390 Unit 4 Healthcare Skills Copyright Goodheart-Willcox Co., Inc. Rationale Assisting a patient to ensure a walker is used cor- rectly reduces the chance of injury and promotes safe ambulation. Preparation 1. Make sure you have a written doctor’s order for ambulation with a walker. 2. Assemble the following equipment: • a robe or well-fi tting clothing • nonslip, properly fi tting, low-heeled footwear • a standard or rolling walker • gait belt (check that it is in good condition and functional) 3. Wash your hands to ensure infection control. 4. Explain in simple terms what you are going to do before assisting the patient to ambulate with a walker. The Procedure 5. Provide privacy. You can draw the bed curtain or put a screen around the bed. 6. If the patient is in bed, lower the bed to its lowest position and lock the wheels. 7. If the patient is in bed, assist him or her to a dangling (sitting) position on the side of the bed. 8. Help the patient as she puts on the nonslip, properly fi tting shoes and robe, if needed. 9. Apply the gait belt, if needed. Put the belt around the patient’s waist, over her clothing, with the buckle in the front. Thread the belt through the teeth of the buckle and through the other two loops to lock it. Make it snug, but leave enough room to place your fi ngers under the belt. 10. While the patient is sitting on the bed, position her so she is centered in front of and inside the frame of the walker. 11. The walker should be placed about one step ahead of the seated patient, making sure the legs of the walker are level on the ground and stable. 12. Using both hands, have the patient grip the top of the walker for support, stand, and walk into it. Then have her take the fi rst step with her weakest leg. The heel of the foot should touch the ground fi rst and the foot should fl atten. 13. As the step is completed, the next step should be taken with the patient’s strong leg. As the patient ambulates, position yourself behind her and slightly to the side. 14. The fi rst step is repeated with the weak leg and then followed by the strong leg. This sequence is repeated. Do not hurry the patient. 15. Make sure the patient does not step all the way to the front bar of the walker. Have her take small steps when she turns. 16. Let the patient set the pace while keeping a fi rm grasp on the gait belt, if used. 17. Encourage the patient to achieve the ordered distance, but be observant. Watch for signs of patient fatigue or a possible collapse. If this occurs, follow the steps discussed earlier. 18. To move the patient to a sitting position, have her begin by standing so her back is to the chair (Figure 13.25A). Make sure the patient is close enough to sit down on the chair. The patient should slide her weaker leg forward and shift her weight to the stronger leg. Have her switch hands from the walker to the arms of the chair and sit down slowly (Figure 13.25B). Procedure 13.4 Assisting with Ambulation Using a Walker A Wards Forest Media, LLC Figure 13.25 B