1.PATIENTTRANSFER

2. PATIENT TRANSFERA transfer is the safe movement ofthe patient from one place to another,like from bed to wheelchair and bythe used of assistive devices. Indoing so, the nurse must teachpatient and ask for his or herparticipation for successful results.There are many methods of transfer. 3. The nurse should choose anappropriate technique for thepatientby takingintoconsiderationshisorherdisabilities and abilities. In mostcases, it is very helpful if thenurse demonstrates the techniquefirst before the transfer. Duringthe transfer, the nurse coachesand assists the patient. 4. LEVEL OF TRANSFERIndependent transfersThe patient consistently performs all aspectsof the transfer, including setup, in a safemanner and without assistance.Assisted transfersThe patient actively participates, but alsorequires assistance by a clinician(s).Dependent transfersThe patient does not participate actively, oronly very minimally and the clinician(s)perform all aspects of the transfer 5. LEVELS OF ASSISTANCEStand-by assist (aka supervision)Close guardingContact guardingMinimal assistModerate assistMaximal assist 6. Risk Factors Related to Patient 7. CommunicationThe caregiver must assess the patientsability or inability to communicate. The risk of injury increases if the patient: Does not speak/understand the samelanguage as thecaregiver Does not understand speech Does not understand non-verbalcommunication Can not follow simple commands 8. Communicates with sign languageor assistive communication devices Has a hearing impairment Has a speech problem Has a low level of consciousness 9. CognitionOften hospitalized patients have analtered level of cognition affecting theirability to participate in lifts/transfers.Short term memory loss, poorjudgment, and difficultymakingdecisions can all be manifestations ofaltered cognition.Questions testing the short termmemory can often give some indicationof the level of cognition. 10. Medical StatusSigns and symptoms of variousmedical conditions can impact on apatients ability to transfer i.e. thetremors and movement initiationproblems associated with Parkinsonsdisease.Medications can alsoaffect the patients ability to transfer.Fatigue, pain and stiffness will affectthe quality of the transfer. 11. The medical status can changedramaticallyduring a shift and caregivers needto observe these changes andmodifythe lift/transfer as necessary. 12. Physical StatusA physical assessment should include: Weight bearing status Weight Height Range of motion (ROM) Strength Balance Coordination Sensation Clothing Footwear 13. Emotional and Behavioral StatusPatients behavioral and emotional statemay change throughout the dayi.e. Sundowners. The caregiver shouldbe aware of behavior changesincluding: Anxiety Aggression Agitation Combativeness Confusion Depression Hostility 14. Impulsiveness Low tolerance for change Low self esteem (if they think poorlyof their abilities they may notcomplete the transfer to the level oftheir ability) Rejection Resistive Self Destructive Unpredictable 15. Risk Factors Related to theEnvironment Layout Space Lighting Color Temperature Obstacles Floor 16. Risk Factors related to the Equipment Medical devices (catheter bags, IVs,prosthesis) Inadequate training in the use ofequipment Improper use of equipment or use offaulty equipmentRisk increases whenfurniture/equipment not adjustable 17. TRANSFER ASSIST DEVICESPrimarily used to:Provide a safer means of moving andtransferring a person from one place toanother.Facilitate independence and maintainthe dignity of the person being movedor transferred.Eliminate or minimize risk factors thatcan lead to caregiver or patient injury. 18. Where possible, patients should beencouraged to move themselves. Thosewith good balance and upper bodystrength may be able to maintain orregain independence through the use ofcertain transfer assist devices.Transfer assist devices may reduce theamount of force exerted by caregiversand improve their posture when movingpartially or totally dependent patients. 19. Transfer assist devices do not reducethe weight of a patient and should notbe used to lift, carry, or support thewhole or a large part of a patients bodyweight.A safer means of moving the patient,such as a mechanical lift, may berequired. Safety for both patient andcaregiver must always be considered. 20. BEST PRACTICES WHEN USINGTRANSFER ASSIST DEVICESOnly use transfer assist devices if properlytrained in their safe use. When safe,encourage patients to move themselves.Tell the patient what you intend to do beforeyou do it. Ensure that the brakes of the bed,stretcher, or wheelchair are on beforebeginning any movement.Inspect each device before use. Tag andremove damaged equipment from service.Set the bed at the height of caregivers upperthighs. 