Body Mechanics and Fall Prevention

Principles of Body Mechanics

As a Licensed Nursing Assistant (LNA), your body is your most important tool. Providing direct resident care involves heavy lifting, transferring, repositioning, and prolonged standing. Without proper body mechanics, you risk severe musculoskeletal injuries, particularly to your lower back. Body mechanics refers to the way the parts of the body work together when you move. Using proper body mechanics saves energy, prevents muscle strain, and ensures the safety of the residents you are assisting.

Three key concepts form the foundation of proper body mechanics:

1. Base of Support: This is the foundation that supports an object. For your body, your feet are your base of support. A wide base of support (feet shoulder-width apart) provides much greater stability than a narrow one.
2. Center of Gravity: This is the point where the most weight is concentrated for an object or body. For a standing person, the center of gravity is typically in the pelvis. A lower center of gravity increases stability. When you bend your knees to lift, you lower your center of gravity and use your strong leg muscles instead of your weaker back muscles.
3. Alignment: Posture is the way the body parts are aligned. Good alignment means the body parts are in a natural, straight line. You should always try to maintain good alignment while working, keeping your back straight and avoiding twisting your spine.

Golden Rules for Safe Lifting

When you need to lift or move a resident or a heavy object, always follow these rules:

• Assess the load: Before lifting, determine if you can safely move the person or object alone. If it's too heavy, ask for help. In New Hampshire facilities, "no-lift" or "safe patient handling" policies often require the use of mechanical lifts for dependent residents.
• Keep the load close: Hold the resident or object as close to your body (and your center of gravity) as possible. Reaching out to lift multiplies the stress on your back.
• Bend at the knees, not the waist: Keep your back straight and bend your hips and knees to get down to the level of the object or resident. Push up with your strong thigh and glute muscles.
• Avoid twisting: Twisting the spine while bearing weight is a primary cause of back injuries. If you need to change direction, pivot your feet instead of twisting your torso.
• Push or pull instead of lifting: Whenever possible, push, pull, slide, or roll an object rather than lifting it.

Transfer Precautions and Gait Belts

Transferring a resident (e.g., from bed to wheelchair) is a high-risk activity for both falls and staff injuries. Always check the resident's care plan before attempting a transfer to understand their weight-bearing status and what equipment is required.

A gait belt (or transfer belt) is a critical safety device used to assist residents who are weak, unsteady, or uncoordinated. It provides the LNA with a secure handle to grasp during transfers and ambulation.

• Apply the belt over the resident's clothing, never directly on bare skin to prevent friction injuries.
• Place it around the resident's natural waist, securing it snugly so that two fingers can fit underneath.
• Do not use a gait belt if the resident has a colostomy, a pacemaker in the abdomen, recent abdominal surgery, or severe rib fractures. Always verify with the charge nurse if you are unsure.
• When assisting a resident to stand, grasp the belt from underneath (an underhand grip) on both sides.

For residents who cannot bear weight or are highly unpredictable, a mechanical lift (such as a Hoyer lift) must be used. In most New Hampshire facilities, operating a mechanical lift requires at least two trained staff members. Never attempt a two-person lift alone.

Fall Prevention Strategies

Falls are a leading cause of injury and accidental death among the elderly in long-term care facilities. Preventing falls is a continuous, facility-wide effort, and LNAs are on the front lines.

Key fall prevention strategies include:

• Environment: Keep pathways clear of clutter, cords, and throw rugs. Ensure adequate lighting, especially at night. Wipe up spills immediately.
• Bed Safety: Always return the resident's bed to its lowest position after providing care. This minimizes the injury if the resident attempts to get out of bed unassisted and falls.
• Call Lights: The call light must always be placed within the resident's reach before you leave the room. Answer all call lights promptly, as residents may attempt to toilet themselves if they wait too long.
• Footwear: Ensure residents wear non-skid footwear (shoes or specialized socks) when out of bed.
• Personal Needs: Anticipate the resident's needs. Offer toileting assistance regularly, especially for residents with dementia who may not remember to ask for help or may become restless when their bladder is full.
• Assistive Devices: Ensure walkers, canes, and wheelchairs are within reach, properly maintained, and locked when stationary during transfers.

Fall Protocols: During and After a Fall

Despite the best prevention efforts, falls can still occur. Knowing how to react correctly is crucial for minimizing injury to both the resident and yourself.

If a resident begins to fall while you are assisting them:

1. Do not attempt to catch or stop them. Doing so can cause severe injury to your back or shoulders and may pull the resident off balance in a worse way.
2. Widen your stance to create a strong base of support.
3. Bring the resident close to your body to support them.
4. Ease them safely to the floor by bending your knees and sliding the resident down your leg.
5. Protect their head as you lower them to the floor.

What to do AFTER a fall occurs:

If you witness a fall or find a resident on the floor, you must follow strict protocols:

1. Do not move the resident. Getting them up before they are assessed can exacerbate a fracture, head injury, or spinal cord injury.
2. Stay with the resident. Calm and reassure them.
3. Call for the charge nurse immediately. The nurse must perform a full assessment to determine if the resident has sustained any injuries.
4. After the nurse has cleared the resident, assist with getting the resident up according to the nurse's instructions (often using a mechanical lift if the resident cannot assist).
5. Observe, Record, and Report. You will need to provide an objective account of what happened (e.g., "Resident found sitting on the floor beside the bed"). Do not document opinions or assumptions (e.g., "Resident fell out of bed"). The facility will require an incident report to be completed.