ASSISTING A PATIENT IN AMBULATION

1. Review the medical record and nursing plan of care for conditions that may influence the patient's
ability to move and ambulate. Assess for tubes, IV lines, incisions, or equipment that may alter the
procedure for ambulation. Identify any movement limitations.

2. Perform hand hygiene. Put on PPE, as indicated.

3. Identify the patient. Explain the procedure to the patient. Ask the patient to report any feelings of
dizziness, weakness, or shortness of breath while walking. Decide how far to walk.

4. Place the bed in the lowest position.

5. Encourage the patient to make use of a stand-assist aid, either freestanding or attached to the side of
the bed, if available, to move to the side of the bed. Assist the patient to the side of the bed, if
necessary.

6. Have the patient sit on the side of the bed for several minutes and assess for dizziness or
lightheadedness. Have the patient stay sitting until he or she feels secure.

7. Assist the patient to put on footwear and a robe, if desired.

8. Wrap the gait belt around the patient's waist, based on assessed need and facility policy

9. Encourage the patient to make use of the stand-assist device. Assist the patient to stand, using the
gait belt, if necessary. Assess the patient's balance and leg strength. If the patient is weak or unsteady.
return the patient to the bed or assist to a chair.

10. If you are the only nurse assisting, position yourself to the side and slightly behind the patient.
Support the patient by the waist or transfer belt. When two nurses assist, position yourself to the side
and slightly behind the patient, supporting the patient by the waist or gait belt. Have the other nurse
carry or manage equipment or provide additional support from the other side. Alternatively, when two
nurses assist, stand at the patient's sides (one nurse on each side) with near hands grasping the gait belt
and far hands holding the patient's lower arm or hand.

11. Take several steps forward with the patient. Continue to assess the patient's strength and balance.
Remind the patient to stand erect.

12. Continue with ambulation for the planned distance and time. Return the patient to the bed or chair
based on the patient's tolerance and condition.

ASSISTING A PATIENT IN AMBULATION USING A WALKER

13. Wrap the gait belt around the patient's waist, based on assessed need and facility policy.

14. Place the walker directly in front of the patient. Ask the patient to push him- or herself off the bed or
chair; make use of the stand-assist device or assist the patient to stand. Once the patient is standing,
have him or her hold the walker's hand grips firmly and equally. Stand slightly behind the patient, on
one side.
15. Have the patient move the walker forward 6 to 8 inches and set it down, making sure all four feet of
the walker stay on the floor. Then, tell the patient to step forward with either foot into the walker,
supporting him- or herself on his or her arms. Follow through with the other leg.

16. Move the walker forward again, and continue the same pattern. Continue with ambulation for the
planned distance and time. Return the patient to the bed or chair based on the patient's tolerance and
condition, ensuring that the patient is comfortable. Make sure call bell and other necessary items are
within easy reach.

ASSISTING A PATIENT WITH AMBULATING USING CRUTCHES

17. Assist the patient to stand erect, face forward in the tripod position. This means the patient holds
the crutches 12 inches in front of and 12 inches to the side of each foot.

18. For the four-point gait: a. Have the patient move the right crutch forward 12 inches and then move
the left foot forward to the level of the right crutch. b. Then have the patient move the left crutch
forward 12 inches and then move the right foot forward to the level of the left crutch.

19. For the three-point gait: a. Have the patient move the affected leg and both crutches forward about
12 inches. b. Have the patient move the stronger leg forward to the level of the crutches.

20. For the two-point gait: a. Have the patient move the left crutch and the right foot forward about 12
inches at the same time. b. Have the patient move the right crutch and left leg forward to the level of
the left crutch at the same time

21. For the swing-to-gait: a. Have the patient move both crutches forward about 12 inches. b. Have the
patient lift the legs and swing them to the crutches, supporting his or her body weight on the crutches.

ASSISTING PATIENT WITH AMBULATION USING A CANE

22. Encourage the patient to make use of the stand-assist device to stand with weight evenly distributed
between the feet and the cane

23. Have the patient hold the cane on his or her stronger side, close to the body, while the nurse stands
to the side and slightly behind the patient.

24. While supporting his or her weight on the weaker leg and the cane, have the patient advance the
stronger leg forward ahead of the cane (heel slightly beyond the tip of the cane).

25. Tell the patient to move the weaker leg forward until it is even with the stronger leg, and then
advance the cane again.

26. Continue with ambulation for the planned distance and time. Return the patient to the bed or chair
based on the patient's tolerance and condition, ensuring the patient's comfort.

27. Make sure call bell and other necessary items are within easy reach.

28. Clean transfer aids per facility policy, if not indicated for single patient use.

29. Remove gloves and any other PPE, if used.

30. Perform hand hygiene.