BODY MECHANICS, PRINCIPLES OF GOOD BODY MECHANICS AND RULES FOR GOOD BODY MECHANICS

BODY MECHANICS

There is a difference in the weight, size and ability to move. Lots of patient care activities require the nurse to pull, push, lift or carry. With the use of proper body mechanics, the nurse can avoid lots of musculoskeletal injuries to him or herself and the patient. What is body mechanics then?

Body mechanics refers to the use the body as a machine and as a means of locomotion. An additional meaning by Patricia Porter is the coordinated use of the musculoskeletal and nervous system to maintain proper balance, posture and body alignment during lifting, sitting, pushing, pulling etc.

You can also define body mechanics as the use of the safest and most efficient method of moving, lifting and pushing a patient without causing injury to both parties involved, thus the nurse and the patient.

Before an individual can utilize the body to perform all of the activities mentioned above, the individual needs to consider some factors.

FACTORS TO UNDERSTAND IN MAINTAINING GOOD BODY MECHANICS

Center of Gravity.

The center of gravity of an object or an individual is the point at which its mass is centered. In an individual, when standing the center of gravity is located in the center of the pelvis approximately midway between the umbilicus and the symphysis pubis.

Base support.

The feet are a person’s base support. The feet are kept apart to avoid tipping or falling over. Some of the positions assumed are

1.Spread the feet to different sides to establish side to side stability.

2.Put one foot slightly in front of the other to give a front-to-front stability when pushing.

3.The body must be turned round instead of twisting.

4.Your weight must be evenly distributed between both legs.

Line of Gravity.

Line of gravity is a vertical line which passes through the center of gravity. An imaginary line drawn through the head and through the base support is how to determine the line of gravity. There is a constant pull exerted by the earth on every object towards its center which helps to maintain the good position and balance.

PRINCIPLES OF GOOD BODY MECHANICS.

Maintain a stable center of gravity.

To maintain a stable center of gravity, you have to do the following…

1.     Keep your center of gravity low

2.     Keep your back straight

3.     Bend at the knees and hips.

Maintain a wide base of support.

This will provide you with maximum stability while lifting. To do this you have to

1.     keep your feet apart

2.     place one foot slightly in front of the other

3.     flex your knees to absorb jolts

4.     turn with your feet.

 Maintain the line of gravity.

The line should pass vertically through base support.

1.      Remember to keep your back straight

2.      Ensure that the objects being lifted close to the body

Maintain proper body alignment.

1.     Tuck in your buttocks

2.      Make sure to pull your abdomen in and up

3.      Also keep your head up

4.     Be sure to keep your chin in

5.     Also keep your weight forward and supported on the outside of your feet.

GENERAL CONSIDERATION FOR PERFORMING PHYSICAL TASKS

1.     It is easier to push, pull or roll than to lift an object. The movement should be continuous rather than jerky.

2.     It takes less effort to lift near objects than to stop or start it.

3.     Less energy is required to keep an object moving than to stop or start it

4.     The legs and arms muscles should be used very often.

5.     Face the direction of the movement in order to prevent abnormal twisting of the spine

6.     Using the back muscle must be avoided to prevent slip disc and damage to the spinal cord because the back muscles are not strong.

RULES FOR GOOD BODY MECHANICS

1.                 Maintain good body posture (anatomical position) in all activities.

2.                 Use the longest and strongest muscles of the extremities to provide the energy needed in strenuous activities

3.                 Keep the object close to the body to prevent unnecessary strain on the muscles. This brings the center of gravity of the object close to the center of gravity of the body. 

4.                 Place the feet apart to provide a wide base of support. A broader base provides a better body balance.

5.                 Flex the knees to come close to the object of bending back

6.                 Keep work close to the body.

7.                 Slide, roll, push or pull an object rather than lifting it in order to reduce the energy needed to lift the weight against the pull of gravity.

8.                 Use the weight of the body to pull or push an object keeping the body above the object.

TECNIQUES OF BODY MECHANICS

LIFTING

1.     Use the stronger leg muscles for lifting

2.     Bend at the knees and hips; keep your back straight.

3.     Lift straight upwards, in one smooth motion

REACHING

1.     Stand directly in front of and close to the object.

2.     Avoid twisting or stretching

3.     Use a stool or ladder for high objects

4.     Maintain a good balance and a firm base support

5.     Before lifting the object, be sure it is not too large or too heavy

PIVOTING

1.     Place one foot slightly ahead of the other

2.     Turn both feet at the same time, pivoting on the heel of one foot and the toe of the other

3.     Maintain a good center of gravity while holding or carrying the object

AVOIDING STOOPING

1.     Squat (bending at the knee and hip)

2.     Avoid stooping (bending at the waist)

3.     Use your leg muscles to return to an upright position

GENERAL INSTRUCTIONS IN MOVING AND LIFTING PATIENTS

1.     Plan the movement of the patient ahead of time and be sure all the path is clear

2.     Place the feet comfortably apart to provide a wide base support

3.     Flex the knees and hip joint but keep the trunk as vertical as possible

4.     Keep the patients as close to the body as possible

5.     Avoid jerking and twisting during lifting

6.     Heavy patients should be moved in bed by sliding them rather than lifting

7.     Assistance should be required when lifting or moving heavy patients

8.     The height of the bed should be adjusted to a height that permits the nurse to keep her back as erect as possible when moving the patient in bed. This reduces injuries to the lower back

9.     The patient is moved to the edge of the bed before he is lifted from the bed. This helps the nurse to keep her trunk more erect.

