Body mechanics & mobility assessment
Muscles are the motor, bones are the levers, and nerves run the show.
How movement works
Skeletal muscle
Movement (main job), posture and positioning, and body heat.Example: shivering is muscles making heat.
Bones
Support, protect organs, produce blood cells in red marrow, store calcium, phosphorus, magnesium, iron, and lipids, and move with the muscles.Example: the skull protects the brain.
Connectors
- Tendons: muscle to bone
- Ligaments: bone to bone
- Cartilage: lets bones glide and absorbs shock
- Synovial joints: fluid-filled, allow bending
Example: the Achilles tendon connects the calf muscle to the heel bone.
Nerves
Spinal cord nerve cells fire signals that make muscles contract and pull on bone. CNS (central nervous system) = brain + spinal cord; PNS (peripheral nervous system) = the nerves branching off it.Example: deciding to take a step sends signals down the spinal cord to the leg muscles.
Proprioception
Feedback between muscles and brain that tells you where your body is. Lets you balance and fine-tune movement. Also called kinesthesia.Example: touching your nose with your eyes closed.
Memory hook · tendons vs ligaments
Tendons Tie muscle To bone. Ligaments Link bone to bone.
The three principles of body mechanics
Lower back injuries are the most common problem for health care workers. Nurses have the highest rate of back injuries, usually from manual lifting and repositioning.
Alignment
Back straight, chin level, abs tight. Ear, shoulder, hip, knee, and ankle on one vertical line.
Balance
Feet shoulder-width apart, knees bent. A lower center of gravity and a wider base = more stable.
Movement
Keep the load close, face the client, pivot your feet instead of twisting.
| Do | Don't |
|---|---|
| Raise the bed to your working height | Reach with extended arms |
| Bend your knees and lift with your legs (quadriceps) | Bend at the waist or lift with your back |
| Pivot or side-step | Twist your torso |
| Keep objects close to your body | Keep your feet close together or knees locked |
Ergonomics
Designing and arranging the work environment to fit the worker. Examples: height-adjustable beds, shower chairs, two-person lifts, transfer devices, side-opening linen bins, removing uneven floors. Solo lifts are the opposite.
Moving a client up in bed, in order
- Assess mobility
- Get lift assistance
- Lock the bed wheels
- Raise the bed
- Cross the client's arms over the chest
- Use the draw sheet
- Lower the bed to the lowest position
Activity intolerance
Loss of the ability to do tasks because of inactivity. Older adults are especially susceptible.
Watch for (during activity)
Weakness, fatigue, lightheadedness, chest pain, diaphoresis, significant vital sign changes.
HR (heart rate), BP (blood pressure), and RR (respiratory rate) rise with activity and should return to baseline with rest.
Borg RPE (rating of perceived exertion) scale
Client rates their own effort from 6 (resting) to 20 (max effort). Target: 12–14, somewhat hard to strong.
Mobility assessment
Done before first mobilizing the client, repeated per policy (every shift to every 24 hr), and after procedures that change mobility. Tells you the interventions, transfers, fall precautions, and devices the client needs.
Assess: usual mobility, ability to sit, stand, and walk, need for help, degree of mobility, skin condition, and manifestations during activity.
Known mnemonic · the BMAT/MAT (Bedside Mobility Assessment Tool) levels
"Sit & Shake, Stretch & Point, Stand, Walk"
Start at Level 1 and only move up if the client passes. Fail a level = that's their level.
| Level | Test | Can't do it? | Equipment | Staff |
|---|---|---|---|---|
| 1 · Maximum assist | Reach across midline to shake hands; sit on edge of bed and hold it 2 min | Level 1 | Mechanical lift, slide boards | 2 or more |
| 2 · Moderate assist | Feet on floor; extend each leg, flex ankle, point toes | Level 2 | Sit-to-stand lift, ambulation devices | 2 or more |
| 3 · Minimal assist | Stand from seated with a device (cane, bed rail); hold 5 sec | Level 3 | Gait belt, ambulation devices | 1–2 |
| 4 · No assist | March in place; step forward and back | Level 3 (also Level 3 if they need a device) | None | 0–1 |
Timed Up & Go (TUG)
Stand up, walk 10 feet, turn, walk back, sit. Older adult taking longer than 12 seconds = increased fall risk.
Quick check
A client can sit on the edge of the bed but can't hold it for 2 minutes. Level?
Level 1, maximum assist. Failing either Level 1 task keeps them there.
Which is correct body mechanics: bending slightly at the waist, or pivoting to move the client?
