SAVE YOUR BACK! How to Safely Use a Back Support Brace, Assisting with Body Positioning, Transfers, ADLs, Adapting the Home, Ambulation and Falling. 5/15/2017
Table of Contents How to Use a Back Support Brace Correctly... 5 Safety... 5 The Ten Rules of Proper Body Mechanics... 5 Body Positioning... 5 Moving a Person Up in Bed when the Client Can Assist... 5 Moving a Client to One Side of the Bed... 6 Turning a Client Toward You... 6 Turning a Client Away From You... 6 Log Rolling a Client... 6 Assisting a Client to the Edge of the Bed (Dangling)... 7 Repositioning a Client in a Wheelchair Moving Forward to the Edge of the Seat... 7 Repositioning a Client in a Wheelchair Moving Back in the Seat... 7 Making an Occupied Bed... 8 Transfers... 8 Types of Transfers... 8 Stand Pivot Transfer with Assistance: Wheelchair to Bed... 8 Stand Pivot Transfer with Assistance: Bed to Wheelchair... 8 Sliding Board Transfer: Bed to Chair / Chair to Bed... 9 Special Transfers... 9 Car Transfers... 9 Toilet Transfers... 10 Bath Transfers... 10 Transfers Using a Mechanical Lift... 10 Guidelines for Using a Mechanical Lift... 10 Activities for Daily Living (ADLs)... 10 Helping a Client Stand and Walk... 10 Page 2 of 14
Dressing and Undressing a Client... 11 Making a Bed... 11 Bathing... 11 Washing Hair (Bed, Sink or Tub)... 11 Adapting the Home... 12 Have Footrests and Pillows Available... 12 Sit When You Can... 12 Assisting the Client with ambulation... 12 Basic Preparation for Ambulation... 12 Using a Transfer Belt to Assist with Ambulation... 13 Using a Cane, Walker, or Crutches to Assist with Ambulation... 13 Using a Cane to Assist with Ambulation... 13 Using a Walker to Assist with Ambulation... 14 Assisting a Falling Person... 14 Page 3 of 14
Remember, back supports do not make you stronger and you should not attempt to lift things you normally would not lift!!!! Using good body mechanics and attempting only those tasks within your physical capabilities will help you avoid injuries to yourself and to your client. Think First! What is your most important body part for any activity? Your most important body part should be used the most. Think before acting! Page 4 of 14
How to Use a Back Support Brace Correctly 1. Be sure that the belt fits properly and is worn correctly. 2. Always identify and assess the weight to be lifted, be sure you can lift the weight identified without over-exertion. 3. Always lift in accordance with safe techniques and correct use of body mechanics. 4. Do not twist or lean sideways during any phase of lifting. 5. Secure and tighten your back support when you are actively lifting. Reduce the tension or remove the support when no lifting or back support is required. **Wearing a back support brace is never a substitute for incorrect lifting. The back support does not give you more strength or the ability to do more!!!! Do not attempt to lift things you cannot normally lift. Safety 1. Always use assistive equipment and devices when they are available, if client needs assistive equipment, contact your supervisor. 2. Do not ever lift or reposition a client if you cannot safely do so. 3. Assistive devices and equipment afford a safe means for lifting, transferring or repositioning tasks. 4. Clients are safer and are subjected to less awkward or forceful handling when assistive devices are used. 5. If you are unsure how to use your client s assistive devices, notify your supervisor. 6. Wear flat shoes with cushioned soles as this can help reduce the pressure on your back. 7. Avoid sudden movements that can cause muscle strain. The Ten Rules of Proper Body Mechanics 1. Assess the load and get help if you need it. 2. Think ahead, plan and communicate the move with your client. 3. Check your base of support and be sure you have firm footing. 4. Face what you are lifting. Your feet should always face the direction you are moving. 5. Keep your back straight, your head up, and your shoulders back. 6. Begin in squatting position and lift with your legs. 7. Contract (tighten) your stomach muscles when beginning the lift. 8. Keep the object close to your center of gravity. 9. Do not twist. Turn your body as one unit. 10. Push or pull when possible rather than lifting. Body Positioning Moving a Person Up in Bed when the Client Can Assist 1. Adjust the bed to a flat position at a comfortable working height, and lower the bed side rail on your side of the bed if applicable. Place the pillow against the headboard. This protects the client s head from hitting the headboard. Page 5 of 14
