Positioning, Transfers, and Ambulation

Why Positioning and Mobility Matter on the NH LNA Exam

Mobility skills appear repeatedly on the New Hampshire LNA competency evaluation administered by Excel Testing. Knowledge questions ask you to choose the correct position for feeding, breathing difficulty, or pressure relief. Skills stations commonly include transferring a resident from bed to wheelchair, positioning a resident on their side, and assisting with range-of-motion (ROM) exercises. Missing a critical step—especially failing to lock wheelchair brakes before a transfer—causes automatic failure of that skill, even if every other step looks polished.

As an LNA, you are often the staff member who turns, transfers, and walks residents throughout the shift. Correct technique protects skin integrity, prevents falls, and preserves dignity. Incorrect technique causes shear injuries, fractures, and aspirated meals.

Common Body Positions You Must Know by Name

Memorize both the name and the clinical reason for each position. Exam questions rarely ask only for a definition; they pair a resident need with the correct position.

Practical tips for Excel skills:

• When positioning on the side, support the back, between the knees, and under the upper arm so the resident does not roll flat.
• Raise the side rail on the far side before rolling if the bed has rails and policy allows.
• Always ask about pain before moving and stop if the resident reports sudden new pain.

Logrolling: Keeping the Spine Straight

Logrolling is a coordinated turn that moves the resident as one rigid unit so the head, shoulders, hips, and feet stay aligned. Use it when the care plan or nurse instructs spinal precautions after injury, surgery, or suspected spinal involvement.

Key logrolling rules:

1. Get enough help—usually at least two caregivers, sometimes three.
2. Place a pillow between the knees before the turn if ordered, to keep hips aligned.
3. On a count ("1-2-3"), turn the resident in one motion; do not twist the shoulders while the hips lag behind.
4. Support the head and neck throughout the turn.
5. Recheck alignment and comfort after the turn; report any new numbness, weakness, or severe pain immediately.

Never attempt solo logrolling of a dependent resident. Twisting the spine defeats the purpose of the skill.

Gait Belts and Transfer Safety

A gait belt (transfer belt) is worn around the resident's waist over clothing, snug enough that you can grasp it firmly without pinching skin. It gives you a secure hold during standing, pivoting, and short walks. Do not place a gait belt over bare skin, open wounds, recent abdominal surgery sites, or feeding tubes unless the nurse gives specific alternate instructions.

Before every transfer, complete this safety sequence:

1. Explain what you will do and get cooperation.
2. Clear the path of clutter, IV poles, and throw rugs.
3. Place the wheelchair at a slight angle on the strong side when possible.
4. Lock the wheelchair brakes and remove or swing away the footrests.
5. Adjust the bed to a safe working height, lock bed brakes, and lower the side rail on the working side.
6. Apply the gait belt and assist the resident to a sitting position at the edge of the bed (dangle) to check for dizziness.
7. Stand in front, knees bent, using good body mechanics; pivot on your feet—do not twist your spine.
8. Lower the resident slowly into the chair and reposition hips fully back.
9. Replace footrests, unlock brakes only when ready to move, and place the call light within reach.

Excel Testing Sample Theme: Brakes Before Transfer

Excel sample-style items emphasize that brakes must be locked before the transfer begins—not after the resident is already standing. If the chair rolls while the resident's weight shifts, a fall is likely. Treat locked brakes as a critical step every time, whether the skill is labeled "transfer to wheelchair" or embedded in another mobility task.

Weak-Side Awareness During Transfers and Ambulation

Many NH LNA residents have hemiparesis after stroke or one-sided weakness from injury. Your job is to protect the weak side while using the strong side for leverage.

• Position the wheelchair so the resident stands and pivots toward the strong side.
• Support the weak arm; never pull on a weak or flaccid arm (risk of shoulder injury).
• Stand slightly behind and toward the weak side when ambulating so you can catch a lean toward the weak side.
• Place assistive devices (walker, cane) where the strong side can control them as taught in the care plan.
• Never rush a pivot; count steps with the resident and wait for dizziness to pass after dangling.

Assisting With Ambulation

Ambulation assist is more than walking beside someone. Before starting:

• Check the care plan for weight-bearing status, fall risk, and required devices.
• Ensure non-skid footwear is on.
• Apply a gait belt unless contraindicated.
• Clear the hallway and know where chairs are if the resident tires.

During the walk, match the resident's pace, keep your center of gravity low, and watch for shuffling, sudden stops, or complaints of chest pain or shortness of breath. If the resident begins to fall, do not try to "catch" them upright by yanking the belt; instead, widen your stance, bring the resident close to your body, and ease them gently to the floor while protecting the head—then call for help and report.

Wheelchair Safety Beyond the Transfer

Wheelchair safety continues after the resident is seated:

• Keep brakes locked whenever the chair is parked for care, meals, or waiting.
• Keep feet on footrests (or per care plan) so heels do not drag.
• Tuck elbows in when moving through doorways.
• Never leave a resident facing a wall with no call access.
• Push, do not pull, when going over thresholds when possible; tip the chair back slightly only if trained and needed for a curb, then lower gently.

Connecting Positioning to ROM Context

Excel skills may pair mobility with range-of-motion exercises. Positioning sets the stage: a resident must be supported in supine or a comfortable side-lying position before you move joints through flexion, extension, abduction, and adduction as ordered. Never force a joint past the point of resistance or pain, and always support the limb proximal and distal to the joint you are moving. Report new swelling, redness, or sharp pain to the nurse before continuing.

Mastering positions, logrolling, gait-belt transfers with brakes locked first, weak-side support, and safe ambulation prepares you for both the written Excel Testing items and the hands-on skills exam, where bold critical steps are immediate fails and four or more skill errors also fail (pass/fail only—no percentage skills score).