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What is the primary focus of bed mobility activities?
What is the primary focus of bed mobility activities?
Which of the following does not count as a type of transfer?
Which of the following does not count as a type of transfer?
What must be documented as part of the bed mobility process?
What must be documented as part of the bed mobility process?
In what position is a patient likely to be before transitioning to sitting EOB?
In what position is a patient likely to be before transitioning to sitting EOB?
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Which of the following best describes functional mobility as it pertains to patient care?
Which of the following best describes functional mobility as it pertains to patient care?
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What is essential when instructing assistants on safe lift transfers?
What is essential when instructing assistants on safe lift transfers?
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Which activity is included under bed mobility?
Which activity is included under bed mobility?
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What is a key factor to consider when implementing scooting methods in patient care?
What is a key factor to consider when implementing scooting methods in patient care?
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In the supine to sidelying rolling method, where should the therapist ideally position themselves?
In the supine to sidelying rolling method, where should the therapist ideally position themselves?
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When transitioning a patient from sitting to supine, what is the critical factor to ensure safety and effectiveness?
When transitioning a patient from sitting to supine, what is the critical factor to ensure safety and effectiveness?
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What should be the primary focus during transfers between surfaces?
What should be the primary focus during transfers between surfaces?
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What hand placement is recommended when performing supine to sitting transitions?
What hand placement is recommended when performing supine to sitting transitions?
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What is the recommended distance to scoot a patient at a time?
What is the recommended distance to scoot a patient at a time?
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Which position of the clinician’s arm placement is correct when scooting a patient side to side?
Which position of the clinician’s arm placement is correct when scooting a patient side to side?
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When is it appropriate to use a draw sheet during patient movement?
When is it appropriate to use a draw sheet during patient movement?
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What should be done with the pillow beneath the patient’s head while scooting up towards the head of bed?
What should be done with the pillow beneath the patient’s head while scooting up towards the head of bed?
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What motion is recommended for a clinician to move a patient sideward?
What motion is recommended for a clinician to move a patient sideward?
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Which arm placement is NOT listed for clinician support during scooting side to side?
Which arm placement is NOT listed for clinician support during scooting side to side?
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What can be used to facilitate a patient sliding downwards in bed?
What can be used to facilitate a patient sliding downwards in bed?
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Which of the following clinician arm placements is appropriate when scooting a patient down towards the feet of the bed?
Which of the following clinician arm placements is appropriate when scooting a patient down towards the feet of the bed?
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What is the primary goal when assisting a patient with scooting movements?
What is the primary goal when assisting a patient with scooting movements?
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What initial step should be taken before performing patient scooting movements?
What initial step should be taken before performing patient scooting movements?
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What is the primary focus of the Bed Mobility Intervention?
What is the primary focus of the Bed Mobility Intervention?
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What should be avoided in the footwear of a patient during bed mobility?
What should be avoided in the footwear of a patient during bed mobility?
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During bed mobility intervention, what command style is most effective?
During bed mobility intervention, what command style is most effective?
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Which condition requires avoiding trunk side bending during bed mobility?
Which condition requires avoiding trunk side bending during bed mobility?
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What is the proper position for a caregiver during bed mobility?
What is the proper position for a caregiver during bed mobility?
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Which of the following movements should NOT be performed after a total hip replacement?
Which of the following movements should NOT be performed after a total hip replacement?
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What tool can be used to aid movement for patients following a hip replacement?
What tool can be used to aid movement for patients following a hip replacement?
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What two movements should patients avoid after a posterior hip replacement?
What two movements should patients avoid after a posterior hip replacement?
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What is essential for a safe and efficient transfer during bed mobility?
What is essential for a safe and efficient transfer during bed mobility?
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In Method 1 for higher level patients, what is the primary role of the therapist?
In Method 1 for higher level patients, what is the primary role of the therapist?
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What is the first step in Method 2 for assisting a lower level patient?
What is the first step in Method 2 for assisting a lower level patient?
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When assisting a patient with bridging, which area do therapists primarily support?
When assisting a patient with bridging, which area do therapists primarily support?
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Which arm does a stronger clinician use to support under the patient's head?
Which arm does a stronger clinician use to support under the patient's head?
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Why should the therapist assess the difficulties a patient has while scooting up?
Why should the therapist assess the difficulties a patient has while scooting up?
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Which technique does NOT involve the therapist's direct support for the head or shoulders?
Which technique does NOT involve the therapist's direct support for the head or shoulders?
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In what situation would the therapist MOST likely assist at the pelvis during scooting up?
In what situation would the therapist MOST likely assist at the pelvis during scooting up?