21. Lower the side rail on the bed toreduce awkward reaching.Minimize gaps and height differencesbetween surfaces whenperforming alateral transfer (for example, from bedto stretcher), and bridge gaps withtransfer boards, where necessary.Avoid differences in height betweentwo surfaces when performing atransfer. A gentle decline, however,may be preferable for some seated orsupine transfers using a transfer board. 22. When moving a patient up in bed, tiltthe bed to a head down position toallow gravitytoassist,unlesscontraindicated.Use moving and handling equipmentin accordance with your organizationspolicies and procedures.Ensure friction-reducing devices arelarge enough to be placed under themain points of contact. For supinepatients, this includes the pelvis,shoulders and, if possible, the feet. 23. Do not leave friction-reducing devicesunder the patient unless the manufacturerspecifically recommends it. Leaving anunsecured friction-reducing device underan unsupervised patient may put thepatient at risk of falling out of bed. as low-friction draw sheets, are designed to beleft under the patient. These sheets aresecured by tucking the sides of the sheetsunder the mattress, so that the sheetsdont have to be continually placed andremovedHave the patient assist as much aspossible during the transfer or reposition.Avoid lifting the patient. 24. Set of two draw sheets Draw and slider sheetsDraw sheetsDraw or slide sheets are made of low-frictionfabrics or gel-filled plastics that enablean individual to slide over a surface instead ofbeing dragged or lifted. These sheets come ina variety of widths and lengths and may beused in pairs, singly, or folded.drawsheet has the slippery surface only onone side and can be kept under the patient.A slide sheet, on the other hand, is slipperyon both sides and should be removed once thepatient is repositioned. 25. Slider sheets Slider or roller sheets are tubular sliding sheets made of specialized fabrics with low-friction inner surfaces that glide over themselves. Slider sheets may be flat or padded and can be placed under draw sheets or incontinence pads. Slider sheets come in several sizes and lengths.Set of two slider sheets 26. Short slider sheets are primarily usedfor pivoting and repositioning taskssuch as sitting a patient up on the sideof the bed or repositioning a patient upin bed.Long lateral slider sheets are intendedfor transferring supine patients fromone surface to another, such as frombed to stretcher. 27. ONE-WAY SLIDES, slide in onedirection only. This facilitatesmoving a patient up in bed or backin a wheelchair, while preventingthe patient from sliding down thebed or forward in a wheelchair.One-way slides reduce the need tomanually reposition a patient in abed or chair. 28. Note: Slider sheets may be used independently or with partial help. When used independently, a patient with good sitting balance and sufficient arm or leg strength may be able to slide from one surface to another or up and down in bed. When providing partial help, it is important to apply forces horizontally only, resulting in a slide, not a lift. The chosen technique should, as much as possible, eliminate the need for the caregiver to twist, reach, or stoop.Padded one-way slide 29. Two roller sheetsUSESFacilitate independent bed mobilityMove patients up in bedMove patients from the side of the bed to thecentre or vice versaTurn patients onto their side in bedTransfer patients from one surface to another,such as from a bed to a stretcher (when used inconjunction with other devices, such as transferboards)Move patients who have fallen into confined orawkward spaces to a place where a mechanicallift can be usedPivot patients in bed and aid exercise 30. Lateral transfer aid ADVANTAGES Draw and slider sheets have the following advantages: Simple and versatile Sliding patients may avoid the need to manually lift them Draw sheets may be tucked partway under seated patients or completely under lying patients who have been rolled onto their sides Handles may provide caregivers with a firm grip 31. DISADVANTAGESSliding patients who have pressure sores orother sources of sensitivity may cause them pain.Heavy patients may still require excessive forceto move. And mechanical lift may be moreappropriate.If the same sheet is used for more than oneperson infection-control precautions must betaken.Not be suitable for some transfers because theydo not bridge gaps. Where gaps need to bebridged, caregivers can use slide sheets inconjunction with transfer boards.Two flat sheets 32. DISADVANTAGESA slide may actually turn into a lift ifcaregivers do not use proper techniques.The move or transfer still requires twocaregivers.The use of these sheets may involveadditional effort and handling tasks toposition and remove them. 33. TIPSFollow these tips when using draw andslider sheets:Use a palms up grip when pulling onthe slide/roller sheet. A palms up grip isa stronger grip than a palms down grip.A palms up grip keeps elbows close tothe body and helps to maintain a neutralshoulder posture.Keep knuckles in contact with thebedsheet to ensure a sliding motion, not alifting motion. 