PERFORMING RANGE-OF-MOTION EXERCISES

Adapted from Altman, Gaylene (2010). Fundamentals and Advanced Nursing Skills;
Christensen and Kockrow (2011). Foundations and Adult Health Nursing.

I. DEFINITION

Range of Motion – is the degree of movement possible for each joint.

Passive Range of Motion – the nurse or another person moves each of the client’s joints through
their complete range of movement, maximally stretching all muscle groups within each plane over
each joint.

Active Range of Motion – the client moves each joint in the body through its complete range of
movement, maximally stretching all muscle groups within each plane over the joint.

Active - Assistive Range of Motion – is carried out with the client and the nurse participating. The
client is encouraged to carry out as much of each movement as possible, within the limitations of
strength and mobility.

I. RATIONALE

1. To improve or maintain joint function.

2. To restore joint function that has been lost due to a disease, injury, or lack of use.
3. To improve or maintain muscle tone and strength.
4. To help maintain cardiorespiratory function in an immobilized client.
5. To prevent contractures.
6. To prepare the client for ambulation.

II. EQUIPMENT

Hospital Bed Sturdy Non – Slip Shoes or Slippers

QUALITY OF LIFE

Remember to:
 Knock before entering the person’s room
 Address the person by name
 Introduce yourself by name and title

PRE-PROCEDURE

III. ASSESSMENT

1. Assess the client’s joint mobility and activity status to determine the need for ROM exercises.
2. Assess the client’s general health status to determine whether any contraindications to ROM
exercises are present.
 3. Assess the client’s ability and willingness to cooperate in ROM exercises.

IV. PLANNING

1. Plan when ROM exercises should be done.

2. Plan whether exercises will be active, active - assistive, or passive as well as which joints are to be
included.
PROCEDURE

V. IMPLEMENTATION

Basic Guidelines:
I. Start gradually and work slowly.
II. Avoid overexertion and using exercises to the point that the client develops fatigue.
III. Move each joint until there is resistance but not pain.
IV. Support the part being exercised at the proximal part of the joints.
V. After each movement, return the part to its correct anatomic position.
VI. Keep friction to a minimum when moving to avoid injuring the skin.
VII. Use range of motion exercises regularly as prescribed to build up muscle and joint
capabilities.
VIII. Expect the client’s respiratory rate and heart rate to increase during the activity.
IX. Use passive exercises as necessary but encourage active exercise of the same kind if the
client’s health condition permits.

General Guidelines for Providing Passive Exercises:

A. Ensure that the client understands the reason for doing ROM exercises.
B. If there is a possibility of hand swelling, make sure rings are removed.
C. Clothe the client in a loose gown and cover the body with a bath blanket.
D. Use correct body mechanics when providing ROM exercises to avoid muscle strain or injury to
both yourself and the client.
E. Position the bed at an approximate height.
F. Expose only the limb being exercised to avoid embarrassing the client.
G. Support the client’s limbs above and below the joint as needed to prevent muscle strain or injury.
H. Use a firm, comfortable grip when handling the limb.
I. Move the body parts smoothly, slowly, and rhythmically.
J. Avoid moving or forcing a body part beyond the existing range of motion.
K. If muscle spasticity occurs during movement, stop the movement temporarily but continue to
apply slow, gentle pressure on the part until the muscle relaxes; then proceed with the motion.
L. If contracture is present, apply slow, firm pressure without causing pain to stretch the muscle
fibers.
M. If rigidity occurs, apply pressure against the rigidity and continue the exercise slowly.
N. For elderly clients, it is not essential to achieve full range of motion in all joints but instead,
emphasize achieving a sufficient range of motion to carry out ADLs.

ACTION RATIONALE

1. Wash your hands. To prevent the spread of microorganisms.

2. Identify the client. To be sure you are carrying out the procedure for the
correct client.
3. Close the door or pull curtains around the bed. To provide privacy.

4. Explain to the client what you are about to do. To gain the client’s cooperation.

5. Position the bed. Lower the head of the bed. Raise To position the client in a supine position.
the entire bed to a comfortable working level for To avoid stretching and reaching.
you.

6. Maintain your own proper body mechanics as you To avoid undue strain.
carry the exercises for the client.

7. Follow the procedure below to administer ROM.

Complete ROM on joints you have determined
should be exercised.

8. Wash your hands. To prevent the spread of microorganisms.

TEMPROMANDIBULAR JOINT (TMJ)

TMJ Opening: Open mouth

TMJ Closure: Close mouth

Protrusion: Jut chin out.(Figure 1)

Retrusion: Tuck chin in. (Figure 1) Figure 1

Lateral Motion: Move jaw from side to side. (Figure 2)

NECK
Figure 2
Flexion: Move the head from the upright midline
position forward, so that the chin rests on the chest.
(Figure 3)

Extension: Move the head from the flexed position to

the upright position. (Figure 3) Figure 3

Hyperextension: Move the head from the upright

position back as far as possible.

Lateral Flexion: Move the head laterally to the right and

left shoulders while facing front. (Figure 4)
Figure 4
Rotation: Turn the face as far as possible to the right
and left. (Figure 5)

SHOULDER

Flexion: Raise each arm from a position by the side

forward and upward to a position beside the head.
(Figure 6)
Figure 5
Extension: Move each arm from a vertical position
beside the head forward and down to a resting position
at the side of the body. (Figure 6)
Figure 6
Hyperextension: Move each arm from a resting side
position to behind the body. (Figure 6)

Abduction: Move each arm laterally from a resting

position at the sides to a side position above the head,
palm of the hand away from the head. (Figure 7)
Figure 7
Adduction (anterior): Move each arm from a position
beside the head downward laterally and across the
front of the body as far as possible. (Figure 8)

Adduction (posterior): Move each arm from a position

beside the head downward laterally and across behind
the body as far as possible. (Figure 8) Figure 8

Horizontal Flexion: Extend each arm laterally at shoulder

height and move it through a horizontal plane across the
front of the body as far as possible. (Figure 9)

