MOBILITY AND SAFETY

BODY MECHANICS
 Involves the coordinated effort of
muscles, bones, and the nervous system
to maintain balance, posture, and
alignment during moving, transferring,
and positioning patients.
 Is the efficient and coordinated use of
body to produce motion and maintain
balance during activity

PURPOSE OF BODY MECHANICS

 To maintain good body posture
 To promote good functioning of the body
 To se the body correctly to maintain its
effectiveness  Normal movement and stability are the
result of an intact musculoskeletal
 To prevent limitation and injury of the
system, an intact nervous system, and
musculoskeletal system
intact inner ear structures responsible for
equilibrium.
ELEMENTS OF BODY MECHANICS  Body movement requires coordinated
1. Body Alignment muscle activity and neurologic integration.
It involves 4 basic elements: body
 The geometric arrangement of body parts
alignment (posture), joint mobility,
in relation to each other.
balance, and coordinated movement.
 Good body alignment and good posture
are synonymous terms.
 Good alighment promotes optimal
balance and maximal body function ALIGNMENT AND POSTURE
whatever position the client assumes like
 a person maintains balance as long as
standing or lying down.
the line of gravity (an imaginary vertical
line drawn through the body’s center of
2. Balance
gravity) passes through the center of
 A state of equilibrium in which opposing gravity (the point at which all of the
forces counteract each other body’s mass is centered) and the base of
 Balance is the result of body alignment support (the foundation on which the
body rests)
3. Coordinated Movement
 Body mechanics involves the integrated
functioning of the musculoskeletal and JOINT MOBILITY
nervous system. Muscle tone.
Neuromuscular reflexes and the
coordinated movement of opposing
voluntary muscle groups play the
important role in producing balanced,
smooth, purposeful movement.
 Joints are the functional units of the
NORMAL MOVEMENT musculoskeletal system.
 The bones of the skeleton articulate at the
joints, and the most of the skeletal
muscles attach to the two bones at the
joint. These muscles are categorized
according to the type of joint movement
they produce on contraction. Muscles are
therefore called flexors, extensors,
internal rotators and the like.

TYPE OF JOINT MOVEMENTS


BALANCE
 Maintenance of balance and posture are
complex mechanisms involving the
labyrinth (inner ear), from vision
(vestibulo-ocular input), and from stretch
receptors of muscles and tendons
(vestibulospinal input)
 Awareness of posture, movements, and
changes in equilibrium and the
knowledge of position, weight, and
resistance of objects in relation to the
body is called proprioception.
COORDINATED MOVEMENT
 The cerebral cortex initiates voluntary
motor activity, the cerebellum
coordinates the motor activities of
movement, and the basal ganglia
maintains posture.
FACTORS AFFECTING BODY ALIGNMENT
AND ACTIVITY
1. Growth and Development
 A person’s age and development affect
their posture, movements, and reflexes.
 Newborns have reflexive and random
movements but gain control over
movement as their neurologic system
matures. Gross motor development
occurs in a head-to-toe fashion and
preceds fine motor skills.
 From ages 1-5 years, both gross and fine
motor skills are refined immobility can
impair the social and motor development
of young children.
 6-12 years of age, motor skills continue
to be refined and exercise patterns for
later life are determined. In adolescence,
growth spurts and behaviors such as
carrying heavy book bags and extended
computer use may result in postural
changes.
 Adults between 20 and 40 years of age
generally have few physical changes
affecting mobility, except for pregnant
women. Pregnancy alters the body’s
center of gravity and affects balance.
Healthy pregnant women should
exercise 30 minutes or more with
moderate intensity on most days of the
week. Exercise can prevent gestational
diabetes and control excess weight gain
during pregnancy.
 As age advances, muscle tone and bone
density decrease, joints lose flexibility,
reaction time slows, and bone mass
decreases.
 Osteoporosis is a condition in which
bones become brittle and fragile due to
calcium depletion. It is common in older
women and affects the weight-bearing
joints and spinal bones. These changes
affect older adults’ posture, gait, and
balance.
o Posture becomes forward leaning
and stooped.
o Gait becomes wide based, short
stepped, and shuffling.
 Regular activity for older adults can
maintain and regain strength, flexibility,
cardiovascular fitness, and bone density.
Other health benefits include reduction in
falls, mood stabilization, reduction in
obseity, diabetes management.
2. Nutrition
 Both undernutrition and overnutrition can
influence body alignment and mobility
 Poorly nourished people may have
muscle weakness and fatigue.
 Vitamin D deficiency causes bone
deformity during growth. Inadequate
calcium intake and vitamin D synthesis
and intake increase the risk of
osteoporosis.
 Obesity can distory movement and
stress joints, adversely affecting posture,
balance, and joint health.
3. Personal Values and Attitudes
 Family influences often determine
whether people value regular exercise.
 Children learn to value physical activity if
their families incorporate regular exercise
into their daily routine or spend time
together in activities.
 Sedentary families participate in sports
only as spectators and this lifestyle is
often transmitted to their children.
 With the increase in TV, computer, and
video activities, youth are increasingly
sedentary with associated declines in
health.
 Values about physical appearance also
influence some people’s participation in
regular exercise. People who value a
muscular build or physical attractiveness
may participate in regular exercise
programs to produce the appearance
they desire.
 Choice of physical activity or type of
exercise is influenced by values,
 geographic, location, and cultural role
expectations.
 Thinking of exercise as “recreational
movement” and “an essential part of
daily self-care” may help overcome
perceptions that exercise is drudgery.
 Options include informal and fun
activities such as dancing to music.
 Exercise behavior may be improved by
addressing individuals’ awareness of
their physiological response to activity
and exercise.
 Individualized exercise prescriptions that
tailor exercise mode and dose will
ensure greater adherence to an exercise
program. Prescriptions should include
frequency, intensity, and time (the FIT
model).
 Nurses must assess each client for
potentially motivation factors such as the
degree of fun or challege of any given
activity, use of music, opportunities for
socializing, positive sensations of the
exercise experience, goal setting anf
progress, competition with oneself or
others, weight management, and the
need to explore less intense and
challenge activities.
used to immobilize body parts to promote
healing.
 Clients who are short of breath may be
advised not to walk up stairs. Bed rest
may be the therapeutic choice for certain
clients to relieve edema, reduce
metabolic and oxygen needs, promote
tissue repair or decrease pain.
 The term bed rest varies in meaning. In
some agencies, bed rest means strict
confinement to bed or “complete” bed
rest. Others may allow the client to use a
bedside commode or have bathroom
privileges.
 Nurses need to familiarize themselves
with the meaning of bed rest in their
practice setting. The effects of limiting
activity are imeddiate and therapeutic
positioning is important to prevent further
complications and improve client
outcomes.
