Where Should a Nursing Assistant Stand While Helping a Resident with Ambulation?

According to the Agency for Healthcare Research and Quality, millions of patient falls occur in healthcare settings each year, underscoring the critical need for proper technique. Knowing exactly where should a nursing assistant stand while helping a resident with ambulation is paramount for safety and preventing injury for both the resident and the caregiver.

Quick Summary

A nursing assistant should stand slightly behind and to the side of the resident, positioned on their weaker or affected side to provide optimal support and a firm grip on the gait belt, ensuring quick intervention if balance is lost. This position allows the NA to guide the resident's movements effectively while maintaining control.

Key Points

• Position on the Weaker Side: For residents with unilateral weakness, stand on the affected side to offer maximum support and stability during ambulation.

• Slightly Behind and to the Side: This strategic position allows the nursing assistant to guide the resident's movement effectively and react quickly to any loss of balance.

• Use a Gait Belt Correctly: A gait belt, grasped with an underhand grip, is essential for control and safety, ensuring the NA can support the resident without straining themselves.

• Never Catch a Falling Resident: Instead of trying to stop a fall, use the controlled lowering technique: widen your stance, guide the resident down your leg, and protect their head.

• Prepare the Environment: Before starting, ensure the path is clear of obstacles and the resident is wearing non-skid footwear to reduce the risk of slips and falls.

• Promote Resident Confidence: Clear communication and a calm, reassuring approach help reduce resident anxiety and encourage greater participation in the ambulation process.

Importance of Proper Positioning and Technique

Assisting a resident with ambulation, or walking, is a fundamental skill for nursing assistants. Proper positioning is not just a matter of protocol; it is a critical safety measure designed to prevent falls, protect both the resident and the caregiver from injury, and promote a resident's sense of security and confidence. A lapse in technique can lead to serious consequences, including fractures, head injuries, or career-threatening back strains for the NA.

The Correct Standing Position for Ambulation

For most ambulation scenarios involving a gait belt, the nursing assistant's positioning is key. The correct stance is slightly behind and to the side of the resident. The side the NA stands on is crucial, especially if the resident has unilateral weakness (weakness on one side).

Standing on the Resident's Weaker Side

When a resident has a known weaker side, such as from a stroke, the nursing assistant should always stand on that side. This strategic positioning provides several advantages:

• Immediate Support: The NA is immediately available to support the weaker side, which is most likely to give way.
• Fall Intervention: If the resident begins to lose balance, the NA is in the ideal position to intervene and guide them safely to the floor without causing injury.
• Enhanced Stability: By being closer to the resident's center of gravity on their less stable side, the NA can exert more effective control and support.

Using a Gait Belt

A gait belt is an essential tool for assisted ambulation. The NA should grasp the belt firmly with an underhand grip, keeping their elbows slightly bent and close to their sides. This grip provides a strong and stable hold, allowing the NA to control the resident's movements and offer support.

Preparing for Safe Ambulation

Proper preparation is just as important as the technique itself. A nursing assistant must take several steps before a resident even begins to stand.

• Explain the Process: Communicate clearly with the resident, explaining each step of the process. This helps build trust and cooperation.
• Check the Environment: Scan the path for any potential hazards. Ensure pathways are clear of clutter, rugs are not loose, and there are no spills on the floor.
• Proper Footwear: Ensure the resident is wearing appropriate, non-skid footwear. Never allow a resident to ambulate in socks or bare feet.
• Manage Equipment: For residents with walkers, canes, or IV poles, ensure the equipment is properly adjusted and in good working order. If an IV pole is used, it should be kept on the resident's stronger side.
• Dangle: Before standing, a resident should sit on the edge of the bed (dangling) for a few moments to prevent orthostatic hypotension (a drop in blood pressure upon standing that can cause dizziness).

