When ambulating the client, the nurse aide should?

According to the Centers for Disease Control and Prevention (CDC), millions of older adults fall each year, with falls being the leading cause of injury-related death in this population. When ambulating the client, the nurse aide should prioritize proper technique and unwavering vigilance to prevent falls and protect their client.

Quick Summary

The nurse aide must first assess the client's condition, ensure a clear path, and apply a gait belt correctly. Throughout the ambulation process, the aide should maintain proper body mechanics, offer clear instructions, and be prepared to safely respond to any loss of balance to prevent injury.

Key Points

• Safety First: Prioritize client safety above all else by assessing the client and environment before starting.

• Gait Belt Mandatory: Always use a gait belt for secure transfers and ambulation, providing a firm grip point.

• Clear Communication: Use simple, clear instructions to inform the client and ensure cooperation during the process.

• Proper Body Mechanics: Protect your own back by bending your knees and using your legs to lift and support.

• Environmental Scan: Clear the path of all obstacles and ensure the client wears appropriate, non-skid footwear.

• Fall Protocol: In case of a fall, ease the client safely to the floor and do not attempt to stop or lift them.

The Core Principles of Safe Ambulation

Safe and effective ambulation is a cornerstone of a nurse aide's responsibilities. It’s not just about getting a client from point A to point B; it's about doing so with respect for their dignity and a focus on preventing harm. Before any movement begins, a systematic approach is essential.

The Pre-Ambulation Safety Checklist

Prior to starting, a thorough assessment is crucial. This involves more than a quick look; it requires active observation and communication.

Assessing the Client

• Evaluate their physical and mental state: Is the client dizzy, weak, or disoriented? Their mental status can be as important as their physical one. A confused client may not follow instructions, increasing the risk of a fall.
• Review the care plan: Always check the client’s care plan for specific instructions, weight-bearing status, and any special considerations or precautions related to their condition.
• Communicate with the client: Explain exactly what you are about to do in simple, clear language. This builds trust and encourages cooperation.

Preparing the Environment

• Clear the path: Remove any clutter, rugs, or other obstacles from the path of travel. Ensure the floor is clean and dry.
• Ensure proper footwear: The client must wear non-skid, well-fitting shoes or slippers. Walking in socks alone is a significant fall risk.
• Lock equipment: If the client is transferring from a wheelchair or bed, make sure the brakes are locked to prevent movement.

The Step-by-Step Guide to Safe Ambulation

Following a consistent procedure ensures all steps are performed correctly, minimizing risk.

The Correct Use of a Gait Belt

A gait belt is a crucial safety device for ambulating clients.

1. Placement: Place the belt snugly around the client's waist, over their clothes. Ensure it's not too tight by checking that you can comfortably fit two fingers between the belt and the client's body.
2. Securing: Fasten the belt securely. The buckle should be positioned to the side or slightly off-center to prevent it from causing pressure on the client’s spine or abdomen.
3. Positioning for support: During ambulation, the nurse aide holds the gait belt from the back or side, providing a secure handhold and control over the client's movements.

Assisting the Client to Stand

1. Position yourself: Stand directly in front of the client with a wide, stable base.
2. Verbal cues: Instruct the client to lean forward and push off with their hands (if they are able) on the armrests of the chair or bed.
3. Providing support: As the client rises, you can provide upward assistance by lifting the gait belt with a firm, steady motion.
4. Steadying: Once the client is standing, allow them a moment to regain their balance before moving.

Providing Support During Movement

• Positioning: Walk slightly behind and to one side of the client, maintaining a hand on the gait belt. This allows you to support them if they lose their balance.
• Pacing: Match your pace to the client's. Never rush them.
• Communication: Continue to provide encouragement and simple instructions, such as, “You’re doing great,” or, “Let's take a small step.”

Comparison of Ambulation Techniques

Different clients require different levels of support. The following table compares general techniques for two common scenarios.

Feature	Assisting a Client with Mild Weakness	Assisting a Client with Significant Weakness
Gait Belt	Always used for a secure grasp point.	Essential for providing maximum support and control.
Aide's Position	Stand to one side and slightly behind, holding the gait belt.	Stand closer, with a wider stance. Position yourself to bear more of the client's weight if needed.
Use of Assistive Devices	The client may use a cane or walker. The aide guides and supports.	The client may require more direct support. The aide's role is more active in managing stability.
Pacing	Can follow the client's natural pace.	Must proceed slowly and deliberately, pausing often.
Risk Level	Moderate risk of falls.	Higher risk of falls, requiring extreme caution.

Special Considerations and Procedures

Some situations require additional techniques to ensure maximum safety.

Ambulation with Assistive Devices

When a client uses a walker or cane, the nurse aide's role shifts to supervision and spotting, not full support. Ensure the client uses the device correctly, and that the device is in good working condition. Always maintain a grip on the gait belt.

Handling a Client Who Starts to Fall

If a client begins to fall, your reaction is critical. Do not attempt to stop the fall by lifting the client back up. This can cause severe injury to both of you. Instead:

1. Widen your stance: Spread your feet to create a solid base.
2. Pull the client close: Using the gait belt, pull the client's body close to yours. This helps control the fall.
3. Ease them to the floor: Bend your knees and slowly ease the client to the floor, guiding them to land in a controlled manner.
4. Check for injuries: Once the client is safely on the floor, assess them for any injuries before calling for help.

The Importance of Proper Body Mechanics

Protecting your back is just as important as protecting your client. Back injuries are common among healthcare workers, but they are often preventable. By bending your knees and using the large leg muscles to lift, you reduce strain on your back.

Conclusion

Safe ambulation is a critical skill for any nurse aide. When ambulating the client, the nurse aide should always conduct a pre-ambulation assessment, use the gait belt correctly, and follow established safety procedures. Maintaining clear communication, a safe environment, and proper body mechanics are all non-negotiable parts of this responsibility. Adhering to these principles protects both the client from injury and the nurse aide from occupational strain. For more information on fall prevention, visit the CDC website.

Frequently Asked Questions

What is the most important step before ambulating a client?

The most important step is to perform a thorough assessment of the client's physical and mental state, as well as the safety of the surrounding environment, to prevent falls.

How do you properly apply a gait belt?

Place the belt snugly around the client's waist over their clothes, ensuring you can fit two fingers underneath. Fasten it securely with the buckle to the side.

What should a nurse aide do if a client starts to fall?

The nurse aide should widen their stance, pull the client close using the gait belt, and ease them gently to the floor. Do not attempt to stop the fall or lift them back up, as this can cause injury to both parties.

Why is it important for the client to wear non-skid footwear?

Non-skid footwear provides better traction and reduces the risk of slipping, which is a major cause of falls, especially on smooth surfaces like tile or linoleum.

How can a nurse aide use proper body mechanics during ambulation?

A nurse aide should bend at the knees and hips, keep their back straight, and use the strength of their leg muscles to assist the client. This protects the aide's back from strain and injury.

Should a client's walker or cane be used to pull them up?

No, a client should be instructed to push up from the armrests of their chair or bed. Walkers and canes are not designed to support a full lift and can tip, causing a fall.

How can clear communication help when ambulating a client?

Clear communication helps the client feel secure and cooperative. Explaining each step allows them to anticipate movements and participate, reducing anxiety and confusion.