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What is the main objective when a therapist removes the pillow for a patient scooting up?
What is the main objective when a therapist removes the pillow for a patient scooting up?
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How does a therapist assist a patient who is using their arms while scooting?
How does a therapist assist a patient who is using their arms while scooting?
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When assisting a lower level patient, which method is recommended?
When assisting a lower level patient, which method is recommended?
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Study Notes
Pierson and Fairchild's Principles & Techniques of Patient Care - Chapter 8: Bed Mobility & Transfer Activities
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Chapter Objectives:
- Instruct patients on bed mobility and functional activities preparing for transfers.
- Adjust recumbent patient positioning for transfers, with or without assistance.
- Instruct individuals on various transfer techniques, with and without assistance.
- Instruct assistants on safe lift transfers.
- Instruct individuals on proper patient guarding and protection during transfers.
Definition of Transfer
- Safe movement of a person from one surface, location, or position to another.
Bed Mobility
- A specific type of transfer.
- Viewed as a separate entity due to the numerous components and considerations involved in transferring someone from a bed.
Functional Mobility: Bed Mobility, Transfers & Gait
- Bed mobility: Techniques, verbal cues, level of assistance, precautions, and sitting balance involved with repositioning in/on a bed, mat, plinth, etc. (e.g., supine, prone, side-lying, sitting).
- Transfers: Moving someone from a surface to another (e.g., sitting to standing, bed to wheelchair, bed to gurney, bed to Hoyer lift).
- Gait: Activities involving patient walking.
Position and Bed Mobility Activities
- Movement in various directions (upward, downward, side-to-side).
- Rolling and turning.
- Moving from recumbent to sitting position. Note: "Bed" refers to a bed, mat, plinth, or any supporting surface.
Required Documentation
- Amount and type of assistance (physical and verbal cues) required.
- Time taken for bed mobility.
- Demonstrated level of safety.
- Consistency of performance level.
- Equipment/devices used (e.g., log-rolling techniques).
Before Performing Bed Mobility
- Analyze transfer into component parts (equipment, operator, patient position, movements).
- Prepare the patient, checking for non-skid socks, dry clothing.
- Prepare the environment, clearing IV lines, tray tables, and wheelchairs.
- Prepare yourself and other personnel involved.
Four General Parameters for Determining Appropriate Bed Mobility Interventions
- Patient's ability to assist.
- Medical review information (e.g., patient/family/caregiver input, co-morbidities like orthostatic hypotension, HTN, confusion).
- Physician's order (e.g., weight-bearing status, precautions like sternal or hip precautions).
- Goals of treatment.
Bed Mobility Equipment and Devices
- Hydraulic/pneumatic lifts (refer to Procedures 8-7).
- Electric beds (refer to Procedure 8-8).
- Bedrails to assist with rolling.
- Over-the-bed/trapeze bar to provide pressure relief or help patients pull themselves. Important consideration: Equipment should only be used if the patient cannot perform the transfer safely without it or if the therapist cannot safely assist the patient.
Preparing for the Transfer (Procedure 8-1)
- Plan the transfer across the shortest distance.
- Move the patient towards their stronger side.
- Ensure necessary equipment and assistance are available.
- Confirm the patient is appropriately dressed.
- Introduce yourself and utilize proper hand hygiene (wash hands and don gloves if appropriate).
- Explain the procedure to the patient, demonstrate if needed, and obtain consent.
- Have the patient repeat steps to ensure understanding.
During the Bed Mobility Intervention
- Lock bed, wheelchair, and other equipment wheels.
- Be aware of extraneous tubes and lines.
- Prepare draw sheets or slings as needed.
- Remain close to the patient for support and appropriate guarding.
- Give concise one-step commands/instructions.
- Encourage patient participation and use proper body mechanics.
Safety Concerns: Bed Mobility
- Proper shoes and clothing (closed-toe shoes or non-skid socks).
- Be prepared for unexpected needs (be alert to possible dependence).
- Proper therapist/caregiver body positioning.
- Ensure positioning devices are being used and that the environment is free from unnecessary equipment.
Conditions Requiring Special Precautions
-
Total Hip Replacement (Posterior/Anterior Approach):
- No hip extension past neutral; no prone position; no full bridges.
- No hip external/internal rotation past neutral.
- No adduction past neutral.
- No hip flexion greater than 90 degrees; no combination movements. Avoid pulling on the prosthetic leg.
-
Low Back Trauma or Discomfort:
- No lumbar rotation or trunk bending/flexion.
- Log rolling technique (simultaneous shoulder/hip movement).
