5.4 Bed Mobility, Positioning & Walking Aids
Key Takeaways
Use the assessed mobility method, required trained help, and prescribed weight-bearing limits before every transfer or walk.
Moving up in bed and log rolling require coordinated help, friction-reducing equipment, and protection of lines and joints.
Support body position and inspect skin; no single position is suitable for every respiratory, feeding, surgical, or pressure-risk condition.
Crutch weight is carried through the hands, not the armpits; the therapist determines fit and gait pattern.
Start with the Resident's Current Mobility Plan
South Dakota's training curriculum specifically includes moving, transferring, turning, positioning, and assistive-device use. These are active safety decisions, not simply tests of strength. Before beginning, verify the resident, explain the task, check the care plan, and obtain the assigned equipment and number of trained helpers. Confirm weight-bearing limits, surgical precautions, pain, dizziness, and whether the resident can understand and participate. A person who walked yesterday may need reassessment after illness or a fall.
The nurse or therapist selects the method. The CNA implements it, watches the response, and reports changes. Do not upgrade a resident from two-person assistance to one person because staffing is short. Do not substitute a walker for a prescribed lift because the resident says they feel stronger. Pause an unsafe task, protect the person, and get help. Body mechanics reduce some risk but do not make manually lifting a dependent resident safe.
Moving a Resident Up in Bed
Raise the bed to a safe working height and lock it as instructed. Explain the coordinated movement and use the required drawsheet, friction-reducing sheet, or powered repositioning device. Check tubes, drainage bags, oxygen tubing, and other attachments so movement does not pull or trap them. Keep skin from dragging across sheets and never pull the resident by the arms, under the shoulders, or by a fragile joint.
Use the prescribed bed position. Some residents cannot tolerate lying flat because of breathing, feeding, or surgical restrictions. Ask the nurse to coordinate competing needs rather than lowering the head without checking. If the resident can assist, use the movements approved in the plan, such as bending the knees and pushing with the feet. Coordinate with helpers using an agreed count and stop if anyone loses position. After movement, restore the ordered head elevation, check alignment and tubing, lower the bed, and put the call device within reach.
Turning and Log Rolling
For an ordinary side turn, use the assigned aid and assistance while supporting the head, trunk, and limbs. Keep the person from rolling off the far edge. A second worker or permitted rail may provide protection under the plan; a rail does not replace supervision. Place pillows where the plan specifies so bony areas and joints are supported without trapping skin or equipment.
Log rolling moves the shoulders, trunk, and hips together to limit twisting when that technique is ordered. It is not an instruction to turn every postoperative resident the same way. The nurse or therapist specifies the staff, movement limits, and equipment. Explain the count, check that each helper is ready, and move as a coordinated unit. Stop for new pain, tingling, weakness, breathing difficulty, or unexpected resistance. Do not independently remove a brace or force a limb straight to improve the turn.
Positioning Terms and Practical Checks
| Position | Basic description | CNA safety consideration |
|---|---|---|
| Supine | Lying on the back | Check heels, sacrum, limb alignment, and ordered head elevation |
| Lateral | Lying on a side | Support alignment and protect ears, shoulder, knees, and ankles |
| Fowler positions | Head and trunk elevated | Follow respiratory/feeding orders and reduce sliding/shear |
| Prone | Lying on the abdomen | Use only when assigned and safe; protect airway, lines, and pressure points |
A name does not replace the individual plan. For example, an upright meal position may be essential for swallowing, while a different resting position protects an injured sacrum. Report an inability to tolerate either so the clinical team can revise the plan. Record the actual position and response rather than checking a box for a turn that was refused or unsafe.
Walking-Aid Checks
Inspect prescribed equipment before use: correct resident, secure height adjustments, intact handgrips, stable frame, and serviceable tips or brakes. Report worn rubber tips, loose fasteners, a sticking walker brake, or a cracked frame; keep faulty equipment out of service. The therapist determines fit. The CNA does not shorten a cane or change walker height based solely on appearance.
A cane is generally held on the stronger side, with gait sequence and assistance determined by therapy. For a standard walker, the usual pattern advances the device and then the weaker and stronger legs, but wheeled walkers and specific weight-bearing restrictions need their own instructions. Do not let a resident pull on a walker to rise unless that is an approved technique for that device and plan; use stable support and prescribed assistance.
Crutches Require a Prescribed Gait
Crutches may be used to reduce loading on an injured limb. Their pattern depends on whether weight bearing is prohibited, partial, or permitted. Use only the gait the therapist taught; do not teach stair negotiation or a new crutch pattern from memory. With underarm crutches, weight is supported through the hands, not compressed into the armpits. Check handgrips and tips and allow enough space to place the devices securely.
If the resident becomes dizzy, fatigued, painful, or unable to maintain restrictions, stop and obtain assistance using the planned method. Do not hurry them to finish a distance target. Tell the nurse what changed, when it happened, how much assistance was needed, and whether symptoms resolved. Safe mobility preserves independence by making the resident's own effort possible within current limits.
Sources checked October 16, 2026
FDA patient lift safety; 2025 AHA adult BLS; MedlinePlus crutch use.
A bedbound resident has an order not to lie flat during tube feeding. What should the CNA do before moving the resident up in bed?
Lower the bed flat because all repositioning requires it
Ask the nurse to coordinate safe positioning/feeding and obtain the prescribed help and repositioning aid
Pull the resident up by both wrists
Pause the feeding pump independently and change the order
A resident using underarm crutches rests all body weight on the padded underarm tops. What should the CNA do?
Tell them this is the safest way to protect their hands
Shorten both crutches without consulting the team
Have them walk faster to reduce contact time
Stop unsafe use and obtain help; weight should be supported through the hands using the prescribed fit and gait
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