What is a safe way to assist a patient to walk?

According to the Agency for Healthcare Research and Quality, up to one million hospitalized patients fall each year. Understanding what is a safe way to assist a patient to walk is crucial for preventing injuries for both the patient and the caregiver, and it involves more than just holding their hand. A combination of proper assessment, body mechanics, and the correct use of assistive devices is key to promoting safe patient ambulation.

Quick Summary

This guide outlines the essential steps for safely assisting a patient to walk, including preparation, proper technique with a gait belt, handling falls, and using assistive devices. It emphasizes communication, correct body mechanics, and assessing patient readiness to prevent injuries and promote confidence.

Key Points

• Pre-Assessment is Key: Always assess the patient's mobility, strength, and balance before attempting to assist them with walking.

• Use a Gait Belt for Safety: A gait belt provides a secure handhold to steady the patient and reduce the risk of falls during ambulation.

• Practice Proper Body Mechanics: Bend your knees, keep your back straight, and use your leg muscles when assisting with transfers to prevent injury to yourself.

• Stand on the Weaker Side: If the patient has a weaker side, position yourself on that side, slightly behind them, to provide extra support and control.

• Match the Patient's Pace: Walk slowly and at the patient's natural speed to prevent them from feeling rushed or losing their balance.

• Know How to Handle a Fall: If a patient falls, do not try to lift them. Instead, widen your stance, bend your knees, and guide them safely to the floor.

• Ensure the Environment is Safe: Clear walkways of clutter and make sure the patient is wearing proper, non-skid footwear before beginning to walk.

Essential Steps for Safe Patient Ambulation

Before you begin assisting a patient with walking, proper preparation and technique are critical. The goal is to provide support while encouraging the patient's independence and ensuring the safety of both parties.

Prioritize Patient Assessment and Preparation

Before any movement, a thorough assessment and preparation of the environment are essential. You must determine the patient's capability and ensure the area is clear of hazards.

1. Assess Patient Mobility: Use a tool like the Bedside Mobility Assessment Tool (BMAT) to gauge the patient's strength, balance, and endurance. This helps determine the appropriate level of assistance required.
2. Clear the Path: Remove any clutter, throw rugs, or obstacles from the walking path to prevent trips and falls. This includes securing any oxygen tubing or IV lines that could cause a hazard.
3. Ensure Proper Footwear: The patient should wear well-fitting, non-skid shoes or slippers with rubber treads. Socks alone are not sufficient and can increase the risk of slipping.
4. Manage Pain: If the patient is recovering from a surgery or injury, coordinate with a healthcare professional to ensure appropriate pain medication is administered before ambulation, as prescribed.

The Importance of a Gait Belt

A gait belt is a standard piece of equipment used to provide a secure handhold and control during ambulation. It is important to note that a gait belt is for steadying and support, not for lifting the patient.

Applying the Gait Belt:

• Place the belt snugly around the patient's waist over their clothing, ensuring it's not too tight by leaving enough room for your fingers to grasp it.
• Position the buckle to the side or back to prevent pressure or discomfort.
• If the patient has a wound or colostomy, adjust the belt's placement accordingly, possibly higher up toward the chest.

Using the Gait Belt:

• Stand on the patient's weaker side, slightly behind them. This position allows you to support the side with less strength.
• Grasp the gait belt firmly from the back with an underhand grip, which provides a stronger and more secure hold.
• Walk at the patient's pace, taking small steps and providing gentle, steady support.

Comparison of Assistive Devices

When assisting a patient, you may need to use an assistive device based on their specific needs, as recommended by a physical therapist.

