{"id":1931,"date":"2015-03-31T20:35:12","date_gmt":"2015-03-31T20:35:12","guid":{"rendered":"http:\/\/opentextbc.ca\/clinicalskills\/?post_type=chapter&#038;p=1931"},"modified":"2021-06-09T15:09:08","modified_gmt":"2021-06-09T15:09:08","slug":"3-5-positioning-a-patient-on-the-side-of-a-bed","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/clinicalskills\/chapter\/3-5-positioning-a-patient-on-the-side-of-a-bed\/","title":{"raw":"3.6 Assisting a Patient to a Sitting Position and Ambulation","rendered":"3.6 Assisting a Patient to a Sitting Position and Ambulation"},"content":{"raw":"Immobility in hospitalized patients is known to cause functional decline and complications affecting the respiratory, cardiovascular, gastrointestinal, integumentary, musculoskeletal, and renal systems (Kalisch, Lee, &amp; Dabney, 2013). For surgical patients, early ambulation is the most significant factor in preventing complications (Sanguinetti, Wild, &amp; Fain, 2014). Lack of mobility and ambulation can be especially devastating to\u00a0the older adult when the aging process causes a more rapid decline in function (Graf, 2006). Ambulation provides not only improved physical function, but also improved emotional and social well-being (Kalisch et al., 2013).\r\n\r\nPrior to assisting a patient to ambulate, it is important to perform a patient risk assessment to determine how much assistance will be required. An assessment can evaluate a patient's muscle strength, activity tolerance, and ability to move, as well as the need to use assistive devices or find additional help. The amount of assistance will depend on the patient's condition, length of stay and procedure, and any previous mobility restrictions.\r\n<h2>Assisting Patient to the Sitting Position<\/h2>\r\nPatients who have been immobile for a long period of time may experience <strong>vertigo<\/strong>, a sensation of dizziness,\u00a0and <strong>orthostatic hypotension<\/strong>, a form of low blood pressure that occurs when changing position from lying down to sitting, making the patient feel dizzy, faint, or lightheaded (Potter, Perry, Ross-Kerr, &amp; Wood, 2010). For this reason, always begin the ambulation process by sitting the patient on the side of the bed for a few minutes with legs dangling. Checklist 27 outlines the steps to positioning the patient on the side of a bed prior to ambulation (Perry, et al., 2014).\r\n<table style=\"border-color: #000000; width: 100%;\" border=\"1px solid rgb(0, 0, 0)\"><caption><a id=\"checklist27\"><\/a>Checklist 27: Assisting a Patient to a Sitting Position<\/caption>\r\n<tbody>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"4\">\r\n<h5 style=\"text-align: center;\"><span style=\"color: #000000;\">Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"4\">\r\n<h5 style=\"text-align: left;\"><span style=\"color: #333333;\">Safety considerations:\u00a0<\/span><\/h5>\r\n<ul>\r\n \t<li><a href=\"\/clinicalskills\/chapter\/1-6-hand-hygiene\/\">Perform hand hygiene<\/a>.<\/li>\r\n \t<li><span style=\"color: #333333;\">Check room for <a href=\"\/clinicalskills\/chapter\/1-8-masks\/\">additional precautions<\/a>.\r\n<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Introduce yourself to patient.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Listen and attend to patient cues.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Ensure patient's privacy and dignity.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Assess <a href=\"\/clinicalskills\/chapter\/2-2-emergency-assessment-checklist\/\">ABCCS\/suction\/oxygen\/safety<\/a>.\r\n<\/span><\/li>\r\n \t<li>Ensure tubes and attachments are properly placed prior to the procedure to prevent accidental removal.<\/li>\r\n \t<li>Follow the principles of proper body mechanics with all patient-handling procedures<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">\r\n<h4 style=\"text-align: center;\">Steps<\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">\r\n<h4 style=\"text-align: center;\">Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">1. Check physician's order to ambulate and supplies for ambulation if required, and perform an assessment of patient's strength and abilities.\r\n\r\nCheck physician orders for any restrictions related to ambulation due to medical treatment or surgical procedure.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Supplies (proper footwear, gait belt, or assistive devices) must be gathered prior to ambulation. Do not leave patient sitting on the side of the bed unsupervised as this poses a safety risk.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">2. Explain what will happen and let the patient know how they can help.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This step provides the patient with an opportunity to ask questions and help with the positioning.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">3. Lower bed and ensure brakes are applied.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This prepares the work environment.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">4. Stand facing the head of the bed at a 45-degree angle with your feet apart, with one foot in front of the other. Stand next to the waist of the patient.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Proper positioning helps prevent back injuries and provides support and balance.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">5. Have patient turn onto side, facing toward the caregiver. Assist patient to move close to the edge of the bed.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This step prepares the patient to be moved.\r\n\r\n[caption id=\"attachment_6124\" align=\"aligncenter\" width=\"197\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-5851.jpg\"><img class=\" wp-image-6124\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-5851-262x300.jpg\" alt=\"Positioning patient on the side of the bed\" width=\"197\" height=\"226\" \/><\/a> Positioning patient on the side of the bed[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">6. Place one hand behind patient's shoulders, supporting the neck and vertebrae.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This provides support for the patient.