BODY MECHANICS

DEFINITION

Body mechanics is the utilization of correct muscles to complete a task safely and efficiently, without
undue strain on any muscle or joint.

PRINCIPLES OF GOOD BODY MECHANICS

 Maintain a Stable Center of Gravity.

 Keep your center of gravity low.
 Keep your back straight.
 Bend at the knees and hips.

 Maintain a Wide Base of Support. This will provide you with maximum stability while lifting.
 Keep your feet apart.
 Place one foot slightly ahead of the other.
 Flex your knees to absorb jolts.
 Turn with your feet.

 Maintain the Line of Gravity. The line should pass vertically through the base of support.
 Keep your back straight.
 Keep the object being lifted close to your body.

 Maintain Proper Body Alignment.

 Tuck in your buttocks.
 Pull your abdomen in and up.
 Keep your back flat.
 Keep your head up.
 Keep your chin in.
 Keep your weight forward and supported on the outside of your feet.
 BODY MECHANICS BASICS

 Test the load. Before you lift, check the weight and make sure you can lift it safely. If not, get help or use
an assistive device.

 Keep your back in its natural curve. Bend at the hips and/ or knees. With the low back erect, the forces
are distributed safely.

 Maintain a wide base of support. A solid and wide base will help reduce the possibility of slipping.

 Hold objects as close to you as possible. This reduces stress on the back.

 Do not twist when carrying. Move or change directions with the feet. This decreases the stress and load
on the back.

 Tighten stomach muscles when lifting. This helps the abdominal are to help in the lift and reduce strain
on the low back.

 Think before you lift. First think how you will lift the object. Plan the path and make sure it is clear.

 Lift with the legs or the large muscles. Using the large muscle groups helps diminish the forces on the
low back.

 Maintain good communication if two or more people are involved. Good timing on a lift reduces the
likelihood of jerky or sudden unexpected movements.

 Move obstacles out of the way. Making sure the path is clear (clearing away toys, tools, loose rugs, etc.)
decrease the risk of slipping or falling.

 Push rather than pull. It is easier to utilize your weight advantage when pushing.

 Eliminate repetitive lifting duties if possible. Place things or supplies that you constantly need or use at a
better height initially to decrease lifting activities.

 When getting out of car, first open the door completely, then swing the legs out to the side and pivoting
on the buttocks so the entire body moves as a unit. Do not twist the low back. Place one hand on the
seat and the other hand on the car frame. Scoot forward and place feet under the hips, lean forward,
and push with one hand while pulling with the other hand, and use the leg muscles to come up to a
standing position. To sit down, reverse the procedure.

 When retrieving things from a low shelf, instead of bending over and twisting it is better to kneel down
or squat in front of the shelf, pick up the objects holding them close to body, and then stand up using
the strong leg muscles and keeping the back straight.

 Many activities require standing for a while such as brushing your teeth, ironing, washing dishes, or
folding laundry. First to avoid fatigue, try to break these duties up into smaller time periods. Second,
place one foot on a step or ledge. Do not bend at the waist, instead bend at the knees and keep back
straight. Third, use one hand to provide support. And lastly, try to do the activity at a comfortable
height.
 When doing activities that are above chest level such as washing windows, painting, changing light bulbs,
or hanging pictures, always use a stable step stool so that these activities are at a better level. Another
alternative is to use a long handled reacher or brush.

TECHNIQUES OF BODY MECHANICS

LIFTING
 Use the stronger leg muscles for lifting.
 Bend at the knees and hips; keep your back straight.
 Lift straight upward, in one smooth motion.

REACHING
 Stand directly in front of and close to the object.
 Avoid twisting or stretching.
 Use a stool or ladder for high objects.
 Maintain a good balance and a firm base of support.
 Before moving the object, be sure that it is not too large or too heavy.

PIVOTING
 Place one foot slightly ahead of the other.
 Turn both feet at the same time, pivoting on the heel of one foot and the toe of the other.
 Maintain a good center of gravity while holding or carrying the object.

AVOID STOOPING
 Squat (bending at the hips and knees).
 Avoid stooping (bending at the waist).
 Use your leg muscles to return to an upright position.

CARRYING
 When carrying things like boxes or other items that can be held, hold the object close to the
trunk. Do not twist.
 If carrying things like suitcases or handbags, observe the following rules:
 Try to carry equal weight in both arms.
 Then picking up the bags, keep back straight and bend at the knees,
 Do not twist wile varying the bags.
 Lower bags by bending knees, not the back.