2. Stand facing the head of the bed, with your feet apart and staggered (one in front of the other). 3. Ask the client to bend her knees, brace her feet against the bed and on a verbal cue, lift her buttocks. The client may reach above her to grab the head of the bed and help pull herself up. She may also rest on her elbows, placing them as far back as she can reach and use them to help support her while you are helping her move up in the bed. 4. Bend at the knees, keep your back straight, and place one arm under the client s shoulder beneath the neck and the other under her thighs. As the client moves on the verbal cue, shift your weight from your back leg to front leg and move her up in bed. 5. Arrange the pillow and linens for the client, adjust her body position for comfort and proper body alignment, and adjust the bed. Raise bed if applicable. Moving a Client to One Side of the Bed 1. Stand on the side of the bed that you want to move the client toward. Adjust the bed to a comfortable working height and lower the bed side rail if applicable. 2. Brace one knee against the bed with knees bent and feet staggered. 3. Reach under the client s shoulders and slide the upper body toward you by shifting your total body weight from the front to the back. Be sure to bend your knees and keep your back straight. 4. Reach under the client s trunk and hips and slide her toward you. 5. Finally reach under the client s legs and slide them toward you. 6. Make sure the client is comfortably and correctly aligned. Raise bed side rail if applicable. Turning a Client Toward You 1. Adjust the bed to a comfortable working height and lower the bed side rail if applicable. 2. Move the client to one side of the bed so there is enough room for turning. Cross his arms over his chest. Cross the leg nearest you over the leg farthest from you. 3. Go to the other side of the bed, reach over the client, support his shoulders with one hand and his hip with the other and roll him toward you. Keep your back straight, and use your stomach and leg muscles to accomplish the turn. 4. Be certain the client is centered in the bed. Adjust his body position for comfort and proper alignment. Raise bed side rail if applicable. Turning a Client Away From You 1. Move the client to one side of the bed so there is enough room for turning. Raise the bed side rail on the side you will be turning the client toward is applicable. Pad it with a pillow. 2. Cross his arms over his chest. Cross the leg nearest you over the leg farthest from you. 3. Support the client s shoulder with one hand and his hip with the other, and smoothly roll him away from you. Keep your back straight and use your stomach muscles and leg muscles to accomplish the turn. 4. Be certain the client is centered in the bed. Adjust his body position for comfort and proper alignment. Raise bed side rail if applicable. Log Rolling a Client 1. Stand at the side of the bed. Position yourself at the middle of the client s body. Page 6 of 14
2. First use the turning sheet to move the client to the side of the bed you are standing on. Ensure the client s body moves as one unit without twisting or bending. 3. Raise the bed side rail if applicable and move to the opposite side of the bed. 4. Lower the bed side rail on this side and reach across the client, roll the turning sheet close to the client s body, turn the client toward you by pulling the turning sheet toward you. Keep your back straight and use your stomach and leg muscles. Assisting a Client to the Edge of the Bed (Dangling) 1. Lower the bed side rail and elevate the head of the bed if applicable. 2. Stand facing the bed, with your feet apart and slightly staggered. 3. Place one arm under the client s shoulder and the other arm under the knees. 4. Slowly move the client to a sitting position while turning the legs over the edge of the bed. 5. Continue to provide support for as long as needed. If performing this procedure prior to standing, allow the client enough time to adjust to the upright position before helping him stand. Repositioning a Client in a Wheelchair Moving Forward to the Edge of the Seat 1. Lock the brakes on the wheelchair and move or remove the footrests. 2. Stand in front of the wheelchair with feet slightly apart and staggered. 3. Ask the client to place both hands on the armrests. 4. Place one arm around the client s shoulders and help the client lean sideways to shift the weight off the opposite buttock. 5. With the other hand, help the client move the leg forward by lifting under the thigh. 6. Reverse position, by placing the other arm around the client s shoulder and helping to move the other leg forward. 7. Repeat this process until the client reaches the edge of the seat. Repositioning a Client in a Wheelchair Moving Back in the Seat This is the reverse process of moving a client to the edge of the seat. 1. Lock the brakes on the wheelchair and move or remove the footrests. 2. Stand in front of the wheelchair with feet slightly apart and staggered. 3. Ask the client to place both hands on the armrests. 4. Place one arm around the client s shoulders and help the client lean sideways to shift the weight off of the opposite buttock. 5. With the other hand, help the client move the leg backward by lifting under the thigh. 6. Reverse position, by placing the other arm around the client s shoulders and helping to move the other leg backward. 7. Repeat this process until the client has moved back completely in the chair. 8. Replace the foot rests and position the client comfortably in the wheelchair. Page 7 of 14
