BODY MECHANICS AND

POSITIONING
BODY MECHANICS
• INVOLVES THE COORDINATED EFFORT OF MUSCLES, BONES, AND THE NERVOUS
SYSTEM TO MAINTAIN BALANCE, POSTURE, AND ALIGNMENT DURING MOVING,
TRANSFERRING, AND POSITIONING PATIENTS.
• PROPER BODY MECHANICS ALLOWS INDIVIDUALS TO CARRY OUT ACTIVITIES
WITHOUT EXCESSIVE USE OF ENERGY, AND HELPS PREVENT INJURIES FOR
PATIENTS AND HEALTH CARE PROVIDERS
(PERRY, POTTER, & OSTENDORF, 2014)
MUSCULOSKELETAL INJURIES (MSI)

• AN INJURY OR DISORDER OF THE MUSCLES, TENDONS, LIGAMENTS, JOINTS

OR NERVES, BLOOD VESSELS, OR RELATED SOFT TISSUE INCLUDING A SPRAIN,
STRAIN, OR INFLAMMATION RELATED TO A WORK INJURY. MSIS ARE THE MOST
COMMON HEALTH HAZARD FOR HEALTH CARE PROVIDERS (WORKSAFEBC,
2013)
FACTORS THAT CONTRIBUTE TO AN
MSI
Factor Special Information

Ergonomic Repetitive or sustained awkward postures, repetition, or

risk factors forceful exertion

Poor work practice; poor overall health (smoking, drinking

Individual
alcohol, and obesity); poor rest and recovery; poor fitness,
risk factors
hydration, and nutrition
ELEMENTS OF BODY MECHANICS
1. BODY ALIGNMENT is achieved by placing one body part in line with another body part in a vertical
or horizontal line. Correct alignment contributes to body balance and decreases strain on muscle-
skeletal structures. Without this balance, the risk of falls and injuries increase.
2. CENTRE OF GRAVITY is the center of the weight of an object or person. A lower center of gravity
increases stability. This can be achieved by bending the knees and bringing the center of gravity
closer to the base of support, keeping the back straight. A wide base of support is the foundation
for stability.
3. WIDE BASE OF SUPPORT is achieved by placing feet a comfortable, shoulder width distance
apart. When a vertical line falls from the center of gravity through the wide base of support, body
balance is achieved. If the vertical line moves outside the base of support, the body will lose
balance.
PRINCIPLES OF BODY MECHANICS
Data source: Berman & Snyder, 2016; Perry et al., 2014; WorkSafeBC, 2013

Action Principle

Assess the environment. Assess the weight of the load before lifting and determine if assistance is required.

Plan the move. Plan the move; gather all supplies and clear the area of obstacles.

Avoid stretching, reaching, and twisting, which may place the line of gravity outside the
Avoid stretching and twisting.
base of support.

Keep stance (feet) shoulder-width apart.

Ensure proper body stance. Tighten abdominal, gluteal, and leg muscles in anticipation of the move.
Stand up straight to protect the back and provide balance.

Place the weight of the object being moved close to your centre of gravity for balance.
Equilibrium is maintained as long as the line of gravity passes through its base of
Stand close to the object being moved. support.

Hold objects close to your centre of gravity

Face direction of the movement. Facing the direction prevents abnormal twisting of the spine.
 PRINCIPLES OF BODY MECHANICS
Data source: Berman & Snyder, 2016; Perry et al., 2014; WorkSafeBC, 2013

Turning, rolling, pivoting, and leverage

requires less work than lifting.
Do not lift if possible; use mechanical lifts as
Avoid lifting.
required.
Encourage the patient to help as much as
possible.
Keep all work at waist level to avoid stooping.
Work at waist level. Raise the height of the bed or object if possible.
Do not bend at the waist.
Reduce friction between Reduce friction between surfaces so that less
surfaces. force is required to move the patient.
Bending the knees maintains your centre of
Bend the knees. gravity and lets the strong muscles of your legs
do the lifting.
 PRINCIPLES OF BODY MECHANICS
Data source: Berman & Snyder, 2016; Perry et al., 2014; WorkSafeBC, 2013