PUSHING
 First, test the load to see how easy it is to push. Make sure the path is clear.
 Stand facing the object, placing the hands on objects.
 Place one leg behind the other, bend the knees and keep the back straight.
 Tighten the abdominal muscles and slowly push with the arms and legs.
 Once moving, continue to push in a slow and steady manner.
 When ready to stop pushing, slowly ease up, and return to a standing position.

PULLING
 Remember try to think of a way to push first. First test the load to see how easy it is to pull.
Make sure the path is clear.
 Stand facing the object, placing the hands on the object. Place one leg behind the other. Bend
the knees and keep the back straight.
 Tighten the abdominal muscles and slowly pull with the arms and legs. Once moving, continue
to pull in a slow and steady manner. When ready to stop pulling, slowly ease up, and return to a
standing position.
GENERAL CONSIDERATIONS FOR PERFORMING PHYSICAL TASKS
 It is easier to pull, push, or roll an object than it is to lift it.
 Movements should be smooth and coordinated rather than jerky.
 Less energy or force is required to keep an object moving than it is to start and stop it.
 Use the arm and leg muscles as much as possible, the back muscles as little as possible.
 Keep the work as close as possible to your body. It puts less of a strain on your back, legs, and
arms.
 Rock backward or forward on your feet to use your body weight as a pushing or pulling force.
 Keep the work at a comfortable height to avoid excessive bending at the waist.
 Keep your body in good physical condition to reduce the chance of injury.

REASONS FOR THE USE OF PROPER BODY MECHANICS

Use proper body mechanics in order to avoid the following:

1. Excessive fatigue.
2. Muscle strains or tears.
3. Skeletal injuries.
4. Injury to the patient.
5. Injury to assisting staff members.

STEPS INVOLVED IN PROPERLY MOVING AN OBJECT TO A NEW LOCATION

The following paragraph takes you through the process of moving (lifting, pivoting, squatting, and
carrying) a heavy object. (The same rules would apply to moving a patient.) The object will be moved
from a waist high area to a lower area five to ten feet away. The procedure will combine all the rules
of body mechanics previously discussed.

 Identify the object to be moved.

 Adopt a stable base of support.
 Your feet are separated.
 One foot is behind the other.
 Your back is straight.

 Grasp the object at its approximate center of gravity.

 Pull the object toward your body's center of gravity using your arm and leg muscles

 Re-establish your base of support and appropriate body alignment.

 Your back is straight.
 You have a stable base of support.
 You are holding the object approximately at waist height and close to your body.
 Pull the object toward your body's center of gravity using your arm and leg muscles.

 Pivot toward the desired direction of travel.

 Turn on both feet at the same time.
  Maintain a stable balance

 Re-establish a stable base of support and appropriate body alignment.

 Your back is straight.
 Your feet are apart, one slightly behind the other.
 The object is at hip level, close to your body.

 Squat and place the object onto the lower area.

 Bend at the knees and hips.
 Maintain a straight back.
 Maintain a stable base of support.
 Use your arm and leg muscles (as needed) for guidance.
 Use your leg muscles to resume an upright position.

II. POSITIONING AND AMBULATING THE ADULT PATIENT

INTRODUCTION

One of the basic procedures that nursing personnel perform most frequently is that of changing the
patient's position. Any position, even the most comfortable one, will become unbearable after a period
of time. Whereas the healthy person has the ability to move at will, the sick person's movements may be
limited by disease, injury, or helplessness. It is often the responsibility of the practical nurse to position
the patient and change his position frequently. Once the patient is able to ambulate, certain precautions
must be taken to ensure the patient's safety.

REASONS FOR CHANGING THE POSITION OF A PATIENT

The following are reasons for changing a patient's position.
1. To promote comfort and relaxation.
2. To restore body function.
o Changing positions improves gastrointestinal function.
o It also improves respiratory function.
 Changing positions allows for greater lung expansion.
 It relieves pressure on the diaphragm.
3. To prevent deformities.
o When one lies in bed for long periods of time, muscles become atonic and atrophy.
o Prevention of deformities will allow the patient to ambulate when his activity level is
advanced.
4. To relieve pressure and prevent strain (which lead to the formation of decubiti).
5. To stimulate circulation.
6. To give treatments (that is), range of motion exercises).