TYPES OF EXERCISES
A. According to Muscular Contraction

4. External Factors
 Many external factors affect a person’s
mobility such as temperature, humidity Isotonic (Dynamic) exercises
and hydration needs.  Are those in which the muscle shortens
 Quality water is the best fluid to replace to produce muscle contraction and active
loss incurred through metabolic movement.
processes and exercise. Drinking 1-2
cups of water is usually adequate for
shorter bouts of exercise. For longer
bouts such as marathons, drinking 2
cups of water 2 hours to prior to the
event and then replacing fluids with a
sports drink that contains sodium during Isometric (Static or Setting) exercises
and after can be beneficial.  Are those in which muscle contraction
 The availability of recreational facilities occurs without moving the joint (muscle
also influences activity, for examplem length does not change).
lack of money may prohibit a client from
joining an exercise club or gymnasium or
from purchasing needed equipment.
 Neighborhood safety promoted outdoor
activity, whereas an unsafe environment
discourages people from going outdoors.
 Adolescents may spend many hours
Isokinetic (Resistive) exercises
sitting at computers, watching television,
 Involve muscle contraction or tension
or playing video games rather than
against resistance.
engaging in physical activities.

5. Prescribed Limitations
 Limitations to movement may be
medically prescribed for some health
problems. Devices such as casts,
braces, splints, and traction are often
B. Source of Energy
 maintained as
Aerobic long as the
 Is activity during which the amount of line of gravity
oxygen taken into the body is grater than passes
that used to perform the activity. through its
 They use large muscle groups that move base of
repetitively. support.
 They imrpove cardiovascular Face direction of the Facing the direction
conditioning and physical fitness. movement. prevents abnormal
twisting of the spine.
Anaerobic Avoid lifting.  Turning,
 Involves activity in which the muscles rolling,
cannot draw out enough oxygen from the pivoting, and
bloodstream, and anaerobic pathways leverage
are used to provide additional energy for requires less
a short time. work than
 This type of exercise is used in lifting.
endurance training for athletes such as  Do not lift if
weight lifting and sprinting. possible; use
mechanical
PRINCIPLES OF BODY MECHANICS lifts as
ACTION PRINCIPLE required.
Assess the Assess the weight of  Encourage
environment. the load before lifting the patient to
and determine if help as much
assistance is as possible.
required. Work at waist level.  Keep all work
Plan the move. Plan the move; at waist level
gather all supplies to avoid
and clear the area of stooping
obstacles.  Raise the
Avoid stretching and Avoid stretching, height of the
twisting. reaching, and bed or object
twisting, which may if possible.
place the line of  Do not bend
gravity outside the at the waist.
base of support. Reduce friction Reduce friction
Ensure proper body  Keep stance between surfaces. between surfaces so
stance. (feet) that less force is
shoulder- required to move the
width apart. patient.
 Tighten Bend the kness. Bending the knees
abdominal, maintains your
gluteal, and center of gravity and
leg muscles in lets the strong
anticipation of muscles of your legs
the move. to do the lifting.
 Stand up Push the object  It is easier to
straight to rather than pulling push an
protect the and maintain object than to
back and continuous pull it
provide movement.  Less energy
balance. is required to
keep an
object moving
Stand close to the  Place the than it is to
object being moved. weight of the stop and start
object being it.
moved close Use assistive Use assistive
to your center devices. devices (gait belt,
of gravity for slider boards,
balance. mechanical lifts) as
 Equilibrium is
 required to position
patients and transfer
them from one
surface to another.
Work with others. The person with the
heaviest load should
coordinate all the
effort of the others
involved in the
handling technique.
ASSISTIVE DEVICES
An assistive device is an object or piece of
equipment designedto help a patient with
activitiesof daily living, such as a walker, cane,
gait belt, or mechanical lift (WorkSafeBC,
2006).
A. Gait belt/ Transfer belt
 Used to ensure a good grip on unstable
patients. The device provides more
stability when transferring patients.
 It is a 2-inch wide (5 mm) belt, with or
without handles, that is placed around a
patient’s waist and fastened with velcro.
The gait belt must always be applied on
top of clothing or gown to protect the
patient’s skin. A gait belt can be used
with patients in both one person or two-
person pivot transfer, or in transfer with a
slider board.
B. Slider board/ transfer board
 Used to transfer immobile patients from
one surfac to another while the patient is
lying supine.
 The board allows health care providers
to safely move immobile, bariatric, or
complex patients.
INFECTION CONTROL
INFECTION
 is an invasion of body tissues by
microorganism and their growth.
TERMINOLOGIES
Pathogens
microorganism that causes disease.
Infection
a disease state resulting from the presence of
pathogens in the body as a result of a cyclic
process
Colonization
the presence of organisms in body secretions or
excretions in which strains of bacteria become
resident flora but do not cause illness.
Virulence
the ability of the microorganism to produce
disease.
Communicable disease
infectious agent transmitted to an individual by
direct
or indirect contact as an airborne infection.
Pathogenicity
is the ability of the microorganism to produce
disease.
Opportunistic Pathogens
can cause disease only in a susceptible
individual.
Sepsis
is the state of infection and can take any forms.
Agent
any environmental factor or stressor (biologic,
chemical, mechanical, physical) can lead to
illness or disease.
Host
person who may or may not be at risk of
acquiring a disease.
Environment
all factors external to the host that may or may
not be predisposed to the person on the
development of disease.
PRINCIPLES
1. Wash hand before handling food, before
eating, after using toilet, before and after any
required home care treatment and after
touching any substances like
open wounds/drainage.
2. Keep your fingernails clean and short.
3. Do not share personnel items such as
toothbrush, wash cloths and towels.
4. Wash raw fruits and vegetables before eating
5. Refrigerate all opened and unpacked foods.
6. Clean used equipment’s (basin) with soap
and water and disinfect with chlorine bleach
solution.
7. Place contaminated dressings and other
disposable items containing body fluids in
moisture-proof plastic bags.
8. Put used needles in a punctured-resistant
container with a screw-top lid. Label so as not
to be discard in the garbage.
9. Clean obviously soiled linen separately from
other laundry.
10. Avoid coughing, sneezing or breathing
directly on others but instead cover mouth and
nose to prevent transmission of airborne
microorganisms.
11. Be aware of any signs and symptoms of an
infection and report these immediately to your
health care contact persons.
12. Maintain sufficient fluid intake to promote
urine production and output.
METHOD OF TRANSMISSION
1. Direct Transmission
 involves immediate and direct transfer of
microorganism from person to person
through touching, biting, kissing or
sexual intercourse.
