Taking good body mechanics too far?

[kool-aide, RN]

Everyone, I would like to hear your opinions on a situation that came up at work this past weekend:

I was taking care of a pt on a m/s floor who was admitted w pneumonia. She was getting ready to be d/c'd in 1-2 days, so, she wasn't too sick..

The pt was a L BKA of 2+ years and used a prosthesis. pt was ambulating w standby assist x1 to BSC to void over the night shift and the nurse had been answering her lights all night (just how it happened to work out, I wasn't refusing to answer her lights or anything like that, I was just already busy when they came on...) and so, the last time she called before the end of shift I answered her light and she needed to use BSC. I put her prosthesis on for her (which she probably could have done herself, but that's another thread...) and then she proceeded to ask me for my hand and to pull her out of bed. I told her that I would prefer for her to use the bedrail and she was completely offended. I told her that by pulling pts out of bed that I could injure my spine and that we're trained to always use good body mechanics to promote spine health. She freaked out and said something like "go get the nurse! she'll HELP me!"

In my opinion, I think I was right. I have seen too many nurses with bad backs, joints, etc, pushed out of nursing because of it and I have too many more years to work to have a bad back! Also, I try to promote independence whenever possible.

I told the nurse about the situation and she agreed that I was right but said she'd been pulling her out of bed all night and said she'd do it just to keep her happy.

What do you guys think about all that? Would any of you sacrifice your back in a situation like this to appease the pt?

Do you think it's no big deal just to give an old lady hand to get OOB even though it's not following proper body mechanics?

Maybe it's just me, but I wouldn't put myself in a situation where I could get injured at work... call me crazy!

I would love some of your opinions!

[FancypantsRN]

Nope I will not sacrifice my back, and neither should you. I already had one knee injury that put me out of work last year (torn ACL) and I don't care for another. If someone is completely incapable of getting up, repositioning, etc. I will get someone to help me with the transfer or reposition (I am a pretty small lady). If they can do it themselves, then I will allow them to. At this point, if family are handy - I get them to help the pt.

I think you are correct, I do not believe in reinforcing a pt's unwillingness to help themselves - it does not help them recover (especially with pneumonia, they need to ambulate and use their IS and such).

ps. don't get me wrong, I want to help them. I want to help them recover, not get sicker or feel helpless.

[kool-aide, RN]

My thoughts exactly!!!!!

[CrimsonAlchemist]

I've only had CNA training, but I believe I would have done the same as you. As I understand it, we are to promote independence whenever possible, and help if they need it. Your pt obviously didn't need the help and can ambulate to a certain degree on her own. We aren't there to attend to the pt's every whim and fancy and IMHO your personal health and safety is more important than her wanting a hand up.

Of course, however, I would love to hear the opinions of some LPNs or RNs, etc...My meager CNA training is all I have to go on and I'm sure ya'll will have more insight on this than I.

[raincitynurse]

I was taught to never pull a pt by their arms.... Who knows what kind of joint damage you might "helpfully"cause. And you gotta save your own back...no one is going to do it for you!!

[LatanyaMay2006]

Save your back! The patient is a 2 year old amputee, she should know how to help herself out out bed by now. We are there to help them to be discharged and go home with functional independence. I had a 60 year old patient who wanted the staff to wipe her after she used the BR. I told her she would be better off doing it because she was going home the next day and needed to regain her independence.

[Biffbradford]

I sure hope you have someone help you load the groceries into your car at the store. You wouldn't want to hurt yourself!

I'd put out my hand and help her out being quite confident that this will not blow my back out. Yes, I'm quite sure.

[roser13, ASN, RN]

I sure hope you have someone help you load the groceries into your car at the store. You wouldn't want to hurt yourself!

I'd put out my hand and help her out being quite confident that this will not blow my back out. Yes, I'm quite sure.

Biffbradford, I'm guessing you've never had anyone drop their dead weight onto your outstretched hand....

OP, you are 99% correct in what you did. That other 1% is this: I likely would not have told the patient that I was safeguarding my own health and safety. After all, it's supposed to be all about the patient and we don't matter:lol2:.

I would have said: "I know that your discharge is fast approaching and I want to make sure you're as strong as you can be when you go home. That way, I will be sure that you can adequately cope when you're on your own."

[*Posh*]

No way would I do it. I've had a back injury that took several trips to the OR and changing jobs for a year to recover from. Letting patients pull on you is a big no-no. Being "confident that you won't blow your back out" doesn't happen after you've actually had an injury...

[raskol]

I would have probably pulled her up. However, I'm not saying it right or appropriate. I am a strong advocate for helping the patient maintain or gain some independence. So if I felt she was capable I would have tried to get her to attempt to do it herself. But more than not, reality sits in and I have too many patients and tasks to do that I find myself wanting to hurry the process up. In addition, I have an EMS background, where my partner was old enough to be my grandmother, so I have acquired some really bad lifting habits. As a result, I am twenty-two years old and I already have a sore back. So I need to start being more like you.

[Oldfatbaldnurse]

I noticed that not one of the replies mentioned the use of a gait belt. I am a staff educator at a physical rehab facility and I insist that all of my staff use gait belts for assisting, transferring, and ambulating. That being said; it is also very important to stress as much independence from the client as possible. I always tell them that if we do it for them all the time, they will not get any stronger and their return home will be delayed. It is okay to provide transfer assistance, but you should judge each client based on their capabilities. I can't say if it was right or wrong to offer assistance to this particular client; but the way in which the assistance was offered was definitely incorrect. If the other employee had used a gait belt and proper body mechanics it would have been better for the client and the employee; whether or not the assistance should have been given at all would need to be assesssed by the client's particular capabilities. I hope this helps somewhat.

[raskol]

I like the idea of gait belts. When i was in nursing school, we had the OT/PT students come teach us different lifting/moving techniques. They all used gait belts. When I see PT on the floor, they have gait belts.

However, as a nurse, and even when I was an aide, I was not taught how to use gait belts, nor were they provided or accessible. We are taught all about the fancy lifting equipment the hospital has. But you have to call for it and it isn't usually available and everyone ends up just throwing out their backs.