Horizontal Extension: Extend each arm laterally at

shoulder height and move it through a horizontal plane
Figure 9
as far behind the body as possible. (Figure 9)

Circumduction: Move each arm forward, up, back, and

down in a full circle. (Figure 10)

External Rotation: With each arm held out to the side

at the shoulder level and the elbow bent to a right
angle, fingers pointing down, move the arm upward so
that the fingers point up. (Figure 11)
Figure 10
Internal Rotation: With each arm held out to the side
at shoulder level and the elbow bent to a right angle,
fingers pointing up, bring the arm forward and down so
that the fingers point down. (Figure 11)

ELBOW Figure 11
Flexion: Bring each lower arm forward and upward so that
the hand is at the shoulder. (Figure 12)

Extension: Bring each arm forward and downward,

straightening the arm. (Figure 12)

Rotation for Supination: Turn each hand and forearm so

that the palm is facing upward. (Figure 13)

Rotation for Pronation: Turn each hand and forearm so Figure 12

that the palm is facing downward. (Figure 13)

WRIST

Flexion: Bring the fingers of each hand toward the inner Figure 13
aspect of the forearm. (Figure 14)

Extension: Straighten each hand to the same plane as the

arm. (Figure 14)

Hyperextension: Bend the fingers of each hand back as Figure 14

far as possible. (Figure 15)

Circumduction: Move the wrist in a circular motion.

Figure 15
Radial Flexion (abduction): Bend each wrist laterally
toward the thumb side with hand supinated. (Figure 16)

Figure 16
Ulnar Flexion (adduction): Bend each wrist laterally
toward the fifth finger with the hand supinated.

HAND and FINGERS

Figure 17
Flexion: Make a fist with each hand. (Figure 17)

Extension: Straighten the fingers of each hand. (Figure

17)

Hyperextension: Bend the fingers of each hand back as Figure 18

far as possible.

Abduction: Spread the fingers of each hand apart.

(Figure 18) Figure 19
Adduction: Bring the fingers of each hand together.
(Figure 18)

THUMB

Flexion: Move each thumb across the palmar surface of Figure 20

the hand toward the fifth finger. (Figure 19)

Extension: Move each thumb away from the hand.

Abduction: Extend each thumb laterally. (Figure 20)

Adduction: Move each thumb back to the hand.
Figure 21
Opposition: Touch each thumb to the tip of each finger
of the same hand. The thumb joint movements involved
are abduction, rotation, and flexion. (Figure 21)

Circumduction: Move the thumb in a circular motion.

HIP
Figure 22
Flexion: Move each leg forward and upward. The knee
may be extended or flexed. (Figure 22)

Extension: Move each leg back beside the other leg.

(Figure 23)

Hyperextension: Move each leg back behind the body.

(Figure 23) Figure 23

Abduction: Move each leg out to the side. (Figure 24)

Adduction: Move each leg back to the other leg and

beyond in front of it. (Figure 24)
Figure 24
Circumduction: Move each leg backward, up, to the
side, and down in a circle. (Figure 25)

Internal Rotation: Turn each foot and leg inward so that Figure 25
the toes point as far as possible toward the other leg.
(Figure 26)

External Rotation: Turn each foot and leg outward so

that the toes point as far as possible away from the
other leg. (Figure 26)
Figure 26
KNEE

Flexion: Bring each leg bringing the heel toward the

back of the thigh. (Figure 27)

Extension: Straighten each leg, returning the foot to its

position beside the other foot. (Figure 27)
Figure 27
ANKLE

Extension (plantar flexion): Point the toes of each foot

downward. (Figure 28)
Figure 28
Flexion (dorsiflexion): Point the toes of each foot
upward. (Figure 28)
Eversion: Turn the sole of each foot laterally. (Figure 29)

Inversion: Turn the sole of each foot medially. Figure 29

FOOT and TOES

Flexion: Curve the toe joints of each foot downward.

(Figure 30)
Figure 30
Extension: Straighten the toes of each foot. (Figure 30)

Abduction: Spread the toes of each foot apart.

Adduction: Bring the toes of each foot together.

TRUNK Figure 31

Flexion: Bend the trunk toward the toes. (Figure 31)

Extension: Straighten the trunk from a flexed position.

(Figure 31) Figure 32
Hyperextension: Bend the trunk backward.

Lateral Flexion: Bend the trunk to the right and to the

left. (Figure 32)

Rotation: Turn the upper part of the body from side to

side. (Figure 33) Figure 33

POST-PROCEDURE

VI. EVALUATION AND DOCUMENTATION

1. Evaluate the client in terms of the following:

a. fatigue
b. joint discomfort
c. joint mobility
2. Document and report the following:
a. unexpected problems or notable changes in the client’s movements such as rigidity
b. type of exercise, body parts involved, duration, client’s tolerance
c. other assessment findings
 MOVING AND LIFTING THE CLIENT USING BODY MECHANICS
Adapted from Potter and Perry (2011). Clinical Nursing Skills and Techniques;
Lippincott Manual of Nursing Practice (2010).

I. DEFINITION

Moving and Lifting - is the procedure involved in turning, positioning, and transferring a client in
and out of bed with the use of proper body mechanics.

Body Mechanics - is the term used to describe the efficient, coordinated, and safe use of the body
to move objects and carry out the activities of daily living.

II. RATIONALE

1. To provide greater comfort.

2. To provide optimal lung expansion and ventilation.
3. To help maintain intact skin and prevent complications of immobility.
4. To prevent injury due to improper movement.
5. To prevent contractures due to constant joint flexion.
6. To promote optimal joint movement.
7. To move or lift a client employing considerable care so as to prevent injury to the client and
undue strain on the part of the nurse or caregiver.

