(performed by one nurse)
Remember! This procedure cannot be performed if:
· spinal injury;
· spine surgery;
· epidural anesthesia.
Target: Preventing improper movement of the patient, ensuring his safety.
Indications: Patient's bed rest, immobility or immobility, inability to receive assistance from the patient, difficulty moving in elderly patients.
The technology is simple medical services:
1 . Requirements for specialists and support staff: Has the right to be performed by a specialist who has a standard diploma of completion of a secondary vocational medical educational institution in the following specialties: nursing, midwifery, general medicine and who has the skills to perform this simple medical service. As well as specialists who have a diploma of completion of a higher professional educational institution specializing in general medicine, pediatrics, and nursing.
Or a specialist who has a document in the specialty of junior nurse in patient care and has the skills to perform this simple medical service.
2. Requirements for ensuring the safety of medical personnel:
· Before and after the procedure, perform hand hygiene.
· During the procedure, use gloves, a mask, and an apron.
3. Conditions for fulfillment: inpatient, outpatient - polyclinic, restorative - rehabilitation.
4. Functional purpose: preventive.
5. Material resources: gloves, mask, apron, antiseptic.
6. Characteristics of the methodology for performing medical services:
| No. | Stages | Rationale | |
| 6.1. | Greet the patient kindly, identify the patient, introduce yourself, explain the upcoming procedure, and make sure the patient has informed consent for the procedure. If there is none, please clarify further actions at the doctor's. | The patient's right to information is respected and the patient is informed. | |
| 2. | Treat your hands hygienically, put on an apron, gloves, and a mask. | Access to the patient and safety of personnel is ensured. | |
| 6.2. | Lower the side rail on one side of the bed (if equipped). | Infectious safety of personnel is ensured. | |
| 4. | Make sure the patient is lying horizontally in the middle of the bed. Gently lift his head and remove the pillow; lean it against the head of the bed. | The safety of the patient is ensured and the possibility of further movement is created. | |
| 5. | Start the transfer procedure from the patient's feet: · stand facing the foot end of the bed at an angle of 45 0; · spread your legs 30 cm wide; move the leg closest to the head of the bed a little back; · bend your knees so that the nurse’s hands are at the level of the patient’s legs; · move the center of gravity to the leg set back; · Move the patient's legs diagonally towards the head of the bed. | Legs are lighter than other parts of the body and are easier to move. Correct biomechanics of the sister's body is ensured and physical stress is reduced. · the sister's position facing the direction of movement ensures good balance; · this arrangement of the legs (in the diagonal direction) coincides with the direction of gravity; · bending the legs ensures that gravity moves downward and engages the muscles of the hips, not the back; · shifting the center of gravity to the leg set back leads to a decrease in physical activity. | |
| 6. | Move parallel to the patient’s thigh, closer to the pelvic part, bend your knees and squat so that your arms are at the level of the patient’s torso. | The correct biomechanics of the sister's body is ensured: · maximum proximity to the moved part of the patient's body; · downward shift of the center of gravity; Involvement of the muscles of the hips, not the back, into work | |
| 7. | Move the patient's pelvic part diagonally towards the head of the bed | Provides alignment of the patient's pelvic part | |
| 8. | Move parallel to the patient's upper torso, bend your knees and squat so that your arms are at the level of the patient's torso. | The correct biomechanics of the sister's body is ensured. | |
| 9. | Place the hand that is closer to the head of the patient under the patient’s neck, clasp it from below and support the shoulder with it. | The correct biomechanics of the patient’s body and his safety are ensured. | |
| 10. | Bring your other hand under top part patient's back | Friction of the skin of the back is reduced, and the risk of developing bedsores is reduced. | |
| 11. | Move the patient's head and upper torso diagonally toward the head of the bed. | The patient's body is positioned horizontally on one side of the bed. | |
| 12. | Raise the side rail (if it exists). Move to the other side of the bed and lower the side rail. | Prevent the patient from falling out of bed. | |
| 13. | Moving from one side of the bed to the other, repeat steps 5-12 until the patient’s body reaches the desired height in bed. | The safety of the patient and staff is ensured. | |
| 14. | Move the patient to the middle of the bed, in the same way, alternately moving three parts of his body. | Provides space for turning the patient over and other manipulations. | |
| 15. | Raise the patient's head and place a pillow under the head and neck. Make sure the patient is lying comfortably and correctly. | A comfortable, safe position for the patient is ensured. | |
| 6. 3. | Remove gloves, apron, mask. Treat your hands in a hygienic manner. Fill in medical documentation travel time. | Infectious safety of personnel, control and continuity of care are ensured. | |
7. Additional information: Train the patient’s relatives on the rules of moving and placing a seriously ill patient.
(performed by one nurse)
Remember! This procedure cannot be performed if:
· spinal injury;
· spine surgery;
· epidural anesthesia.
