55. CCA Study Notes: Body Mechanics and Safe Client Moving, Repositioning, and Transfers

The Big Picture

Moving and repositioning clients requires planning. You need to protect the client while also protecting yourself from injury.

Good posture, balance, correct equipment, teamwork, and careful movement all matter. Before moving a client, check the care plan, consider the client’s abilities, and know what help or equipment the situation requires.

Some procedures have a strict order. Others depend on the client’s condition, workplace policy, and the directions in the care plan.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

Body Mechanics, Body Alignment, and Balance

body mechanics refers to movement of the body. Proper body mechanics use efficient, careful movement, good posture, good balance, and the strongest muscle groups available for the work.

Poor positioning or movement increases the risk of fatigue, muscle strain, and injury. You need to pay attention to your own movement as well as the client’s positioning.

body alignment, also called posture, describes how the head, trunk, arms, and legs line up with one another while lying, sitting, or standing.

Good body alignment:

• helps the body move with strength and efficiency
• reduces strain on muscles and joints
• helps prevent injury
• helps protect people with limited mobility from complications such as muscle atrophy and contractures

Poor positioning affects the client. A stooped position might interfere with deep breathing. Lying flat without knee support might cause severe lumbar spine pain. Support workers must keep watching the client’s position and reposition the client properly when required.

Centre of Gravity and Base of Support

The centre of gravity is the point where body weight is balanced evenly on either side.

The line of gravity is an imaginary vertical line running from the centre of gravity toward the base of support.

The base of support is the area on which an object rests. Your feet provide your base of support when you stand.

A wide base gives more stability and balance than a narrow one.

Body balance is achieved when a relatively low centre of gravity is balanced over a wide, stable base.

Keep your feet and legs apart when moving, lifting, or transferring weight.

A lunge (or stride) stance places one foot in front of the other while both feet remain about shoulder-width apart. This stance helps you keep your balance during moving tasks.

Good Standing Body Alignment

Good standing posture includes these features:

• Keep the head and neck straight and upright.
• Keep the shoulders and hips parallel.
• Hold the shoulders back.
• Keep the chest out.
• Maintain the natural lumbar curve of the spine.
• Tuck in the abdomen and tilt the pelvis inward.
• Keep the knees slightly flexed.
• Let the arms hang comfortably at the sides.
• Keep the feet about shoulder-width apart.
• Point the toes forward and place one foot slightly ahead of the other.

A pelvic tilt involves tightening the stomach muscles and adjusting the pelvis so the small of the back flattens. This positioning supports posture, strengthens the lower spine, and reduces back-injury risk.

Good alignment also matters while sitting and lying down.

Use the Strongest Muscles

The strongest and largest muscle groups used for lifting and moving are found in the:

• shoulders
• upper arms
• hips
• thighs

Relying on smaller muscles, including the lower-back muscles, increases back strain, fatigue, and injury risk.

Guidelines for Good Body Mechanics

First: Assess the situation before attempting to move a client.

Check the care plan ⓘ and employer policy. Determine whether you need help, special equipment, or qualified assistance. If the client’s weight is more than you safely manage, get help.

If your employer has a no-lift policy, workers are not allowed to manually lift clients. Follow the workplace requirement for mechanical equipment and qualified assistance.

When you move, lift, push, pull, or carry:

• Face the work area instead of twisting toward it.
• Use a wide base of support.
• Bend at the knees and hips when working below waist level.
• Squat instead of bending forward from the waist.
• Tighten the stomach muscles and tuck in the pelvis while lifting.
• Keep the back straight.
• Use the legs and thighs to raise an item toward waist level.
• Keep objects close to the body.
• Use both hands and arms with heavy objects.
• Do not lift an object higher than chest level.
• Arrange supplies within easy reach before starting.
• Raise a hospital bed close to waist level when appropriate.
• Adjust an overbed table to about waist height.
• Use a stepstool for an object above chest level.
• Turn the whole body together when changing direction.
• Move the feet toward the direction of the turn.
• Avoid twisting the body.
• Use smooth, even movements instead of sudden or jerky ones.
• Push, slide, or pull heavy objects whenever you can instead of lifting them.
• Pushing with your body weight is easier than pulling.
• Widen the base of support while pushing or pulling.
• Move the front leg forward while pushing.
• Move the rear leg backward while pulling.

