When moving a resident up in bed, the CNA should? A Comprehensive Guide to Safe Techniques

According to the CDC, manual patient handling is one of the leading causes of musculoskeletal disorders among healthcare workers. To prevent injuries for both themselves and the resident, certified nursing assistants must master proper techniques when moving a resident up in bed, using a methodical and ergonomic approach.

Quick Summary

To safely move a resident up in bed, CNAs should first assemble necessary equipment like a draw sheet, ensure they have an assistant for heavier residents, lower the bed's head, and communicate the steps clearly. Utilizing proper body mechanics and working together on a synchronized count, the CNA and assistant can effectively reposition the resident while preventing injury and promoting dignity.

Key Points

• Pre-Move Assessment: Always check the resident's care plan, assess their ability to assist, and explain the procedure clearly before you begin.

• Use a Draw Sheet: Never manually pull a resident by their limbs. Use a draw sheet or repositioning device to reduce friction and minimize the risk of skin tears.

• Employ Proper Body Mechanics: Protect your back by bending your knees, keeping the resident close to your body, and using your legs for the lifting effort.

• Teamwork is Essential: For most residents, two CNAs are required to safely perform the move. Coordinate with your partner on a count to ensure a synchronized, smooth motion.

• Prioritize Privacy and Dignity: Always ensure the resident's privacy by closing curtains and keeping them covered, treating them with respect throughout the procedure.

Preparing for the Resident's Move

Proper preparation is the foundation of a safe and efficient transfer. Before you begin the process of moving a resident up in bed, take a moment to assess the situation and gather your resources. Skipping this crucial step can lead to resident injury, skin tears, or back strain for the CNA.

Assessment and Communication

Before touching the resident, introduce yourself and explain exactly what you are about to do. For residents with cognitive impairments, use a calm, slow, and respectful tone, using gestures to support your words. Assess the resident's mobility and ability to assist. Do they have limitations due to pain, paralysis, or a recent surgery? Check the care plan for any specific instructions or precautions.

Assembling Equipment

Using the right equipment is critical for a smooth transfer and minimizes friction and shearing forces that can damage the resident’s fragile skin. Essential equipment includes:

• Draw sheet or slide sheet: A folded sheet or a specialized friction-reducing sheet that goes under the resident's torso and hips. This is a non-negotiable tool for safer moving.
• Assistant: For most residents, a two-person lift is safer and standard practice. Never attempt to manually lift a heavy or non-ambulatory resident alone.
• Pillows: Place pillows against the headboard to protect the resident's head during the move.

Preparing the Environment

Just as important as preparing yourself and the resident is preparing the environment. Ensure the bed is at a safe, working height for the CNAs to prevent back strain, typically around waist level. Lock the bed wheels to prevent movement during the procedure. Remove any unnecessary items from the bed that could interfere with the process, such as bedside tables or loose blankets.

The Step-by-Step Procedure for Moving a Resident

Following a consistent and coordinated procedure ensures the safety and comfort of the resident. Here is the recommended process for a two-person move using a draw sheet.

1. Lower the head of the bed: If the resident can tolerate it, lower the head of the bed to a flat or near-flat position. This reduces the risk of shearing.
2. Position the draw sheet: Roll the resident onto their side and place the rolled-up draw sheet against their back. Roll the resident back onto the sheet and spread it out, ensuring it is positioned under the resident's shoulders, back, and hips.
3. Encourage participation: If the resident is able, ask them to bend their knees and push with their feet during the move. Instruct them to tuck their chin toward their chest to protect their head.
4. Stand correctly: The two CNAs should stand on opposite sides of the bed with a wide, stable base of support. One foot should be slightly forward in the direction of the move.
5. Grab the draw sheet: Each CNA should grasp the rolled-up draw sheet firmly near the resident's shoulders and hips.
6. Coordinate the move: On a pre-arranged count (e.g., “one, two, three”), both CNAs simultaneously shift their weight and pull the sheet toward the head of the bed in a smooth motion. Avoid jerky movements.
7. Reposition and complete: Once the resident is in the correct position, remove the draw sheet and replace the pillows under their head. Ensure the resident is comfortable, and raise the head of the bed to their desired position, if appropriate.

