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Pull the patient to the head of the bed.
If the ward can help the nurse, then she acts alone.
· Go to the patient's bed.
◦ stand to the right of the patient;
◦with one hand, take the person under your charge from behind under the right armpit;
◦ place your other hand under the patient’s left armpit so that his armpit rests on the carpal crook of your hand from the thumb side;
◦ bend your knees slightly and place your knees firmly on the edge of the bed.
2. Pull back the blanket as far as necessary.
3. Ask the patient to bend their knees and place their feet on the mattress.
4. Lift the patient using a supportive grip:
5. Ask the patient to raise his head and tilt it forward.
6. Command “One, two - hold your breath”
7. Pull your ward up so that he simultaneously pushes off the bed with his feet and helps you move him.
8. Let the patient rest his head on the pillow.
9. Check whether the patient is positioned correctly, cover him with a blanket; find out how he feels.
Ticket number 27
When putting drops into the ear, the patient almost always feels dizzy. She stores the drops in a first aid kit, in a cool place.
In the department, when drops are instilled into the ear, nothing like this happens, the procedure is pleasant, the drops are warm and do not cause discomfort associated with dizziness.
1. Demonstrate putting drops into the eyes, ears, nose, providing medical service within the limits of their powers.
2. Prepare 10 liters of 5% chloramine solution, ensuring infection safety.
3. List adverse effects medicinal substances on the patient when safety precautions are not followed, ensuring a safe hospital environment.
Response standard
Demonstrate the placement of drops into the eyes, ears, and nose while providing medical services within the scope of your authority.
Putting drops into the eyes
Prepare sterile:
Pipettes,
Gauze balls.
1. Heat the drops to 36-37°C.
2. Sit the patient facing the light with the head slightly thrown back or lay on the back without a pillow.
3. Pipette the medicine with your right hand, and left hand take a sterile gauze swab.
4. Pull back the lower eyelid with your left hand using a gauze pad.
5. Invite the patient to look up (if possible).
6. Release 1-2 drops slowly medicine into the conjunctival sac, closer to the nose.
7. Ask the patient to close his eyes ( medicinal solution should not leak).
8. Place the pipette in the boiling container
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 is lying 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.
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.Put 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 top part his 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 use a thumb grip: hold right hand patient in your right hand and do the same with your 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.
E.V. Barkhatova
Collection of manipulations
on ergonomics
E.V. Barkhatova, ergonomics teacher at KBMK.
Reviewers:
I.V. Bayko, chief nurse of the Kaluzhskaya State Healthcare Institution regional hospital»;
L.G. Polkovnikova, Deputy Director for CMR, teacher of therapy at KBMK highest category;
M.D. Kubacheva, methodologist, teacher of infectious diseases at KBMK of the highest category.
E.V. Barkhatova
Collection of manipulations on ergonomics. Methodical recommendations For self-study students for practical classes. 2005. 40 p.
Annotation.
The collection of manipulations is intended for use in practical classes and for self-training of students medical schools and colleges in the subject “Fundamentals of ergonomics and safe travel patient." Recommended for practitioners nurses. Techniques and pictures explaining them are presented for each type of patient movement.
Introduction. Methods of holding, lifting, moving a patient by one, two or more persons.
Lifting the patient.
Holding the patient while lifting.
Holding the patient using the “over-arm” method.
Restraining the patient using the “elbow-raised grip” method.
Holding the patient using the “Underarm grip” method.
Holding the patient by the belt.
Supporting the patient while walking.
Raising the patient's head and shoulders.
Shoulder Raise Method.
Lifting a patient in a bed with variable height.
Lifting and moving the patient to the head of a low bed.
Moving the patient to the head of the wide bed.
Moving the patient using a pad to the edge of the bed with varying heights.
Moving the patient to the head of the bed. Performed by two people.
Moving the patient to the head of the bed. Performed by one sister.
Moving the patient to the head of a drop-down bed using a sheet.
Moving the helpless patient to the head of the bed.
Moving the patient to the edge of the bed.
Moving the patient from the “lying on his side” position to the “sitting with legs down” position.
Moving the patient from the “sitting on the bed with legs down” position to a chair.
Transferring the patient from the “sitting on the bed with legs down” position to a wheelchair with a non-removable footrest.
Placing the patient in a wheelchair.
Transferring the patient from a bed to a chair (wheelchair).
Transferring a patient from a bed to a chair without armrests or backrest.
Moving the patient from the “sitting on a chair” position to the “lying on the bed” position.
Transferring the patient from bed to gurney and back.
Transferring a patient from a regular bed to a gurney and vice versa.
Turning the patient onto his side using a pad and placing him in this position.
Turning the patient onto his side using the “joint log roll” method and placing him in this position.
Turn the patient and place him in the lateral position.
Turn over and place the patient in the prone position.
1 Introduction
Techniques for holding, lifting, moving a patient by one, two or more persons
The medical profession is humane in its essence. Regardless of the hardships, the health worker goes to any lengths to solve the problem. Often these difficulties are directly related to risks to one’s own health.
There are objective data on occupational hazards associated with chemical, epidemiological, and ergonomic factors in the work of a medical worker.
Of the ergonomic factors, doctors and nurses most often identified eye strain. Overload of the musculoskeletal system was higher in the youngest medical personnel, which is explained by the need to move seriously ill patients to the “operating unit, intensive care, resuscitation."
The lack of various aids for working with seriously ill patients is one of the causes of pain in the lumbosacral region and accidents.
Ergonomics is a scientific discipline that studies labor processes with the aim of optimizing tools and working conditions, increasing efficiency labor activity person and maintaining his health.
Knowledge and use in nursing special methods and techniques that reduce the load on the spine can reduce the risk of injury and damage to nurses.
Today, there are more than thirty technical methods of moving that are relatively safe for the sister’s health.
