Nursing SkillsLifting and MovingPrepared by: Mark Fredderick R. Abejo R.N, M.A.N 1Foundations of Nursing AbejoLifting and MovingNURSING SKILLSLifting and MovingLecturer: Mark Fredderick R. Abejo R.N, M.A.NLIFTING and MOVINGPURPOSES OF LIFTING AND MOVING POSITION• To encourage patient’s mobility• To promote patient’s comfort• To promote blood circulation• To maintain skin integrity• To transfer patient safely• To avoid injury whenever a patient is moved.• To practice using equipment.• To know that certain patient conditions call for specialtechniques.BASIC PRINCIPLES OF LIFTING AND MOVINGPATIENTS1) Keep the weight of the object as close to the body aspossible.2) To move a heavy object, contract your abdominalmuscles and lift with the leg, hips, and glutealmuscles.3) When lifting, align your shoulders, hips and feet in avertical line.4) Reduce the height or distance through which theobject must be moved.TYPE OF MOVES.Emergency movesThis used when there is immediate danger to thepatient or to threscuer1. Top priority in emergency care is to maintain thepatient’s ABCs. Generally, you will control any life-threatening problems and stabilize the patient beforemoving2. If scene is unstable or unsafe and there is threat to thelife or well-being of the patient or of you, the abovepriority changes.3. Emergency moves are a last resort. Do only when yourun out of options.4. Three reasons to use an emergency move: There is an immediate environmental danger tothe patient or rescuer such as fire, exposure toexplosives, toxic fumes, etc. You cannot gain access to other patients whoneed life-saving care. You cannot render life-saving care due to thepatient’s location or position.5. Three types of emergency moves:i. Bent Arm Dragii. Clothing Drag.iii. Blanket Drag.An Urgent MoveThis used when the patient is suffering from animmediate threat to life.1) A patient in an MVA must be quicklymoved from the vehicle for emergency careand immediate transport2) In this case, fully immobilizing the spinewould take too much time.A non-urgent Move1) When there is no immediate threat to life, takethe time to choose the best equipment andpositioning for moving the patient safely2) The best way to move a patient is the easiestway that will not cause injury or pain3) There are many ways to move patient’s, youare only limited by your imagination and thesafety and comfort of the patient.Example: Crutch Method-patient leaning onyou while walking4) Extremity lift is the most popular non-urgentmovePRINCIPLES FOR MOVING PATIENTSEmergency MovesA patient should be moved immediately by an emergencymove only when there is an immediate danger to the patient orthe EMTs including:Fire or danger of fire.Danger of explosives or other hazardous materials.Inability to protect patient from other hazards at thescene.Inability to gain access to other patients who needlifesaving care.Inability to provide care due to location or position.Clothing Drag1. Tie the patients wrists together if you have somethingquickly available. If nothing is available, tuck thehands into the waist band to prevent them from beingpulled upwards.2. Clutch the patients clothing on both sides of the neckto provide a support for the head.3. Pull the patient towards you as you back up, watchingthe patient at all times. The pulling force should beconcentrated under the armpits and NOT the neck.Blanket Drag1. Lay a blanket lengthwise beside the patient.2. Kneel on the opposite side of the patient and roll thepatient toward you.3. As the patient lies on their side while resting againstyou, reach across and grab the blanket.4. Tightly tuck half of the blanket lengthwise under thepatient and leave the other half lying flat than gentlyroll the patient onto their back.5. Pull the tucked portion of the blanket out from underthe patient and wrap it around the body.6. Grasp the blanket under the patients head to form asupport and means for pulling.7. Pull while backing up and while observing the patientat all times.Bent Arm Drag1. Reach under the patients armpits from behind andgrasp the forearms or wrists.2. Use your arms as a cradle for the patients head andkeep the arms locked in a bent position by your grasp.3. Drag the patient towards you as you walks backwards,observing the patient at all times.
