You will move persons often. You assist with bed mobility. The Centers for Medicare & Medicaid Services (CMS) defines bed mobility as how a person moves to and from a lying position, turns from side to side, and re-positions in a bed or other furniture. You also position persons in chairs and wheelchairs. You must work carefully to protect yourself and the person from injury.
Preventing Work-Related Injuries
Moving procedures involve lifting, awkward postures, and repeated motions. These place you at increased risk for injury. You must prevent work-related injuries during moving procedures. See Chapter 17.
Good body mechanics alone will not prevent injury. The Occupational Safety and Health Administration (OSHA) recommends:
Each person is different. Careful planning is needed to move the person safely. You must know:
• The person’s functional status. Functional status is the person’s ability to perform the activities of daily living (ADL) required to meet basic needs and required for health and well-being. Some persons move without help. Others depend on the staff. Know the person’s functional status before you move a person. See Box 18-1. Tell the nurse about changes in the person’s abilities.
• The number of staff needed. This depends on the person’s height, weight, cognitive function, and functional status. Some persons need no help. Or they just need reminders or help with devices or equipment. Others need help from 1, 2, 3, or more staff.
• The equipment needed. Assist equipment and devices are presented throughout this chapter. The nurse and care plan tell you what to use. Always follow the manufacturer’s instructions. Ask for training to use the equipment and devices safely.
Protecting the Skin
Protect the person’s skin during moving procedures. Friction and shearing injure the skin. Both cause infection and pressure ulcers (Chapter 37).
• Friction is the rubbing of 1 surface against another. When moved in bed, the person’s skin rubs against the sheet.
To reduce friction and shearing when moving the person in bed:
• Use friction-reducing devices. Such devices include a lift sheet (turning sheet). Drawsheets (Chapter 21) serve as lift sheets (turning sheets). Turning pads (Fig. 18-2), large re-usable waterproof under-pads (Chapter 21), and slide sheets (p. 269) are other friction-reducing devices.
Moving Persons in Bed
Some persons can move and turn in bed. Others need help from at least 1 person. Those who are weak, unconscious, paralyzed, or in casts need help. Sometimes 2 or 3 people or a mechanical lift (Chapter 19) is needed. Follow the guidelines in Box 18-2 when lifting or moving persons in bed.
Raising the Person’s Head and Shoulders
Sometimes you raise the person’s head and shoulders to give care. Simply turning or removing a pillow requires this procedure. You can raise the person’s head and shoulders easily and safely by locking arms with the person. Do not pull on the person’s arm or shoulder. Have help with older persons and with those who are heavy or hard to move. This protects the person and you from injury.
Moving the Person Up in Bed
When the head of the bed is raised, it is easy to slide down toward the middle and foot of the bed (Fig. 18-5). You move the person up in bed for good alignment and comfort.
You can sometimes move light-weight adults up in bed alone if they assist using a trapeze. However, it is best done with help and an assist device (p. 269). For heavy, weak, and older persons, 2 or more staff members are needed. Always protect the person and yourself from injury.