What action should you take while assisting a resident who is learning to use a walker?

Ambulation is the medical term used for walking. Ambulation provides weight-bearing activity that promotes bone health and joint mobility. A physical therapist will determine if a person can safely walk independently, with the assistance of one or two people, or if they require an assistive device such as a cane or walker. This information is documented in their nursing care plan. Similar to when assisting a client to transfer with a gait belt, the nursing assistant should place nonskid footwear on the person and allow them to dangle on the edge of the bed before standing to ambulate. For specific steps, see the “Ambulation From Wheelchair” Skills Checklist.

If a resident requires assistance with a cane, the cane should be placed on the resident’s stronger side. The resident should step forward with the strong leg and then use the cane and the weaker leg for the next step.

There are three types of walkers: a standard walker, a two-wheeled walker (2WW), and a four-wheeled walker (4WW). The type of walker a resident should use is recommended by the physical therapist. A 2WW or standard walker allows for more support and a slower gait, whereas a 4WW is used by clients with better balance and mobility.

View the following video of a client correctly walking with a cane: How to Ambulate With a Cane.

Regardless of the assistive device used for ambulation, the NA should remind the resident to stand up straight and look forward when walking. The resident should be encouraged to take purposeful steps and to not shuffle their feet. The NA should stand to one side of the resident and slightly behind them, with one hand on their gait belt. If the resident has a weaker side, the NA should stand on that side. The NA’s fingertips should be facing upwards underneath the gait belt for proper support. If the resident loses their balance while in this position, the NA’s arm will allow them to use their bicep muscle, rather than their forearm, to steady the client. The bicep is larger and stronger than the forearm and can provide better support.

A second staff member can follow a resident who is ambulating with assistance with their wheelchair in case they experience weakness or dizziness. If the client needs to sit while ambulating, the wheelchair brakes should be applied before they sit, or in an emergent situation, the NA should block the back of the wheelchair with their body to ensure stability when the resident sits.

If a resident starts to fall while standing or ambulating, do not attempt to stop their fall or catch the resident because this can cause you to injure your back. Instead, move behind the patient and take one step back with one leg so you have a wide base of support. Support the patient around their waist or hip area or grab the gait belt. Bend one of your legs and place it between the patient’s legs from behind. Slowly slide the patient down your bent leg, lowering yourself to the floor at the same time. Always protect the resident’s head to prevent head injury. After the resident is on the floor, do not move them. For witnessed or unwitnessed falls, notify the nurse immediately for assessment. After the nurse has completed the assessment and met the resident’s immediate needs, use a mechanical lift to transfer the resident back to a wheelchair or bed. An incident report will be completed by the nurse, and the NA will be asked to give a statement on what occurred and their actions in response to the situation. See Figure 8.21 for an image of lowering a resident to the floor.

CNAs may be tested on a skill for how to ambulate with a walker. When dealing with elderly residents, it will be critical for CNAs to properly know how to work with a resident and ambulate with a walker. . 

To learn all the necessary steps for this skill, please watch this CNA Skills How to Ambulate with a Walker for a complete demonstration of the skill. 

CNA Skill – How to Ambulate with a Walker

The process for patient or resident ambulation with a cane or walker during the CNA skills exam is as follows:

1. Perform the standard CNA beginning tasks. Knock before entering the patient’s room, greet the patient by name, introduce yourself, explain the task you are about to perform, close the privacy curtain, and wash your hands. . 
2. Lock the bed brakes to ensure resident safety.
3. Lock the wheelchair.
4. Lower the bed, then raise the head of the bed to a workable sitting position.
5. Standing beside the bed, bend the resident’s knee that is farthest away from you and roll to you.
6. Drop the resident’s feet and then push up. 
7. Make sure to ask the resident if they are light headed. 
8. Place a gait belt on the resident and then put their shoes on.
9. Position the walker in front of the resident. Count out to three with the resident and then assist them to stand and stabilize themselves with the walker.
10. Position yourself to the side of the resident and them in the the walker to their wheelchair
11. Pivot and rotate resident so that they may be able to gently guide back into the wheel chair, making sure that the resident feels the chair at their knees as they guide back into it. 
12. Remove the resident’s gait belt. 
13. Perform your standard completion tasks – wash your hands, ensure the patient has a clean environment, ask if they are comfortable, give them their call light and close their privacy curtain.

* Please be sure to consult the testing materials provided by the skills test provider in your state to ensure that these steps for CNA Skill Ambulation with a Walker are in compliance. The procedure in different states and from different test providers can vary slightly and greatly affect your score.

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