What a Transfer Means

A transfer means moving a person from one place to another while the client assists with partial to full weight-bearing.

Before Moving a Client in Bed

Clients have different movement abilities. Some move independently. Others assist during a move. Clients who are unconscious, paralyzed, or weak might need extensive help, equipment, or several workers.

Before starting:

1. Check the care plan.
2. Check with the supervisor.
3. Ask the client about their ability to help.
4. Determine the equipment needed.
5. Determine the number of workers needed.
6. Do not attempt the move alone when you do not think you will perform it safely.

If a no-lift policy applies, never move or lift the client without the required equipment, the correct number of qualified helpers, and direction from your supervisor.

Client safety and worker safety both matter.

Help in Home Care

Home care differs from a facility because another worker often is not present to help with lifting equipment. Plan duties with your supervisor when the client’s care requires assistance that will not routinely be available.

A family member, primary caregiver, or another person in the home might want to help move the client.

A nurse or physiotherapist is responsible for teaching the client’s family or primary caregiver about:

• body mechanics
• moving
• positioning
• transferring

Your responsibility is to make sure that anyone helping you has received the required training.

Protect the Client From Friction and Shearing

Moving and repositioning place the client’s skin at risk.

Friction is resistance created when skin rubs against another surface. Examples include clothing, bedding, or another area of skin.

Shearing happens when the skin remains against a surface while deeper tissues move downward. It often occurs when a client slides down in a bed or chair or during movement in bed.

Shearing might:

• tear the skin
• cause pain
• contribute to infection
• contribute to pressure ulcers
• lead to serious skin and health problems

Rolling or lifting the client reduces friction and shearing. Turning pads and sliders also reduce friction during appropriate moves.

Older people have a greater risk of shearing because their skin is fragile and tears easily. They also tend to have less body fat, which makes bony areas more prominent. Skin over these areas has a greater risk of tearing and scraping.

Always use a turning pad when lifting and moving an older person.

Comfort and Safety During Bed Moves

Before and during a bed move:

• Check the care plan and supervisor directions for positioning restrictions.
• Decide how the move will happen and how much help you need before starting.
• Get the needed help before beginning.
• Give clear directions to helpers.
• Agree in advance whether everyone moves on the count of three or immediately after three.
• Use several small movements when they work better than one large movement.
• Cover and screen the client for privacy.
• Protect connected tubes and drainage containers from pulling, tangling, or pinching.
• Return the client to good body alignment after the move.
• Straighten wrinkled linens underneath the client.

Clients with conditions such as severe arthritis or osteoporosis might experience pain or injury during movement. Follow the supervisor’s directions and the care plan for the required measures.

Turning Pads and Sliders

A turning pad is a small pad or folded sheet placed over the bottom sheet. It extends from around the client’s head to above the knees.

Other names include:

• sliding pad
• turning sheet
• transfer sheet
• lift pad

The term drawsheet is sometimes used for a turning pad, but that name is inaccurate.

A turning pad also helps keep the mattress and bottom linens clean and dry. Some workplaces use waterproof material or folded sheets. Some use reusable waterproof incontinence pads. Other workplaces do not permit incontinence pads for moving or repositioning.

Follow the employer’s equipment requirements.

A slider is a low-friction moving device with handles. Slider equipment includes:

• slider sheets
• slider boards
• slider sheet systems

A slider sheet system uses two slider sheets together to reduce friction between the client and the bed surface.

Turning pads and sliders support repositioning for people such as:

• older clients
• larger clients
• clients with arthritis
• clients with spinal cord injuries
• clients with paralysis
• unconscious clients

These devices help reduce pain and protect the skin, bones, and joints from damage related to friction and shearing.

Your supervisor and the care plan identify whether a turning pad or slider is required.

When directed, position the device under the client from above the head to above the knees. When using a turning pad with a helper, roll it close to the client’s body and hold it firmly with the palms up, or follow employer policy.

Using the turning pad or slider is safer for the worker and client than grasping the client’s body.

Protect Your Back During Bed Moves

Stretching before moving activities reduces injury risk.

Raise the client’s bed to a suitable working height. When the bed does not raise, placing the knee closest to the client’s head on the bed reduces how far you need to bend.

