Safe Patient Handling
Assisting with Ambulation Using a Gait Belt
Select a Skill:
- » Assisting with Moving a Patient in Bed
- » Assisting with Positioning a Patient in Bed
- » Transferring from a Bed to a Wheelchair Using a Transfer Belt
- » Transferring from a Bed to a Stretcher
- » Performing Passive Range-of-Motion Exercises
- » Applying Elastic Stockings
- » Assisting with Ambulation Using a Gait Belt
- » Using a Sequential Compression Device
- » Using a Hydraulic Lift
Take the Review Test:
Safety
- Obtain and become familiar with the gait belt to be used.
- Assess the patient to make sure he or she is rested and not fatigued.
- Obtain extra personnel to assist with ambulation if necessary.
- Place bed in the low position with the bed wheels locked.
- Address the patient’s fear of falling if present.
- Use safety precautions before and during ambulation to control orthostatic hypotension and subsequent falling. For example, if the patient has been lying in bed, have him or her dangle the legs over the side of the bed before ambulating.
- Before getting the patient up to walk, help him or her put on safe, nonskid shoes, make sure the environment is clutter free, and check to see that the floor is dry.
- Remove obstacles from the pathways, including throw rugs, and wipe up any spills immediately. Avoid crowds. Crowds increase the risk that the patient will lose balance.
- If the patient becomes weak or dizzy, help him or her return to bed or to a chair, whichever is closer to the patient.
- If the patient begins to fall, gently ease him or her to the floor by holding firmly onto the gait belt, standing with your feet apart to provide a broad base of support, extending one leg, and letting the patient gently slide to the floor. As the patient slides, bend your knees to lower his or her body.
Equipment
(Roll cursor over items to see labels)
Gait belt
Quad cane (optional)
Well-fitting, flat, nonskid shoes for the patient
Robe for patient
PrintableDelegation
The skill of assisting a patient with ambulation can be delegated to nursing assistive personnel (NAP). Be sure to inform NAP of the following:
- Instruct the NAP that if the patient has been lying in bed, have him or her dangle the legs over the side of the bed before ambulating.
- Direct the NAP to immediately return the patient to the bed or to a chair if the patient becomes nauseated, dizzy, pale, or diaphoretic, and to report these signs and symptoms to you immediately.
- Discuss the importance of ensuring that the patient wears safe, nonskid shoes, and that the environment is clutter free and the floor dry before ambulating the patient.
Preparation
- Assess the degree of assistance the patient needs.
- Assess the patient’s physical readiness for ambulation.
- Prepare the patient for ambulation by doing the following:
- Explain the reasons for exercise, and demonstrate any specific gait techniques to the patient or family caregiver.
- Decide with the patient how far to ambulate.
- Schedule ambulation around the patient’s other activities.
- Place the bed in the low position, and slowly help the patient into the Fowler’s upright position. If the patient is in a chair, have the patient sit upright with the feet flat on the floor.
- Help the patient who has been lying in bed move into a dangling position on the side of the bed.
- Let the patient sit for a few minutes and take a few deep breaths until he gains balance.
- Have the patient move her legs and feet up and down in a circular motion while dangling them over the side of the bed.
- Help the sitting patient to a standing position, and allow the patient to stand until he or she gains balance.
- Ask if the patient feels dizzy or lightheaded. If the patient appears lightheaded, sit him or her back down and recheck his blood pressure.
- Be cautious if the patient has intravenous (IV) tubing or an indwelling catheter. Obtain an IV pole with wheels that can be pushed as the patient walks. Urinary catheter drainage bags must stay at or below the level of the patient’s bladder, so a second person may be needed to assist with walking.
- Ensure that the surface the patient will walk on is clean and dry. Remove any objects that might obstruct the pathway.
- Know the patient’s home care plan. The patient may need to continue the exercise regimen or use a gait belt at home.
Follow-up
- After ambulation, observe the patient’s tolerance to the activity. Obtain the patient’s vital signs. Note any changes in skin color and any signs of fatigue or dyspnea.
- Evaluate the patient’s subjective statements regarding the experience of walking.
- Evaluate the patient’s gait, and observe his or her body alignment and balance in the standing position.
- Observe the patient’s ability to perform self-care activities.
- Immediately report to the nurse in charge or to the health care provider any injury the patient might have sustained during attempts to ambulate, any alteration in the patient’s vital signs, or the patient’s inability to ambulate.
