Patient transfer

Patient transfer

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  PATIENT TRANSFER
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  PATIENT TRANSFER A transferis the safe movement of the patient from one place to another, like from bed to wheelchair and by the used of assistive devices. In doing so, the nurse must teach patient and ask for his or her participation for successful results. There are many methods of transfer.
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  The nurse shouldchoose an appropriate technique for the patient by taking into considerations his or her disabilities and abilities. In most cases, it is very helpful if the nurse demonstrates the technique first before the transfer. During the transfer, the nurse coaches and assists the patient.
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  LEVEL OF TRANSFER Independenttransfers ◦The patient consistently performs all aspects of the transfer, including setup, in a safe manner and without assistance. Assisted transfers ◦The patient actively participates, but also requires assistance by a clinician(s). Dependent transfers ◦The patient does not participate actively, or only very minimally and the clinician(s) perform all aspects of the transfer
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  LEVELS OF ASSISTANCE Stand-byassist (aka supervision) Close guarding Contact guarding Minimal assist Moderate assist Maximal assist
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  Risk Factors Relatedto Patient
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  Communication The caregiver mustassess the patient’s ability or inability to communicate. The risk of injury increases if the patient: • Does not speak/understand the same language as the caregiver • Does not understand speech • Does not understand non-verbal communication • Can not follow simple commands
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  •Communicates with signlanguage or assistive communication devices • Has a hearing impairment • Has a speech problem • Has a low level of consciousness
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  Cognition Often hospitalized patientshave an altered level of cognition affecting their ability to participate in lifts/transfers. Short term memory loss, poor judgment, and difficulty making decisions can all be manifestations of altered cognition. Questions testing the short term memory can often give some indication of the level of cognition.
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  Medical Status Signs andsymptoms of various medical conditions can impact on a patient’s ability to transfer i.e. the tremors and movement initiation problems associated with Parkinson’s disease. Medications can also affect the patient’s ability to transfer. Fatigue, pain and stiffness will affect the quality of the transfer.
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  The medical statuscan change dramatically during a shift and caregivers need to observe these changes and modify the lift/transfer as necessary.
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  Physical Status A physicalassessment should include: • Weight bearing status • Weight • Height • Range of motion (ROM) • Strength • Balance • Coordination • Sensation • Clothing • Footwear
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  Emotional and BehavioralStatus Patients behavioral and emotional state may change throughout the day i.e. Sundowners. The caregiver should be aware of behavior changes including: • Anxiety • Aggression • Agitation • Combativeness • Confusion • Depression • Hostility
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  •Impulsiveness • Low tolerancefor change • Low self esteem (if they think poorly of their abilities they may not complete the transfer to the level of their ability) • Rejection • Resistive • Self Destructive • Unpredictable
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  Risk Factors Relatedto the Environment • Layout • Space • Lighting • Color • Temperature • Obstacles • Floor
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  Risk Factors relatedto the Equipment • Medical devices (catheter bags, IV's, prosthesis) • Inadequate training in the use of equipment • Improper use of equipment or use of faulty equipment •Risk increases when furniture/equipment not adjustable
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  TRANSFER ASSIST DEVICES Primarilyused to: •Provide a safer means of moving and transferring a person from one place to another. •Facilitate independence and maintain the dignity of the person being moved or transferred. •Eliminate or minimize risk factors that can lead to caregiver or patient injury.
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  •Where possible, patientsshould be encouraged to move themselves. Those with good balance and upper body strength may be able to maintain or regain independence through the use of certain transfer assist devices. •Transfer assist devices may reduce the amount of force exerted by caregivers and improve their posture when moving partially or totally dependent patients.
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  •Transfer assist devicesdo not reduce the weight of a patient and should not be used to lift, carry, or support the whole or a large part of a patient’s body weight. •A safer means of moving the patient, such as a mechanical lift, may be required. Safety for both patient and caregiver must always be considered.