Remember! Never lift the patient in front of you (in front of your knees), as you will have to do this with your arms outstretched. Never lift a patient from the side of you, as this will significantly bend the spine!
The position of the sister's hands. The method of restraint used during transfer depends on the patient's painful areas and how much assistance will be provided during transfer. It is necessary to control the patient's body position and movement as much as possible.
Patient position. Before lifting (moving) the patient, you need to help him lie down or give him a comfortable position, taking into account the biomechanics of the body during subsequent movement.
Sister's back position and spine must be straight during movement. The shoulders, as far as possible, should be in the same plane as the pelvis. When lifting a patient with one hand, the other, free, maintains the balance of the torso and, therefore, the position of the back, serving as a support for relieving the load from the spine.
Some patients can help themselves to rise if, with the help of a nurse, they make several rocking movements to create driving force. In this case, the actual force expended by the nurse to lift the patient to a standing position may be minimal.
When dealing with even a helpless patient, gentle rocking of him and the nurse can encourage movement and make the lifting process easier. These skills can be learned, but require a sense of rhythm, coordination, and patient understanding and cooperation.
Working in a team. Patient movement can only be successful ifcoordination of movements. For example, one sister plays the role of leadergives orders, makes sure that everyone involved in the process and the patient are completelyready to move, She assesses the safety of the environment, observesgives behind the patient's facial expression as he moves. The physically strongest nurse in the team (regardless of position) must take on the heaviest part of the body– the patient's hips and torso.
2 Lifting the patient
When starting the lift, you need to: make sure that your sister’s legs are in a stable position on the floor.
Choose the most best way holding the patient.
Get as close to the patient as possible. Keep your back straight.
Make sure that the team and the patient perform movements in the same rhythm.
3 Holding the patient while lifting
(performed by two or more persons)
a) with your right hand, grab your assistant’s right wrist from the front- This carpal or single grip.
b) clasp each other’s right hand in the area of the right wrist, placingbrush on the front surface- This double wrist grip.
Fig. 1 Methods of restraining the patient.
c) take each other with your right hand, as if shaking hands- This hand grip.
d) cover 1-4 fingers of each other with your right hand- This finger grip.
4 Restraining the patient using the “over-the-arm” method
(done by one nurse, patient can help)
Usage: support and movement to the back of a chair (armchair) of a patient who is able to provide assistance.
Fig. 2 Restraining the patient using the “Grasp by hand” method.
Ask the patient to cross his arms and press them to his chest (if one arm is weak, the patient grabs the wrist of the weaker arm with the stronger one).
Stand behind the patient (the chair or stool on which he is sitting).
The nurse should wrap her hands around the patient’s arms as close to the wrists (behind the chest) as possible (Fig. 2).
Support or move the patient to the back of the chair.
5 Restraining the patient using the “elbow-raised grip” method
Usage: support and movement of the patient who is able to provide assistance.
Fig.3 Restraining the patient using the “Grip with the elbow raised” method.
Explain the procedure to the patient, make sure he understands it and obtain his consent to perform it.
Assess the patient's condition and environment.
Stand on the side of the patient sitting on a chair (low bed), facing him, place one leg next to the chair, the other, slightly turning the foot, in front of the patient’s legs, fixing his knees with your foot.
Make sure you can move your body weight freely from one leg to the other and are standing comfortably.
Ask the patient (or help him) to lean forward so that one shoulder closer to you rests firmly on your torso.
Bend slightly forward behind the patient's back and firmly grasp his elbows, supporting them from below (Fig. 3).
Substitute the other shoulder so that the patient's other shoulder rests on your hand.
6 Holding the patient using the “Underarm grip” method
(performed by one nurse, patient can help)
Usage: support and movement of the patient who is able to provide assistance.
Fig.4 Holding the patient using the “Underarm grip” method.
Assess the patient's condition and environment (Fig. 4).
Stand on the side facing the patient sitting on a chair (low bed): oneplace your foot next to the chair, the other, slightly turning your foot,- in front of the legs the patient, fixing his knees with your leg.
Place your hands in the patient’s armpits: one hand in the direction front - back, palm up, thumb outside the armpit; another - towards the rear– forward, palm up, thumb outside,outside the armpit.
Make sure you are moving your weight freely from one leg to the other and are standing comfortably. Ask the patient (or help him) to lean forward so that the shoulder closest to you rests firmly on your torso.
7 Holding the patient by the belt
(performed by one nurse, patient can help)
Usage: support and movement of the patient who is able to provide assistance.
Fig.5 Holding the patient by the belt.
Explain the procedure to the patient, make sure he understands it and obtain his consent to perform it.
Assess the patient's condition and environment.
Stand on the side facing the patient, place one leg next to his leg with the other– in front of his legs, fixing his knees.
Place the thumbs of both hands behind the waistband of the patient’s trousers (patient’s skirt), then grasp the clothing with all fingers (Fig. 5). (An additional wide belt can be placed on the patient.)
Make sure the belt is securely fastened.
Ask the patient to support himself by placing his hands on your lower back or holding your belt.
8 Supporting the patient while walking
(performed by one sister)
Usage: helping a person walk after an injury, stroke, etc.
Explain the principle of restraint to the patient and make sure he understands it. Assess the patient's condition and capabilities:
Fig.6 Supporting the patient while walking.
Assess the surrounding environment (floor moisture, slippers, foreign objects on the floor, equipment standing in the patient’s path of movement). Stand next to the patient.
Apply a “thumb grip”: hold the patient’s right hand in your right (or left in your left) hand; the patient’s hand is straight, resting the palm on the sister’s palm with the thumbs closed (Fig. 6).
Use your other hand to support the patient under the elbow or armpit, or grab the patient around the waist.
Fig.7 Support the patient's knees right foot.
