Maintenance of Proper Body Mechanics

Maintenance of Proper Body Mechanics

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  MAINTENANCE OF PROPER BODYMECHANICS SWATILEKHA DAS (RN,MSN)
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  INTRODUCTION Clinical nursing requirescoordinated efforts of musculo- skeletal and nervous systems and therefore involves body mechanism. It includes the how and why of using various muscles of our body in a more coordinated manner so that it involves integrated functioning and efficient use of the skeletal system, muscular system and the nervous system as a machine.
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  To understand thebody mechanics, it is important for us to describe the centre of gravity of an object and various planes of our body. The centre of gravity of an object may be defined as the point at which its mass is centres. In the standing position, the centre of gravity is located in the centre of pelvis approximately midway between the umbilicus and the symphysis pubis. The line of gravity is a vertical line that passes through the centre of gravity. The constant pull exerted by earth on every object towards its centre helps to maintain a good posture and balance. Hence we can say that the key of comfort and efficient use of energy of an individual is to maintain proper body mechanics.
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  DEFINITION Body mechanics isthe coordinated effort of the musculo- skeletal and nervous system to maintain balance, posture and body alignment during lifting, moving, positioning and performing activities of daily living.
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  PURPOSES OF MAINTAINING PROPERBODY MECHANICS Use of proper body mechanics in terms of posture and alignment helps in- • reducing risk of injury to the musculo-skeletal system. • facilitating body movement without muscle strain and excessive use of muscle energy. • maintaining adequate muscle tone; thus contributing to balance of the body. • preventing fatigue and deformities e.g. kyphosis, lordosis etc. • promoting physiological functions of the body as it aids in circulation and digestion. • reducing energy expenditure. • facilitating aesthetic well-being in terms of physical fitness and shape.
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  TERMINOLOGY RELAED TOBODY MECHANICS There are various terms used in relation to body mechanics. Some of these terms are: • Body Alignment- Body alignment refers to the positioning of joints, tendons, ligaments and muscles while in standing, sitting and lying positions. • Body Balance- Body balance refers to a state of the body achieved when the centre of gravity is balanced over a wide, stable base of support and a vertical line falls from the centre of gravity through the base of support. • Posture- Posture refers to the position of the body in relation to the surrounding space. It is the relationship of various body parts at rest or any phase of activity. • Mobility- Mobility is a person’s ability to move about freely owing to his/her voluntary motor and sensory control of the body’s regions.
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  • Immobility- Immobilityoccurs when the individual is confined to a position and is unable to move or change positions independently. • Bed Rest- Bed rest is an intervention in which the client is restricted to bed for therapeutic reasons. • Weight- Weight is the force exerted on a body by gravity. • Friction- Friction is a force that occurs in a direction to oppose movement. • Anatomical Position- Anatomical position refers to a position wherein the individual stands erect (upright position) facing the observer, with feet on the floor and arms placed at the sides, and the palms of the hands turned forward.
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  FACTORS INFLUENCING BODY MECHANICS •Muscle tone- It is the normal state of balanced muscle tension that is achieved by alternative contraction and relaxation, without active movement of neighbouring fibres of a specific muscle group. This helps a body part to be maintained in a functioning position without muscle fatigue. • Muscle groups- The type of muscle group involved in posture and movement also influence body mechanics. These muscle groups can be three types:  Antagonistic muscles work together to bring about movement at the joint.  Synergistic muscles contract together to accomplish the same movement.  Antigravity muscles continuously oppose the effect of gravity on body and permit a person to maintain an upright or sitting posture. • Personality and mood of individual- Posture and movement can be reflections of personality and mood. For instance, a person with a dramatic personality gestures with hands; a person who is fatigued or depressed may show minimum or least movements with a dull posture.
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  PRINCIPLES OF BODY MECHANICS •Certain principles underlying body movement can serve as guide for the patient and the nurse. Correct body mechanics is necessary for health promotion and prevention of disability. The principles of body mechanics include: • The wider the base of support, the greater the stability of the nurse. • The lower the centre of gravity, the greater the stability the nurse. • The equilibrium of an object is maintained as long as the line of gravity passes through its base of support. • The stronger the muscle group, the greater amount of work that can be safely done by it. • Facing the direction of movement prevents abnormal twisting of spine.
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  • Dividing balancedactivity between arms legs reduces the risk of back injury while lifting or moving an object. • Leverage, rolling, turning or pivoting requires less work than lifting. • When friction is reduced between the object to be moved and the surface on which it is moved, less force is required to move it. • Reducing the force of work reduces of injury. • Maintaining good body mechanics reduces fatigue of the muscle groups. • Alternating periods of rest and activity help reduce fatigue.
