Body Mechanics and Positioning Notes

Chapter 18: Body Mechanics

Objectives

  • Define key terms and abbreviations.

  • Explain the purpose and rules of body mechanics.

  • Identify risk factors for work-related injuries.

  • Identify high-risk activities for work-related injuries, including back injuries.

  • Identify causes, signs, and symptoms of back injuries.

  • Explain how to prevent work-related injuries.

  • Position persons in basic bed positions and in a chair.

  • Explain how to promote PRIDE in the person, family, and yourself.

Key Terms

  • Base of support: The area on which an object rests.

  • Body alignment: The way the head, trunk, arms, and legs align with one another; posture.

  • Body mechanics: Using the body in an efficient and careful way.

  • Dorsal recumbent position: The back-lying or supine position.

  • Ergonomics: The science of designing a job to fit the worker; ergo means work, nomos means law.

  • Fowler's position: A semi-sitting position; the head of the bed is raised between 45 and 60 degrees.

  • Lateral position: The person lies on 1 side or the other; side-lying position.

  • Musculo-skeletal disorders (MSDS): Injuries and disorders of the muscles, tendons, ligaments, joints, and cartilage.

  • Posture: See "body alignment".

  • Prone position: The person lies on the abdomen with the head turned to 1 side.

  • Semi-prone side position: See "Sims' position".

  • Side-lying position: See "lateral position".

  • Sims' position: A left side-lying position in which the upper leg (right leg) is sharply flexed so it is not on the lower leg (left leg) and the lower arm (left arm) is behind the person; semi-prone side position.

  • Supine position: The back-lying or dorsal recumbent position.

Key Abbreviations

  • MSD: Musculo-skeletal disorder

  • OSHA: Occupational Safety and Health Administration

Body Mechanics Overview

  • Body mechanics involves using the body efficiently and carefully with good posture, balance, and utilizing the strongest muscles for work.

  • Incorrect body positioning can lead to fatigue, muscle strain, and injury.

  • Focus on both the individual's and your own body mechanics to reduce the risk of injury.

Musculo-Skeletal System Review

  • The musculo-skeletal system provides the body's framework, allows movement, protects internal organs, and gives the body shape.

Bones

  • Bones are rigid structures that bear weight (leg bones), allow skilled movement (wrist, finger, ankle, toe bones), protect organs (ribs, skull, pelvic bones, shoulder blades), and allow movement and flexibility (vertebrae).

Joints

  • A joint is where two or more bones meet, allowing movement. There are three major types of joints:

    • Ball-and-socket joint: Allows movement in all directions (e.g., hip and shoulder joints).

    • Hinge joint: Allows movement in one direction (e.g., elbow).

    • Pivot joint: Allows turning from side to side (e.g., connection between skull and spine).

  • Some joints, like those connecting skull bones, do not move.

Muscles

  • The human body has over 500 muscles.

    • Voluntary muscles: Consciously controlled (e.g., skeletal muscles attached to bones like arm and leg muscles).

    • Involuntary muscles: Work automatically (e.g., muscles in the stomach, intestines, and blood vessels).

    • Cardiac muscle: Involuntary muscle in the heart that pumps blood.

  • Muscles facilitate movement and maintain posture. Muscle contraction utilizes energy and produces heat.

Principles of Body Mechanics

  • Body alignment (posture): The alignment of the head, trunk, arms, and legs.

    • Good alignment enables efficient and strong movement and function.

    • Essential for standing, sitting, and lying down.

  • Base of support: The area on which an object rests; a good base of support is crucial for balance.

    • When standing, the feet serve as the base of support. A wider stance provides better balance.

  • The strongest muscles are in the shoulders, upper arms, hips, and thighs.

    • Using these muscles reduces strain on smaller, weaker muscles, preventing fatigue and injury.

    • Back injuries are a major risk when proper body mechanics are not followed.

  • Lifting: Always bend your knees and squat to lift heavy objects instead of bending at the waist to prevent back strain.

