2.2 Mobility, Positioning & Transfers

Body Mechanics

Quick Answer: Good body mechanics means using your body safely to prevent injury: feet about shoulder-width apart for a wide base of support, bend at the knees and hips (not the back), keep the load close to your body, and push, pull, or roll instead of lifting whenever possible.

Safe mobility is a high-yield Safety topic on the Minnesota CNA exam because back injuries are the most common workplace injury for nursing assistants. Most lifting power comes from the strong muscles of the legs, not the smaller muscles of the back, so the body must be set up correctly before any move. Key principles:

• Keep a wide base of support with feet about shoulder-width apart, one foot slightly forward
• Bend your knees, not your back, and use your strong leg and thigh muscles to do the work
• Hold the load close to your body at about waist level to shorten the lever your spine must control
• Face the direction you are moving and pivot your whole body to avoid twisting the spine
• Tighten your stomach and buttock muscles before the move, and lift on a count so a partner moves with you
• Get help or use a mechanical lift for heavy, dependent, or unpredictable residents

Applying these rules protects the CNA from a career-ending injury and protects the resident from being dropped or jolted.

Common Positions

Residents who cannot move themselves must be repositioned and supported in proper body alignment, which keeps the spine and limbs in a natural line and prevents contractures, pressure, and breathing trouble. Know these positions for the exam:

Support the body with pillows to keep proper alignment, for example a pillow behind the back and between the knees in the lateral position. Reposition residents who cannot move themselves at least every two hours to relieve pressure and protect the skin.

Range of Motion

Range-of-motion (ROM) exercises move each joint through its normal movements to prevent stiffness and permanent contractures in residents who cannot move on their own. There are three types:

• Active ROM: the resident performs the movements without help
• Active-assisted ROM: the resident moves with some help from the CNA
• Passive ROM (PROM): the CNA moves the joints for a resident who cannot move them at all

Procedure rules the exam loves to test:

• Move each joint slowly and gently to the point of resistance, never past the point of pain
• Support the joint above and below the area being exercised to protect it
• Repeat each movement the number of times in the care plan (often 3-5)
• Stop and report if the resident reports pain, or if you feel new resistance or hear a grinding

Terms worth knowing include flexion (bending), extension (straightening), abduction (moving away from the body), and adduction (moving toward the body).

Transfers and Ambulation

A gait belt (transfer belt) is buckled snugly around the resident's waist over clothing to give the CNA a secure hold during transfers and walking; you grasp the belt, never the resident's arm or under the arms. Steps for a safe stand-and-pivot transfer from bed to wheelchair:

1. Explain the move, lock the bed and wheelchair wheels, and lower the bed so the resident's feet reach the floor
2. Apply the gait belt and put nonskid footwear on the resident
3. Position the wheelchair on the resident's strong (unaffected) side, footrests up or removed
4. Help the resident sit at the edge and dangle their feet, then have them lean forward, place hands on the bed or armrest, and push up on the count of three
5. Pivot toward the chair, keeping the resident close, and lower them gently until they feel the seat

During ambulation, walk slightly behind and to the weak side, holding the gait belt. If the resident starts to fall, do not try to hold them upright; widen your stance and ease them down to the floor along your body, protecting their head, then call for help.

Fall Prevention

Falls are a leading safety concern in long-term care and a frequent exam topic. To reduce risk:

• Keep the bed in the lowest position with wheels locked
• Keep the call light within reach and answer it promptly
• Keep floors dry and walkways clear of clutter and cords
• Provide nonskid footwear, good lighting, and night lights
• Ensure the resident uses prescribed assistive devices such as a walker or cane, fitted to their height
• Lock wheelchair and bed wheels every time the resident gets in or out

Know that physical restraints are not a fall-prevention tool; they require a physician order, are a last resort, and can cause injury, so the CNA uses positioning, supervision, and the environment instead. Report any fall, even with no apparent injury, and do not move the resident until the nurse assesses them, because a hidden fracture or head injury could be made worse. After a fall, observe and report the resident's level of consciousness, pain, and any change in movement.