2. Indirect Transmission
may be either:
 Vehicle-borne transmission – transport of
an infectious agent into a susceptible
host via any intermediate substances like
fomites, food, handkerchief.
 Vector-borne transmission- a vector is an
animal, flying or crawling insect serves
as an immediate means to transfer
infectious agent through injecting saliva
fluid during biting, or depositing feces or
other materials in the skin.
 Airborne-transmission- droplet nuclei or
dust particles containing an infectious
agent transmitted by air current to a
suitable portal of entry usually respiratory
tract of another person.
CHAIN OF INFECTION
The chain of infection, also referred to as the
chain of transmission, describes how an
infection spreads based on these six links of
transmission:
 Infectious Agent: Microorganisms, such
as bacteria, viruses, fungi, or parasites,
that can cause infectious disease.
 Reservoir: The host in which infectious
agents live, grow, and multiply. Humans,
animals, and the environment can be
reservoirs. Examples of reservoirs are a
person with a common cold, a dog with
rabies, or standing water with bacteria.
Sometimes a person may carry an
infectious agent but is not symptomatic
or ill. This is referred to as being
colonized, and the person is referred to
as a carrier. For example, many health
care workers carry methicillin-resistant
Staphylococcus aureus (MRSA) bacteria
in their noses but are not symptomatic.
 Portal of Exit: The route by which an
infectious agent escapes or leaves the
reservoir. In humans, the portal of exit is
typically a mucous membrane or other
opening in the skin. For example,
pathogens that cause respiratory
diseases usually escape through a
person’s nose or mouth.
 Mode of Transmission: The way in
which an infectious agent travels to other
people and places because they cannot
travel on their own. Modes of
transmission include contact, droplet, or
airborne transmission. For example,
touching sheets with drainage from one
person’s infected wound and then
touching another person without washing
one’s hands is an example of contact
transmission of an infectious agent.
Examples of droplet or airborne
transmission are coughing and sneezing,
depending on the size of the
microorganism.
 Portal of Entry: The route by which an
infectious agent enters a new host (i.e.,
the reverse of the portal of exit). For
example, mucous membranes, skin
breakdown, and artificial openings in the
skin created for the insertion of medical
equipment (such as intravenous lines)
are at high risk for infection because they
provide an open path for microorganisms
to enter the body. Tubes inserted into
mucous membranes, such as a urinary
catheter, also facilitate the entrance of
 microorganisms into the body. A
person’s immune system fights against
infectious organisms that have entered
the body using nonspecific and specific
defenses.
 Susceptible Host: A person at elevated
risk for developing an infection when
exposed to an infectious agent due to
changes in their immune system
defenses. For example, infants (up to 2
years old) and older adults (aged 65 or
older) are at higher risk for developing
infections due to underdeveloped or
weakened immune systems. Additionally,
anyone with chronic medical conditions
(such as diabetes) are also at higher risk
of developing an infection. In health care
settings, almost every patient is
considered a “susceptible host” because
of preexisting illnesses, medical
treatments, medical devices, or
medications that increase their
vulnerability to developing an infection
when exposed to infectious agents in the
health care environment. As caregivers,
it is the NA’s responsibility to protect
susceptible patients by breaking the
chain of infection.
After a susceptible host becomes infected, they
become a reservoir that can then transmit the
infectious agent to another person. If an
individual’s immune system successfully fights
off the infectious agent, they may not develop
an infection, but instead the person may
become an asymptomatic “carrier” who can
spread the infectious agent to another
susceptible host. For example, individuals
exposed to COVID-19 may not develop an
active respiratory infection but can spread the
virus to other susceptible hosts via sneezing.
MEANS HOW TO BREAK THE CHAIN OF
INFECTION
a. use of antiseptic agent
 agent that inhibit the growth of some
microorganism.
b. disinfectant
 agent that destroy microorganisms other
than spores.
c. sterilization
d. handwashing
Asepsis
is freedom from disease causing
microorganism.
 Rationale: To decrease the possibility of
transferring microorganisms from one
place to another.
Aseptic Technique
an effort to keep client as free from hospital
microorganism.
2 BASIC TYPES OF ASEPSIS TECHNIQUE
1. Medical Asepsis
 are all practices intended to confine a
specific microorganism to a specific area,
limiting the number, growth and
transmission of the microorganism.
 Rationale: in medical asepsis, the object
is referred as clean, whichmeans the
absence of almost microorganisms. Ex:
hand washing and cleaning medicine
cups
2. Surgical Asepsis
 or sterile technique refers to those
practices that keep an area or object free
of all microorganisms, it includes
practices that destroy all microorganisms
and spores.
 Ex: sterilization
PRINCIPLES OF STERILE TECHNIQUE
Safety considerations:
 Hand hygiene is a priority before any
aseptic procedure.
 When performing a procedure, ensure
the patient understands how to prevent
contamination of equipment and knows
to refrain from sudden movements or
touching, laughing, sneezing, or talking
over the sterile field.
 Choose appropriate PPE to decrease the
transmission of microorganisms from
patients to health care worker.
 Review hospital procedures and
requirements for sterile technique prior to
initiating any invasive procedure.
 Health care providers who are ill should
avoid invasive procedures or, if they
can’t avoid them, should double mask.

TRANSFERRING OF CLIENT-
ASSISTING WITH MOVING A
PATIENT BED
1. Verified health care provider’s orders.
2. Gathered necessary equipment and supplies.
3.Performed hand hygiene, ensured patient
privacy.
4. Introduced self to patient and family.
5.Identified patient using two identifiers,
compared these with ID bracelet.
6. Assessed amount of weight to be lifted,
assess for assistance needed to ensure safety
of all involved.
7. Moved patient with a drawsheet:
a) Placed patient in appropriate position,
adjusted bed to proper height for both
nurses.
b) Removed pillow from patient’s head, had
patient cross arms over chest.
c) Rolled patient side to side to place draw
sheet properly, crossed patient’s one leg
over the other.
d) Returned patient to appropriate position.
e) Fan folded drawsheet to patient’s sides.
f) Stood properly, shifted weight from front
to back foot, used drawsheet to move
patient up to bed.
8. Moved patient with friction-reducing device:
a) Positioned patient as in Steps 6A-D,
ensured enough nurses are available to
help, positioned nurses properly.
b) Placed friction-reducing device under
drawsheet by rolling patient side to side,
crossed one leg over other, returned
patient to proper position.
c) Had nurses grasp drawsheet and device
properly, followed steps 6E-F to move
patient up in bed.
d) Removed device, assisted patient to
comfortable position.
