Policy Manual sample

MDT Home Health Care Agency, Inc. AMBULATION Ambulation training is done per physician plan/physical therapy. If helping lesser disabled patient, know the basic assisting position: Patient "walks tall", picks up feet. As needed, you support at back - close and slightly to weak side. Grasp safety belt; other hand stabilizes shoulder. To toilet: -- Technique can vary per room facilities and PM disability. Patient loosens clothing; a. Pushes up on chair arm; b. Grasps wall rail while turning, lowers slacks, sits down. You assist as needed to lift, guide, steady chair. (If paraplegic, use sliding transfer.) To tub: -- Tub dry; chair in tub: a. Hemiplegic: Patient lifts weak leg in, then pulls at wall rail onto tub chair. Lifts other leg in. b. Paraplegic: Patient lifts both legs in, moves onto tub edge. Then both hands grasp wall rail and tub top to hoist self in. (You assist as needed to lift legs, steady chair, etc.). To car: -- At front seat, passenger side. Chair close, at street level. Sitting at chair edge. a. Patient pushes up on chair arm; b. Standing, patient pivots, using chair or door for support, sits down, lifts feet in. You assist as needed - to lift, steady chair or car door. Supine to sitting/passive: -- Turn on side, flex patient's knees. a. One arm reaches over to grasp bottom knee; b. Other arm supports head and shoulders - with your hip against bed; c. " 1 2 3 move". in one motion. As you shift your weight to rear leg, swing patient's legs over edge while you pull his shoulders to sitting. Supine to Sitting/Assist: -- Assist per patient's needs. Can patient: a. Push up to short sitting position? Then, b. You can help by boosting patient's trunk with your arm -- "1 2 3 move". Support your knee at bed as you shift your weight to rear leg. Sit to standing/ assist: - Bed in low position. Transfer belt on patient. Feet apart for balance. At edge, leans forward. Uses siderails for grip. You are in balance. Spine supported. Knees bent - set to use your leg power. Patient understands the move, sees destination. Then on signal "l 2 3 Stand" patient pushes off as your strong legs straighten and arms pull. Give patient room for balance. Use your knee to support his weak leg if needed. Stand to sitting-Assist: - Wheelchair is close to bed. Wheels locked, footrests up. Get set. Then "1,2,3 Move"; you pivot as patient steps to chair (on strong leg). Home Health Agency Nursing Care & Procedures K-45