When moving a resident up in bed who is able to move with assistance, the nursing assistant should? Do this.

According to the Occupational Safety and Health Administration (OSHA), musculoskeletal disorders resulting from manual patient handling are a leading cause of injury among healthcare workers. To prevent injury to both caregiver and resident, knowing the correct procedure for when moving a resident up in bed who is able to move with assistance, the nursing assistant should follow specific steps to maximize safety, comfort, and resident participation.

Quick Summary

This guide details the crucial safety measures, preparatory actions, and step-by-step procedures for repositioning a resident who can provide partial assistance. It covers the use of assistive devices like draw sheets, proper body mechanics, effective communication, and strategies to minimize skin shear and friction during the movement. The article also provides comparative information on different assistive techniques to ensure safety for both the nursing assistant and the resident.

Key Points

• Involve the Resident: Explain the procedure clearly and ask them to participate by bending their knees and pushing with their feet on the count of three.

• Use a Draw Sheet: Always use a draw sheet or lift sheet under the resident to reduce friction and shear forces, which helps prevent skin damage.

• Protect Your Back: Employ proper body mechanics by keeping your knees bent, back straight, and using your leg muscles for the movement. Avoid bending at the waist.

• Position for Safety: Lower the head of the bed as flat as possible, lock the bed's wheels, and place a pillow at the headboard to protect the resident's head.

• Avoid Lifting: Use a smooth, sliding motion with the draw sheet rather than lifting the resident's weight to prevent injury to both yourself and the resident.

• Move Together: Coordinate the movement with the resident, timing the action with their push on the count of three for a synchronized and efficient move.

• Utilize a Second Assistant: For heavier residents or those who can provide less assistance, use a second nursing assistant to ensure the move is safe for all involved.

• Re-align After Moving: After repositioning, ensure the resident is comfortably and properly re-aligned in the center of the bed to prevent falls and discomfort.

Preparing to Move a Partially Assisting Resident

Proper preparation is the foundation of a safe and effective patient repositioning procedure. It protects both the resident and the nursing assistant from potential injury. Before any movement begins, ensure you have the correct equipment and have communicated clearly with the resident.

Communicating and Involving the Resident

• Explain the Procedure: Always tell the resident what you are going to do, speaking in a calm, clear voice. This reduces anxiety and builds trust. Explain your plan step-by-step to promote their comfort and cooperation.
• Encourage Participation: Emphasize that their assistance is valuable. Ask them to participate by pushing with their feet or helping on the count of three. Involving them increases their sense of control and independence while reducing the physical effort required from the nursing assistant.
• Use Visual and Verbal Cues: For residents with cognitive impairment, use simple, direct instructions. For residents with hearing loss, ensure you have their attention and face them directly so they can read your lips.

Essential Equipment and Setup

A properly prepared environment minimizes risks and streamlines the process. Use the following equipment and procedures to ensure safety:

• Draw Sheet (Lift Sheet): A draw sheet is a folded sheet placed under the resident from the shoulders to the thighs. Using it creates a smooth surface that reduces friction and shear, preventing skin tears and bruises. A draw sheet is mandatory when repositioning someone who requires assistance.
• Adjustable Bed: Adjust the bed to a comfortable working height for the nursing assistant to prevent back strain. The bed should be flat for the move, if the resident can tolerate this position. Place a pillow against the headboard to protect the resident's head during the upward movement.
• Lock Brakes: Always lock the wheels on the bed to prevent it from moving during the procedure.

Step-by-Step Technique for Moving the Resident

Once prepared, a nursing assistant can proceed with the coordinated movement. This technique relies on leveraging the resident's abilities and using proper body mechanics.