9. Log rolled patient:
a) Placed a small pillow between patient’s
knees.
b) Crossed patient’s arms over his or her
chest.
c) Positioned nurses properly around bed.
d) Fan folded drawsheet alongside toward
which patient was turning.
e) Rolled patient properly on the count of
three.
f) Placed pillows along length of patient if
appropriate.
g) Leaned patient back toward pillows for
support.
10. Helped patient to a comfortable position,
placed personal items in reach.
11. Placed call light within easy reach, ensured
patient knows how to use it.
12. Raised side rails and lowered bed to ensure
patient safety.
13. Disposed of used supplies and equipment
properly, left patient’s room tidy.
14. Removed and disposed of gloves,
performed hand hygiene.
15. Documented and reported patient’s
response and outcomes.
TRANSFERRING OF CLIENT-
ASSISTING IN POSITIONING
A PATIENT IN BED
PROCEDURE GUIDELINE
1. Verify the health care provider’s orders.
2. Provide for the patient’s privacy.
3. Perform hand hygiene.
4. Introduce yourself to the patient and family if
present.
5. Identify the patient by using two identifiers.
6. Position the patient in one of the following
positions, using correct body alignment. Protect
pressure areas. Begin with the patient lying
supine. Place the bed in a good working height.
A. Position the patient in the supported Fowler’s
position.
a) With the patient lying supine, raise the
bed to a working height and elevate the
head of the bed to 45 degrees.
b) Rest the patient’s head against the
mattress or on a pillow.
c) If needed, position a small pillow or rolled
towel at the patient’s lower back.
d) Use pillows to support the arms and
hands of the patient if he or she does not
have voluntary control or use of the
hands and arms.
e) Place a pillow or roll under the patient’s
thighs.
f) Support the patient’s calves and ankles
with a pillow or roll.
 g) Place pillows or rolls at the feet to keep
the feet aligned and maintain dorsi-
flexion of feet.
B. Position the patient in the supported supine
position.
a) Lower the head of the bed so that the
patient is lying flat.
b) Place a small rolled towel under the
lumbar area of the patient’s back, if
needed.
c) Place a pillow behind the patient’s upper
shoulders, neck, or head, if needed.
d) Place pillows under the patient’s
pronated forearms, keeping the upper
arms parallel to the patient’s body.
e) Place trochanter rolls or sandbags
parallel to the lateral surface of the
patient’s thighs.
f) Protect the patient's feet with a small
trochanter roll or therapeutic boots.
g) Place the fingers and thumb of each of
the patient's hands around a rolled cloth.
(Consider a physical therapy referral for
the use of hand splints.)
C. Position the patient in the prone position,
using two nurses.
a) Lower the head of the bed to the flat
position, and remove any pillows.
b) Lower the side rail and move the patient
to the side of the bed opposite from the
direction you will turn him. Move his or
her upper trunk first, supporting the
shoulders. Then move his or her lower
trunk, supporting the patient's hips.
Adjust the patient's legs and feet to
maintain good body alignment.
c) Stand on one side of the bed, and ask
another nurse to cover the other side.
d) As you roll the patient, the patient's arm
on the side to be turned should be held
alongside the body. Place a towel or
pillow beneath the patient's abdomen,
below the level of the diaphragm. For
patients with hemiplegia, move the
patient toward the unaffected side.
e) Roll the patient’s body over the tucked
arm, keeping the elbow straight and the
hand tucked under the hip. Center the
patient in the bed to maintain good body
alignment.
f) Turn the patient’s head to one side, and
support the head with a small pillow.
g) Support the patient’s arms in the flexed
position at the level of the shoulders.
h) To elevate the toes, gently wedge a
pillow below his or her lower legs.
D. Position the patient in a 30-degree lateral
(side-lying) position.
a) Raise the bed to a working height. Lower
the head of the bed completely, or as far
as the patient can tolerate.
b) Lower the side rail, and position the
patient on the side of the bed facing the
opposite direction toward which he or
she is going to be turned. Move the
patient’s upper trunk first, supporting the
shoulders. Then move the lower trunk,
supporting the hips.
c) Raise the side rail, and go to the
opposite side of the bed.
d) Flex the patient’s knee that will not be
next to the mattress. Place one of your
hands on the patient’s hip and the other
on his or her shoulder.
e) Roll the patient onto his or her side
toward you.
f) Place a pillow under the patient’s head
and neck.
g) Place your hands under the dependent
shoulder, and bring the shoulder blade
forward.
h) Position both of the patient’s arms in a
slightly flexed position.
i) Place a small tuck-back pillow behind the
patient’s back. Make a tuck-back pillow
by folding a pillow lengthwise. The
smooth area of the pillow is slightly
tucked under the patient’s back.
j) Support the upper arm with a pillow that
is level with the shoulder; the other arm
will be supported by the mattress.
k) Slide your hands under the patient’s
dependent hip, and bring the hip slightly
forward, so that the angle between the
hip and the mattress is approximately 30
degrees.
l) Place a pillow under the patient’s semi
flexed upper leg at the level of the hip
from groin to foot.
m) Place sandbags parallel to the plantar
surface of the dependent foot. If they are
available, use ankle-foot orthotics on the
patient’s feet.
E. Position the patient in the Sims’ (semi prone)
position.
a) Lower the head of the bed. Place the
patient in the supine position, and
position the patient on the side of the bed
facing the opposite direction toward
which he or she is going to be turned.
Remove the pillow.
b) The patient's arm on the side to be
turned should be tucked alongside the
body. Flex the knee of the leg that will
not be next to the mattress. Turn the
patient onto his or her side. Position
 them in the lateral position lying partly on
his or her abdomen.
c) Place a small pillow under the patient’s
head.
d) Place a pillow under the flexed upper
arm, supporting the arm so that it is level
with the shoulder.
e) Place a pillow under the patient’s flexed
upper legs, supporting the leg so that it is
level with the hip.
f) Place sandbags or small trochanter rolls
parallel to the plantar surface of the
patient’s foot.
7. Place toiletries and personal items within
reach.
8. Place the call light within easy reach, and
make sure the patient knows how to use it to
summon assistance.
9. To ensure the patient’s safety, raise the
appropriate number of side rails and lower the
bed to the lowest position.
10. Follow up with all body position changes to
check for body alignment and patient comfort
level.
11. Dispose of used supplies and equipment.
Leave the patient’s room tidy.
12. Remove and dispose of gloves, if used.
Perform hand hygiene.
13. Document and report the patient’s response
and expected or unexpected outcomes.
ASSISTING WITH POSITIONING A PATIENT
IN BED
SAFETY CONSIDERATIONS
For your safety when moving a patient:
 Outline any special safety precautions to
be followed.
 Raise the level of the bed to a
comfortable working height.
 Keep back, neck, pelvis, and feet
aligned, and avoid twisting.
 Tighten the stomach muscles, and tuck
the pelvis to protect your back.
