Chapter 3: Safer Patient Handling, Positioning, Transfers and Ambulation
3.10 Assisting a Patient to Ambulate Using Assistive Devices
Critical Thinking Exercises: Questions, Answers, and Sources / References
Critical thinking questions are in bold type, and the answers are italicized. Additional resources or references are provided below.
- A 90-year-old male patient is required to ambulate. He had a total hip arthroplasty and is post-operative day 2. What risk factors should be considered prior to ambulating an elderly patient who has been immobile after hip surgery?
Assess yourself as the healthcare worker: Have I had the necessary training? Is my footwear appropriate? Can I maintain a neutral spine with no twisting or side bending? Will I use proper body mechanics? Do I need help, and if so who will be designated the leader? Can I use weight shift techniques and no actual lifting?
Assess the client: Are they cooperative and able to follow directions? Can the patient weight-bear? Can the patient sit-up on the side of the bed without support? Can the patient sit forward on a chair or edge of the bed without support? What (if any) activity restrictions are in place for this patient? Does ambulation require an order from a prescriber? What should you do if a patient feels dizzy or lightheaded before ambulation?
Assess the environment: do I need any equipment and does it work?; is there sufficient workspace
Assess my organization: do I have enough help? Is there enough time to perform this ambulation safely? Do I need any assistive devices?
Provincial Health Services Authority (PHSA). (2010). Employee wellness elearning courses: Safe patient handling. http://learn.phsa.ca/phsa/patienthandling/
2. Does ambulation require an order from a prescriber?
Rarely does ambulation require an order. That being said, there may be some circumstances when ambulation is contraindicated (i.e., if it may cause harm to the patient). For example: spinal cord injury, extensive CNS surgery, dural tear, some orthopaedic surgeries. In addition, the prescriber may order limitations on weight bearing for some clients (e.g., post orthopaedic surgery). If in doubt the nurse should ask the prescriber for guidance.
- What should you do if a patient feels dizzy or light headed before ambulation?
Stop. The ongoing risk assessment suggests ambulation is not safe. The patient and helper are at risk for injury. Suggest having the patient sit first to determine if light headedness is transient.