Pivoting. Bending at the waist and twisting both load the spine.
On the RPE scale, what range should activities fall in?
12–14. Somewhat hard to strong.
Complications of immobility
Bed rest for as little as 1 week can affect ADLs (activities of daily living). Every body system takes a hit.
Musculoskeletal
Disuse osteoporosis
Bones thin and weaken without weight-bearing, leading to fragility fractures from minor stress. Bone takes longer to rebuild than muscle.Watch for new vertebral pain: could be a fracture.
Atrophy & sarcopenia
Unused muscles shrink. The more developed the muscle, the faster it atrophies. Sarcopenia (lean muscle loss) hits the legs first, so clients report weak legs after a few days in bed.Prevent: early mobility, active ROM (range of motion), and enough protein.
Joint contractures
Joint stuck in a bent, nonfunctional position. May need surgery to fix.Prevent: move every joint at least every 8 hr; check alignment every 2 hr.
Foot drop
Can't dorsiflex (pull toes up). Toes point down and drag when walking. Caused by nerve entrapment and a shortened calf and Achilles tendon.Assess gait for toe dragging; splints as prescribed.
Memory hook · contractures
Flexors win the tug-of-war
Flexor muscles are naturally stronger than extensors. When both atrophy, the flexors pull the joint into a bent position and the collagen stiffens it there.
Cardiovascular
Orthostatic hypotension
BP drops and client gets dizzy when sitting or standing up. Raises fall risk.Change positions slowly; check lying, sitting, and standing vitals.
Deep vein thrombosis (DVT)
Clot in a deep vein. Thick blood + weak calf muscles = venous stasis. Worst complication: pulmonary embolism.Look for unilateral edema and check pulses and cap refill. Prevent with antiembolism stockings, SCDs (sequential compression devices), lower-leg exercises (ankle flexing, foot circles), fluids, frequent ambulation, and anticoagulants as prescribed.
Cardiac deconditioning
Fluid shifts cause diuresis, lower blood volume, and less work for the heart, so the heart muscle atrophies.Increase activity gradually and watch HR and BP during activity.
Memory hook · orthostatic hypotension
"20/10 in 3"
Systolic drop of 20 mm Hg or more, OR diastolic drop of 10 or more, within 3 minutes of sitting or standing up.
Respiratory
Lying supine limits chest expansion, pushes abdominal organs up into the diaphragm, and makes coughing weak. Dehydration thickens mucus.
Atelectasis
Partial or complete lung collapse from shallow breathing.Incentive spirometer, deep breathing and coughing, HOB (head of bed) 30–45°, turn every 2 hr.
Pneumonia
Thick secretions pool and trap pathogens.Fluids to thin secretions, HOB 30–45°, turn every 2 hr, prone if appropriate.
Gastrointestinal, genitourinary & skin
| Complication | Why it happens | Key interventions |
|---|---|---|
| Constipation / fecal impaction | Slow peristalsis, drier stool, no gravity to trigger the urge; opioids make it worse | Fluids, high-fiber foods, increase mobility |
| GERD (gastroesophageal reflux disease) | Lying supine puts gastric fluid on the lower esophageal sphincter | Elevate HOB after meals |
| Malnutrition | Low appetite on bed rest | Monitor intake and weight; high-protein, nutrient-dense foods; consult dietitian |
| Urinary retention | No gravity to drain the kidneys and bladder | Fluids; sit upright to void; commode or toilet |
| Renal calculi & UTI (urinary tract infection) | Urine pools and bacteria grow | Void frequently, increase activity in bed, perineal cleanliness |
| Pressure injury | Pressure over bony prominences blocks blood flow; moisture, shear, and friction make it worse | Reposition at least every 2 hr, pressure redistribution devices, keep skin dry, adequate protein and calories |
Pressure injury hot spots: back of the head, shoulder blades, elbows, sacrum, ischium, heels.
Pressure damage, least to worst
- Skin intact: persistent redness, temperature difference, firmness
- Into the skin: lighter area, blister, or shallow pink/red wound
- Beyond the skin: open wound, fat or granulation tissue visible
- Deep: exposed muscle, ligament, or bone, dead tissue
Psychological
Loss of independence, privacy, work, and hobbies can cause frustration, anxiety, depression, and social isolation.
Monitor emotional status every shift, encourage them to express feelings, encourage visits and interaction.
Quick check
A client on bed rest can't pull their toes up toward their knee and drags their toes while walking. What is this?