34. Avoid shrugging the shoulders whilemoving the patient, as this indicates alifting motion.If repositioning the patient up in bed, tiltthe entire bed with the head down, whichallows gravity to assist with the movement.Ensure that the sheet is taut beforemoving the patient to prevent jerking thepatient.Draw sheets can be left under the patient 35. Reduces the forces required to movepatientsReduces awkward postures if usedcorrectlyMore comfortable for patients thantransfer boards 36. Transfer belts TRANSFER BELTS Transfer belts do not reduce the patients weight in any way, and must not be used for lifting patients. Transfer belts come in a variety of sizes and shapes. They fasten with a buckle, a clasp, or Velcro, and they usually have handles. Note: Although Velcro fastening is quicker and easier than using buckles or clasps, the hooks may get caught on the patients clothing and may deteriorate rapidly if not carefully laundered. 37. USESTransfer belts can be used:During assisted walkingTo guide patients along transfer boards duringseated transfersADVANTAGESTransfer belts have the following advantages:They provide a secure grip.Caregivers do not need to grip the patients clothingor limbs.Caregivers can guide a falling patient to the floor.NOTE Do not use transfer belts to catch or support afalling patients weight.Caregivers can work in a more upright posture. 38. DISADVANTAGESTransfer belts have the following disadvantages:Belts that are too wide may affect a patientsability to lean forward. Narrow, unpadded beltsmay dig into the patients waist.Using a belt to lift all or most of a patients bodyweight is not an acceptable practice.Belts without handles encourage the caregiverto grip the belt with a clenched fist. This generallycauses the knuckles to press into the patientsside, resulting in discomfort. 39. Caregivers should not place their arms through handles, as pictured. Caregivers would rarely have time to free their arms if the patient reacted or fell suddenly. Caregivers are placed at significant risk when patients are allowed to hold around the caregivers neck. Caregivers can avoid this situation by placing their arms outsideNever place your those of the patient when providingarm throughtransfer beltassistance. handles 40. TIPSFollow these tips when using transfer belts:As long as it is safe to do so, place thetransfer belt on the patientvwith the bed ina raised position to avoid awkwardbending.Ensure that the belt is fairly snug (youshould only be able to place two fingers inbetween the belt and the patient) toreduce the chances of the belt sliding upthe patient during the transfer. 41. When performing the transfer, caregiversshould shift their body weight from one legto the other and perform a gentle pullingmotion, using the legs to do the work.Avoid lifting during the transfer movement.Get the patient to assist as much aspossible. 42. SLIDE/TRANSFER BOARDS Slide/transfer boards or smooth movers are made of wood or plastic and can be used in conjunction with roller sheets or slide sheets. Some boards have rollers, while others have fabric or vinyl coverings designed to further reduce friction. Slide/transfer boards are used to reduce friction and bridge gaps when sliding patients between two horizontal surfaces such as from a bed to a stretcher.Rolling slide/transfer board 43. These boards are suitable only for thosepatients who can power themselves by sliding orrolling along the board with guidance from aknowledgeable caregiver. Some proceduresrequire the caregiver to push or pull the board toaccomplish the transfer.Others involve pushing the patient or pulling adraw sheet across the transfer board. Largepatients and patients with sensitive skin may findslide/transfer boards uncomfortable. If possiblethe use of a mechanical lift is recommended overa slide/transfer board. 