4.3 Mobility, Positioning, Transfers & ROM
Key Takeaways
- Use good body mechanics: feet shoulder-width apart, bend the knees not the back, keep the load close, push or pull rather than lift
- Reposition bedbound residents at least every 2 hours to prevent pressure injuries; use a turning schedule and a draw sheet
- Apply a gait (transfer) belt over clothing, snug enough to fit a flat hand underneath, and transfer toward the resident's strong side
- Lock all wheelchair and bed wheels before any transfer, and lower the bed to its lowest position to prevent falls
- Passive range of motion (PROM) is done by the CNA for a resident who cannot move; active ROM is done by the resident — never push a joint past the point of resistance or pain
Moving and positioning residents safely protects them from falls, pressure injuries, and contractures, and protects the New Jersey CNA from back injury. Transfers and repositioning are frequently chosen for the NNAAP skills evaluation.
Body Mechanics
Body mechanics is the safe, efficient use of the body to prevent injury. Key rules:
- Keep a wide, stable base — feet about shoulder-width apart, one foot slightly forward.
- Bend at the knees and hips, not the waist; keep your back straight.
- Hold the load close to your body and lift with your legs.
- Push, pull, or roll rather than lift whenever possible.
- Face the direction of movement and pivot your feet — never twist your spine.
- Get help or a mechanical lift for heavy or dependent residents.
Positioning
Residents who cannot move themselves must be repositioned at least every 2 hours in bed (every 1 hour in a chair). Use a draw sheet and a partner to avoid friction and shearing. Support the body with pillows and keep good alignment.
| Position | Description | Common Use |
|---|---|---|
| Fowler's | Head of bed raised 45-60° | Eating, breathing difficulty |
| Semi-Fowler's | Head of bed raised 30-45° | Rest, tube feeding |
| Supine | Flat on the back | Resting, exams |
| Lateral | Lying on the side | Pressure relief, sleeping |
| Prone | Lying on the stomach | Used briefly; not common in elderly |
| Sims' | Left side, upper knee bent forward | Enemas, rectal procedures |
A turning schedule posted at the bedside (for example, left side - back - right side) ensures no area bears pressure too long.
Transfers
Before any transfer:
- Lock the wheels on the bed and wheelchair.
- Lower the bed to its lowest position.
- Apply non-skid footwear.
- Explain the steps and let the resident help.
Gait (Transfer) Belt
A gait belt (transfer belt) is placed snugly over the resident's clothing around the waist — snug enough that a flat hand fits underneath. The CNA grasps the belt with an underhand grip, never pulling on the resident's arms or under the armpits. Transfer toward the resident's strong (unaffected) side and block the resident's weak knee with your knee.
Mechanical Lift
A mechanical (Hoyer) lift is used for residents who cannot bear weight. Two staff are required: one operates the lift, one guides the resident. Check the sling and straps before lifting and keep the resident centered.
Fall Prevention
Falls are a leading cause of injury in long-term care. Prevent them by keeping the bed low and locked, the call light within reach, the floor dry and clutter-free, and non-skid footwear on. If a resident starts to fall, do not try to stop the fall — ease them to the floor protecting the head, stay with them, and call the nurse. Never lift a fallen resident before the nurse assesses for injury.
Range of Motion
Range-of-motion (ROM) exercises move joints through their full movement to prevent contractures and maintain mobility.
- Active ROM (AROM): the resident performs the movement independently.
- Active-assisted ROM: the resident moves with some CNA help.
- Passive ROM (PROM): the CNA moves the joint because the resident cannot.
During PROM, support the joint above and below, move slowly and gently, and stop at the point of resistance or pain — never force a joint. Exercise each joint about 3-5 repetitions per the care plan.
A New Jersey CNA is walking a resident with a gait belt when the resident's knees suddenly buckle and the resident begins to fall. What is the SAFEST action?
A CNA is performing passive range-of-motion exercises on a New Jersey resident's shoulder. When the arm reaches a certain point, the resident grimaces and the joint resists. What should the CNA do?