Stand as close to the patient as possible, supporting his knees with his right leg (if the nurse is standing on the right), if the patient feels unsure (Fig. 7)
Move around the patient as long as he feels unsure.
9 Raising the patient's head and shoulders
(performed by one sister)
Usage: adjust the pillow; straighten clothes; as a step when changing linen.
Explain the procedure to the patient, make sure he understands it, and obtain his consent to the procedure. Set the bed brakes.
Lower the side rails on one side (if equipped).
Stand on the side of the bed, facing the headboard, spread your legs 30 cm wide (Fig. 8).
Bend your knees. Don't lean forward!
Ask the patient to help you (if he can): put his arm around your shoulder, put his hand under yours, or grab the bed rails.
Insert your hand under the patient’s arm, located closer to you, and place the other under his shoulders and neck.
Raise the patient's head and shoulders, shifting your weight back toward their legs. Do not turn the patient while lifting the patient!
Fig. 8 Raising the patient's head and shoulders.
Ask the patient to help you with his free hand. Adjust the pillow with the hand supporting the patient's shoulders and neck.
Lower the patient's shoulders and head onto the pillow. Make sure it lies comfortably.
10 Shoulder lift method in a bed with varying heights
(Australian uplift)
(performed by two or more people, the patient can help)
Usage: lifting the patient in bed; moving from bed to chair and vice versa. Contraindications: the patient cannot sit; damage or pain in the shoulder, chest, upper back.
Explain the procedure to the patient, make sure he understands it and obtain consent to perform it. Assess the patient's condition and environment.
Help the patient sit up: one nurse supports the patient; the other places a pillow at the head of the bed (or raises the head of the bed).
Stand on both sides of the bed:
facing each other;
close to the bed;
legs apart;
the leg closest to the head is turned in the direction of movement;
bend your knees;
keep your back straight.
Place the shoulder closest to the patient in armpit and to the patient's torso. The hand of this hand is brought under the patient's hips. The patient places his hands on the nurses' back (Fig. 9).
Fig.9 Shoulder lift method (Australian lift).
If it is not possible to place your shoulder in the patient's armpit or if he can place his hand on the nurse's back, place your hand between the patient's torso and shoulder. Place the hand of this hand under the patient’s hips.
Lean with one hand on the head of the bed (elbow bent), with the otherplaced under the hips, grab the assistant's wrist (“double wrist grip”)– Fig.9,b.
Warn your colleague (if you are a leader) and the patient that on the count of three you will raise him.
Straighten the leg located at the patient’s feet, and transferring the weight of your body to the other leg, located closer to the head, lift the patient. The elbow, which provides support, is straightened.
Completely lift the patient over the bed, move him a short distance and lower him back onto the bed, bending the leg closest to the head of the bed and the arm that provides support.
Move the patient to the desired distance, repeating the previous two steps.
Provide the patient with the necessary position in bed.
11 Lifting a patient in an adjustable-height bed using a taut sheet (performed by two or more people, the patient may assist)
Usage: lifting in cases where it is not possible to use a shoulder lift.
Fig. 10 Raising a patient in a bed with variable height.
Explain the procedure to the patient, make sure he understands it, and obtain his consent to perform the procedure.
Assess the patient's condition and environment
Lower the bed to the middle of your thigh. Set the bed brakes.
Stand on both sides of the bed facing each other (if the patient is obese, 2 people stand on each side of the bed):
stand close to the bed;
nurses' shoulders at the level of the patient's back;
legs apart
the leg closest to the head is turned in the direction of movement,
legs bent at the knees;
back straight.
Lightly roll up the sheet (to chest level on one side and under hip - on the other). Lift the patient -
take the top corners of the sheet,
grab the bottom corners of the sheet,
place your foot in the direction of movement, gradually move the patient intovertical position in bed (count of three)– the leader commands) (Figure 10).
Next steps depend on the purpose of lifting the patient.
12 Lifting and moving the patient to the head of a low bed (performed by two people)
"Australian uplift" is used. 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 sit down, one nurse supports him, the second- places a pillow.
Stand on both sides close to the bed, facing each other and behind the patient so that your shoulders are level with the patient's back (Fig. 11).
Place a diaper on the edge of the bed. Turn your face towards the head of the bed. Place one knee parallel to the edge of the bed on the diaper placed, and move the lower leg as close to the patient as possible. The leg standing on the floor is a support when lifting the patient).
Apply "Australian lift".
Carefully move the patient a short distance to the head of the bed.
Fig. 11 Lifting and moving the patient to the head of a low bed.
Having finished moving, remove the diapers, creating a comfortable position for the patient
13 Moving the patient to the head of a wide bed
(performed by two people)
"Australian uplift" is used.
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 sits on her knees 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) (Fig. 12). The second sister stands on the floor in the Australian lift position.
Fig. 12 Moving the patient to the head of the wide bed.
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.
14 Moving the patient using a pad to the edge of a bed with varying heights
(performed by two people)
Usage: change of linen; as a preliminary stage for other movements. Contraindications:
Fig. 13 Moving the patient using a diaper to the edge of a bed with varying heights.
Explain the procedure to the patient, make sure he understands it, and obtain his consent to perform it. Imagine a person helping you move.
Make sure the patient is lying horizontally in the middle of the bed. Lower the handrails (if equipped).
Tell your assistant to stand on the other side of the bed. Rice. 13.
Ask the patient to raise his head (if he is unable to do this, carefully lift it), remove the pillow. Place a pillow at the head of the bed.
Roll the edges of the padding towards the patient until your hands touch the patient's body.
Place a pad (protector) in front of you on the vacant part of the bed along the patient.
Your assistant stands in a 30cm-wide leg-spread position, one leg in front, knees slightly bent.
Stand as close to the bed as possible, place one knee on the protector lying on the bed, the other leg firmly on the floor.