 Bend at the knees, and let the strong
muscles of the legs do the lifting.
 The person with the heaviest load
coordinates the efforts of the personnel
involved in transferring.
For patient safety when positioning:
 Verify the patient’s range of motion
(ROM).
 Obtain additional help as needed for
positioning a patient.
 Verify the health care provider’s order for
position changes. Some positions may
be contraindicated in certain situations
such as spinal cord injury, hip fracture,
respiratory difficulties, certain
neurological conditions, or presence of
incisions, drains, or tubing.
 Keep the patient's neck and spinal
column in alignment to prevent further
injury.
 Before flattening the bed, account for all
tubing, drains, and equipment to avoid
dislodgment and spills.
 Increase the frequency of positioning the
patient if the patient reports discomfort.
 Supervise and aid assistive personnel
when positioning a patient in bed who is
unable to assist with the movement.
 Explain what to report back to the nurse.
EQUIPMENT
 Draw sheet
 Pillows
 Bath towels or wash cloth
 Trochanter rolls (optional)
DELEGATION
The skill of positioning patients in bed and
maintaining correct body alignment can be
delegated to nursing assistive personnel (NAP).
Be sure to inform NAP of the following:
 Explain any positioning restrictions, such
as avoiding the prone position if the
patient has weakness on one side of the
body.
 Designate specific times throughout the
shift at which NAP must reposition the
patient.
 Provide information regarding the
patient’s individual needs for body
alignment, for example, if the patient has
a spinal cord injury.
PREPARATION
 Assess the patient’s range of motion
(ROM), body alignment, and comfort
level while the patient is lying down.
 Assess for risk factors that contribute to
complications of immobility, such as
decreased sensation, impaired mobility,
impaired circulation, and very young or
 older adult age.
 Assess the patient’s level of
consciousness.
 Assess the condition of the patient’s skin,
especially over bony prominences.
 Assess the patient’s physical ability to
help with positioning, which may be
affected by age, level of consciousness,
disease process, strength, ROM, and
coordination.
  Assess for the presence of tubes,
incisions, and equipment, such as
traction.
 Assess the motivation of the patient and
the ability of family caregivers to
participate in positioning.
 Check the physician’s or health care
provider’s orders before positioning the
patient.
 Raise the level of the bed to a
comfortable working height.
 Remove all pillows and devices used in
the previous position.
 Get extra help as needed.
 Explain the procedure to the patient.
FOLLOW-UP
 Assess the patient’s body alignment,
position, and comfort level.
 Report the patient’s ability to assist with
moving.
DOCUMENTATION
 Assess the patient’s body alignment,
position, and level of comfort. The
patient’s body should be supported by an
adequate mattress, and the vertebral
column should be without observable
curves.
 Measure the patient's range of motion
(ROM).
 Observe for areas of erythema or
breakdown involving the skin.
TRANSFERRING OF CLIENT-
TRANSFERRING FROM BED
TO A WHEELCHAIR USING A
BELT
PROCEDURAL GUIDELINE FOR
TRANSFERRING A PATIENT FROM A BED
TO A WHEELCHAIR
1. Verify the health care provider’s orders.
2. Gather the necessary equipment and
supplies.
3. Provide for the patient’s privacy.
4. Introduce yourself to the patient and family if
present.
5. Identify the patient using two identifiers, such
as name and date of birth or name and account
number, according to agency policy. Compare
these identifiers with the information on the
patient’s identification bracelet.
6. Explain the procedure to the patient.
7. Perform hand hygiene and apply gloves if
indicated.
8. Lock the bed brakes and wheelchair wheels.
Secure the wheelchair wheels bypushing the
handles forward on the locks, which are located
above the wheel rims.
9. Adjust the height of the bed to the level of the
wheelchair seat.
10. Place the wheelchair facing toward the foot
of the bed, midway between the head and the
foot of the bed.
11. Position the wheelchair at a 45-degree
angle to the bed on the same side on the
patient’s stronger side.
12. Secure the wheels by pushing the handles
forward on the locks above the wheel rims.
13. Raise the footrests and swing the leg rests
outward on the wheelchair.
14. You may remove the leg rests before
transferring the patient to avoid trips and falls.
15. Sit the patient up on the side of the bed by
doing the following:
a) With the patient supine, raise the head of
the bed 30 degrees.
b) Turn the patient onto his or her side
facing you, on the side of bed on which
the patient will be sitting.
c) Stand opposite the patient’s hips. Turn
diagonally, so that you face the patient
and the far corner of the foot of the bed.
d) Create a wide base of support by
spreading your feet apart, with the foot
that is closer to the head of the bed in
front of your other foot.
e) Slip your arm that is nearer the head of
the bed under the patient’s shoulders,
supporting the head and the neck.
f) Place your other arm over the patient’s
thighs.
g) Move the patient’s lower legs and feet
over the side of the bed by pivoting
toward your back leg, allowing the
patient’s upper legs to swing down.
h) At the same time, shift your weight to
your back leg and lift the patient on the
side of the bed.
16. Help the patient move to the edge of the
mattress.
17. Allow the patient to sit on the side of the
bed, legs dangling, for a few minutes before
transferring him or her to a wheelchair. Do not
leave the patient unattended during this time.
Ask if the patient feels dizzy.
18. Help the patient apply stable, nonskid
shoes. Place the patient’s weight-bearing, or
stronger, leg forward, with the weaker foot to
the back.
19. Place the transfer belt on the waist of the
patient, over the gown.
20. With the tag of the belt touching the
patient’s gown, slide the metal trimmed end of
the gait belt through the teeth on the other end.
Pull the metal trimmed end away from the teeth.
Tighten the belt until snug on the patient’s
center of gravity. The belt should be tight
enough for 2 fingers to slide into the belt.
21. Spread your feet. Flex your hips and knees,
and align your knees with those of the patient.
22. Grasp the transfer belt along the patient’s
sides.
23. Position yourself slightly in front of the
patient, to guard and protect him or her
throughout the transfer.
24. On the count of three, rock the patient up to
a standing position by straightening your hips
and legs, keeping your knees slightly flexed.
25. While rocking the patient in a back-and-forth
motion, make sure your body weight is moving
in the same direction as that of the patient.
Unless contraindicated, ask the patient to push
up off the mattress.
26. Maintain the stability of the patient’s weak or
paralyzed leg with your knee, and pivot on the
foot that is farther from the wheelchair.
27. Instruct the patient to feel for the edge of the
wheelchair seat against the legs and to use the
armrests for support as you ease him or her into
the wheelchair.
28. Flex your hips and knees while lowering the
patient into the wheelchair.
29. Ensure that the patient is positioned well
back in the seat. Provide support to the
extremities if needed.
