Nursing Care Assistant Program: American Red Cross Nurse Assistant Training Textbook 3rd Ed PDF

C HA P T E R 12 Assisting with Positioning and Transferring After reading this chapter, you will have the information needed to: Explain factors that put people at risk for developing pressure ulcers. De...

C HA P T E R 12 Assisting with Positioning and Transferring After reading this chapter, you will have the information needed to: Explain factors that put people at risk for developing pressure ulcers. Describe the role frequent repositioning plays in helping to prevent pressure ulcers. Describe basic positions that are often used in the health care setting. Explain the importance of good body alignment for the people in your care. Goals Protect your safety and the safety of those in your care when you position or transfer them. After practicing the corresponding skills, you will have the information needed to: Reposition a person in bed or a chair. Transfer a person from a bed to a chair, and from a chair to a bed. Use a mechanical lift to transfer a person from a bed to a chair. 158 | | Nurse Assistant Training  Key Terms: pressure ulcer shearing high Fowler’s position Sims’ position bony prominences supine position side-lying (lateral) position prone position skin breakdown Fowler’s position modified side-lying logrolling position friction low Fowler’s position a chair) for a long period of time. Pressure ulcers usually You have been providing care for 78-year-old develop over bony prominences (parts of the body Victor Rivera since he was transferred from the where there is only a thin layer of fat and muscle between hospital to Morningside Nursing Home several weeks the skin and the bone or cartilage underneath). Examples ago. An earlier stroke left him paralyzed on his left of these areas include the back of the head, shoulder side and incontinent of urine and stool. The stroke blades, elbows, hips, coccyx (tailbone), knees, ankles and also affected Mr. Rivera’s ability to speak, chew heels (Figure 12-1). When a person stays in one position and swallow. too long, the weight of his body squeezes the tissue between the bone and the surface he is resting on, which Because of his paralysis, Mr. Rivera is unable to move slows down blood flow to the area. Because the tissue is much by himself. So every day, according to his care not getting enough oxygen and nutrients, it starts to die. plan, you help him change position at least every 2 This loss of healthy, intact skin, called skin breakdown, hours. By changing his position and relieving pressure can lead to a pressure ulcer. on certain parts of his body, you help provide comfort and help prevent pressure ulcers from developing on Friction and shearing injuries can also lead to skin his dry, fragile skin. When Mr. Rivera’s wife comes to breakdown, putting a person at risk for developing a visit every day, she helps by gently rubbing lotion into pressure ulcer. Friction occurs when two surfaces rub his skin. against each other. Friction injuries can occur when the skin rubs against another surface, such as the bed This morning, when you first check on Mr. Rivera, linens, or when skin rubs against skin (for example, you notice that he has been positioned on his side for under folds of skin in very overweight people, under the sleeping. But he has moved his unaffected leg, which breasts, or where the buttocks meet the thighs). Medical has caused the pillow that was between his knees devices, such as catheter tubing or a nasal cannula to shift out of position, so his knees have been lying (the device used to deliver oxygen through the nose), against each other. As you reposition him, you check can also cause friction injuries when they rub against the inner surfaces of his knees and notice a red spot the skin. Shearing occurs when a surface moves one on each knee. You report the condition of Mr. Rivera’s way against another surface that offers resistance, skin to the nurse. causing a dragging effect. Shearing injuries can occur when a person is pulled across the bed instead of lifted. Because the bed offers resistance, the person’s Like Mr. Rivera, many of the people in your care will body does not move easily across the sheets, and the have difficulty changing positions, moving from one place to another, or both. As you learned in Chapter 11, immobility puts a person at risk for many serious complications. In addition, remaining in one position for too long is very uncomfortable. As a nurse assistant, you will help to prevent complications of immobility and promote comfort by assisting those in your care to reposition themselves and to transfer (that is, move from one place to another). PRESSURE ULCERS Pressure ulcers are one of the most serious complications of immobility. A pressure ulcer is a sore that develops when part of a person’s body presses Figure 12-1 A pressure ulcer can form on any part of the body. against a hard surface (such as a mattress or the seat of Common sites of pressure ulcer formation are shown here. Chapter 12 | Assisting with Positioning and Transferring | 159 top layer of skin is pulled in a direction opposite the and prevent pressure ulcers (Table 12-1, Figure 12-2). underlying layers, leading to injury. Closely observing the person’s skin for signs of excessive pressure and skin breakdown while you are providing