Hold the edges of the rolled up diaper with your palms facing up.
Tighten the muscles of your stomach, buttocks and back. On the count of three, carefully lift the patient and move him to the edge of the bed, using a pad.
Move it slowly, without jerking, lifting it high enough so that it does not slide on the bed.
When lifting, transfer your weight from your foot on the floor to your knee on the bed; your assistant shifts his weight from the forward leg to the backward leg.
Help the patient raise his head and neck and place a pillow under it.
Tuck in the edges of the padding.
Perform a procedure for which the patient was moved to the edge of the bed.
15 Moving the patient to the head of the bed
(performed by two people; patient can help)
Make sure the patient is lying horizontally. Ask him to raise his head and shoulders; if he cannot, gently lift his head and remove the pillow; lean it against the head of the bed.
Fig. 14 Moving the patient to the head of the bed. Performed by two people.
Stand on different sides facing the head of the bed.
Both nurses place one hand under the patient's shoulders, the other- under the hips (unsafe way); or one nurse stands at the patient's upper torso. He puts his hand under his neck andpatient's shoulder. With her other hand she clasps the arm and shoulder lying nearby.patient. The second nurse stands near the patient’s lower torso and brings her arms upunder his lower back and thighs.
Spread your legs 30 cm wide, placing one leg slightly back.
Ask the patient to bend his knees without lifting his feet from the bed.
Ask the patient to press their chin to their chest.
Ensure that the patient can assist in ambulation by pushing off the bed with their feet.
Bend your knees so that your forearms are level with the bed.
Ask the patient to push off from the bed on the count of “three” and, exhaling, raise his torso and move towards the head of the bed.
On the count of “three”, swing and transfer your body weight to the leg placed back. At this time, the patient pushes off with his heels and lifts his torso.
Elevate the patient's head and shoulders and provide a pillow. Make sure it lies comfortably in the desired position.
16 Moving the patient to the head of the bed
(performed by one nurse, patient can help)
Explain to the patient the process of the upcoming procedure, make sure he understands it and obtain his consent. Imagine a person helping you move.
Fig. 15 Moving the patient to the head of the bed. Performed by one sister.
Assess the surrounding environment. Lower the side rails, if equipped. Set the bed brakes.
Make sure the patient is lying horizontally. Ask him to raise his head, and if he cannot, gently lift his head and remove the pillow, lean it against the head of the bed.
Spread your legs 30 cm wide. Turn the toe of the leg closest to the headboard towards the headboard.
Ask the patient to bend their knees and press their feet firmly against the mattress, and hands - towards the bed, palms down.
Place one hand under the patient's shoulders, the other– under his buttocks. Notlean forward. Keep your back straight. Bend your knees.
Ask the patient to push off the bed with his feet and palms on the count of “three,” after exhaling, or ask him to grab the head of the bed with his hands, on the count of “three,” after exhaling, help the sister by pulling himself up.
Repeat these steps until the patient takes the appropriate position. Move it gradually, over a short distance, so as not to hurt your back.
Elevate the patient's head and shoulders and provide a pillow. Make sure it lies comfortably.
17 Moving the patient to the head of a bed with a drop head using a sheet
(performed by one sister)
Indications patient helplessness; lack of assistant.
Explain to the patient the process of the upcoming procedure, make sure he understands it and obtain his consent. Assess your surroundings. The bed should not have a hard headboard and should be set back from the wall. Secure the bed brakes (if equipped).
Ask the patient (if possible) how he can help.
Pull the edges of the sheet out from under the mattress.
Remove the pillow and place it next to you. Lower (remove) the head of the bed.
Make sure the patient is lying horizontally.
Stand at the head of the bed, spread your legs 30 cm wide and place one foot slightly in front. Do not lean over the headboard.
Roll the sheet over the patient's head and shoulders. Ask him to bend his knees (if possible) and press his feet into the mattress.
Fig. 16 Moving the patient to the head of a bed with a drop-down headboard using a sheet.
Take with both hands, palms up, the rolled edges of the sheet on both sides of the headboard.
Bend your knees and keep your back straight!
Ask the patient to help with the movement, after exhaling. On the count of three, tilt the body back and pull the patient to the head of the bed.
Place a pillow under your head and straighten the sheet. Make sure it lies comfortably.
18 Moving a helpless patient to the head of the bed
(performed by one sister)
Contraindications: spinal injury; spine surgery; epidural anesthesia.
Explain the procedure to the patient (if possible), make sure he understands it, and obtain his consent.
Assess your surroundings. Lower the side rails, if equipped. Set the bed brakes.
Make sure the patient is lying horizontally. Ask him to raise his head; if he cannot, carefully lift his head and remove the pillow, lean it against the head of the bed. Fig. 17.
Start the transfer procedure from the patient’s feet:
stand at the patient’s feet at an angle of 45°;
spread your legs 30 cm wide;
leg towards the head, set back a little;
bend your knees so that your 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 headboard.
Move the patient's pelvis diagonally towards the head of the bed.
Move with your knees bent so that your arms are at the level of the patient’s torso.
Place one hand under the patient's neck, supporting his shoulder, and the other hand- under his back.
Move the patient's head and upper torso diagonally toward the head of the bed.
Raise the side rail, if present. Move to the other side of the bed and lower the side rail.
Move from one side of the bed to the other, repeating previous operations until the patient’s body reaches the desired height in bed.
Move the patient to the middle of the bed, alternately moving the upper body, pelvis, and legs.
Elevate the patient's head and shoulders and place a pillow. Make sure it lies comfortably.
Fig. 17 Moving a helpless patient to the head of the bed using the “snake method”.
19 Moving the patient to the edge of the bed
(performed by one nurse, the patient can help)
ANDusage: change of linen as a preliminary step for other movements.
Contraindications: spinal trauma, spinal surgery, epidural anesthesia.