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">7. On the count of three, instruct the patient to use their elbows to push up on the bed and then grasp the side rails, as you support the shoulders as the patient sits up. Shift weight from the front foot to the back foot.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Do not allow the patient to place their arms around your shoulders. This action can lead to serious back injuries.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">8. At the same time as you're shifting your weight, gently grasp the patient's outer thighs with your other hand and help the patient slide their feet off the bed to dangle or touch the floor.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This step helps the patient sit up and move legs off the bed at the same time.\r\n\r\n[caption id=\"attachment_6029\" align=\"aligncenter\" width=\"201\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-587.jpg\"><img class=\" wp-image-6029\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-587-223x300.jpg\" alt=\"Assisting patient into a sitting position\" width=\"201\" height=\"270\" \/><\/a> Assisting patient into a sitting position[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">\r\n<p style=\"text-align: left;\">9. Bend your knees and keep back straight and neutral.<\/p>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Use of proper body mechanics helps prevent injury when handling patients.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">\r\n<p style=\"text-align: left;\">10. On the count of three, gently raise the patient to sitting position. Ask patient to push against bed with the arm closest to the bed, at the same time as you shift your weight from the front foot to the back foot.<\/p>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This allows the patient to help with the process and prevents injury to the health care provider.\r\n\r\n[caption id=\"attachment_6030\" align=\"aligncenter\" width=\"167\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-588.jpg\"><img class=\" wp-image-6030\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-588-237x300.jpg\" alt=\"Assist into a sitting position\" width=\"167\" height=\"211\" \/><\/a> Assist into a sitting position[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">\r\n<p style=\"text-align: left;\">11. Assess patient for orthostatic hypotension or vertigo.<\/p>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">\r\n<p style=\"text-align: left;\">If patient is not dizzy or lightheaded, the patient is safe to ambulate.<\/p>\r\n<p style=\"text-align: left;\">If patient becomes dizzy or faint, lay patient back down on bed.<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">\r\n<p style=\"text-align: left;\">12. Continue with mobilization procedures as required.<\/p>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Mobilization helps prevent complications and improves physical function in hospitalized patients.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"4\">Data source: ATI, 2015b; Interior Health, 2013;\u00a0Perry et al., 2014; PHSA, 2010<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h3><a id=\"video3.2\"><\/a>Video 3.2<\/h3>\r\n<div class=\"textbox shaded\" style=\"text-align: center;\">Watch the video <a href=\"https:\/\/barabus.tru.ca\/nursing\/sit_to_stand.html\"><em>Sit to Stand Mechanical Assist<\/em><\/a>\u00a0by\u00a0<a href=\"\/clinicalskills\/back-matter\/appendix-3\/\">Ren\u00e9e Anderson &amp; Wendy McKenzie<\/a>, Thompson Rivers University.<\/div>\r\n<h2>Ambulating a Patient<\/h2>\r\n<strong>Ambulation<\/strong> is defined as moving a patient from one place to another (Potter et al., 2010). Once a patient is assessed as safe to ambulate, determine if assistance from additional health care providers or assistive devices is required. Checklist 28 reviews the steps to ambulating a patient with and without a gait belt.\r\n<table style=\"border-color: #000000; width: 100%;\" border=\"1px solid rgb(0, 0, 0)\"><caption><a id=\"checklist28\"><\/a>Checklist 28: Ambulating a Patient<\/caption>\r\n<tbody>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 100.905%;\" colspan=\"4\">\r\n<h5 style=\"text-align: center;\"><span style=\"color: #000000;\">Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 100.905%;\" colspan=\"4\">\r\n<h5 style=\"text-align: left;\"><span style=\"color: #333333;\">Safety considerations:<strong>\u00a0<\/strong><\/span><\/h5>\r\n<ul>\r\n \t<li><a href=\"\/clinicalskills\/chapter\/1-6-hand-hygiene\/\">Perform hand hygiene<\/a>.<\/li>\r\n \t<li><span style=\"color: #333333;\">Check room for <a href=\"\/clinicalskills\/chapter\/1-8-masks\/\">additional precautions<\/a>.\r\n<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Introduce yourself to patient.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Listen and attend to patient cues.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Ensure patient's privacy and dignity.<\/span><\/li>\r\n \t<li><span style=\"color: #333333;\">Assess <a href=\"\/clinicalskills\/chapter\/2-2-emergency-assessment-checklist\/\">ABCCS\/suction\/oxygen\/safety<\/a>.\r\n<\/span><\/li>\r\n \t<li>Ensure tubes and attachments are properly placed prior to the procedure to prevent accidental removal.<\/li>\r\n \t<li>Bring in required assistive devices and proper footwear.<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 49.9497%;\" colspan=\"2\">\r\n<h4 style=\"text-align: center;\">Steps<\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000; width: 50.9548%;\" colspan=\"2\">\r\n<h4 style=\"text-align: center;\">Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 49.9497%;\" colspan=\"2\">1. Ensure patient does not feel dizzy or lightheaded and is tolerating the upright position.\r\n\r\nInstruct the patient to sit on the side of the bed first, prior to ambulation.\r\n\r\nEnsure proper footwear is on patient, and let patient know how far you will be ambulating. Proper footwear is non-slip or slip resistant footwear. Socks are not considered proper footwear.\r\n\r\nCheck physician's orders for any activity restrictions related to treatment or surgical procedures.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 50.9548%;\" colspan=\"2\">Proper footwear is essential to prevent accidental falls.