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  PROCEDURES FOR MOVING, LIFTIINGAND POSITIONING OF PATIENTS
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  General Instructions inMoving and Lifting Patients • Maintaining a good anatomical position of the body. • Use longest and strongest muscles extremities to provide energy needed in strenuous activities. • Keep the objector the patient close to the body to prevent unnecessary strain on the muscles as this brings the centre of gravity of the object/patient close to the centre of the gravity of the body. • Place the feet apart to provide a wide base of support. This facilitates better body balance. • Flex knees to come closer to the object/ patient. • Keep work close to the body. • Maintain the four body curves of human body and work with their proper alignment. • Slide, roll, push or pull an object rather than lift in order to reduce the energy needed to lift the weight against pull of gravity. • Keep the body above the object and the use the weight of the body to pull or push the object. • Avoid disturbances/ interruptions in the path of movement of patients. • Move obese patients by sliding them rather than lifting them.
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  • Seek assistancewhen lifting or moving heavy patients. • The height of the bed should be adjusted to a height that allows the nurse to keep her back as erect as possible while moving the patient in the bed. This reduces the injury to the lower back. • The patient is moved to the edge of the bed before he is lifted from the bed. This helps the nurse to keep her trunk more erect. • When moving a patient by more than one nurse, each nurse assumes the responsibility for supporting one of the patient’s body sections. The areas to be supported include head, shoulders, chest, hips, thighs and ankles. • In order to coordinate the movements of the nurses and to maintain the patient’s body in correct alignment, the nurse gives the signal by counting 1,2,3 etc. with each activity of the procedure. • Unless contra-indicated, encourage the patient to use his abilities as much as possible. • Observe the patient for symptoms of orthostatic hypotension e.g. fainting, dizziness, sweating etc. • Do not support the patient under his armpits, since injury to major nerves and blood vessels may occur. • Always lock the wheels of the bed, stretcher or wheel chair while transferring the patient so as to increase the maximum static friction between the wheels and floor.
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  Steps of movingpatient to one side of the bed Steps Rationale Stand facing the patient at the side of the bed in which he is to be moved. Stand with a wide base of support with knees and hips flexed to bring your arms to the level of the bed. Wide base provides a stable base. Flexed knees, bring the nurses’ arms to the bed level and place them in a position to lift with strong leg muscles. Place the arm of the patient on his/her chest. Place one arm under the shoulders and neck of the patient and the other under the patient’s back. This will help prevent an injury and will not hinder movement. Helps to move the patient’s body in unison. Shift own body weight from your front foot to your back foot as you ruck backward, bringing the patient towards you to the side of the bed. Avoids strain on the patient’s as well as the nurse’s muscles. Move the middle part of the patient in the same manner by placing one arm under his back and one arm under his thighs. Helps to move the patient’s body in unison. Then move the feet and lower legs with the same motion. Avoids any musculo-skeletal injury to the patient and the nurse.
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  Moving patient toone side of the bed
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  Steps of Movingpatient in bed Steps Rationale Stand at the side of the patient’s bed and face the foot end of the bed. Stand with a broad stance placing one foot behind the other. Wide base provides a stable base. Flex your knees to bring your arms at bed level. Put your arms under the patient. Supports the body of the patient. Helps in easy movement of the patient. Place one arm under the patient’s head and shoulders and one arm under his back. Supports the body of the patient. Helps in easy movement of the patient. Move forward and shift your weight from forward foot to her backward foot with hips flexed. Avoids strain on muscles of the nurse. Slide the patient diagonally across the bed towards the head and side of the bed. Bringing the patient close to the body prevents unnecessary strain on his and the nurse’s muscles. Move the trunk and legs of the patient in the same manner. Helps to maintain a good anatomical position. Go to the other side of the bed and repeat the above steps till the patient is positioned satisfactorily. To be systemic and methodical.
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  Moving a helplesspatient in the bed
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  Steps of turninga patient to one side of the bed Steps Rationale Move the patient to the same side of the bed so as to bring him slightly off the centre of the mattress. If the patient is not moved to the side of the bed, he/she may fall to the ground when he/she is turned on his/her side. Keep the farthest arm along the side of the head and face, the near arm across the chest and the near leg flexed over the farthest leg. Helps to prevent injury. Helps in easy turning of the patient. Place your arm under the shoulders and hips of the patient and roll him gently away. Make the patient comfortable by placing pillows as in a side lying position. Supports the body and turns the body as a whole.
