NSE111 Week #4 Minimizing Effects of Immobility – Transfers and Ambulation - Fall 23.pptx

NSE111 Week #4 Minimizing Effects of Immobility Transfers and Ambulation Week #4 Learning Objectives 1. Review proper body mechanics (see Week #3 readings). 2. Describe the benefits of activity and exercise and how the concepts of mobility and immobility relate. 3. Differentiate activity toleranc...

NSE111 Week #4 Minimizing Effects of Immobility Transfers and Ambulation Week #4 Learning Objectives 1. Review proper body mechanics (see Week #3 readings). 2. Describe the benefits of activity and exercise and how the concepts of mobility and immobility relate. 3. Differentiate activity tolerance, deconditioning and functional decline. 4. Recognize physiological and psychological changes associated with immobility. 5. Describe how body alignment, body balance, friction, shear and gravity influence body movement. 6. Understand how to use the Morse Falls Scale to improve client safety Nurses and Body Mechanics In Ontario, more than 50% of nurses who lost work time experienced musculoskeletal disorders including injuries to the neck, shoulders and back. Nurses: • Work with patients who may be immobile and physically dependent for mobility. • Teach patients’ families how to transfer or position patients properly. • Lifting, transferring patients contributes to high incidence of work-related injuries. • Need to utilize good body mechanics to reduce the risk of injury (self, patients, coworkers) and to decrease work effort and lessen strain on musculoskeletal system (MSK). • Culture of safety and use principles for safe patient handling. Workers Health and Safety Centre (2011), as cited in P&P, 2014, p. 784; P&P, 2019, p. 839 What 3 body systems are integrated to produce coordinate body movement? The three body systems that contributes to the regulation of movements are: Muscular system Skeletal system Nervous system TED Ed lesson: The Benefits of Good Posture http://ed.Ted.Com/lessons/the-benefits-of-good-posture-murat-dalkinic Remember… The coordinated efforts of our body systems help to maintain balance, posture & body alignment to reduce the risk of injury when moving! A few words to become familiar with… • Body mechanics • Body alignment • Body balance • Gait • Gravity • Friction • Shear • Ergonomics Body Mechanics • MSK and nervous systems are needed to complete a task safely and efficiently, without undue strain on muscles or joints. • Maintain balance, posture, and body alignment during lifting, bending, moving, and performing activities of daily living (ADLs). • Proper use of body mechanics will ensure the safety of the client and nurse. (P&P, 2019, p. 836) Body Alignment • Body alignment refers to the relationship of one body part to another body part along with horizontal or vertical line (P&P, 2019, p. 833) • Correct alignment reduce the strain on musculoskeletal structures. Body Balance • Achieved when a centre of gravity is balanced over a stable base of support and enhanced by proper posture (P&P, 2019, p.833) What maintains body balance when lifting and moving? Friction • A force that occurs in a direction to oppose movement; the force of 2 surfaces moving across one another (P&P, 2019). • Increases risk of skin and tissue damage and potential pressure injuries. • It’s hard to talk about friction without talking about gravity and shear Gravity • Exerts a downward force or weight on the body Shear • The force exerted parallel to the skin and results from both gravity and pushing down on the body and resistance (friction) between the patient and surface (Pieper, 2016 in P&P, 2019, p. 1292) How can friction be reduced? Decreasing the Risk of Friction • Assess the client’s cognitive status. • Provide directions to the client verbally and nonverbally. • Collaborate with the client during lifting and transferring if the client is able to assist in the procedure. • Use the client’s strength when lifting, transferring or moving them. • Ask the client to help when possible (e.g., bend their knees, cross and hold arms over their chest to decrease surface areas). • Explain each step of the procedure. Ergonomic Strategies • Knowledge of safe working posture is crucial to prevent injury. • Implement the principles of body mechanics. • Increases client and nurse safety. • Decreases work effort. Safe Patient Handling Principles of Body Mechanics • The wider the base of support the greater the stability • The lower the centre of gravity, the greater the stability • Face the direction of movement prevent abnormal twisting of the spine • Use transfer sheet to reduce friction between the patient and the surface Principles of Body Mechanics • Leverage, rolling, turning or pivoting requires less work than lifting. • Transferring