In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of ergonomic principles in order to:

  • Assess client ability to balance, transfer and use assistive devices prior to planning care (e.g., crutches, walker)
  • Provide instruction and information to client about body positions that eliminate potential for repetitive stress injuries
  • Use ergonomic principles when providing care (e.g., assistive devices, proper lifting)

Ergonomics is a scientific discipline that addresses the human being in the environment to facilitate human wellbeing. For example, an ergonomically designed computer mouse and ergonomically and anatomically correct chairs that curve to conform to our normal lumbar curve are examples of ergonomic principles applied to products that are used in the home and the workplace.

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. An example of a good body mechanics principle is to push rather then pull objects and people.

Nurses must apply the principles of ergonomics and well as body mechanics in their personal and professional life.

Assessing the Client Ability to Balance, Transfer and Using Assistive Devices Prior to Planning Care

Upon admission, and whenever a significant client change occurs, the client's ability to balance, safely transfer and use assistive devices is assessed and then incorporated into the client's plan of care. As previously discussed in terms of falls and fall prevention, the nurse assessing the client may determine that the client is at risk for falls because they lack the muscular strength, coordination, and/or balance to do so in a safe manner and without injury to self and the staff that are performing care.

In addition to increasing the client's muscular strength, coordination, and/or balance, nurses, often in collaboration with a physical therapist and other health care providers, nurses assess the client's ability to safely use an assistive device such as a walker or a cane to facilitate their movement and ambulation.

Providing Instruction and Information to Client about Body Positions that Eliminate the Potential for Repetitive Stress Injuries

In addition to the fact that health care staff must be knowledgeable about and use good body mechanics and ergonomic principles, clients also need knowledge and skill in content areas including body position, proper bodily alignment and ways to prevent repetitive stress injuries.

Some of the common used, anatomically correct positions that are used by patients in bed are the Fowler's position which is a sitting position with the head of the bed elevated, the dorsal recumbent position and supine positions which are lying on the back with or without a pillow for the head, the prone position on the stomach, the lateral position which is a side lying position with the upper most knee bent and often maintained in that position with a pillow, and the Sim's position which is a semi prone position.

Repetitive stress injuries, simply defined, are injuries that lead to muscular and neurological pain and discomfort, stiffness, and cramping as the result of repeated and repetitive movements and other things that lead to the overuse of a muscle or muscle group. The most often affected muscles and muscle groups include those of the wrist, forearm, elbow, fingers, hands, neck and shoulders.

Some of the activities and conditions associated with repetitive stress injuries include:

  • Prolonged and intense activity without taking a break from it
  • Poor posture and poor bodily alignment
  • Stress
  • Cold ambient temperatures

Using Ergonomic and Body Mechanics Principles When Providing Care

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.

Safe patient handling and the application of the principles of body mechanics protect the patient and they also protect the nurse. Patients benefit because they are being lifted and transferred by one or more people who are using the strongest muscles of the body and nurses benefit because they have avoided patient injury and they have also protected themselves from sometimes severe and permanent injuries, particularly to their back, which can sometimes cease the nurse's ability to return to nursing.

In addition to getting the assistance of another or using a mechanical life, nurses should follow these principles of safe patient handling and body mechanics.

  • 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. For example, tell the patient to bend their knees and press their feet into the mattress and, then on the count of three, tell the patient that they should push up to the top of the bed as you assist them. Even very weak patients can help you with a lift or transfer when they know what you are about to do and how they can help you.
  • 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.
  • Tuck your chin in and keep your neck and head aligned.
  • 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 and.
  • Use slow, smooth and non-jerky movements.

If your facility requires the use of a back support and/or you choose to use it, please understand that these back supports are useful, however, they will not protect you unless you also use good body mechanics.

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 also for patients who are, for one reason or another, not able to provide any help or assistance with their lifts and transfers, such as a person who is paralyzed.

A gait or transfer belt is also used to assist with transfers and lifting. These wide and sturdy belts are placed around the patient's waist when they stand, transfer and ambulate. They are very often also used for physical therapy.

Slide boards are particularly useful to move a patient from one flat surface to another. These boards reduce friction and, therefore, make the move easier and less irritating to the patient's skin.

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