Nursing SkillsLifting and MovingPrepared by: Mark Fredderick R. Abejo R.N, M.A.N 2Foundations of Nursing AbejoLifting and MovingUrgent MovesSometimes a patient must be moved more quickly than usualdue to reasons of an urgent nature. Weather conditions, hostilebystanders, uncontrolled traffic, and rapidly rising flood watersare some examples of situations requiring an urgent move.Procedure for Rapid ExtricationOne EMT should be stationed behind the patient.Place one hand on each side of the patients head tostabilize the neck in a neutral position. It is done asyou begin evaluation of the airway.The second EMT quickly applies a cervical spineimmobilization device while doing a rapid primarysurvey.A third EMT simultaneously places the longbackboard onto the seat and, if possible, slightly underthe patients buttocks.The second EMT supports the chest and back as thethird EMT frees the patients legs from the pedals andfloor panel.The patient is rotated in several short coordinatedmoves until the patients back is in the open doorwayand feet are on the backboard.Another EMT supports the patients head until the firstEMT gets out and takes control of the cervical spineimmobilization device from outside the vehicle.The EMT team lowers the patient and slides thepatient onto the board in short coordinatedmovements. Straighten the patients legs and makesure the neck and back do not bend. Secure patient tobackboard after the patient is brought back to theambulance.Non-urgent MovesThis is the most frequent type of move and the best way tomake the move depends on the illness or injury, factors at thescene, and equipment and personnel resources available.Direct Ground Lift1. 2-3 EMTs line up on the same side of a supine patient.2. The EMTs all kneel on one knee.3. Cross the patients arms on the chest if injuries dontprevent it.4. The EMT at the head places one arm under thepatients head and shoulders, cradling the head. Theother arm is placed under the patients lower back.5. The second EMT places one arm directly below thefirst EMTs arm in the small of the patients back. Thesecond arm is placed under the patients knees.6. The third EMT (if available) slides both arms underthe patients waist. The other EMTs adjust their armsaccordingly.7. On signal, the EMTs lift the patient to their knees androll the patient in toward their chests.8. On signal, the EMTs stand and move the patient to thestretcher.9. On signal, the patient is lowered onto the stretcher,which has been positioned at waist level.Extremity LiftThis is only used when a spinal injury is not suspected. It isbest used for short distances.1. One EMT kneels at the patients head and the otherEMT kneels at the patients side by the knees.2. The EMT at the head reaches under the patient arms atthe shoulders and grasps the patients wrists. If thepatient is unresponsive or uncooperative, the otherEMT may assist by lifting the patients wrists to withinthe reach of the partner. To improve stability, thepatients left wrist may be grasped by your right handand their right wrist by your left hand. This crosses thepatients arms over their chest creating a more securehold with less give.3. The second EMT reaches under both knees with onearm and under the buttocks with the other arm.4. The EMTs raises to a crouching position, thensimultaneously stand and move with the patient to thestretcher.EQUIPMENT FOR MOVING PATIENTSWheeled StretcherTwo basic types of stretchers are used: the two-personand the one-person. The two-person requires two EMTs to liftand load in the ambulance, whereas, the one-person stretcher hasspecial loading wheels at the head that allows one EMT to loadit into the ambulance. Stretchers are usually adjustable todifferent heights and different angles. Some can be adjusted toelevate the legs (Trendelenberg position). Additional equipmentmay be attached to the stretchers including oxygen, IV lines, andcardiac monitors or defibrillators.Stair ChairThese are designed for patients that can sit up whilebeing carried. They are useful for taking patients up or downstairs, or through narrow passageways. The patient must betransferred to the stretcher once back at the ambulance.The extremity lift is used to place the patient in the stair chair.All belts and straps must be secured before moving patient. Thepatients wrists may be loosely tied to prevent grabbing ontofixtures and causing loss of balance when moving them. Thechair is tilted slightly backwards to allow movement with thewheels on the chair.Short BackboardThis is used when a spinal injury is suspected and thepatient is in a seated position. They made be made from wood,aluminum, or plastic. A vest type is also used when a patient isfound inside a small car or place. It wraps around the patient andhas all the straps attached or enclosed.Scoop (Orthopedic) StretcherThis is designed to easily lift supine patients. Thestretcher is made of a rectangular aluminum tube with V-shapedlifts to "scoop" patients from the floor or ground withoutchanging their position. Its greatest advantage is that it can beused in confined spaces where other stretchers cannot fit.Flexible StretcherDo not use the flexible, or "pole" stretcher if spine injury issuspected. It is designed for limited access space, on stairs oraround cramped corners, or when other equipment is notavailable