\r\n\r\n[caption id=\"attachment_6034\" align=\"aligncenter\" width=\"226\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-597.jpg\"><img class=\" wp-image-6034\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-597-300x182.jpg\" alt=\"Footwear\" width=\"226\" height=\"137\" \/><\/a> Footwear[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 49.9497%;\" colspan=\"2\">2. Apply gait belt snugly around the patient's waist if required.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 50.9548%;\" colspan=\"2\">\r\n\r\n[caption id=\"attachment_6482\" align=\"aligncenter\" width=\"183\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-118.jpg\"><img class=\"wp-image-6482\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-118-300x224.jpg\" alt=\"Assessment and instructions prior to ambulation\" width=\"183\" height=\"137\" \/><\/a> Assessment and instructions prior to ambulation[\/caption]\r\n\r\nGait belts are applied over clothing.\r\n\r\n[caption id=\"attachment_6483\" align=\"aligncenter\" width=\"148\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-119.jpg\"><img class=\" wp-image-6483\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-119-300x286.jpg\" alt=\"Apply gait belt over clothing\" width=\"148\" height=\"141\" \/><\/a> Apply gait belt over clothing[\/caption]\r\n\r\n[caption id=\"attachment_6485\" align=\"aligncenter\" width=\"171\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-121-001.jpg\"><img class=\"wp-image-6485\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-121-001-300x147.jpg\" alt=\"Sept 22, 2015 121-001\" width=\"171\" height=\"84\" \/><\/a> Gait belt should be snug, not tight[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 49.9497%;\" colspan=\"2\">3. Assist patient by standing in front of the patient, grasping each side of the gait belt, keeping back straight and knees bent.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 50.9548%;\" colspan=\"2\">The patient should be cooperative and predictable, able to bear weight on own legs and to have good trunk control. Apply gait belt if required for additional support.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 49.9497%;\" colspan=\"2\">4. While holding the belt, gently rock back and forth three times. On the third time, pull patient into a standing position.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 50.9548%;\" colspan=\"2\">This action provides momentum to help patient into a standing position.\r\n\r\n[caption id=\"attachment_6486\" align=\"aligncenter\" width=\"139\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-122-e1443986200821.jpg\"><img class=\"wp-image-6486\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-122-240x300.jpg\" alt=\"Rock back and forth to provide momentum\" width=\"139\" height=\"174\" \/><\/a> Rock back and forth to provide momentum[\/caption]\r\n\r\n[caption id=\"attachment_6487\" align=\"aligncenter\" width=\"126\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-124.jpg\"><img class=\" wp-image-6487\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-124-255x300.jpg\" alt=\"Pulled to a standing position\" width=\"126\" height=\"148\" \/><\/a> Pulled to a standing position[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 49.9497%;\" colspan=\"2\">5. Once patient is standing and feels stable, move to the unaffected side and grasp the gait belt in the middle of the back. With the other hand, hold the patient's hand closest to you.\r\n\r\nIf the patient does not require a gait belt, place hand closest to the patient around the upper arm and hold the patient's hand with your other hand.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 50.9548%;\" colspan=\"2\">Standing to the side of the patient provides assistance without blocking the patient.\r\n\r\n[caption id=\"attachment_6488\" align=\"aligncenter\" width=\"155\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-128.jpg\"><img class=\" wp-image-6488\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-128-260x300.jpg\" alt=\"Assisting ambulation with a gait belt\" width=\"155\" height=\"179\" \/><\/a> Assisting ambulation with a gait belt[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 49.9497%;\" colspan=\"2\">6. Before stepping away from the bed, ask the patient if they feel dizzy or lightheaded. If they do, sit patient back\u00a0down on the bed.\r\n\r\nIf patient feels stable, begin walking, matching your steps to the patient's. Instruct patient to look ahead and lift each foot off the ground.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 50.9548%;\" colspan=\"2\">Always perform a <a href=\"\/clinicalskills\/chapter\/positioning-a-patient-in-bed\/\">risk assessment prior to ambulation<\/a>.\r\n\r\nWalk only as far as the patient can tolerate without feeling dizzy or weak.\r\n\r\nAsk patient how they feel during ambulation.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 49.9497%;\" colspan=\"2\">7. To help a patient back to bed, have patient stand with back of knees touching the bed. Grasp the gait belt and help patient into a sitting position, keeping your back straight and knees bent.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 50.9548%;\" colspan=\"2\">Allowing a patient to rest after ambulation helps prevent fatigue.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 49.9497%;\" colspan=\"2\">8. When patient is finished ambulating, remove gait belt and settle patient into bed or a chair.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 50.9548%;\" colspan=\"2\">This provides a safe place for the patient to rest.\r\n\r\n[caption id=\"attachment_6483\" align=\"aligncenter\" width=\"126\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-119.jpg\"><img class=\"wp-image-6483\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-119-300x286.jpg\" alt=\"Apply gait belt over clothing\" width=\"126\" height=\"120\" \/><\/a> Remove gait belt[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 49.9497%;\" colspan=\"2\">9. When patient returns to bed, place the bed in lowest position, raise side rails as required, and ensure call bell is within reach. <a href=\"\/clinicalskills\/chapter\/1-6-hand-hygiene\/\">Perform hand hygiene<\/a>.