________
5. What postural abnormality is described as the lateral S- or C-shaped spinal column with vertebral rotation,
unequal heights of hips and shoulders
A. Toticollis C. Kyphosis
B. Lordosis D. Scoliosis
Rationale: _______________________________________________________________________________________
_________________________________________________________________________________________________
6. How does the principle of enlarging the base of support increases the stability of the body work?
A. In assisting the patient to move, your feet should be close together to be more stable.
B. In assisting the patient to move, your feet should be apart to be more stable.
C. In assisting the patient to move, your feet should be widely apart to be more stable.
D. None of the above
Rationale: _______________________________________________________________________________________
_________________________________________________________________________________________________
7. This principle is applied when picking an object up from the floor by bending at the knees and keeping your
back straight rather than by bending forward at the waist.
A. Enlarging the base of support increases the stability of the body.
B. Weight is balanced best when the center of gravity is directly above the base of support.
C. A person or an object is more stable if the center of gravity is close to the base of support.
D. None of the above
Rationale: _______________________________________________________________________________________
_________________________________________________________________________________________________
8. If a nurse is to push a patient’s bed forward, where should he place his foot to observe proper body
mechanics?
A. Forward C. Maintain feet close together
B. Spread sideways D. Opposite the direction of the bed.
Rationale: _______________________________________________________________________________________
_________________________________________________________________________________________________
9. Which of the following describes a nurse who does not observe proper body mechanics?
A. Picking up an object by bending at the knees and keeping your back straight.
B. Keeping feet apart when assisting a patient.
C. Twisting your body from the waist.
D. Working on a smooth surface to reduce friction.
Rationale: _______________________________________________________________________________________
_________________________________________________________________________________________________
10. By adjusting the level of the bed of a patient as the nurse is at the bedside, what is the rationale?
A. Adjust the height of the client’s bed to avoid back strain.
B. Adjust the height of the client’s bed to avoid patient fall.
C. Adjust the height of the client’s bed to promote patient comfort.
D. Adjust the height of the client’s bed to provide privacy.
Rationale: _______________________________________________________________________________________
_________________________________________________________________________________________________

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LESSON WRAP-UP (5 minutes)
In your work tracker, put a mark or encircle which session have you finished today. This is to provide a visual and help
students track how much work they have accomplished and how much work there is left to do.

Activity: 3-2-1
Each student to bring out a sheet of paper and will be given a minute or two to answer. After the activity, instructor will
randomly select 3 students to share their answers to the class.

3 things you learned:

1. ________________________________________________
2. ________________________________________________
3. ________________________________________________

2 things that you’d like to learn more about:

1. ________________________________________________
2. ________________________________________________

1 question you still have:

1. ________________________________________________

Reading Assignment: Chapter 28 Immobility – Mobility

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