After completing the chapter, you will be able to accomplish the following:

1. Assist a patient with repositioning in bed.
2. Transfer a patient from the bed to a stretcher.
3. Transfer a patient from the bed to a chair.
4. Transfer a patient using a full-powered body sling lift.
5. Provide range-of-motion exercises.
6. Assist a patient with ambulation.
7. Assist a patient with ambulation using a walker.
8. Assist a patient with ambulation using crutches.
9. Assist a patient with ambulation using a cane.
10. Apply and remove graduated compression stockings.
11. Apply pneumatic compression devices.
12. Apply a continuous passive motion device.
13. Apply a sling.
14. Apply a figure-eight bandage.
15. Assist with a cast application.
16. Care for a patient with a cast.
17. Apply and care for a patient in skin traction.
18. Care for a patient in skeletal traction.
19. Care for a patient with an external fixation device.

• Assessment
• Clinical Decision Making/Clinical Judgment
• Functional ability
• Health promotion
• Mobility

• abduction
• adduction
• arthroplasty
• compartment syndrome
• contractures
• contusions
• deep vein thrombosis (DVT)
• extension
• flexion
• fracture
• friction
• pronation
• range of motion (ROM)
• rotation
• safe patient handling and mobility (SPHM)
• shearing forces
• supination
• thrombophlebitis
• venous stasis

The ability to move is closely related to the fulfillment of other basic human needs. Regular exercise contributes to the healthy functioning of each body system. Conversely, lack of exercise and immobility affect each body system negatively. A summary of the effects of immobility on the body is outlined in Fundamentals Review 9-1. An important nursing role is to encourage activity and exercise to promote wellness, prevent illness, and restore health.

Nursing interventions are directed at preventing potential problems and treating actual problems related to a patient's activity and mobility status. Strategies designed to promote correct body alignment, mobility, and fitness are important parts of nursing care. Nurses use knowledge of safe patient handling and mobility (SPHM) along with specific nursing interventions to promote fitness and to address mobility problems.

An effective approach to safe patient transfers includes patient assessment criteria; screening and algorithms for patient handling and mobility decisions; specialized patient handling equipment used properly and operated using proper ergonomics; and the use of lift teams. The proper use of assistive devices to lift, move, reposition, and transport patients is key to SPHM (Fragala et al., 2016). In addition, the use of assistive patient handling equipment contributes to patient comfort and protects patient dignity, while increasing safety. The National Institute for Occupational Safety and Health (NIOSH, 2013) and the Occupational Safety and Health Administration and the Joint Commission recommend a no-lift policy in conjunction with technology, assistive devices, education, and a culture of safety for all health care facilities (Fragala et al., 2016; OSHA and Joint Commission Resources Alliance, 2017). Many devices and equipment are available to aid in transferring, repositioning, lifting and/or moving patients. It is important to use the right equipment and appropriate device based on patient assessment and desired movement and to use the equipment in the proper manner (Arnold, 2019; Fragala et al., 2016).

Always check facility practices and guidelines and available equipment related to safe patient handling and movement. Samples of algorithms to aid decision making to prevent injury to staff and patients during patient movement and handling are provided in the appropriate skills. When using any equipment, check for proper functioning before using with the patient. Fundamentals Review 9-2 presents guidelines for safe patient handling and mobility. Fundamentals Review 9-3 discusses examples of equipment and assistive devices that are available to aid with safe patient mobility and handling. Fundamentals Review 9-4 provides an example of a mobility assessment tool to aid in patient assessment and associated SPHM equipment to consider. See also Figure 1 in Skill 9-1 for an example of an algorithm (assessment tool) to aid in decision making regarding safe patient handling and mobility to reposition a patient in bed.

This chapter covers skills to assist the nurse in providing care related to activity and inactivity, and health care problems related to the musculoskeletal system.

1. Teaching that should be included for Bobby and his parents related to his injury and his plaster cast includes the following: keeping the extremity elevated to reduce edema; handling the cast with the palm of the hands for the first 24 to 36 hours; keeping the cast uncovered until fully dry; reporting pain, odor, drainage, changes in sensation, abnormal sensation, or the inability to move his fingers; and avoiding putting anything in the cast.
2. Reassure the patient, Esther Levitz, that the device will not hurt. Explain how the pneumatic compression device works and the rationale for its use. In addition, describe potential adverse symptoms, such as pain or discomfort in the legs and changes in sensation that the patient should report while the pneumatic compression device is in use.
3. Additional assessments that should be performed as part of Mr. Esposito's care include the following: assessing the traction equipment to ensure proper function, including inspecting the ropes for fraying and proper positioning; assessing the patient's body alignment; performing skin and neurovascular assessments; assessing pin sites; performing a pain assessment; assessing for complications of immobility, including alterations in respiratory function, skin integrity, urinary and bowel elimination, and muscle weakness, contractures, thrombophlebitis, pulmonary embolism, and fatigue.