BASIC PRINCIPLES IN POSITIONING OF PATIENTS

1. Maintain good patient body alignment. Think of the patient in bed as though he were standing.
 2. Maintain the patient's safety.
3. Reassure the patient to promote comfort and cooperation.
4. Properly handle the patient's body to prevent pain or injury.
5. Keep in mind proper body mechanics for the practical nurse.
6. Obtain assistance, if needed, to move heavy or helpless patients.
7. Follow specific physician's orders. A physician's order, such as one of the following, is needed for
the patient to be out of bed.
o "Up ad lib."
o "Up as desired."
o "OOB" (out of bed).
8. Do not use special devices (that is., splints, traction) unless ordered. Ask if you do not know what
is allowed.

TURNING THE ADULT PATIENT

a. General Principles for Turning the Adult Patient

Sometimes the physician will specify how often to turn a patient. A schedule can be set up for turning
the adult patient throughout his "awake" hours. The patient should be rotated through four positions
(unless a particular position is contraindicated):
Plan a schedule and follow it. Record the position change each time to ensure that all positions are used.

PRONE POSITION

SUPINE POSITION

SIM’S POSITION

One example of a schedule for turning would be:

1000-- Prone position
1200--Left Sim's position
1400--Supine position
1600--Right Sim's position
1800--Prone position

Notice that in the preceding sequence, the patient is required to make only a quarter turn rather than a
half turn each time the position is changed. If the patient experiences pain while turning, a quarter turn
will be less painful than a half turn.

Certain conditions may make it impossible to turn the patient. Turning may be impossible if the patient
has fractures that require traction appliances. Turning may be harmful to patients with spinal injuries. In
these cases, you need to rub the back by lifting the patient slightly off the bed and massaging with your
hand held flat. It is especially important to prevent skin breakdowns in the person who lies on his back
for long periods of time.

NOTE: For the initial development of skin breakdown, a patient does not have to lie on his back for long
periods of time, especially if moisture and sheet wrinkles are present.

You may want to turn a patient only to wash or rub the back or change the bed.
 LOGROLLING

LOGROLLING

DESCRIPTION
 Logrolling is a technique used to turn a patient whose body must at all times be kept in a straight
alignment (like a log).
 This technique is used for the patient who has a spinal injury.
 Logrolling is used for the patient who must be turned in one movement, without twisting.
 Logrolling requires two people, or if the patient is large, three people.

TECHNIQUE
1. Wash your hands.
2. Approach and identify the patient (by checking the identification band) and explain the
procedure (using simple terms and pointing out the benefits).
3. Provide privacy.
4. Position the bed.
o The bed should be in the flat position at a comfortable working height.
o Lower the side rail on the side of the body at which you are working.
5. Position yourself with your feet apart and your knees flexed close to the side of the bed.
6. Fold the patient's arms across his chest.
7. Place your arms under the patient so that a major portion of the patient's weight is centered
between your arms. The arm of one nurse should support the patient's head and neck.
8. On the count of three, move the patient to the side of the bed, rocking backward on your heels
and keeping the patient's body in correct alignment.
9. Raise the side rail on that side of the bed.
10. Move to the other side of the bed.
11. Place a pillow under the patient's head and another between his legs.
12. Position the patient's near arm toward you.
13. Grasp the far side of the patient's body with your hands evenly distributed from the shoulder to
the thigh.
14. On the count of three, roll the patient to a lateral position, rocking backward onto your heels.
 15. Place pillows in front of and behind the patient's trunk to support his alignment in the lateral
position.
16. Provide for the patient's comfort and safety.
 Position the call bell.
 Place personal items within reach.
 Be sure the side rails are up and secure.
17. Report and record as appropriate.

MAINTAINING PROPER BODY ALIGNMENT WITH THE PATIENT ON HIS BACK

Patients who must lie on their backs much of the time should be kept as comfortable as possible to
prevent body deformities. The paraplegic and quadriplegic may not be able to tell you if their position is
uncomfortable. You must be especially attentive in this case to prevent possible problems from
malalignment.

Pillows can be used to support the patient's head, neck, arms, and hands and a footboard used to
support the feet.
 Proper alignment gives respiratory and digestive organs room to function normally.
 The footboard is slanted to support the feet at right angles to the leg (a normal angle) and
prevent foot drop.