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 50.9548%;\" colspan=\"2\">Placing bed and side rails in a safe position reduces the likelihood of injury to patient. Proper placement of call bell facilitates patient's ability to ask for assistance.\r\n\r\n[caption id=\"attachment_6489\" align=\"aligncenter\" width=\"167\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-067.jpg\"><img class=\" wp-image-6489\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-067-300x199.jpg\" alt=\"Bed in the lowest position, call bell in reach, and side rail up\" width=\"167\" height=\"111\" \/><\/a> Bed in the lowest position, call bell in reach, and side rail up[\/caption]\r\n\r\nHand hygiene reduces the spread of microorganisms.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 49.9497%;\" colspan=\"2\">10. Document patient's ability to tolerate ambulation and type of assistance required.<\/td>\r\n<td style=\"border: 1px solid #000000; width: 50.9548%;\" colspan=\"2\">This provides a baseline of patient's abilities and promotes clear communication between health care providers.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000;\">\r\n<td style=\"border: 1px solid #000000; width: 100.905%;\" colspan=\"4\">Data source: ATI, 2015b; Interior Health, 2013; Perry et al., 2014; PHSA, 2010<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h3><a id=\"video3.3\"><\/a>Video 3.3<\/h3>\r\n<div class=\"textbox shaded\" style=\"text-align: center;\">Watch the video <a href=\"https:\/\/barabus.tru.ca\/nursing\/ambulate_with_gait_belt.html\"><em>How to Ambulate With or Without a Gait Belt or Transfer Belt<\/em><\/a> by Kim Morris, Thompson Rivers University.<\/div>\r\n<h3><a id=\"video3.4\"><\/a>Video 3.4<\/h3>\r\n<div class=\"textbox shaded\" style=\"text-align: center;\">Watch the video\u00a0<a href=\"https:\/\/barabus.tru.ca\/nursing\/ambulate_with_cane.html\"><em>How to Ambulate with a Cane<\/em><\/a>\u00a0by Kim Morris of Thompson Rivers University.<\/div>\r\n<h3><a id=\"video3.5\"><\/a>Video 3.5<\/h3>\r\n<div class=\"textbox shaded\" style=\"text-align: center;\">Watch a video <em><a href=\"https:\/\/barabus.tru.ca\/nursing\/ambulate_with_crutches.html\">How to Ambulate With Crutches<\/a><\/em> by Kim Morris, Thompson Rivers University.<\/div>\r\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\r\n<p class=\"textbox__title\">Critical Thinking Exercises<\/p>\r\n\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<ol>\r\n \t<li>A 90-year-old male patient is required to ambulate. He had a total hip arthroplasty and is post-operative day 3 (POD 3). What risk factors should be considered prior to ambulating an elderly patient who has been immobile after hip surgery?<\/li>\r\n \t<li>Does ambulation require a physician's order?<\/li>\r\n \t<li>What should you do if a patient feels dizzy or lightheaded before ambulation?<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>","rendered":"<p>Immobility in hospitalized patients is known to cause functional decline and complications affecting the respiratory, cardiovascular, gastrointestinal, integumentary, musculoskeletal, and renal systems (Kalisch, Lee, &amp; Dabney, 2013). For surgical patients, early ambulation is the most significant factor in preventing complications (Sanguinetti, Wild, &amp; Fain, 2014). Lack of mobility and ambulation can be especially devastating to\u00a0the older adult when the aging process causes a more rapid decline in function (Graf, 2006). Ambulation provides not only improved physical function, but also improved emotional and social well-being (Kalisch et al., 2013).<\/p>\n<p>Prior to assisting a patient to ambulate, it is important to perform a patient risk assessment to determine how much assistance will be required. An assessment can evaluate a patient&#8217;s muscle strength, activity tolerance, and ability to move, as well as the need to use assistive devices or find additional help. The amount of assistance will depend on the patient&#8217;s condition, length of stay and procedure, and any previous mobility restrictions.<\/p>\n<h2>Assisting Patient to the Sitting Position<\/h2>\n<p>Patients who have been immobile for a long period of time may experience <strong>vertigo<\/strong>, a sensation of dizziness,\u00a0and <strong>orthostatic hypotension<\/strong>, a form of low blood pressure that occurs when changing position from lying down to sitting, making the patient feel dizzy, faint, or lightheaded (Potter, Perry, Ross-Kerr, &amp; Wood, 2010). For this reason, always begin the ambulation process by sitting the patient on the side of the bed for a few minutes with legs dangling. Checklist 27 outlines the steps to positioning the patient on the side of a bed prior to ambulation (Perry, et al., 2014).<\/p>\n<table style=\"border-color: #000000; width: 100%;\">\n<caption><a id=\"checklist27\"><\/a>Checklist 27: Assisting a Patient to a Sitting Position<\/caption>\n<tbody>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"4\">\n<h5 style=\"text-align: center;\"><span style=\"color: #000000;\">Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"4\">\n<h5 style=\"text-align: left;\"><span style=\"color: #333333;\">Safety considerations:\u00a0<\/span><\/h5>\n<ul>\n<li><a href=\"\/clinicalskills\/chapter\/1-6-hand-hygiene\/\">Perform hand hygiene<\/a>.<\/li>\n<li><span style=\"color: #333333;\">Check room for <a href=\"\/clinicalskills\/chapter\/1-8-masks\/\">additional precautions<\/a>.<br \/>\n<\/span><\/li>\n<li><span style=\"color: #333333;\">Introduce yourself to patient.<\/span><\/li>\n<li><span style=\"color: #333333;\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\n<li><span style=\"color: #333333;\">Listen and attend to patient cues.<\/span><\/li>\n<li><span style=\"color: #333333;\">Ensure patient&#8217;s privacy and dignity.<\/span><\/li>\n<li><span style=\"color: #333333;\">Assess <a href=\"\/clinicalskills\/chapter\/2-2-emergency-assessment-checklist\/\">ABCCS\/suction\/oxygen\/safety<\/a>.<br \/>\n<\/span><\/li>\n<li>Ensure tubes and attachments are properly placed prior to the procedure to prevent accidental removal.