Pressure ulcers develop in stages (Box 12-1) and can care and reporting your observations to the nurse can be very difficult to treat, especially in the later stages. help prevent a pressure ulcer in the early stages from Pressure ulcers are extremely painful for the person, and getting worse. You also help to prevent pressure ulcers they can lead to the person’s death. For these reasons, by regularly helping the people in your care to reposition every effort must be made to prevent a pressure ulcer themselves, if they cannot do this independently. from forming in the first place. When you report the reddened areas on Observations Into Action! Mr. Rivera’s knees to the nurse, she thanks you and The following may be early signs of a pressure ulcer says that she will go check on Mr. Rivera right away. and should be reported to the nurse right away. Your She says, “Mr. Rivera has so many risk factors for ability to identify a pressure ulcer in the early stages developing pressure ulcers—it’s great that you are can make all the difference! paying such close attention to the condition of his skin. We’ll keep a close eye on those areas, and I’ll take A reddened or darkened area that does not another look at Mr. Rivera’s care plan to make sure return to normal within a few minutes when we are doing everything we can to protect his skin and the pressure is relieved lower his risk for developing a pressure ulcer.” A white, pale or shiny area An area that feels hot or cool to the touch, Why could Mr. Rivera easily develop pressure or is painful ulcers? Give three reasons. In addition to immobility, many of the people in your care What are some of the actions to help prevent will have other risk factors for developing pressure ulcers pressure ulcers that you would expect to see (Box 12-2). As a nurse assistant, you will play a very listed on Mr. Rivera’s care plan? important role in helping to keep the person’s skin healthy ▼ Box 12-1 Stages of Pressure Ulcer Development Stage 1. An area is red, pale or dark, and the normal color does not return within a few minutes of relieving the pressure. The area may be firmer, softer, warmer, cooler or more painful than the surrounding tissue. Detection may be more difficult in people with darker skin. Stage 2. The area may look like a shallow, open ulcer with pink or red exposed tissue at the bottom. Sometimes, instead of looking like an ulcer, the area looks like a blister. Stage 3. More tissue is lost. The fat that lies beneath the skin may be visible. Stage 4. A deep crater forms. Muscle or bone may be visible. Stage 4 pressure ulcer. Image © B. Slaven/Custom Medical Stock Photo, Inc., 2012. ▼ Box 12-2 Risk Factors for Pressure Ulcer Development Immobility Poor nutrition Advanced age Poor hydration (not enough fluid intake) Fragile, dry skin Poor circulation (for example, as a result of Moisture (for example, where one skin surface touches cardiovascular disease) another, or where skin is in contact with soiled linens Poor oxygenation (for example, as a result of respiratory or clothes) disease) 160 | | Nurse Assistant Training Table 12-1 Protecting the Person’s Skin To Prevent This… Do This… Direct Pressure Change the person’s position according to the person’s care plan and at least every 2 hours. Observe and report immediately any reddened, pale or darkened areas of the skin. Make sure the person is in good body alignment. Use appropriate positioning aids when needed. Use pressure-reducing devices (for example, pressure-reducing mattress pads, heel and elbow protectors) as ordered to relieve pressure and protect skin. If the person uses hair pins or barrettes to style the hair, make sure these items are removed when the person’s head is resting on a pillow. Friction and Get help when moving the person—be sure to lift the person’s body all the way off Shearing Injuries the mattress. Elevate the head of the bed no more than 30 degrees (except when a person is eating or has difficulty breathing). This will keep the person from sliding down in bed. Avoid leaving the person in Fowler’s position for any length of time. Make a tight, neat, wrinkle-free bed. Prevent medical equipment from rubbing against the person’s body. Pad supportive devices (such as splints). Ensure that shoes and socks fit correctly. Skin-to-Skin Check for skin changes under skin folds, especially under breasts, and under the folds of skin on Contact people who are overweight. Position the person so that air circulates around the person’s arms and legs to keep skin from touching skin. Moisture Wash, rinse and dry the person’s skin thoroughly, especially in areas where skin meets skin. Check people with incontinence at least every 2 hours and keep their skin, clothing and linens clean and dry. Cover a vinyl chair with a pad or sheet. Have the person wear moisture-absorbing clothes made from natural fabrics such as cotton. Poor Circulation Elevate the person’s arms and legs. Provide gentle massage. Observe the person’s skin frequently and report any changes to the nurse. To Improve This… Do This… Nutrition and Encourage the person to eat a well-balanced diet. Hydration Encourage the person to drink an adequate amount of fluids. Mobility Reposition the person often. If the person is able, assist the person with transferring out of bed and walking. Chapter 12 | Assisting with Positioning and