Body Mechanics

 

Please watch this Patient Lifting Techniques video made by Therapists from rehabilitation provider Tx

 

INTRODUCTION

Nursing job requirements includes lifting, moving and carrying objects. Not surprisingly, nursing ranks among the worst occupations in relation to work-related injuries pushing nearly half of the profession into an early retirement. Nursing staff often experience musculoskeletal disorders at a rate exceeding that of workers in construction, mining, and manufacturing.These injuries are due in large part to repeated manual patient handling activities, often involving heavy manual lifting associated with transferring, and repositioning patients and working in extremely awkward postures. The problem of lifting patients is compounded by the increasing weight of patients to be lifted due to the obesity epidemic in the United States and the rapidly increasing number of older people who require assistance with the activities of daily living.

Due to nature of their duties, nurse aides are subject to back and other injuries to the body so practicing correct body mechanics is critical. Proper use of body mechanics maximizes strength, minimizes fatigue, avoids muscle strain and injury, and assures personal and patient’s safety.

 

Terminology

• Alignment (posture) – how the head, trunk, arms, and legs are aligned with one another, when the back is straight
• Base of Support – foundation that supports an object
• Body Mechanics – efficient and safe use of the body by the coordination of body alignment, balance, and movement
• Center of Gravity – point where most weight is concentrated for an object or body
• Posture- is the position in which you hold your body upright against gravity while standing, sitting or lying down
• Good posture –is when the spinal curves are in correct alignment. It involves training your body to stand, walk, sit and lie in positions where the least strain is placed on supporting muscles and ligaments during movement or weight-bearing activities.
• Ergonomics- is the study of body mechanics. It studies the physiologic limitations of body movement and what factors contribute to musculoskeletal disorders. It evaluates what factors contribute to repetitive stress injuries, and what changes can be made in the workplace to protect employees from developing such work-related injuries.

 

Background

Continuous, repeated performance of patient handling tasks  like lifting and repositioning, is the primary cause for musculoskeletal disorders among the nursing workforce causing  severely debilitating back injuries and shoulder strains. Compared to other occupations, nursing personnel are among the highest at risk for musculoskeletal disorders.

Every year, low back pain accounts for 93 million workdays lost and costs over 5 billion dollars. Direct and indirect costs associated with back injuries in the healthcare industry are estimated to be $20 billion annually. Nurses and Nursing Assistants suffer the highest prevalence (18.8%) and report the most annual cases (269,000) of work-related back pain among female workers in the United States. Some of the most common injuries sustained by members of the health care team are severe musculoskeletal strains like low back pain. Lower back injuries are also the most costly musculoskeletal disorder affecting nursing staff. Studies of back-related workers compensation claims reveal that nursing personnel have the highest claim rates of any occupation or industry.

Many injuries can be avoided by the conscious use of proper body mechanics when performing physical labor like transferring or lifting a patient. Most work-related injuries are preventable if a person maintains good physical condition, understands basic body mechanics, and practices proper techniques with lifts and transfers. 

Body mechanics is the utilization of correct muscles to complete a task safely and efficiently, without undue strain on any muscle or joint. The adult spine is shaped like a shallow “S” with three natural curves which are; neck curve is seven cervical vertebrae, middle back curve is twelve thoracic vertebrae, and low back curve is five lumbar vertebrae. It is very important for Nurse Assistants to be aware that they only have one back and need to protect their back from work related injuries. A healthy back requires lifelong attention, maintaining good posture, proper exercise and proper body mechanics.

Regulation/Legislation

• The Occupational Safety and Health Administration (OSHA) promulgated a standard intended to protect workers from ergonomic hazards, such as patient handling. In March 2001, Congress repealed the OSHA standard and ordered that the agency cease all work related to the standard.
• In March 2003, federal OSHA released its “Guidelines for Nursing Homes – Ergonomics for the Prevention of Musculoskeletal Disorders.” In these “Guidelines,” which are not requirements, OSHA recommends that “manual lifting of patients be minimized in all cases and eliminated when feasible.” Legislation was introduced in three states in 2003 but was not enacted.

 

California’s safe patient handling policy

The state of California’s Hospital Patient and Health Care Worker Injury Protection Act (AB 1136) became effective on January 1, 2012. This law, which has been incorporated into the California Labor Code as Section 6403.5 requires general acute care hospitals to adopt a safe patient handling policy as part of the Injury and Illness Prevention Program. AB 1136 became effective on January 1, 2012. It is now incorporated into the California Labor Code as Section 6403.5. Designed to protect nursing staff from work-related injuries, the patient handling policy requires replacement of manual lifting and transferring of patients with powered patient transfer devices, lifting devices, and lift teams, as appropriate for the specific patient and consistent with the employer’s safety policies and the professional judgment and clinical assessment of the registered nurse. The employer is required to maintain a safe patient handling policy at all times for all patient care units, and is required to provide trained lift teams or other support staff trained in safe lifting techniques.

PRINCIPLES OF GOOD BODY MECHANICS

Maintain a Stable Center of Gravity.

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.

1. Keep your feet apart.
2. Place one foot slightly ahead 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 the base of support.

1. Keep your back straight.
2. Keep the object being lifted close to your body.

 

Maintain Proper Body Alignment.

1. Tuck in your buttocks.
2. Pull your abdomen in and up.
3. Keep your back flat.
4. Keep your head up.
5. Keep your chin in.
6. Keep your weight forward and supported on the outside of your feet

 

TECHNIQUES 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 upward, 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 of support.
5. Before moving the object, be sure that 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.