If the patient's trunk must lie flatter than the neck and head:
 The patient should have only one pillow to support the head and neck.
 The patient may have a pillow placed under the legs to prevent pressure on the heels

III. POSITIONING AND AMBULATING THE ADULT PATIENT

COMMON POSITIONS UTILIZED FOR THE ADULT PATIENT

A. Placing the Adult Patient in the Supine Position

1. Collect equipment.
 Pillows.
 Positioning aids as indicated.
2. Wash your hands.
3. Approach and identify the patient (by checking the identification band) and explain the
procedure (using simple terms and pointing out the benefits).
4. Provide privacy throughout the procedure.
5. Position the bed.
 Place the bed in a flat or level position at working height, unless contraindicated.
 Lower the side rails on the proximal side (as necessary).
6. Move the patient from a lateral (side) position to a supine position.
 For the patient on his side, remove supportive pillows.
 Fold top bedding back to the hips, being careful to avoid any undue exposure of the
patient's body.
 With one hand on the patient's shoulder and one on the hip, roll his body in one piece
(like a log) over onto his back.

7. Align the patient's body in good position.

  Head, neck, and spine are in a straight line.
 Arms are at the patient's sides (parallel to the body) with hands prone.
 Legs are parallel to his body.
 Hips, knees, and feet should be in good alignment.
8. Support the body parts in good alignment for comfort.
 Place a pillow under the head and shoulders to prevent strain on neck muscles and
hyperextension and flexion of the neck.
 Support the small of the back with a folded bath towel or small pillow.
 Put a footboard at the foot of the bed and place the feet flat against it (at right angles to
the legs) to prevent plantar flexion ("foot drop").
 Arrange a sandbag along the outer portion of the right foot to keep the foot upright.
 Make a trochanter roll and arrange it along the right hip and thigh to keep the hip joint
from rotating outward.
 Place a pillow under each forearm so the arm is at least six inches from the body.
9. Provide for the patient's comfort and safety.
 Replace the bedding neatly and raise the side rails, if used.
 Place the call light within reach.
 Position the bedside stand or over bed table so that the patient will be within easy reach
of drinking water and personal items.
 Leave the bed in the low position.
10. Report significant nursing observations to the charge nurse.

B. Placing the Adult Patient in the Fowler's and Semi-Fowler's Position

1. Collect equipment.
 Pillows.
 Positioning aids as indicated.
2. Wash your hands.
3. Approach and identify the patient (checking the ID band) and explain the procedure (in simple
terms and pointing out benefits).
4. Provide for privacy throughout the procedure.
5. Be sure the patient is in a supine position with his head near the top of the bed.
6. Elevate the head of the bed.
 Elevate 60 to 90 degrees for the Fowler's position.
 Elevate 45 to 60 degrees for the semi-Fowler's position.
 Raise the knee gatch (knee rest) of the bed approximately 15 degrees unless
contraindicated.
7. Use a footboard to maintain the feet at right angles to the legs.
8. Use pillows for support as needed.
 Behind the shoulders and head to prevent flexion and hyperextension of the neck.
 Behind the lower back to prevent posterior convexity of the lumbar spine region.
 Under the thighs to prevent hyperextension of the knees.
9. Place the patient in good body alignment.
 Head, neck, and back are straight.
 The weight of the body is supported where the hips are flexed in the sitting position.
 Feet are straight.
 Toes are pointing up.
 10. Provide for the patient's comfort and safety.
 Replace bedding neatly.
 Raise and secure the side rails.

 Place the call light within reach.

 Position the bedside stand or over bed table so that the patient will be within easy
reach of drinking water and personal items.
 Leave the bed in a low position.
11. Report significant nursing observations to the charge nurse.
12. Report significant nursing observations to the charge nurse