30. Lower the footrests after transferring the
patient, and place the patient’s feet on them.
31. Provide comfort measures for the patient
and ensure that the call light is within reach.
32. Place a blanket over the patient’s legs, if
needed.
33. Monitor the patient’s vital signs as needed.
Ask if the patient feels dizzy or fatigued. Note
the patient’s behavior during the transfer.
34. Document how long the patient was on the
chair and the care provided in the EMR.
SAFETY CONSIDERATIONS
 Determine if the patient can fully assist or
partially assist. Do not start the
procedure until all required caregivers
are at the bedside.
 If the patient demonstrates weakness or
paralysis of one side of the body, place
the wheelchair on the patient’s stronger
side.
 Properly apply the transfer belt.
 Position the wheelchair facing toward the
foot of the bed, midway between the
head and the foot of the bed.
 Position the wheelchair at a 45-degree
angle to the bed, lock the brakes, and
remove the footrests or swing them out
of the way. Lock the bed brakes.
 Adjust the height of the bed to the level
of the wheelchair seat.
 Keep back, neck, pelvis, and feet
aligned, and avoid twisting. Twisting your
spine can lead to serious injury.
 Tighten stomach muscles and tuck your
pelvis; this provides balance and protects
the back.
 Bend at the knees; this helps to maintain
your center of gravity and lets the strong
muscles of the legs do the lifting.
 Keep the weight to be lifted as close to
the body as possible; this action places
the weight in the same plane as the lifter
and keeps it close to the center of gravity
for balance.
 Maintain the trunk erect and the knees
bent, so that multiple muscle groups
work together in a synchronized manner.
 The best height for lifting vertically is
approximately 2 feet off the ground and
close to the lifter’s center of gravity.
 The person with the heaviest load
coordinates efforts of the personnel
involved in lifting or transferring.
 Know how physiological influences on
body alignment and mobility affect
patients throughout the life span.
 Know the pathological conditions that
affect a patient’s body alignment and
mobility. Postural abnormalities affect
body mechanics.
 Know the history of underlying chronic
conditions (e.g., diabetes, chronic
obstructive pulmonary disease) or
malnutrition.
  Control factors that indirectly affect body
mechanics by altering the safety of the
environment. Cluttered hallways and
bedside areas increase the risk of falling.
 Know the patient’s fluid balance status.
Dehydration predisposes patients to
orthostatic hypotension.
 Know the patient’s range of motion
(ROM). Contractures or spasticity limit
joint and muscle mobility.
 Determine the patient’s level of sensory
perception.
EQUIPMENT
 Wheelchair
 Gait belt
 Nonskid slippers or shoes
DELEGATION
The skill of transferring a patient from a bed to a
wheelchair using a transfer belt can be
delegated to nursing assistive personnel (NAP).
Be sure to inform NAP of the following:
 How to assist and supervise when
moving patients who are transferring for
the first time after prolonged bed rest,
extensive surgery, critical illness, or
spinal cord trauma
 Report any changes, such as the
patient's mobility restrictions, changes in
blood pressure, or sensory alterations, or
any factors that may affect a safe
transfer
PREPARATION
 Determine if the patient can fully or
partially assist. Do not begin the
procedure until all required caregivers
are at the bedside.
 Assess the physiological capacity of a
patient to transfer and the need for
special adaptive techniques. Assess for
the following:
o Muscle strength (legs and upper
arms)
o Joint mobility and contracture
formation
o Paralysis or paresis (spastic or
flaccid)
o Bone continuity (trauma,
amputation
 Assess for the presence of weakness,
dizziness, or postural hypotension.
 Assess the patient’s level of endurance:
o Assess level of fatigue during
activity.
o Assess vital signs
 Assess the patient’s proprioceptive
function, or awareness of posture, and
changes in equilibrium:
o Ability to maintain balance while
sitting in bed or on the side of the
bed
o Tendency to sway to one side or
to position himself or herself to
one side
 Assess the patient’s sensory status,
including adequacy of central and
peripheral vision, adequacy of hearing,
and loss of peripheral sensation.
 Assess the patient for pain, such as joint
discomfort or muscle spasms, and
measure the level of pain, using a scale
from 0 to 10. Offer a prescribed
analgesic 30 to 60 minutes before
transfer.
 Assess the patient’s cognitive status:
o Ability to follow verbal instructions
o Short-term memory
o Recognition of physical deficits
and limitations to movement
 Assess the patient’s level of motivation,
such as eagerness versus unwillingness
to be mobile.
 Assess conditions such as
neuromuscular deficits, motor weakness,
calcium loss from long bones, cognitive
and visual dysfunction, and altered
balance.
 Assess for previous modes of transfer (if
applicable).
FOLLOW-UP
 Monitor the patient’s vital signs. Ask if
the patient feels dizzy or fatigued.
 Note the patient’s behavioral response to
the transfer.
 Ask if the patient experienced pain
during the transfer.
DOCUMENTATION
 Record the procedure, including
pertinent observations regarding
weakness, ability to follow directions,
balance, weight-bearing ability, ability to
pivot, and amount of assistance (muscle
strength) required to complete the
transfer.
 Report to the next shift or other
caregivers the patient’s transfer ability
and the amount of assistance needed.
Report the patient’s progress or
remission to the rehabilitation staff
(physical therapist, occupational
therapist).
TRANSFERRING FROM A
BED TO A STRETCHER
PROCEDURE GUIDELINE IN
TRANSFERRING A PATIENT FROM A BED
TO A STRETCHER
1. Introduce yourself to the patient.
2. Explain the procedure to the patient
3. Perform hand hygiene and ensure patient
privacy.
4. Identify the patient using two identifiers, such
as name and date of birth or name and account
number, according to agency policy. Compare
these identifiers with the information on the
patient’s identification bracelet.
5. Determine the number of staff required to
transfer the patient safely from the bed to a
stretcher using a horizontal slide board or other
friction-reducing device. At least 2 assistants
are needed for any type of transfer. A third
assistant is recommended to support the head
and neck if the patient is weak or unable to
assist during the transfer.
6. Raise the bed to a comfortable height.
7. Make sure the bed brakes are locked. Lower
the head of the bed as much as the patient can
tolerate.
8. Support the patient’s head as you remove the
pillow.
9. Cross the patient’s arms over his or her
chest.
10. Lower the side rails of the bed. To place a
slide board under the patient, position two
nurses on the side of the bed to which the
patient will be turned. Position the third nurse
on the other side of the bed.
11. Fanfold the draw sheet on both sides.
12. On the count of three, turn the patient onto
his or her side toward the two nurses. Turn the
patient as a single unit, with a smooth,
continuous motion.
