Learning objectives:
1 describe the principles of moving andturning clients.
2 demonstrate the procedures for turningpositions.
3 demonstrate the procedures for movingclient up in bed.
4 demonstrate the procedures fortransferring client by gurney or wheelchair.
Trying to lift or move too much weightforces you to use your body incorrectly and frequently causes injures.Incorrect lifting puts most of the pressure on the muscles of your lower back.Because these muscles are not strong enough to handle the stress, you cansustain severe injuries. If you do not follow guidelines for promoting properbody mechanics, you are putting yourself in jeopardy (危险).Proper use of body mechanics prevents injuries to clients and all members ofthe health team. Guidelines that underlie the implementation of body mechanics appear below.
1 Assume a proper stance before moving orturning clients.
2 Distribute workload evenly before movingor turning clients.
3 Establish a comfortable height whenworking with clients.
4 Use large muscles for lifting andmoving, not the back muscles.
5 Avoid leaning and stretching.
6 Avoid twisting your body.
Principles of moving and turning clients
1. Beforeyou lift or move a client, determine the causes and consequences（后果) of the client’s illness. This knowledge enables you to move the clientwithout causing additional discomfort. If there are any kinds of tubes（管道) the client wear, you should check if the tube is twisted（扭曲) or pressed after moving. If the dressing（敷料) is wet, youshould change it before moving. If there is traction（牵引), you shouldn’t relax it. If there is wound, shouldn’t press it.
2. Evaluate（评估) the client’s weight and the extent he can move himself in order todecide how much person you need to move the client. Assess the weight of everypart of the client’s body to know where is the center of gravity （重心)of the part, and then you can distribute（分配) workload evenlybefore moving or turning clients. The weight of head, neck and trunk（躯干) of a person is about 58% of the whole weight, so when moving a clientyou should pay more attention to the part. Upper limb（肢)is about 5%; lower limb is about 16%.
3. Beforeyou begin, thoroughly explain the procedures you will be completing so that youobtain the client’s cooperation.
4. Positionsin which clients are placed, methods of moving, and turning should all be basedon the principles of maintaining the musculoskeletal（骨骼肌肉) system in proper alignment（同轴性).
5. Whenmoving a client you should lift him or her up from bed, in case of rubbing the skin off.
Objectives
To provideincreased comfort
To preventcomplications（并发症). Such as press ulcer（压疮), joint contractures（关节挛缩), pneumonia（肺炎).
To facilitate（使方便) treatment and nursing
1. Identifythe client.
2. Explainthe rationale（基本原理) for the procedure to the client.
3. Lowerthe head of the bed completely or to a position that is as low as the clientcan tolerate.
4. Elevate（提高) the bed to a comfortable working height.
5. Put theclient’s hands on his abdomen（腹部) orchest.
6. Movethe client to your side of the bed. First move his head and should; and thenmove his hip and leg.
7. Flexthe client’s knees.
8. Placeone hand on client’s hip and one hand on the client’s shoulder; roll onto side.
9. Positionpillow to maintain proper alignment. Be sure to position the client’s arms sothat they are not under the body.
Turning position with two nurses
1~5, 9 are the same as before.
6. Positionone nurse at the client’s upper body. The nurse’s arm nearest the head of thebed should be under the client’s head and opposite shoulder. The other armshould be under the client’s chest. Position the other nurse at the client’slower torso（躯干). Thenurse’s arms should be under the client’s lower back and thighs（大腿).
7. Coordinatethe movements of all nurses on count of three. Move the client to your side ofthe bed.
8. Place one hand of the nurse who is at the client’supper body on client’s shoulder, the other on waist; place one hand of theother nurse who is at the client’s lower torso on client’s hip and the other onknee. Roll the client onto side coordinately.
Moving the client up in bed
Objectives
To provide comfort
To move the client up in bed who can’t movehimself
Procedure
Moving upwith one nurse
7. Identifythe client
8. Explainthe rationale for procedure to the client.
9. Lowerthe head of the bed so that it is flat or as low as the client can tolerate.
10. Raisethe bed to a comfortable working height.
11. Removethe pillow and place it at the head of the bed. This prevents striking theclient’s head against the bed.
12. Placeone arm under the client’s shoulders and the other arm under the client’sthighs.
13. Instructthe client to hold the railings（栏杆), bendlegs and put feet flat on the bed.
14. Flexyour knees and hips. Move feet close to bed.
15. Placeyour weight on your back foot.
16. Shiftyour weight from back to front foot as you lift the client up in bed.
17. Askclient to push with feet as you move him.
18. Positionthe client comfortably, replacing the pillow and arranging bedding asnecessary.
Note: There are several other methods of moving a client up in bed---includingusing client’s elbows, and having client use the trapeze（秋千).
Moving up with two nurse
1~5 are the same as before.