Target: Preventing improper movement of the patient, ensuring his safety.
Indications: Patient's bed rest, immobility or immobility, inability to receive assistance from the patient, difficulty moving in elderly patients.
Technology for performing a simple medical service:
1 . Requirements for specialists and support staff: Has the right to be performed by a specialist who has a standard diploma of completion of a secondary vocational medical educational institution in the following specialties: nursing, midwifery, general medicine and who has the skills to perform this simple medical service, as well as specialists who have a diploma of completion of a higher professional educational institution specializing in general medicine, pediatrics, and nursing.
Or a specialist who has a document in the specialty of junior nurse in patient care and has the skills to perform this simple medical service.
2. Requirements for ensuring the safety of medical personnel:
· Before and after the procedure, perform hand hygiene.
· During the procedure, use gloves, a mask, and an apron.
3. Conditions for fulfillment: inpatient, outpatient - polyclinic, restorative - rehabilitation.
4. Functional purpose: preventive.
5. Material resources: gloves, mask, apron, antiseptic.
6. Characteristics of the methodology for performing medical services:
| No. | Stages | Rationale | |
| 6.1. | Greet the patient kindly, identify the patient, introduce yourself, explain the upcoming procedure, and make sure the patient has informed consent for the procedure. If this is not the case, check with your doctor for further steps. | The patient's right to information is respected and the patient is informed. | |
| 2. | Treat your hands hygienically, put on an apron, gloves, and a mask. | Access to the patient and safety of personnel is ensured. | |
| 6.2. | Lower the side rail on one side of the bed (if equipped). | Infectious safety of personnel is ensured. | |
| 4. | Make sure the patient is lying horizontally in the middle of the bed. Gently lift his head and remove the pillow; lean it against the head of the bed. | The safety of the patient is ensured and the possibility of further movement is created. | |
| 5. | Start the transfer procedure from the patient's feet: · stand facing the foot end of the bed at an angle of 45 0; · spread your legs 30 cm wide; move the leg closest to the head of the bed a little back; · bend your knees so that the nurse’s hands are at the level of the patient’s legs; · move the center of gravity to the leg set back; · Move the patient's legs diagonally towards the head of the bed. | Legs are lighter than other parts of the body and are easier to move. Correct biomechanics of the sister's body is ensured and physical stress is reduced. · the sister's position facing the direction of movement ensures good balance; · this arrangement of the legs (in the diagonal direction) coincides with the direction of gravity; · bending the legs ensures that gravity moves downward and engages the muscles of the hips, not the back; · shifting the center of gravity to the leg set back leads to a decrease in physical activity. | |
| 6. | Move parallel to the patient’s thigh, closer to the pelvic part, bend your knees and squat so that your arms are at the level of the patient’s torso. | The correct biomechanics of the sister's body is ensured: · maximum proximity to the moved part of the patient's body; · downward shift of the center of gravity; Involvement of the muscles of the hips, not the back, into work | |
| 7. | Move the patient's pelvic part diagonally towards the head of the bed | Provides alignment of the patient's pelvic part | |
| 8. | Move parallel to the patient's upper torso, bend your knees and squat so that your arms are at the level of the patient's torso. | The correct biomechanics of the sister's body is ensured. | |
| 9. | Place the hand that is closer to the head of the patient under the patient’s neck, clasp it from below and support the shoulder with it. | The correct biomechanics of the patient’s body and his safety are ensured. | |
| 10. | Place your other hand under the patient's upper back | Friction of the skin of the back is reduced, and the risk of developing bedsores is reduced. | |
| 11. | Move the patient's head and upper torso diagonally toward the head of the bed. | The patient's body is positioned horizontally on one side of the bed. | |
| 12. | Raise the side rail (if it exists). Move to the other side of the bed and lower the side rail. | Prevent the patient from falling out of bed. | |
| 13. | Moving from one side of the bed to the other, repeat steps 5-12 until the patient’s body reaches the desired height in bed. | The safety of the patient and staff is ensured. | |
| 14. | Move the patient to the middle of the bed, in the same way, alternately moving three parts of his body. | Provides space for turning the patient over and other manipulations. | |
| 15. | Raise the patient's head and place a pillow under the head and neck. Make sure the patient is lying comfortably and correctly. | A comfortable, safe position for the patient is ensured. | |
| 6. 3. | Remove gloves, apron, mask. Treat your hands in a hygienic manner. Fill in the medical documentation with the time of travel. | Infectious safety of personnel, control and continuity of care are ensured. | |
7. Additional information: Train the patient’s relatives on the rules of moving and placing a seriously ill patient.
Make instructions for relatives and other caregivers on moving and accommodating a seriously ill patient.