<\/li>\n<li>Follow the principles of proper body mechanics with all patient-handling procedures<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">\n<h4 style=\"text-align: center;\">Steps<\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">\n<h4 style=\"text-align: center;\">Additional Information<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">1. Check physician&#8217;s order to ambulate and supplies for ambulation if required, and perform an assessment of patient&#8217;s strength and abilities.<\/p>\n<p>Check physician orders for any restrictions related to ambulation due to medical treatment or surgical procedure.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Supplies (proper footwear, gait belt, or assistive devices) must be gathered prior to ambulation. Do not leave patient sitting on the side of the bed unsupervised as this poses a safety risk.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">2. Explain what will happen and let the patient know how they can help.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This step provides the patient with an opportunity to ask questions and help with the positioning.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">3. Lower bed and ensure brakes are applied.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This prepares the work environment.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">4. Stand facing the head of the bed at a 45-degree angle with your feet apart, with one foot in front of the other. Stand next to the waist of the patient.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Proper positioning helps prevent back injuries and provides support and balance.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">5. Have patient turn onto side, facing toward the caregiver. Assist patient to move close to the edge of the bed.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This step prepares the patient to be moved.<\/p>\n<figure id=\"attachment_6124\" aria-describedby=\"caption-attachment-6124\" style=\"width: 197px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-5851.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-6124\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-5851-262x300.jpg\" alt=\"Positioning patient on the side of the bed\" width=\"197\" height=\"226\" srcset=\"https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-5851-262x300.jpg 262w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-5851.jpg 894w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-5851-65x74.jpg 65w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-5851-225x258.jpg 225w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-5851-350x401.jpg 350w\" sizes=\"auto, (max-width: 197px) 100vw, 197px\" \/><\/a><figcaption id=\"caption-attachment-6124\" class=\"wp-caption-text\">Positioning patient on the side of the bed<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">6. Place one hand behind patient&#8217;s shoulders, supporting the neck and vertebrae.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This provides support for the patient.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">7. On the count of three, instruct the patient to use their elbows to push up on the bed and then grasp the side rails, as you support the shoulders as the patient sits up. Shift weight from the front foot to the back foot.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Do not allow the patient to place their arms around your shoulders. This action can lead to serious back injuries.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">8. At the same time as you&#8217;re shifting your weight, gently grasp the patient&#8217;s outer thighs with your other hand and help the patient slide their feet off the bed to dangle or touch the floor.<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This step helps the patient sit up and move legs off the bed at the same time.<\/p>\n<figure id=\"attachment_6029\" aria-describedby=\"caption-attachment-6029\" style=\"width: 201px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-587.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-6029\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-587-223x300.jpg\" alt=\"Assisting patient into a sitting position\" width=\"201\" height=\"270\" srcset=\"https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-587-223x300.jpg 223w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-587.jpg 760w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-587-65x88.jpg 65w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-587-225x303.jpg 225w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-587-350x472.jpg 350w\" sizes=\"auto, (max-width: 201px) 100vw, 201px\" \/><\/a><figcaption id=\"caption-attachment-6029\" class=\"wp-caption-text\">Assisting patient into a sitting position<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">\n<p style=\"text-align: left;\">9. Bend your knees and keep back straight and neutral.<\/p>\n<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Use of proper body mechanics helps prevent injury when handling patients.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">\n<p style=\"text-align: left;\">10. On the count of three, gently raise the patient to sitting position. Ask patient to push against bed with the arm closest to the bed, at the same time as you shift your weight from the front foot to the back foot.<\/p>\n<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">This allows the patient to help with the process and prevents injury to the health care provider.<\/p>\n<figure id=\"attachment_6030\" aria-describedby=\"caption-attachment-6030\" style=\"width: 167px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-588.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-6030\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-588-237x300.jpg\" alt=\"Assist into a sitting position\" width=\"167\" height=\"211\" srcset=\"https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-588-237x300.jpg 237w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-588.jpg 808w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-588-65x82.jpg 65w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-588-225x285.jpg 225w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-588-350x444.jpg 350w\" sizes=\"auto, (max-width: 167px) 100vw, 167px\" \/><\/a><figcaption id=\"caption-attachment-6030\" class=\"wp-caption-text\">Assist into a sitting position<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">\n<p style=\"text-align: left;\">11. Assess patient for orthostatic hypotension or vertigo.