Explain the procedure to the patient, make sure he understands it and obtain his consent to perform it.
Assess the patient's condition and environment. Set the bed brakes.
Make sure the patient is lying horizontally. Lower the side rails on the sister's side
Raise the patient's head and shoulders, remove the pillow and lean it against the headboard
Stand at the head of the bed. Spread your legs 30 cm wide, bend your knees without leaning forward.
Ask the patient to grab his or her elbows.
Place one hand under the patient's neck and shoulders, the other– under the top his back.
On the count of three, tilt your body and pull the patient’s upper back towards you.
Change the position of the hands, put one hand under the waist, the other- under the hips.
On the count of three, tilt your body and pull your lower body towards you.
Place your hands under the patient's legs and feet and, on the count of three, move them towards you.
Help the patient raise his head and place a pillow. Raise the side rails (if equipped).
Perform the procedure for which the patient was moved.
20 Moving the patient from the side-lying position
into the “sitting with legs down” position
(performed by one sister)
Fig. 18 Moving the patient from the “lying on his side” position to the “sitting with legs down” position.
Can be performed on both functional and regular ones.Used in a forced and passive position.
Explain the procedure to the patient, make sure he understands it and obtain his consent to perform it.
Assess the patient's condition and environment. Secure the brake; beds.
Lower the side rails (if equipped) on the nurse's side.
Stand opposite the patient: place your left hand under your shoulders, right- under knees, covering them from above. Bend your knees. Don't bend over!
Raise the patient by lowering his legs down and at the same time turning him on the bed in a horizontal plane at an angle of 90°.
Place the patient in a seated position, holding the shoulder with one hand and the other- for the body.
Make sure the patient sits securely and firmly. Place a back support.
Put slippers on the patient if his feet touch the floor, or place a bench under his feet if they do not touch the floor.
21 Moving the patient from position
"sitting on the bed with legs down" on a chair
(functional wheelchair with a removable footrest) (performed by one nurse, patient can assist)
Fig. 19 Moving the patient from the “lying on his side” position to the “sitting with legs down” position.
Can be used when moving from a functional bed to a functional wheelchair with a movable (removable) footrest and to a chair.
Used when changing position; transportation. Fig. 19.
Explain the procedure to the patient, make sure he understands it and obtain his consent to perform it.
Assess the patient's condition and environment. Set the bed brakes.
Place a chair (wheelchair) next to the bed. If possible, lower the bed to the level of the chair. Move the footrest of the wheelchair and secure the brakes.
Use one of the ways to restrain the patient (Fig. 1).
Stand on the side where the wheelchair (chair) is located. Do not put pressure on the patient's armpits!
Warn the patient that on the count of three you will help him stand up. While counting, swing slightly. Having placed the patient on his feet at the count of three, turn with him until his back is to the wheelchair (chair). Ask the patient to tell you when he touches the edge of the wheelchair (chair).
Lower him into a wheelchair (on a chair): bend your knees and hold the patient’s knees with them, keep your back straight. The patient will help you if he puts his hands on the handle of the wheelchair (on the edge of the chair) and lowers himself into it.
Make the patient sit comfortably in a chair (chair).
22 Transferring the patient from the “sitting on the bed with legs down” position to a wheelchair with a non-removable footrest
(performed by two people, the patient can help)
Use for subsequent transportation.
Explain the procedure to the patient, make sure he understands it and obtain consent to perform it.
Assess the patient's condition and environment. Set the bed brakes. Place the wheelchair at the patient's feet. If possible, lower the bed to the level of the chair.
One nurse stands behind the wheelchair and tilts it forward so that the footrest touches the floor.
The second sister (assistant) stands opposite the patient sitting on the bed with his legs down, the sister’s legs are spaced 30 cm wide and bent at the knees.
Ask the patient to grab the nurse by the waist and hold him by the shoulders.
Pull the patient to the edge of the bed so that his feet (in non-slip shoes) touch the floor (Fig. 20 a).
Place one leg between the patient's knees and the other– in the direction of movement.
Rice. 20 Moving the patient from the “sitting on the bed with legs down” position to a wheelchair with a non-removable footrest.
Hold the patient in a “hug” position and gently lift him without jerking or turning. Do not put pressure on the patient's armpits!
Warn him that on the count of three you will help him get up. While counting, sway slightly with it. On the count of three, stand the patient, turn with him until he is in a position with his back to the wheelchair. Ask the patient to alert you when he touches the edge of the gurney.
Lower the patient into the wheelchair: bend your knees and hold the patient’s knees with them; keep your back straight. The patient may be able to help by placing his hands on the armrests of the wheelchair.
Release the patient, making sure he is securely seated in the chair.
Place the patient comfortably in the chair.
If necessary to transport the patient, release the brake.
23 Placing the patient in a wheelchair
(performed by two people)
Check that the brakes of the wheelchair are secure.
Stand behind the wheelchair behind the patient.
Provide yourself reliable support: lean one leg on the back of the chair, put the other leg back. Bend your knees.
Ask the second nurse (assistant) to sit on one knee on the side of the patient, lift his legs to hip level and place them on your knee.
Support the patient's head with your chest or shoulder. Make an overhand grab. Keep your back straight, tensing your abdominal and buttock muscles.
Tell the patient and assistant that on the count of three you will move the patient toward the back of the chair.
On the count of “three”: the assistant slightly lifts the patient’s hips and moves them towards the back of the chair; you pull the patient to the back of the chair using a slide.
Fig. 21 Placing the patient in a gurney.
Make sure the patient is comfortable and remove the brakes on the wheels of the wheelchair.
24 Transferring a patient from a bed to a chair (wheelchair) (performed by two or more people using the “shoulder lift” method; the patient can sit, but does not move independently)
Explain the procedure to the patient, make sure he understands it and obtain his consent to perform it.