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  Turning a patientto one side of the bed
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  Steps of transferringa helpless patient from bed to stretcher Steps Rationale Position the stretcher at right angle to head or foot end of the bed. Gives space for nurses to move. Shortens the distance to carry the patient. Call helpless to position them at the bedside along the same side of the bed. If the patient is heavy, Call for more helpers. Move the patient to the edge of the bed. Placing the patient to the edge of the bed prevents over reaching and sustains injury to the back. Position yourself(three nurses) at the i. Head, shoulders and chest ii. Hips iii. Thighs and ankles, level of the patient Facilitates moving of the body as a whole. Count 1,2,3,4 and 5 i. At count 1, the nurses slide their arms under the patient to support his body sections. ii. At count 2, the nurses stand with back erect, holding the patient as near their body as possible. iii. At count 3, the nurses take one step backwards and pivot on their heels towards the stretcher. iv. At count 4, the nurses move to the side of the stretcher and stand with a wide base and flexed knees ready to lower the patient into the stretcher. v. At count 5, the nurses lower the patient to the stretcher in a back lying position. Helps to bring the patient’s body weight within nurse’s base of support. A feeling of security to the patient.
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  Steps of transferringa helpless patient from bed to stretcher
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  Steps of assistingthe patient to sit on the side of the bed Steps Rationale Assist the patient to move towards the edge of the bed on the right side. The patient moves close enough to the edge of the bed to allow his knees to bend over the edge of the mattress when sitting. The nurse stands at the side of the bed at the level of the patient’s waist. To protect the patient from rolling out of bed and to assist him, when needed. Help the patient to turn to the right side of the bed. The right hand is kept along the side of the head or face, the left hand is brought over the chest and the left leg flexed over the right. A side lying position enables the patient to assume an upright position easily. Ask the patient to slide his heels off the edge of the mattress, at the same time to raise his head and trunk by pushing the mattress with the first of the left hand and grasping the edge of the mattress with the right hand. Then, roll upwards on elbow till he reaches a sitting position. Use of stronger muscle groups helps in moving the patient easily and safely. In sitting position, ask the patient to keep both arms extended backwards with palms supporting on the mattress. Tell the patient to place both feet flat on the floor. Both arms help to maintain the balance of the body in a sitting position. Watch for symptoms of orthostatic hypotension such as faintness, dizziness and sweating. When bedridden patients assume an upright position, they develop orthostatic hypotension.
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  Steps of assistingthe patient to sit on the side of the bed
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  Steps of assistinga patient from bed to chair or wheel chair Steps Rationale Place the chair/wheel chair at the right side of the bed, with the back towards the foot of the bed. Helps to reduce energy expenditure. The wheels should be locked or placed against the wall or another person. Help the patient to sit on right side of the bed. To prevent rolling of the wheel chair during transfer of the patient. Stand in front of the patient, facing him. To extend help to the patient, when needed. Slide the patient’s buttocks close to the edge of the bed by shifting his weight alternatively from right to left buttock till his feet are placed on the floor. Rocking motion lifts weight on alternate buttocks and enhances forward movement. Instruct the patient to stand on command by simultaneously leaning forward, pushing with the foot placed at the back as he straightens his legs. Balance the patient on the armchair / side rail or mattress. Do not risk the danger of the patient falling to the floor. Observe for symptoms of orthostatic hypotension. Instruct the patient to step back to the chair/ wheel chair until he/she touches the seat and grasps the other arm of the chair with his/her right hand. Facilitates sitting in the chair with ease. Instruct the patient to lean forward and lower his/her buttocks slowly to the seat by bending knees and elbows. Facilitates sitting in the chair with ease. Check for any discomfort, correct posture of the patient. Helps to check for orthostatic hypotension.
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  Steps of assistinga patient from bed to chair or wheel chair
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  After care ofthe patient • Ensure correct body alignment and comfort of the patient. • Replace pillow and other comfort devices as needed. • Raise the side rails if necessary for the safety of the patient. • Check for any discomfort, pain, skin condition etc. • Check vital signs of the patient after assessing the desired posture for assessing orthostatic hypotension. • Remain with the patient during change of position to prevent his/her falling. • Return to the supine position in case of any discomfort. • Record the following aspects:  Duration of the assumed position of the patient.  Amount of assistance/instruction needed.  Vital signs of the patient-temperature, pulse, respiration, blood pressure.  Reaction of the patient to activity.  Observations, if any.  Recommendations for progressive activity and independence. • Ensure that the patient is comfortable and safe.
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  COMPLICATIONS OF IMPROPER BODYMECHANICS If body mechanics principles are not observed, it may lead to various complications like: • Musculo-skeletal injuries • Complications of immobility, e.g. pressure sores, contractures, constipation etc. • Muscle fatigue • Orthostatic hypotension • Hypotension bronchopneumonia • Decreased basal metabolic rate
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  CONCLUSION The nurses incorporateknowledge of the physiological factors of movement and principles of transfer and position their client’s safely. Correct body mechanics protect the nurse and the patient/ client from musculo-skeletal injuries and also help in preventing muscle fatigue. Maintaining good body mechanics by observing the principles and general rules will certainly help to impart a feeling of well- being for the patient and a sense of physical fitness and beauty for the nurse.