Should a nursing assistant use a gait belt and walk during ambulation of an unsteady resident?

According to the Agency for Healthcare Research and Quality (AHRQ), effective teamwork and communication are essential for preventing falls in long-term care settings. A key component of this team approach is understanding when and how to properly use a gait belt and walk during ambulation of an unsteady resident.

Quick Summary

Using a gait belt is standard practice for assisting unsteady residents to ensure safety during ambulation and transfers. It provides a secure grip for the caregiver, helping to stabilize the resident and prevent falls, but should not be used as a lifting device. Proper technique and resident assessment are essential.

Key Points

• Gait belts enhance safety: A gait belt provides a secure grip for a nursing assistant, offering stability and control when assisting an unsteady resident with walking.

• Assessment is crucial: A nursing assistant must always assess a resident's mobility and fall risk before ambulating and should consult the care plan for appropriate assistance levels.

• Proper technique is essential: Ambulation requires the NA to stand slightly behind and to the side of the resident, holding the gait belt with a firm, underhand grip, and walking at the resident's pace.

• Not for every resident: A gait belt should not be used on residents with recent abdominal or chest surgery, internal devices like G-tubes, or severe respiratory issues.

• Never try to lift a falling resident: If a resident begins to fall, the nursing assistant's priority is to use the gait belt to guide them safely to the floor, protecting their head, and immediately notifying a nurse.

• Know when to use alternatives: For residents who are non-weight bearing, a gait belt is inappropriate. A mechanical lift or transfer board should be used instead, depending on the resident's needs.

Using a gait belt to assist an unsteady resident during ambulation is not only appropriate but is also a standard safety protocol in most healthcare settings. The gait belt provides a secure handhold for the nursing assistant (NA), allowing them to offer necessary support and stability without resorting to unsafe holds that could injure either party. While the gait belt is a crucial tool, it is just one part of a comprehensive approach to safe patient handling that includes proper assessment, technique, and communication.

The Critical Role of Gait Belts in Patient Safety

A gait belt, often made of canvas or nylon, is designed to be placed around a resident's waist to assist with transfers and ambulation. For an unsteady resident, the benefits are clear:

• Enhanced Stability: The belt offers the NA a firm point of contact to steady the resident if they lose their balance. This is especially vital for residents with muscle weakness, balance issues, or a fear of falling.
• Fall Prevention: Studies have shown that using gait belts as part of a fall prevention strategy can decrease the odds of unassisted or injurious falls. The device helps the NA control a potential fall by guiding the resident back to a safe, controlled position.
• Caregiver Protection: By providing a proper grip, the gait belt helps the NA use correct body mechanics, protecting their back and joints from strain that can occur when manually grasping a resident's clothes or arms.
• Improved Confidence: For residents who have recently experienced a fall or feel nervous about walking, the physical reassurance of the gait belt can build confidence and encourage mobility.

The Ambulation Process: Step-by-Step

For a nursing assistant, assisting an unsteady resident with ambulation requires a precise and practiced process. This ensures maximum safety for both individuals.

Preparing for Ambulation

1. Assess the resident: Before starting, assess the resident's strength, balance, and cognitive status. Check their care plan for specific instructions and the level of assistance required.
2. Gather equipment: Ensure you have a gait belt in good condition and that the resident is wearing appropriate non-skid footwear.
3. Explain the procedure: Clearly and calmly explain to the resident what you will be doing. This prepares them and encourages cooperation.
4. Position the bed: Adjust the bed to a low position with the wheels locked so the resident's feet are flat on the floor when sitting on the edge.

Applying the Gait Belt

• Place the belt around the resident's natural waist, over their clothing. The buckle should be slightly off-center for comfort.
• Tighten the belt snugly so it won't slip, but not so tight as to be constricting. You should be able to slide two fingers comfortably between the belt and the resident's body.
• Tuck any excess strap back into the belt to prevent it from getting caught during ambulation.

Assisting with the Walk

• Help the resident to a standing position, ensuring they are not dizzy before starting.
• Stand slightly behind and to one side of the resident. If they have a weaker side, stand on that side to provide extra support.
• Hold the gait belt firmly from the back, using an underhand grip for better control.
• Encourage the resident to walk at their own pace, looking forward, not at their feet.
• Throughout the walk, monitor the resident for signs of fatigue, pain, or dizziness.

Gait Belts vs. Other Assistive Devices

Not all residents require or are suited for a gait belt. The choice of assistive device depends on a thorough assessment of their mobility needs.