6. Positionwith two nurses or staff members.
u Firstposition: Position one nurse on each side of the client. Each nurse should have one arm under theclient’s shoulders and one arm under the client’s thighs.
u Alternativeposition: Place folded drawsheet（垫单) under client’s body extending from shoulder lineto just below buttocks. Position one nurse owww.med126.com/pharm/n each sideof bed. Roll up sides of lift sheet as close as possible to sides of client.Assist client to flex knees, if possible. Each nurse firmly grasps（抓)sheet at level of client’s upper back with one hand and at level of buttockswith other hand.
7. Coordinatethe movements of all nurses.
8. Nursesplace weight on back foot and shift weight to front foot with the move, liftingclient toward head of bed.
9. Placeclient in a comfortable position.
Transferring Client
Transferring Client From Bed ToGurney
Objectives
To transporting client who can’tmove himself to receive some examinations or treatments, etc.
Equipment
Gurney（平车) with sheet, pillow, quilt（被子)
Board on the gurney if the client is fracture（骨折)
Procedure
Choosing methods according to theclient’s illness and weight.
Transferring by himself
For the client who can cooperatewith you
1. Identifythe client.
2. Explainthe rationale for the procedure to the client.
3. Placebed in flat position and lower side rails on the side nearest nurses.
4. Positionthe gurney and the bed in immediate contact and lock brakes（刹车).
5. Assistthe client move himself in sequence（顺序): upper body, hip, lower torso.
6. Checkclient alignment, fix safety straps（皮带) on gurney, and put up side rails. Ensures clientsafety during transfer.
Note: when transferring theclient from gurney to bed, moving sequence: lower torso, hip, upper body.
Transferring with one nurse
For the client who’s state ofillness is not so bad and who’s weight is light
1~3 are the same as before.
4. Positionthe gurney at obtuse angle（钝角) tobed, the head of the gurney and the end of the bed contact with each other.Lock brakes.
5. Placeone arm nearest the head of the bed under the client’s upper back and hold thefar edge. The other arm under the client’s thighs and hold it too.
6. Ask theclient’s arms round the nurse’s neck.
7. Liftthe client up from bed, and transfer the client to the gurney.
8. Positionthe client comfortably, arranging bedding as necessary.
Transferring with two and three nurses
It’s a common method to moveclient. For the client who’s illness is worse than before and who is heavy.
1~4 are the same as before.
5. Placeclient’s arms across chest or stomach.
6. Positionnurses on the side toward which the client will move.
u Positionwith two nurses: Position one nurse at the client’s upper body. The nurse’s armnearest the head of the bed should be under the client’s head, neck andopposite shoulder. The other arm should be under the client’s waist, and holdfar side of it. Position the other nurse at the client’s lower torso. Thenurse’s arms should be under the client’s hips and knees. Note: the fingersshould be wrapped around client’s body, which allow a secure hold before movingclient to gurney.
u Positionwith three nurses: one nurse is at the head, neck, shoulders and chest, one atthe waist and hips, and the third nurse is at the knees and ankles of theclient.
7. Flexknees. This position reduces back strain and lowers center of gravity.
8. Liftclient on the count of three and bring client to nurses’ chests. Counting tothree ensures that nurses will move together and keep client in alignment.
9. Steptoward gurney with client on the second count of three.
10. Lowerclient gently to center of gurney by flexing knees and hips. This positionprevents back strain from bending at the waist.
11. Checkclient alignment, fix safety straps on gurney, and put up side rails.
12. Arrangingbedding as necessary.
Transferring with four nurses
This method is used to moveclient whose vertebras（脊椎)arebroken or the state of illness is critical. When you use this method, youshould prepare a sheet. The function of the sheet is to maintain client’s bodyin alignment more effectively. This is crucial to the client whose vertebrasare broken.
1~4 are the same as before.
5. Placefolded drawsheet under client’s body extending fromshoulder line to just below buttocks.
6. Positionone nurse at the head of bed whose arm should be under the head, neck and twoshoulders of client. One at the end of bed whose arm should be under the feetof client. The other two nurses on each side of bed roll up sides of lift sheetas close as possible to sides of client, firmly grasp sheet with one hand atthe level of chest and one hand at the level of hips.
7. Flexknees. This position reduces back strain and lowers center of gravity.
8. Liftclient on the count of three. Counting to three ensures that nurses will movetogether and keep client in alignment.
9~12 are the same as before.
How to move the gurney
1. Payattention to the client’s state of illness in case anything happens.
2.&nwww.med126.combsp; Thespeed you move the gurney should not be too quick.
3. When upor down a slope, the head of client should be at the upper position.
4. Ifthere are big wheels and small wheels, the head of client should be put on thepart of big wheels.
5. Ifthere is a door, you should open the door first, and then pull the gurney in.
Moving client from bed to wheelchair（轮椅)
Moving client from bed to stretcher litter（担架)
