Question

a nurse is preparing to turn a client who is unable to mobilize independently. which action best ensures the safety of both the client and the nurse?

placing the bed in its lowest position to reduce the clients risk for falls
positioning a friction-reducing sheet under the client to facilitate movement
using back muscles to gently and gradually pull the client to the side
standing at the top of the bed and having a colleague stand at the bottom of the bed

Explanation:

Analyze the clinical scenario

The scenario involves turning a client who cannot mobilize independently. The goal is to identify the action that best ensures the safety of both the client and the nurse.

Evaluate the options

Using the Musculoskeletal Injury Prevention and Safe Patient Handling knowledge points:

• Placing the bed in its lowest position: While this is a standard safety measure to prevent fall injuries when leaving a client unattended, keeping the bed too low during a manual turn forces the nurse to bend at the waist, increasing the nurse's risk of back injury. The bed should be raised to a comfortable working height (usually elbow height) during the procedure.
• Positioning a friction-reducing sheet under the client: Using assistive devices like a drawsheet, slide board, or friction-reducing sheet minimizes friction and shearing forces on the client's skin (protecting the client) and significantly reduces the physical effort required by the nurse (protecting the nurse from musculoskeletal strain).
• Using back muscles to pull the client: Nurses should avoid using back muscles to lift or pull. Instead, they should use their leg and gluteal muscles, maintain a wide base of support, and keep their spine aligned to prevent injury.
• Standing at the top and bottom of the bed: This positioning does not provide optimal leverage or body mechanics for turning a client laterally and increases the risk of strain.

Select the best action

Using the Safe Patient Handling knowledge point:

• Utilizing a friction-reducing sheet directly addresses safety for both parties: it prevents skin breakdown (shearing) for the immobile client and prevents back strain for the healthcare provider.

Answer:

• placing the bed in its lowest position to reduce the client's risk for falls
• positioning a friction-reducing sheet under the client to facilitate movement (Correct answer)
• using back muscles to gently and gradually pull the client to the side
• standing at the top of the bed and having a colleague stand at the bottom of the bed