Body Mechanics for PSWs

Body Mechanics Overview

• Body mechanics involves moving, positioning, transferring, and lifting clients.
• Understanding and applying proper body mechanics can help prevent injuries for both the caregiver and the client.

Importance of Good Body Mechanics

• Daily tasks involve lifting, moving, and carrying items.
• Good body mechanics include moving efficiently and carefully, having good posture and balance, and using the strongest and largest muscles.
• Shoulders, upper arms, hips, and thighs are the strongest and largest muscles to utilize.
• Avoid using back muscles to prevent injuries.

Client and PSW Injuries

• Client injuries due to poor body mechanics: shearing, pressure ulcers, contractures, difficulty breathing.
• PSW injuries include back pain, sprains, fatigue, and muscle pain.

Base of Support and Guidelines

• Feet provide the base of support for good body mechanics.
• A base of support is the area on which an object rests.
• A wide base of support is more stable than a narrow one.
• Maintain feet shoulder-width apart when performing activities with a client.
• Get help if the client's weight is too much to handle safely.
• Squat instead of bending over.
• Bend at the knees and hips, not forward from the waist.
• Keep one leg back when pulling an object.
• Avoid using your back muscles.
• Arrange equipment and supplies within easy reach before starting a task.
• Turn your whole body as one unit when changing direction.
• Avoid twisting the body.
• Move your feet in the direction of the turn.
• Push, slide, or pull objects instead of lifting them.
• Pushing is easier than pulling because you are using your body weight.

Body Alignment

• Body alignment refers to how body parts (head, trunk, arms, and legs) are positioned in relation to one another.
• Good body alignment helps the PSW move and function efficiently, reduces strain, and prevents injury.
• Good body alignment helps patients avoid disabling complications like muscle atrophy and contractures.
• Constantly check to ensure clients are properly positioned or repositioned.

Client Mobility Differences

• Some clients can move and position themselves, while others need support or assistance.
• Some clients can’t move by themselves due to paralysis or being unconscious
• Some patients may need assistance from assistive devices like turning pads or lifts
• Check the care plan to know how to assist

Pre-Moving/Lifting Safety

• Before moving or lifting a client ask; "Can I do this safely?"
• Ensure you have the proper equipment including assistive devices such as; turning pads or lifts.
• Assess the client's ability to assist or follow instructions.
• Check the care plan and consult with your supervisor.
• Be sure that there's enough qualified assistants.
• Check for a "NO LIFT" policy, which indicates a mechanical lift must be used.

Movement Safety

• Friction is the resistance the skin encounters when rubbing against another surface.
• Shearing occurs when skin tissues tear due to the skin sticking to a surface.
• Shearing happens when a client slides down or is moved in bed.
• Friction and shearing can be painful and cause skin and health problems.
• Elderly clients are at higher risk due to fragile skin.
• Quilted turning pads and slider sheets help avoid friction and shearing.
• Use the right number of caregivers during assistance.
• Ensure bed sheets are wrinkle-free and smooth to minimize friction and pressure.

Position and Alignment Importance

• Always ensure proper client positioning
• Regular position changes promotes comfort, well-being, breathing and circulation.
• Regular positon also helps prevent pressure ulcers and contractures.

Moving Clients Up in Bed

• Clients often slide down and slouch in bed.
• Leaving clients in a slouched position can impair breathing and cause shearing.
• Use a quilted turning pad, under the client.
• Have the patient can use their own hands or feet to push, or get another person to assist.

Self Care

• Be aware of your own body alignment.
• Keep the bed at your waist level.
• Avoid twisting or bending your back.
• Ask for help when needed.
• Lower the side rail instead of reaching over it.

Repositioning

• Clients in bed or chair should be repositioned every 2 hours.
• Follow supervisor's instructions and the care plan.
• Physician orders may limit some positions.
• Always leave the client in good body alignment.
• Observe the skin for redness, paleness, or discoloration and report it immediately.

