Regarding ambulation techniques.

1. Shipra Mishra
Clinical instructor

2. Ambulation is the ability to walk from place to place
independently, with or without assistive devices.

4. Definition
 Equipment that assists or aides the mobility of a person who has an injury or
illness that affects the ability to walk
 Uses of these devices range from providing support for minor balance issues to
eliminating full weight bearing
 Types
 Parallel Bars
 Walkers
 Crutches
 Canes
 Rollators
 Wheelchairs

5. Immobility in hospitalized patients is known to cause
functional decline and complications affecting the
respiratory, cardiovascular, gastrointestinal,
integumentary, musculoskeletal, and renal systems.
For surgical patients, early ambulation is the most
significant factor in preventing complications) Lack of
mobility and ambulation can be especially devastating
to the older adult when the aging process causes a
more rapid decline in function Ambulation provides
not only improved physical function, but also improves
emotional and social well-being.

6. Once a patient is assessed as safe to ambulate, the nurse
must determine if assistance from additional healthcare
providers or assistive devices is required.
Prior to assisting a patient to ambulate, it is important to
perform a patient risk assessment to determine how much
assistance will be required. An assessment can evaluate a
patient’s muscle strength, activity tolerance, and ability to
move, as well as the need to use assistive devices or The
find additional help.

7. Before ambulating, the patient may need assistance getting to a
sitting position.
 Patients who have been immobile for a long period of time may
experience vertigo, (a sensation of dizziness), and orthostatic
hypotension (a form of low blood pressure that occurs when
changing position from lying down to sitting), making the patient
feel dizzy, faint, or lightheaded
 For this reason, always begin the ambulation process by helping the
patient to sit on the side of the bed for a few minutes with legs
dangling.

8.  Ensure patient does not feel dizzy or lightheaded and is tolerating
the upright position.
 Instruct the patient to sit on the side of the bed first, prior to
ambulation.
 Ensure proper footwear on patient, and let patient know how far you
will be ambulating.
 Explain to the patient what will happen and what is done to help.
 Apply gait belt snugly around the patient’s waist.
 Check physician’s orders for any activity restrictions related to
treatment or surgical procedures.

9.  Stand in front of the patient, grasping each side of the gait belt,
keeping back straight and knees bent.
 While holding the belt, gently rock back and forth three times. On
the third time, assist the patient to rise into a standing position.
 Once patient is standing and feels stable, move to the unaffected
side and grasp the gait belt in the middle of the back. With the
other hand, hold the patient’s hand closest to you.
 Before ambulating ask the patient if he feels dizzy or lightheaded.
If so, make patient sit back down on the bed.
 If patient feels stable, begin walking, matching your steps to the
patient’s. Instruct patient to look ahead and lift each foot off the
ground.

10.  To help a patient back to bed, have patient stand with back of
knees touching the bed. Grasp the gait belt and help patient into
a sitting position, keeping your back straight and knees bent.
 On completion of ambulation, remove gait belt, and settle
patient into bed or a chair.
 Leave the patient in a safe place. If in bed, place the bed in
lowest position, raise side rails as required, and ensure call bell
is within reach. Perform hand hygiene.
 Document patient’s ability to tolerate ambulation and type of
assistance required.

11.  Assess whether the patient is independent, partially dependent or totally
dependent. Based on the assessment nurse, can plan the care or assistance
required for the patient.
 Involve family members in providing care which is based on the assessment so
that they can continue the care at home without fear and anxiety

12. Assessment of self-care ability
Along with the hazards of immobility the patient may have some other
limitations that may again contribute to self- care disability. The patient
should be assessed for his ability to perform self-care activities
(Activities of Daily Living) in terms of the following:
Meeting hygienic needs such as bathing, brushing teeth, combing hair,
dressing and grooming
Dressing/ grooming: Ability to wear his own dress
Toileting: Ability to meet the elimination needs. Urinary and fecal
continence