Comparison of Repositioning Techniques

Technique	Advantages	Disadvantages	Best For
Manual Repositioning (no device)	No special equipment needed, faster for very minor adjustments.	High risk of CNA back injury, increased risk of skin shearing and friction.	Extremely lightweight residents who can fully assist and for minor adjustments only.
Draw Sheet Repositioning	Significantly reduces friction and shearing, distributes resident's weight, safer for CNA.	Requires two CNAs for most residents.	Most standard resident moves where the resident has some or limited mobility.
Mechanical Lift	Safest for bariatric or non-weight-bearing residents, minimizes CNA strain.	Can be time-consuming to set up, requires special training and equipment, may be intimidating for residents.	Bariatric, completely dependent, or fragile residents.

Ergonomic Principles for CNAs

Practicing proper body mechanics is not just a suggestion; it is a vital part of protecting your long-term health and career. Over time, poor lifting techniques can cause debilitating back pain and injury.

To protect yourself when repositioning residents:

• Bend with your knees, not your back. This transfers the lifting force to your stronger leg muscles. (Source: OSHA's Safe Patient Handling page).
• Keep the resident close to your body. The closer the load is to your center of gravity, the less strain it places on your back.
• Avoid twisting. Pivot with your feet instead of twisting your spine. Always face the direction of the move.
• Use a wide stance. This provides a stable base of support.
• Communicate with your partner. Coordinate movements to ensure you are lifting and moving in sync.

Promoting Dignity and Avoiding Complications

Providing care with dignity is at the heart of the CNA's role. A patient's dignity can be compromised if they feel exposed or are handled roughly. Remember to always provide privacy by closing curtains or doors and keeping the resident properly covered. Ensure their clothes and linens are smooth after the move to prevent wrinkles, which can cause skin irritation.

Shearing and friction are two primary causes of pressure injuries in residents. Shearing occurs when skin stays in place while underlying tissue shifts, as when a resident slides down in bed. Friction is the rubbing of skin against a surface. A draw sheet is the single best tool for mitigating these risks by allowing for a smooth gliding motion. Proper technique, communication, and equipment are your best defenses against both resident and staff injury.

Conclusion

For any CNA, mastering the safe and proper technique for moving a resident up in bed is a fundamental skill. By prioritizing patient safety through clear communication, protecting their dignity, utilizing the right equipment, and adhering to strict ergonomic principles, you ensure the well-being of both yourself and the person in your care. This methodical approach not only prevents common injuries but also enhances the resident's comfort and trust, building a foundation of quality, compassionate care.

Frequently Asked Questions

What is a CNA's primary consideration when moving a resident?

A CNA's primary consideration is the safety and dignity of the resident, along with the CNA's own ergonomic safety. This means using proper techniques and equipment to prevent injury to all involved.

Can a CNA move a resident up in bed alone?

A CNA should only attempt to move a resident alone if the resident is lightweight and able to fully assist. For most residents, especially those with limited mobility, a two-person team using a draw sheet is the safest and required protocol.

Why is using a draw sheet so important?

Using a draw sheet is important because it significantly reduces friction and shearing forces on the resident’s skin, which can cause painful skin tears and pressure ulcers. It also helps distribute the resident's weight, making the move easier for the CNA.

What if the resident is unable to bend their knees?

If a resident cannot bend their knees, the two-person draw sheet method is even more critical. Do not attempt to move them by pulling their limbs. The CNAs should perform the move using the draw sheet and their leg muscles, ensuring the resident’s body is moved as a single, coordinated unit.

How do CNAs prevent back injuries when repositioning residents?

CNAs prevent back injuries by using proper body mechanics, which includes bending their knees instead of their back, keeping the resident close to their body, using a wide stance, and pivoting with their feet instead of twisting their spine.

How does communication help when moving a resident?

Clear communication helps the CNA explain the process, reduce the resident's anxiety, and gain their cooperation. For a two-person team, coordinating the move with a clear count ensures everyone moves in sync, preventing sudden movements that could cause injury.

When should a mechanical lift be used instead of manual repositioning?

A mechanical lift should be used for bariatric residents, residents who are completely dependent and unable to bear any weight, or when specified in the resident's care plan. It is the safest option for moves that would otherwise require excessive manual force.