III. EQUIPMENT

Hospital Bed
Draw sheets
Pull Sheet / Turning Sheet
Chair / Wheelchair
Assistive Device such as Overhead trapeze, Transfer Bar or Sliding Bar

IV. PLANNING AND IMPLEMENTATION

Special Considerations:
1. Know the client’s diagnosis, capabilities, ability to understand instructions, medications,
extent of injury, and any movement not allowed for him / her. To obtain a thorough
information as to the client’s condition.
2. Decide exactly what you will do when you plan to move or lift a client. To be able to utilize
appropriate moving and lifting techniques.
3. If indicated, use pain relief modalities or medications prior to moving the client. To provide
client’s comfort.
4. Explain the procedure to the client and assess his / her ability to assist you. To solicit the
client’s cooperation and to promote ease and comfort.
5. Remove obstacles that may make moving and lifting inconvenient. To prevent injury and to
promote ease and comfort.
6. Elevate the bed as necessary so that you are working at a height that is comfortable and safe
for you. To prevent back injury on the part of the nurse or caregiver.
7. Lock the wheels of the bed, wheelchair, or stretcher. To prevent them from sliding about
 during the procedure.
8. Observe the principles of body mechanics while you work. To prevent injuring yourself.
9. Be sure the client is in good body alignment while moving and lifting him / her. To protect him
/ her from strain and muscle injury.
10. Support the client’s body well. Avoid grabbing or holding an extremity by its muscles. To
prevent injury.

11. Avoid causing friction on the client’s skin during the move or lift. To prevent the skin from
getting injured or irritated.
12. Move your body in a smooth, rhythmic motion. To promote ease and comfort.
13. Use supportive device such as turning sheet when available. To provide assistance during the
procedure thereby promoting ease and comfort.
14. Be realistic about how much you can safely perform the procedure without injury. Ask for
assistance from other health care personnel when needed. To prevent injury.

I. MOVING A CLIENT UP IN BED

ACTION RATIONALE

1. Explain the procedure to the client. To solicit client’s cooperation.

2. Wash hands and observe other appropriate To prevent the spread of microorganisms.
infection control procedures.

3. Provide for client’s privacy. To promote comfort.

4. Adjust the bed and the client’s position.

- Adjust the head of the bed to a flat position or
as low as the client can tolerate.
- Raise the bed to the height of your center of
gravity.
- Lock the wheels on the bed and raise the rail
on the side of the bed opposite you.
- Remove all pill ows, then place one against the
head of the bed.
To prevent back strain on the part of the nurse or
caregiver. Moving the client upward against gravity
requires more force.
To prevent undue strain.
To prevent accidental falls.
To protect the client’s head from injury against the
top of the bed during the move.

5. Elicit the client’s help in lessening your workload.

- Ask the client to flex the hips and knees and To prevent friction during movement and to ensure
position the feet so that they can be used use of large muscle groups in the client’s legs when
effectively for pushing. pushing, thus increasing the force of movement.
- Ask the client to: To provide additional power to overcome inertia and
friction during the move.
a. Grasp the head of the bed with both hands
and pull during the move, or
b. Raise the upper part of the body on the
elbows and push with the hands and
 forearms during the move, or
c. Grasp the overhead trapeze with both
hands and lift and pull during the move.

6. Position yourself appropriately and move the client.

- Face the direction of the movement, and then To promote stability during the move.
assume a broad stance with the foot nearest
the bed behind the forward foot, with your
weight on the forward foot. Lean your trunk
forward from the hips. Flex hips, knees, and
ankles.
- Place your near arm under the client’s thighs. To provide support to the heaviest part of the body.
Push down on the mattress with the far arm. The far arm acts as a lever during the move.
- Tighten your gluteal, abdominal, leg, and arm To ensure a stable move.
muscles and rock from the back leg to the
front leg and back again. Then, shift your
weight to the front leg as the client pushes
with the heels and pulls with the arms so that
the client moves toward the head of the bed.

VARIATION: A CLIENT WHO HAS LIMITED STRENGTH

OF THE UPPER EXTREMITIES

 Assist the client to flex the hips and knees as in To keep the arms and head off the bed surface, thus
Step 5. Place the client’s arms across the chest. Ask preventing friction during movement.
the client to flex the neck during the move and
keep the head off the bed surface.

 Position yourself as in Step 6 and place one arm This placement of the arms distributes the client’s
under the client’s back and shoulders and the weight and supports the heaviest part of the body.
other arm under the client’s thighs. Shift your
weight as in Step 6.

VARIATION: TWO NURSES USING A HAND – FOREARM

INTERLOCK. Two people are required to move clients
who are unable to assist because of their condition or
weight.

 Using the technique described in Step 6, with the
second staff member on the opposite side of the
bed, both of you interlock your forearms under the
client’s thighs and shoulders and lift the client up
in bed.
To allow the client’s weight to be distributed and the
heaviest part of the body to be supported by two
staff members.
 VARIATION: TWO NURSES USING A TURN SHEET.
Two nurses can use a turn sheet to move a client up in
bed.

 Place a draw sheet or a full sheet folded in half To distribute the client’s weight more evenly,
under the client, extending from the shoulders to decrease friction, prevent injury to the client’s skin,
the thighs. Each person rolls up or fanfolds the and exert a more even force on the client during the
turn sheet close to the client’s body on either side. move.

 Both individuals grasp the sheet close to the To allow a smoother movement. This draws the
shoulders and buttocks of the client. Follow the weight closer to the nurse’s center of gravity and
method of moving clients with limited upper increases the nurse’s balance and stability.
extremity strength as described earlier.

7. Ensure client’s comfort.

- Elevate the head of the bed and provide To promote client’s comfort.
appropriate support devices for the client’s
new position.

II. TURNING A CLIENT TO THE LATERAL OR PRONE POSITION IN BED

Movement to the lateral (side – lying) position may be necessary when placing a bedpan beneath the
client, when changing the bed linen, or when repositioning the client.

ACTION RATIONALE

Follow Steps 1 to 3 of Moving a Client Up in Bed.