<\/p>\n<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">\n<p style=\"text-align: left;\">If patient is not dizzy or lightheaded, the patient is safe to ambulate.<\/p>\n<p style=\"text-align: left;\">If patient becomes dizzy or faint, lay patient back down on bed.<\/p>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">\n<p style=\"text-align: left;\">12. Continue with mobilization procedures as required.<\/p>\n<\/td>\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"2\">Mobilization helps prevent complications and improves physical function in hospitalized patients.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 250px;\" colspan=\"4\">Data source: ATI, 2015b; Interior Health, 2013;\u00a0Perry et al., 2014; PHSA, 2010<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3><a id=\"video3.2\"><\/a>Video 3.2<\/h3>\n<div class=\"textbox shaded\" style=\"text-align: center;\">Watch the video <a href=\"https:\/\/barabus.tru.ca\/nursing\/sit_to_stand.html\"><em>Sit to Stand Mechanical Assist<\/em><\/a>\u00a0by\u00a0<a href=\"\/clinicalskills\/back-matter\/appendix-3\/\">Ren\u00e9e Anderson &amp; Wendy McKenzie<\/a>, Thompson Rivers University.<\/div>\n<h2>Ambulating a Patient<\/h2>\n<p><strong>Ambulation<\/strong> is defined as moving a patient from one place to another (Potter et al., 2010). Once a patient is assessed as safe to ambulate, determine if assistance from additional health care providers or assistive devices is required. Checklist 28 reviews the steps to ambulating a patient with and without a gait belt.<\/p>\n<table style=\"border-color: #000000; width: 100%;\">\n<caption><a id=\"checklist28\"><\/a>Checklist 28: Ambulating a Patient<\/caption>\n<tbody>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 100.905%;\" colspan=\"4\">\n<h5 style=\"text-align: center;\"><span style=\"color: #000000;\">Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 100.905%;\" colspan=\"4\">\n<h5 style=\"text-align: left;\"><span style=\"color: #333333;\">Safety considerations:<strong>\u00a0<\/strong><\/span><\/h5>\n<ul>\n<li><a href=\"\/clinicalskills\/chapter\/1-6-hand-hygiene\/\">Perform hand hygiene<\/a>.<\/li>\n<li><span style=\"color: #333333;\">Check room for <a href=\"\/clinicalskills\/chapter\/1-8-masks\/\">additional precautions<\/a>.<br \/>\n<\/span><\/li>\n<li><span style=\"color: #333333;\">Introduce yourself to patient.<\/span><\/li>\n<li><span style=\"color: #333333;\">Confirm patient ID using two patient identifiers (e.g., name and date of birth).<\/span><\/li>\n<li><span style=\"color: #333333;\">Listen and attend to patient cues.<\/span><\/li>\n<li><span style=\"color: #333333;\">Ensure patient&#8217;s privacy and dignity.<\/span><\/li>\n<li><span style=\"color: #333333;\">Assess <a href=\"\/clinicalskills\/chapter\/2-2-emergency-assessment-checklist\/\">ABCCS\/suction\/oxygen\/safety<\/a>.<br \/>\n<\/span><\/li>\n<li>Ensure tubes and attachments are properly placed prior to the procedure to prevent accidental removal.<\/li>\n<li>Bring in required assistive devices and proper footwear.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 49.9497%;\" colspan=\"2\">\n<h4 style=\"text-align: center;\">Steps<\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000; width: 50.9548%;\" colspan=\"2\">\n<h4 style=\"text-align: center;\">Additional Information<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 49.9497%;\" colspan=\"2\">1. Ensure patient does not feel dizzy or lightheaded and is tolerating the upright position.<\/p>\n<p>Instruct the patient to sit on the side of the bed first, prior to ambulation.<\/p>\n<p>Ensure proper footwear is on patient, and let patient know how far you will be ambulating. Proper footwear is non-slip or slip resistant footwear. Socks are not considered proper footwear.<\/p>\n<p>Check physician&#8217;s orders for any activity restrictions related to treatment or surgical procedures.<\/td>\n<td style=\"border: 1px solid #000000; width: 50.9548%;\" colspan=\"2\">Proper footwear is essential to prevent accidental falls.<\/p>\n<figure id=\"attachment_6034\" aria-describedby=\"caption-attachment-6034\" style=\"width: 226px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-597.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-6034\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-597-300x182.jpg\" alt=\"Footwear\" width=\"226\" height=\"137\" srcset=\"https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-597-300x182.jpg 300w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-597.jpg 1024w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-597-65x39.jpg 65w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-597-225x137.jpg 225w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-597-350x213.jpg 350w\" sizes=\"auto, (max-width: 226px) 100vw, 226px\" \/><\/a><figcaption id=\"caption-attachment-6034\" class=\"wp-caption-text\">Footwear<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 49.9497%;\" colspan=\"2\">2. Apply gait belt snugly around the patient&#8217;s waist if required.<\/td>\n<td style=\"border: 1px solid #000000; width: 50.9548%;\" colspan=\"2\">\n<figure id=\"attachment_6482\" aria-describedby=\"caption-attachment-6482\" style=\"width: 183px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-118.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-6482\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-118-300x224.jpg\" alt=\"Assessment and instructions prior to ambulation\" width=\"183\" height=\"137\" srcset=\"https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-118-300x224.jpg 300w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-118-65x48.jpg 65w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-118-225x168.jpg 225w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-118-350x261.jpg 350w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-118.jpg 902w\" sizes=\"auto, (max-width: 183px) 100vw, 183px\" \/><\/a><figcaption id=\"caption-attachment-6482\" class=\"wp-caption-text\">Assessment and instructions prior to ambulation<\/figcaption><\/figure>\n<p>Gait belts are applied over clothing.