- Flex hips/knees in supine or side-lying to relieve low back pressure (avoid bending, lifting, or twisting).
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Spinal Cord Injury:
- No traction or rotational forces.
- Log roll for turning in bed.
- Osteoporosis is a common concern.
- Potential for syncope (fainting) during supine-to-sitting transfers.
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Burns:
- Avoid shearing forces across burn site.
- Avoid sliding to prevent friction.
- Have patients elevate limbs during movement.
-
Hemiplegia:
- Avoid pulling on affected extremities (especially the shoulder).
- Possible subluxation risk.
- Possible pain during rolling over involved shoulder.
- Communication issues (if aphasia is present).
Mobility Activities - Purpose
- Adjust recumbent patient position.
- Prevent skin problems and contractures.
- Encourage independence.
- Reduce friction before moving.
- Consider gravitational effects.
- Use proper body mechanics.
Types of Bed Mobility
- Hooklying/bridging.
- Rolling (left to right).
- Scooting (forward/backward, side-to-side).
- Supine-to-prone/prone-to-supine.
- Supine-to-sitting.
Note About Assistance
- After demonstrating, have the patient attempt the movement (assistance if needed).
- Observe challenges and provide assistance.
- Focus on patient learning and ability, not just completing the task.
Scooting Side-to-Side (Procedure)
- Clinician arm placement: neck/shoulders, mid-back.
- The motion should be parallel to the bed surface.
Scooting Up/Down
- Use draw sheet for heavy/unassisted patients; Avoid pillow under patient's head.
Scooting Up/Down & Higher/Lower Level Patients
- Techniques for dependent patients, including lifting hips and/or shoulders for assistance with scooting up and/or down.
Rolling: Supine to Sidelying
- Method 1: Swinging.
- Method 2: Pushing.
- Hand Placement: Scapula and Pelvis.
- Stand on patient's side as they roll.
Supine to Prone to Supine
- Method 1: Arm down.
- Method 2: Arm overhead.
- Therapist assists on rolling side.
Supine to Sit - Method 1
- Estimate space.
- Hand placement: scapula and pelvis.
- Lower mat to floor level.
Sit to Supine - Method 1
- Therapist positions themselves to assist with lifting the patient.
Supine to Sit to Supine -Method 2
- Assisting method with the Supine to Sit to Supine.
Supine to Sit
- Provide URL for video demonstration.
Scooting Down: Method 1
- Therapist assists at patient's pelvis.
- Patient participates (chin tuck assists).
Scooting Down: Method 2
- Therapist assists at distal thighs (applying traction).
- Patient uses back of head and arms on mat.
Rolling: Supine to Sidelying
- Hand placement and the therapist's positioning on the patient's side as they roll toward that side.
Transfer Essentials
- Lock wheels to prevent unintentional movement.
- Remain aware of any devices or foreign objects.
- Use concise commands and proper body mechanics.
- Utilize proper positioning for the patient.
Safety Concerns in Transfers
- Proper shoes (non-skid soles).
- Alertness to unexpected situations.
- Proper caregiver positioning.
- Secure devices and equipment.
Types of Knee Blocks for Transfers
- Anterior Tibial Block (single leg, anterior, lateral)
- Single Leg Block (squeeze)
- Double Leg Anterior Tibial Block
Anterior Tibial Block - Single Leg
- Best for single leg blocking.
- Support to prevent buckling; therapist's foot inside patient's involved limb; therapist's knee outside.
- Cannot cross the other direction (abducting leg).
- Allows therapist to avoid patient.
Alternate Anterior Tibial Block - Lateral
- Best block for single leg blocking; support due to placement of lower extremity.
- Therapist's knee flexed; foot outside the patient's foot.
Single Leg Block - Squeeze
- Therapist uses their thighs around the patient’s medial and lateral femoral epicondyles.
- Doesn't prevent sagittal plane buckling.
Double Anterior Tibial Knee Block
- Used for patients with weakness/involvement of both legs.
- Therapist's feet are medial to the patient's feet, with medial epicondyles lateral to patient's knees.
Sit to Stand Transfers (Dependent/Assisted)
- Various methods using different knee blocks (anterior tibial, double anterior tibial) and assistive devices (crutches, canes, lofstrand crutches) depending on patient needs and assistive device type.
Stand to Sit Transfers (Assisted)
- Methods using different knee blocks (anterior tibial, double anterior tibial) and assistive devices.
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Description
This quiz focuses on understanding bed mobility activities and safe transfer techniques in patient care. It covers various essential concepts such as patient positioning, documentation, and the importance of functional mobility. Test your knowledge and ensure safe practices in healthcare settings.