Foot drop. It's an inability to dorsiflex, not plantar flex.
BP lying 128/80, standing 104/74 two minutes later. Orthostatic?
Yes. Systolic dropped 24 mm Hg (20 or more) within 3 minutes.
Which intervention prevents atelectasis: incentive spirometer or high-fiber diet?
Incentive spirometer. It promotes slow, deep breaths that expand the lungs.
Promoting mobility
Ambulation builds strength, prevents complications, and shortens hospital stays.
Before ambulating
Do the mobility assessment. Have the client sit on the side of the bed a few minutes first (orthostatic hypotension). Nonskid footwear, clear path, tubes and IV (intravenous) lines positioned.
Assistive devices
Gait belt
Over clothing at the waist. Snug, with room to slip your fingers under. Shift it for abdominal incisions or drains.
Cane
Top at the wrist crease with arms at sides; elbow bent 20–30° when gripping. Quad cane = broader base for more support. On stairs, keep the cane level with the weaker leg.
Walker
Top at the wrist; elbow bent 15°. Move the walker, then step with the weaker leg, then the stronger. Standard (no wheels) gives the most support but needs strength. Never on stairs or escalators.
Crutches
Usually younger clients with upper body strength. Pads 1–2 inches below the axilla, grips at hip level, elbows bent 20–30°. Weight goes on the hands, not the armpits, to avoid crutch palsy (numbness and tingling).
Known mnemonic · canes and crutches on stairs
Up with the good, down with the bad
Going up, step up with the stronger leg first, then bring up the cane or crutches with the weaker leg. Going down, lead with the cane or crutches and the weaker leg.
Memory hook · elbow angles
The walker is the odd one out
Walker = 15°. Cane and crutches = 20–30°. Everything else (top at the wrist) matches.
Transfer devices
| Device | Who it's for |
|---|---|
| Slide board | Immobile or acutely ill; lateral transfer (gurney to bed); 3–4 staff |
| Pivot disc | Cooperative, can bear weight and stand but has trouble moving their feet; use with a gait belt |
| Sit-to-stand lift | Has the leg strength and balance to stay upright once standing, but can't get up alone |
| Mechanical lift | Can't support own weight. Client must be calm and cooperative. Inspect the sling; base in max open position |
Before any transfer: secure tubes and IV lines.
Client positioning
Two goals: promotion (comfort, safety, dignity, privacy, participation, frequent changes) and prevention (strain, injury, skin breakdown).
| Position | Setup | Why |
|---|---|---|
| Fowler's | HOB 45° (semi-Fowler's 30–45°, high-Fowler's 60–90°) | Lung expansion; helps prevent GERD after feeding; helps with urinary retention |
| Supine (dorsal recumbent) | Flat on back, knees may be bent | Visualization for exams; comfort |
| Prone | On abdomen, head turned, hips unflexed | Full hip and knee extension (prevents contractures); drains secretions |
| Lateral | Side-lying, hips and knees flexed, pillow between legs | Spinal alignment; less pressure on sacrum and heels |
| Lateral semi-prone recumbent (Sims') | Between prone and lateral, top leg flexed toward chest; bottom arm at side, not under | Less pressure on sacrum and hips; drains secretions; rectal exam and enema (left side) |
| Trendelenburg | Foot of bed higher than head | Venous return; drains lower lung lobes |
| Reverse Trendelenburg | Foot of bed lower than head | Relieves pressure on stomach and diaphragm; helps prevent GERD (from class discussion; ATI doesn't describe its use) |
Range of motion
Active ROM
Client moves the joint on their own.
Passive ROM
Someone else moves the relaxed joint. Keeps the joint flexible but does not prevent muscle loss or bone demineralization (no contraction, no weight-bearing).
| Movement | What it does |
|---|---|
| Flexion / extension | Bend (decrease the angle) / straighten |
| Abduction / adduction | Away from midline / toward midline |
| Pronation / supination | Palm faces down / palm faces up |
| Inversion / eversion | Sole turns in / sole turns out |
| Circumduction | Circle |
| Rotation | Turn along the long axis |
Known mnemonic · ab vs add
Abduction abducts (takes away) the limb from the midline. Adduction adds it back.
Exercise
Adults: at least 150 min/week of moderate aerobic activity (30 min, 5 days). Older adults benefit from programs that mix aerobics, strength, and balance (adapted yoga, resistance bands). After illness, start with a few minutes and build up.
