Procedure: Proper Body Mechanics

Proper body mechanics means using your body in an efficient and safe way. Using proper body mechanics prevents Home Health Aides/Personal Care Aides from injuring themselves or their patient. Proper body mechanics involves always using good posture, keeping your back and trunk straight and aligned with your hips, and keeping your head facing forward toward the direction you are working. This prevents twisting, which increases your risk of injury. Turn your entire body, including your legs in the direction you move. Never twist the trunk or waist.

Bend your legs and not your back while working. Your feet should be about 12 inches apart to provide a strong base of support and balance for you to work. Use the larger and stronger muscles of your thighs, hips, shoulders, and upper arms while bending or lifting objects. This protects your back and smaller muscles from injury.

Keep objects close to your body when lifting or carrying them. Home Health Aides/Personal Care Aides should always raise the bed to waist height when working with a patient who is in bed or making a bed. This prevents unnecessary bending of the back. When pushing, place one leg forward. When pulling, move one leg back. This provides you with a stronger and more stable base of support. Keep in mind when moving a patient that your path, or direction in which you are moving should be clear of objects that could get in the way and cause potential injury. Home Health Aides/Personal Care Aides should always lock the brakes on the bed and wheelchair before transferring a patient. This prevents the bed or wheelchair from moving and causing potential injury to them or the patient.

Procedure: Standing

1. Place your feet hip width apart (about 12 inches) with one foot in front of the other to create a firm base of support. This provides you with a stronger sense of balance than if your feet were close together.
2. Keep your back and neck straight and pelvic area aligned with your hips. Always keep your upper body aligned with your lower body to prevent injury. Alignment means that a vertical (up and down) line can be drawn from your head to your feet so that both sides of your body are equal. One side is not leaning more in one direction.
3. Face toward the direction of movement. Keep your head and neck straight and turn toward the direction in which you are working or moving. This avoids straining your neck muscles.

 Procedure: Lifting

1. Use a firm base of support when lifting objects. Keep your feet hip width apart and your upper and lower body aligned.
2. Use the stronger muscles of your hips and thighs to provide a center of gravity, which gives you more balance and support. Do not bend your back to lift items.
3. Bend at your knees and hips to lower yourself. Do not bend your back or lean forward to push or pull objects. Use the large muscles in your legs and hips to bend and support your weight rather than using the smaller muscles of your back.
4. When lifting an object, use the stronger muscles of your thighs and upper arms to lift the object. Do not reach for the object by stretching your back. Position yourself close enough so that you do not have to overextend your back or your arms to obtain the object.
5. Keep objects you are lifting close to your body. This keeps the weight of the objects closer to your center of gravity, which provides you with more balance and stability. Keep your legs hip width apart while lifting. Keep your back straight.
6. Pivot (turn) with your feet. Keep your upper and lower body aligned with one another when turning. Do not twist at your waist. Face objects or people you are moving to help avoid twisting at the waist.When standing up, use the strength of your hip and thigh muscles to raise your body and the object.
7. Carry the object close to your body.
8. Use a lift sheet or bed pad, placed under the patient, to assist with moving and positioning a patient in bed. Grasping the edges of the bed pad on either side, rather than grasping the patient’s body parts or clothing, to lift the patient prevents the HHA/PCA and the patient from injury. Use a partner to assist with lifting patients in bed.

 Procedure: Using Proper Working Height

1. When making a bed, do not lean forward over the bed. If using an adjustable bed, raise it to waist level. Lower side rails of the side in which you are working. This allows you to move as close as possible to the patient to avoid awkward movements or unnecessary bending, leaning, or twisting.
2. If making a regular bed, without an adjustable height, kneel on the bed to support yourself, with your back straight. This prevents unnecessary bending of your back.
3. Always move to the other side of the bed, rather than leaning over the bed, when you must work on theopposite side of the bed, such as during bed making.Raise bed tables, if you can, to waist height. This allows materials you need to be at working height so that you do not need to bend or twist to reach them. This also prevents contamination of items when you are bathing a patient or assisting with changing dressings on wounds.
4. When assisting a patient with dressing, applying lotion, socks, or shoes, Home Health Aides/Personal Care Aides should use a firm base of support, bend using the strength of their thighs to provide balance, and position themselves at the level where they are working. Alternatively, they may kneel. Do not bend over to put lotion or shoes on a patient.

Overview: Turning and Positioning the Patient

 Turning a patient in bed is an important task of the Home Health Aide/Personal Care Aide. It is very important to protect the patient’s skin any time they are turned or moved. Friction (rubbing of two surfaces together, such as the skin rubbing against a sheet) and shearing (when skin sticks to a surface, such as a sheet, and the muscles underneath slide in the direction the body moves) can cause skin breakdown and injury. Friction and shearing can also occur when the patient slides down in bed. To reduce friction and shearing, use a draw sheet or bed pad (these are special linens placed underneath patients to help lift them in bed) when moving a patient. When lifting or moving a patient in bed use at least two people to assist, as much as possible. Never pull on a patient’s body part to lift or turn them, as this can cause a serious injury.

Patients should be turned every two hours to prevent development of pressure ulcers. There are a number of positions in which patient can be placed. Alternate the positions used to help prevent pressure ulcers and to provide patient comfort. Position pillows under bony areas to prevent pressure ulcers. If patients prefer to stay in one particular position, a pillow should be placed under one buttock or hip to prevent pressure ulcers. This pillow can be rotated to the other side with the next position change. For example, the patient has a pillow placed under their right buttock at 10 am. With the 12 noon turn and position, the pillow can be moved to under the left buttock.

Positions:

Fowler’s Position: In this position the patient is placed in a sitting up or upright position.

• This is the position patients should be placed for eating, taking medications, and if they have difficulty with swallowing or breathing.
• Pillows may be placed behind the head, under each arm, under a hip to lift the buttock from the bed, and one under each leg with heels off the surface of the bed.

Supine Position: In this position the patient is placed in a lying or reclining position with their back against the bed and their face positioned up.

• Pillows may be placed behind the head, under a buttock, and one under each leg with heels off the surface of the bed.

Prone Position: In this position the patient is placed face down with their belly against the bed. Arms should be positioned so they are not underneath the patient. Arms may be gently bent at an angle at the patient’s side.

• Pillows may be placed under calves, feet, arms, and head for comfort and to prevent pressure ulcers.

Lateral Position: In this position the patient is placed on one side.

• Pillows should be placed between their knees, under their head, under the arm that is draped over their top leg, and under the leg that is closest to the bed to keep heels off the surface of the bed.
• Pillows should be placed under bony prominences to prevent pressure ulcers.

Examples of bony prominences that are at risk for pressure ulcers:

• Back of the head
• Heels
• Elbows
• Ankles
• Hips
• Sacrum (lower back)
• Coccyx (tailbone)

Before re-positioning the patient, Home Health Aides/Personal Care Aides should also offer the use of the restroom, bedpan, or urinal. Patients should be offered a glass of water at this time. Ensure the patient’s body is in proper alignment once you are done positioning them, and that pillows are used to support body parts.