Feature	Gait Belt	Mechanical Lift	Transfer Board
Resident Mobility Level	Partially dependent; needs assistance with balance or stability during transfers and ambulation.	Non-weight bearing or requires total assistance; unable to stand or bear weight.	Able to sit up and follow directions; assists with transfers from seated position.
Primary Use	Ambulating (walking) and standing transfers (e.g., bed to chair) for partial support.	Transferring residents who need full assistance from bed to chair, chair to toilet, etc.	Bridging gaps to transfer a resident between two surfaces (e.g., wheelchair to bed).
Caregiver Effort	Reduced strain by providing a secure handhold and improving body mechanics.	Requires specialized training but minimal physical effort for lifting.	Requires upper body strength from both resident and caregiver to slide across.
Safety Considerations	Risk of falls if resident is fully dependent; requires correct application and ambulation technique.	Risk of injury if sling is applied improperly or lift malfunctions; requires proper training.	Risk of falls if board is not secure or resident loses balance; requires controlled movement.
When to Avoid	Contraindicated with recent abdominal or chest surgery, ostomies, or severe heart conditions.	Not required for residents who can bear some weight and assist with transfers.	Not suitable for ambulation; only for seated transfers.

When Not to Use a Gait Belt

While a powerful tool, a gait belt is not appropriate in all situations. A nursing assistant must be aware of contraindications and facility policy. Situations where a gait belt should not be used include:

• Recent surgery: After abdominal, chest, or back surgery.
• Internal devices: In the presence of a gastrostomy tube (G-tube), colostomy bag, or other abdominal drains.
• Advanced conditions: With severe cardiac or respiratory issues, advanced osteoporosis, or abdominal aneurysm.
• Open wounds: The belt should not be placed over open skin, unhealed surgical incisions, or fragile skin prone to tearing.
• Total dependency: For residents who cannot bear any weight, a mechanical lift is the safer and more appropriate device for transfers.

Responding to a Resident Fall

Even with the best precautions, an unsteady resident can lose their balance. If this happens, a nursing assistant must know how to react safely to protect both themselves and the resident.

Instead of trying to stop the fall completely, the NA should use the gait belt to guide the resident's descent to the floor in a controlled manner. This involves widening your stance, bending your knees, and letting the resident slide down your leg while protecting their head from injury. An attempt to lift or stop a falling person can cause a serious back injury to the NA. After the resident is safely on the floor, the NA should notify the nurse immediately for assessment.

Conclusion

A nursing assistant should use a gait belt and walk during ambulation of an unsteady resident as a standard and critical safety measure. This practice, when performed correctly, provides vital stability for the resident and helps prevent falls, while also protecting the caregiver from injury. However, the decision to use a gait belt must be made after a careful assessment of the resident's condition, with consideration for any contraindications. By following established protocols, prioritizing patient safety, and using proper technique, NAs can ensure that ambulation is a safe and positive activity that promotes resident mobility and independence. For more on proper patient handling, consult resources from authoritative organizations like the National Institutes of Health.

Frequently Asked Questions

When is it appropriate for a nursing assistant to use a gait belt for ambulation?

A nursing assistant should use a gait belt whenever assisting a resident who is unsteady, has poor balance, or requires help with walking or transfers.

What is the correct way to position yourself when walking with a resident using a gait belt?

The nursing assistant should walk slightly behind and to one side of the resident, staying on their weaker side if applicable. The NA should maintain a firm, underhand grip on the belt.

How should a nursing assistant respond if a resident starts to fall during ambulation?

Do not try to stop the fall. Instead, widen your stance, support the resident with the gait belt, and slowly guide them to the floor while protecting their head.

Are there any conditions where a gait belt should not be used?

Yes, gait belts should be avoided for residents with recent abdominal or chest surgery, abdominal aneurysms, gastrostomy tubes, or severe heart and respiratory conditions.

What is the difference between a gait belt and a transfer belt?

While the terms are often used interchangeably, gait belts are primarily for assisting with walking (ambulation), whereas transfer belts are used for repositioning or transferring a resident from one place to another. Some modern belts are designed for both uses.

Can one nursing assistant ambulate a very unsteady resident with a gait belt alone?

For very unsteady or significantly impaired residents, a single NA may not be sufficient. Another staff member may be needed to provide a safe "two-person assist" to prevent falls.

How tightly should a gait belt be applied?

A gait belt should be snug enough to prevent slipping but not so tight that it constricts the resident's breathing. There should be enough room to slide two fingers between the belt and the resident's body.