Nursing SkillsLifting and MovingPrepared by: Mark Fredderick R. Abejo R.N, M.A.N 3Foundations of Nursing AbejoLifting and MovingGUIDELINES FOR LIFTING AND MOVINGGuidelines for Safe LiftingConsider the weight of the patient together with theweight of the stretcher or other equipment beingcarried and determine if additional help is needed.Know your physical ability and limitations. Knowyour combined ability with your partner. If absolutelynecessary, you can ask bystanders to help. You oryour partner must be in charge and give the orders, notthe bystander.Lift without twisting. Avoid any kind of swingingmotion when lifting as well.Position your feet shoulder width apart with one footslightly in front of the other. Wear proper boots thatgo above the ankle to protect your feet and help keep afirm footing. Boots should have nonskid soles.Communicate clearly and frequently with yourpartner. Decide ahead of time how you will move thepatient and what verbal commands will be used. Also,tell the patient what you will be doing ahead of time.A startled patient may reach out or grab somethingand cause a loss of balance.Guidelines for Lifting Cots and StretchersMost back injuries to EMTs can be avoided by following thefollowing guidelines:Know or find out the weight to be lifted.Use a minimum of two people to lift, even if a one-person stretcher is being used.Use an even number of people to maintain balanceduring the lift.Know the weight limitations of the equipment youuse. Know what to do if the patient exceeds the weightlimitations of the equipment.Use the power lift or squat lift position. Feet areshoulder width apart. Back is tight and the abdominalmuscles lock the lower back in a slight inward curve.Distribute weight to the balls of the feet. Keep bothfeet in full contact with floor or ground. Whilestanding, keep the back locked in, as the upper bodycomes up before the hips.Use a power grip to get maximum force from thehands. Hands should be at least 10 inches apart. Palmsface up and fingers in complete contact with thestretcher bar.Lift while keeping your back in the locked-in position.When lowering the cot or stretcher, reverse the steps.Avoid bending at the waist.Avoid twisting. "Feed" the stretcher into theambulance while face across the patient.Guidelines for Moving StretchersStretchers should be handled by two EMTs with bothhands on the stretcher. Other personnel or bystandersmay be asked to help carry additional equipment ifnecessary.Never leave the patient alone on the stretcher.Load the stretcher with the foot end first or goingupstairs.Position one EMT at the foot and one EMT at the headof the stretcher when rolling it. The EMT at the footshould pull while the EMT at the head should push.Always maintain a firm grip on the stretcher whenrolling to prevent a tipover.Lower the stretcher and carry end to end if the groundis to rough to roll the stretcher safely.Use four EMTs, one at each corner, when moving astretcher across extremely rough terrain.Turn corners slowly and squarely, avoiding sidewaysmovements that might make the patient dizzy.Lift the stretcher over rugs, grates, door jams, andother such obstacles on the ground or floor.Keep the patient secured with belts at all times whileon stretcher even if the stretcher is not being movedCOMPONENT SKILL FOR MOVING AND LIFTINGA. MOVING TO THE SIDE OF THE BED1. Stand facing patient at the side of the bed.2. Assume a broad stance, one leg forward of the otherwith knees and hips flexed, bring arms to the level ofthe bed.3. Place one arm under shoulders and neck of patient andanother arm under small of patient’s back.4. Shift body weight from front to back foot, rockbackward to a crouch position, bringing patientstowards his side. Nurse’s hips come downwards as herocks backwards. Patient should be pulled.B. HELPING THE PATIENT TURN ON HIS SIDE1. Stand at the side of the bed towards which patient is tobe turned. Place patient’s far arm across his chest andfar leg over near leg, near arm is lateral to and awayfrom his body.2. Stand opposite to the patient’s waist and face side ofthe bed with one foot a step in front of the other.3. Place one hand on patient’s far shoulder and one handon his far hip.4. Shift weight from forwarded leg to rear leg, patient isturned towards the nurse hips come downward.5. Patient is stopped by nurse’s elbows, which come torest on mattress at the edge of the bed.C. RAISING SHOULDERS OF THE HELPLESSPATIENT1. Stand at side of the side of the bed and face patienthead.2. Assume a wide stance with foot next to bed behind theother foot.3. Pass arm over the patient’s near shoulders and resthand between patient’s shoulder blades.4. Rock backward, shift weight from forwarded foot torear foot, hips coming straight down.D. RAISING THE SHOULDERS OF TH SEMIHELPLESS PATIENT1. Stand at one side of the bed facing the head of thepatient. Foot next to bed is to rear and the other footforward. Provide wide base of support.2. Bend knees to bring arm next to bed down to a levelwith a surface of the bed.3. With elbow on the patient‘s bed grasps the nurse’sarm in the same manner.4. Rock forward, shift weight from forwarded foot torear foot to bring hips downward. Elbow remains onbed, which serves as fulcrum.E. MOVING THE HELPLESS PATIENT UP IN BED1. Stand at the side of the bed and face the far corner ofthe foot of the bed.2. Flex knees so that arms are leveled with the bed. Putarm under patient, one arm under patient’s head andshoulders, one hand under small of his back.3. Rock forward. Shift weight from forwarded foot torear foot, hips coming downward. Patient will slidediagonally across the bed towards the head and side ofthe bed.4. Repeat from tuck and legs of patient.