1. Position yourself and the client appropriately.

- Move the client closer to the side of the bed To ensure that the client will be positioned safely in
opposite the side the client will face when the center of the bed after turning.
turned. Use a pull sheet beneath the client’s
trunk and thighs to pull the client to the side of
the bed. Roll up the sheet as close as possible
to the client’s body and pull the client to the
side of the bed. Adjust the client’s head and
reposition the legs appropriately.
- While standing on the side of the bed nearest To facilitate the turning motion and to prevent the
the client, place the client’s arm across the arm from being caught beneath the client’s body
chest. Abduct the client’s far shoulder slightly during the roll.
from the side of the body and externally rotate
the shoulder.
- Place the client’s near ankle and foot across To prevent unnecessary reaching.
the far ankle and foot.
- Raise the side rail next to the client before To avoid accidental fall.
 going to the other side of the bed.
- Position yourself on the side of the bed toward To promote ease during the turn.
which the client will turn, directly in line with
the client’s waistline and as close to the bed as
possible.
- Lean your trunk forward from the hips. Flex To prevent undue strain on the nurse.
your hips, knees, and ankles. Assume a broad
stance with one foot forward and the weight
placed on this forward foot.

2. Pull or roll the client toward you to the lateral

position.
- Place one hand on the client’s far hip and the To provide greater control in movement during the
other hand on the client’s far shoulder. roll.
- Tighten your gluteal, abdominal, leg, and arm To promote the client’s sense of security.
muscles; rock backward, shifting your weight
from the forward to the backward foot, and
roll the client onto the side of the body to face
you.
- Position the client on his / her side with arms To promote client’s comfort in his / her new position.
and legs positioned and supported properly.

VARIATION: TURNING THE CLIENT TO A PRONE

POSITION

To turn the client to the prone position, follow the

preceding steps, with two exceptions:

 Instead of abducting the far arm, keep the client’s To prevent the arm from being pinned under the
arm alongside the body for the client to roll over. client when he / she is rolled.

 Roll the client completely onto the abdomen. To ensure that the client will be lying on the center of
Never pull a client across the bed while the client the bed after rolling and to prevent injury on the
is in the prone position. woman’s breasts or a man’s genitals.

III. LOGROLLING A CLIENT

Logrolling is a technique used to turn a client whose body must at all times be kept in straight alignment
(like a log). This technique requires two nurses or, if the client is large, three nurses.

ACTION RATIONALE

Follow Steps 1 to 3 of Moving a Client Up In Bed

1. Position yourselves and the client appropriately

before the move.
 - Stand on the same side of the bed, and assume To obtain a stable stance.
a broad stance with one foot ahead of the
other.
- Place the client’s arms across the chest. To prevent injury on the arms.
- Lean your trunk, and flex your hips, knees, and
ankles.
- Place your arms under the client, depending To center the client’s major weight area between the
on the client’s size. nurse’s arms.
- Tighten your gluteal, abdominal, leg, and arm
muscles.

2. Pull the client to the side of the bed.

- One nurse counts: One, two, three, go. Then, To maintain the client’s body alignment when moving
at the same time, all staff members pull the in unison.
client to the side of the bed by shifting their
weight to the back foot.
- Elevate the side rail on this side of the bed.

3. Move to the other side of the bed, and place
supportive devices for the client when turned.
- Place a pillow where it will support the client’s
head after the turn.
- Place one or two pillows between the client’s
legs to support the upper leg when the client
is turned.
To prevent accidental fall.
To prevent lateral flexion of the neck and to ensure
alignment of the cervical spine.
To prevent adduction of the upper leg and to keep
the legs parallel and aligned.

4. Roll and position the client in proper alignment.

- All nurses flex their hips, knees, and ankles and
assume a broad stance with one foot forward.
- All nurses reach over the client and place
hands at the far side of the client.
- One nurse counts: One, two, three, go. Then,
at the same time, all nurses roll the client to a
lateral position.
- Support the client’s head, back, and upper and
lower extremities with pillows.
- Raise the side rails and place the call bell within
the client’s reach.
To establish a stable stance.
To center a major weight area of the client between
each nurse’s arms.
To maintain the client’s body alignment.
To promote client’s comfort in his / her new position.
To provide a safe and convenient environment for
the client.

VARIATION: USING A TURN OR LIFT SHEET

 First, stand with another nurse on the same side of To help maintain the client’s alignment when turning.
the bed. Assume a broad stance with one foot
forward, and grasp half of the fan folded or rolled
edge of the turn sheet. On a signal, pull the client
toward both of you.

 Before turning the client, place pillow supports for To ensure good alignment in the lateral position.
 the head and legs as described in Step 3. Then, go
to the other side of the bed (farthest from the
client), and assume a stable stance. Reaching over
the client, grasp the far edges of the turn sheet,
and roll the client toward you. The second nurse
(behind the client) helps turn the client and
provides pillow supports.

IV. ASSISTING THE CLIENT TO SIT ON THE SIDE OF THE BED (DANGLING)

The client assumes a sitting position on the edge of the bed before walking, moving to a chair or
wheelchair, eating, or performing other activities.

ACTION RATIONALE

Follow Steps 1 to 3 of Moving A Client Up In Bed

1. Position yourself and the client appropriately

before performing the move.
- Assist the client to a lateral position facing you.
- Raise the head of the bed slowly to its highest To decrease the distance the client needs to move.
position.
- Position the client’s feet and lower legs at the To allow ease during the move.
edge of the bed.
- Stand beside the client’s hips and face the far To establish a stable stance.
corner of the bottom of the bed (the angle in
which movement will occur). Assume a broad
stance, placing the foot nearest the client
forward. Lean your trunk forward from the
hips. Flex your hips, knees, and ankles.

2. Move the client to a sitting position.

- Place one arm around the client’s shoulders
and the other arm beneath both of the client’s
thighs near the knees.
- Tighten your gluteal, abdominal, leg, and arm
muscles.
- Lift the client’s thighs slightly.
- Pivot on the balls of your feet in the desired
direction facing the foot of the bed pulling the
client’s feet and legs off the bed.
- Keep supporting the client until the client is
well balanced and comfortable.
- Assess client’s vital signs as indicated by the
client’s health status.
-
To prevent the client from falling backward, to
reduce friction of the thighs against the bed surface,
and to increase the force during the movement.
To reduce friction against the bed surface.
To prevent twisting of the nurse’s spine, to increase
downward movement of the client’s lower body and
to help make the client’s upper body vertical.
To ensure client’s safety.
To assess client's health status.
VARIATION: TEACHING A CLIENT HOW TO SIT ON THE
SIDE OF THE BED INDEPENDENTLY

Instruct the client to:

 Roll to the side and lift the far leg over the near leg. To facilitate movement.