Place a chair next to the bed. Assess your surroundings. Fig.22.
Help the patient sit closer to the edge of the bed with his legs dangling.
Stand on either side of the patient, facing him. Both sisters place their hand under his hips and hold each other in a “wrist lock” (Figure 1), supporting his hips.
Both nurses place their shoulders under the patient's shoulders, and he places his hands on the backs of the sisters. Bend your free arm at the elbow, resting it on the bed. Legs apart, knees bent.
One of the sisters gives the command. On the count of three, both straighten their knees and elbows, stand up and lift the patient. Support the patient's back with your free hand while you carry him to a chair (wheelchair).
Rice. 22 Transferring a patient from a bed to a chair (wheelchair).
Each nurse places a supporting hand on the armrest or chair seat and lowers the patient onto the chair, bending the knees and elbow. Make sure you lower the patient into the chair at the same time. The chair should not tilt back: one of the sisters holds the back of the chair.
Place the patient comfortably on the chair.
25 Moving a patient from a bed to a chair without armrests or backrest (performed by two or more people using the “over-the-arm” method; the patient can sit, but does not move independently)
Explain the procedure to the patient, make sure he understands it and obtain his consent to perform it. Introduce everyone involved in the move.
Set the height of the bed to the height of the chair. Assess your surroundings.Help the patient sit up (the patient's legs are not lowered). One of the nurses stands behind the patient– puts one knee on the bed andmakes an “over-arm grab.”
Move the patient to the edge of the bed. Support him by standing on the floor with both feet behind him.
Fig. 23 Transferring a patient from a bed to a chair without armrests or backrest.
The second nurse places the chair comfortably and close to the bed, but so that the patient does not rest his elbow on the bed when sitting on the chair.
The same nurse stands opposite the chair facing the patient. Legs are bent at the knees (squatting position), one leg is put forward.
She puts her hands under the patient’s knees and, on the count of three, drags his legs to the edge of the bed, while the other nurse lifts his torso and, bending her knees, lowers the patient onto a chair. Place the patient comfortably on the chair.
26 Lifting the patient from a chair using
rocking and moving onto a chair (bed)
(performed by one sister)
Used for the need to move the patient at an angle of 90 0 from a chair to a wheelchair or other seat.
Explain the procedure to the patient, make sure he understands it and obtain his consent to perform it.
Assess your surroundings. Move both seats together, fixing the brakes and removing the side bars of the chairs.
Face the patientplace your feet shoulder-width apart, hold the patient’s feet with one foot, and the other- a chair leg.
Ask the patient to lean forward so that his shoulder rests against chest sisters.
Fig.24 Lifting the patient from a chair by rocking and moving to a chair (bed).
Move the patient to the edge of the chair, rocking the chair from side to side and moving the legs forward. The patient's knees are at a 90° angle. The knees and feet are together.
Place one leg next to the patient and support his knees with the other. Start smoothly rocking, moving your body weight back and forth, keeping the patient close to you.
Warn the patient that on the count of three you will help him stand up.
Lift the patient and move him at a 90° angle to another chair (chair).
27 Moving the patient from the “sitting on a chair” position to the “lying on the bed” position (performed by one nurse)
Hold the patient using one of the methods known to you (see Fig. 1).
Explain the procedure to the patient, make sure he understands it and obtain his consent to perform it.
Assess the patient's condition and environment. Secure the bed brakes
Warn the patient that on the count of three you will help him stand up. While counting to three, swing. On the count of three, stand the patient, then turn with him, foot to foot, until his hips touch the edge of the bed.
Place the patient on the bed. Stand on the side facing him. Spread your legs width 30 cm. Bend your knees. Keep your back straight
Rice. 25 Moving the patient from the “sitting on a chair” position to the “lying on the bed” position.
Place your hand under your knees, grab them from above, and with your other hand grab the patient’s shoulders.
Raise the patient's legs onto the bed, turning his torso 90°, and lower his head onto the pillow. Cover the patient and make sure he is lying comfortably.
28 Transferring a patient from bed to gurney and back
(for four people, bed with variable height)
After the operation, the patient remains in a state of anesthesia for some time, or conscious, but experiences pain.
During the transfer, visitors are asked to temporarily leave the room. You need to ask someone to hold the IV, drainage tubes and other devices.
When starting to move onto a gurney (bed), you need to know in which area the operation was performed, as well as other restrictions.
You and your assistant stand on one side, the other two sisters- from another goy side of the bed. Secure the brakes. Fig.26.
Place the gurney on the side of the bed where you will be moving the patient. It is necessary to leave space to be able to stand between the bed and the gurney.
Cover the patient with a sheet or blanket. Tell him to hold the sheet or blanket with his hands while you roll the sheet up at his feet.
Move the patient to the edge of the bed.
Unfold the sheet and leave it on the mattress (without tucking it in). Wrap the top sheet around the patient, tucking the ends under it. Stand close to the bed to prevent the patient from falling.
Fig. 26 Moving the patient from the bed to the gurney and back.
Note.The head of the bed is in horizontal position. Two nurses stand on the opposite side of the wheelchair and hold the patient; two other assistants move the gurney to the edge of the bed.
Note.Make sure the gurney is level with the bed. Do not leave space between the bed and the gurney. Check that the sheet is on the mattress.
Roll the sheet into a roll and hold it in your hands on all sides, palms up.
Two sisters kneel on the free part of the bed (after placing the protector).
On the count of “three” (the leader gives the command), all four lift the sheet and transfer the patient to the gurney along with the sheet. Make sure the patient is lying in the middle.
Note. If the gurney is equipped with belts, secure the patient with them.
Transport the patient to the destination: one nurse- at the head, the other - at the patient’s feet.
When moving it from the gurney to the bed, place the gurney close to the bed, secure the brakes, and release the edges of the sheet on the gurney.