Transferring | 161  Figure 12-2 Nurse assistants do many things to lower a person’s risk for developing pressure ulcers. your care, too. It is essential for comfort, and it helps ASSISTING WITH POSITIONING to prevent complications such as contractures and Many of the people in your care will need your help to pressure ulcers. change positions and maintain good body alignment. Helping people to reposition themselves and ensuring In Chapter 7, you learned how maintaining good body good body alignment are major responsibilities of the alignment can help to reduce strain on your joints and nurse assistant. Some people will only need to be muscles and prevent you from injuring yourself on the encouraged to change their position, and checked job. Good body alignment is important for those in to make sure they are in good body alignment. Other 162 | | Nurse Assistant Training people, such as those who are confused, weak, frail, in pain, paralyzed or unconscious, will need more help from you. To check the alignment of a person who is lying in bed, imagine a line starting at the person's nose, continuing through the person's belly button, and ending between the person's feet. The line should be straight (Figure 12-3, A). When a person is sitting in a chair, his back and buttocks should rest against the back of the chair. His feet should rest flat on the floor (or the footrests of a wheelchair), and his knees should be level with his hips (see Figure 12-3, B). Many people will have a tendency to lean to the side or slump when they are in bed or sitting in a chair. To help the person maintain good body alignment, you may need to support parts of the body with rolled towels or pillows (Figure 12-4). Special positioning aids, such as foam wedges, may also be ordered for the person to help keep the body in Figure 12-4 You may need to use positioning aids such as pillows, proper alignment. rolled towels or blankets, or devices made specifically for the purpose of providing support, to help the person maintain good body alignment. Basic Positions In the health care setting, several basic positions are used. A person may be positioned a certain way during a procedure, or to make an activity, such as eating, easier and safer. People who are unable to change positions easily on their own will have an individualized schedule for repositioning. This schedule will be part of the person’s care plan. The schedule uses a sequence of positions to ensure that no single area is under pressure for too long. This is essential for reducing the person’s risk for developing pressure ulcers. Basic positions that are commonly used in the health care setting are shown in Figure 12-5 and described in the sections that follow. Supine position In the supine position, the bed is flat. The person is on her back, with her head supported by a pillow. A small pillow or rolled towel is used to support the small of the back. The person’s arms are extended at her sides, with her palms down. If the person’s arms are paralyzed or weak, they should be supported with small pillows. The person’s thighs extend in a straight line from her hips. If the person’s feet tend to roll outward, rolled towels or pillows can be placed against the outer thighs to keep the legs in alignment. A foot board may be used to prevent foot drop and keep the toes pointing upward. To keep pressure off the heels, a small pad may be placed under the person’s calves and ankles. Fowler’s position Figure 12-3 Proper body alignment is as important for those in your In Fowler’s position, the person is in the supine care as it is for you. (A) When a person is lying in bed, the spine position, but the head of the bed is raised 45 degrees should be straight. (B) When a person is seated in a chair, the back and buttocks should be positioned against the chair, the feet should so that the person is sitting up in bed. There are two be resting flat on the floor (or on the footrests of a wheelchair) and the variations of Fowler’s position: low Fowler’s position knees should be level with the hips. (also called semi-Fowler’s position), where the head of Chapter 12 | Assisting with Positioning and Transferring | 163  Figure 12-5 Basic positions used in the health care setting. the bed is raised only 30 degrees, and high Fowler’s person will tend to slide down in the bed. Fowler’s position, where the head of the bed is raised position also places a great deal of pressure on 90 degrees. If the person is in an adjustable bed, the the person’s tailbone, which can lead to pressure bed may be raised under the person’s knees to prevent ulcer formation. him from sliding down in the bed. Alternatively, a small pillow or folded blanket can be placed under the Side-lying (lateral) position person’s knees. As in the supine position, positioning In the side-lying (lateral) position, the person is aids should be used as necessary to support the arms, lying on her side, with her head supported by a pillow. legs and feet. The lower arm is positioned so that the person is not Fowler’s position should only be used for short periods lying on it, and the top arm is supported on a pillow. of time (for example, when the person is eating in bed). A rolled blanket or towel is placed along the back to Leaving a person in Fowler’s position for too long puts keep the person in the proper position. The bottom leg the