 Grasp the mattress edge with the lower arm and To increase the force of the movement.
push the fist of the upper arm into the mattress.

 Push up with the arms as the heels and legs slide To allow an increase in the downward movement of
over the mattress edge. the lower body.

 Maintain the sitting position by pushing both fists To help make the client’s upper body vertical and to
into the mattress behind and to the sides of the maintain the sitting position.
buttocks.

V. TRANSFERRING A CLIENT BETWEEN BED AND CHAIR / WHEELCHAIR

ACTION RATIONALE

Follow Steps 1 to 3 of Moving a Client Up In Bed

1. Position the equipment appropriately.

- Lower the bed to its lowest position and lock
the wheels of the bed.
- Place the chair / wheelchair parallel to the bed
as close to the bed as possible. Put the chair /
wheelchair on the side of the bed that allows
the client to move toward his or her stronger
side. If a wheelchair is used, lock the wheels
and raise the footplate.
To allow the client’s feet to rest flat on the floor.
To prevent the bed from rolling.
To allow more room for you to assist the client.
To make it easier for the client to grasp the handle
and swivel into the chair.
To prevent accidental movement of the chair during
the transfer.

2. Prepare and assess the client.

- Assist the client to a sitting position on the side To help the client overcome dizziness before
of the bed. standing.
- Assess the client for orthostatic hypotension To prevent the client from fainting during the move.
before moving the client from the bed.
- Assist the client in putting on a bathrobe and To provide comfort and ensure client’s safety.
nonskid slippers or shoes.
- Place a transfer belt snugly around the client’s To aid in transferring the client safely.
waist. Check to be certain that the belt is
securely fastened.
3. Give explicit instructions to the client. Ask the
client to:
- Move forward and sit on the edge of the bed. To bring the client’s center of gravity closer to the

- Lean forward slightly from the hips.
- Place the foot of the stronger leg beneath the
edge of the bed and put the other foot
forward.
- Place the client’s hands on the bed surface or
on your shoulders so that the client can push
while standing. The client should not grasp
your neck for support.
4. Position yourself correctly.
- Stand directly in front of the client. Lean the
trunk forward from the hips. Flex the hips,
knees, and ankles. Assume a broad stance,
placing one foot forward and one back. Mirror
the client’s feet, if possible.
- Encircle the client’s waist with your arms, and
grasp the transfer belt at the client’s back with
thumbs pointing downward.
- Tighten your gluteal, abdominal, leg, and arm
muscles.
5. Assist the client to stand, and then move together
toward the wheelchair.
- On the count of three, ask the client to push
with the back foot, rock to the forward foot and
extend (straighten) the joints of the lower
extremities. Push or pull up with the hands,
while pushing with the forward foot, rock to the
back foot, extend the joints of the lower
extremities, and pull the client (directly toward
your center of gravity) into a standing position.
- Support the client in an upright standing
position for a few moments.
- Together, pivot or take a few steps toward the
wheelchair.
6. Assist the client to sit.
- Ask the client to:
a. Back up to the chair / wheelchair and place
the legs against the seat.
b. Place the foot of the stronger leg slightly
behind the other.
c. Keep the other foot forward.
d. Place both hands on the chair / wheelchair
arms or on your shoulders.
- Stand directly in front of the client. Place one
nurse’s.
To bring the client’s center of gravity more directly
over the base of support.
To enable the client to use the stronger leg muscles
to stand and power the movement. A broader base
of support provides more stability.
To provide additional force for the movement and
reduce the potential for strain on the nurse’s back.
To prevent loss of balance during the transfer.
To provide a secure handle for holding on to the client
and controlling the movement. Downward placement
of the thumb prevents potential wrist injury.
To provide a stronger force for the movement.
To allow the use of the client’s weight and good body
mechanics to help him / her stand. Rocking uses both
client’s and nurse’s weight to gain momentum and
move the client.
To ensure that the client is stable before moving
away from the bed.
Pivoting allows for greater movement with least
expenditure of energy.
To minimize the risk of the client from falling when
sitting down.
To support the body weight during the movement.
To provide a broad base of support.
To increase stability and lessen the stain on the
nurse.
To provide stability.
 foot forward and one back.

- Tighten your grasp on the transfer belt, and To provide for the use of your body to move the
tighten your gluteal, abdominal, leg, and arm client.
muscles.
- On the count of three, have the client shift the To allow the use of the client's weight and good body
body weight by rocking to the back foot, lower mechanics to help him / her sit.
the body onto the edge of the chair /
wheelchair seat by flexing the joints of the legs
and arms. Place some body weight on the
arms, while shifting your body weight by
stepping back with the forward foot and
pivoting toward the chair / wheelchair while
lowering the client onto the seat.

7. Ensure client’s safety.

- Ask the client to push back into the seat. To provide a broader base of support and greater
stability and minimize the risk of falling from the
wheelchair.
- Lower the footplates of the wheelchair and To promote comfort.
place the client’s feet on them.
- Apply a seat belt as required. To ensure safety.

VARIATION: ANGLING THE WHEELCHAIR/ CHAIR

 For clients who have difficulty walking, place the To enable the client to pivot into the chair and lessen
chair / wheelchair at a 45 – degree angle to the bed. the amount of body rotation required.

VARIATION: TRANSFERRING WITHOUT A BELT

 For clients who need minimal assistance, place the To allow the nurse to hold the client securely and be
hands against the sides of the client’s chest (not at able to control the movement.
the axillae) during the transfer.

 For clients who require more assistance, reach To prevent injury on the client especially clients with
through the client’s axillae and place the hands on paralysis since they cannot feel the degree of
the client’s scapulae during the transfer. Avoid pressure applied.
placing hands or pressure on the axillae, especially
for client’s who have upper extremity paralysis or
paresis.