44. Banana boardSMALLER SLIDE/TRANSFER BOARDS Smaller slide/transfer boards are designed for seated lateral transfers. They are often tapered at each end and can be used to bridge a gap such as when transferring between a bed and aSmaller slide/transfer wheelchair or commode. Patients with good to boardswith movable sliding use their arms and legs to move themselves.sections Boards are often made of a low-friction material or with moveable sliding sections. Be careful when using slide/transfer boards with sliding sections because these sliding sections may cause pinching. 45. USESSlide/transfer boards can be used tobridge gaps between two surfaces tofacilitate patient transfer, such as between:Bed and wheelchairWheelchair and toiletChair and wheelchairWheelchair and carRolling slide boards can be used whentransferring supine patients between bedand stretcher. 46. Roller sheet ontransfer board ADVANTAGESSlide/transfer boards have the followingadvantages:Caregivers do not need to lift manually.Some patients may be able to transferthemselves, avoiding the need for caregivers toperform certain transfers.When used appropriately, slide/transfer boardsallow for less horizontal forces during caregiver-assisted transfers.Boards are available in a range of widths,lengths, and curves.Curved transfer boards make it possible totransfer around fixed armrests. 47. DISADVANTAGESSlide/transfer boards have the followingdisadvantages:Inappropriate use (for example, withpatients who cannot offer sufficientassistance) may put caregivers at a high riskof MSI.Some slide/transfer boards do notsufficiently reduce friction.Two equal-height surfaces are needed foreasy transfer. For seated transfers, patientsmust have some degree of sitting balance. 48. Many boards have no handles forpositioning or carrying the board.Caregivers must be careful not to twistduring the transfer.Caregivers may still apply horizontal forcesin awkward postures.Fingers may be trapped under boardedges. 49. TIPSFollow these tips when using slide/transferboards:When transferring a patient between twosurfaces, ensure the receiving surface is alittle bit lower (no more than 2.5 centimetresor one inch) to allow gravity to assist. Avoid adifference of more than 2.5 centimetres asthis may be too jarring for the patient.Use of a flat sheet directly under the patientwill increase the ease of the transfer becauseit will provide the caregivers with somethingto grasp onto when pulling the patient ontothe bed/stretcher 50. If the patient is lying on a fittedsheet, do not use the sheet for thetransfer. Its difficult to keep the sheettaut during the transfer, and it createsmore friction with the slide/transferboard, thereby increasing the forcerequired by the caregiver.When applicable, place the receivingsurface to the patients stronger side. 51. TURNING DISCSTurning or pivot discs come invarious sizes and may be flexible orsolid. They consist of two circulardiscs that rotate against each other.The inner surfaces are made of low-friction material, while the outersurfaces are typically high-frictionmaterial. Turning discs are often usedwith transfer boards or transfer belts.Turning discs 52. FLEXIBLE TURNING DISCSFlexible turning discs conform to thecontours of a surface and are mostuseful for pivoting seated patients (forexample, when transferring patientsinto vehicles). The inner surfaces aretypically low-friction plastic or othersynthetic material. The top is oftenmade of quilted or padded fabric forcomfort. 53. SOLID TURNING DISCSSolid turning discs are more durable andare used for pivoting patients who areweight bearing and can stand. Solid turningdiscs are usually made of wood or mouldedplastic and may contain bearings. Patientswho are weight bearing and can balancewhen standing may be guided to a standingposition and swivelled around withouthaving to adjust their feet. 54. Patients must have the strength to stand, orthis procedure will require the caregiver to exertexcessive force in an awkward posture. Usetransfer belts with handles to pivot patientsstanding on flexible or solid turning discs. Useturning discs only for patients who can stand upindependently. Patients who are unable toindependently rise to a standing position requirea sit-stand or total body lift. 55. USESTurning discs assist with rotation ofpatients during a transfer between:Wheelchair and bedWheelchair and chairWheelchair and car 56. ADVANTAGESTurning discs have the followingadvantages:The patients feet do not need to beturned or adjusted after the transfer.Some discs have a small handle thatmakes positioning and storing easier.Turning discs reduce the forces requiredto rotate or pivot patients. 