Apply the rules of biomechanics when moving not only for the patient, but also for medical personnel.
If the patient is in an elevated position and can often slide down, monitor the position every 30 minutes.
The procedure cannot be performed if:
· spinal injury;
· spine surgery;
· epidural anesthesia.
8. Achieved result: Relocation and placement completed. The patient feels comfortable.
SECTIONS 9,10,11,13 see TPMU No. 39 p. 132
Moving the patient to the head of the bed using a sheet (performed with one nurse)
4.Pull the edges of the sheet out from under the mattress on all sides.
5.Remove the pillow from under the patient’s head and place it next to him. Lower the head of the bed. Make sure the patient lies horizontally.
6.Stand at the head of the bed with your feet 30 cm wide and place one foot slightly in front of the other.
7.Roll up the sheet around the patient’s head and shoulders. Ask the patient to bend his knees (if he can do this) and press his feet to the mattress so that he is able to help.
8.Grip the rolled edges of the sheet on both sides of the patient’s head with both hands, palms up.
9.Bend your knees to keep your back straight.
10.Warn the patient to be ready to move.
11. Having warned the patient, tilt the body back and pull the patient to the head of the bed.
12.Place a pillow under the patient’s head and straighten the sheet.
Moving the patient to the edge of the bed (performed by one nurse, the patient can help).
4.Remove the pillow from under the patient’s head and place it next to him. Lower the head of the bed.
5. Make sure that the patient lies strictly horizontally.
6.Stand at the head of the bed with your feet 30 cm wide and place one foot slightly in front of the other. Bend your knees.
7.Ask the patient to cross his arms over his chest, clasping his elbows.
8. Place one hand under the patient’s neck and shoulders, and the other under his upper back.
9. Tilt your body back and pull your upper back towards you.
10.Change the position of the hands: place one hand under the patient’s waist, the other under the patient’s hips.
11.Also tilt the body back and pull it towards you bottom part patient's torso.
12. Place your hands under the patient’s shins and feet and move them towards you. Raise the patient’s head and place a pillow under it.
End of the procedure:
13. Make sure the patient is lying comfortably. Raise the side rails of the bed.
14.Move the bedside table next to the bed and place items frequently needed by the patient on the table.
15.Remove gloves.
16. Wash, dry and treat your hands with an antiseptic solution.
17.Make an appropriate entry about the procedure performed in the medical documentation.
Supporting the patient while walking
First, carefully assess what the patient can do independently or with the assistance of one or more persons, using assistive devices such as a cane, crutches, or when a support structure can be used. When you decide to help, stand close to the patient and apply a thumb grip: hold the patient's right hand in yours right hand and do the same with the left. The patient's hand should be straight, with the palm resting on your palm with the thumbs clasped together. You can use your other hand to avoid unnecessary stress on your back and also to support the patient. If he feels unsure, support him at the waist and support his knees with your dominant leg. In this position, you can keep the person from falling with minimal effort.
Learning to walk
When the doctor has allowed and strongly recommended that the patient begin to walk, a nurse assists him. The first step means a lot for the patient. First, help him get up. To facilitate walking and secure the patient, a belt can be worn. While the patient is moving, you should position yourself on the affected side, placing your non-working hand on your shoulder and holding the patient by the belt to increase his stability. If, however, the patient begins to fall, it is thanks to the belt that you can smoothly lower him to the floor.
Another option for learning to walk is to use a special device, a “walker.” Most modern models of “walkers” have variable height, which allows them to be used by both short and tall people. tall patients(according to standards, the “walker” should be up to the level hip joint patient).
There are several types of walkers:
Portable, consisting of a structure made of durable but lightweight metal on four legs with rubber tips (to reduce slipping when in contact with the floor) and two handles for gripping with a brush. This model is intended for people who are unstable but do not need to lean heavily on the walker.
Four-wheeled - a design similar to the first, in which wheels are attached instead of rubber tips. This model is designed for patients who need constant support while walking.
Two-wheeled - a kind of transitional option between the first and second models: two wheels in the front and two legs with rubber tips in the back. If the patient is tired, he can stop and lean on the walker. To resume movement, you just need to lift the back legs and roll the “walker” on the front wheels.
The next type of device that makes it easier for the patient to move is a stick with a rubber tip. The size of the stick is selected in this way: the upper end is located at the level of the hip joint, while the lower end should not reach the floor 20 cm.
