Body Mechanics and

Positioning
HEALTH ASSESSMENT’ (NCM 101) SKILLS

Mr. JHONEE F. BALMEO

 Body mechanics is the term used to describe
the efficient, coordinated, and safe use of
the body to move objects and carry out the
ADLs.
How about Ergonomics?

Until recently, nurses believed that “correct” body mechanics

would facilitate the safe and efficient use of appropriate muscle
groups to maintain balance, reduce the energy required, reduce
fatigue, and decrease the risk of injury for both nurses and clients,
In reality, more than 30years of evidence
show that:
 Educating nurses in body mechanics alone will not prevent
job- related injuries.
 Back belts have not been shown to be effective in reducing
back injury.

 Nurses who are physically

fit are at no less risk of injury.
 The formerly widely accepted National Institute for
Occupational Safety and Health (NIOSH) “lifting equation,”
which recommended that workers observe a limit of 51 pounds
of lifting, cannot be safely applied to nursing practice.

 The long-term benefits of using the

proper equipment (e.g., mechanical lifts) far
outweigh the costs related to injuries.
 Staff will use equipment when they have participated in the
decision-making process for purchasing the equipment
(AmericanNursesAssociation[ANA], HandlewithCare,n.d.).
Body Mechanics

 Body mechanics is the safe use of the body using the correct
posture, bodily alignment, balance and bodily movements to
safely bend, carry, lift and move objects and people.
In addition to getting the assistance of another or using a mechanical
life, nurses should follow these:

 Take the time to do a little bit of muscular warmup and stretching

before you attempt to lift or transfer a person or object.

 Think about and plan your approach before you attempt to do

it.
 Explain what you will be doing and how you will perform the lift or
transfer to the client. Instruct the patient about what you and they
will be doing.

 Remain as close to the person or the object, such as a large box,

when you are about to lift it and while you are lifting.
 Face the person or object that you are about to
lift.

 Keep your spine, neck and back straight and aligned throughout the
lift or transfer. Do not twist
 Maintain a wide and secure base of support by keeping your feet
apart.

 Pivot on your feet in the direction of the move and not against
it.

 Get a secure and good grip on the object or person that

you are about to lift.
 Use the long and strong muscles of your arms and legs to lift. Do NOT
use back muscles.

 Use slow, smooth and non-jerky movements.

Principles of Body Mechanics

 Principles underlying proper body mechanics involve three

major factors: center of gravity, base of support, and line
of gravity.
Center of Gravity

 A person’s center of gravity is located

in the pelvic area.

 When lifting an object, bend at the

knees and hips and keep the back
straight. By doing so, the center of
gravity remains over the feet, giving
extra stability. It is thus easier to
maintain balance
Base of Support

 A person’s feet provide the base

of support.

 The wider the base of support, the

more stable the object, within
limits
Basic Principles of Body Mechanics

 1. It is easier to pull, push, or roll an object than it is to

lift it. The movement should be smooth and continuous,
rather than jerky.
 2. Often less energy or force is required to keep an
object moving than it is to start and stop it.
Basic Principles of Body Mechanics

 3. It takes less effort to lift an object if the nurse works as close to it

as possible. Use the strong leg and arm muscles as much as possible.
Use back muscles, which are not as strong, as little as possible. Avoid
reaching.

 4. The nurse rocks backward or forward on the feet and with his or
her body as a force for pulling or pushing.
Line of Gravity

 Draw an imaginary vertical (up and

down) line through the top of the
head, the center of gravity, and the
base of support.

 For highest efficiency, this line should

be straight from the top of the head to
the base of support, with equal
weight on each side.
Body
Alignment
 When lifting, walking, or
performing any body activity,
proper body alignment is essential
to maintain balance.

 When a person is in proper

alignment, an imaginary straight
line can be drawn connecting the
person’s nose, breastbone
(sternum), and pubic bone.
?
?
 To increase stability during client
transfer, the nurse increases the base
of support by performing which
action?

1. Leaning slightly backward

2. Spacing the feet farther apart.
3. Tensing the abdominal muscles
4. Bending the knees
 ?
 A client weighs 250 pounds and needs to be
transferred from the bed to a chair. Which
instruction by the nurse to the unlicensed
assistive personnel (UAP) is most appropriate?