13. Place the slide board under the draw sheet.
14. Gently roll the patient back onto the slide
board.
15. Adjust the position of the patient to center
his or her weight onto the slide board.
16. Line up the stretcher with the bed. Lock the
brakes on the stretcher.
17. Two nurses position themselves on the side
of the stretcher, while the third nurse is
positioned on the side of the bed without the
stretcher.
18. Fanfold the draw sheet. On the count of
three, the two nurses pull the draw sheet, with
the patient, onto the stretcher as the third nurse
holds the slide board stationary.
19. Position the patient in the center of the
stretcher and remove the slide board from
under the patient.
20. Raise the head of the stretcher if doing so is
not contraindicated. Raise the side rails on the
stretcher, and cover the patient with a blanket.
21. Perform hand hygiene.
22. Document the procedure and how well the
patient tolerated the procedure.
SAFETY CONSIDERATIONS
 Use a friction-reducing device if any
caregiver will be expected to lift more
than 35 pounds of the patient’s body
weight. Do not start the procedure until
all required caregivers are at the
bedside.
 The person with the heaviest load
coordinates the efforts of the personnel
involved in lifting or transferring.
 Determine if the patient can fully or
partially assist.
 Ensure that the brakes are locked on the
bed and the stretcher.
 Position an assistant at the head of the
bed to protect and support the head and
neck if the patient is weak or unable to
assist with the transfer.
 Use appropriate body mechanics to
avoid injury of the nursing staff.
 Keep the weight to be lifted as close to
the body as possible; this action places
the weight in the same plane as the lifter
and close to the center of gravity for
balance.
 The best height for vertical lifting is
approximately 2 feet off the ground and
close to the lifter’s center of gravity.
 Know the pathological conditions that
affect a patient’s body alignment and
mobility. Postural abnormalities affect
body mechanics.
 Control factors that indirectly affect body
mechanics by altering the safety of the
environment.
EQUIPMENT
 Drawsheet
 Blanket
 Slide board or friction-reducing device
 Stretcher
 peripheral vision, adequacy of hearing,
DELEGATION and presence of peripheral sensation
The skill of transferring a patient from a bed to a loss.
stretcher can be delegated to nursing assistive  Assess the patient for pain (e.g., joint
personnel (NAP). Be sure to inform NAP of the discomfort, muscle spasm), and measure
following: the level of pain using a scale from 0 to
10. Offer a prescribed analgesic 30 to 60
 How to assist and supervise when  minutes before transfer.
moving patients who are transferred for  Assess the patient’s cognitive status,
the first time after prolonged bed rest, including the following:
extensive surgery, critical illness, or o Ability to follow verbal instructions
spinal cord trauma o Short-term memory
 Report any changes, such as the  Recognition of physical deficits and
patient's mobility restrictions, changes in movement limitations
blood pressure, sensory alterations, or
 Assess the patient’s level of motivation,
any factors that may affect a safe
such as eagerness versus unwillingness
transfer.
to be mobile.
 Assess for conditions such as
PREPARATION
neuromuscular deficits, motor weakness,
 Determine the number of people needed
calcium loss from long bones, cognitive
to assist with transfer. Do not begin the
and visual dysfunction, and altered
procedure until all required caregivers
balance.
are available.
 Assess for previous mode of transfer (if
 Determine whether any caregiver would
applicable).
be required to lift more than 35 pounds of
a patient’s weight. If so, the patient is
considered fully dependent, and an FOLLOW-UP
assist device is used.  Monitor the patient’s vital signs. Ask if
 Assess whether a nurse needs to be the patient feels dizzy or fatigued.
positioned at the head of the patient’s  Note the patient’s behavioral response to
bed to protect and support the head and the transfer.
neck if the patient is weak or unable to
 Ask if the patient experienced pain
assist.
during the transfer.
 Assess the patient’s physiological
capacity to transfer and the need for DOCUMENTATION
special adaptive techniques.
 Record the procedure, including
 Assess for the following: pertinent observations such as patient
o Muscle strength (legs and upper weakness, ability to follow directions,
arms) number of personnel needed to assist,
o Joint mobility and contracture and amount of assistance (muscle
formation strength) required.
o Paralysis or paresis (spastic or  Report the patient’s transfer ability and
flaccid) the amount of assistance needed to the
o Bone continuity (trauma, next shift or to other caregivers.
amputation)
 Assess for the presence of weakness,
dizziness, or postural hypotension.
PERFORMING PASSIVE
 Assess the patient’s level of endurance, RANGE OF MOTION
including level of fatigue during activity
and vital signs.
EXERCISES
 Assess the patient’s proprioceptive
function (awareness of posture and
changes in equilibrium), including the PROCEDURE GUIDELINE FOR
following: PERFORMING PASSIVE RANGE OF MOTION
o Ability to maintain balance while EXERCISES
sitting in bed or on the side of the
bed
o Tendency to sway to one side or 1. Verify the health care provider’s orders.
to position himself or herself to
2. Gather the necessary equipment and
one side
supplies.
 Assess the patient’s sensory status,
including adequacy of central and
3. Perform hand hygiene and provide patient
privacy.
4. Introduce yourself to the patient and family, if
present.
5. Identify the patient using two identifiers, such
as name and date of birth or name and account
number, according to agency policy. Compare
these identifiers with the information on the
patient’s identification bracelet.
6. For all passive ROM:
A. Expose only the limb being exercised. Move
each joint slowly and gently. When performing
passive ROM exercises, support each joint by
holding the distal portion of the extremity or
using a cupped hand to support the joint.
B. Complete the exercises in head-to-toe
sequence, being careful to not exercise a joint
to a point of fatigue, pain, or resistance.
C. Repeat each movement five times during the
exercise period. Inform the patient how these
exercises can be incorporated into routine
activities of daily living.
D. Measure the joint motion as needed, to
record improvement in a patient’s flexibility as
rehabilitation progresses.
7. Apply clean gloves if the patient has any
wound drainage or open skin lesions, or is on
isolation precautions.
8. Stand on the side of the bed closest to the
joint to be exercised. Cover the patient with a
bath blanket and fold down the top linens to the
foot of the bed.
9. Help the patient into a comfortable position,
preferably sitting or lying down in bed.
10. To perform passive ROM on a patient’s
neck:
A. Move the neck into flexion by tipping the
patient’s chin toward the chest. Move the neck
into extension by positioning the patient’s head
erect. Hyperextend the neck by tipping the head
back as comfortably as the patient is able to
tolerate.
B. Move the neck to lateral flexion by tipping the
head to each shoulder as far as possible.
C. Perform rotation by rotating head as far as
possible in a circle.
11. To perform passive ROM on a patient’s
shoulder:
A. Move the shoulder into flexion by raising the
arm forward and above the patient’s head.