57. DISADVANTAGESTurning discs have the following disadvantages:The larger the disc, the greater the risk that thedisc will be in the way of the caregivers feet.Some solid discs have ball bearings in theirswivel mechanism.Choose and use these discs with care. They canbe difficult to control, especially with lightpatients. 58. Do not use turning discs to transfer unpredictablepatients or dependent, non-weight-bearingpatients.The greater the profile (thickness) of a solid disc,the greater the tripping hazard it presents to thepatient and caregiver.A patients support base is narrowed whilestanding on a turning disc.Some patients may become disoriented whenthey are turned on the disc.Heavy patients may still require excessive force tomove them. 59. TIPSFollow these tips when using turning discs:For standing pivots, only one of the patients feetshould be placed on the solid disc. The patient mustbe able to use the other leg to guide the pivotmotion.For standing pivots, the patients foot should beplaced in the centre of the disc.Remove obstacles.Place caregivers feet shoulder-width apart for agood base of support. 60. AssessmentPrior to lifting any object or materials an assessment ofthe most appropriate method of lifting should becompleted. Plan the lift in your mind - organize the lift sothat it will be best for you and your co-workers. If you are uncertain about your ability to lift an objectsafely, get help! Never go it alone. Try the heft test. Getan idea if you can manage the lift. Always consider proper positioning of the spine andupper extremity to prevent injury. If you have an idea how the lift or environment couldbe improved, talk to your manager. Taking a few secondsto consciously prepare for the lift may prevent you or aco-worker from days, months or years of pain. 61. Assessment before starting a lift ortransfer is essential.A good assessment Ensures that the transfer/lift isappropriate for the caregiver andpatient Aids in preventing back andshoulder strain/injury to the caregiver Reduces the risk to the patientand/or caregiver 62. An appropriate transfer/lift Is safe for the caregiver and patient Enables the patient to be asindependent as possible Is comfortable for the patient Provides the least wear and tear onthe back and shoulders of thecaregiver 63. Why is consistency important? Unexpected incidences or lack of patientcooperation are often contributing factors ininjuries to caregivers. When the lifting techniqueis consistent the patient is more likely tocooperate and be less anxious.Who should do the assessment? The nurse is responsible for assessing thepatients transfer/lift needs. Physiotherapists and/orOccupationalTherapists are available for consultationconcerning complex cases. A referral may berequired if intervention to improve transfers isindicated. 64. When should the initial assessment be done? The admitting nurse should do the assessmentof the most appropriate lift/transfer at the timeof admission. The accepted lift/transfer should be noted onthe admission history and the Kardex.What should be included in the initialassessment? Caregiver status Assess the patients abilities (strength, ROM,balance, etc) The environment Equipment available 65. When are lifts/transfers reassessed? A brief reassessment must be done everytime, before a caregiver intends tolift/transfer a patient Reassessment is important because apatients ability to assist and cooperatemay vary from day to day, or even atdifferent times during the same daybecause of medication, fatigue, stress orpain 66. Reassessment may help to prevent thoseunexpected incidents More formal reassessments arenecessary when a patients conditionimproves or deteriorates. This ensure theprocedure listed on the kardex is mostappropriate Reassessment also helps to maintain ahigh level of awarenessabout patient handling 67. What needs to be reassessed? Change in medical status Patients ability to communicate Level of cognition Level of aggression Physical Abilities (ROM, strength) Environment Availability of EquipmentCaregiver Ability 68. FACTORS TO CONSIDER WHEN ASSESSING PATIENT HANDLING TASKS 69. PREPARATIONPreparing for the lift/transfer1. Prepare the equipment Adjust position of the equipment (bed,stretcher, wheelchair, etc) Adjustments to the chair include lockingbrakes, checking cushion position (ifavailable), removing arm rests if necessaryfor transfer/lift, positioning chair atappropriate angle. 70. Adjustments to the bed include lockingbrakes, putting down side rails, adjustingbed height (hip height if standing, midthigh height if knee on bed, level withchair if using sliding board or hemitransfer) Ensure all devices are in good workingorder including belts, lifts,slings 71. 