7.1 Body Mechanics, Positioning & Transfers

Body Mechanics, Positioning & Transfers

Safe Patient Handling and Oregon Regulations

Safe patient handling is a fundamental competency for Certified Nursing Assistants (CNAs) in Oregon, governed by the Oregon State Board of Nursing (OSBN) and the Oregon Safe Patient Handling Act. Under Oregon Administrative Rules (OAR) Chapter 851, CNAs must adhere strictly to the resident's care plan regarding mobility, transfer techniques, and assistive devices. Failing to use proper techniques can lead to severe injury to the resident (such as falls or skin tears) and to the CNA (such as musculoskeletal disorders). When a resident's status changes, the CNA must immediately document the observations and report them to the charge nurse.

Core Principles of Body Mechanics

Body mechanics refers to the safe use of muscles, bones, and the nervous system to move objects and perform physical tasks. Essential principles include:

1. Wide Base of Support: Stand with feet shoulder-width apart to provide a stable, broad foundation.
2. Lower Center of Gravity: Bend at the knees and hips rather than bending from the waist. This utilizes the powerful muscle groups in the thighs and buttocks (quadriceps and gluteals) rather than the weaker muscles of the lower back.
3. Line of Gravity: Keep this imaginary vertical line running from the pelvis through the base of support. Face the direction of the move.
4. Keep Load Close: Holding residents close to the body’s center of gravity minimizes leverage forces on the spine.
5. Push, Pull, or Slide: Sliding or rolling a resident in bed requires much less exertion than lifting. Use friction-reducing drawsheets.
6. Avoid Twisting: Always face the direction of movement and pivot the feet instead of twisting the torso, which is the primary cause of spinal injuries.
7. Coordinate Movements: When working with another caregiver, coordinate the movement with a clear count (e.g., 'one, two, three, move') to ensure simultaneous effort.

Therapeutic Resident Positioning

Immobile residents must be repositioned at least every two hours in bed, and at least every hour when seated in a chair, to prevent pressure injuries, muscle contractures, and respiratory complications. Common positioning options include:

• Supine: The resident lies flat on their back. Pillows support the head and calves (to 'float' the heels off the mattress). Trochanter rolls along the hips prevent outward rotation of the legs.
• Prone: The resident lies on their abdomen with the head turned to one side. Pillows are placed under the head, abdomen, and lower legs to lift the toes off the bed. This position is rarely used for elderly residents due to respiratory limitations.
• Lateral: The resident lies on their side. Pillows support the head, back, upper arm, and between the knees/ankles to prevent bone-on-bone friction and maintain hip alignment.
• Fowler's: A semi-sitting position with the head of the bed (HOB) elevated 45 to 60 degrees. This helps with breathing, eating, and communication.
• Semi-Fowler's: The HOB is elevated 30 to 45 degrees. Commonly used for cardiac comfort or to prevent aspiration during tube feedings.
• High-Fowler's: The HOB is elevated 60 to 90 degrees. Required during meals and oral hygiene to prevent aspiration.
• Sim's: A semi-prone position where the resident lies on their left side, left arm behind the body, and right leg flexed toward the chest. This position is used for enemas and rectal procedures.

Safe Transfer Techniques and Equipment

Transferring involves moving a resident from one surface to another. Safe transfers require matching the transfer type to the resident's capabilities:

• Application of a Gait Belt: A gait (transfer) belt is a critical safety device used during transfers and ambulation. It must be applied over clothing to protect skin. The belt is placed around the waist, with the buckle positioned slightly off-center. It should be snug, allowing only two flat fingers to fit between the belt and the resident. The CNA must maintain an underhand (palms up) grip. Gait belts are contraindicated for residents with recent abdominal surgery, colostomies, gastrostomy tubes, or severe osteoporosis.
• Pivot Transfers: Used for residents who can bear weight on at least one leg but cannot walk. The CNA positions the wheelchair at a 45-degree angle to the bed on the resident's stronger side. The bed is lowered until the resident’s feet are flat on the floor. The CNA blocks the resident's knees and feet with their own to prevent sliding, assists the resident to stand, pivots them, and ensures their legs touch the chair before lowering them.
• Mechanical Lifts: If a resident is non-weight-bearing, a mechanical lift must be used. OSBN standards mandate that at least two trained staff members must be present to operate a mechanical lift. The CNA must inspect the lift and sling for damage before use. The base of the lift must be opened to its widest setting during transfer for stability.

Oregon Headmaster/TMU Skills Evaluation Guidelines

For the Oregon Headmaster/TMU clinical skills exam, candidates must perform transfers with absolute precision. Critical steps include:

1. Locking Brakes: Locking both the bed brakes and the wheelchair brakes before initiating the transfer is a critical safety step.
2. Non-Skid Footwear: The candidate must assist the resident in putting on non-skid footwear (shoes or socks) before the resident's feet touch the floor.
3. Proper Grip: The candidate must apply the gait belt correctly and maintain an underhand grip throughout the entire transfer.
4. Safety Verification: The candidate must ensure the resident is safely positioned with hips fully back in the wheelchair and feet on the footrests before completing the task.