MDS Alert

Bone up on these key pointers.

Restorative nursing techniques can help prevent falls and fractures by keeping people's bones and muscles as strong as possible. You can also use ADL care strategies to help prevent fractures in those with osteoporosis.

As an overall strategy to increase residents' strength, anything a caregiver can do to encourage the resident to engage in weight-bearing activities is a positive, advises Cheryl Field, RN, MSN, CRRN, a consultant with LTCQ Inc. in Lexington, MA. "As a person loses more of the late-loss ADL skills, he isn't doing weight-bearing activities anymore as a general rule. That's a huge reason why nurses should encourage the weight-bearing component required in a transfer."

To improve upper-body strength, ask residents who play bingo to wear a one-pound weight on each wrist while they play the game for 15 minutes, a strategy Field has used with patients. Encourage the person wearing a wrist weight to use multiple bingo cards, requiring him to completely extend an arm to reach a top card, she adds.

The activities departments in one Minnesota nursing facility came up with a simple restorative activity to help make residents more fall-proof. "The residents lined up in their wheelchairs or chairs and practiced sitting and standing," relays Bet Ellis, RN, healthcare manager for LarsonAllen in Charlotte, NC. The goal was to strengthen lower-extremity muscles and improve balance to prevent falls when getting in out of chairs. A licensed nurse evaluated the outcome of the restorative intervention, Ellis says. The activities personnel were instructed in how to perform the activity safely and demonstrated their competency in doing so, she adds.

Help Prevent ADL Care-Related Fractures

Residents with osteoporosis can suffer fractures during the course of routine ADL care. But the right care techniques can help prevent that from occurring. These include the following:

• Transfer residents in a way that reduces stress on bones. For example, when the CNAs or nurses help a resident transfer, they should allow the resident to initiate the activity, Field advises. Then the caregiver follows through in assisting the person to continue the motion.

"The idea of counting 1, 2, 3 is to allow the resident to start on 3 so she uses her own strength to start the motion," Field explains.

"You continue with the motion but you don't want to initiate it because, if you do, you are almost working against the resident," Field cautions. "Allow the resident to begin the activity whether it's a transfer or hiking up clothing," she adds. The technique works for anyone who is not totally dependent. "It's a lot less work for the staff and less forceful for the resident, reducing the risk of fracturing."

• Know how to handle limbs when bathing or helping with range of motion. "If you grab a hold of the wrist fast while doing the bath or range of motion, the action could accidentally result in a fracture," Field cautions.

"If the resident's limb is flaccid, always use two points of contact" on the limb when moving it, Field advises. "If the person can move some, ask her to please move her arm up or out a little and then continue with the motion to assist her."