 Follow the steps described previously.

VARIATION: TRANSFERRING WITH A BELT AND TWO

NURSES

 When the client is able to stand, position To prevent loss of balance during the transfer.
 yourselves on both sides of the client, facing the
same direction as the client. Flex your hips, knees,
and ankle. Grasp the client’s transfer belt with the
hand closest to the client and with the other hand
support the client’s elbows.

 Coordinating your efforts, all three of you stand To assist the client to move in unison, thereby
simultaneously, pivot, and move to the chair / maintaining good body alignment.
wheelchair. Reverse the process to lower the client
onto the seat.

VARIATION: TRANSFERRING A CLIENT WITH AN

INJURED LOWER EXTREMITY

 When the client has an injured lower extremity, To allow the client to use the unaffected leg most
movement should always occur toward the client’s effectively and safely.
unaffected (strong) side. For example, if the
client’s right leg is injured and the client is sitting
on the edge of the bed preparing to transfer to a
chair / wheelchair, position the chair / wheelchair
on the client’s left side.

VARIATION: USING A SLIDING BOARD

 For clients who cannot stand, use a sliding board To help promote client’s sense of independence and
to help them move without nursing assistance. preserve your energy.

VI. TRANSFERRING BETWEEN BED AND STRETCHER

ACTION RATIONALE

Follow Steps 1 to 3 of Moving a Client Up in Bed

1. Adjust the client’s bed in preparation for the transfer.

- Lower the head of the bed until it is flat or as To promote ease and comfort.
low as the client can tolerate.
- Raise the bed so that it is slightly higher than To make it easier for the client to move down a slant.
the surface of the stretcher.
- Ensure that the wheels on the bed are locked. To prevent the bed from rolling during the move.
- Pull the draw sheet out from both sides of the To promote ease.
bed.

2. Move the client to the edge of the bed and position

the stretcher.
 - Roll the draw sheet as close to the client’s side
as possible.
- Pull the client to the edge of the bed and cover
the client with a sheet or bath blanket.
- Place the stretcher parallel to the bed next to
the client and lock the stretcher wheels.
- Fill the gap that exists between the bed and
the stretcher loosely with the bath blankets
(optional).
To make it easier to pull the client.
To maintain comfort.
To prevent the stretcher from rolling during the
transfer.
To prevent the possibility that the client may be
trapped in the space between the bed and stretcher.

3. Transfer the client securely to the stretcher.

- In unison with the other staff members, press
your body tightly against the stretcher.
- Roll the pull sheet tightly against the client.
- Flex your hips and pull the client on the pull
sheet in unison directly toward you and onto
the stretcher.
- Ask the client to flex the neck during the move,
if possible, and place the arms across the chest.
To prevent the stretcher from moving.
To achieve better control over the client’s
movement.
This requires less force than pulling along a flat
surface.
To prevent injury to these body parts.

4. Ensure the client’s comfort and safety.

- Make the client comfortable, unlock the wheels, To promote comfort.
and move the stretcher away from the bed.
- Immediately raise the stretcher side rails and / or To prevent accidental falls.
fasten the safety straps across the client.

VARIATION: USING A TRANSFER BOARD

The Transfer Board is a lacquered or smooth
polyethylene board measuring 45 to 55 cm (18 to 22
in.) by 182 cm (72 in.) with handholds along its edges.
The device may be used by one nurse alone or up to
four nurses together.

 Turn the client to a lateral position away from you,

position the board close to the client’s back, and To promote ease when moving the client.
roll the client onto the board.

 Pull the client and the board across the bed to the To ensure safety.
stretcher. Safety belts may be placed over the
chest, abdomen, and legs.

VARIATION: USING A THREE – PERSON CARRY (USE

CAUTION)
 Three people of about equal height stand side by To distribute the client’s weight appropriately.
side facing the client. Recommendations vary as to
which staff member lifts a specific area of the
 client. Often, the strongest supports the heaviest
part of the client or the tallest person with the
longest reach supports the head and shoulders.

 The stretcher or bed to which the client will be moved To promote ease during the transfer.
is placed at a right angle at the foot of the bed.

 The wheels of the bed and stretcher are locked. To prevent the bed and stretcher from rolling during
the move.

 Each person flexes the knees and places the foot To allow the nurses to provide a stronger force.
nearest to the stretcher slightly forward.

 The arms of the lifters are put under the client at To ensure good body alignment.
the head and shoulders, hips and thighs, and upper
and lower legs.

 On the count of three, the lifters roll the client onto This technique ensures good body alignment and use
their chests and step back in unison. They then of body mechanics.
pivot around to the stretcher and lower the client
by flexing their knees and hips until their elbows
are on the surface of the stretcher. The client is
then released on the stretcher surface and is
aligned and covered.

 The stretcher side rails are raised. To prevent accidental falls.

V. EVALUATION AND DOCUMENTATION

1. Evaluate the following:

- skin integrity of the pressure areas from the previous position
- proper alignment after the position
- client’s comfort
- all required safety precautions are in place
- client’s tolerance of the activity particularly the first time the client changes position

2. Document the following relevant information:

- time and change of position moved from and position moved to
- any signs of pressure areas
- use of support devices
- ability of the client to assist in moving and turning
- response of the client to moving and turning
VI. ILLUSTRATION

Moving a Client to a Lateral Position

Moving a Client Up in Bed

Placement for Logrolling a Client Correct Hand

Two Nurses Using a Hand-Forearm Interlock
Assisting a client to a sitting position on the edge of the bed

Moving to a sitting position independently

Lowering a Client Who

Feels Faint to the Floor

Using a Turn
Sheet Using a Transfer
Belt to Support A Client
Transferring Without a Belt

Using a transfer belt

Turning a client
 SUPPORTING A CLIENT IN PROPER BODY ALIGNMENT
Adapted from Potter and Perry (2011). Clinical Nursing Skills and Techniques

I. DEFINITION

Positioning a client – is placing a client in positions that are anatomically correct as well as
comfortable.