<\/p>\n<figure id=\"attachment_6483\" aria-describedby=\"caption-attachment-6483\" style=\"width: 148px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-119.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-6483\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-119-300x286.jpg\" alt=\"Apply gait belt over clothing\" width=\"148\" height=\"141\" srcset=\"https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-119-300x286.jpg 300w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-119-65x62.jpg 65w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-119-225x214.jpg 225w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-119-350x333.jpg 350w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-119.jpg 627w\" sizes=\"auto, (max-width: 148px) 100vw, 148px\" \/><\/a><figcaption id=\"caption-attachment-6483\" class=\"wp-caption-text\">Apply gait belt over clothing<\/figcaption><\/figure>\n<figure id=\"attachment_6485\" aria-describedby=\"caption-attachment-6485\" style=\"width: 171px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-121-001.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-6485\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-121-001-300x147.jpg\" alt=\"Sept 22, 2015 121-001\" width=\"171\" height=\"84\" srcset=\"https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-121-001-300x147.jpg 300w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-121-001-65x32.jpg 65w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-121-001-225x110.jpg 225w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-121-001-350x171.jpg 350w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-121-001.jpg 873w\" sizes=\"auto, (max-width: 171px) 100vw, 171px\" \/><\/a><figcaption id=\"caption-attachment-6485\" class=\"wp-caption-text\">Gait belt should be snug, not tight<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 49.9497%;\" colspan=\"2\">3. Assist patient by standing in front of the patient, grasping each side of the gait belt, keeping back straight and knees bent.<\/td>\n<td style=\"border: 1px solid #000000; width: 50.9548%;\" colspan=\"2\">The patient should be cooperative and predictable, able to bear weight on own legs and to have good trunk control. Apply gait belt if required for additional support.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 49.9497%;\" colspan=\"2\">4. While holding the belt, gently rock back and forth three times. On the third time, pull patient into a standing position.<\/td>\n<td style=\"border: 1px solid #000000; width: 50.9548%;\" colspan=\"2\">This action provides momentum to help patient into a standing position.<\/p>\n<figure id=\"attachment_6486\" aria-describedby=\"caption-attachment-6486\" style=\"width: 139px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-122-e1443986200821.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-6486\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-122-240x300.jpg\" alt=\"Rock back and forth to provide momentum\" width=\"139\" height=\"174\" \/><\/a><figcaption id=\"caption-attachment-6486\" class=\"wp-caption-text\">Rock back and forth to provide momentum<\/figcaption><\/figure>\n<figure id=\"attachment_6487\" aria-describedby=\"caption-attachment-6487\" style=\"width: 126px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-124.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-6487\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-124-255x300.jpg\" alt=\"Pulled to a standing position\" width=\"126\" height=\"148\" srcset=\"https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-124-255x300.jpg 255w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-124-65x76.jpg 65w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-124-225x265.jpg 225w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-124-350x412.jpg 350w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-124.jpg 745w\" sizes=\"auto, (max-width: 126px) 100vw, 126px\" \/><\/a><figcaption id=\"caption-attachment-6487\" class=\"wp-caption-text\">Pulled to a standing position<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 49.9497%;\" colspan=\"2\">5. Once patient is standing and feels stable, move to the unaffected side and grasp the gait belt in the middle of the back. With the other hand, hold the patient&#8217;s hand closest to you.<\/p>\n<p>If the patient does not require a gait belt, place hand closest to the patient around the upper arm and hold the patient&#8217;s hand with your other hand.<\/td>\n<td style=\"border: 1px solid #000000; width: 50.9548%;\" colspan=\"2\">Standing to the side of the patient provides assistance without blocking the patient.<\/p>\n<figure id=\"attachment_6488\" aria-describedby=\"caption-attachment-6488\" style=\"width: 155px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-128.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-6488\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-128-260x300.jpg\" alt=\"Assisting ambulation with a gait belt\" width=\"155\" height=\"179\" srcset=\"https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-128-260x300.jpg 260w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-128-65x75.jpg 65w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-128-225x260.jpg 225w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-128-350x404.jpg 350w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-128.jpg 822w\" sizes=\"auto, (max-width: 155px) 100vw, 155px\" \/><\/a><figcaption id=\"caption-attachment-6488\" class=\"wp-caption-text\">Assisting ambulation with a gait belt<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 49.9497%;\" colspan=\"2\">6. Before stepping away from the bed, ask the patient if they feel dizzy or lightheaded. If they do, sit patient back\u00a0down on the bed.<\/p>\n<p>If patient feels stable, begin walking, matching your steps to the patient&#8217;s. Instruct patient to look ahead and lift each foot off the ground.<\/td>\n<td style=\"border: 1px solid #000000; width: 50.9548%;\" colspan=\"2\">Always perform a <a href=\"\/clinicalskills\/chapter\/positioning-a-patient-in-bed\/\">risk assessment prior to ambulation<\/a>.<\/p>\n<p>Walk only as far as the patient can tolerate without feeling dizzy or weak.<\/p>\n<p>Ask patient how they feel during ambulation.