Avoid twisting or bending your back while moving the client.

Protect the Client’s Quality of Life During Moves

During moving and transfer procedures, promote the client’s dignity, independence, individualized care, preferences, privacy, and safety.

Moving the Client Up in Bed

Clients often slide toward the middle or foot of the bed while sitting up. Moving the client upward restores better body alignment and comfort. Workers also often reposition a client upward before bedside care.

Check workplace or provincial guidelines for any size or weight limits that affect whether one worker performs a move.

Some workplaces permit one worker to move a child or lightweight adult when the client helps. The client might push with the hands or feet or use a trapeze.

A trapeze attaches to the bed or a frame above it. The client grasps its bar and pulls.

Always check the care plan for the required number of workers.

Clients who are especially heavy or weak need two workers and usually require a mechanical lift. A mechanical lift raises and moves a person in a special body sling.

Know your workplace lifting programs, safety policies, and procedures. Check with the supervisor or care plan before attempting the move.

Moving Up in Bed, Correct Order

Before the Procedure

1. Identify the client according to employer policy.
2. Check the care plan for the client’s abilities and limitations.
3. Obtain a turning pad, slider sheet, or other equipment required by the workplace.
4. Ask another worker to help.
5. Explain the procedure to the client.
6. Perform hand hygiene.
7. Provide privacy.
8. Raise the bed to a comfortable working height.
9. Lock the bed wheels.
10. Follow the care plan for bed rail use.
11. Lower the head of the bed to an appropriate level, as flat as possible for the client.

Raising the bed reduces back strain. Lowering the head of the bed makes upward movement easier.

During the Procedure

12. Stand with one worker on each side of the bed.
13. Lower one bed rail and communicate throughout the procedure.
14. Roll the client onto one side so the client faces the raised bed rail.
15. One worker supports the client and maintains safe body alignment.
16. If appropriate, keep the rail in front of the client raised so the client has something to hold.
17. The second worker fan-folds the slider sheet or turning pad.
18. Place it behind the client from the back of the head to below the thighs.
19. Tuck it close to the client’s body while protecting the skin.
20. Tell the client that they will roll over a small bump.
21. Assist the client to log-roll to the opposite side.
22. Raise the rail facing the client when appropriate so the client has support to grasp.
23. Lower the opposite rail.
24. Grasp and straighten the turning pad or slider sheet.
25. Assist the client to log-roll onto the back.
26. Lower the raised rail.
27. Grasp the slider handles or roll the turning pad edges close to the client for a secure hold.
28. Support the client’s head when the client lacks enough strength to hold it up.
29. If the client does not need the pillow under the head during the move, place it against the headboard for padding.
30. On the count of three, move the client upward while both workers shift their weight from the rear leg to the front leg.
31. Unroll the turning pad.
32. Position the client in good alignment according to the care plan.
33. Straighten the linens.
34. When the client lies in a hospital bed, the easiest and safest way to raise the head and shoulders is to raise the head of the bed with the electronic control.

A fan-fold places the sheet back and forth in a fan-like arrangement. This makes the sheet easier to grasp and straighten.

Wrinkles under the client increase pressure-sore risk. A rolled edge left under the client also creates pressure.

After the Procedure

35. Put the pillow under the client’s head and shoulders.
36. Tidy the bed linens.
37. Put the call bell ⓘ within reach.
38. Provide for safety and comfort.
39. Recheck the client’s body alignment.
40. Return the bed to its lowest position when it was raised.
41. Follow the care plan for bed rail use.
42. Remove privacy measures.
43. Perform hand hygiene.
44. Report and record your actions and observations according to employer policy.

The client might slide downward again after repositioning, so recheck alignment.

Actions, observations, and basic assessments are reported and recorded according to workplace policy for legal reasons and to keep the health care team informed.

Rolling and Log-Rolling

Regular Rolling

Turning a client onto the side helps prevent complications from bed rest. Some care procedures also require the side-lying position.

Rolling turns a person from the back or one side onto the other side.

For clients whose care plan permits regular rolling, bending the knee opposite the direction of the turn often helps.

For example, when turning the client toward the right:

1. Bend the left knee.
2. Roll the client toward the right.
3. Avoid twisting the spine.

When bending the knee would cause discomfort or injury, cross the ankles in the direction of the roll instead.