1. Lower the head of the bed as flat as the resident can tolerate.
2. Move the resident to the side of the bed in segments to prevent back strain and prepare for the upward boost. This involves moving the upper body, then the lower body.
3. Place the resident's arms across their chest and ask them to tilt their head towards their chest. This prevents injury to their arms and head during the boost.
4. Help the resident bend their knees and place their feet flat on the mattress, using their strong leg muscles to assist with the push.
5. Use a draw sheet by rolling the excess fabric up close to the resident's body on both sides for a firm grip.
6. Position yourself with a wide stance, knees bent, and back straight. A second assistant is ideal for safety and proper ergonomics, positioned on the opposite side of the bed.
7. Coordinate the move. On the count of three, instruct the resident to push with their feet while you and your assistant (if applicable) pull the draw sheet toward the head of the bed. Use a smooth, sliding motion rather than a lift to prevent friction and shear.
8. Re-align and reposition the resident for comfort once the move is complete. Ensure they are centered in the bed and replace the pillow under their head.

Safety and Resident Involvement

Maximizing resident participation is a key aspect of this procedure. The technique outlined uses the resident's own strength to make the move safer and more efficient for everyone involved. This collaborative approach fosters a sense of dignity and can be a form of exercise for the resident.

Comparison of Techniques

Method	Technique	Equipment	Safety and Benefits
Partial Assist Boost	Coordinated push (resident) and pull (NA via draw sheet). Resident bends knees and pushes with feet.	Draw sheet or lift sheet, adjustable bed.	Promotes resident participation and independence. Reduces strain on nursing assistant. Minimizes friction and shear.
Total Dependence Move	Two or more NAs use a draw sheet to lift and reposition the resident, who cannot assist.	Draw sheet, adjustable bed.	Eliminates resident effort. Requires multiple staff. Increased risk of injury if not performed with proper body mechanics.
Mechanical Lift	Uses a mechanical device (e.g., Hoyer lift) with a sling to move the resident.	Mechanical lift, appropriate sling.	Used for residents who cannot bear weight or have extensive assistance needs. Eliminates manual lifting. Requires proper training for safe use.

Conclusion

For when moving a resident up in bed who is able to move with assistance, the nursing assistant should focus on a collaborative approach that prioritizes safety for both parties. The procedure involves proper communication, the use of a friction-reducing draw sheet, and leveraging the resident's own strength to propel them upward. By following established safety guidelines—including proper body mechanics and clear coordination—nursing assistants can effectively reposition residents while minimizing the risk of injury and maintaining the resident's dignity and comfort. This practice, when performed correctly, is a cornerstone of restorative care, encouraging resident independence and well-being.

Frequently Asked Questions

What is the primary purpose of involving the resident in the repositioning process?

Involving the resident empowers them by encouraging participation, promoting independence, and reducing the physical strain on the nursing assistant. It also ensures they feel comfortable and safe during the move.

Why is it important to use a draw sheet?

A draw sheet creates a smooth surface to slide the resident up the bed, which significantly reduces friction and shear. This prevents skin damage, such as tears and pressure ulcers, which are common risks during repositioning.

How do proper body mechanics protect the nursing assistant?

Proper body mechanics, including bending your knees, keeping your back straight, and using your legs to power the movement, prevents back injuries and musculoskeletal strain. It ensures you use your strongest muscles for the task.

What should the nursing assistant tell the resident before moving them?

The nursing assistant should explain the entire procedure in simple, clear terms and tell the resident exactly how they can help. This includes informing them of the 'count of three' cue so they know when to push with their feet.

What is the role of the resident's bent knees in the process?

When the resident bends their knees and pushes with their feet, they use their leg strength to help move themselves. This significantly reduces the effort required from the nursing assistant and contributes to the coordinated movement.

When should two nursing assistants be involved in the move?

A second nursing assistant should be involved for heavier residents or those who can provide less assistance. This ensures the safety of all involved and allows for more controlled, evenly distributed movement.

How do you prevent the resident from sliding back down after being repositioned?

Once the resident is moved up, reposition them comfortably in the center of the bed. If necessary, the head of the bed can be elevated slowly and carefully to a 30-degree angle or less to reduce gravity-induced sliding.