10.         When moving a patient by more than one person, each worker assumes the responsibility for supporting one of the following parts of the patients.

a.     Head, shoulders and chest

b.     Hips

c.      Thighs and ankle

11.         To coordinate the movement of the workers and to maintain the patient’s body in correct alignment, throughout, the leader gives the signal by counting 1, 2,3 etc. during each count a particular procedure is carried out by the workers, unless contraindicated, encourage the patient to use his abilities as much as possible

12.         Observe the patient for symptoms of orthostatic hypertension such as fainting, dizziness, sweating etc.

13.         Do not support the patient under his armpit since injury to major nerves and blood vessels can occur.

14.         Always lock the wheel of the bed and stretcher prior to transferring a patient to increase the maximum static friction between the wheels and the floor.

REASONS FOR THE USE OF PROPER BODY MECHANICS

1.     Body mechanics used to avoid excessive fatigue.

2.     It is used to avoid strains on the body.

3.     It is used in order to prevent skeletal injuries

4.     It is used to avoid injury to the patient

5.     It helps prevent injuring to assisting staff members

In the nutshell, in order to effectively carry, lift, push or pull a patient or an equipment without sustaining injuries to either parties, proper body mechanics should be used.

NURSES RESPONSIBILITY IN MOVING A PATIENT.

1.     Check the diagnoses and the specific precautions regarding the movement of the patient.

2.     Assess the level of consciousness and the ability to follow instructions

3.     Assess the ability for self-care.

4.     Assess the abilities and limitations such as paralysis, fractures, sprains etc.

5.     Assess for the presence of muscle, skin and bone lesions and attachments such as catheters and IV lines in-situ.

6.     Articles available in the patient’s unit such as stretcher, IV stand, clamps, drainage bags etc.   

GENERAL PREPARATION OF A PATIENT AND THE UNIT/ WARD BEFORE MOVING.

1.     Explain procedure to patient and tell him/her how he can help you

2.     Provide privacy

3.     Adjust the bed the working height, lower the side rails and lock the wheels of the bed, wheel chair etc.

4.     Fan fold the top linen to the foot end of the bed or remove them leaving a sheet or bath blanket over the patient.

5.     Change wet or soiled lined.

6.     Offer bedpan if needed

7.     Remove all comfort devices used for the patient

8.     Remove pillow and place it against the head of the bed

9.     Clap catheter (do not disconnect) to prevent backflow of urine during transfer. Also clamp nasogastric tube and tubes if any.

10.         Attach IV stand to the stretcher to hang the IV bottle

11.         Position the foot stool if needed

MOVING PATIENT TO ONE SIDE OF THE BED (BY 3 NURSES)

Procedure:

1.     Three nurses position themselves at the bedside along the same side. Each assumes the responsibility for supporting one of the following body sections of the patient

a.     Head, shoulders and chest

b.     Hips

c.      Thighs and ankles

Strongest worker stands beside male patient’s head and shoulders or beside female patients hips this is because the strongest person can lift the heaviest parts of the patient, which are mentioned above.

2.     Nurses stand with wide base support with knees flexed to provide a wide base of support for a stable base. Flexed knees brings the nurses arms to the bed level and place them in a position to lift with strong led muscles.

3.     The nurses place their arms of bed, sliding them under the patient’s head, shoulders, chest, hips and legs. This helps to move the patient in unison.

4.     Leader gives the signal by counting up to 3. The workers then move the patient to the side of the bed at the end of the count. Signal counting is essential because it helps to coordinate the movements of the nurse and to maintain the patient’s body in correct alignment.

MOVING A HELPLESS PATIENT UP IN BED (BY 3 PERSONS)

1.     Follow the steps of the procedure above. At the count of 3 move the patient to the side of the bed towards the head end of the bed.

a.     Raise the side rails next to the patient and go to the opposite side.

b.     Repeat the pull of the body as described above.

c.      Pull the patient to the edge of the bed on alternate sides of the bed until the desired height in bed is reached.

d.     Slide patient to the center of the bed and put the body in the correct alignment.

