Certified Nursing Assistant (CNA) Exam Positioning, Transfers, and Body Mechanics Summary

In Fowler's position the resident lies on the back with the head of the bed raised, often about 45 to 60 degrees, and the knees may be slightly bent. It helps with breathing, eating, and talking.

Wrong choices

• Prone position: Prone means lying face down on the stomach.
• Lateral (side-lying) position: In the lateral position the resident lies on one side.
• Supine position: Supine means lying flat on the back with the head of the bed down.

If the bed or wheelchair rolls during a transfer, the resident can fall. Lock all brakes first, lower the bed so the feet are flat on the floor, and have the resident wear non-skid footwear.

Wrong choices

• Remove the resident's shoes: Non-skid shoes help the resident stand safely.
• Raise the bed to its highest position: The bed should be low so the resident's feet are flat on the floor.
• Release the brakes so the chair can roll closer: An unlocked chair can roll away during the transfer.

Supine means lying flat on the back. A memory tip: you lie on your spine when supine. Prone is the opposite: face down.

Wrong choices

• Sims': Sims' means lying on the left side with the upper leg bent.
• Fowler's: Fowler's means lying on the back with the head of the bed raised.
• Prone: Prone means lying on the stomach.

The picture shows the aide bending at the waist with straight legs and the box far from the body, which strains the back. Good body mechanics: bend at the knees and hips, keep the back straight, hold the load close, keep the feet about shoulder-width apart, and use the strong leg muscles to lift.

Wrong choices

• Place the feet close together: Feet close together give a narrow, unsteady base.
• Keep the knees locked and lift faster: Locked knees and fast, jerky lifts put strain on the back.
• Twist at the waist while lifting: Twisting while lifting is a common cause of back injury.

Place the wheelchair on the resident's strong (unaffected) side and close to the bed, and lock the brakes. The resident stands and pivots on the strong leg, so the chair must be on that side and near. In the picture, only position A is both on the strong side and next to the bed.

Wrong choices

• Position B: Position B is on the weak side, which cannot safely bear weight during the pivot.
• Position C: Position C is at the foot of the bed, which makes the pivot long and awkward.
• Position D: Position D is on the strong side but too far from the bed.

A wide base of support (feet about shoulder-width apart) keeps you balanced. Bend at the knees, keep your back straight, hold loads close, and pivot with your feet instead of twisting.

Wrong choices

• Keeping the feet close together: A narrow base makes you less steady.
• Twisting at the waist to turn: Twisting strains the back; turn the whole body by moving your feet.
• Lifting with the back muscles: The leg muscles are stronger and should do the lifting.

A transfer belt goes around the waist over clothing. It should be snug, with just enough room to slip your fingers under it. Grip it from underneath with your palms up.

Wrong choices

• Around the chest under the arms on bare skin: The belt goes at the waist, over clothing, to protect the skin.
• As tight as possible to prevent any movement: A belt that is too tight is painful and can hurt the skin or breathing.
• Loosely around the hips so it can slide: A loose belt can slip, and you lose control of the resident.

Stand on the weak side, slightly behind the resident, holding the transfer belt if one is used. This is the side the resident is most likely to fall toward, so you can support them quickly.

Wrong choices

• Several steps behind the resident: From far away you cannot help if the resident starts to fall.
• Directly in front, walking backward: Walking backward is unsafe for the aide and blocks the path.
• On the resident's strong side, slightly in front: The weak side is the side most likely to give way.

Moving a resident who cannot help needs two workers and a lift sheet (or the lift device the care plan lists). Lifting with the sheet lowers friction and shearing, which can tear the skin and lead to pressure injuries.

Wrong choices

• Have him push hard with his heels: He cannot help, and pushing with the heels causes heel friction.
• Drag him up by the ankles: Dragging causes friction and shearing that damages the skin.
• Pull him up by his arms: Pulling on the arms can injure the shoulders and rubs the skin.

Reaching puts the load far from your body and strains the back. Move close to the resident instead. Raising the bed to working height, pushing or pulling instead of lifting, and pivoting with the feet are all good body mechanics.

Wrong choices

• Turning the whole body by moving the feet: Pivoting with the feet avoids twisting the back.
• Raising the bed to a comfortable working height: Working at the right height protects your back.
• Pushing or pulling instead of lifting when possible: Pushing or pulling uses less force than lifting.