There are several models of sticks. The most famous is with one rubber tip (necessary for those patients who have relatively good balance when walking). There are also sticks with three and four tips (for patients who are less stable when moving).
As a rule, the stick is used by the patient if he needs support on one side of the body, but only when he is able to move independently. And yet, in the first days of using the stick, the patient should be insured on the affected side.
Some patients prefer to use a crutch instead of a stick. When choosing the size of a crutch, use the rule - between it top edge and two fingers should fit under the armpit. In addition, the patient should be able to comfortably grasp the crossbar of the crutch and rest on his unbent arm.
Once the patient has started walking, it is very important to minimize the likelihood of him falling, each of which can result in injury. The injury will again bind the patient to bed, which will not only negatively affect his psychological state, but can also cause the development of potential problems and complications, including life-threatening ones.
What to do if the patient does fall?
Let it slide down along your body without straining yourself. This fall is controlled. You can then help the patient lie on their side or sit up with a pillow or blanket.
If there is no danger to the patient and he can assist you, then one of the nurses can lift the patient using an arm grab, while the other lifts the legs. You both bend your knees and carefully straighten up. Alternatively, you can use a modified shoulder lift technique. For the first stage of lifting - from the floor to a low chair - you may find it most comfortable to kneel, but at each stage of the lift you need to be sure that you have a firm support for your non-lifting arms.
Patients who are only partially ambulatory are sometimes able to cope with minimal assistance: they may first roll onto their side, then lean their shoulder on a low stool, chair, or bed to kneel; from this position they can sit or lie down.
Fallen patient
If the patient cannot or does not need to be seated using a lifting device, stretcher, or lifting aid, the patient must be lifted from the floor manually. In this case, the patient is lifted by three people. This requires great care. This technique involves bending in and lifting in front of the knees, so it is potentially dangerous. Put yourself physically strong man in the middle he would take on the heaviest part of the burden. Coherence of movements is important; If inexperienced persons assist in lifting, ensure that they are properly instructed.
Moving the patient to the head of a wide bed (performed by two people).
Used "Australian uplift"
Explain the procedure to the patient, make sure he understands it, and obtain his consent to perform it. Imagine a person helping you move.
Assess the patient's condition and environment.
Help the patient move to the edge of the bed, moving first his legs, then his buttocks, torso and head.
Help the patient sit up.
One of the nurses kneels next to the patient on the vacant part of the bed, placing her shins along the patient’s hips (previously lay a diaper on the bed). Second sister - stands on the floor in the “Australian lift” position.
Lift the patient off the bed using your shoulder and move him a short distance towards the head of the bed.
Gradually move the patient to the desired distance, lifting him above the bed. Remove the diaper.
Create a comfortable position for the patient.
Patient safety – correct placement in bed, movement and transportation.
Risk of injury to the patient
Functional bed necessary to create a comfortable, if necessary, forced position, ease of movement and movement of the patient.
A necessary or forced position in bed is ensured by the presence of two or three movable sections, handles at the head and foot ends of the bed.
Mobility of transportation is provided by silent wheels, safety is provided by the brake handle and side rails of the bed. Some bed models have specially built-in bedside tables, tripods for IVs, stands for vessels and urinals. Additional functions in the bed model make it easier for the patient and his care.
Before moving or transferring from bed to gurney and vice versa, the nurse determines the patient's ability to independent actions selects a safe method of transportation, assesses the volume of nursing interventions.
Stand closer to the patient
Use physical abilities Ask the patient to tense the gluteal and abdominal muscles several times.
Ask the patient to spread his legs wide to increase the area of support.
Invite the patient to bend his knees and use his body weight to facilitate movement.
Use the muscles of your arms and legs, but not your back.
Move the patient using pushing, connecting movements, excluding friction, and do not lift him.
Fix the patient's arms to prevent dislocation shoulder joint.
Patient's position in bed
Sequencing:
Lying on your back, head and shoulders on a pillow:
Place the roller along outer surface thighs, starting from the greater trochanter area femur– preventing outward rotation of the hip;
Place a cushion under the shin in the area of the lower lower third with a slight bend of the knees - reducing pressure on the heels, preventing bedsores;
Provide support for the feet at an angle of 90° - prevention of sagging feet;
Turn the patient's hands palms down and place them along the body; place cushions under the forearms - reduce shoulder rotation, prevent hyperextension in elbow joint;
Place hand rollers in the patient's hands - decrease finger extension, abduct the thumb.