II. RATIONALE

1. To maintain correct alignment of all body parts so they remain functional and unstressed.
2. To prevent contractures.
3. To stimulate circulation and to help prevent thrombophlebitis, pressure sores, and edema of
the extremities.
4. To promote lung expansion and drainage of respiratory secretions.
5. To relieve pressure on a body area.

III. EQUIPMENT

Pillows
Footrest
Footboard
Linen or washcloth for hand rolls
Sheet or bath towel or bath blanket for trochanter rolls

IV. PLANNING AND IMPLEMENTATION

Special Considerations:
1. One should have a knowledge of anatomy and physiology and good body alignment.
2. One should remember that correct body mechanics are essential for both the client and the
nurse.
3. Know the client’s diagnosis, capabilities, extent of injury, and any movement not allowed for
him/her.
4. Remove obstacles that may make positioning inconvenient and unsafe for the client.

ACTION RATIONALE

1. Wash your hands. To prevent the spread of microorganisms.

2. Identify the client. To ensure accuracy.

3. Explain the procedure to the client. To gain the client’s cooperation.

4. Assess the client’s need to move. To be able to plan the client’s activity.

5. Assess the client’s ability to move unaided. To identify the extent of assistance the client needs.
6. Check on the assistive devices that are available.
7. Plan the moving technique.
8. Obtain any needed supportive device or
assistance.
9. Provide for client privacy.
10. Raise the bed to an appropriate high position.
11. Place the bed in a flat position if possible.
12. Correctly and comfortably position the client using
any appropriate position described below.
Supporting a Client in Dorsal Recumbent Position
Position the client to the supine position.
- The client lies on her back with the spine in straight
alignment.
- The arms positioned at the client’s side with the
hands pronated.
Provide supportive devices.
- Place a pillow of suitable thickness under the
client’s head and shoulders as needed.
- Place a pillow under the lower legs from below the
knees to the ankles.
- Place trochanter rolls laterally against the femurs.
- Place a rolled towel or small pillow under the
lumbar curvature if you feel a space between the
lumbar area and the bed.
- Put a footboard or rolled pillow on the bed to
support the feet.
- If the client is unconscious or has paralysis of the
upper extremities, elevate the forearms and hands
(not the upper arm) on pillows.
- If the client has actual or potential finger and wrist
flexion deformities, use handrails (with a
circumference of 13 -15 cm.) or wrist/hand splints.
Supporting a Client in the Prone Position
Position the client.
- The client lies on his/her abdomen with the head
turned to one side.
To identify any assistive device needed by the client
which may not be available.
To prevent undue strain on the part of the nurse as
well as the client.
To maintain alignment and to prevent stress on the
client’s muscles and joints.
To promote comfort on the part of the client.
To promote good body mechanics and prevent
undue strain on the part of the nurse.
To prevent working against the pull of gravity.
To provide comfort and to facilitate healing following
certain surgeries.
To prevent hyperextension of the neck.
To prevent hyperextension of the knees, keep the
heels off the bed, and reduce lumbar lordosis.
To prevent external rotation of the hips.
To support the lumbar curvature and prevent flexion
of the lumbar spine.
To prevent plantar flexion or footdrop.
To promote comfort and prevent edema.
Pillows are not placed on the upper arm, to prevent
shoulder flexion.
To prevent flexion contractures of the fingers.
To promote drainage from the mouth.
- The hips are not flexed.
Provide supportive devices.
- Place a small pillow under the head, aligning the
head with the trunk. If drainage from the mouth is
encouraged, omit the pillow entirely.
- Avoid placing the pillow under the shoulders. Place
a small pillow or roll under the abdomen in the
space between the diaphragm or breasts of a
woman and the iliac crests.
- Place a pillow under the lower legs from below the
knees to just above the ankles.
Or
Position the client on the bed so that the feet are
extended in a normal anatomic position over the
lower edge of the mattress.
Supporting a Client in Fowler’s Position
Position the client.
- Have the client flex the knees slightly before raising
the head of the bed.
- Be certain the client’s hips are positioned directly
over the point where the bed will bend when the
head is raised.
- Raise the head of the bed to 45 degrees or the
angle required by or ordered for the client.
Provide supportive devices.
- Place a small pillow or roll under the lumbar region
of the back if you feel a space in the lumbar
curvature.
- Place a small pillow under the client’s head.
Alternatively, have the client rest the head against
the mattress.
- Place one or two pillows under the lower legs from
below the knees to the ankles. Make sure that no
pressure is exerted on the popliteal space and that
the knees are flexed.
- Avoid using the knee gatch of a hospital bed to flex
the client’s knees.
- Put a trochanter roll lateral to each femur.
- Support the client’s feet with a foot board, allow it
to protrude several inches above the toes. The
footboard should be placed 1 inch away from the
heels.
To prevent flexion contractures of the hips & knees.
To prevent flexion of the neck laterally.
To reduce the incidence of lumbar lordosis.
To prevent hyperextension of the lumbar curvature,
difficulty of breathing, and pressure on the breasts
for some women.
To raise the toes off the bed surface and to reduce
plantar flexion and excessive pressure on the
patellae.
To prevent pressure on the toes.
To prevent the person from sliding toward the foot of
the bed as the bed is raised.
To ensure that the client will be sitting upright when
the head of the bed is raised.
To position the client appropriately as this is the
recommended position for clients with breathing
difficulty or cardiac problem.
To support the lumbar curvature and prevent flexion
of the lumbar spine.
To support the cervical curvature of the vertebral
column. To prevent neck flexion contracture.
To provide a broad base of support, prevent
uncomfortable hyperextension of the knees, and
reduce pressure on the heels. To prevent damage on
the nerves and vein walls. To prevent the person
from sliding down in the bed.
To prevent pressure on the popliteal space and
beneath the client’s calves
To prevent external rotation of the hips.
To prevent plantar flexion and pressure on the toes
by the top bedding.
To prevent undue pull on the Achilles tendon and
discomfort.
- Place pillows to support both forearms and hands
up to the elbow.
Supporting a Client in the Lateral Position
Position the client.
- The client lies on one side of the body, flexing the
top hip and knee and placing this leg in front of the
body.
Provide supportive devices.
- Place the pillow under the client’s head so that the
head and neck are aligned with the trunk.
- Have the client flex the lower shoulder and
position it forward so that the body does not rest
on it. Rotate it into any position of comfort.
- Place a pillow under the upper arm. If the client has
respiratory difficulty, increase the shoulder flexion
and position the upper arm in front of the body off
the chest.
- Place two or more pillows under the upper leg and
thigh so that the extremity lies in a plane parallel
to the surface of the bed.
- Ensure that the two shoulders are aligned in the
same plane as the two hips. If they are not, pull one
shoulder or hip forward or backward until all four
joints are aligned in the same plane.
- Place a folded towel under the natural hollow at
the waistline. Take care to fill in only the space at
the waistline.
- Place a rolled pillow alongside the client’s back.
May not be needed if the client’s upper hip and
knee are appropriately flexed.
Supporting a Client in Sim’s Position
Turn the client as for the prone position.
Provide supportive devices.
- Place a small pillow under the client’s head, unless
drainage from the mouth is being encouraged.
- Place the lower arm behind and away from the
To prevent shoulder and muscle strain, dislocation of
the shoulder, edema of the hands and arms, and
flexion contracture of the wrist.
To reduce lordosis and promote good back
alignment. This is the position good for resting and
sleeping clients.
To prevent lateral flexion and discomfort of the major
neck muscles.
To prevent disruption of circulation.
To prevent internal rotation and adduction of the
shoulder and downward pressure on the chest that
could interfere with chest expansion during
respiration.
To approximate correct standing alignment and
prevent internal rotation of the thigh and adduction
of the leg. To prevent pressure on the lower leg by
the weight of the top leg.
To prevent twisting of the spine.
To prevent postural scoliosis of the lumbar spine and
to prevent undue pressure against the rib cage or iliac
crests.
To stabilize the position.
To prevent lateral flexion of the neck and cushion the
cranial and facial bones and the ear. Contraindicated
if drainage from the mouth is encouraged.
To prevent damage to the nerves and blood vessels
 client’s body in a position that is comfortable and in the axillae.
does not disrupt circulation.
- Position the upper shoulder so that it is abducted To prevent internal shoulder rotation and adduction
slightly from the body and the shoulder and elbow and to maintain alignment of the upper trunk.
are flexed. Place a pillow in the space between the
chest and abdomen and the upper arm and bed.
- Place a pillow in the space between the abdomen To prevent internal rotation and adduction of the hip
and pelvis and upper thigh and bed. and to reduce lumbar lordosis.
- Ensure that the two shoulders are aligned in the To prevent twisting of the spine.
same plane as the two hips. If they are not, pull one
shoulder or hip forward or backward until all four
joints are aligned in the same plane.
- Place a support device against the lower foot. To prevent footdrop.