  • Holding: Keep items close to the body and base of support to engage stronger upper arm and shoulder muscles.

Rules for Body Mechanics

  • Good body mechanics are essential for all activities to safely and efficiently handle and move people and heavy objects.

  • Key rules include:

    • Maintaining good body alignment with a wide base of support (feet at least 12 inches or shoulder-width apart).

    • Using an upright working posture and bending the legs, not the back.

    • Engaging stronger muscles in shoulders, upper arms, thighs, and hips.

    • Keeping objects close to the body when lifting, moving, or carrying them.

    • Avoiding unnecessary bending and reaching; adjust bed and table heights.

    • Facing the work area to prevent twisting.

    • Pushing, sliding, or pulling heavy objects instead of lifting.

    • Widening the base of support when pushing or pulling; move the front leg forward when pushing and the rear leg back when pulling.

    • Using both hands and arms to lift, move, or carry objects.

    • Turning the whole body to change direction instead of twisting.

    • Working with smooth, even movements and avoiding sudden or jerky motions.

    • Avoiding leaning over a person to give care.

    • Seeking help from a co-worker to move people or heavy objects.

    • Bending hips and knees to lift from the floor, straightening the back as the object reaches thigh level.

    • Avoiding lifting objects higher than chest level; use a step stool for higher objects.

    • do not lift above your shoulder

Work-Related Injuries

  • Musculo-skeletal disorders (MSDs): Injuries and disorders of muscles, tendons, ligaments, joints, and cartilage.

    • Can be caused or worsened by the work setting and may involve the nervous system.

    • Commonly affect arms, back, hands, fingers, neck, wrists, legs, and shoulders.

    • Can develop slowly over time or result from a single event.

    • Symptoms include pain, numbness, tingling, stiff joints, difficulty moving, and muscle loss; sometimes paralysis.

  • Early signs and symptoms include pain, limited joint movement, or swelling.

  • May require time off work and can result in disabilities.

MSD Risk Factors

  • The Occupational Safety and Health Administration (OSHA) has identified risk factors that increase the likelihood of MSDs, especially when combined:

    • Force: Physical effort needed for a task (e.g., lifting heavy people, preventing falls, sudden motions).

    • Repeating actions: Doing the same motions often or continually (e.g., re-positioning people, transfers without adequate breaks).

    • Awkward postures: Positions that stress the body (e.g., reaching above shoulder height, kneeling, squatting, leaning over a bed, bending, or twisting).

    • Heavy lifting: Manually lifting people who cannot move themselves.

  • Nursing assistants are at high risk according to the U.S. Department of Labor.

High-Risk Tasks for MSDs

  • Transfers to and from various surfaces (beds, chairs, wheelchairs, toilets, etc.).

  • Trying to stop a person from falling.

  • Picking up a person from the floor.

  • Lifting alone or lifting heavy persons.

  • Weighing a person.

  • Lifting confused or uncooperative persons.

  • Lifting persons who cannot support their own weight.

  • Moving a person up in bed or re-positioning them in bed or chair.

  • Changing incontinence products or making beds.

  • Dressing/undressing and feeding a person in bed.

  • Giving bed baths or applying anti-embolism stockings.

  • Prolonged holding of a body part.

Back Injuries

  • Back injuries are a significant threat, resulting from repeated activities or single events.

  • Signs and symptoms include:

    • Pain when trying to assume a normal posture.

    • Decreased mobility.

    • Pain when standing or rising from a seated position.

Factors Leading to Back Disorders

  • Reaching while lifting.

  • Poor posture when sitting or standing.

  • Staying in one position too long.

  • Poor body mechanics when lifting, pushing, pulling, or carrying objects.

  • Poor physical condition.

  • Repeated lifting of awkward items, equipment, or persons.

  • Shifting weight when a person loses balance.

  • Twisting or bending while lifting.

  • Maintaining a bent posture.

  • Reaching over raised bed rails.

  • Working in confined areas.

