Ch 14 Ergonomic Principles and client position

Safe, Effective Care Environment

Ergonomic Principles

  • Definition of Ergonomics: A science focused on the design and use of objects that contribute to comfort, safety, efficiency, and ease of use.

  • Importance of Body Mechanics: Proper body mechanics during positioning and moving clients enhances safety for both clients and healthcare staff.

    • Begin with mobility assessments before moving clients, starting with simple movements like range of motion.

    • Progress based on client tolerance, addressing balance, gait, and exercise needs.

  • Body Alignment: Maintaining proper body alignment is crucial to ensure safety and comfort during client care.

    • Targeted body positioning is generally part of provider prescriptions and nursing interventions that relate to the client's specific condition and needs.

Ergonomic Principles and Body Mechanics

  • Body Mechanics: Refers to the use of muscles to keep balance, posture, and alignment during physical tasks. Nurses employ this principle, especially during lifting and assisting clients with daily activities.

    • Keeping body alignment stabilizes the center of gravity, enhancing comfort while reducing muscle strain.

    • Adopting good body mechanics significantly lowers the risk of injury during tasks.

    • Utilize mechanical lifting devices when possible, per "no manual lift" policies in many healthcare facilities.

Center of Gravity

  • The center of gravity is defined as the center of mass in a body or object. Understanding this concept is essential when lifting objects to manage safety and control:

    • Upright Positioning: In an upright position, the pelvis is considered the center of gravity.

    • Movement shifts the center of gravity, and stability improves when the line of gravity is close to the center of the base of support.

    • To lower the center of gravity, bend at the hips and knees and spread feet apart for enhanced stability and balance.

Lifting Techniques

  • Risk Factors for Injury: Identify situational and client-related factors that increase lifting injury risks:

    • Twisting while lifting, confined spaces, lifting from kneeling or sitting positions, and extended work hours.

    • Moving clients with physical limitations or who are uncooperative presents additional challenges.

  • Proper Lifting Techniques:

    • Use larger muscle groups to prevent back strain and tighten abdominal muscles for better support.

    • Flex hips, knees, and back when lifting objects from the ground, positioning equipment as close to the body as possible throughout the lift.

    • Employ assistive devices for weights exceeding 35 lbs (15.9 kg) and seek help when needed.

Pushing or Pulling Techniques

  • Guidelines for Safe Movement:

    • Widen your base of support and pull loads toward your center of gravity rather than pushing.

    • Move legs in unison with the load – step forward when pushing and backwards when pulling to maintain balance.

    • Help prevent injury by avoiding twisting motions and always face the direction of your movement.

Transfers and Use of Assistive Devices

Client Assessment for Mobility

  • Always evaluate client functionality prior to transfers:

    • Can they bear weight? Assist them? Are they cooperative?

  • Specialized Equipment: Consider assessing the need for assistive devices like transfer belts, hydraulic lifts, or sliding boards during transfers.

  • Monitor the use of mobility aids (canes, walkers, crutches) and include these resources in the care plan for safer transfers.

Guidelines for Injury Prevention

  • Familiarize with facility policies regarding lifting and handling clients to minimize risks.

  • Have adequate staff available for assistance in client positioning as improper manual movements are a leading cause of back pain.

  • Maintain good posture, rest between heavy activities, and exercise regularly to increase muscle strength, reducing energy expenditure during manual tasks.

  • Avoid repetitive motions, spine twisting, and excessive flexing at the waist when performing physical tasks.

Positioning Clients for Safety and Comfort

  • Importance of Positioning: Position clients properly to maintain body alignment and prevent discomfort, pressure sores, and other complications.

    • RegularlyChanging client positions supports circulation and stimulates postural reflexes.

  • Assistive Devices: Use pillows and supports to help maintain proper alignment in various conditions.

Client Positions Explained

  • Semi-Fowler's Position:

    • Bed head elevated 15° to 45°, typically at 30°. This position aids in preventing aspiration and promotes lung expansion.

  • Fowler's Position:

    • Bed head elevated 45° to 60°. Useful for procedures and improving ventilation post-surgery.

  • High-Fowler's Position:

    • Bed head elevated 60° to 90°. Maximizes lung expansion for clients experiencing severe dyspnea.

  • Supine Position:

    • Lying on back with head support. Correct alignment is essential.

  • Prone Position:

    • Lying on the abdomen, which promotes drainage post-surgery but is for short-term use due to inhibiting chest expansion.

  • Lateral Position:

    • Side-lying with weight on the dependent hip and shoulder to maintain comfort and alignment, while the client requires regular repositioning.

  • Orthopneic Position:

    • Seated with support facilitating chest expansion, particularly useful for clients with COPD.

  • Trendelenburg Position:

    • The bed is tilted with the head lower than the feet to enhance venous return.

  • Reverse Trendelenburg Position:

    • The foot of the bed is lower than the head to promote gastric emptying.

  • Modified Trendelenburg Position:

    • Clients remain flat with legs elevated to treat hypovolemia and support venous return.