person at risk for shearing injuries, because the is straight, and the top knee is bent. A pillow is placed 164 | | Nurse Assistant Training lengthwise between the lower legs to support the (Figure 12-6) or a raised side rail that the person can knee and ankle and prevent the legs from resting on grasp may increase the person’s ability to assist with the each other. move. Also consider whether or not you will need help from a co-worker to move the person safely. Two people The modified side-lying position is a variation of the can lift or move someone more easily than one person side-lying position. In the modified side-lying position, can. Generally, if a person is much heavier or larger than a pillow is placed along the person’s back, and the you are, or very ill or injured, it is best to ask a co-worker person is tilted slightly backward to lean onto the pillow. to help you with repositioning the person. Just remember This helps to relieve pressure on the hip. The modified to return the favor! Guidelines for repositioning people side-lying position is frequently part of the sequence safely are given in Box 12-3. of positions used in a repositioning schedule. For example, the person may move from the left modified ELDER CARE NOTE. Elderly skin is very fragile side-lying position (left side down) to the supine or low and thin, and it can rip or tear very easily. Fowler’s position, and then to the right modified Whenever you are repositioning an elderly side-lying position (right side down). person (or providing any other type of hands-on care), handle the person carefully to avoid Sims’ position damaging the person’s skin. Sims’ position is an exaggerated side-lying position that is used for procedures such as taking a rectal temperature or giving an enema. In Sims’ Many different skills are used for repositioning a person position, the person is almost lying on his stomach. in bed or a chair: His head is turned to the side. The top leg is bent at Lifting a person’s head and shoulders. To adjust the knee and supported by a pillow, and the top arm a pillow or help a person sit up in bed (for example, is bent at the elbow, with the hand near the face and to readjust her clothing), you will have to lift the supported by a pillow. The bottom leg is straight person’s head and shoulders off the bed. This is and the bottom arm is positioned so that the hand is described in Skill 12-1. near the person’s hips. Make sure the person is not Moving a person up in bed. A person who is lying on the arm. sitting up in bed may slide down toward the end of the bed. To ensure good body alignment and to Prone position keep the person comfortable, you will need to move In the prone position, the person lies on his the person up in bed. Skills 12-2, 12-3 and 12-4 stomach, with his head turned toward the side. The describe different ways of moving a person up in bed, head is supported with a small pillow. The arm the depending on the situation, the person’s ability to help, person is facing is bent at a 90-degree angle, with the and whether or not you have help from a co-worker. hand placed palm-down near the person’s head. The Moving a person to the side of the bed. The first other arm is extended straight along his side. step of many procedures is to move the person to A folded blanket or small pillow is tucked underneath the side of the bed. For example, if you want to turn the person’s lower abdomen or pelvis to give the person’s chest room to expand when the person breathes. A pillow is placed under the person’s shins to raise the person’s toes off the bed. The prone position is not used often because many people find it uncomfortable. If the prone position has been ordered for a person (or the person prefers the prone position), ask the nurse to help you assist the person into the prone position. Helping a Person to Change Position in a Bed or a Chair Before repositioning a person in bed, it is important to know the person’s capabilities and plan the move accordingly. Always encourage the person to help you as much as possible with the move. This is important for the person’s self-esteem and sense of independence. Figure 12-6 A trapeze enables people to change positions by Equipment such as a trapeze that hangs over the bed themselves or with some assistance. Chapter 12 | Assisting with Positioning and Transferring | 165  Box 12-3 Nurse Assistant DO’s and DON’Ts Repositioning People DO be familiar with the person’s care DO give clear directions to the people that may be in place, such as catheter plan. Not all positions are allowed for who are helping you (that is, the person tubing or an IV line. every person. receiving care, your co-worker or both). DO protect the person’s dignity by not DO plan how you will reposition the DO use good body mechanics to protect exposing her body unnecessarily while person and what you need to accomplish your back. Raise the bed to a comfortable you are moving her. the move safely (for example, help from a working height. DO smooth the bed linens and the co-worker, special equipment). DO make sure the brakes on the bed person’s clothes after repositioning the DO tell the person how you are going are locked. person. Lying on wrinkles can cause skin to reposition him, even if the person is breakdown, putting the person at risk for DO use a draw (lift) sheet to lift, rather