C. Prone Position

1. Collect the equipment.

 Pillows.
 Positioning aids as indicated.
2. Wash your hands.
3. Approach and identify the patient and explain the procedure.
4. Provide for privacy.
5. Adjust the bed.
 Lower the headrest and knee rest so that the bed is in a flat position.
 Raise the bed to working height.
 Lower the side rails on the side where you are working.
 Fold the top bedding down to the level of the patient's hips, but avoid undue exposure
of the patient's body, which may cause embarrassment.
6. Position the patient in bed.
 If there is room between the end of the mattress and the foot of the bed, the patient
should be moved down in the bed so that his feet extend over the edge of the mattress.
 Remove the footboard if one is present.
7. Turn the patient onto his side and then onto his stomach.
 Roll toward you so you can observe him closely.
 Continue to roll until he is on his stomach.
8. Align the patient in good position.
 Head is turned to one side.
 Neck and back are in a straight line.
 Arms are parallel to the body in a slightly flexed position; or arm on the same side
toward which the head is turned can be flexed sharply at the elbow so the hand is near
the head.
 Legs are straight.
 Feet are extended over the edge of the mattress to avoid hyperextension of the
foot; or a pillow is placed under both ankles to prevent plantar flexion (foot
drop) as a result of prolonged hyperextension.
9. Support the patient's body and keep it in good alignment.
 A small pillow or folded towel under the head may be used to prevent hyperextension
and flexion of the neck.
 A pillow under the abdomen provides comfort and prevents hyperextension of the lower
spine.
 10. Provide for the patient's comfort and safety.
 Replace bedding neatly.
 Raise and secure the side rails.
 Place the call light within reach.
 Position the bedside stand or over-the-bed table within reach so the patient can get
drinking water and personal items.
 Leave the bed in a low position.
11. Report significant nursing observations to the Charge Nurse.

D. Lateral and Sim's Positions

1. Collect equipment.
 Pillows.
 Positioning aids as indicated.
2. Wash hands.
3. Approach and identify the patient by checking identification band.
4. Explain the procedure and gain patient's cooperation.
 Use simple terms.
 Point out benefits.
Lateral position
5. Provide for privacy.
6. Position the bed.
 Lower head and foot of the bed so it is level or flat.
 Lower the side rails on the proximal side; the distal side rail must be up.
7. Turn the patient onto the side.
 Obtain assistance, if needed.
 Fold the top bedding back to the level of the patient's hips, but avoid undue exposure of
the patient's body which may cause embarrassment.
 Flex the distal knee and place the distal arm across the chest.
 "Log-roll" the patient toward you by placing one hand on the shoulder and the other on
the distal hip and pulling without twisting the patient's torso.
 Reach behind the patient's back with both hands, placing one on the proximal hip and
lift slightly outward and roll the body toward yourself.
8. Alternative method: turn the patient onto the side away from self.
 "Log-roll" the patient's body away from self by putting one hand on the proximal
shoulder and the other on the hip and rolling the patient to the distal side.
 Lower hands to the distal shoulder and hip and pull them toward self to stabilize the
patient in the lateral position.
9. Align the patient's body in good position.
 Ensure the patient is not lying on his/her arm.
 Head, neck, and back are in a straight line.
 Legs are parallel with knees slightly flexed.
 Uppermost arm may be flexed across patient's abdomen or supported on his/her body
and hip.
10. Support the body in good alignment for comfort.
 Place a pillow under the patient's head and neck to prevent muscle strain and maintain
alignment.
  Put a pillow under the uppermost leg so that it is supported from the knee to the foot.
 Place another pillow firmly against the patient's abdomen to support the back and hips
in better alignment, if necessary.
 You may want to use a pillow to support the back.
 Place a pillow lengthwise along the back.
 Tuck one edge under the side.
 Roll the remainder of the pillow under (toward the bed surface).
 Tuck the pillow firmly against the back.
 You may also want to use a pillow to support the knee.
 Place a pillow between the knees.
 Bend the upper knee to provide stability.
11. Provide for the patient's comfort and safety.
 Replace the bedding neatly.
 Raise and secure the side rails.
 Place the call light within reach.
 Position the bedside stand and over-the-bed table so that the patient is within easy
reach of drinking water and personal items.
 Leave the bed in a low position.
12. Report significant nursing observations to the charge nurse.

POSITIONING AND AMBULATING THE ADULT PATIENT

ACTIONS THE PRACTICAL NURSE CAN TAKE TO ALLEVIATE DISCOMFORT AND PROMOTE RELAXATION

1. Obtain comfortable bedding. Allow some of patient's own possessions (such as a pillow or
afghan) when possible.
2. Change the bed position (head and knee).
3. Reduce the noise and light in the patient's room.
4. Check for mechanical reasons for discomfort:
o Bed linens or Chux® which are gathered and wrinkled under the patient.
o Plastic mattress covers that wrinkle and cause pressure.
o Top covers which may be pulled too tightly over the feet and legs.
o The patient lying on tubes, drains, syringe caps, or other equipment.
o Soiled dressings, urine, and feces causing the bed to be wet.
o Nonfunctioning equipment, to include alarms sounding without cause.