Making an Occupied Bed 1. Be certain the bed is flat, or if the client cannot tolerate the flat position, raise the head of the bed only as far as necessary. 2. Elevate the bed to a comfortable working height. Ensure the client will not roll off the bed by using the bed side rails, bolsters, or an assistant. 3. Use the procedure for moving the client to one side of the bed. Remove soiled linens and replace with clean ones. Turn the client across the clean linens to the other side of the bed and finish making the bed. Note: Always prepare for any transfer before beginning. Types of Transfers Stand Pivot Transfer with Assistance Sliding Board Transfer Special Transfers Mechanical Lift Transfers Transfers Stand Pivot Transfer with Assistance: Wheelchair to Bed 1. The bed should be in the lowest position, flat and with the bed side rails down. The wheelchair should be positioned parallel or slightly next to the bed, with the footrests off and the brakes on the wheelchair and the bed locked. The client should be wearing a transfer belt. 2. Have the client lead with her strong side in the direction of the transfer. 3. Instruct the client to scoot her hips toward the edge of the wheelchair. Stand close in front of the client as she leans forward with her head out over her feet and then pushes up to a standing position using the wheelchair armrests. 4. Have the client turn approximately a quarter turn while holding on to the chair, place a hand on the bed, pivot the rest of the way, and then sit down on the bed. Assist the client to a reclining position. Stand Pivot Transfer with Assistance: Bed to Wheelchair 1. The bed should be in the lowest position, flat and with the bed side rails down. The wheelchair should be positioned parallel or slightly angled next to the bed, with the footrests off and the brakes on the wheelchair and the bed locked. Page 8 of 14
2. Assist the client to a dangling position and support her while she acclimates to the upright position. Place a transfer belt on her once she is steady. 3. When the client feels ready to move, reach under her arms and grasp the transfer belt on both sides. Have the client place her hands on your waist or shoulders. Be certain the client does not grab your neck Keeping your back straight, your head up, and using the muscles in your legs, help the client scoot her hips to the edge of the bed. 4. Have the client lean forward until her weight is centered over her feet. 5. Ask the client to place her hands on the bed or on the wheelchair armrests, depending on which gives her the appropriate leverage for her height. 6. Have the client stand, pivot, and sit on the wheelchair. Use proper body mechanics as you help her ease into a sitting position. Keep your back straight, head up, shoulders back, and use your leg muscles. Note: For either transfer, a more independent client can push to a standing position and accomplish the pivot by herself. In this case, you should simply stay close to the client and guide the transfer for safety. Sliding Board Transfer: Bed to Chair / Chair to Bed 1. Adjust bed to the flat position and to the height of the wheelchair. Lower the bed side rails. Position the wheelchair parallel or slightly angled next to the bed and remove the armrest on the bed side of the chair. Position footrests out of the way or remove them. 2. Lock the wheelchair 3. Assist the client to a dangling position and put a transfer belt on her. 4. Have the client lean away from the transfer side to take weight off her thigh. Place the sliding board under the buttocks and thigh, taking care not to pinch the client s skin between the bed and the board. Block the knees by placing your knees on the outside and/or front of the client s knees to keep them from buckling during the transfer. Make sure your back is straight. 5. Get as close to the client as possible and have the client lean into you as you grasp the transfer belt from the sides. Lean back with your knees bent and use your legs rather than your back to lean the client forward and slide her across the board. 6. Complete the transfer in two to three lifting and sliding movements, never dragging the client across the board. 7. After the client is in the chair, remove the sliding board. Make sure the client is sitting in a comfortable upright position. Reposition or replace the footrests. NOTE: A more independent client can place her hands on the board, push up, and slide herself. In this case, you should simply stay close to the client and guide the transfer for safety. Special Transfers Car, toilet, and bathtub transfers pose additional risk for injury because you are working in a confined space, you have limited access to the seat, and there are variations in seat, chair, and floor height. Car Transfers Place the wheelchair parallel to the car seat, lock the wheelchair, and use a standing pivot transfer with or without assistance to transfer the client to the edge of the car seat. Place one arm around the client s shoulders and the Page 9 of 14