Heat & cold therapy
Heat
Increases circulation and tissue metabolism, relaxes muscles, eases stiffness and pain. Moist: warm compress, soaks, sitz bath. Dry: hot pack, heating pad, warming blanket.
Heat cautions
Bony prominences are more sensitive. No heat over metal devices, under an immobile client, or on a pregnant client's abdomen. Never in the first 24 hr of a traumatic injury, or with active bleeding, noninflammatory edema, or some skin disorders.
Cold
Decreases inflammation, swelling, bleeding, fever, muscle spasms, and pain. Moist: cold compress, soaks. Dry: ice bag, collar, or glove, cold pack, cooling blanket.
Cold cautions
Don't use with cold intolerance, vascular insufficiency, open wounds, or disorders cold makes worse.
Memory hook
Heat opens up, cold shuts down
Heat brings blood in and loosens things up. Cold clamps down on swelling, bleeding, and pain, which is why a fresh injury gets cold, not heat.
Older adults
Stooped posture (kyphosis, most common in older females), poor balance and reflexes, slow and stiff joints with ankle and foot weakness, less muscle mass and endurance, and lower vision and depth perception. Result: slower, unsteadier walking and more falls. Building muscle strength helps preserve mobility.
Quick check
A client can stand from a chair using a cane. What equipment do you use to ambulate them?
Gait belt. That's Level 3, minimal assist.
Client using a walker: which moves first after the walker, the weaker or stronger leg?
The weaker leg, then the stronger.
Why doesn't passive ROM prevent muscle atrophy?
The muscle isn't contracting and the bone isn't bearing weight. It only preserves joint flexibility.
Hygiene & basic care
Let the client do as much as they can. Hygiene time is assessment time.
The body's barriers
Skin
Largest organ and first line of defense: a physical barrier plus Langerhans cells, which activate the immune response.
Mucous membranes
Line the respiratory, digestive, and urinary tracts. Mucus traps pathogens; nasal cilia push particles out to be coughed or sneezed.
Teeth
Chew food into a swallowable ball, support and shape the face, help with speech. Mouth bacteria make acid that dissolves enamel, leading to caries, infection, and tooth loss.
Nails
Layers of keratin that protect fingertips and toes. The cuticle and hyponychium block infection underneath.
Tooth layers, outside in
Hand hygiene
Prevents health care–associated infections (HAIs), the most common adverse events in client care.
Alcohol-based sanitizer (60% alcohol)
Default choice: before touching a client, before sterile technique, dirty-to-clean site on the same client, after touching the client or their environment, after body fluids, right after removing gloves. Rub about 20 sec until dry.
Soap and water
15–20 sec of vigorous rubbing. Avoid hot water (dries skin). Dry with a disposable towel and use it to turn off the faucet.
Memory hook · when sanitizer won't cut it
Soap for the 3 S's
Soiled (visibly dirty hands) · Stool (infectious diarrhea) · Spores (C. difficile)
Skin integrity
Incontinence is a major cause of breakdown. Hips, genitals, buttocks, and perineum are hit hardest. Clean with a pH-balanced cleanser. Mild soap has fewer irritants.
Development & culture
Teens
Bathe daily, wash hair at least every other day, daily deodorant, noncomedogenic cleansers.
Older adults
May resist bathing (pain, fear of falling, water, or temperature, low energy). Find the reason and offer choices. Ignoring a refusal to bathe can be considered abuse.
Privacy & culture
Ask before exposing the body and expose only the part you need, briefly. Many clients prefer a same-gender nurse. Respect faith-based routines.
Clients with disabilities
Stroke
Hemiparesis = weakness on one side. Hemiplegia = paralysis on one side. Affects the side opposite the stroke. Poor oral care → aspiration pneumonia. Shower instead of tub (fewer falls) with a shower chair or tub bench, long-handled brush, handheld shower head.
Spinal cord injury
May not feel hot or cold, so check the water temperature to prevent burns. Wet skin is fragile: dry carefully with a soft towel, especially the groin and buttocks.
Visual impairment
Can learn to shave: feel the face first, practice with an empty razor or with the electric razor off, use the free hand to guide and pull skin taut. Teach oral care with large print, Braille, audio, and dental models.
Bariatric
Deep skin folds (abdomen, groin, buttocks, under breasts, behind knees, elbows, ankles, neck) trap sweat and cause rashes and infection. Wash with pH-balanced liquid soap and dab dry. Barrier creams for incontinence.