Assistive Device	Best For	Safety Considerations
Cane	Patients with slight weakness, instability, or minor balance issues. Used on the stronger side.	Ensure proper height (handle at hip level, with a slight elbow bend) and rubber tip is not worn.
Standard Walker	Patients requiring maximum support due to significant balance or strength issues. Requires lifting to move.	Instruct patient to lift the walker, not slide it, and ensure all four legs are on the ground before stepping.
2-Wheeled Walker	Patients with better mobility who need support but find a standard walker too slow.	Less stable than a standard walker; check for functioning wheel locks on turns. Patient should push down for support.
4-Wheeled Walker (Rollator)	Patients with good mobility and balance who need only mild support and a seat for resting.	Can roll away easily, increasing fall risk. Only use for patients with good balance and ability to control its movement.

Proper Technique for Assisting from Sitting to Standing

Transitions are a high-risk time for falls. Use proper body mechanics to protect both yourself and the patient.

1. Prep the Patient: Ensure the patient is sitting on the edge of the bed or chair with feet flat on the floor. Ask them to scoot forward so their feet are underneath them.
2. Position Yourself: Stand in front of the patient, bracing their knees with your own to prevent them from buckling. Bend your knees and keep your back straight.
3. Rock and Stand: Use a rocking motion to build momentum. On the count of three, have the patient push up with their arms as you gently pull forward on the gait belt, assisting them to a standing position.
4. Ensure Stability: Once standing, allow the patient a few seconds to regain their balance before walking. Ask if they feel dizzy or lightheaded.

Handling a Fall Safely

If a patient begins to fall, your reaction is critical. Do not try to catch or lift them, as this can cause injury to both of you.

1. Widen Your Stance: Widen your base of support by spreading your legs.
2. Guide to the Ground: Guide the patient's body close to yours using the gait belt. Bend your knees and use the strength of your legs to gently lower them to the floor in a controlled manner.
3. Protect the Head: As you lower them, protect the patient's head from hitting the ground or any objects.
4. Do Not Move Them: After the patient is on the floor, do not attempt to get them up alone. Assess for injuries and call for assistance from another caregiver or emergency services.

Conclusion

Assisting a patient to walk requires careful planning, proper equipment, and sound technique to ensure the safety of everyone involved. By conducting a mobility assessment, using a gait belt correctly, understanding when to use assistive devices, and knowing how to respond during a fall, caregivers can promote a secure and confident ambulation experience. Constant communication and observation are vital throughout the process to prevent injury and support the patient's progress toward greater mobility.

American Nurses Association's Handle with Care website

Frequently Asked Questions

What is a gait belt, and how is it used?

A gait belt is a durable strap, typically made of canvas or nylon, that is placed snugly around a patient's waist. It provides a secure handhold for a caregiver to assist with walking, standing, and transfers, helping to control the patient's center of gravity and prevent falls.

How do you properly position yourself when assisting a patient to walk?

You should stand on the patient's weaker side, slightly behind them. This allows you to support the side with less strength while using an underhand grip on the gait belt for a secure hold. Match their pace and keep them close to your body.

What should I do if a patient starts to fall?

Do not attempt to lift or stop the fall. Instead, widen your stance, hug the patient close to your body using the gait belt, and bend your knees to guide them gently and safely to the floor. Protect the patient's head as they descend.

What should the patient wear on their feet for safe ambulation?

Patients should wear well-fitting, non-skid shoes or slippers with rubber treads. Socks alone can be very slippery and are not appropriate for safe walking.

How do you assist a patient from a sitting to a standing position?

First, help the patient sit on the edge of the bed or chair with their feet flat on the floor. Stand in front of them with your knees bracing theirs. Use a rocking motion and, on a count of three, help them push up with their arms while you pull gently on the gait belt.

When should I use a walker instead of just a gait belt?

A walker is appropriate for patients with significant balance or strength issues, or those who need maximum support while walking. A gait belt is used in combination with the walker to provide additional stability and control.

Can I use a gait belt to lift a patient?

No, a gait belt is a support tool, not a lifting device. Its purpose is to provide a secure grip for a caregiver to steady and control a patient, not to bear their full weight. If a patient cannot bear their own weight, a mechanical lift is likely needed.