other arm under his knees. Bend at the knees and keep your back straight while helping the client pivot on the car seat and lift his legs into the car. Toilet Transfers Place the wheelchair at a slight angle facing the toilet. Use a standing pivot transfer with or without assistance to help the client achieve a standing position in front of the toilet. When the client has completed the pivot, steady him while he partially disrobes, or assist him in partially disrobing. Bath Transfers Place the wheelchair parallel to the bathtub with the brakes locked and the armrest on the tub side removed. Assist the client in sliding to the outside edge of the tub bench. Place one arm around the client s shoulders and the other arm under his knees. Bend at the knees and keep your back straight while helping the client pivot on the bench and lift his legs over the side of the tub. Transfers Using a Mechanical Lift Be sure you are trained on any whatever mechanical lifting equipment before use, and make sure the client is positioned correctly on the sling before moving it away from the bed. Do not allow the sling to swing free with the client suspended in it, and never leave the client suspended in a mechanical lift. Guidelines for Using a Mechanical Lift 1. Explain what you are going to do. Be reassuring. 2. Be sure you are trained to operate the mechanical lifting equipment available to you. 3. Safety check the equipment before use. 4. Once you have lifted the client check that he is correctly positioned in the sling before moving the lift. 5. Do not allow the sling to swing free with the client in it. Steady, guide, and reassure the client. 6. Never leave the client suspended in a mechanical lift. Activities for Daily Living (ADLs) Keep a wide stance. Avoid bending if possible. Breathe deeply to check posture. Keep knees slightly bent. Do not lock them. Alternate weight bearing from one leg or foot to the other. Stretch before activities. Be patient and take the time to prepare for activities. Helping a Client Stand and Walk 1. Whenever you need to support a client s weight, protect yourself by assuming a good stance. Feet should be about shoulder width apart, one foot slightly in front of the other, knees bent, shoulders back, and head up. Page 10 of 14
2. Keep your upper body upright and aligned. Dressing and Undressing a Client 1. Allow your client to do as much to dress or undress himself as possible. Dressing himself may take longer, but it helps maintain independence, build self-esteem, and regain self-care skills. It also decreases the strain on your body. 2. Limit excessive bending. Sit in a chair if possible. 3. Kneel, squat, or sit on a footstool to put on shoes and socks. 4. Begin dressing on the affected side. Begin undressing on the unaffected side. Place yourself on the affected side for safety and to provide maximum assistance. 5. Dress upper part of body while client is in the sitting position. Making a Bed 1. As with any job that requires bending, use a good stance bending your knees to lower yourself rather than bending from the waist. Raise the bed to a comfortable working height if possible. 2. When lowering your position, use the larger muscles in your legs and hips rather than straining the smaller muscles in your back. 3. If no draw sheet is available, make one by folding a clean top sheet. Using a draw sheet can save energy and prevent back injury. 4. Put bed on blocks if working with a bedbound/immobile client. Remember to use bed side rails. 5. Kick one leg up behind you to release lower back pressure. 6. After making the bed, take a moment to stretch your back. Bathing 1. Keep a wide base of support when standing, and bend at the knees whenever possible. 2. Use a European style, handheld shower head if possible. 3. Use soap on a rope to minimize dropping it. 4. Get a plastic lawn chair for the client to sit on in the bath or shower instead of bending to wash feet and legs. Elderly clients should always shower while sitting down. Sudden changes in blood pressure can cause them to fall. 5. If giving a bed bath, raise the bed to the highest horizontal position and help the client move to the side of the bed you are on. Remember to use the bed side rails. Washing Hair (Bed, Sink or Tub) 1. Hair washing can mean standing in one small area for a painful amount of time. 2. Use a European-style, handheld shower head or the rinse attachment from the kitchen sink faucet when possible. 3. If standing, use a footstool and elevate one foot to shift strain on the lower back. 4. If washing hair while the client is in bed, place a chair at the side of the bed near the client s head, and help the client move to the side of the bed you are on. 5. Stop and do a back extension exercise every few minutes to counteract strain from bending. Page 11 of 14