Always maintain good body alignment. Turn the neck and spine together without twisting.

Log-Rolling

log-rolling turns the person as one aligned unit in one motion while preventing twisting of the spinal column.

This method is used for clients who need straight spinal alignment after situations such as:

• severe spinal cord injury
• severe hip injury
• neck surgery
• back surgery
• spinal surgery

Turning as one unit helps prevent further injury when straight spinal alignment is required.

Clients Who Need More Helpers

Some clients require at least two workers for rolling. Tall or heavy clients might require three.

Three workers are needed to roll clients with:

• arthritic spines or knees
• hip fractures during recovery
• spinal cord injuries
• spinal surgery during recovery

For spinal cord injury and spinal surgery, keep the spine straight throughout the move.

Log-Rolling the Client, Three-Team-Member Procedure

This procedure requires three team members.

Before the Procedure

1. Identify the client according to employer policy.
2. Check the care plan for the client’s abilities and limitations.
3. Ask two other team members to help.
4. Perform hand hygiene.
5. Explain the procedure to the client.
6. Provide privacy.
7. Raise the bed to a comfortable working height.
8. Lock the bed wheels.
9. Follow the care plan for bed rail use.
10. Lower the head of the bed to an appropriate level, as flat as possible for the client.

During the Procedure

11. Place a pillow between the client’s knees. This reduces tension on the spinal column and prevents hip adduction.
12. Cross the client’s arms over the chest to protect the arms.
13. Position two team members on one side of the bed and the third team member on the opposite side.
14. Communicate directions throughout the procedure.
15. Lower the bed rails on both sides.
16. On the count of three, use the slider sheet or turning pad to move the client as one unit toward the side of the bed.
17. Use one smooth, continuous motion so the neck and spinal column remain aligned.
18. The worker on the opposite side places pillows along the client’s length.
19. Make sure the pillow surfaces beside the client have no wrinkles.
20. Tuck the pillows toward the client.
21. Gently lean the client as one unit back against the pillows.
22. Adjust the pillow under the head so the head remains aligned.
23. Adjust the shoulder so the client does not lie on an arm.
24. Bend the upper arm toward the client’s head.
25. Place a small pillow under the upper hand and arm to support proper alignment.

After the Procedure

26. Provide for safety and comfort.
27. Put the call bell within reach.
28. Return the bed to its lowest position.
29. Raise or lower bed rails according to the care plan.
30. Remove privacy measures.
31. Perform hand hygiene.
32. Report and record actions and observations according to employer policy.

Moving a Client From a Bed to a Stretcher

Stretchers support transport for clients who:

• are unable to sit up
• must remain lying down
• are seriously ill
• are waiting for surgery or returning from surgery

Prepare the stretcher with a folded flat sheet. Keep a pillow and extra blankets available.

With supervisor permission, the stretcher head might be placed in semi-Fowler’s position. This position raises the head of the bed between 30 and 45 degrees.

A slider board reduces friction during the move and provides handles for staff.

At least three staff members are needed for a bed-to-stretcher move.

Maintain good body alignment and use good body mechanics throughout the procedure.

Stretcher Transport Safety

After moving the client:

• Fasten the safety straps across the client’s chest.
• Keep the stretcher side rails raised during transport.
• Move the client feet first so the client sees where they are going.
• Watch the client’s breathing and colour during transport.
• Never leave the client unattended on the stretcher.

Bed-to-Stretcher Procedure

Before the Procedure

1. Identify the client according to employer policy.
2. Check the care plan for the client’s abilities and limitations.
3. Ask two co-workers to help.
4. Explain the procedure to the client.
5. Gather the stretcher with a sheet, another sheet, the slider board, and any needed pillows.
6. Perform hand hygiene.
7. Provide privacy.