Documentation
Record the following:
- Distance ambulated
- Types of assistive devices used, including the gait belt
- Amount of assistance required
- Patient’s activity tolerance
- Any injury that occurred during ambulation, any alterations in vital signs, or inability to ambulate.
Review Questions
1. The nurse is helping a patient with hemiparesis take a few steps. A gait belt has been applied. The patient is using a cane. Where should the nurse stand in relation to the patient?
INCORRECT. Stand on the patient’s weak side. The strong side has no need of support from the nurse.
CORRECT. The patient’s weak side would need support if the patient begins to fall.
INCORRECT. Standing behind the patient would provide no support to the patient if the patient begins to fall.
INCORRECT. Standing in front of the patient would provide no support to the patient if the patient begins to fall.
2. The nurse is preparing to initiate ambulation with a patient who is recovering from a stroke. What information will help the nurse determine how far to walk?
Ask the patient how far she would like to go. 
Review the health care provider’s order. - Review the medical record to see how far the patient has walked during the past several therapeutic ambulations.
- Review the records of other patients who are at a similar point in their stroke rehabilitation.
CORRECT. Setting mutual goals increases the likelihood of success in achieving the goal of ambulation.
INCORRECT. The health care provider’s order will only state “ambulate”; it will not specify how far to ambulate the patient.
INCORRECT. The patient’s circumstances or condition may not be similar to those he or she undertook during the past several ambulations.
INCORRECT. Patient care should be individualized. The status of other patients in stroke rehabilitation is not relevant to this patient.
3. The nurse has applied a gait belt to a postoperative patient to facilitate ambulation. Within a few feet of the bed, the patient begins to complain of dizziness and leans heavily on the nurse. What would be the nurse’s initial response?
- Slowly lower the patient to the floor.
- Attempt to sit the patient down on a chair just a few steps away.
- Try to hold the patient up until the dizziness passes.
- Call for assistance in a loud but calm voice.
CORRECT. The safest action would be for the nurse to slowly lower the patient to the floor. The patient is already leaning heavily on the nurse, and attempting to ambulate him or her even a few steps may injure the patient, the nurse, or both.
INCORRECT. The safest action would be for the nurse to slowly lower the patient to the floor. The patient is already leaning heavily on the nurse, and attempting to ambulate the patient even a few steps may injure the patient, the nurse, or both.
INCORRECT. Trying to hold up a patient to keep him or her from falling is never a safe action for either the nurse or the patient.
INCORRECT. This is not an appropriate initial response and does not provide immediate safety for the patient.
4. The nurse is preparing to delegate the ambulation of a patient with the use of a gait belt to nursing assistive personnel (NAP). Which statement made by NAP requires the nurse to follow up?
- “I will be sure to put nonskid slippers on the patient before getting him up to ambulate.”
- “I will use the under-axillae technique to help him up to a standing position.”
- “Rocking the heavier patient into a standing position seems to work really well for me.”
- “I will grasp the gait belt in the middle of the patient’s back.”
INCORRECT. Applying nonskid socks or slippers will help minimize the risk of falling, so this statement does not require the nurse to follow up.
CORRECT. This is not a safe lifting technique, so this statement requires the nurse to follow up.
INCORRECT. This technique gives the patient’s body momentum and helps facilitate standing, so this statement does not require the nurse to follow up.
INCORRECT. If the patient begins to fall, this position provides support at the patient’s waist (so the center of gravity remains midline) and allows the nurse to move him or her to the stronger side and reduce injury.
5. The nurse is ambulating a patient with a gait belt when he says he feels sick to his stomach. What would the nurse do?
- Return the patient to the bed or chair (whichever is closer).
- Encourage the patient to complete the distance of ambulation.
- Help him to the restroom.
- Ease him to the floor.
CORRECT. This action allows patient to rest, and the nausea may subside.
INCORRECT. This action does not focus on the patient’s need to relieve nausea. The patient may become more nauseated, become weak or dizzy, and begin to fall.
INCORRECT. This action does not focus on immediate need; it may require more exertion to reach the restroom, resulting in increased nausea.
INCORRECT. The patient’s nausea indicates that the ambulation is not being well tolerated. Ease the patient to the floor only if the nausea is accompanied by dizziness or lightheadedness causing the patient to begin to fall.
You have completed the Review Questions for this skill. To take the Review again select the Start Over button. To proceed to another skill select from the dropdown menu. Select the Home or Back button to proceed to the next section.