a client who is in supine with another healthcare provider (HCP), always work at the height of the taller person. Principles of Body Mechanics • Balance or alternate periods of rest and activity help reduce fatigue and risk of falling. Principles of Body Mechanics • Plan your lift. • Ask for help when needed. • Widen your base of support. • Bend at your knees. • Tighten your abdominal muscles. • Lift with your leg muscles. • Keep you’re the object close to your body. • Keep your back straight. Additional resource: http://images.Ccohs.Ca/products/liftinglrg.jpg Principles of Body Mechanics • Mechanical lifts are essential when a client is unable to assist. • Checkpoints when transferring a client (see next slide). • When client is unable to assist: • • • • • • • Wider base of support, and lower centre of gravity = greater stability Face direction of movement Divide balanced activity between arms and legs Leverage, rolling, turning, or pivoting require less work than lifting Use transfer sheets to reduce friction, to reduce force to reposition patient Maintain good body mechanics to reduce fatigue Alternate rest and activity periods • Work at height of taller person when transferring patient in supine position. (Box 36-2, Potter & Perry, 2019, p. 837.) When is it safe to manually lift a patient? • Recommend 35 lbs [16 kg] maximum weight limit for use in patient handling tasks where clients collaborate and unlikely to move suddenly during the task. • Less when task is performed under less than ideal conditions (e.g., when lifting with extended arms; item is near the floor; trunk twisted; in a restricted space; working more than 8 hours). • Clients behaviours that can be unpredictable: • Muscle spasms, combative or resistant or sometimes heavier than they appear. • Client movement during a lift can create loads within the lifter’s spine greater than those created by slow, smooth lifting of a stable object • When weight exceeds 16 kg use assistive devices. Waters, T. (2007). When is it safe to manually lift a patient? American Journal of Nursing, 107(8), 53 When Conditions are “Right” • Client can follow directions. • Amount of weight can be accurately estimated (35 lbs.). • Lifting is smooth and slow. • Body and hand positions in relation to object being lifted, and amount of weight are not subject to change. Waters (2007) Mobility • Mobility refers to the ability to move easily and independently (P&P, 2019, p.1246). • The musculoskeletal and nervous systems of the body must be intact and functioning to maintain optimal physical mobility. • Illnesses, surgery, injuries, pain, and aging can temporarily or permanently impair mobility. Let’s think about gait… • Manner of style of walking, which includes rhythm, cadence, and speed. • Assess balance, posture, and ability (P&P, 2019, p.854). What should the nurse note during a gait assessment? Benefits of Activity and Exercise • Enhance feeling of well-being. • Improve strength, flexibility, and endurance. • Reduce the risk of health problems such as cardiovascular disease, diabetes and osteoporosis. • Effects of exercise Box 36.1 Pathological Influences on Mobility • Postural abnormalities. • Impaired muscle development. • Direct trauma to the musculoskeletal system. • Damage to central nervous system. • Congenital abnormalities. • Degenerative diseases. • Episodic illnesses. Activity Tolerance • The type and amount of exercise or activity that the individual is able to perform (P&P, 2019, p. 833). • Assess for fatigue during activity and the client’s ability to help. Functional Decline The loss of the ability to perform selfcare or activities of daily living (P&P, 2019, p.833) Illness OR Deconditioning associated with inactivity, the negative effects can be seen over short periods of time. Immobility • Is the inability to move freely, easily and with purpose. What can a nurse do to decrease effects of immobility? Safe transfer of clients requires nurses to apply the following: Body Mechanics Ergonomics Safe Patient Handling Safe and Effective Transfer Techniques Go to Centennial’s library and watch the Mosby video: a) Transferring from bed to a wheelchair with a transfer belt. b) Assisting with moving and positioning a patent in bed. c) Using a hydraulic lift. d) Assisting with ambulation using a gait belt. e) Transferring from a bed to a stretcher. Transferring From Bed to Chair • How should the nurse prepare the environment? • Think about the client’s safety, body mechanics • What equipment is required? • What position should the chair be in? • How should the client & nurse be positioned? • If the client has one weak leg, where or how should it be placed? • What do you need to asses prior to transferring a client out of bed? Transfer Techniques • Introduction (e.g., first and last name), designation, hand hygiene and contract. • Assess client for: • Comprehension. • Mobility, including activity tolerance. • Contracture formation and paralysis. • Muscle strength to determine what assistance client can offer during transfer. • Presence of pain. • Vital signs, including orthostatic or postural hypotension. Transfer Techniques • Assess client’s sensory status. • Adequacy of central and peripheral vision, hearing, and loss of sensation. • Assess client’s cognitive status. • Assess client’s level of motivation. • Assess previous mode of transfers. • Determine need for extra nursing assistance. • Risk of falling. • Special equipment. Transferring Client • Raise side rail on opposite side you are working on. • Elevate the bed to a comfortable height (mid-thigh). • Assist the client to sitting position. • Assist the client to sitting position on side of bed. • Ask client to dangle feet, lower bed until client’s feet touch the ground completely (e.g., flat on the floor). • Transfer the client from bed to chair. • Assess for correct body alignment. Assisting Client into a Sitting Position Transferring from Bed to Chair Nurse flexes hips and knees, aligning knees with client’s knees. Nurse flexes hips while easing client into chair. Algorithm use to transfer a client. Consider how to transfer a client out of a stretcher… Transferring Using a Sling • Read unit policies and procedure • Students would never use this device on their own • With each transfer, evaluate client’s body alignment • With each transfer, evaluate client’s tolerance and level of fatigue and comfort. Assisting the Client to Walk Assess for the following cues: • Activity tolerance and strength • Discomfort or pain • Coordination and balance • Orientation • Motivation • Level of co-operation • Environment for safety before ambulation Assistive Devices: Walkers Should be waist high and elbows should be flexed 15-30 degrees. Top of walker should line up with crease inside the client’s wrist. Provide a wide base of support. Wheels vs. no wheels. Move walker forward, then step with affected leg, then unaffected leg. Assistive Devices: Canes Single-straight leg: used on stronger side of body, cane forward body. Quad Cane: provides most support. Provides less support and less stable than a walker. Technique: cane forward 15-25cm, weaker leg to cane, advance stronger leg past cane and repeat. 2 points of support needed at all times. A nurse with any doubt about their strength or ability to ambulate a client on their own should always request for help. Ambulation of client hemiplegia/ hemiparesis • Nurse stands at clients affected side • Support client with 1 arm at the waist and 1 arm around inferior aspect of upper arm • A gait belt may be used for client’s stability. • Client’s unaffected arm is free to enable client to assist If a Client Begins to Fall • Provide support at the waist. • Assume a wide base of support. • One foot in front of the other. • Support client’s body weight when lowering client to the floor. • Protect the client’s head. • Proceed more slowly and with caution on next ambulation. If a client begins to fall… (using a transfer belt) Safe Client Handling for Healthcare Providers • When planning to move a client, arrange for adequate help. • Use client equipment and devices (i.e., height adjustable bed, friction reducing slide sheets). • Encourage client to assist as much as possible. • Take position close to the client (or object being lifted). • Perform and follow body alignment guidelines. MORSE FALLS SCALE • HTTPS://NETWORKOFCARE.ORG/LIBRARY/MORSE%20FALL%20SCALE.PDF • THE MORSE FALL SCALE (MFS) IS A RAPID AND SIMPLE METHOD OF ASSESSING A PATIENT’S LIKELIHOOD OF FALLING. A • IT CONSISTS OF SIX VARIABLES THAT ARE QUICK AND EASY TO SCORE, AND IT • HAS BEEN SHOWN TO HAVE PREDICTIVE VALIDITY AND INTERRATER RELIABILITY. THE MFS IS USED WIDELY IN ACUTE CARE • SETTINGS, BOTH IN THE HOSPITAL AND LONG TERM CARE INPATIENT SETTINGS. CASE • A 23-YEAR-OLD CLIENT WAS ADMITTED TO A HOSPITAL FOR A BROKEN RIGHT ANKLE DUE TO A WATER-SKIING ACCIDENT 1 DAY AGO. THE CLIENT’S ANKLE HAS BEEN IMMOBILIZED WITH A SPECIAL FRACTURE BOOT. THE CLIENT HAS SWELLING, BRUISING, AND TENDERNESS IN THE AREA. THE CLIENT IS ON PAIN MEDICATION WHICH CAUSES FATIGUE. CLIENT STATED THEY FEEL ‘RESTRICTED’ IN THE FRACTURED BOOT. • AS THE FIRST-YEAR NURSING STUDENT, YOUR ROLE IS TO HELP THE CLIENT TO AMBULATE FROM HIS BED TO THE BATHROOM AND HELP HIM WITH MORNING HYGIENE CARE. THE CLIENT IS HAVING PAIN WITH WALKING AND BEARING WEIGHT ON HIS RIGHT FOOT. THE CLIENT IS SITTING UP IN BED AS YOU ENTERED THE ROOM. There is a lot of information to cover. Remember to review your readings and watch the Mosby videos and PRACTICE when you can.