 

AVOID STOOPING

1. Squat (bending at the hips and knees).
2. Avoid stooping (bending at the waist).
3. Use your leg muscles to return to an upright position.

 

GENERAL CONSIDERATIONS FOR PERFORMING PHYSICAL TASKS

1. It is easier to pull, push, or roll an object than it is to lift it.
2. Movements should be smooth and coordinated rather than jerky.
3. Less energy or force is required to keep an object moving than it is to start and stop it.
4. Use the arm and leg muscles as much as possible, the back muscles as little as possible.
5. Keep the work as close as possible to your body. It puts less of a strain on your back, legs, and arms.
6. Rock backward or forward on your feet to use your body weight as a pushing or pulling force.
7. Keep the work at a comfortable height to avoid excessive bending at the waist.
8. Keep your body in good physical condition to reduce the chance of injury.
   • Never lift more than you can comfortably handle.
   • Create a base of support by standing with your feet 8–12” (shoulder width) apart with one foot a half-step ahead of the other.
   • DO NOT let your back do the heavy work—USE YOUR LEGS. (The back muscles are not your strongest muscles.)
   • If the bed is low, put one foot on a footstool. This relieves pressure on your lower back.
   • Consider using a support belt for your back.

 

REASONS FOR THE USE OF PROPER BODY MECHANICS

Use proper body mechanics in order to avoid the following:

1. Excessive fatigue.
2. Muscle strains or tears.
3. Skeletal injuries.
4. Injury to the patient.
5. Injury to assisting staff members

 

Correct Lifting Position

• If you must lift objects, do not try to lift objects that are awkward or are heavier than 30 pounds.
• Before you lift a heavy object, make sure you have firm footing.
• To pick up an object that is lower than the level of your waist, keep your back straight and bend at your knees and hips. Do not bend forward at the waist with your knees straight.
• Stand with a wide stance close to the object you are trying to pick up and keep your feet firm on the ground. Tighten your stomach muscles and lift the object using your leg muscles. Straighten your knees in a steady motion. Don’t jerk the object up to your body.
• Stand completely upright without twisting. Always move your feet forward when lifting an object.
• If you are lifting an object from a table, slide it to the edge to the table so that you can hold it close to your body. Bend your knees so that you are close to the object. Use your legs to lift the object and come to a standing position.
• Avoid lifting heavy objects above waist level.
• Hold packages close to your body with your arms bent. Keep your stomach muscles tight. Take small steps and go slowly.
• To lower the object, place your feet as you did to lift, tighten stomach muscles and bend your hips and knees
• Keep your work close to your body. – This is the most basic principle of good body mechanics.
• Maintain your whole body in good alignment. Transferring patients from bed to chair or vice versa can be the most dangerous activity because there is a tendency to bend at the waist and twist at the same time.
• When moving a patient, count “1, 2 and 3” with patient moving on “3” to synchronize your actions

 

             Why is it important?

• Reduces costs for facilities

• Reduces injuries for patients and employees

• Reduces employee absences due to back injuries

• Reduces liability for the facility due to workman’s compensation

• Increase patient’s satisfaction

 

Moving a Person

Nurse Assistants should use these tips when moving a patient either in bed or out of bed

• Plan the move and know what you can and cannot do.
• Let the patient do as much work as he is capable of.
• Avoid letting the patient put his arms around your neck or grab you.
• Use a transfer belt to balance and support the patient
• Place transfer surfaces (wheelchair and bed) close together.
• Check wheelchair position, brakes locked, armrests and footrests swung out of the way.
• Let the patient look to the place where he is being transferred.
• If the patient is able, place his hands on the bed or chair so he can assist in the movement. If the patient has had a stroke or is afraid, have him clasp his hands close to his chest.
• Ask the patient to push rather than pull on the bed rails, the chair, or you.
• Work at the patient’s level and speed and check for pain.
• Avoid sudden jerking motions
• Never pull on the patient’s arms or shoulders.
• Have the person wear shoes with good treads or non skid socks.

 

General Rules of Lifting

• Never lift more than you can comfortably handle.
• Create a base of support by standing with your feet 8–12” (shoulder width) apart with one foot a half-step ahead of the other.
• DO NOT let your back do the heavy work—USE YOUR LEGS. (The back muscles are not your strongest muscles.)
• If the bed is low, put one foot on a footstool. This relieves pressure on your lower back.
• Consider using a support belt for your back

 

Three behaviors for good posture are;

      a. Achieve and maintain a healthy weight

b. Control the stress in your life

c. Do regular exercise to strengthen muscles, reduce vulnerability to disease, and resist power of gravity

 

CONCLUSION

It is far easier to prevent injuries than it is to fix them after they occur. Although it is the responsibility of the employer to provide a safe, “work-friendly” environment, it is the responsibility of employees to use good body mechanics and maintain healthy life-style habits to help prevent injury.

 

 

 

 

References:

Nursing Fundamentals 1 Multimedia Edition – Body Mechanics – Techniques of Body Mechanics. (n.d.). Retrieved November 15, 2014, from http://www.brooksidepress.org/Products/Nursing_Fundamentals_1/lesson_4_Section_1.htm

Preventing Back Injuries in Health Care Settings. (n.d.). Retrieved November 15, 2014, from http://blogs.cdc.gov/niosh-science-blog/2008/09/22/lifting/