Push the object rather than pull It is easier to push an object than to pull it.
it, and maintain continuous Less energy is required to keep an object
movement. moving than it is to stop and start it.
Use assistive devices (gait belt, slider boards,
Use assistive devices. mechanical lifts) as required to position patients
and transfer them from one surface to another.
The person with the heaviest load should
Work with others. coordinate all the effort of the others involved in
the handling technique.
POSITIONING
• POSITIONING a patient in bed is important for maintaining alignment and for
preventing bed sores (pressure ulcers), foot drop, and contractures. Proper
positioning is also vital for providing comfort for patients who are bedridden or
have decreased mobility related to a medical condition or treatment. When
positioning a patient in bed, supportive devices such as pillows, rolls, and
blankets, along with repositioning, can aid in providing comfort and safety
(Perry et al., 2014)
PURPOSES
• To promote comfort to the patient
• To relieve pressure on various parts
• To stimulate circulation
• To provide proper body alignment
• To carry out nursing intervention
• To perform surgical and medical interventions
• To prevent complications caused by immobility
• To promote normal physiological functions
BASIC PRINCIPLES IN POSITIONING OF PATIENTS

1. Maintain good patient body alignment. Think of the patient in bed

as though he were standing.
2. Maintain the patient's safety
3. Properly handle the patient's body to prevent pain or injury.
4. Keep in mind proper body mechanics for the practical nurse.
5. Obtain assistance, if needed, to move heavy or helpless patients
6. Follow specific physician's orders for ambulation and positioning.
7. Make sure the mattress is firm and level yet enough to give to fill
in and support natural body curvatures.
8. Ensure that the bed is clean and dry
9. Place support devices in specified areas according to the
client's position
10. Avoid placing one body part , particularly one with bony
prominences, directly on top on top of another body part
11. Avoid friction and shearing
12. Plan a systematic 24-hour schedule for position changes
13. Always obtain information from the client to determine which
position is most comfortable and appropriate
BODY POSITIONS
PRONE

Position in which the patient lies on the abdomen with the

head turned to one side with one small pillow under the
ankle.
INDICATIONS: Post operatively; Patient with pressure
sores, burns, injuries and operations on the back; To
relieve abdomen distension; Renal biopsy; Examine the
back; For patients after 24 hours of amputation of lower
limbs
SUPINE

The patient lies on his back with

his head and shoulders are
slightly elevated.
INDICATIONS: Examination of the
chest and abdomen; Post-
operative
FOWLER’S / SEMI-FOWLER’S
It is a sitting position in which the
head is elevated at 45˚ to 60˚, and
the client knees are slightly
elevated, avoiding pressure on
the popliteal vessels. Backrest
and two pillows are used for the
back and head. Pillows can be
used to maintain natural
alignment of the hands wrist and
forearms.
INDICATIONS: To relieve dyspnea;
To improve circulation; To relax
the muscles of the abdomen, back
and thighs; To relieve tension on
abdominal stature.
LATERAL
This position involves the patient
lying on either her right or left
side. Right lateral means the
patient’s right side is touching the
bed, while left lateral means the
patient’s left side is touching the
bed. A pillow is often placed in
between the legs for patient
comfort.
INDICATION: helps relieve
pressure on the coccyx
SIM’S
In this position the client lies on
either the right or left side. The lower
arm behind the body and upper arm
is bent at the shoulder and elbow.
The knees are both bent, with the
upper most leg more acutely bent.
These positions similar to the lateral
position except that the patient’s
weight is on the anterior aspect of
the patient’s shoulder girdle and hip.
INDICATIONS: Vaginal and rectal
examination; Administration of
enema and suppository; Used for
relaxation in antenatal exercises;
Position for sigmoidoscopy and
protoscopy
TRENDELENBURG
The patient lies on the back with the
head low. The foot of the bed is
elevated at 45˚ angle. Entire frame
of bed is tilted with head of bed
down.
INDICATIONS: Used in emergency
situations like shock, hemorrhage
and hypotension; Postural drainage;
Patients with deep vein thrombosis
REVERSE TRENDELENBURG
A supine position with the patient on
a plane inclined with the head higher
than the rest of the body and
appropriate safety devices such as a
footboard.
INDICATIONS: Used in surgery,
especially of the abdomen and
genitourinary system.
REVERSE TRENDELENBURG
A supine position with the patient on
a plane inclined with the head higher
than the rest of the body and
appropriate safety devices such as a
footboard.
INDICATIONS: Used in surgery,
especially of the abdomen and
genitourinary system.
DORSAL RECUMBENT
Patient lies on back, knees fully
flexed, thighs flexed and externally
rotated feet flat on the bed. In this
position clients with painful disorders
are more comfortable with knees
flexed. This position should not be
used for abdominal assessment
because it promotes contraction of
abdomen muscles.
INDICATIONS: Catheterization;
vaginal douche, vulval, vaginal and
rectal examination
LITOTHOMY
The client lies supine with hips
flexed. The legs are separated and
thighs are flexed. The patient’s
buttocks are kept at the edge of
the table and legs are supported
by stirrups.
INDICATIONS: For delivery of
baby; For rectal examination &
surgeries; For vaginal
examination & hysterectomy
KNEE-CHEST
The patient rests on the knees and the
chest. The body is at 90˚ angle to the hips
with back straight, the arm above the
head, and the head turned to one side.
The abdomen remains unsupported.
INDICATIONS: Used for vaginal and rectal
examination; Used in first aid treatment in
cord prolapse or retroverted uterus; As
exercise for postpartum and gynecology
patients.
ORTHOPNEIC