than unconscious. As you move through the pressure ulcers. pull, the person into position. This helps to steps, explain each step as you come to it. prevent friction and shearing injuries. DO make sure the person is comfortable, DO tell the person what he can do to help that his body is in proper alignment and DO be careful while you are repositioning make the move easier, and encourage the that he is supported as needed by pillows the person not to pull out medical devices person to help as much as possible. or other positioning aids. a person onto his side in bed, first you will need to move him to the side of the bed so that he is in the tells you that he wants to rest. Although you had center of the bed when you are finished repositioning planned to start your day by providing personal care him. Skill 12-5 describes how to move a person to for Mr. Rivera, you observe that he seems tired, and the side of the bed if you are working alone. Skill 12-6 you adjust your schedule to meet his needs. Because describes how to move a person to the side of the he has just eaten, you lower the head of the bed to low bed when you have help. Fowler’s position and make him comfortable. Turning a person onto her side in bed. Skill In about 15 minutes, you return to Mr. Rivera’s room 12-7 describes how to turn a person onto her side to help him with his bath. To perform this personal in bed. Logrolling is the method used to turn a care procedure, you lower the head of the bed and put person onto her side in bed when her spine must be him in a supine position. During the bath you need to kept in alignment throughout the move. Skill 12-8 turn him onto his side to wash his back and give him explains how to logroll a person. a backrub. Because of his paralysis, he finds it difficult Repositioning a person in a chair. A person who to position himself but is able to help turn with his is seated in a chair may slide down in the chair over unaffected side. time. Skill 12-9 explains how to move the person back up in the chair for proper body alignment. As you reposition Mr. Rivera in his bed to make it easier to accomplish various tasks throughout the day, what will you do to ensure You return to Mr. Rivera’s room to prepare Mr. Rivera’s safety, as well as your own? him for breakfast. He is lying on his right side in a What skills will you use? modified side-lying position, with a rolled blanket supporting his back. He has a pillow between his knees to reduce strain on his upper hip and to prevent pressure on his knees and ankles. His paralyzed arm rests on a pillow. You ask a co-worker to help you ASSISTING WITH TRANSFERRING position Mr. Rivera in high Fowler’s position for To transfer means to move from one place to another eating. You roll him onto his back, move him up in (for example, from the bed to a chair). As when bed, and elevate the head of his bed so that he can sit repositioning a person in bed or a chair, you will need up and eat. After breakfast, you collect Mr. Rivera’s to plan the safest way to transfer the person and make meal tray and tell him it will soon be time for his arrangements for help or special equipment (such as personal care. He shakes his head and, with effort, a mechanical lift or standing-assist device) as needed. When planning a transfer, knowledge about the 166 | | Nurse Assistant Training person’s mobility and level of independence can help you determine how much the person will be able to help with the transfer. Questions to consider include: Can the person support all of his weight on one leg or both legs? Is one side stronger than the other? Can the person maintain his sense of balance? Does the person have vision problems? Is the person able to hear and respond to verbal instructions? Does the person have pain when he moves? Is the person afraid of being moved? Has the person ever suddenly refused to cooperate? Does the person behave in a predictable way? Figure 12-7 A mechanical lift is the safest way to assist a person who When assisting a person who can bear weight, a transfer is heavy or unable to bear weight with transferring. belt is used unless the person has a medical condition that makes it dangerous to use a transfer belt (see Chapter 11). During the transfer, you grasp the transfer General guidelines for completing transfers safely are belt to support the person, rather than the person’s given in Box 12-4. Skill 12-10 describes how to assist a clothing or arms. Remember that the transfer belt is a person with transferring from a bed to a chair, and Skill support device, not a lifting device! A person who cannot 12-11 describes how to assist a person with transferring bear any weight at all or who is very heavy will need to from a chair to a bed. If the person is usually predictable be transferred using a mechanical lift (Figure 12-7). but may not be consistent about helping to bear his There are many different types of mechanical lifts. own weight, you will want to ask a co-worker to help Although they all work in generally the same way, make you with the transfer. Skill 12-12 describes how to use sure you have been trained specifically in how to use the a mechanical lift to transfer a person. Use a mechanical lift at your facility before using it. lift according to your employer’s policy and the person’s Box 12-4 Nurse Assistant DO’s and DON’Ts Transferring People