Turning Clients

• Certain procedures may require turning a patient to a side-lying position.
• Frequent repositioning helps prevent bedsores and bedrest complications.
• Easiest way to turn is to roll, neck and spine must be turned in one step
• Turning pads assist turning
• Clients are turned either away or toward you depending on where standing.
• Turning may be painful for clients with arthritis or who have had surgery.
• Two caregivers may be needed with tall, heavy, or painful turn patients.

Lateral or Side Lying Position

• Lower the head of the bed to flat or mostly flat; some clients may have breathing trouble if completely flat.
• Place a small pillow under the head and shoulders.
• Position arms along the person's sides with palms facing down.
• Place a small pillow under the arms and hands.
• Put a small pillow under the knees to keep them flexed, reducing back strain.
• Use small pillows or rolled towels under the lower back, thighs, and ankles as directed.

SIMS, and Supine Positions

• Lower the head of the bed to flat or mostly flat; some may have trouble breathing if completely flat.
• Pillows under the head and shoulders.
• Position palms facing down.
• Use pillows or rolled towels under the lower back, thighs, and ankles if your supervisor tells you to.
• SIMS is a left side lying position with special attention to pillow and arm usage.
• Lateral is comfortable for resting, check hip
• Supine is good for resting

Fowler's Positions

• Fowler's position is a semi-sitting to upright sitting position in bed.
• High Fowler's: Head of bed raised 45-90 degrees, knees may be slightly elevated.
• Semi-Fowler's: Head of bed at 30-45 degrees.
• Low-Fowler's: Head of bed at 15-30 degrees.
• Clients confined to bed use these positions for eating, visiting, watching TV, and reading.
• Use pillows for support and maintain good body alignment during all Fowler's positions.
• It is important to reposition clients every 2 hours
• Never leave frail clients unattended in a 90-degree position.

Moving Clients in Segments

• Moving a client in segments involves lifting and pulling them towards the edge of the bed in stages.
• Step 1: One arm under client's shoulders and neck, other arm under client's back.
• Step 2: One arm under client's back, the other under upper thigh just below buttocks.
• Step 3: One arm under client's mid-thighs, the other under mid-calf, also supporting shoulders and neck.
• Push down into the mattress when sliding your arms under client’s body to avoid shearing.

Moving to Edge of Bed

• Move client to the edge of the bed avoid reaching too much when providing care.
• Caregivers move clients here before repositioning or turning.
• Support patient when sitting at side (edge) of bed.
• The client can steady themselves, perform exercises, breathe or cough while sitting at side of bed.
• This can also help those preparing to walk or transfer to a wheelchair.

Reporting

• Always report observations; especially if the patient exhibits pale, greyish, or bluish skin(cyanosis)
• Report if you discover complains of dizziness, light headedness and difficulty breathing
• If client faints or experiences dizziness, lay the client back down
• Accurately reporting how well the activity was tolerated and the amount of time the legs dangled.
• Accurately report the level of the amount of help needed

Log-Rolling Clients

• Log-rolling is turning the client as a unit while keeping proper alignment, in one smooth motion
• log-rolling requires 3 people.
• Used for older clients with arthritic spines or knees.
• This can also be used with clients recovering from hip fractures, spinal cord injuries, or spinal surgery.

Procedure Key Skills

• Key skills to perform during any procedure during pre, post and during.
• Check the care plan, control infection, set bed brakes, organize supplies and ensure privacy before.
• Make necessary observations about client tolerance and assess pain during.
• Increase safety of environment, ensure call bell is within reach, make sure infection is controled, and remove any privacy measure after.

PSW Principles

• The five key principles for the PSW when completing are task are:
• Organization, communication, control infection, knowledge and safety.

DIIPPS

• DIIPPS stands for Dignity, Independence, Individualized, Privacy, Preference, Safety.
• Do not forget DIIPPs during client care.