Definition
Assisting a patient with walking using a walker or cane is a vital nursing skill that promotes mobility, independence, and safety.
It involves assisting a patient to walk using a walker while providing support and balance.
Patient’s requirements to use walker:
- Partial strength in both hands and wrists.
- Strong elbow extensors, such as triceps brachii.
- Strong shoulder depressors, such as the pectoralis minor.
- Ability to bear at least partial weight on both legs.
Procedure
| Nursing action | Rationale | |
| 1 | Explain the method of using walker. | Prevents anxiety and helps in obtaining cooperation of the patient. |
| 2 | Instruct the patient to wear non-skid shoes or slippers. | Prevents falling. |
| 3 | Instruct patient not to use walker on stairs. | |
| 4 | Have patient stand in center of walker and grasp handgrips on upper bars. | Patient balances self before attempting to walk. |
| 5 | Lift walker, and move it 6-8 inches forward, making sure all four feet of the walker stays on the floor. Take a step forward with one foot. Then follow through with the other leg. | Provides broad base of support between walker and patient. Patient then moves center of gravity toward the walker. Keeping all four feet of the walker on the floor is necessary to prevent tipping of the walker. |
| 6 | If there is unilateral weakness, after the walker is advanced, instruct the patient to step forward with the weaker leg, support self with the arms, and follow through with the uninvolved leg. If patient is unable to bear weight on one leg, after advancing walker, have the patient swing on to it, supporting weight on hands. |
Cane Walking
Canes are light weight, easily movable devices that are made of wood or metal. They provide less support than a walker and are less stable.
A person’s cane length is equal to the distance between the greater trochanter and the floor.
Types of canes
- Single – ended canes with half – circle handles: Recommended for patient’s requiring minimal support and those who will be using stairs frequently.
- Single – ended canes with straight handles: Recommended for patient with hand weakness because the handgrip is easier to hold but not recommended for patients with poor balance.
- Canes with three or four prongs (Quad cane): Provides a wide base of support and it is recommended for patients with poor balance.
Procedure
| Nursing action | Rationale | |
| 1 | Instruct patient to stand with weight, evenly distributed between the feet and the cane. | |
| 2 | The cane is held on the patient’s stronger side. Instruct patient to position cane 6” laterally and 6” anterior of the near foot. Ensure the flexion of elbow joint is maintained at 30 degrees. | Helps in improving stability. |
| 3 | Instruct the patient to advance the cane 4-12 inches while supporting the weight on the stronger leg. | |
| 4 | Supporting weight on the stronger leg and the cane, the patient advances the weaker foot forward, parallel with the cane. | Helps in improving stability. |
| 5 | Supporting weight on the weaker leg and the cane, the patient next advances the stronger leg forward ahead of the cane. | Helps in improving stability. |
| 6 | The weaker leg is moved forward until even with the stronger leg, and the cane is once again advanced. | |
| 7 | Instruct patients to position their canes within easy reach, when they sit down, so that they can rise easily. | |
| 8 | Teach patient to stand erect when walking with a cane and not lean over the cane. |
Special Consideration
- The patient should be taught to examine the frame daily when inspecting a walker. The patient should observe for signs of bending or deformation of the frame, protruding screws that can scratch and loose or missing screws that can weaken the joints of the frame. Handgrips should be assessed for any cracks or signs of being loose.
- Use caution when attempting to ambulate a patient who has already been given an Antihypertensive or Analgesic medication because the medication may cause dizziness or instability
- Caution should be used if the patient uses a walker or uneven terrain or on inclines.
- Care must be taken if the patient has IV-line, Urinary catheter, etc.
When patient is ambulating with /without assistive device, emphasize need to always look ahead to prevent injuries and maintain a good posture.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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