During the Procedure

8. Raise the bed until it matches the stretcher height.
9. Place two workers on the side where the stretcher will sit.
10. Place the third worker on the opposite side.
11. Communicate directions throughout the procedure.
12. Cover the client with a sheet for warmth and privacy.
13. Fan-fold the top linens toward the foot of the bed.
14. Lower the head of the bed until it is as flat as possible.
15. Lower the bed rails when used.
16. Protect the client from falling and log-roll the client onto one side.
17. Place the slider board between the bed and bottom sheet, extending from the client’s head toward the legs.
18. Do not place the slider board directly against the client’s skin.
19. Log-roll the client back onto the back.
20. Restore good body alignment.
21. Place a pillow under the client’s head and provide comfort.
22. Leave the top sheet over the client if the client prefers.
23. Use the slider-board handles to move the client toward the side of the bed.
24. Protect the client from falling while the co-workers move the stretcher directly beside the bed.
25. Position the workers behind the stretcher.
26. Lock both the bed and stretcher wheels.
27. Roll up and grasp the slider board so the client’s body remains supported. Staff may need to kneel on the bed to help prevent back injury.
28. On the count of three, move the client onto the stretcher by lifting and pulling. Make sure the client is centred on the stretcher.
29. Place pillows under the client’s head and shoulders when allowed.
30. Provide for safety and comfort.
31. Fasten the safety straps.
32. Raise the stretcher side rails.
33. Unlock the stretcher wheels.
34. Transport the client.

Keeping the stretcher directly against the bed with the wheels locked reduces the risk of the client falling between the two surfaces.

After the Procedure

35. Perform hand hygiene.
36. Reverse the procedure when returning the client to bed.
37. Report and record your actions and observations according to employer policy.

Include:

• the time of transport
• where the client went
• who accompanied the client
• how the client tolerated the transfer

Moving the Client to the Side of the Bed

Moving a client toward the side of the bed reduces how far the worker needs to reach during care. It also often happens before repositioning or turning.

Before starting, determine whether the client assists with the movement.

One method moves the client in body segments and often requires only one worker.

Do not use segment-by-segment movement for clients who require protection from this type of movement. Examples include:

• older people
• people with arthritis
• people with spinal cord injuries

For these clients, a turning pad helps protect against pain, skin damage, and injury to bones, joints, and the spinal cord.

When using a turning pad to move a client to the side of the bed, it is best to have help. Check with your supervisor for the correct procedure for each client.

Helping the Client Sit on the Side of the Bed

Sitting on the side of the bed with the legs hanging down is often called dangling the legs.

Many older clients become dizzy or faint when they get out of bed too quickly. This is called postural hypotension.

These clients need to sit at the side of the bed for 1 to 5 minutes before walking or transferring to reduce the risk of postural hypotension.

Activity Might Increase in Stages

The supported progression is:

1. Rest in bed.
2. Sit on the side of the bed.
3. Sit in a chair.
4. Walk.

Clients also dangle their legs while doing exercises. Activities listed during dangling include:

• coughing and deep breathing
• moving the legs backward and forward
• moving the legs in circles

Dangling also helps prepare a client for walking or moving to a chair or wheelchair.

Support Clients With Balance or Coordination Problems

You might need a helper when assisting a client to dangle.

When the client has balance or coordination problems:

1. Stand in front of the client.
2. Place your hands on the client’s shoulders for support.
3. Follow the supervisor’s directions and care-plan safety measures.

People recovering from a stroke ⓘ often have balance problems while sitting. They must receive support while dangling to prevent falls and injuries.

What to Report and Record After Dangling

Report and record:

• pulse and respirations, when instructed to measure them
• pale, greyish, or bluish skin colour, including cyanosis
• dizziness or light-headedness
• difficulty breathing
• how well the client tolerated the activity
• how long the client dangled the legs
• how much help the client needed
• any other observations or complaints

Common Mix-Ups

Wrong Idea	Better Idea
Body mechanics means posture only.	body mechanics covers body movement, posture, balance, and efficient use of strong muscles.
Body alignment and body mechanics mean the same thing.	body alignment describes how body parts line up. body mechanics describes how the body moves.
A narrow stance gives better balance.	A wide base of support gives greater stability.
Regular rolling and log-rolling are the same.	Regular rolling turns the client from side to side. log-rolling moves the client as one aligned unit without spinal twisting.
Any pad works for moving a client.	Use the equipment required by the employer, supervisor, and care plan.
One worker should attempt the move and ask for help if it becomes difficult.	Decide how much help you need and get that help before starting.
A stretcher client is safe once the move is complete.	Use safety straps and raised side rails, observe the client during transport, and never leave the client unattended.