Dementia
Loses ADL ability over time. Try a towel bath (warm towel with no-rinse soap), bathing on the commode, sitting in a recliner, or one body part per day. Offer choices, schedule toileting, limit caffeine and fluids late in the day. Poor oral care → aspiration pneumonia.
Amputation
Battery-powered toothbrush, grab bars, bath seat, anti-slip mats and bath strips, supplies within reach. Wash the residual limb daily with soapy water, rinse, dry thoroughly, report skin changes.
Memory hook · dressing after a stroke
Out with the unaffected, in with the affected
Undressing: clothes come off the unaffected side first. Dressing: clothes go on the affected side first.
Bathing & linens
Shower beats a bed bath; bed bath is the last resort.
| Method | Key point |
|---|---|
| Basin, soap & water | Basins can harbor pathogens; soap and water can deteriorate hospitalized clients' skin |
| Prepackaged no-rinse cloths | One cloth per body part; let it air dry, don't towel-rub |
| CHG (chlorhexidine gluconate) bath | Chlorhexidine cloths on all skin except the face; reduces infection, especially in ICU (intensive care unit) |
Warm bath water is 43–46°C (110–115°F).
Linen changes
Ask about PRN (as-needed) pain medication before an occupied bed change. Wear gloves, keep soiled linen away from your body, and put it straight into the designated receptacle.
Head to toe
Hair
Brush from the ends up toward the roots, holding the hair at the scalp. Ask about products. Cowashing (conditioner only) suits dry, curly, or coarse hair. Locs aren't combed. Check for scalp pressure injuries under protective styles.
Lice & dandruff
Lice: notify the provider immediately. Dandruff: itchy, flaky scalp.
Eyes
Wash from the inner to outer canthus, a clean part of the cloth for each eye. Poor eyesight raises fall risk. Keep glasses clean and document vision aids.
Ears
Washcloth over your finger. No cotton swabs. Drainage is abnormal and may mean infection.
Feet
Wash daily and dry between the toes. Lotion on the feet, not between the toes. For diabetes or poor circulation: warm (not hot) water, don't soak (dries skin), inspect for cuts and blisters. Trim straight across and file, per facility policy.
Your slides say podiatry should be the only specialty to clip toenails for clients with diabetes, poor circulation, or immunosuppression; an emery board can file long toenails down. The module says to check facility policy and, if trimming is allowed, cut straight across and file.
Fingernails
Soak 10 min, clean under nails with an orange stick, cut straight across, file, apply lotion. Longer nails hide more germs.
Known mnemonic · washing the face
Clean to dirty
Eyes first, then forehead, cheeks, nose, ears, neck.
Perineal care
Wear clean gloves. Let the client do it if appropriate.
Vagina
Wash front to back to lower UTI risk.
Uncircumcised penis Flagged
Retract the foreskin and clean underneath, then always return the foreskin to prevent swelling, pain, and poor circulation to the tip.
Catheter care
Daily. Genitals → meatus → catheter, moving away from the body. Hold the catheter near the meatus so you don't tug it.
Supplies: washcloths, skin cleanser, skin protectant cream, waterproof pad. Not cotton swabs, peroxide, gauze, talc, sterile gloves, or povidone-iodine.
Oral care
Daily routine
Brush twice a day for 2 min with fluoride toothpaste and a soft brush (battery-powered is best). Clean the tongue. Floss daily. Fluoride mouthwash.
Healthy vs not
Healthy: pink, moist lips and tongue, clean intact teeth, visible saliva. Unhealthy: dry mouth, chipped teeth, coated tongue, plaque, thrush (may mean dentures with poor hygiene).
Why it matters
Plaque → gingivitis → periodontitis. Mouth bacteria can reach the heart. Ventilated clients need nurse-provided oral care to prevent ventilator-associated pneumonia (VAP).
Dentures
Clean them to remove trapped food and prevent thrush. Lost dentures affect eating, speech, mental health, and wallets.
Quick check
A nurse finishes caring for a client with C. diff. Sanitizer or soap and water?
Soap and water. Spores need soap.
Client with left-sided hemiplegia needs a shirt on. Which arm goes in first?
The left (affected) arm.
Which is a risk of bathing a client with a basin?
Contamination with pathogens. Basins can carry hospital pathogens.
Client education
Ongoing, goal-driven, and interactive. Required by the Joint Commission.
The practical nurse's (PN's) role
Reinforce teaching the RN (registered nurse) has already done.
Why teach
Builds skills and accountability for self-care, supports lifestyle changes, helps clients advocate for themselves and manage their care.