Two assistants kneel on the bed with the protector down.
All the sisters fold the edges of the sheet towards the center.
On the count of “three” (the leader gives the command), everyone lifts the sheet, holding it by the edges with their palms up, and moves the patient to the edge of the bed.
The nurses, kneeling on the bed, go down to the floor and hold the patient while others move the gurney.
Move the patient, tuck the sheet under the mattress and straighten it.
If necessary, place a small pillow under your head. If the patient experiences pain when moving, or the bandage gets wet, or there is blood in the drainage tubes, report to the doctor.
29 Transferring a patient from a regular bed to a gurney
(and vice versa) (performed by three people)
Place the gurney at an angle of at least 60° at the edge of the bed (at the feet). Rice. 27.
Fig. 27 Transferring a patient from a regular bed to a gurney and vice versa.
Secure the brakes on the gurney and bed.Everyone stand along the bed. SaMay is a strong (physically) sister- in the center.
Place one leg forward, bending the knee, and put the other back. Place your arms (up to the elbow) under the patient:
the sister at the head raises her head, supports her shoulders and upper back,
the sister in the center supports the lower back and buttocks,
the nurse standing at the patient's feet supports the legs.
Note. If the patient is very sick, you will need more people and the load will have to be redistributed.
Lifting the patient:
at the leader’s command “three”, transfer your body weight to the leg set back,
gently pull the patient to the edge of the bed;
take a break
on new team“three” roll the patient onto you, press him and lift him, straightening his knees and straightening his back (do not hold the patient on outstretched arms!)
Move backward to face the gurney:
the nurse holding the patient's legs takes wider steps,
the nurse holding the patient's head, shoulders and back - less wide, turning to face the gurney
Move forward (toward the gurney). On the count of three, bend your knees and carefully lower the patient onto the gurney.
30 Turning the patient on his side using a pad and placing him in this position
(performed by two people)
Usage when changing linen; placement in a lateral position; preliminary, stage for other movements.
Explain the process of the upcoming procedure, make sure that the patient understands it and obtain his consent to perform it.
Assess the patient's condition and environment. Set the bed brakes. Have your assistant stand on the opposite side of the bed from you.
Lower the side rails (or one of them if you are performing the procedure without an assistant).
Ask the patient to raise his head (if possible), or raise his head and shoulders, remove the pillow. Place a pillow against the head of the bed.
Make sure the patient is lying horizontally on the edge of the bed.
Ask the patient to cross his arms over his chest.
If you turn him over on his right side, he should put left leg to the right. Help him if necessary.
Stand on the side of the bed where you turn him over.
Place a protector next to the patient.
Stand closer to the bed, place your knee on the protector, the other leg serves as a support.
Rice. 28 Turning the patient on his side using a pad and placing him in this position
Place your hand on the patient's shoulder, which is further from the nurse, the other– on the corresponding hip, i.e. if the patient turns over to the right side, halfplace your left hand on his left shoulder, and the right– on his left thigh.
Your assistant should pull the edge of the diaper out from under the mattress and roll it close to the patient's body, then take the rolled end of the diaper with your palms up and, resting your feet, turn the patient on his side on the count of three. You turn the patient towards you, placing your weight on the leg that is on the floor. Help the patient raise his head and place a pillow.
Note. Further actions depend on the purpose of the turn.
For example, in case placements:
turn the patient so that he is not lying on his arm;
place a folded blanket under your back for stability;
place a pillow under the arm lying on top;
Bend the leg lying on top at the knee and place a pillow between the knees.
Unfold the diaper.
31 Turning the patient onto his side using the “joint log roll” method and placing him in this position
(performed by two people)
Usage when changing linen; placement in a lateral position; a preliminary stage for other movements.
Assess the patient's condition and environment. Set the bed brakes.
Fig. 29 Turning the patient on his side using the “joint log rolling” method and placing him in this position.
Ask your assistant to stand next to you.
Remove the pillow from under your head and place it at the head of the bed. Place your hands under the patient's head and shoulders. Tell your assistant to place his hands under the patient's hips.
Place one leg slightly in front of the other, swing back on the count of three, shift your body weight onto the leg placed back and move the patient to the edge of the bed.
Lower the bed so that one of the sister's knees is on the bed (on the protector), and the other leg is firmly on the floor.
Together with an assistant, move to the other side of the bed. Place a pillow between the patient's legs and cross his arms over his chest.
Have both sisters place the protectors on the edge of the bed and place one knee on the protector.
Place one hand on your shoulder, the other– on the patient's pelvis, ask the landowner to place his hands on the patient's thighs and legs.
On the count of three, turn the patient to face you, keeping his head, back and legs in line. Bend your upper leg slightly.
Make sure the pillow remains between the patient's legs.
Place the support at the sole of the foot lying underneath.
Be sure to place a pillow under the patient's back to maintain this position. Also place a pillow under your upper arm. If possible, place a small pillow under the patient's head. Cover him.
Raise the side rails. Make sure the patient feels comfortable.
32 Turning the patient and placing him in a lateral position. Performed on a bed with variable height (performed by one nurse, the patient can help)
Usage at forced or passive position; risk of developing bedsores, changing position.
Prepare: extra pillow, footrest, sandbag. Explain to the patient the process of the upcoming procedure, make sure that he understands it and obtain his consent to perform it.
Assess the patient's condition and environment. Set the bed brakes.
Fully (if possible) lower the head of the bed; the patient should lie horizontally. Lower the bed to mid-thigh level.
Move the patient closer to the edge of the bed opposite to where he is being turned.
Tell the patient to cross his arms over his chest.
If you turn him over on his right side, he will put his left leg on his right.vuyu (if he can’t do this, help him), and whether bend the patient's left leg: one hand covers the shin, the other- popliteal cavity.