Adapting the Home Have the right tools for a job. For example, do not try to iron on a table top. Use an ironing board with adjustment height to avoid bending. Have Footrests and Pillows Available You can make any position safer and more comfortable by using footrests and pillows to keep the body in alignment. For example, tasks that require standing for long periods can be more comfortable if you rest one foot on a footrest. This flexes the muscles in the lower back and keeps the spine in alignment. When sitting, a footrest can allow comfortable positioning of the legs. Crossing the legs disrupts alignment and should be avoided. Using pillows can make any chair safer and more comfortable. Use pillows behind the back or in the small of the back to keep the back straight. Keep things organized to help you find what you need without straining. Keep tools and supplies off the floor. Reduce the need for bending by keeping frequently used items on shelves or counters where they can be easily reached without lifting. Place heavy objects at midlevel in the front of shelves and cupboards, where they are easily accessible. Carpenter or cobbler-type aprons are handy for pocket space and can minimize reaching for materials, especially for repetitious tasks. Sit When You Can Chopping vegetables, folding clothes, and many other tasks can easily be done while sitting. For jobs like scouring the bathtub, kneel or use a low stool, but never bend from the waist. Lean your body toward the client when assisting with meals, feeding, or other ADLs. Position yourself so the client is on your dominant side. If you are right handed, the client should be on your right side. If you are left handed, the client should be on your left side. Use assistive devices whenever possible. Place handholds and bars at levels and locations that accommodate client and caregiver needs. Lift/pull sheets, bed side rails, removable chair arms, leg/footrests, and elevated beds help in caring for those who are immobile. A trapeze can help the client lift herself. Encourage use of raised toilet seats and heavy dining armchairs that will not tip when used by weak or unsteady clients. Assisting the Client with ambulation Basic Preparation for Ambulation 1. Wash your hands and explain what you are going to do. Check the client record and observe the client for strength and coordination. Be sure the client is wearing supportive footwear for ambulation. Make certain glasses are clean, hearing aids are in place, and shoes are in good repair. Page 12 of 14
2. Prepare the environment. Make sure there are no obstacles in the client s path. Make sure the pathways are clear of uneven surfaces like throw rugs or uneven thresholds or floors that could cause the client to lose balance or fall. Keep pets and children out of the pathway when ambulating. Ensure that you will be able to provide a chair or other resting place if the client becomes dizzy. 3. Place the transfer/gait belt around the client s waist, directly above the hip bones, and help her to a standing position. Use the client s strengths to maximize her efforts. Using a Transfer Belt to Assist with Ambulation 1. Follow the steps in basic preparation for ambulation. 2. Stand behind and to the side of the client as you hold on to the belt. If the client is weaker on one side of the body, stand at the weak side. Use the hand that is not holding on to the belt to support the client s arm on the weak side. 3. Observe the client s strength while you walk together. Help the client to a chair if he becomes dizzy. Encourage use of handholds and railing whenever possible. 4. Settle the client back into a safe and comfortable position after ambulation. 5. Wash your hands and record the procedure, including how far the client walked, how much help you gave, and any problems. Using a Cane, Walker, or Crutches to Assist with Ambulation 1. Follow the steps in basic preparation for ambulation. 2. Whether the client is using a cane, walker, or crutches, your role is to ensure safety. Walk slightly behind the client, on the involved side if there is one. Hold the transfer/gait belt unless you think the client is steady on her own. 3. Watch for obstacles in the client s path and encourage the client to look ahead, rather than down at her feet. Encourage the client to use handholds and railings if available. 4. Settle the client back into a safe and comfortable position after ambulation. 5. Wash your hands and record the procedure, including how far the client walked and how much help was needed. Using a Cane to Assist with Ambulation 1. Hold cane on the strong (uninvolved) side of the body. 2. Place cane ahead of feet. 3. Step forward with weak (involved) foot. 4. Move strong (uninvolved) foot ahead of involved foot. Page 13 of 14
5. Repeat steps 1, 2, and 3. Using a Walker to Assist with Ambulation 1. Move walker ahead. 2. Step forward with involved foot. 3. Bear weight on hands and move uninvolved foot forward ahead of involved foot. 4. Repeat steps I, 2, and 3. Assisting a Falling Person If a client starts to fall despite all precautionary measures, the caregiver's role is to try to prevent injury. If a client begins to fall, do not attempt to stop the fall. Attempting to stop the fall will only increase the possibility of injury to yourself. Quickly attain a good, wide base of support and bring the client s body close to you to break the fall. Use the transfer belt, if the client is wearing one. Bend your hips and knees and help to slowly lower the client to the floor. Lessen the impact as much as possible, and focus on protecting the client s head. If you can drop to one knee directly behind the client, you can use the other leg to make a "chair" that will support the client s weight until help arrives. Call for help if another staff member or a family member is in the area. Page 14 of 14