 1. “Using proper body mechanics will prevent

you from injuring yourself.”
 2. “You are physically fit and at lesser risk for
injury when transferring the client.”
 3. “Use the mechanical lift and another person
to transfer the client from the bed to the
chair.”.
 4. “Use the back belt to avoid hurting your
back.”
Lifting

 It is important to remember that nurses should not

lift more than 35 pounds without assistance from
proper equipment and/or other persons.
There are a number of assistive devices that can
be used to safely lift and transfer patients.

 Mechanical lifts
are used mostly for patients who
are obese and cannot be safely
moved or transferred by two
people, and are paralyzed.
 A gait or transfer
belt
is also used to assist with transfers and lifting.
 Slide boards
are particularly useful to move a patient from one flat surface to another.
Pulling and Pushing

 When pulling or pushing an

object, a person maintains
balance with least effort when
the base of support is increased
in the direction in which the
movement is to be produced or
opposed
Pivotin
g
 Pivotingis a technique in which the
body is turned in a way that avoids
twisting of the spine
POSITIONING THE CLIENT
 Encouraging clients to move in
bed, get out of bed, or walk serves
several positive purposes. Clients may be
reluctant to move or may stay in bed
unnecessarily.
This immobility can contribute to a number of disorders,
among which are;
 pressure ulcers,
 blood clots,
 constipation,
 muscle weakness and atrophy,
 pneumonia,
 joint deformities, and
 mental disorders
?

 The nurse is performing an

assessment of an immobilized
client. Which assessment causes
the nurse to take action?
 1. Heart rate 86
 2. Reddened area on sacrum.
 3. Nonproductive cough
 4. Urine output of 50 mL/hour
Moving and Positioning Clients
 There are many reasons to change the client’s position,
including promoting comfort, restoring body function,
preventing deformities, relieving pressure, preventing
muscle strain, stimulating proper respiration and
circulation, providing diversion, and giving nursing
treatments.

!!!Any position, correct or incorrect, can be detrimental if

maintained for a prolonged period.
Positioning for Examinations and Treatments
 The client is sometimes helped into a special
position as part of a treatment or
examination. Many different positions are used
for physical examinations, nursing treatments
and tests, and to obtain specimens.

 Because nurses assist clients into some of

these positions and will see other positions
used, it is important to know how to assist the
client and how to place the necessary drapes.
IN PRACTICE :NURSING CARE GUIDELINES

 POSITIONING THE CLIENT FOR COMFORT

 • Maintain functional client body alignment. (Alignment

is similar whether the client is standing or in bed.)

 • Maintain client safety.

 • Reassure the client, to promote comfort and

cooperation.
 • Properly handle the client’s body, to prevent pain or
injury

 • Follow proper body mechanics, to protect yourself and

the client.

 • Obtain assistance, if needed, to move heavy or

immobile clients.

 • Follow specific provider’s orders.

 • Remember that a specific order is needed for a client

to be out of bed.
 • Do not use special devices (eg, splints, traction) unless
ordered and trained to use this equipment.

 • Make sure the client is comfortable and has the nurse

signal cord available after positioning.

 • A urine specimen is collected, as ordered.

 • The client is encouraged to defecate before most

examinations, particularly a rectal examination.

 • The client is provided with an examination gown

and/or bath towel to cover the chest and perineal area.
 • A bath blanket or sheet is provided for warmth and
privacy. In some cases, a small pillow is provided.

 • The examination procedure is explained to the client.

 • The body is draped appropriately for client privacy

and examiner’s access.

 • Appropriate lighting is provided for the examiner.

 • Needed equipment and supplies are prepared

before
the examination begins.
 • The nurse stays with the client during the
examination.

 • Examiner and nurse wash or sanitize their hands

before and after any examination.

 • Gloves are worn in many cases.

 • Other personal protective equipment is worn when

needed.

 • A signed release is obtained from the client when

needed.
 • The nurse observes, in order to document the
procedure and to maintain client safety and
confidentiality.

 • After the examination, the nurse assists in disposing of

equipment and supplies and readying the examination
room for the next examination.

 • The nurse needs to know why the examination is being

done so the client’s questions can be answered and to
anticipate problems that might arise.
?

 The client is ambulating for the first time

after surgery. The client tells the nurse,
“I feel faint.” Which is the best action by
the nurse?
 1. Find another nurse for help.
 2. Return the client to her room as
quickly as possible.
 3. Tell the client to take rapid, shallow
breaths.
 4. Assist the client to a nearby chair..
Client Positions
Supine (Dorsal Recumbent)

 General examination;
examination of chest,
abdomen, pelvic area.