Stand on the side of the bed where you are turning the patient. Place the protector next to it. Bend your leg at the knee and place it on the tread. The second is a support.
If you turn the patient on his right side, place your left hand on hisleft shoulder, and right– on his left thigh.
Turn the patient onto their side, placing your weight on the leg on the floor. Place a pillow under the patient's head.
Fig. 30 Rotating the patient and placing him in a lateral position. Performed on a bed with variable height.
Note. The patient should lie on his or her arm.
Bend the patient's arms slightly. The arm on top lies on the pillow.
Place a pillow under the patient's back.
Place a pillow under the patient's half-bent leg lying on top (from the groin area to the foot).
Place a sandbag (footrest) at the sole of the foot that lies underneath. Unfold the diaper.
33 Turning over and placing the patient in the “prone” position (performed as prescribed by the doctor by one nurse; the patient cannot help)
Performed on both a functional and a regular bed. Use when forced or passive position; risk of developing bedsores, changing position. Rice. 31.
Prepare: a folded blanket or bath towel, a small pillow, bolsters.
Explain to the patient the course of the upcoming procedure, make sure that he understands it and obtain his consent to perform it.
Assess the patient's condition and environment. Set the bed brakes.
Lower the side rails (if equipped) on the nurse's side.
Lower the head of the bed (or remove the pillows). Make sure the patient is lying horizontally.
Rice. 31 Turning over and placing the patient in the “lying on his stomach” position (performed as prescribed by the doctor by one nurse; the patient cannot help).
Gently lift the patient's head, remove the usual one and place a small pillow.
Move the patient to the edge of the bed.
Extend the patient's arm and press it to the body.
Raise the side rails. Move to the other side of the bed and lower the 5m side rails.
Place your knee on the bed. Place a folded blanket (towel) ora small pillow under the patient's upper abdomen. Place one hand on the squareyes, and the other– on the thigh farthest from you, place your knee on the bedpatient by placing a small pillow (protector) under him.
Turn the patient onto his stomach towards the nurse. The patient's head is on its side.
Place a pillow under your shins so that your toes do not touch the bed.
Bend one of the patient's arms elbow joint at an angle of 90°, another– Bylay along the body.
Place pillows (or foam in a cover) under your elbows, forearms and hands.
Place small cushions next to your feet (outside).
Straighten the sheet and diaper.
Make sure the patient is lying comfortably. Raise the side rails.
Rice. 32 Technique for turning the patient onto his stomach together.
References
Mukhina S.A., Tarnovsky I.I. Practical guide to the subject “Fundamentals of Nursing”, Moscow, 2002.
Atlas of Human Anatomy, Moscow, Medicine, 1978.
Atlas of Human Anatomy, Moscow, Onyx Alliance, 2002.
Educational and methodological manual on OSD. Moscow, 2003.
Magazines "Nursing", "Nursing"
Algorithm for moving a seriously ill patient in bed
MOVEMENT OF A PATIENT IN SERIOUS CONDITION IN BED
Preparation for the procedure:
1. Introduce yourself to the patient, explain the purpose and course of the procedure (if the patient is conscious).
2. Put on gloves.
3. Adjust the height of the bed for ease of manipulation.
Moving the patient to the head of the bed on a low bed (performed by two people)
4.Help the patient sit down: one nurse supports the patient, the other can provide a pillow.
5.Stand on both sides of the bed, facing each other, close to the bed and slightly behind the patient so that your shoulders are level with the patient's back.
6.Put a diaper on the edge of the bed.
7. Stand with the knee closest to the patient on the bed, placing your shin on the diaper along the edge of the bed and moving your shin as close to the patient as possible. The foot on the floor is the fulcrum when lifting the patient.
8. Bring the shoulder closest to the patient into the armpit and towards the patient’s torso. The hand of this hand is brought under the patient's hips. The patient places his hands on his back to the nurses.
9. In the event that it is impossible to bring the shoulder to axillary region patient or the patient cannot place the nurse's hand on the back, it is necessary to place the hand between the patient's torso and shoulder. The hand of this hand is located under the patient's hips.
10.Place the hand located closer to the head of the bed on the bed behind the patient (elbow bent). With the other hand, located under the patient's hips, closer to the buttocks, nurses grab each other's wrist.
11. Raise the patient, move him a short distance and lower him onto the bed, bending the leg located closer to the head of the bed and the arm providing support. 12.Repeat the movement until the patient is located in the specified location.
4.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 is lying strictly horizontally.
5. Stand facing the foot end of the bed at an angle of 45°. Spread your legs 30 cm wide. Place the leg closest to the head of the bed a little back. Bend your knees (the nurse's hands should be at the level of the patient's legs).
6.Move the center of gravity to the leg placed back.
7.Move the patient’s legs diagonally towards the head of the bed.
8.Move parallel to the patient’s upper torso, bend your knees so that your arms are at the level of the patient’s torso.
9.Place the arm closest to the head of the patient under the patient’s neck, and grasp and support his shoulder from below. Place your other hand under the patient's upper back.
10.Move the patient's head and upper torso diagonally towards the head of the bed.
11.Move from one side of the bed to the other, repeating paragraphs. 2-8 until the patient’s body reaches the desired height in bed.
12.Move the patient to the middle of the bed, alternately moving three parts of his body in the same way. Elevate the patient's head and shoulders and provide a pillow.
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 amount 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
Sequence of actions:
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 to reduce shoulder rotation and prevent hyperextension in the elbow joint;
Place hand rollers in the patient's hands - decrease finger extension, abduct the thumb.
Fowler's position (half-lying/half-sitting) – the patient lies on his back, the bed is in a 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 the patient’s left leg at the knee joint, bringing in the left foot and right popliteal cavity - creating a lever for turning 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
Sequence of actions
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
Sequence of actions:
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
Sequence of actions:
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;
An “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.