Reasons…

1.     Patient’s body is now on the side of the bed near the nurse and has been moved upward in bed

2.     Patient’s body is moved to the other side of the bed and upward

3.     Patient is gradually moved up in bed being moved from side of the bed to the other.

LIFTING TECHNIQUES

 Lifting is the art of carrying a patient from one place to  another with minimal effort of both patient and nurse and without injury.

Lifting may be done for the reasons below.

1.     To help a helpless patient to sit up in bed

2.     To move a patient from a stretcher to a bed and from a bed to a stretcher.

3.     To move a patient into a sitting position out of a bed

4.     To move a patient from a while chair to a bed

GUIDELINES FOR LIFTING.

1.     Assess the patient and the environment to establish what aid or help will be required for the lifting.

2.     Decide on how patient is to be lifted and ensure other nurses are aware of what they are to do

3.     Prepare area and move equipment into a suitable position making equipment secure.

4.     Screen area if necessary

5.     Adopt suitable stance for the proposed lift

Feet should be wide apart with one foot pointing the directions of the initial movement and the other right angle to it

Stand as close as possible to the patient

Bend knees and hips to allow a suitable grasp to be taken.

Grasp the other lifter’s hand or wrist firmly avoiding tender and painful areas.

6.     Lift patient into a desired position, one nurse acting as a leader and coordinating the movement of lifting

7.     Checking whether lift was comfortable for patient.

CRITERIA FOR LIFTING

1.     Position of weight

The weight of the object to be lifted should be as close to the lifter as possible. Positioning the object in such a manner utilizes the lifting force of the nurse because the object to be lifted is in the same place as the nurse.

2.     Height of the object.

The best height for lifting a patient or an object vertically is slightly above the level of the middle finger of a person with the arm hanging at the side.

3.     Body position

This varies with different lifting tasks

4.     Maximum weight.

Weight of the object should not be more than 35% of the nurses’ body weight.

PROPER LIFTING STEPS

1.     Assess the position of the weight, the height of the object, the body position and the maximum weight.

2.     Come close to the object to be moved.

3.     Enlarge your base of support by placing feet slightly apart.

4.     Lower your center of gravity to the object to be lifted

5.     Maintain proper alignment of the head and the neck with the vertebrae.

As a nurse, It is better to always consider your safety and the safety of the patient first.

SAFETY FIRST.

1.     Safety must never be compromised

2.     Never select method of transfer by ease

3.     When in doubt always use an assistant.

4.     Always stabilize equipment (use wheel locks)

5.     Secure all lines when transferring

6.     Use proper body mechanics

LEVELS OF ASSISTANCE IN THE MANAGING OR TRANSFER OF A PATIENT

1.     Standby assistance

With this type of assistance, patient is able to perform transfer on their own but may require some verbal cues

2.     Close guarding 

Patient is able to do transfer on their own but have a likelihood of needing physical assistance such as balance or support

3.     Contact guarding

Patient is able to perform transfer with minimal assistance, constant assistance should be given to ensure safety.

4.     Minimal assistance

Patient who can perform at least 75% of the activities.

5.     Moderate assistance

Patient can perform at least 50% of the activity

6.     Maximum assistance

Patient can perform at least 25% of the activity.

EQUIPMENTS USED IN NURSING.

1.     Wheelchair

2.     Trolley

3.     Hydraulic lift

4.     Gait belts

5.     Sliding board etc.

TYPES OF LIFTING

Orthodox lifting

1.     Stand close to the bed facing each other

2.     Ask patient to cross his arm across his chest with the head bent forward

3.     Clasp each other’s arm at the back of the patient and under his knees with feet wider apart to give greater support.

4.     Lift patient to bed or chair.

Australian lifting

1.     Nurses should stand close to the bed with their inner shoulder under the patient’s axillae

2.     Place patient’s weight on nurse’s shoulder muscles

3.     Straighten flexed hips and place feet wide apart

4.     Lift patient while outer arms are used to support the bed and adjust pillows

5.     Check whether lift was comfortable for patient

ASSISTING PATIENT TO SITTING POSITION.

1.     Place client in a supine position

2.     Remove all pillows from the bed

3.     Face the head of the bed

4.     Place feet apart with the foot nearest the bed behind the other foot

5.     Place hand further from under the shoulder of the patient giving support to his head and vertebrae

6.     Place other hand on the bed surface

7.     Raise patient to a sitting position by shifting your weight from the front leg to the back leg

LIFTING UNCONSCIOUS PATIENTS

Two or three nurses are needed.

1.     Ensure movement is smooth to avoid jostling which may increase shock

2.     Get all to stand on the same side of the patient

3.     Lift patient with the nurse who is holding the patient’s head, move toward the head of the bed while those holding the trunk and feet move at the same time. Move patient with the sheet he is lying on.

BASIC RULES FOR LIFTING

1.     Keep back straight

2.     Keep feet separated to provide a good base of support

3.     Bend from hips and knees to get close to the object or patient. Do not bend from the waist.