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 49.9497%;\" colspan=\"2\">7. To help a patient back to bed, have patient stand with back of knees touching the bed. Grasp the gait belt and help patient into a sitting position, keeping your back straight and knees bent.<\/td>\n<td style=\"border: 1px solid #000000; width: 50.9548%;\" colspan=\"2\">Allowing a patient to rest after ambulation helps prevent fatigue.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 49.9497%;\" colspan=\"2\">8. When patient is finished ambulating, remove gait belt and settle patient into bed or a chair.<\/td>\n<td style=\"border: 1px solid #000000; width: 50.9548%;\" colspan=\"2\">This provides a safe place for the patient to rest.<\/p>\n<figure id=\"attachment_6483\" aria-describedby=\"caption-attachment-6483\" style=\"width: 126px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-119.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-6483\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-119-300x286.jpg\" alt=\"Apply gait belt over clothing\" width=\"126\" height=\"120\" srcset=\"https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-119-300x286.jpg 300w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-119-65x62.jpg 65w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-119-225x214.jpg 225w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-119-350x333.jpg 350w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-119.jpg 627w\" sizes=\"auto, (max-width: 126px) 100vw, 126px\" \/><\/a><figcaption id=\"caption-attachment-6483\" class=\"wp-caption-text\">Remove gait belt<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 49.9497%;\" colspan=\"2\">9. When patient returns to bed, place the bed in lowest position, raise side rails as required, and ensure call bell is within reach. <a href=\"\/clinicalskills\/chapter\/1-6-hand-hygiene\/\">Perform hand hygiene<\/a>.<\/td>\n<td style=\"border: 1px solid #000000; width: 50.9548%;\" colspan=\"2\">Placing bed and side rails in a safe position reduces the likelihood of injury to patient. Proper placement of call bell facilitates patient&#8217;s ability to ask for assistance.<\/p>\n<figure id=\"attachment_6489\" aria-describedby=\"caption-attachment-6489\" style=\"width: 167px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-067.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-6489\" src=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-067-300x199.jpg\" alt=\"Bed in the lowest position, call bell in reach, and side rail up\" width=\"167\" height=\"111\" srcset=\"https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-067-300x199.jpg 300w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-067-1024x678.jpg 1024w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-067-65x43.jpg 65w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-067-225x149.jpg 225w, https:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Sept-22-2015-067-350x232.jpg 350w\" sizes=\"auto, (max-width: 167px) 100vw, 167px\" \/><\/a><figcaption id=\"caption-attachment-6489\" class=\"wp-caption-text\">Bed in the lowest position, call bell in reach, and side rail up<\/figcaption><\/figure>\n<p>Hand hygiene reduces the spread of microorganisms.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 49.9497%;\" colspan=\"2\">10. Document patient&#8217;s ability to tolerate ambulation and type of assistance required.<\/td>\n<td style=\"border: 1px solid #000000; width: 50.9548%;\" colspan=\"2\">This provides a baseline of patient&#8217;s abilities and promotes clear communication between health care providers.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000;\">\n<td style=\"border: 1px solid #000000; width: 100.905%;\" colspan=\"4\">Data source: ATI, 2015b; Interior Health, 2013; Perry et al., 2014; PHSA, 2010<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3><a id=\"video3.3\"><\/a>Video 3.3<\/h3>\n<div class=\"textbox shaded\" style=\"text-align: center;\">Watch the video <a href=\"https:\/\/barabus.tru.ca\/nursing\/ambulate_with_gait_belt.html\"><em>How to Ambulate With or Without a Gait Belt or Transfer Belt<\/em><\/a> by Kim Morris, Thompson Rivers University.<\/div>\n<h3><a id=\"video3.4\"><\/a>Video 3.4<\/h3>\n<div class=\"textbox shaded\" style=\"text-align: center;\">Watch the video\u00a0<a href=\"https:\/\/barabus.tru.ca\/nursing\/ambulate_with_cane.html\"><em>How to Ambulate with a Cane<\/em><\/a>\u00a0by Kim Morris of Thompson Rivers University.<\/div>\n<h3><a id=\"video3.5\"><\/a>Video 3.5<\/h3>\n<div class=\"textbox shaded\" style=\"text-align: center;\">Watch a video <em><a href=\"https:\/\/barabus.tru.ca\/nursing\/ambulate_with_crutches.html\">How to Ambulate With Crutches<\/a><\/em> by Kim Morris, Thompson Rivers University.<\/div>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\">Critical Thinking Exercises<\/p>\n<\/header>\n<div class=\"textbox__content\">\n<ol>\n<li>A 90-year-old male patient is required to ambulate. He had a total hip arthroplasty and is post-operative day 3 (POD 3). What risk factors should be considered prior to ambulating an elderly patient who has been immobile after hip surgery?<\/li>\n<li>Does ambulation require a physician&#8217;s order?<\/li>\n<li>What should you do if a patient feels dizzy or lightheaded before ambulation?<\/li>\n<\/ol>\n<\/div>\n<\/div>\n","protected":false},"author":5,"menu_order":6,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-1931","chapter","type-chapter","status-publish","hentry"],"part":1510,"_links":{"self":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/1931","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/users\/5"}],"version-history":[{"count":29,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/1931\/revisions"}],"predecessor-version":[{"id":10199,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/1931\/revisions\/10199"}],"part":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/parts\/1510"}],"metadata":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/1931\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/media?parent=1931"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapter-type?post=1931"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/contributor?post=1931"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/license?post=1931"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}