7.6 Positioning, Transfers, and Mobility

Body Mechanics and Bed Positions

Body mechanics are techniques that use the body efficiently so neither CNA nor patient is injured during lifting, moving, or positioning. Back injuries end CNA careers, so these rules are non-negotiable.

Common Bed Positions

The Fowler's family of positions is the standard answer when a patient is short of breath or eating, because elevating the head opens the airway and reduces aspiration risk.

Pressure Injuries, Transfers, Falls, and Range of Motion

Pressure Injury Prevention

Pressure injuries (formerly bedsores) form when steady pressure cuts off blood flow to skin over a bony area. The single most important prevention is repositioning at least every 2 hours in bed (and shifting weight roughly every 15 minutes in a chair). High-risk bony spots: heels, sacrum (tailbone), hips, shoulder blades, elbows, ears, and the back of the head.

Gait Belts and Lifts

A gait belt is a safety strap around the waist that gives a secure handhold. Apply it over clothing, snug enough for two fingers to slip under. Never use a gait belt on someone with recent abdominal or chest surgery, pregnancy, an ostomy, or certain fractures, and never lift a person by hauling on the belt; it is for control, not hoisting.

When a patient cannot bear weight, use a mechanical lift: a full-body (Hoyer) lift for non-weight-bearing patients or a sit-to-stand lift for those with some leg strength. Check the weight capacity, inspect the sling, and use the manufacturer's instructions, typically with two staff.

Safe Bed-to-Chair Transfer

Lock the bed and chair, place the chair at a 45-degree angle, apply the gait belt, let the patient dangle at the bedside to check for dizziness, block their feet with yours, and rise on a count of three before pivoting and lowering.

Handling a Fall

If a patient begins to fall, do not try to catch them, which injures you both. Instead, ease them down your body to the floor while protecting the head, stay with them, call for help, and let the nurse assess for injury before moving them. An incident report follows.

Range of Motion (ROM)

ROM exercises keep joints flexible for patients with limited movement. In active ROM the patient moves alone; in active-assisted you help; in passive ROM you move the limb entirely. Support the limb above and below the joint, move slowly, repeat each motion 3-5 times per the care plan, and stop if the patient reports pain rather than pushing through it.

Weight-Bearing Status, Devices, and Worked Scenarios

Know the Weight-Bearing Status First

Before any transfer or walk you must know the patient's weight-bearing status from the care plan, because it dictates the method. Common terms: full weight bearing (FWB), partial weight bearing (PWB), toe-touch / touch-down (TTWB), and non-weight bearing (NWB). A non-weight-bearing patient is never stood up on the affected leg; they require a mechanical lift or specific technique. Guessing the status is a serious error that can refracture a hip or tear a surgical repair, so a CNA who does not know asks the nurse rather than improvising.

Ambulation Devices

Apply non-skid footwear before standing any patient, clear the path of cords and rugs, and walk slightly behind and to the weaker side holding the gait belt.

Worked Scenario

A CNA is told to walk a resident who had right-hip surgery and is partial weight bearing on the right with a walker. The CNA applies non-skid shoes and a gait belt, has the resident dangle and checks for dizziness, positions the walker, stands slightly behind on the right (weaker) side, holds the gait belt, and watches for fatigue. If the resident suddenly weakens, the CNA eases them to the floor protecting the head, never yanking the belt, then calls for help and lets the nurse assess before moving the resident.

Skin and Reporting Duties

During repositioning, inspect the skin over bony areas. Report non-blanchable redness (redness that does not whiten when pressed), broken skin, or a new complaint of pain over a pressure point promptly, because a stage 1 pressure injury caught early is reversible. Document the position you placed the patient in and the time, so the next caregiver knows when the next 2-hour turn is due.