Topic 3

Basic Care, Comfort, and Mobility

deconditioning

taking a break from something, going back ti it and not being able to do it

example: taking 3 weeks off from running then trying to run

joint contractures

permanent muscle shortening (flexor muscle stronger than extensors)

effects of physical activity

boosts mood/energy, improves sleep and stress, supports behavior change

external factors that affect activity

culture, employment, community, environment, schools, family, peers

internal factors that affect activity

development, behavior, disease, lifestyle

psychological effects of immobility

• metabolic/GI

• respiratory

• cardiovascular

• musculoskeletal

• urinary

• integumentary

psychosocial effects of immobility

• loss of independence

• altered sleep patterns

• decreased social interaction

• changes in body image

acute disease

reversible, short duration

chronic disease

lasts >6 months, irreversible

diagnostic process

critical analysis, recognize data patterns, identify accurate nursing diagnoses

common nursing diagnoses

activity intolerance: tired/weak after exertion, abnormal HR

fatigue: always feeling tired, reduced participation in activities

impaired mobility: weakness, reduced strength, difficulty with assistive devices

risk for falls: previous falls, age, weakness, impaired gait, hazards

evidence based practice (EBP)

• best research evidence from peer-reviewed studies

• clinician expertise and clinical judgment

• patient preferences and values

ANA code of ethics

standards and scope of nursing practice

WOCN

wound, ostomy, continence nurses)

• guidelines for skin care and pressure injury prevention

patient-centered hygiene care

assessment considerations:

• physical status (mobility, activity tolerance, sensory deficits)

• developmental factors (age-appropriate techniqies)

• cultural preferences (respect individual hygiene practices)

• lifestyle and living arrangements

• patient preferences (timing, methods, products)

restraint guidelines

intervention but used as LAST RESORT

legal requirements for restraint use

1. only to ensure physical safety

2. when less restrictive interventions are unsuccessful

3. only on written order of a health care provider

regulatory standards for restraints

CMS (2024), ANA (2012), TJC (2022)

• set standards to reduce restraint use in all health care settings

Safe Patient Handling and Mobility (SPHM)

SPHM techniques are standardized, evidence-based methods for handling, moving, and mobilizing patients based on individual patient characteristics and conditions

• use mechanical lifts and assistive devices - NOT manual lifting

ergonomics

the study of people's efficiency in their working environment

why does ergonomics matter

healthcare has one of the highest rates of work-related injuries

SPHM Program Components

five components that reduce injury rates

1. ceiling-mounted lifts

2. peer leader effectiveness

3. competency equipment use

4. facility coordinator links

5. peer leader training

ergonomics principles in practice

assessment first: use patient-handling algorithms

equipments and devices: mechanical lifts, transfer devices, proper body mechanics when equipment unavailable

benefits of SPHM for nurses

• significant reductions in bio-mechanical loads

• fewer overexertion injuries

• reduced lost work time

benefits of SPHM for patients

• reduced pressure injuries

• prevention of falls

• fewer complications form immobility

nurse responsibilities

• know agency SPHM policies

• use available lift equipment consistently

• never attempt manual lifts alone

• advocate for minimal policies

• report equipment malfunctions immediately