This document provides guidance on various nursing skills related to ambulation, patient transfers, range of motion exercises, and restraints. Key points include: - Assess patient's capabilities and explain the plan before ambulating or transferring a patient - Use proper body mechanics and any necessary equipment to move patients safely - For ambulation, two nurses can support the patient under the arms or each take an arm - When transferring from bed to chair, position the chair close to the bed and pivot the patient while bracing their legs - Use draw sheets and leverage techniques to transfer a patient from bed to stretcher safely - Obtain a physician's order and use the least restrictive restraints possible, checking the patient regularly

1. Ambulation, Patient
transfer, Restraints, ROM
PN 1 Nursing Skill Labs

2. Before you ambulate the
pt……….
 assess pt capabilities
 administer pain med if needed
 plan what you are going to do and make
sure you have the right number of
helpers, the right equipment etc.
 explain to patient what is going to
happen and what their role is

3.  make sure the area is free of obstacles
 elevate bed, lock wheels etc.
 watch body mechanics of both you and
your patient
 protect patient from harm if dependent
 avoid friction on patients skin
 move smoothly using a rhythmic motion

4.  use mechanical devices as indicated but
make sure you know how to use them
safely !!!!
 be realistic about what you can do safely
and without injury
 dangle patient prior to standing to avoid
incidents related to postural hypotension

5. Ambulating with one nurse……...
 always dangle before you get pt up
 stand patient and remind to stand erect
 start with short walk if first time up
 if patient starts to faint, have wide base
of support, encircle pt under arms and
gently lower to floor
 if wearing belt use it to lean pt back and
to floor

6.  stand at patients side and place both
hands at patients waist if not using belt
 place belt securely on patient and grasp
at back
 walk behind and slightly to side of patient
 if pt weak on one side, stand on that side
and put arm around waist
 support weak arm with other arm

7. Ambulating with two
nurses……..
Two methods:
 1. Each nurse stands at pts side and
grasps interior aspect of pts upper arm
holding pts lower arm or hand with other
hand

8.  2. Nurses place arms under pts axillae
and grasp each others forearms behind
pt while patient puts arms over nurses
shoulders and nurse grasps pt hand with
free hand - all three must be same
height

9. Transferring from bed to chair -
one nurse
 place bed in low position
 prepare patient
 if patient not impaired, place chair close
to bed facing foot of bed
 if patient impaired, place chair facing
head of bed
 lock wheels!!!!!!

10.  get foot pedals out of the way
 raise head of bed to highest position
 assist pt to sit on side of bed
 assist pt to stand (may use belts for this)
 face patient and brace his feet and
knees with yours
 place your hands around the pts waist

11.  pivot the patient into position in front of
the chair with legs up against back of
chair
 have patient place one arm on chair to
steady self while lowering to chair while
you continue bracing feet and knees with
yours
 position for comfort, call bell, blanket

12. Transferring from bed to chair -
two nurses
 prepare equipment and patient
 move pt to side of bed and cross pts
arms across chest
 lock wheels on bed
 put chair next to bed with back of chair
parallel to head of bed
 lock wheels on chair

13.  adjust bed to comfortable level for nurses
 first nurse stands behind chair and slips arms
under pts axillae grasping pts wrists securely
 second nurse faces wheelchair and supports
pts knees by placing arms under them
 on prearranged signal, lift together

14. Transferring from bed to
stretcher
 prepare patient and room
 raise bed to same height as stretcher
 place draw sheet under pt and use it to
move patient to side of bed
 position stretcher parallel to bed
 lock wheels on bed and stretcher
 nurse 1 kneels on bed on far side of pt at
upper torso and grasps draw sheet

15.  nurse 2 reaches across stretcher and grasps
draw sheet securely at head and chest area
 nurse 3 reaches across stretcher and grasps
draw sheet at waist and thigh area
 have patient hold arms across chest
 on count of three, move patient
 put up siderails and cover patient

16.  transfer boards are sometimes used for
this purpose and they make it much
easier as you simply slide the patient on
a draw sheet over to the stretcher
 a three carrier lift may also be used

17. Therapeutic mobility techniques
- SMART MOVES
 Concepts: discal load, COM, leverage,
friction reduction, normal movements
 Equipment needed: velcro belts, beds,
drawsheets, garbage bags, towels,
w.chair,stretcher board

18. Harness the principles
 Safer patient moves & transfers by staff
with:
 1.COM-centre of mass
 2.leverage
 3.friction reduction
 vs. muscle mass & strength

19. Safety Strategies for
Transferring patients
 plan ahead
 equipment set up
 communications
 consistency
 symmetrical movements
 don’t block pt. knee, cradle them
 transfer belts/slider bags

20.  use center of mass and leverage to
move patient (shift your weight)
 place your knee on bed to assist with
movement - this will save your back!!!
 keep a wide stance and your knees bent

21. Range of Motion positions
 Head - flexion, extension, lateral flextion
 Neck - rotation
 Shoulder - flexion, extension, abduction,
adduction, internal and external rotation
 Elbow - flexion, extension
 Forearm - supination, pronation
 Wrist - flexion, extension,
hyperextension

22.  Fingers - flexion, extension, abduction,
adduction, opposition of thumb to fingers
 Hip - flexion, extension, abduction,
adduction, internal rotation, external
rotation
 Knee - flexion, extension

23.  Ankle - dorsiflexion, plantar flexion,
inversion, eversion
 Toes - flexion, extension, abduction,
adduction

24. Restraints………..
 anything that limits movement - tables,
bed rails, towels, jackets etc.
 must have MD order
 must have pt. permission
 least restraint policy
 how can restraints cause harm?
 restraints don’t guarantee safety and
probably do more harm than good!!!

25.  check patient at least once an hour
 remove restraints, massage area, check
for skin breakdown or redness, perform
ROM, reapply only if necessary
 pad bony prominences under restraint
 should allow two fingers under restraint
 use least restrictive form of restraint
possible

26.  maintain restrained extremity in normal
anatomical position
 use appropriate tie
 fasten to bed frame not side rail
 reassure patient frequently
 DOCUMENT reason for restraint, alternate
measures tried, date and time of application,
type of restraint, times when removed and
ongoing assessment

27. If absolutely necessary to use
 R espond to the present, not the past
 e valuate the potential for injury
 s peak with family members/caregivers
 t ry alternative measures
 r easses need for restraints frequently
 a lert physician and family
 I ndividualize restraint use
 n ote important information in chart
 t ime the use of restraints