High fowler’s position with over bed table to be

placed across the front of the patient. Patient to
rest both hands on over bed table/on pillow
placed in it and leans forward. Leaning forward
facilitates respiration by allowing maximum
chest expansion by reducing pressure of
abdominal organs on diaphragm.
INDICATIONS: Patients with severe dyspnea;
Cardiac patients; Position for thoracocentesis;
Patient with chest drainage tubes
CLINICAL SITUATIONS IN WHICH YOU
MAY ENCOUNTER THESE SKILLS

• The client who has been confined to bed or who is weak who
may need assistance with ambulation. If the client is unsteady, a
second nurse should assist. The client may complain of dizziness
or faintness. If this happens, help the client to sit down or return
to bed.
• ADVERSE RESPONSES
• The client complains of dizziness or faintness.

• ANTICIPATED RESPONSES
• The client is able to ambulate without injury.
• The client does not complain of dizziness or faintness.
EQUIPMENT

• SLIPPERS
• HOUSECOAT
• AMBULATION (GAIT) BELT (OPTIONAL)
 PROCEDURE
1. Check the client’s medical diagnosis and any other medical
Assist you in determining any problems that may encountered.
problems.
2. Ask the client how long did he or she last walk and how far.
3. Clear the path of any obstacles.
4. Lock the wheels of the bed.
5. Lower the client’s bed to the lowest position.
6. Help the client to sit on the side of the bed.
7. Help the client to put on slippers and housecoat / patient
gown.
8. Apply an ambulation (gait) belt if needed.
9. Hand around his or her waist, or grasping the ambulation
belt. If the client has weaknesses on one side, you should
support that side.
10. After the walk is completed, help the client to return to bed. The client may be tired and may need your assistance.
11. Wash your hands
12. Assess how well the client tolerated the walk and whether
any dizziness was experienced.
13. Record the procedure
RATIONALE
Helps you to determine how far the client may be able to work.
Obstacles present a safety hazard to the client.
Prevents the bed from rolling when the client is moved.
Ensures the client’s safety
Helps the client to overcome any dizziness before standing or
prevent orthostatic hypertension.
Slippers protect the client’s feet. The shoes should have no
slip soles. Patient’s gown provides privacy and comfort to the
patient
Helps you support the client.
The client may be tired and may need your assistance.
Decreases the transmission of microorganisms.
These data are necessary for charting whether the client
experienced any problems.
Communicates to the other members of the health care team
and contributes to the legal record by documenting the care
given to the client.
ASSISTING WITH RANGE-
OF-MOTION (ROM)
EXERCISE (PASSIVE)
The movement of a joint to the extent possible without causing pain
PURPOSES

• PROMOTE AND MAINTAIN JOINT MOBILITY

• PREVENT CONTRACTURES AND SHORTENING OF MUSCLES AND TENDONS
• INCREASE CIRCULATION TO EXTREMITIES
• FACILITATE COMFORT FOR THE PATIENT
TYPES OF ROM
• ACTIVE ROM EXERCISES – Movement produced on a segment upon
active contraction of the muscles crossing the joint within the
unrestricted range of motion
• PASSIVE ROM EXERCISES – Movement produced by an external force
within the unrestricted range of motion of a segment
• ACTIVE ASSISTED ROM EXERCISES – Assistance is provided by an
outside force (manual or mechanical), as the prime mover
muscles are unable to complete the motion