2. Prepare the patient Explain what you are about to dowith the patient A well-prepared patient can makeyour workload easier! Ensure the patient places theirhands on the appropriate place toassist with the lift i.e. the side rail. DONOT ALLOW THE PATIENT 72. TO GRAB AROUND THECAREGIVERS NECK. This could leadto neck injury or strain. Position the IV tubing/poles,catheter bags and otherappliances so that they do notinterfere with the transfer Maintain the patients dignity 73. 3. Prepare the Caregiver Complete a brief reassessment to ensure appropriate lift Position the caregiver so the patient feels safe, thepatient can hear and see the caregiver, and withappropriate body mechanics (the feet apart and kneesbent slightly) Discuss the plan with lifting partners Explain the plan to the patient including their role in thetransfer/lift Use simple instructions/one step commands Tighten abdominal muscles (core) before you lift.Maintain normal spinal alignment by keeping a slightinward curve just above the pelvis. Use the powerful legmuscles to help with the handlingprocedure 74. Use both hands and hold the patient as close toyour body as possible. Never grasp the patientunder the arms. This can lead to injury orsubluxation Count with lifting partners so everyone movesat same time 1,2,3,lift Be prepared for the unexpected. If the load starts to slip or the patient starts tofall, go with it. Try not to rotate. Protect thepatients head If the patient falls assess their condition beforereturning them to bed Postpone the lift/transfer if the patient isresistive, uncooperative or aggressive (if nonemergent) 75. 4. The Environment Clear a working area Eliminate any obstacles Ensure adequate lighting Dry floor Minimize distracting noises 76. THE PRINCIPLES OF SAFER PATIENT HANDLINGBefore the task: Wear the right clothes: Make sure your clothingand footwear are appropriate clothes shouldallow free movement and shoes should be non-slip, supportive and stable Never lift: Never plan to lift manually alwaysuse a hoist to lift a patient Know your limits: Know your own capabilitiesand dont exceed them forinstance, if you need training in the technique tobe used, tell your manager 77. Do one thing at a time: Dont try to do twothings at once for instance, dont try to adjustthe patients clothing during the transfer Prepare for the task: Make sure everything isready before you start for instance, check othercarers are available if needed, equipment isready and the handling environment is prepared Choose a lead carer: The lead carer checks thepatient profi le and co-ordinates the move. Youshould also try to match the height of carers ifpossible to avoid awkward postures 78. Apply safe principles: Always use safebiomechanical principles and use rhythmand timing to aid the task.caution High risk. The patient shouldnthold on to you or your clothing, because itis diffi cult for you to disengage and thepatient could pull you off balance. It isunsafe for carers and patients. 79. Safe biomechanical principlesHeres the safe way to hold your body: Stand in a stable position: Your feet should beshoulder distance apart, with one leg slightly forwardto help you balance you may need to move yourfeet to maintain a stable posture Avoid twisting: Make sure your shoulders andpelvis stay in line witheach other Bend your knees: Bend your knees slightly, butmaintain your naturalspinal curve avoid stooping by bending slightly atthe hips (bottomout) 80. Elbows in: Keep your elbows tucked inand avoid reaching the further away fromthe body the load is, the greater thepotential for harm Tighten abdominal muscles: Tighten yourabdominal muscles to support your spine Head up: Keep your head raised, withyour chin tucked in during the movement Move smoothly: Move smoothlythroughout the technique and avoid fixedholds. 81. Carrying out the task: Check patient profi le: Decide if the task is stillnecessary and that the handling plan is stillappropriate. Check it still matches the clinicalpathway and physicians orders Seek advice: Talk to your manager or the patienthandling adviser if you need advice on thetechniques and equipment you should be using Check equipment: Ensure equipment is availablein good order with all components in place andready to use (eg. batteries charged). Always followthe manufacturers instructions 82. Prepare handling environment: Position furniturecorrectly, check route and access ways are clear, andcheck the destination is available Explain the task: Explain the task to the patient andother carers who will be helping Prepare the patient: Ensure the patients clothes andfootwear are appropriate for the task, and they haveany aids they need. Adjust their clothes, aids andposition for instance, encourage the patient to leanforward Give precise instructions: The lead carer directs themove and gives clear instructions, eg. Ready, steady,stand. This helps carer/s and patient work together. 