Comparison of Ambulation Scenarios

Scenario	NA Standing Position	Grip and Hold	Key Consideration
General Ambulation	Slightly behind and to the side.	Firm grip on gait belt with both hands (underhand).	Walk at the resident's pace and encourage normal gait.
Weakness (e.g., post-stroke)	Behind and to the side of the weaker side.	Firm grip on gait belt with both hands.	Focus support on the weaker side; communicate clearly.
No Gait Belt	Use the hand closest to the resident to support their back at the waist or arm.	Secure but gentle grip, supporting the back.	Be ready to provide more physical support if needed.
Two-Person Assist	One NA on each side of the resident.	Both NAs grasp the gait belt with one hand each.	Coordinate movements and communication to ensure steady support.

Handling a Fall During Ambulation

One of the most critical safety aspects is knowing how to react if a resident begins to fall. The immediate, instinctual reaction to catch a falling person is dangerous and can lead to serious back injury for the nursing assistant.

The Correct Fall Procedure

1. Do Not Catch: Do not try to stop the fall. Instead, move your body to a supportive position behind the resident.
2. Widen Your Stance: Take a step back and spread your feet to establish a wide base of support.
3. Maintain Your Grip: Keep a firm grip on the gait belt or around the resident's waist/hips.
4. Create a Ramp: Place one of your legs between the resident's legs from behind.
5. Lower Slowly: Slowly slide the resident down your leg to the floor, bending your knees to absorb the weight. This controlled descent protects both parties.
6. Protect the Head: Always protect the resident's head from hitting the floor.
7. Do Not Move: Once the resident is safely on the floor, do not attempt to move them. Notify the nurse immediately for an assessment.

Importance of Training and Protocol

Every nursing assistant must receive thorough training on proper ambulation techniques and fall procedures. Facilities often have specific protocols and incident reporting requirements. Always adhere to the established care plan and seek assistance when necessary. When in doubt, it is always better to get help than to risk an injury.

Conclusion: Prioritizing Safety and Confidence

Mastering the skill of assisting with ambulation is a cornerstone of effective nursing care. Knowing where should a nursing assistant stand while helping a resident with ambulation is fundamental to ensuring safety, preventing harm, and fostering a resident's independence. By combining correct positioning, proper gait belt usage, and a clear, rehearsed fall procedure, nursing assistants can provide the highest level of care. Maintaining professionalism, using proper body mechanics, and communicating clearly with residents will make the ambulation process safer and more dignified for all involved. For more in-depth clinical skills, reference authoritative nursing guidelines, such as those found on the NCBI Bookshelf.

Frequently Asked Questions

What is the primary purpose of a gait belt?

The primary purpose of a gait belt is to provide the nursing assistant with a secure and controlled grip point to help steady and support a resident during ambulation. It is a safety tool, not a device for lifting the resident off the floor.

When should a nursing assistant not use a gait belt?

A gait belt should not be used on residents with certain medical conditions, including recent abdominal or chest surgery, abdominal hernia, or certain respiratory conditions. Always check the resident's care plan and consult with a nurse if unsure.

How do you ensure the gait belt is applied correctly?

The gait belt should be placed snugly around the resident's natural waist, over their clothing, and above the hips. It should be tight enough that two fingers can fit comfortably underneath, but no tighter. The buckle should be placed slightly off-center for comfort.

What should the nursing assistant do if the resident becomes dizzy?

If a resident becomes dizzy, the nursing assistant should immediately guide them to a nearby chair or back to the bed to sit down. Do not continue ambulating. Ensure they are safe and notify the nurse.

Is it safe for a nursing assistant to try and lift a resident who has fallen?

No, it is not safe. An NA should never attempt to lift a resident from the floor alone. After the controlled fall procedure, the resident should be left in place until a nurse or other trained personnel can assess them and use a mechanical lift if necessary.

How do you assist a resident who uses a walker?

When assisting a resident with a walker, the nursing assistant should still stand slightly behind and to the side, maintaining a grip on the gait belt. The NA's role is to provide backup support, not to pull or guide the walker, allowing the resident to use the device correctly.

Why is it important to have the resident dangle their legs before standing?

Allowing a resident to 'dangle' their legs by sitting on the edge of the bed helps their body adjust to the upright position. This prevents orthostatic hypotension, a condition where blood pressure drops and causes dizziness or fainting, which increases the risk of a fall.