Supporting a Client in a Sitting or Chair Position

Position the client.

- The client sits in a chair, feet flat against the floor To promote good body alignment.
with the knees and hips at right angles.
- The buttocks should rest firmly against the back of
the chair and the spine should be in straight
alignment.

Provide supportive devices.

- Support the client’s elbows with arm rests. To promote comfort.
- Place hand rolls, if needed. To prevent flexion contractures of the fingers.
- Support feet with foot rest, if needed. To prevent plantar flexion.
- Avoid placing pillows at the back. To prevent flexion of the lumbar spine.

Supporting a Client in Orthopneic Position

Position the client.

- The client sits either in bed or on the side of the To facilitate respiration by allowing maximum chest
bed with an overbed table across the lap. expansion.

- The client leans forward and rests the head and

arms on the table.

Provide supportive devices.

- Place one or two pillows on the over bed table. To act as padding on the overbed table.
- Elevate the overbed table to an appropriate To promote comfort.
height.
- Provide supportive device appropriately as in
Fowler’s position.

Supporting a Client in a Knee - Chest Position or

Genupectoral Position
Position the client.
- The client kneels on the bed, leans forward with
the torso at a 90-degree angle to the hips and the
head and chest on the bed.
- The head is turned to one side and the arms are To facilitate breathing.
held above the head.

Provide supportive devices.

- Place a pillow under the client’s head. To promote comfort.
- A pillow can be placed under the client’s chest if To prevent undue strain on the chest muscles.
you feel a space between the chest and the bed.

Supporting a Client in a Lithotomy Position

Position the client.

- Assist client to a supine position.
- Both knees are flexed simultaneously so that the To facilitate easy visualization of the perineum as this
feet are brought close to the hips. position is used in examination of the perineum and
rectum as well as in labor and delivery.
- The legs are separated widely and are supported in
stirrups.
- The hips should be in line with the edge of the bed
or table.

Provide supportive devices.

- Place a pillow under the client’s head. To promote comfort.
- Pad the stirrups before positioning the client’s To prevent pressure on the legs.
legs.

Supporting a Client in Trendelenburg Position

Position the client.

- Assist client to a dorsal or supine position.
- The head of the bed is lowered and the foot of the To promote circulation towards the heart and to
bed is elevated in a straight incline. promote postural drainage.

Provide supportive devices as in dorsal recumbent

position.

Supporting a Client in a Reverse Trendelenburg

Position

Position the client.

- Assist client to a dorsal or supine position.
- The head of the bed is elevated and the foot of the To promote arterial circulation to the legs.
 bed is lowered in a straight incline.

Provide supportive devices as in dorsal recumbent

position.

13. Clean and return equipment properly. To prevent contamination.

14. Wash your hands. To prevent the spread of microorganisms.

V. EVALUATION AND DOCUMENTATION

1. Time and change of position according to agency protocol.

2. Any signs of pressure areas of contractures.
3. Any difficulty the client has with breathing.
4. Use of support devices.
5. Any other signs and symptoms indicative of an alteration from normal.

VI. ILLUSTRATIONS

Orthopneic Position Semi-Fowler’s Position

Dorsal Recumbent Lateral Position

 Sim’s Position Prone Position

Lithotomy Trendelenburg’s

Knee-chest