83. After the task: Correct your posture: Stand up straight tocorrect your spinal alignment. Hold your chestopen, shoulders back and abdominal muscles inso your lower body aligns properly with yourupper body Re-evaluate the task: Could the task have beendone better? How? Mark the patient profile withyour comments Report any issues: If you identify issues thataffect patient handling, report them to yourmanager and add them to the workplace controlplan for action. 84. MOVING PATIENTS FROM BED TOWHEELCHAIRRemember: When patients are weak,brace your knees against theirs to keeptheir legs from buckling. Also, transfertoward patients stronger side if possible. 85. 1.Sit the Patient UpPosition and lock thewheelchair close to the bed.Remove armrest nearestbed and swing away bothleg rests.Help the patient turn over.Put an arm underthepatients neck with yourhand supportingthe Swing legs overshoulder blade; put your the edge of theother hand under the bed, helping theknees. patient to sit up. 86. 2.Stand the Patient UpHave the patient scoot to the edge of thebed.Put your arms around the patients chestand clasp your hands behind his or herback. Or, you may also use a transfer belt toprovide a firm handhold.Supporting the leg farthest from thewheelchair between your legs, lean back,shift your weight, and lift. 87. 3. Pivot Toward ChairHave the patientpivot toward thechair, as you continueto clasp your handsaround the patient.A helper can supportthe wheelchair orpatient from behind. 88. 4. Sit the Patient DownAs the patient bends toward you, bendyour knees and lower the patient into theback of the wheelchair.A helper may position the patientsbuttocks and support the chair. 89. PULLING A PATIENT UP IN BED1. Grasp the Draw-SheetPut the head of thebed down andadjust the top of thebed to waist- or hip-level of the shorterperson.Grasp the draw-sheet, pointing onefoot in the directionyoure moving thepatient. 90. Lean in the directionof the move, usingyour legs and bodyweight.On the count ofthree, lift and pull thepatient up. Repeatthis step as manytimes as needed toposition the patient.Also, patients can bend their knees, push downwith their feet, and pull up with a trapeze (adevice overhead) to help 91. Remember:Putting a pillow under your patientsfeet helps them push down, making iteasier for you to pull them up.Never clasp the underarm to move thepatient. This may cause injury to theshoulder (i.e., dislocation). 92. TURNING PATIENTS OVER IN BED1.Cross ArmsPut the bed rail and head of the bed down;adjust the top of the bed to waist- or hip-level.Cross the patients arms on his or her chest;bend the leg farther away from you. 93. 2.Turn the Patient Put one hand behindthe patients far shoulder. Put your other handbehind the patientship.Turn the patient, supporting the patientsleg with your knee.Remember: Putting one knee on the bed gets you closerto the patient, so you pull more with you 94. MOVING PATIENTS FROM BED TO STRETCHER (GURNEY) Remember: If you move patients legs first, you can decrease the stress on your back by as much as a third.Patient safety is often the main concern whenmoving patients from bed. But remember not tolift at the expense of your own back. And, nevermove a patient by yourself. Two people usuallycan do this move safely. The leader, who pulls,should be the stronger of the two. The helperholds the draw-sheet, neither pushing nor lifting. 95. 1The leader should have onefoot forward with kneesbent.1.Prepare to MovePut the head of thebed down and adjustthe bed height. Move the patients legs closer to the edgePut a garbage bag or of the bed.plasticslide board Instruct patient tobetween the sheet and cross arms across chestdraw-sheet,beneath and explain move toone edge of the patient.patients torso. 96. 2. Pull to Edge of BedGrasp the draw-sheet on both sides of the bed.On the count of three, lean back and shift yourweight, sliding the patient to the edge of the bed.The helper holds the sheet, keeping it fromslipping.3.Position StretcherHave the helper cradle the patient in thedraw-sheet while you retrieve a stretcher.Adjust the bed to be slightly higher than thestretcher. Then, position the stretcher, locking itin place.Move the patients legs onto the stretcher. 97. 