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Assisting clients with ambulation: Clinical skills notes

Notes

Notes

Basic Client Care Skills

Assisting Clients with Ambulation

Introduction

Ambulation means “walking,” and your client might need to ambulate to get to places or may need to do it to prevent atrophy, which is when muscles waste away from prolonged bed rest. Other health problems from long-term immobility include: decreased cardiovascular and pulmonary functions, poor digestion, pressure ulcers, contractures, urinary problems, and many others. So, even if they require assistance, clients are encouraged to ambulate frequently.  

Common Care Tips

Before we talk about ambulation assistance, here are some general considerations.
  • Explain to the client how far you’ll be walking with them and how you will assist them. 
  • Check if they need an ambulation device, like a cane or walker. If a device is needed, check to see if it’s functional. 
  • Make sure the route is not slippery and that there are no obstacles. 
  • Make sure IV lines and poles are free from tangles, and that the IV pump is unplugged from the wall and has enough battery to last during ambulation. 
  • Make sure they’re properly dressed and wearing non-skid footwear. 
  • During ambulation, encourage them to walk normally without shuffling or sliding. 
  • You might need an additional assistant if the person’s unbalanced, weak, or not cooperative. 
  • Finally, and most importantly, be sure not to leave the client’s side at any time during the process.  

Figure 1: General considerations.

Dangling Position

Figure 2: Dangling position.

Now, before getting a resting person to stand and walk, you need to get them into a sitting, or “dangling,” position, where they sit erect with their feet dangling off the side of the bed. The main reason for this is to protect against falling. One common cause of falls is orthostatic hypotension, where blood rushes into the legs as the person shifts into an upright position, causing a drop in blood pressure and decreased blood flow to the brain. It can result in dizziness or even fainting, especially in the elderly. If you have the person stand in this condition, it could lead to falls, so having them sit in the dangling position will help their body adjust without the risk. 

Figure 3: Repositioning a client to dangling position.

To help a person into the dangling position, first make sure the wheels on the beds are locked and the side railings are down. Then:
  1. Help the person into the lateral position and ask them to bend their knees. 
  2. Ask them to push themselves into an upright position by pushing with the elbow of the bottom arm while propping themselves up with the top arm. 

Now, some people might be too weak to do this, so you’ll need a more hands-on approach. 
  1. Ask them to bend their knees and push their feet against the bed. 
  2. With one hand, reach under their arm to support their shoulder and back while reaching under the knees with the other hand. 
  3. On the count of three, in one fluid motion, lift their shoulders up straight while moving their legs off the side of the bed.

If the client reports dizziness or lightheadedness, help them back into the supine position. If not, let them rest in the dangle position. Finally, either help them into the standing position or to lie back down.

Ambulation Assistance

Next let’s look at assisting in ambulation. When the client is in the dangling position, help them put on a gait or transfer belt. Before they stand up, make sure their feet are flat on the ground and have them hold the edge of the bed with both hands. 

  1. Reach under their arms with both hands and support their back or hold on to the gait belt on both sides of the body. Place your feet outside their feet while keeping your knees flexed. Block their knees with your knees in case they slip or their knees buckle. 
  2. Once you’re in position, ask them to lean forward and, on the count of three, 
  3. have them push down on the bed with their hand and propel themselves to a standing position while you pull on the gait belt or lift with your arms to help them up. Keep your back straight to prevent injury to yourself. 
  4. Once they are standing, check again for lightheadedness and dizziness, balance problems, weakness, and pain when weight bearing, meaning putting weight on each leg. 
  5. If there are no issues, have the person grab their walking assistant device, like a walker, crutches, or cane, after you have assessed them. Make sure they’re using it correctly. 
  6. Begin ambulation by walking slightly behind the client and towards their stronger side. 

Figure 4: Repositioning client from dangling position to standing.

Once the client has started ambulating, keep the following considerations in mind:
  • When assisting someone with crutches going up stairs, stand behind them; for people going down stairs, stand in front of them. 
  • If an IV pole is used, the client should hold onto it on their stronger side for support. 
  • If they use ambulation assistance devices, like crutches, you might need to hold the pole while keeping pace behind them. 
  • If two people are assisting, one person should stand to each side of the client. 
  • If a gait belt is in use: 
    • Hold it with both hands at the middle of the back of the person. Keep pace with them as they ambulate and try to match their steps. 
    • If they start to fall, pull on the belt and ease them towards the stronger side, letting them slowly slide to the floor. Having them fall towards the stronger side will reduce the severity of injury. 
  • Check frequently to see if they need to rest. 
    • If they experience dizziness, fatigue, or loss of balance, ease them onto the closest available chair or bed. 
  • Once ambulation is over, help them return to their room and their own bed or seat.

Figure 5: Considerations for ambulation A. Stand behind a client when going up the stairs; stand in front of a client when going down the stairs. B. IV pole should stay on the client's stronger side. C. If using a gait belt, hold with both hands at the middle of the back. D. If the client falls, pull on the gait belt and ease client towards their stronger side, letting them slowly slide to the floor.

Documentation

Remember to report dizziness, lightheadedness, balance problems, weakness, pain when bearing weight, chest pain, breathing problems, or abnormal heart rhythms to the healthcare provider. 

Document these signs if present and also:
  • the distance walked
  • what ambulatory device was used 
  • if they needed a gait belt 
  • the extent to which they tolerate walking 
  • any falls or other incidents