  • Fatigue or poor footing.

  • Lifting with forceful movement.

  • Follow safety measures to prevent back injuries, especially during high-risk tasks.

Preventing MSDs

  • Work settings must be free of hazards that may cause death or serious harm; employers must attempt to prevent or reduce hazards.

  • Ergonomics:is the science of Designing a job to fit the worker to reduce stress on the body.

    • Involves changing tasks, workstations, equipment, and tools.

    • The goal is to eliminate work-related MSDs.

  • Report work-related injuries as soon as possible; early attention can prevent problems from worsening and reduce treatment costs.

  • Follow rules in Box 18-1 (Rules for Body Mechanics) and Box 18-3 (Preventing Work-Related Injuries).

General Guidelines for Preventing Work-Related Injuries

  • Wear shoes with good traction.

  • Use assistive equipment when possible.

  • Get help from other staff.

  • Plan and prepare for tasks.

  • Schedule harder tasks earlier in the shift and balance them with lighter tasks.

  • Lock bed and wheelchair wheels.

  • Instruct the person on how they can help.

  • Avoid holding/grabbing under the underarms or allowing the person to hold/grasp around your neck.

Manual Lifting Guidelines

  • Minimize or eliminate manual lifting when possible.

  • Maintain good posture with a straight back, bending your legs.

  • Use leg muscles to do the work.

  • Face the person, avoiding twisting.

  • Keep the person close to you.

  • Use a wide, balanced base of support and smooth, even movements.

  • Lift on the "count of 3" when lifting with others.

Moving the Person in Bed

  • Adjust bed height, lower the bed rail, and work on the side closest to you.

  • Place equipment close to you.

  • lower the bed rail

  • Use friction-reducing devices (drawsheets, turning pads, etc.).

Transfer/Gait Belts

  • Keep the person as close as possible, avoiding bending, reaching, or twisting.

  • Use a gentle rocking motion to help the person stand.

Stand and Pivot Transfers

  • Use assist devices and transfer belts as directed.

  • Plan the transfer so the person's strong side moves first.

  • Lower the bed, get the person close to the edge, and ask them to lean forward.

  • Block the person’s weak leg, keeping feet shoulder-width apart, bending your legs, and pivoting your feet to turn.

  • pivot with your feet to turn

Lateral Transfers

  • Position surfaces close to each other and adjust to waist height.

  • Adjust surfaces to the same level or with the receiving surface slightly lower.

  • Lower bed and stretcher rails, use friction-reducing devices, and get a good hand-hold.

  • Kneel on the bed or stretcher to prevent extended reaching; have staff on both sides and move on the "count of 3".

Transporting the Person and Equipment

  • Push rather than pull, keeping the load close to your body.

  • Use an upright posture and push with your whole body.

  • Move down the center of the hallway, watching for door handles and thresholds.

Transferring the Person From the Floor

  • Refer to Chapter 14 for guidelines.

  • Injuries commonly occur from manual lifting, transferring, and re-positioning persons.

  • Proper body mechanics alone do not reduce MSDs; policies minimizing manual lifting must be followed.

  • Use assistive devices and mechanical lifts when possible.

Positioning the Person

  • Correct positioning is crucial for comfort and well-being, promoting breathing, circulation, and preventing pressure injuries and contractures.

  • Re-position individuals at least every 2 hours or more often, following the nurse's instructions and care plan.

Safe Positioning Guidelines

  • Use good body mechanics.

  • Ask for help if needed.

  • Explain the procedure.

  • Provide privacy.

  • Be gentle.

  • Use pillows as directed.

  • Provide comfort after positioning.

  • Place the call light within reach.

  • Complete a safety check.

Communication During Positioning

  • Moving can be painful, especially for older patients or those recovering from surgery/injury. Communicate effectively:

    • Ask about pain or discomfort during movement.

    • Offer pillow adjustments.

    • Ensure the person is comfortable.

