9.6: Summary
9.1 Assessing Functional Ability
Assessing a patient’s functional status is important in planning care. There are many validated and standardized tools to assess the patient’s baseline status. These tools are to be used not only by the nurse but also with input and discussion among the interprofessional team members, such as physical therapy, occupational therapy, physicians, other nurses, and patient care technicians. Nurses and their colleagues should always have a plan of care based on their assessment and data from the tool. This allows for a personalized plan with interventions to promote patients’ functional abilities and improve ADLs. There are many simple exercises patients can perform to improve their ADL functionality. Some exercises only require body weight such as isotonic and isometric exercises, and others may require minimal equipment, such as a resistance band, for isokinetic exercises.
9.2 Assessing Mobility
This section identified key factors that affect mobility. Internal factors such as changes due to aging and medical conditions should be combined with external factors such as climate and housing structure. A comprehensive mobility assessment includes ROM, posture, gait, balance, and strength measurements to gather data about a patient’s mobility status. Limitations in mobility can affect multiple body systems, so improving mobility and educating patients on the importance of mobility is essential for healthy living.
9.3 Transferring Patients
Safe patient handling includes techniques in transferring, lifting, and ambulating patients using assistance from nurses, equipment, devices, and proper body alignment. Patient transfers that are poorly managed are associated with higher fall rates, morbidity, mortality, and healthcare worker injury. A variety of devices, ranging from sling transfers and sliding boards to gait belts and crutches, are available for patients who are weight-bearing or non-weight-bearing or have an impaired gait, muscle weakness, joint problems, or injury. Nurses should use a step-by-step process to gather their supplies and equipment, clearly communicate, guide the patient through all the steps of the movement, and monitor the patient for pain or adverse symptoms. Patient education should include safety measures, maneuver instructions, and signs and symptoms to report to the nurse. Clear communication during patient transfer can ensure patient safety and prevent healthcare worker injury.
9.4 Positioning in Bed
A patient who is immobile in bed for long periods of time is at risk for musculoskeletal complications due to reductions in muscle mass and bone mineral density, improper body alignment, and impairment of other body systems. Equipment and devices, such as specialty mattresses, are designed to offload pressure from pressure points in the body and eliminate friction and shear. Specialty boots and wedges, as well as mattresses and repositioning techniques, relieve and distribute pressure throughout the body and aid in alignment. Common patient positions include prone, lateral, supine, and Fowler’s. Nurses should educate patients and families about the various devices available to provide comfort for the patient. Collaboration with physical and occupational therapists is also beneficial as their expertise is in function and mobility.
9.5 Limited Movement Devices
A bone or soft tissue injury may warrant limiting mobility in a joint or limb. The limitation of movement allows the body to repair the injury without the risk of re-injury, complications, or further damage. Common types of devices include casts, braces, slings, bandages, skeletal traction, and external fixation. Each device has its own appropriate indications when treating injury. Nurses should be proactive in caring for these patients, and provide targeted assessments to recognize and prevent complications.
In certain situations, restraint use may be necessary. Restraints can be physical or chemical. The nurse should always ensure that the least restrictive measure is used, the restraint is used properly, frequent assessments are completed to prevent complications, the environment remains safe for the patient and staff, and the restraint is discontinued as soon as possible. Alternatives such as patient diversion, pain relief, and diversionary techniques can reduce the need for restraints, especially in long-term care settings.