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01.05 Mobility & Assistive Devices

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Overview

  1. Purpose
    1. Proper movement of patients while in bed, out of bed, and during ambulation prevents injury to the patient AND the nurse
    2. Assistive devices provide stability and balance during ambulation to prevent falls

Nursing Points

General

  1. Supplies
    1. Draw sheet
    2. Gait belt
    3. Cane
    4. Walker
    5. Crutches
  2. Pro-Tips
    1. Fit the patient for their device based on manufacturer instructions
    2. Top priority = safety
    3. Utilize PT/OT as a resource for education

Nursing Concepts

  1. Moving a patient up in bed
    1. Two staff members should position themselves at the patient’s waist with the head of bed flat
    2. Each staff member should fan-fold and grasp the draw sheet tightly
    3. Have the patient cross their arms over their chest and tuck their chin to chest
      1. Remind the patient to let the staff do all the work
    4. Staff members should have a wide stance, knees bent, with one foot at the patient’s hip and the other ready to step toward the patient’s head
    5. On a count of 3,  the staff members should step towards the head of the bed to slide the patient upward
      1. Try not to “drag” – this will hurt your back and cause friction/shear for the patient
      2. Lift the patient off the bed whenever possible to avoid friction/shear
    6. If unsure of ability to hoist patient up the bed without ‘drag’ – obtain help from extra staff members
  2. Getting a patient out of bed
    1. Lower the bed to its lowest position
    2. Lock wheels
    3. Turn patient to side facing where they will exit
    4. Lower side rail
    5. Have patient lift up on their lower elbow and push up to sitting while they swing their legs over the side of the bed
    6. Evaluate for dizziness/lightheadedness
      1. If none, move forward
      2. If so, wait
    7. If instability is suspected, apply a gait belt at this time
    8. Have the patient scoot their hips forward until their feet can touch the floor
      1. For very short patients and/or tall beds, a step stool should be utilized
    9. Rock back and forth 3 times for momentum, then have the patient stand up on 3.  Use the gait belt for support – don’t pull.
    10. The patient should:
      1. Keep their head up and eyes forward
      2. Push with their legs
      3. Stand up nice and tall with a straight back
    11. Evaluate again for dizziness
      1. If none, continue with next task
  3. Cane
    1. Position the cane on the unaffected side
    2. Patient’s arm should stay slightly bent at the elbow
    3. Advance cane approximately 6-10 inches in front
    4. Move the affected leg forward even with the cane
    5. Using the cane for stability, advance unaffected leg past the cane
    6. Bring affected leg even with the unaffected leg
    7. Repeat steps C – F
  4. Walker
    1. Stand in the center of the walker
    2. Lift/slide the walker 6-8 inches forward
      1. Too far forward can cause the patient to fall
      2. Ensure all 4 feet of the walker are on the ground
    3. Take a step forward with affected side, putting weight on the walker and the unaffected leg
    4. Bring unaffected leg in line with the affected leg/walker
    5. Repeat steps B – D
  5. Crutches
    1. Setup/Placement
      1. Use handles for stability, not arm rests
      2. Don’t place in armpits
        1. Can cause injury to axilla
      3. Brace through arms and shoulders
    2. Three-Point Gait
      1. Used when affected leg is partial-weight bearing
      2. Advance crutches WITH affected leg approximately 1 foot to the front
      3. Bring unaffected leg forward
      4. Repeat ii – iii
    3. Swing-Through Gait
      1. Used when affected leg is non weight bearing
      2. Stand on unaffected leg, lift affected foot off ground
      3. Advance both crutches approximately 1 foot forward
      4. Put weight on the hand grips, bracing through shoulders and arms
      5. Swing both legs through the crutches to approximately 1 foot in front of the crutches
      6. Repeat ii – v

Patient Education

  1. Educate, re-educate, reinforce education, demonstrate, watch return demonstration – this is ALL about educating the patient on the proper use of these devices.
  2. Be clear and concise with your instructions during mobility and ambulation – if you aren’t clear, a patient could make a wrong move and be injured

Reference Links

Study Tools

Video Transcript

In this video we’re going to look at a few highlights in patient mobility. Moving a patient up in bed, getting a patient out of bed, and the use of assistive devices like a cane, walker, and crutches.