Delegation Guidelines for Positioning

  • Obtain the following information from the nurse and care plan:

    • Positioning orders/limits.

    • Frequency of turning/re-positioning.

    • Number of staff needed.

    • Assist devices to use.

    • Skin care measures.

    • Range-of-motion exercises.

    • Pillow placement.

    • Positioning devices needed.

    • Observations to report and record.

  • Report any patient/resident concerns immediately.

Safety and Comfort Considerations for Positioning

  • Pressure injuries are a major threat from prolonged pressure; ensure linens are clean, dry, and wrinkle-free.

  • Contractures can develop from staying in one position too long; encourage re-positioning, exercise, and activity.

  • Pillows and positioning devices support body parts and promote good alignment.

  • Prone and Sims' positions may not be comfortable for older adults with limited neck range of motion; check with the nurse before using these positions.

Common Positions

Fowler's Positions

  • Semi-sitting position with the head of the bed raised between 45 and 60 degrees.

  • Variations include:

    • Semi-Fowler's: Head of bed raised 30 degrees (sometimes with knee portion raised 15 degrees).

    • High-Fowler's: Head of bed raised 60 to 90 degrees.

  • Good alignment includes a straight spine, head support, and arm support with pillows.

  • May use pillows under the lower back, thighs, and ankles.

  • Beneficial for individuals with heart and respiratory disorders.

*To estimate the angle:

  1. Use the bed frame and the head of the bed as the 2 lines.

  2. Estimate the angle from the bed frame to the head of the bed. See Figure 18-7.

Supine Position

  • Back-lying position (dorsal recumbent).

  • The bed is flat.

  • Head and shoulders supported on a pillow, arms at the sides (supported with pillows if needed).

  • May use a folded towel under the lower back and a pillow under the thighs, with a pillow under the lower legs to lift heels off the bed.

Prone Position

  • Lying on the abdomen with the head turned to one side.

  • The bed is flat.

  • Small pillows under the head, abdomen, and lower legs.

  • Arms flexed at the elbows with hands near the head.

  • Feet can hang over the end of the mattress.

Lateral Position

  • Side-lying position.

  • The bed is flat.

  • Pillow under the head and neck.

  • The upper leg is in front of the lower leg.

  • The ankle, upper leg, and thigh are supported with pillows.

  • A small pillow is against the person’s back at a 45-degree angle with the mattress, with a small pillow under the upper hand and arm.

Sims' Position

  • Left side-lying position with the upper leg (right leg) sharply flexed.

  • The bed is flat.

  • Pillow under the person’s head and shoulder.

  • The upper leg (right leg) is supported with a pillow.

  • A pillow is under the upper arm (right arm) and hand (right hand).

Chair Position

  • Individuals in chairs must maintain an erect upper body and head.

  • Proper alignment includes:

    • Back and buttocks against the back of the chair.

    • Feet flat on the floor or wheelchair footplates.

    • Space between the backs of the knees/calves and the edge of the seat.

  • May use a small pillow for lower back support (unless restraints are used).

  • Support paralyzed arms using pillows or elevated armrests; use positioners as directed.

  • Consider postural supports for those who cannot keep their upper bodies erect.

Focus on Pride: Personal and Professional Responsibility

  • Make daily decisions to protect yourself, such as bending at the hips and knees to lift, using a step stool, exercising, raising the bed when giving care, and getting help when moving a person.

  • Your decisions affect the safety of yourself and others; use good judgment at home and in the workplace.

Rights and Responsibilities

  • OSHA requires a safe work setting; you have the right to ask about safety plans, training programs, and reporting procedures.

Promoting Independence and Social Interaction

  • Involve the individual in positioning decisions to promote comfort, independence, and social interaction.

Delegation and Teamwork

  • Be aware of tasks that increase your risk of injury; exercise caution and seek help when needed.

Ethics and Laws

  • Failure to move and position the person correctly places the person at risk of pressure injuries or other harm.

  • Provide care that maintains or improves the quality of life, health, and safety.

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