Documentation
Verifies care, supports continuity, and affects reimbursement.
Knowles's principles of adult learning
Relevance
Knows why it applies to them.A client wants to learn foot care after hearing it can prevent an amputation.
Self-directed
Controls choices and owns the consequences.A client chooses when to practice their insulin injections.
Life experience
Builds on what they already know.A client who cooks relates carb counting to following a recipe.
Readiness
Ready, willing, and able right now.A client in hypertensive crisis isn't ready to learn new meds.
Task-centered
Tied to real problems, not memorization.Practicing on their own glucometer instead of memorizing ranges.
Motivation
Internal and external both needed; internal is what makes it stick.A client quits smoking so they can keep up with their grandkids.
What helps and what hurts
| Promotes learning | Hinders learning |
|---|---|
| Perceived benefit | Fear, anxiety, depression |
| Enhanced health literacy | Lack of motivation |
| Nonjudgmental support | Environmental distractions |
| Quiet, low-stimulus environment | Psychomotor deficits |
| Repetition | Physical discomfort (pain, fatigue), bad timing |
Health literacy
Ability to obtain, read, and understand health info. Low literacy → more med errors, ED (emergency department) visits, admissions, and deaths. Universal precautions (Agency for Healthcare Research and Quality, AHRQ): treat every client as if they might have low health literacy. Plain language: "Your blood pressure is a little high" instead of "You have hypertension."
Low-stimulus environment
Good ventilation and lighting, comfortable temperature, low noise, privacy. TV off, and don't teach at mealtimes.
Repetition & feedback
Repeat to build confidence. Give feedback during and after, like watching a client take their own BP.
Barriers to learning
Pain & discomfort
Assess and treat comfort before teaching.
Language
Hospital-based or telephone interpreter. Never family or friends (confidentiality, accuracy).
Hearing
Face to face, speak clearly, cut background noise, hands away from your face, write key info down.
Vision
Large print, voice-generated computers, Braille.
Cognition
Involve family; evaluate often.
Psychomotor
Fine motor: small muscles (writing, opening med packages, injections, dressing changes). Gross motor: large movements (walking, ROM, propelling a wheelchair).
Domains of learning
| Domain | Focus | Best teaching methods |
|---|---|---|
| Cognitive | Thinking | Lecture, question-and-answer, discussion |
| Affective | Feelings, values, beliefs | Discussion, role play |
| Psychomotor | Doing (skills) | Demonstration, return demonstration, games |
Known mnemonic · the three domains
Head, heart, hands
Teaching strategies
Group
Two or more clients. Childbirth classes, support groups, diabetes clinics.
Individual
One-on-one: at the bedside or a clinic visit.
Teach-back
Client explains in their own words or demonstrates the skill. Shows what they understood and what needs reteaching.
Digital
Websites, multimedia, mobile devices. Consistent, and works best combined with traditional teaching.
Age & culture
| Age | Approach |
|---|---|
| Infant/toddler | Teach caregivers; pictures, dolls, puppets; brief sessions close to the event |
| Preschool (3–6) | Include caregivers; play and sensory experiences; let them voice fears |
| School-age (6–12) | Logical thinkers; games, role play, stories, art |
| Adolescent | Abstract thinkers; the teen is the focus; guide, don't lecture; protect privacy |
| Older adult | Fewer distractions, lower tone of voice, more time, smaller chunks; include family if cognition declines |
Assess beliefs, customs, and values. Use certified medical interpreters. Avoid stereotypes: reflect on your own self-bias and implicit bias before care, and collaborate with clients on materials.
The teaching plan
Mirrors the nursing process, but focused on learning needs.
- Assessment: learning needs, readiness, motivation, resources, health literacy, disabilities, preferences, culture
- Analysis (RN only): identify and prioritize learning needs
- Planning: individualized plan with goals and strategies
- Implementation: remind them why it matters, encourage questions; mix verbal, demonstration, print, video, teach-back
- Evaluation: were goals met? Teach-back or return demonstration. If not, is the goal realistic or do the methods need to change?
Known mnemonic
Goals should be SMART
"The client independently checks blood glucose with a glucometer by discharge."
Quick check
A client with a new ostomy practices changing the pouch while the nurse watches and coaches. Which domain?
Psychomotor. Performing with instruction and supervision.
A client's son offers to translate the discharge teaching. What do you do?
Get a hospital-based or telephone interpreter. Family can't verify accuracy and it breaches confidentiality.
Which part of the teaching plan can a PN not do?
Analysis. That's RN only.