13. Feeding: Is he able feed by himself or need assistance
Mobility status: If he is ambulating, using wheel chair, able
to move from bed to chair and back.
Communication: Is he able to verbalize his needs and
problems
Medications: Is he able to take his own medications without
assistance

14. Assessment of mobility status of the patient includes the
following
 Range of Motion: Assess the patient for joint stiffness, swelling,
pain, limitations in movement, and unequal movement.
Examine all the joints such as neck, shoulders, elbow, forearm,
wrist, fingers and thumb, hip, knees, ankle and foot and toes.
 Gait: Gait is the particular manner or style of walking.

15. Exercise and activity tolerance: Find out how much
exercise the patient is able to tolerate without much
physical strain or physiological changes. Activity
tolerance is the amount and type of activity or work a
person is able to perform.
Body Alignment and posture: Perform assessment in
standing, sitting and lying down position.

16. A head to foot examination has to be carried out to assess
if patient has any hazards of immobility both physical and
physiological. Assess all systems of the body for the effects
of immobility. Give special consideration for psychosocial
assessment also.

17. Two nursing diagnoses directly related to problems of
immobility are
Impaired physical mobility
Risk for disuse syndrome
The diagnosis of Impaired physical mobility is applied to
patients with some mobility limitations but they are not
totally immobile, whereas the diagnosis of Risk for disuse
syndrome is applied for patients who are totally immobile
and inactive and are liable for multisystem problems.

18. Ineffective airway clearance
Risk for injury
Risk for impaired skin integrity/ Impaired skin integrity
Ineffective individual coping
Social isolation
Impaired urinary/bowel elimination.

19. The nurse may consult with other members of the health
care team for resources to improve the patient’s mobility
status.
Prepare individualized plan of care for each nursing
diagnosis
Develop goals and expected outcomes to help patient to
achieve highest level of mobility and to reduce hazards of
immobility
Identify and plan nursing interventions to reduce hazards
of immobility.

20. While planning set priorities to ensure that the immediate
needs are met first
Reinforce prevention techniques in the plan e.g.Prevention
of bed sores
Include family members for assessing and planning care.
Plan for a team approach (collaborative care) in the care of
patient e.g.. Getting help from nursing assistants,
respiratory therapists, occupational and physiotherapists
etc.
Design interventions that help the patient to increase the
activity level

21. Apply measures for fall prevention
Consider patient’s home environment while
planning for discharge

22. Implementation of nursing care for patients having
impaired physical mobility depends on the condition of the
patient, the diagnosis, and the duration of immobility.
Nursing care is directed towards meeting all needs of the
patient such as physical needs, nutritional needs,
elimination needs, hygienic needs, psychological needs etc.
in the bed itself.
Prevention of associated problems is another important
aspect. Most of the complications can be prevented by
prompt nursing care.

23. Aspects of the care
Consult with physiotherapist regarding the transfer
techniques to be used for the patient.
Instruct the patient and care givers regarding transfer
and ambulation techniques
Assist the patient in transfer and ambulation
Provide written materials to reinforce verbal instructions
 Administer analgesics as needed preferably half an hour
before ambulation as per physician’s orders

24. Use non pharmacological techniques (e.g. Guided imagery,
listening to music etc) for pain relief
Encourage active range of motion exercises if possible. If
patient is unable to carry out exercises by self, the nurse
can do passive ROM exercises for the patient.
 Meet all hygienic needs in the bed itself. Get the
cooperation of the patient if possible to meet the activities
of daily living.
Monitor the patient closely for the development of any
complications of prolonged immobility such as decubitus
ulcer, hypostatic pneumonia, joint contractures etc.
Provide psychological support to relieve the anxiety of
patient and relatives.

25. Evaluate the outcomes/effectiveness of the interventions
carried out for the patient.
Evaluate the signs and symptoms of improved or
decreased mobility status
Evaluate the patient’s and his family’s understanding
about the teachings provided to him/them.