Fowler's position (reclining/half sitting) – the patient lies on his back, the bed is in horizontal position:
Raise the head of the bed to an angle of 45-60° (half-lying/half-sitting) – provides a comfortable and physiological position for breathing and communication;
Place a pillow under your head and shoulders to prevent flexion contracture of the neck muscles;
Place cushions under the forearms and hands to prevent shoulder dislocation and flexion contracture of the arm muscles;
Place a cushion under the lower back - reduce the load on the lower spine;
Place bolsters under the knees to prevent hyperextension in the knee joint and compression of the popliteal artery;
Provide support for the feet at an angle of 90° - prevention of sagging feet.
Lying position on the right side - the patient lies on his back at the edge of the bed:
bend left leg the patient in the knee joint, bringing the left foot and right popliteal cavity - creating a lever to rotate the body;
Place one hand on the patient’s thigh, the other on the shoulder and turn him sideways towards himself - the action of the lever on the thigh facilitates the turn;
Place a pillow under your head and shoulders - reduce the lateral bending of the neck and tension in the neck muscles;
Give both the patient’s arms a slightly bent position: the hand located on top lies at the level of the shoulder and head, and the hand located below lies on a pillow next to the head - preventing dislocation of the shoulder joint and facilitating breathing;
Place a cushion along the back with a smooth edge - fix the patient on his side;
Place the roller along the patient’s bent leg - prevention of bedsores in the area of the knee joint and ankles, hyperextension of the leg;
Ensure that the spot rests at an angle of 90° - to prevent sagging feet.
Prone position - the patient lies on his back at the edge of the bed:
Extend the arm at the elbow joint, press it to the body along its entire length, placing the hand under the thigh, or stretch it along the head - eliminating the danger of squeezing the arm, reducing flexion or hyperextension of the cervical vertebrae;
Place a cushion in the projection of the abdomen below the level of the diaphragm - reducing hyperextension of the lumbar vertebrae and tension in the lower back, reducing pressure on the mammary glands;
Turn over onto your stomach (toward your sister); turn the patient's head to the side;
Bend the patient’s arms at the shoulders, raise them up, hands at head level;
Secure the bolsters under the elbows, forearms and hands;
Place bolsters under your feet to prevent sagging and turning outward.
Sims position is intermediate between the prone and side lying positions - the head of the bed is in a horizontal position, the patient lies on his back at the edge of the bed:
Move the patient onto his side and partially onto his stomach;
Place a pillow under your head to prevent excessive bending of the neck;
Bend one arm and place it on the pillow at shoulder level, and place the other on the sheet along the body - correct biomechanics;
Similarly to the bent arm, bend the leg, place a bolster so that the leg is at the level of the hip - preventing the hip from turning inward, preventing overextension of the hip turning inward, preventing the extension of the limb, preventing bedsores in the area knee joints and ankles;
Provide foot support at an angle of 90°.
Transferring a patient from bed to gurney, from gurney to bed
Sequencing
The gurney is filled with individual bed linen.
Ways to shift a patient in a group (two/three):
Stand closer to the bed at the level of your head, lower back, and legs.
Half squat with one leg forward.
Bring your arms under the patient’s body at once:
The patient's head and shoulder blades;
Pelvis and upper thighs;
Mid thighs and lower legs.
The patient's head and torso;
Pelvis and middle.
Hold the patient close to you and, on the count of “one, two, three,” immediately lift the patient, turn around and place him on the surface of the gurney/bed.
Cover the patient.
Moving the patient from a side-lying position to a sitting position with legs down
Sequencing:
Lock the bed brake.
Lower the side rails on the nurse's side.
Stand opposite the patient.
Place your left hand under his shoulders, your right hand under his knees, covering them from above.
Raise the patient, lower his legs down and at the same time turn him on the bed in a horizontal plane at an angle of 90 0.
Sit the patient down, continue to face him, hold the shoulder with your left hand, and the body with your right hand.
Place a backrest and make sure the patient's posture is stable.
Put the patient's shoes on or secure his feet on a bench.
Transferring the patient from a sitting position on the bed with legs down to a wheelchair
Sequencing:
Lock the bed brake.
Place the wheelchair on the brake next to the bed.
Use a method of restraining the patient:
Grab “under the elbow” - the nurse fixes the patient’s knees with her legs, the patient leans forward so that his shoulder rests against the sister’s torso; the nurse holds him, pressing him by the elbows with bent arms;
“Elbow” grip - the nurse holds the patient not by the elbows, but under the armpits.
Place the patient on his feet and turn toward the wheelchair at the same time.
Lower the patient onto the wheelchair, bend your knees and support the patient's knees.
Secure the patient's arms on the armrests.
Sit comfortably, remove the brake and transport.