 Back-lying, legs
extended or slightly
bent. Arms up or down.
Small pillow allowed.
May be uncomfortable
for client with back
problem
Prone
 Examination of spine, back. (Long time in this position
may cause neck strain and/or headache.)

 On abdomen, head to side. Arms above head or beside

body.
 (Small pillow or folded towel may be placed under
shoulder toward which head is turned. Difficult for
pregnant woman, obese client, or client with abdominal
incision or breathing problem
Lateral (Side Lying)
 Client positioned for extended rest periods.
 Side-lying, bottom arm behind or in front of client, not as
extreme as Sims’. Pillow placed under top leg for support.
Comfortable for longer time than prone
 Sims’ (Semi
Prone)

 Rectal examination;
procedures such as
colonoscopy or enema

 Side-lying (usually left side),

upper knee flexed sharply,
bottom arm behind body.
Small pillow allowed under
head. Pillow may be placed
under top leg. Difficult for
client with arthritis or leg
injuries
 Fowler’s

 Promotes drainage; assists

with breathing; preparation
for dangling or walking
 Semi-Fowler’s position is
when the head and trunk are
raised 15 to 45 degrees.
 In high Fowler’s position, the
head and trunk are raised 60–
90 degrees
Orthopneic position

 Facilitates breathing in client

with severe cardiac or
respiratory disorders. Can be
used for an extended length
of time

 High Fowler’s, leaning on

overbed table, arms
outstretched, head held up or
turned to side on pillows.
knee-Chest (Genupectoral)

Rectal or vaginal examination;

treatment to bring
retroflexed uterus into
normal position

Client on knees with chest resting

on bed. Arms above head or to
the side; head turned to side.
Thighs straight up and down;
lower legs flat on bed. Client may
become dizzy; do not leave alone
Lithotomy (Dorsal Lithotomy)

 Pelvic or perineal
examination.

 Supine, with legs separated,

knees acutely flexed, hips at
end of examination table,
and feet in stirrups
Modified Standing

 Prostate examination.

 Standing, with chest, head, and

arms on table.
Trendelenburg’s Position
(Head Down Position)

 Treatment of shock,
simulated using drainage,
promoting venous
return.

 Head lower than feet.

(May be simulated using
pillows under feet in
emergency.) Place pillow
between client’s head and
headboard of bed
Reverse Trendelenburg’s Position
(Head Elevated)

 To facilitate tube feedings,

emergency treatment in severe
bleeding, head injury

 Head higher than feet.

 Place pillow between client’s feet
and footboard of bed.
Support Devices
Pillows.
 Different sizes are available. Used for support or elevation of an arm or leg.

Mattresses.
 There are two types of mattresses: ones that fit on the bed frame and
mattresses that fit on the standard bed mattress. Mattresses should be
evenly supportive.

Suspension or heel guard boot.

 These are made of a variety of substances. They usually have a firm
exterior
and padding of foam to protect the skin.
Footboard.
 A flat panel often made of plastic or wood. It keeps the feet in
dorsiflexion to prevent plantar flexion.

Hand roll.
 Can be made by rolling a washcloth. Purpose is to keep hand in a
functional position and prevent finger contractures.

Abduction pillow.
 A triangular-shaped foam pillow that maintains hip abduction to
prevent
hip dislocation following total hip replacement
?
 What type of patient would benefit from
an elevated head of the bed position?

A. Patient with burns of the face and head .

B. Patient with a broken femur
C. Patient who had a hemorroidectomy
D. Patient who had a lumbar puncture
?

A patient is supine and the head of

the bed is elevated to 45 to 60
degrees.
What position is this called?

 A. Semi-Fowler's Position
 B. High Fowler's Position
 C. Sim's Position
 D. Fowler's Position.
?

 Your patient is getting prepped for a

lumbar puncture. What position do you
assist the patient in?

 A. Lateral Side-lying Position.

 B. Prone
 C. Head of the bed at 45 degrees
 D. None of the above
?

 Which of the following statements

made by the patient is true regarding
positioning after cataracts surgery?

 A. I will sleep on the unaffected

side. .
 B. I will sleep on the affected side to
help decrease drainage.
 C. I know I can't lay on my back and be
on my side for at least a week.
 D. I will sleep on my stomach to help
 References:
 AudreyBerman . . . [et al.]. – 9th ed. (2012)
KOZIER & ERB’S Fundamentals of NURSING
Concepts, Process, and Practice.
DEMONSTRATION 