Skill Checklists for Taylor's Clinical Nursing Skills: A Nursing Process Approach

192

Copyright © 2011 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Skill Checklists for Taylor's Clinical Nursing Skills:

Skill Checklists for Taylor's Clinical Nursing Skills:
A Nursing Process Approach, 3rd edition

Name Date

Unit Position

Instructor/Evaluator: Position

SKILL 9-7

Assisting a Patient With Ambulation

Goal:The patient ambulates safely, without falls or injury. Comments

1. Review the medical record and nursing plan of care for
   conditions that may influence the patient’s ability to move
   and ambulate. Assess for tubes, IV lines, incisions, or
   equipment that may alter the procedure for ambulation.
   Identify any movement limitations.


2. Perform hand hygiene. Put on PPE, as indicated.


3. Identify the patient. Explain the procedure to the patient.
   Ask the patient to report any feelings of dizziness, weakness,
   or shortness of breath while walking. Decide how far to
   walk.


4. Place the bed in the lowest position.
   5.Encourage the patient to make use of a stand-assist aid,
   either freestanding or attached to the side of the bed,
   if available, to move to the side of the bed. Assist the
   patient to the side of the bed, if necessary.


5. Have the patient sit on the side of the bed for several min-
   utes and assess for dizziness or lightheadedness. Have the
   patient stay sitting until he or she feels secure.


6. Assist the patient to put on footwear and a robe, if desired.


7. Wrap the gait belt around the patient’s waist, based on
   assessed need and facility policy.


8. Encourage the patient to make use of the stand-assist
   device. Assist the patient to stand, using the gait belt, if
   necessary. Assess the patient’s balance and leg strength. If
   the patient is weak or unsteady, return the patient to the
   bed or assist to a chair.

ExcellentSatisfactoryNeeds Practice