Nursing SkillsLifting and MovingPrepared by: Mark Fredderick R. Abejo R.N, M.A.N 4Foundations of Nursing AbejoLifting and Moving5. Go to the other side of the bed and repeat number 1 –3. Continue this process until patient is satisfactorilypositioned.F. MOVING THE SEMI HELPLESS PATIENT UP IN BED1. Patient flexes knees, bringing heels up to his buttocks.2. Stand at the side of the bed, turn slightly towardspatient’s head. One foot is stepped in front of the otherfoot closer to bed. Feet are directed towards the headof the bed.3. Place one arm under patient’s shoulders, one armunder thighs. Flex knees to bring arms to the level ofthe surface of the bed.4. Patient places chin on his chest and pushes with hisfeet. Nurse shifts weight from rear foot to forwardedfoot. Patient grasps the head of the bed with his handsto pull on his own weight.G. HELPING THE SEMI HELPLESS: PATIENT RAISEHIS BUTTOCKS1. Patient flexes knees and brings heels towards thebuttocks.2. Nurse faces the side of the bed and stands opposite tothe patient’s buttocks. Assume a board stance.3. Flex knees to bring arms to the level of the bed, placeone hand under sacral area of the patient. The elbow isresting firmly on the 3 bed.4. As the patient raises his hips, the nurse comes to acrouching position by bending his knees while hisarms act as a lever to help support the patient’sbuttocks. Nurse’s hips come straight down. Whilesupporting patient in this position, free hand can placebedpan under the patient’s sacral area.H. ASSISTING THE PATIENT TO A SITING POSITIONON THE SIDE OF THE BED1. Patient is turned to the side towards the edge of thebed.2. The nurse ensures that the patient does not fall out ofthe bed by raising the head of the bed.3. Face the far bottom corner of the bed, support theshoulders of the patient with one arm and the otherarm helps patient extend lower legs over the side ofthe bed top the rear of the other foot.4. Bring patient to a natural sitting position on the bed;support the patient’s shoulders and legs over the sideof the bed. Pivot body to lower legs of the patient.Patient’s legs are swung downward. Nurse’s weight isshifted form front to rear leg.I. ASSISTING THE PATIENT TO GET OF BED ANDINTO A CHAIR1. The patient assumes a suiting position on the edge ofthe bed, put on shoes/slipper and gown.2. Place the chair at the side of the bed with backtowards foot of the bed.3. Stand facing patient with foot closer to the chair and astep in front of the other to give the nurse a wide baseof support.4. Place patient’s hands on the nurses shoulders and thenurse grasps patient’s waist.5. Patient steps on the floor and the nurse flexes herknees, forwarded knee is against the patient knee. Thisprovides patient’s knees bending involuntarily.6. Turn with the patient while maintaining a wide base ofsupport. Bend knees as the patient sits on chair.J. TRANSFERRING PATIENT FROM BED TOSTRETCHER1. In preparation of the transfer, lower the head of thebed until it is flat or as low as the patient can tolerate2. Raise the bed so that it is slightly higher than thestretcher.3. To transfer with client assistant: Ask the client omove feet, legs, buttocks and upper body to thestretcher, make sure that the client is in the center ofthe stretcher.4. To transfer without client assistant: Make sure thereare two to three caregivers for this procedure, if thereare two, one should stand on the side of the bed andthe other is on the side of the stretcher. If 3, twoshould stay at the side of the stretcher.5. Grasp pull sheet that support client’s head to mid-thigh.6. Roll pull sheet close to the body7. Assist client to cross arms over the chest.8. On the count of 3, slide the client towards the edge ofthe bed.9. Repeat and slide the patient towards the center of thestretcher.10. Raise the side rails and head of the bed if notcontraindicatedK. LOGROLLING PATIENTLogrolling is a technique used to turn a patient whose bodymust at all times be kept in a straight alignment (like a log).This technique is used for the patient who has a spinalinjury for the patient who must be turned in one movement,without twisting. Logrolling requires two people, or if thepatient is large, three people. The techniques involved are:1. Wash your hands and approach and identify thepatient (by checking the identification band) andexplain the procedure (using simple terms andpointing out the benefits).2. Provide privacy. Position the bed should be in the flatposition at a comfortable working height. Lower theside rail on the side of the body at which you areworking.3. Position yourself with your feet apart and your kneesflexed close to the side of the bed.4. Fold the patients arms across his chest. Place yourarms under the patient so that a major portion of thepatients weight is centered between your arms. Thearm of one nurse should support the patients head andneck.5. On the count of three, move the patient to the side ofthe bed, rocking backward on your heels and keepingthe patients body in correct alignment.6. Raise the side rail on that side of the bed and move tothe other side of the bed.7. Place a pillow under the patients head and anotherbetween his legs.8. Position the patients near arm toward you. Grasp thefar side of the patients body with your hands evenlydistributed from the shoulder to the thigh.9. On the count of three, roll the patient to a lateralposition, rocking backward onto your heels.10. Place pillows in front of and behind the patients trunkto support his alignment in the lateral position.11. Provide for the patients comfort and safety which isposition the call bell and place personal items withinreach. Also be sure the side rails are up and secure.12. Report and record as appropriate.