POSITIONING THE ADULT TO PROMOTE SLEEP AND RELAXATION

If a patient is restless, having difficulty getting comfortable, or not sleeping well, consider the following
steps. As always, be sure you have a physician's order for the patient to be turned when necessary.
1. Wash your hands.
2. Approach and identify the patient (by checking the ID band) and explain the procedure (using
simple terms and pointing out the benefits).
3. Perform practical nursing care to promote relaxation.
 Straighten or change the linens.
 Give the patient a back massage.
 Provide oral hygiene.
  Administer hair care.
 Administer a sponge bath and get fresh pajamas.
4. Position the patient in the preferred position for rest if possible. Follow the physician's order for
turning if specified.
5. Modify the position for support and comfort. Use aids for the patient's positioning as indicated.
6. Check for the position and function of tubes and drains.
7. Check the bed linens for comfort.
 Wrinkles in linens.
 Wrinkles in mattress cover.
 Tightness over the feet and lower extremities.
8. Tell the patient when you plan to return.
9. Position the call light and bedside table within easy reach.
NOTE: To keep the call light within the patient's reach, secure it to the bed linen with a safety
pin, if necessary.
10. Provide for quiet in the area when possible.
 Close the doors.
 Turn off any radios or TVs.
 Ask unnecessary visitors and personnel to leave the area.
11. Avoid interrupting the patient once he falls asleep.
 Schedule medications for times when the patient is being turned.
 Keep nursing care treatments and procedures to a minimum during sleep hours.
12. Report and record significant nursing observations.

PRINCIPLES OF ASSISTING PATIENTS OUT OF BED

1. Reassure the patient of his personal safety against injury and over-exertion.
2. If necessary, get additional help to assist you in ambulating the patient.
3. Support the affected side or extremities of the patient when ambulating or moving.
4. Do not overtire the patient; increase time up in the chair and ambulation gradually.
5. Lock all wheelchair or litter wheels before transferring the patient from the bed.
6. Stabilize the footstool, when it is utilized.
7. Place a signal cord or call-light button within easy reach of the patient while he is up.
8. Check on the patient frequently.

STEPS IN PREPARING TO AMBULATE THE PATIENT

1. Review the patient's medical record for an authorizing physician's order.

2. Review the patient's nursing care plan for information regarding the following:
 Physical limitations.
 Mechanical equipment being utilized; that is, IV infusion pumps, chest drainage set,
urinary drainage sets.
 Distance patient is to ambulate.
 Length of time patient is to be out of bed.
 Frequency patient is to get out of bed.
3. Review the Nurse's Notes to identify the patient's previous tolerance of the activity specified.
4. Explain the rationale for getting out of bed to the patient.
5. Pre-medicate for pain prior to getting out of bed, if necessary.
6. Ensure that the patient is appropriately clothed, including footwear.
STAGES IN ASSISTING THE PATIENT TO AMBULATE
 1. Assist the patient to sit on the side of the bed (dangling).
2. Assist the patient to stand.
3. Assist the patient to move to a chair, or to ambulate.

MANAGEMENT OF THE FALLING PATIENT

The Patient Who Collapses

1. Assume a broad stance with one foot slightly forward, grasp the patient's body firmly at the
waist or under the axilla, and allow him to slide down against your leg.
2. Ease the patient slowly to the floor using your body as an incline.
3. Lower your body along with the patient, if necessary.
4. Utilize proper body mechanics.

The Patient Who Loses Balance

1. Attempt to stabilize the patient by bracing him against you.
2. Guide the patient to the bedside or chair, if possible.
3. If a fall begins to occur, guide him slowly toward the floor.

CLOSING
The physiological and psychological benefits of repositioning, being out of bed, and sitting up or
ambulating should not be under-emphasized. Basic nursing care activity such as this, although not
always pleasant for the patient, does make a significant difference in the recovery and return to health of
the patient.

DEVICES USED FOR PROPER POSITIONING

DEVICES USES AND DESCRIPTION

1. PILLOWS Make sure pillows are appropriate size for the body part you will
position. They provide support, elevate body parts, and splint incisional
areas

2. FOOT BOOTS Foot boots maintain feet in dorsiflexion. Remove boots at least 2 – 3
times per day to assess skin integrity and joint mobility

3. TROCHANTER ROLLS
Trochanter rolls prevent external rotation of legs when patients are in
the supine position. To form a trochanter roll, fold a cotton bath blanket
or sheet lengthwise to a width extending from the greater trochanter
of the femur to the lower border of the Popliteal space. Place the roll
under the buttocks, and then roll it away from the patient until the thigh
is in neutral position or inward position with the patella facing upward.