4. Slide ontoStretcherHave the helperkneel on the bed,holding on to thedraw-sheet.On the count ofthree, grasp thedraw-sheet andslide the patientonto the stretcher.You may need torepeat this step. 98. TRANSFERRING USING A TRANSFER BOARDA caregiver may use a gait belt tohelp you move across the transferboard.Using a Transfer Board1. Place the wheelchairas close to the bed aspossible, and position itat about a 30-degreeangle with the bed.2. Lock the brakes on the wheelchair, move thefootrests out of the way, and remove the armreston the side closest to the patient. 99. 3. Help the patient to sit on the edge of thebed with his feet flat on the floor.4. Help the patient to lean over slightly awayfrom the wheelchair, and carefully slide oneend of the transfer board under the thigh thatis closest to the wheelchair. Point the end ofthe board down into the bed as you do this, toavoid pinching the patients skin.5. Place the other end of the transfer boardflat on the seat of the wheelchair with the endof the board pointed at the back seat cornerfarthest from the bed. 100. 6. Assist the patient with several short"scooting" motions onto the board. If theboard is on the patients left, have him leanhis upper body slightly to the right beforeeach scooting motion. The patient can placehis hands on the bed and rest some of hisweight on his hands to make it easier to moveonto the board.7. Make sure the patient doesnt fall as hemoves across the board in several smallmovements, until he is seated on thewheelchair.8. Remove the board, replace the armrest,and position the footrests. 101. TRANSFER: WHEELCHAIR TO CHAIR1. Patients who cannot walkaretaughtto usewheelchairs. For safety, havethe therapist show you thecorrect waytohelpsomeone out ofawheelchair. Start by lockingthe wheels of the chair.Then stand as close to thepatient as you can. Make2.Help the person scoot tosure your footing is stable.the edge of the chair. BeThe patient should alwayssure the patients feet arewear a special belt for youunder his or her body. Liftto grip.as the person pushes up. 102. 3.Keepthepersons weakerknee betweenyour legs. Pivotthe person aroundin front of thetoilet or chair.Lower him or hergently. 103. TRANSFERWHEELCHAIR TO TOILET1. Stand the patient upLock the wheelchair.Be sure the persons feet are under his or her body.Grasp the back of a belt or pants and lift.2. Move on the toiletKeep the persons weaker kneebetween your legs.Pivot the person around in front ofthe toilet. Always transfer toward thepersons stronger side.Gently sit the patient down onto thetoilet.Help the patient adjust their clothing.Never pull on the persons weakerarm or lift the person by the armpits. 104. Take Care of Your BackLifting a patient can be hard on your back. Toreduce the risk of a back injury, remember todo the following: Organize the steps in your head before you move. Keep the patient close to you. Keep your knees bent and your back straight. Get help when you need it. 105. WHEN A PATIENT FALLSOnce the momentum has started, its almost impossibleto stop a patient from falling. By trying to do so, you caninjure your back. Instead, guide the patient to theground; then get help to move the patient back to a bedor stretcher.Guiding the FallHelp falling patients to thefloor with as little impact aspossible. If youre near a wall,gently push the patientagainst it to slow the fall. Ifyou can, move close enoughto hug the patient. Focus onprotecting the patients headas you move down to thefloor. Then call for help. 106. Moving a Fallen Patient1. Roll onto BlanketRoll the patient onto hisor her side.Put a blanket under thepatient and roll thepatient onto it.Position two or morepeople on each side ofthe patient. 107. 2. Lift from Floor Kneel on oneknee and graspthe blanket. On a count ofthree, lift thepatient and standup. Move the patientonto a bed orstretcher.Remember: Be proactive; assess and identify a patientas a fall risk and start intervention to prevent a fall. 108. PATIENT SAFETYThis is demonstrated by keeping the following things in mind:S Sliding boards are used to bridge the gap between the bedand the chair if the patients muscles are not strong enough toovercome the resistance of body weight. Transfer or movementdevices may be used in cases where mechanical devices are notavailable, additional personnel is needed for large patients.A Ascertain that chairs and beds are locked before thepatient transfers. Potential hazards associated with transferringpatients should be identified by the nurse and establishment ofsafe practices is essential.F Frequent assessment of patient needs by a registerednurse before transfer to determine patients ability toparticipate during the transfer and use necessary skillappropriate for this patient.E Ensure that one staff member remains with the patientduring the transfer. 109. THANK YOU FORLISTENING! MOHAMMAD SHAH J. AHID