Proper Body Mechanics for caregivers

Introduction:

Back pain is an economic and social issue within healthcare. It is the main reason stated for sickness and absence and is a significant occupational health problem that has an influence in all areas of health care provision (Wanless, 2018). Nursing is a job that needs a lot of bending our backs, flexing our arms and legs, and pushing and pulling patients. Because of this, many nurses are at risk for developing physical strain and back injuries or even fractures.   Back pain in healthcare workers have shown a correlation between the symptoms of back pain and being in a poor posture, from lifting clients and patients and musculoskeletal stress in the workplace (Wanless, 2018). One way to prevent these from happening is to practice proper body mechanics. The nurse or nursing assistant will use body mechanics daily in making beds, assisting patients to walk, carrying supplies and equipment, providing patient care, and carrying out other procedures. The characteristic ways that people sit, stand and walk are among the strongest of all habits, with deep roots in an individual’s personality and so changing posture may be as difficult as quitting any type of major behavioral change.

Common Causes of injury to healthcare workers

Healthcare workers constantly rank amongst the main occupations with permanent back injuries which occur mainly from the handling of patients. This is true for caregivers in the hospital, long term care facilities and Home Health Agencies. The hazards that lead to injury are:

<!--[if !supportLists]-->·         <!--[endif]-->Poor posture

<!--[if !supportLists]-->·         <!--[endif]-->Out-of-shape and overweight conditions

<!--[if !supportLists]-->·         <!--[endif]-->Failure to prepare.

<!--[if !supportLists]-->·         <!--[endif]-->Incorrect movement

<!--[if !supportLists]-->·         <!--[endif]-->Failure to wear slip-resistant footwear.

<!--[if !supportLists]-->·         <!--[endif]-->Combative, contracted, or uncooperative residents or patients

<!--[if !supportLists]-->·         <!--[endif]-->Unpredictable behavior (i.e., sudden resistance or grabbing)

<!--[if !supportLists]-->·         <!--[endif]-->Space limitations

<!--[if !supportLists]-->·         <!--[endif]-->Lack of assistance

<!--[if !supportLists]-->·         <!--[endif]-->Lack of assistive devices

<!--[if !supportLists]-->·         <!--[endif]-->Tight or restrictive clothing that inhibits movement (i.e., bending or stooping)

<!--[if !supportLists]-->·         <!--[endif]-->Moving too quickly

<!--[if !supportLists]-->·         <!--[endif]-->Not working at an appropriate height (i.e., back is stooped)

Body Mechanics

Body mechanics is the way the parts of the body work together whenever you move. It involves the coordinated effort of muscles, bones, and the nervous system to maintain balance, posture, and alignment during moving, transferring, and positioning patients. Body mechanics also involves standing and moving one’s body to prevent injury, avoid fatigue, and make the best use of strength. When you learn how to control and balance your own body, you can safely control and move another person. Good body mechanics are based on good posture and good posture is when the spine is in a “neutral” or sloppy “S” position, so it is not too rounded forward and not arched back too far in what is termed as a critical “C” position (Wanless, 2018). Good posture is usually regarded as the most comfortable position and is the natural position of the spine in a normal, healthy person. Being in a standing position puts the spine in to a neutral healthy position rather than that in a sitting position where the spine is regarded as comfortably straight. Proper body mechanics allows individuals to carry out activities without excessive use of energy and helps prevent injuries for patients and health care providers (Perry, Potter, & Ostendorf, 2014).

ELEMENTS OF BODY MECHANICS

The essential elements of good body mechanics are alignment, base of support and center of gravity.

Alignment: When standing, sitting, or lying down, you should try to keep your body in alignment. This means that the two sides of the body are mirror images of each other, with body parts lined up naturally. This brings body parts into position to promote optimal balance and body function. When the body is well aligned, whether standing, sitting, or lying, the strain on the joints, muscles, tendons, and ligaments is minimized.  Body alignment is achieved by placing one body part in line with another body part in a vertical or horizontal line. Correct alignment contributes to body balance and decreases strain on muscle-skeletal structures. Without this balance, the risk of falls and injuries increase.

Base of Support: The feet are the body’s base of support. This means that they are the foundation that supports you when you stand. The wider the base of support, the more stable it is. So, a person who is standing with legs apart has a greater base of support and is more stable than someone standing with the feet close together. A wide base of support is achieved by placing feet a comfortable, shoulder width distance apart.

Center of Gravity: The center of gravity in your body is the point where the most weight is concentrated. This point will depend on the position the body is in. When you stand, your weight is centered in your pelvis and therefore lowers your center of gravity. This gives you more stability and makes you less likely to fall or strain the working muscles. A lower center of gravity increases stability. This can be achieved by bending the knees and bringing the center of gravity closer to the base of support, keeping the back straight.

Rules of proper body mechanics

The brain is the most important part of the body to use in applying proper body mechanics. The brain enables you to think before acting. You must think about good body mechanics while performing every task or activity, making sure to follow the rules of proper body mechanics.

<!--[if !supportLists]-->·         <!--[endif]-->Assess the load: Before attempting a lift, assess the weight of the load to determine if you can safely move the object without help. Know the lift policies of the facility and never attempt a lift you do not feel comfortable doing. Consider using assistive devices as necessary. When you are satisfied that you can perform the lift alone, or you have enough help to perform the lift, prepare the environment.