4. SANDBAGS Sandbags provide support and shape to body contours; they immobilize
extremities and maintain specific body alignment. You use them in place
of or in addition to the trochanter roll.
5. HAND ROLLS Handrolls maintain the thumb slightly adducted and in opposition to the
fingers; they maintain fingers in a slightly flexed position, You make
hand rolls by folding a wash cloth in half, rolling it lengthwise, and
securing the roll with tape. Place the roll against the palmar surface of
the hand. Evaluate the position of the hand to make certain the hand is
in a functional position.

6. HANDWRIST SPLINTS Hand – wrist splints are individually molded for the patient to maintain
proper alignment of the thumb in slight adduction and the wrist in slight
dorsiflexion. Use these splints only for the patient for whom they were
made.

7. TRAPEZE BAR Trapeze bar descends from a securely fastened overhead bar attached to
the bed frame. The trapeze allows the patient to use upper extremities
to raise the trunk off the bed, to assist in transfer from bed to wheel
chair, or to perform upper arm – strengthening exercises.

8. SIDE RAILS Side rails are bars positioned along the sides of the length of the bed.
They are designed to increase patient’s ability to move and turn in bed,
for example, rolling from side to side or sitting up in bed.

9. BED BOARDS Bed Boards are plywood boards placed under the entire surface of the
mattress. They are useful in increasing back support and alignment,
especially with a soft mattress.

10. WEDGE PILLOW a wedge or abductor pillow is a triangular – shaped pillow made of
heavy foam. You use it to maintain the legs in abduction following total
hip replacement surgery.
A. SCIENTIFIC PRINCIPLES

1. BODY MECHANICS are associated with the action and function of muscles that are used to maintain
the balance and posture of the body during all the activities involved in daily living.

In nursing practice, these principles are used to protect both the nurse and client from injury to the
musculoskeletal and nervous system.

These principles involve the concept of the center of gravity, line of gravity and the base of support; the
following concepts are based on these principles:

 The body is more stable with a greater base of support

 Holding an object close to the body requires less energy
 When a person moves, the center of gravity shifts continuously in the direction of moving body
parts
 Facing the direction of work and using the pelvic tilt before an activity decreases the chance of
injury
 Balance depends on the interrelationship between the center of gravity, line of gravity, and base
of support; if all the body parts are balanced, less energy is used.

CORRECT BODY ALIGNMENT

1. The bones and muscles of the musculoskeletal system and central and peripheral nerves are
responsible for body shape, form and movement

2. Related Concepts

a. Correct body alignment and posture require that the weight of the body is centered and forces of
gravity are balanced; when the joints and muscles are not experiencing an extreme flexion or extension,
or unusual stress, alignment is achieved and structures and internal organs are supported.

b. The usual line of gravity begins at the top of the head and bisects the shoulders, trunk and weight –
bearing joints; the base of support is slightly anterior to the sacrum.

c. Maintaining proper body alignment promotes functioning of the respiratory system, circulatory
system, renal system, and gastrointestinal system

EFFECTIVE BODY MOVEMENT

1. Balance and movement occur with coordinated muscle activity and neurologic integration; reticular
formation integrates neural input that helps maintain the body’s balance.

2. Equilibrium is a function of the vestibular apparatus of the ear

3. the cerebellum coordinates motor activities of movement , the cerebral cortex begins voluntary
movement , and the basal ganglia maintain posture.

METHODS TO PROTECT THE BACK

Nurses need to be mindful of proper body mechanics when providing care to clients.

Measures to prevent back injury:

a. Maintain a wide base of support when assisting clients with position changes
b. Avoid twisting movements of the spine.
c. Adjust the height of the work area when working
d. Bend hips and knees to alter position of the body
e. When lifting use the large muscle groups of the legs
f. Hold objects close to the body when lifting
g. Employ mechanical devices when appropriate
h. Use smooth and coordinated motions when walking
What are body mechanics?

Body mechanics refers to the way we move during every day activities. Good body mechanics may be
able to prevent or correct problems with posture (the way you stand, sit, or lie.) Good body mechanics
may also protect your body, especially your back, from pain and injury. Using good body mechanics is
important for everyone.

