Assisting with ambulation (for nursing assistant training)

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.  

Before we talk about ambulation assistance, here are some general considerations. Explain to the client how far you’ll be walking 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.  

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. 

To help a person into the dangling position, first make sure the wheels on the beds are locked and the side railings are down. Help the person into the lateral position and ask them to bend their knees. Then 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. Ask them to bend their knees and push their feet against the bed. With one hand, reach under their arm to support their shoulder and back while reaching under the knees with the other hand. On the count of 3, 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. You might be asked to take a pulse, and if it’s weak, that could be another sign of orthostatic hypotension. Finally, either help them into the standing position or to lie back down.