12.8.10: Procedure- Helping the Patient to Ambulate (Walk)
Many patients will benefit from ambulation (walking), even for short distances. It helps to promote strength, endurance, and to improve circulation. It can also provide distraction and a sense of empowerment for a patient. Never push a patient to walk further than they feel able. Always follow the Care Plan for guidelines and instructions in ambulating a patient.
- Explain the procedure to the patient. Ensure the patient understands the benefits for their health of ambulation. Provide reassurance and safety for the patient throughout ambulation.
- Instruct and assist the patient to apply appropriate shoes. Shoes should be laced if they have laces and should have rubber backing with treads for safety. Socks should be worn with shoes.
- If using a gait belt, walk slightly behind and to the side of the patient, while holding onto the gait belt with both hands. If the patient is weaker on one side, Home Health Aides/Personal Care Aides should stand on the weaker side to provide extra support.
- If not using a gait belt, walk slightly behind and to the side of the patient, while supporting the patient’s back with the arm closest to the patient. Use your other arm to provide necessary support at the patient’s waist or to hold their arm at their elbow.
- Walk slowly, taking small steps, and provide reassurance as needed. Instruct the patient to look forward, and not down, during walking. Assess the patient’s strength, balance, and any signs of fatigue while you are walking.
- If the patient has a visual impairment, provide directions and inform the patient of any obstacles in their way, steps that need to be stepped up or down on, and when corners will be turned.
- Ensure the patient uses ambulation devices (e.g. cane, walker) safely and appropriately.
- Walk for short distances and take the patient’s response to the walking into consideration. If the patient appears fatigued, encourage and take breaks. Allow the patient to sit and rest if needed.
- If the patient begins to fall during ambulation, widen your stance. Bring the patient’s body close to you to provide support. Bend your knees and using the strength of your thighs, lower the patient to the ground. If the patient falls, do not attempt to get the patient up alone. The agency may require the patient gets evaluated by a nurse before helping the patient back up. Report the near fall or any actual falls immediately to a supervisor. Report any injuries or concerns. Home Health Aides/Personal Care Aides will also likely be required to complete an incident report, and they should seek direction from their supervisor about completing the incident report.
- Observe, record, and report any changes in condition or behavior. Document the distance the patient walked and assistance needed during ambulation.
- Procedure: Transfer to a Wheelchair, Chair, or Commode
When transferring a patient to a wheelchair, chair, or commode, Home Health Aides/Personal Care Aides should position the chair the patient is transferring to on the patient’s strongest side. When transferring a patient back to the bed, wheelchair, or another chair, they should reverse the procedure, following the same safety rules. Home Health Aides/Personal Care Aides should always use proper body mechanics to ensure the safety of themselves and their patient.
- Explain the procedure to the patient.
- Wash your hands and don gloves as needed.
- Ensure the bed locks are on and the bed is in its lowest position.
- Angle the wheelchair, chair, or commode next to the bed. Angle it so that it is slightly turned toward the bed. If using a wheelchair, ensure the chair brakes are on and remove the footrests.
- Assist the patient to a sitting position as outlined in the procedure , “ Helping the Patient to Sit at the Side of the Bed”.
- Place non-skid slippers or shoes on the patient’s feet.
- Place a gait belt on the patient, if using.
- Stand in front of, and facing, the patient. Place your feet about 12 inches apart. Use your thigh muscles to provide a strong base of support. Keep your back aligned with your hips. Slightly bend your knees. Remember to avoid twisting your body as you move. Brace your knees against the patient’s knees and block their feet with yours. Alternatively, you can place one knee and foot against the patient’s weakest leg. Your other foot should be slightly behind you. You may also straddle both your legs around the patient’s weakest leg.
- Place your hands on the patient’s waist, or if using a gait belt, grasp the gait belt with both hands.
- If able, instruct the patient to push down on the bed with their hands at their sides. Instruct them that you will assist them to a stand on the count of 3. Alternatively, instruct the patient to place their hands on your hips or shoulders. Do not allow them to hold onto your face or neck.
- With a gentle rocking back and forth motion, and on the count of three, assist the patient to a stand. If using a gait belt, follow the same procedure.
- Assist the patient to pivot slightly toward the chair/wheelchair.
- Instruct the patient to take small steps backward until they feel the chair/wheelchair/commode behind their knees.
- When the patient’s knees are touching the chair/wheelchair/commode, ask them to put their hands on the armrests, and gently lower them into a sitting position.
- Stay in front of the patient and check to ensure they are not experiencing dizziness, weakness, or shortness of breath. Make sure to record and report any conditions observed or statements made by the patient to indicate this.
- If putting a patient into a wheelchair or chair with wheels, ensure the locks are on and leg rests are positioned so that the patient’s feet are resting comfortably on the footplates.
- If the patient begins to fall during a transfer, widen your stance. Bring the patient’s body close to you to provide support. Bend your knees and using the strength of your thighs, lower the patient to the ground. Home Health Aides/Personal Care Aides should report the near fall or any actual falls immediately to their supervisor. Do not attempt to get the patient up alone. The agency may require the patient gets evaluated by a nurse before helping the patient back up. Report any injuries or concerns. Home Health Aides/Personal Care Aides will also likely be required to complete an incident report, and should seek direction from their supervisor about completing the incident report.
- Position and cover the patient for comfort, warmth, and privacy.
- Remove gloves if wearing and wash your hands.
- Document the procedure and any observations or changes in condition.