First let’s look at moving a patient up in bed. The whole goal here is to protect your back while also preventing any friction and shear for the patient
So you and another colleague will stand at the patient’s waist with the head of bed flat and you’ll grab the draw sheet firmly. You want to have a wide stance with your knees bent. You need to be able to step toward the patient’s head, so make sure your other foot isn’t farther than their hips.
Have the patient cross their arms over their chest and tuck their chin and remind them to let you do all the work
On the count of 3 you’ll lift and step towards the patient’s head. The BIG thing here is you should not be dragging the patient. If the patient is too heavy to avoid dragging, use trendelenburg or get more help!
Now, let’s say you want to get the patient out of bed. The first thing you’ll do is have them turn towards you on their side. Then lower the side rail.
Then, they should lift themselves up onto their elbow, then up to sitting as they swing their legs over the side. You can help them with their legs if necessary.
At this point if your patient might be a little unstable when they stand, you can go ahead and apply a gait belt for support.
Then you’ll have the patient scoot their hips forward until their feet touch the ground, or a step stool if you need it.
Have the patient rock back and forth a few times for momentum, then stand up on 3. Tell the patient to keep their head up, push with their legs, and straighten their back. Make sure you’re standing in front of the patient to help hold them steady.
Now that they’re up, you can move on to the next task. So let’s say they need to ambulate with a cane. In this case, we’ll call the LEFT side the affected side. So you want the patient to hold the cane on the UNaffected side!
The patient should advance cane approximately 6-10 inches in front of them, then move their affected leg forward even with the cane.
Now, using the cane for stability, they will advance unaffected leg past the cane, then bring the affected leg and the cane even with the unaffected leg. And then repeat.
Cane, bad leg even, good leg past, bring it together. That’s it.
Now, let’s look at the use of crutches. Poor Tammy, she’s broken today. Again, we’ll say the LEFT leg is the affected leg. There are two main ways we want to show you – a partial weight-bearing method and a non-weight bearing method.
For partial weight bearing, you use the three-point gait. The patient will advance the crutches WITH affected leg approximately 1 foot to the front. Then, using the crutches for stability, bring the unaffected leg forward to meet it. Remember the weight on the crutches should be on the handles, NOT in the armpits. Then, just repeat.
Crutches and bad leg, good leg meets them.
Now, if the patient is NON weight bearing on that leg, we use the swing-through gait. The patient should hold that foot up, bending at the knee.
The patient will advance both crutches approximately 1 foot forward by themselves. Then they’ll put weight on the hand grips, bracing through shoulders and arms – again NOT the armpits. Then they’ll swing both legs through the crutches to approximately 1 foot in front of the crutches. And repeat.
Crutches, swing legs, repeat. If they aren’t sure, they can use a smaller distance with the crutches to keep themselves more steady.
Lastly, let’s look at using a walker. Again, with the LEFT side as the affected side. Have the patient stand in the center of the walker.
Then, they should lift or slide the walker 6-8 inches forward, but not TOO far forward or they could fall over.
Once all 4 feet of the walker are on the ground, the patient can take a step forward with affected side, putting weight on the walker and the unaffected leg. Then bring unaffected leg in line with the affected leg and walker.
So walker, bad leg, good leg, repeat.

So that’s it for these important mobility topics and assistive devices. We hope that was helpful. If at any point you aren’t sure if you’re teaching it well enough, grab your physical therapists and watch them teach it – they’re mobility rockstars!

Okay guys, go out and be your best selves today. And, as always, happy nursing!

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