Nursing Foundations · Mobility & Immobility

Mobility & Immobility

Ergonomicsdefinition

The applied science of arranging work so that people and things interact efficiently and safely.

in simple words: Applying body mechanics principles to tasks like lifting, transferring and repositioning to prevent injury to staff and patients.

Why body mechanics matters

The primary objective of body mechanics is to avoid strain and fatigue during physical work. Good posture is a component, not the goal. Good muscle strength alone does not prevent injury — correct technique is more critical.

Core principles

Base of support – Wide base by spreading feet apart — lowers centre of gravity, increases stability.
Bend at – Knees and hips, not at the waist — uses strong leg and gluteal muscles.
Large muscles – Use quadriceps, gluteals, abdominals for lifting.
Load – Carry close to the body's midline — reduces lever arm and strain.

Mobility & Immobility · Nursing Foundations

Safe Patient Handling

Log-rolling

Used to turn a patient while maintaining spinal alignment — the correct technique when spinal injury is suspected. A blanket lift is contraindicated in suspected spinal injury; log-rolling with a spine board keeps the spine neutral.

Log-rolling sequence

Position teamNurse at head leads, ensures head, neck, spine aligned.
Cross armsPatient's arms crossed over chest.
Turn as unitCoordinated movement as a single unit — prevents twisting.
Support spineSpine board keeps spine neutral.

Blanket lift

Multiple caregivers lift evenly by holding edges.
Blanket acts as a sling, distributes weight.
Contraindicated in suspected spinal injury.

Log-rolling

Maintains spinal alignment.
Correct when spinal injury suspected.

Lifting methods

Choose the right technique

Mobility & Immobility · Nursing Foundations

Exercise Types

Why exercise matters

Aims of assisted mobility include performing active and passive range-of-motion exercises and promoting patient independence. ROM exercises prevent contractures and atrophy; promoting independence enhances psychological well-being.

Types of exercise

Type	Definition	Example
Isotonic	Muscle contraction changes length, produces joint movement	Walking, bathing, dressing, eating
Isometric	Contraction without change in length or joint movement	Maintains strength in immobilized part (limb in cast)
Isokinetic	Contraction against resistance at constant speed	Specialized equipment (dynamometers)
Endurance (aerobic)	Sustained activity raising heart and breathing rates	Classified by cardiovascular effect

Range of motion

Active ROM – Improves muscle strength — requires voluntary contraction.
Passive ROM – Maintains joint mobility but does not strengthen muscles.
ADLs – Walking, bathing, dressing, eating are isotonic exercises.
Bedridden – Active or passive ROM are forms of isotonic exercise — prevent contractures and circulatory problems.

Mobility & Immobility · Nursing Foundations

Effects of Immobility

Systemic effects

Prolonged immobility causes disuse atrophy of muscles and disuse osteoporosis from bone resorption exceeding formation. Bone demineralisation releases calcium into blood, causing hypercalcaemia and raising risk of renal calculi.

Musculoskeletal

Disuse atrophy
Disuse osteoporosis
Negative nitrogen balance

Cardiovascular

Venous stasis — Virchow's triad
DVT risk

Immobility

Respiratory

Reduced vital capacity
Atelectasis

Renal

Hypercalcaemia
Renal calculi

Key mechanisms

System	Effect	Mechanism
Musculoskeletal	Disuse atrophy & osteoporosis	Protein breakdown; osteoclasts outpace osteoblasts
Metabolic	Negative nitrogen balance	Muscle protein broken down in catabolic state
Respiratory	Atelectasis	Shallow breathing, reduced chest wall movement
Cardiovascular	DVT	Venous stasis — loss of skeletal muscle pump

Mobility & Immobility · Nursing Foundations

Positioning & Alignment

Why positioning matters

Maintaining normal body alignment prevents complications. Immobile patients should be repositioned at least every 2 hours to redistribute pressure and maintain skin integrity.

Common positions

Position	Description	Use
Supine	Flat on back	Can worsen dyspnoea — abdominal contents press diaphragm
Fowler's	Semi-sitting, head 45–60°	General breathing difficulty; reduces work of breathing
High Fowler's	Head 60–90°	Most effective to promote lung expansion; contraindicated in suspected spinal injury
Lithotomy	Supine, hips/knees flexed, legs in stirrups	Perineal, rectal, vaginal procedures
Sims'	Side-lying (semi-prone)	Oral care of unconscious patient — secretions drain by gravity
Trendelenburg	Entire bed tilted, head lower than feet	Specific therapeutic indication

Patient reclined with the head of the bed elevated in Fowler's position. — Fowler's position

Patient lying supine with hips and knees flexed and legs supported in stirrups. — Lithotomy position

Patient lying on the side with the upper leg flexed and head tilted back to keep the airway open. — Recovery position

Mobility & Immobility · Nursing Foundations

Positioning Devices

Purpose of devices

Positioning devices maintain functional alignment, prevent contractures and footdrop, and reduce pressure. They should be removed at scheduled intervals (e.g., every 2 hours) to check for redness, irritation or pressure sores over bony prominences.

Devices and their functions

Device	Function
Trapeze bar	Overhead device grasped to help repositioning and strengthen upper body; prevents shearing by lifting torso off bed
Hand roll	Maintains functional position of hand, thumb, fingers; prevents contractures
Positioning boots	Hold foot and ankle in neutral dorsiflexion at 90° to prevent footdrop
Trochanter roll	Placed along outer thigh to prevent external rotation of hip; maintains neutral alignment
Bed cradle	Keeps weight of top linens off feet; prevents pressure but does not support foot position
Splint	Rigid device maintains joint in functional position; foot splint holds dorsiflexion

Mobility & Immobility · Nursing Foundations

Nursing Interventions

Preventing pressure ulcers

Repositioning a bedridden patient at least every two hours is the most effective way to prevent pressure ulcers. Sustained pressure exceeding capillary closing pressure of approximately 32 mmHg obstructs blood flow, leading to tissue ischemia and necrosis.

Key interventions

Reposition – Every 2 hours — redistributes pressure from bony prominences (sacrum, heels, hips).
Skin care – Keep clean and dry; moisture makes skin susceptible to breakdown. Lubricate with lotion to maintain pliability.
Nutrition – Adequate protein vital for healthy skin and healing.
Special mattresses – Pressure-redistributing surfaces reduce pressure on vulnerable areas.
Water mattress – Static pressure-relieving device; conforms to body contours, distributes weight.