Why do I need to have good body mechanics?

Having your body in the right position helps protect your back and allows you to use your body in a safe
way. Your spine goes through the midline of your back, giving your back stability and controlling it's
movement. Your spine is made up of:

 Thirty-three bones called vertebrae (VER-tih-bray). These bones are stacked on top of each other
in a line. The line goes from the base of your skull to your rear-end.
 Shock absorbers called disks. Disks lie between the vertebrae, and cushion and protect the
vertebrae. They also allow some movement of the spine.
 Spinal cord and nerves. The spinal cord sends messages from your brain to your body. The spinal
cord is protected by the vertebrae, and is surrounded by spinal fluid.
 Small joints. Joints allow movement and help to stabilize your body.
 Muscles and ligaments. Ligaments support and strengthen joints. Muscles and ligaments provide
strength and power, support and stability.

Injury to the spine may cause problems such as a loss of feeling, movement, and strength. There may
also be problems with the organs in your body, and a loss of normal body functions. These functions may
include going to the bathroom, swallowing, or breathing. Good body mechanics are important because
they will help protect your spine and other parts of your body from injury.

When caring for a person who is recovering from an illness it is important to use good body mechanics.
You may need this when helping a person get in and out of bed, into a chair, walk, or just move around
the house. You may also need to push a person in a wheel chair or move the person in bed.

How do I practice good body mechanics?

A caregiver called a Physical Therapist may teach you good body mechanics. Following are some steps to
help you with good body mechanics:

When standing:

 Wear shoes. They protect your feet from injury, give you a firm foundation, and keep you from
slipping.
 Keep your feet flat on the floor separated about 12 inches (30 cm).
 Keep your back straight
When walking:

 Keep your back straight as you walk.

 If helping a person to walk you may need one arm around the back of the person. Put the other
arm at the side or ready to help the person if needed.

When lifting an object:

 Your feet should be apart, in a standing position.

 Keep your back straight.
 Lower your body to get close to the object.
 Bend from your hips and knees. DO NOT bend at the waist.
 When turning, rotate your whole body, not just your back.
 Hold the object by putting your hands around it.
 Keeping your knees bent and your back straight, lift the object using your arm and leg muscles.
 Do not use your back muscles.
 If the object is too heavy ask another person to help you.
 Many devices are available to help move or lift heavy objects. If you need help from a device,

When carrying an object:

 Hold the object close to your body.

 DO NOT carry things that are too heavy for you. Always ask for help to move heavy objects.
 There are many devices available to help carry heavy objects. If you need help from a device, ask
caregivers how to get one. Ask caregivers how to get one.

Pushing or pulling:

 Use the weight of your body to help push or pull an object.

 Your feet should be apart as in the standing position.

Keep your back straight.

 Lower your body to get close to the object. Bend from your hips and knees. DO NOT bend at the
waist.
 If the object or person you are pulling or pushing is too heavy ask someone to help you.
 There are many devices available to help you move, push or pull heavy objects. If you need help
from a device, ask caregivers how to get one.

Sitting:

 If you can, sit on a hard chair with a straight back. Put a pillow or rolled towel to support your
lower back.
 When you sit for a long time, raise one leg higher than the other to help keep from getting tired.
This can be done by putting the leg on a footstool.
 If doing something, such as reading or knitting, put a pillow on your lap to raise the items closer
to you. This will help keep your back straight.
 When you are driving, adjust the seat to a comfortable distance to the wheel. Sit back in the seat
so your knees are even with the seat.

Sitting at a desk:

 Sit in your chair with your back straight and with support in your lower back.
 Do not sit for long periods of time. Get up and change positions.
 Ask your caregiver for special exercises to stretch the muscles in your neck.
 Adjust the monitor of your computer so that the top is at the same level as your eyes.
 Use a paper holder so that the document is at the same level as the computer screen.
 Use a headset or the phone speaker if you use the telephone often.

To position a person on his side in bed:

 Ask or help the person to bend their knees.

 Put a soft pillow between the knees.
 Keep your back straight.
 Lower your body to get close to the object. Bend from your hips and knees. DO NOT bend at the
waist.
 If the object or person you are pulling or pushing is too heavy ask someone to help you.
 There are many devices available to help you move, push or pull heavy objects. If you need help
from a device, ask caregivers how to get one.