DO plan the transfer and identify DO use good body mechanics to protect DO allow the person to sit on the edge what you need to accomplish the your back. Get as close as possible to theof the bed for several minutes before transfer safely (for example, help from person. Use a good base of support, keep continuing with the transfer. Dizziness a co-worker, special equipment). Move the person close, keep your back straight is common when a person sits up after furniture out of the way, if necessary, and and lift smoothly, without jerking or twisting. being in bed for awhile. If the person is plan the transfer so that the person is dizzy and the dizziness does not pass, DO lower the bed to its lowest height and leading with her strongest side. do not continue with the transfer. make sure the brakes on the bed and the DO tell the person how you are going to wheelchair are locked. DON’T rush the person. Ask the person transfer him, even if he is unconscious. As if she is ready to stand up before DO make sure the person is wearing you move through the steps, explain each continuing with the transfer. footwear. The person’s shoes or slippers step as you come to it. should fit well and have nonskid soles. DON’T allow the person to put her arms DO tell the person what he can do to help around your neck during the transfer. DO use a transfer belt, unless the person make the transfer easier, and encourage Instead, have the person place her hands has a condition that makes the use of the person to help as much as possible. on your arms for support. a transfer belt dangerous (for example, DO give clear directions to the people recent abdominal, chest or back surgery; DON’T use a mechanical lift until you who are helping you (that is, the person severe respiratory problems; or severe have been properly trained in its use. receiving care, your co-worker or both). cardiac problems). Chapter 12 | Assisting with Positioning and Transferring | 167 care plan. For many people, being moved in a lift is 5. Mr. Klein is in the side-lying (lateral) position. very frightening, so be sure to reassure the person Where will you place positioning aids to ensure throughout the procedure. good body alignment? a. Under Mr. Klein’s knees b. Between Mr. Klein’s lower legs and against After his bath, Mr. Rivera agrees that he his back would like to get out of bed and sit in the chair by his c. Against his outer thighs bed. His mobility is limited because of his left-sided d. Against his feet paralysis, but he can balance himself with assistance and can support his own weight. 6. Miss Singleton is at risk for developing pressure ulcers. Which piece of equipment What do you consider before getting will you use when repositioning her to help Mr. Rivera out of bed and into the chair? prevent friction and shearing that can lead to Which type of transfer method should skin breakdown and put her at further risk for you use? pressure ulcers? a. A foot board b. A bed cradle c. A draw sheet CHECK YOUR UNDERSTANDING d. A wheelchair 7. You are helping Mr. Lipkin transfer from his bed Questions for Review to a wheelchair. What should you do to ensure Mr. Lipkin’s safety during the transfer? 1. What is the first sign of a pressure ulcer? a. Allow him to place his arms around your neck. a. A reddened area on the skin b. Use a draw (lift) sheet. b. A fever c. Allow him to rest on the edge of the bed before c. An open sore continuing with the procedure. d. Bleeding d. Raise the bed to a comfortable working height 2. To avoid damaging the skin of a person who and unlock the wheels on the bed and wheelchair. is unable to move without help, you should reposition him: Questions to Ask Yourself a. Whenever you can fit him into your schedule. 1. Mrs. Karmody has been sitting in a chair watching b. At least every 4 hours. television for the past 2 hours. When you come to c. According to the schedule in the person’s help her change position, she wants to lie on her care plan. back and sleep. What should you do? d. When you come to work and before you go home. 2. Mr. Eller, who is paralyzed on his right side, is sitting in a chair next to his bed. Every time you look into 3. When planning to move a person, some of the his room, he has slumped over to his weaker side. things you must know are: What could you do to position him properly and a. Whether the person is permitted to move (per maintain his alignment? the person’s care plan). 3. Mrs. Hillman, who weighs 200 pounds, begins b. Whether the person has risk factors for to stand up from the chair where she is sitting. pressure ulcers. Knowing that she often gets dizzy without warning, c. How recently the person ate. you offer to help her, but she insists that she is able d. The person’s mobility, level of independence and to stand up by herself. What safety precautions ability to help. should you take to prevent potential injury? How many people are needed to help Mrs. Hillman 4. In which position is the head of the bed raised transfer safely? 30 degrees? 4. Mrs. Romano is sitting in the chair in her room while a. Supine her niece is visiting. When Mrs. Romano says she b. Modified side-lying wants to get back into her bed, her niece says that c. Prone she will help her. You offer to help, but the niece d. Low Fowler’s says she can do it by herself. What should you do? 168 | | Nurse Assistant Training