Extension is performed by lowering the patient’s
arm to his or her side. Hyperextend the arm by
moving the arm behind the patient’s body,
keeping the elbow straight.
B. Move shoulders into abduction by raising the
arms to the side and overhead with the palms
facing out. Move the shoulders into adduction
by lowering arm sideways and across the body
as far as possible.
C. Perform internal rotation by moving the
patient’s arm at the shoulder, with the elbow
flexed, until the patient’s thumb is down and the
elbow is lateral to the side. External rotation is
done by moving the arm, with the elbow flexed,
until the elbow is lateral to the head.
D. Perform circumduction by moving the
patient’s arm in a full circle.
12. To perform passive ROM on a patient’s
elbow:
A. Flexion of the elbow is done by bending the
arm at the elbow until the patient’s hand is
touching his or her shoulder. Extension of the
elbow is done by straightening elbow and
lowering his or her hand.
B. supination of the elbow is done by turning the
patient’s lower arm and hand until the palm is
facing up. Pronation is done by turning lower
arm and hand until the palm is facing down.
13. To perform passive ROM on a patient’s
wrist
A. Wrist flexion is done by moving the palm
towards the inside of the forearm. Extend the
wrist by moving the fingers into the same plane
as the hand and forearm. Hyperextend the wrist
by moving the dorsal surface of the hand back
as far as possible.
B. Move the wrist into radial deviation by
bending it medially toward the thumb. Move the
wrist into ulnar deviation by bending the wrist
laterally towards the fifth finger.
14. To perform passive ROM on a patient’s
finger:
A. Finger flexion is done by closing the patient’s
fingers and making the hand into a fist. Extend
the fingers by straightening the fingers.
Hyperextend the fingers by gently bending them
back as far as the patient can tolerate.
B. Abduct fingers by spreading them apart.
Adduct fingers by bringing them together.
15. To perform passive ROM on a patient’s
thumb:
A. Move the patient’s thumb across the palm for
thumb flexion. Move patient’s thumb directly
away from the hand for thumb extension.
B. For abduction, extend the thumb laterally.
For adduction, move the thumb back toward the
hand. Touch patient’s thumb to each finger for
opposition
16. To perform passive ROM on a patient’s hip:
A. Move the patient’s leg forward and up for hip
flexion. Return leg to original position for hip
extension. With the patient prone, lying on side,
or standing, hyperextend the hip by moving the
leg back beyond the normal range of extension.
B. Abduction is done by moving the leg laterally
away from the body. Adduction is done by
moving the leg toward the patient’s midline and
beyond.C. Externally rotate the hip by turning
the foot and leg out. Internally rotate
the hip by turning the foot and leg in.
D. Circumduction is performed by moving the
leg in a full circle.
17. To perform passive ROM on a patient’s
knee:
A. With the patient prone, side-lying, or
standing, bend the knee by bringing the heel
toward the back of the thigh for knee flexion.
For knee extension, return the leg to a straight
position.
18. To perform passive ROM on a patient’s
ankle/foot:
A. With the patient supine, perform dorsiflexion
by pointing the toes toward the head. For
plantar flexion, point the toes toward away from
the patient’s head.
19. To perform passive ROM on a patient’s foot:
A. Invert the foot by turning the sole medially or
toward the middle. Eversion of the foot is done
by turning the sole laterally or outward.
B. Circumduction of the foot is done by moving
the foot in a full circle.
20. To perform passive ROM on a patient’s
toes:
A. Curl the toes down for toe flexion. Straighten
the toes for toe extension.
B. Toe abduction is done by spreading the toes
apart. Toe adduction is done by bringing the
toes back together.
21. Place the call light within easy reach, and
make sure the patient knows how to use it to
summon assistance.
22. To ensure the patient’s safety, raise the
appropriate number of side rails and lower the
bed to the lowest position.
23. Remove and dispose of gloves, if used.
Perform hand hygiene.
24. Leave the patient’s room tidy.
25. Document and report the patient’s response
and expected or unexpected outcomes.
SAFETY CONSIDERATIONS
 Prepare the patient. Make sure that the
patient is rested and not fatigued.
 Perform exercises slowly, and provide
adequate support to each joint being
exercised.
 Do not exercise joints beyond the point
of resistance or to the point of fatigue or
pain.
 When you note resistance within a joint,
do not force the joint motion. Consult
with the health care provider or a
physical therapist.
 Patients with spinal cord or orthopedic
trauma usually require ROM exercise by
specialized health care professionals or
physical therapists.
EQUIPMENT
 Working gloves
 Goniometer (if available)
DELEGATION
 The skill of performing ROM exercises
can be delegated to nursing assistive
personnel (NAP). Be sure to inform NAP
of the following:
 Remind NAP not to perform exercises on
any patient with spinal cord or orthopedic
trauma, since exercising will be done by
a specialized health care professional or
physical therapist.
 Remind NAP to perform exercises slowly
and to provide adequate support to each
joint being exercised.
 Caution NAP not to exercise joints
beyond the point of resistance or to the
point of fatigue or pain.
  Discuss the patient’s individual
limitations or preexisting conditions, such
as arthritis, that may affect ROM.

PREPARATION
 Review the patient’s chart for physical
assessment findings, health care
provider’s orders, medical diagnoses,
medical history, and progress.
 Obtain data on the patient’s baseline
joint function. Observe for limitations in
joint mobility; redness or warmth over
joints; joint tenderness; joint deformities;
and crepitus produced by joint motion.
 Assess the patient’s level of comfort (on
a scale of 0 to 10, with 0 being no pain
and 10 being the worst pain possible)
before exercising. Determine if the
patient would benefit from receiving pain
medication before beginning ROM
exercises.
 Determine the patient’s or family
caregiver’s readiness to learn. Explain all
rationales for the ROM exercises, and
describe and demonstrate the exercises
to be performed.
 Know the patient’s home care plan. The
patient may need to continue the
exercise regimen or use an assistive
device at home.

FOLLOW-UP
 Observe the patient performing ROM
activities.
 Evaluate the patient’s response to the
ROM exercises. Note any discomfort or
fatigue.
 Compare the patient’s performance of
ROM exercises to the baseline.
 Measure the patient’s joint motion as
needed.
 Monitor the patient for any pain
throughout the ROM exercise period.

DOCUMENTATION
 Record which joints were exercised with
passive ROM exercises, type of exercise
performed, number of repetitions of each
exercise, extent to which the joints can
be moved, any joint abnormalities, your
assessment of the patient’s muscular
strength and comfort after exercise, the
patient’s subjective statements regarding
muscular strength, and the patient’s
ability to perform the exercises.