<!--[if !supportLists]-->·         <!--[endif]-->Think ahead, plan, and communicate the move. Scan the environment for any objects in your path or any potential risk such a wet floor. Ensure pathway is clear. Accounts for hazards like high traffic areas, combative residents or patients, person losing balance or a loose toilet seat. Decide exactly what you are going to do together and agree on verbal cues you will use before attempting to transfer.

<!--[if !supportLists]-->·         <!--[endif]-->Check your base of support and be sure you have firm footing. Use a wide but balanced stance to increase your base of support and keep this stance when walking. Keep stance (feet) shoulder-width apart and tighten abdominal, gluteal, and leg muscles in anticipation of the move. Stand up straight to protect the back and provide balance. Ensure you have enough room to maintain a wide base of support and ensure you and the resident are wearing slip resistant shoes.

<!--[if !supportLists]-->·         <!--[endif]-->Face what you are lifting. Your feet should always face the direction you are moving. This enables you to move your body as one unit and keep your back straight. Twisting at the waist increases the likelihood of injury. Avoid stretching, reaching, and twisting, which may place the line of gravity outside the base of support.

<!--[if !supportLists]-->·         <!--[endif]-->Keep your back straight. Keep your head up and shoulders back in proper position. Take a deep breath to help regain correct posture.

<!--[if !supportLists]-->·         <!--[endif]-->Begin in a squatting position and lift with your legs. Bend at the hips and knees and use the strength of your leg muscles to stand and lift the object. You need to push your buttocks out to accomplish this. Before you stand erect with the object, remember it is your legs, not your back that will enable you to lift. You should be able to feel your leg muscles as they work. Lifting with the large leg muscles decreases stress on the back.

<!--[if !supportLists]-->·         <!--[endif]-->Contract (tighten) your stomach muscles when beginning to lift. This will help to take the weight off the spine and maintain alignment.

<!--[if !supportLists]-->·         <!--[endif]-->Keep the object close to your body. This decreases the distance from your center of gravity to the object being carried and the stress to your back. Lift objects to your waist. Carrying objects any higher can compromise your balance.

<!--[if !supportLists]-->·         <!--[endif]-->Do not twist. Turn and face the area you are moving the object to and set the object down. Twisting increases the stress on your back and should always be avoided. The muscles that you use to twist are not strong and therefore twisting is not as stable as turning your whole body as one unit.

<!--[if !supportLists]-->·         <!--[endif]-->Push or pull, when possible, rather than lifting. When you lift an object, you must overcome gravity and be able to balance the load. When you push or pull an object, you only need to overcome the friction between the surfaces of the object. You can use the body weight to move the object, rather than pull whenever possible, and stay close to the object to decrease distance from your center of gravity to the object being carried. Use both arms and tighten the stomach muscles. Avoid lifting. Turning, rolling, pivoting, and leverage requires less work than lifting. Do not lift if possible and encourage the patient to help as much as possible. Use mechanical lifts as required.

<!--[if !supportLists]-->·         <!--[endif]-->Work at waist level. Keep all work at waist level to avoid stooping by Raising the height of the bed or object if possible. Do not bend at the waist.

<!--[if !supportLists]-->·         <!--[endif]-->Use assistive devices (gait belt, slider boards, mechanical lifts) as required to position patients and transfer them from one surface to another.

<!--[if !supportLists]-->·         <!--[endif]-->Work with others. The person with the heaviest load should coordinate all the effort of the others involved in the handling technique.

Importance of Body Mechanics

The importance of body mechanics impacts healthcare workers such as nurses because of the frequent need to move and lift patients. Each time a nurse transfers a patient to the commode or chair, they risk back or neck injury if proper body mechanics are not followed. If a staff member sits for long hours at a desk, it is imperative that proper techniques for sitting, and posture are followed to reduce shoulder, neck, and back strain. When spending multiple hours standing during the day, understanding the proper stance and the need for stretching can reduce fatigue and muscle aches. Proper body mechanics is therefore important to avoid musculoskeletal strain, injuries to healthcare workers, injuries to residents or patients and fatigue (Jayakrishnan, 2016).

Common examples of applying body mechanics

Lifting a heavy object off the floor

To lift a heavy object from the floor, spread your feet apart and bend your knees. Using the strong, large muscles in your thighs, upper arms, and shoulders, lift the object and pull it close to your center of gravity and base of support. When you stand up, push with your strong hip and thigh muscles to raise your body and the object together. Do not twist when you are moving an object. Always face the object or person you are moving. Pivot your feet instead of twisting at the waist.

Helping a resident or patient sit up, stand up or walk.

Whenever you need to support a resident or patient’s weight, protect yourself by assuming a good stance. Your feet should be 12 inches or hip width apart, one foot in front of the other, and knees bent. Your upper body should stay upright and in alignment. If the resident or patient starts to fall, you will be in a good position to help support him or her. However, never try to catch a falling resident or patient. In the event of a resident or patient falling, assist the resident or patient to the floor or a level area. If you try to reverse a fall in progress, you will probably injure yourself and/or the resident or patient.

Making a bed or any job that requires bending.

Anytime a task requires bending, you should use a good stance, bending your knee to lower yourself rather than bending from the waist. This allows you to use the big muscles in your legs and hips rather than straining the smaller muscles in your back. If you are making an adjustable bed, adjust the height to working level. If you are making a regular bed, you may need to put one knee on the bed, lean, or even kneel to support yourself at working level. Avoid bending at the waist.