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  BEST PRACTICES WHENUSING TRANSFER ASSIST DEVICES •Only use transfer assist devices if properly trained in their safe use. When safe, encourage patients to move themselves. •Tell the patient what you intend to do before you do it. Ensure that the brakes of the bed, stretcher, or wheelchair are on before beginning any movement. •Inspect each device before use. Tag and remove damaged equipment from service. •Set the bed at the height of caregivers’ upper thighs.
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  •Lower the siderail on the bed to reduce awkward reaching. •Minimize gaps and height differences between surfaces whenperforming a lateral transfer (for example, from bed to stretcher), and bridge gaps with transfer boards, where necessary. •Avoid differences in height between two surfaces when performing a transfer. A gentle decline, however, may be preferable for some seated or supine transfers using a transfer board.
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  •When moving apatient up in bed, tilt the bed to a “head down” position to allow gravity to assist, unless contraindicated. •Use moving and handling equipment in accordance with your organization’s policies and procedures. •Ensure friction-reducing devices are large enough to be placed under the main points of contact. For supine patients, this includes the pelvis, shoulders and, if possible, the feet.
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  •Do not leavefriction-reducing devices under the patient unless the manufacturer specifically recommends it. Leaving an unsecured friction-reducing device under an unsupervised patient may put the patient at risk of falling out of bed. as low- friction draw sheets, are designed to be left under the patient. These sheets are secured by tucking the sides of the sheets under the mattress, so that the sheets don’t have to be continually placed and removed •Have the patient assist as much as possible during the transfer or reposition. •Avoid lifting the patient.
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  Set of twodraw sheets Draw and slider sheets Draw sheets •Draw or slide sheets are made of low- frictionfabrics or gel-filled plastics that enable an individual to slide over a surface instead of being dragged or lifted. These sheets come in a variety of widths and lengths and may be used in pairs, singly, or folded. •drawsheet has the slippery surface only on one side and can be kept under the patient. •A slide sheet, on the other hand, is slippery on both sides and should be removed once the patient is repositioned.
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  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
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  •Short slider sheetsare primarily used for pivoting and repositioning tasks such as sitting a patient up on the side of the bed or repositioning a patient up in bed. •Long lateral slider sheets are intended for transferring supine patients from one surface to another, such as from bed to stretcher.
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  •“ONE-WAY SLIDES,” slidein one direction only. This facilitates moving a patient up in bed or back in a wheelchair, while preventing the patient from sliding down the bed or forward in a wheelchair. One-way slides reduce the need to manually reposition a patient in a bed or chair.
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  •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
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  Two roller sheets USES •Facilitate independent bed mobility •Move patients up in bed •Move patients from the side of the bed to the centre or vice versa •Turn patients onto their side in bed •Transfer patients from one surface to another, such as from a bed to a stretcher (when used in conjunction with other devices, such as transfer boards) •Move patients who have fallen into confined or awkward spaces to a place where a mechanical lift can be used •Pivot patients in bed and aid exercise
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  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
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  DISADVANTAGES •Sliding patients who have pressure sores or other sources of sensitivity may cause them pain. •Heavy patients may still require excessive force to move. And mechanical lift may be more appropriate. •If the same sheet is used for more than one person infection-control precautions must be taken. •Not be suitable for some transfers because they do not bridge gaps. Where gaps need to be bridged, caregivers can use slide sheets in conjunction with transfer boards. Two flat sheets
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  DISADVANTAGES •A slide mayactually turn into a lift if caregivers do not use proper techniques. •The move or transfer still requires two caregivers. •The use of these sheets may involve additional effort and handling tasks to position and remove them.
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  TIPS Follow these tipswhen using draw and slider sheets: •Use a “palms up” grip when pulling on the slide/roller sheet. A “palms up” grip is a stronger grip than a “palms down” grip. A “palms up” grip keeps elbows close to the body and helps to maintain a neutral shoulder posture. •Keep knuckles in contact with the bedsheet to ensure a sliding motion, not a lifting motion.
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  •Avoid shrugging theshoulders while moving the patient, as this indicates a lifting motion. •If repositioning the patient up in bed, tilt the entire bed with the head down, which allows gravity to assist with the movement. •Ensure that the sheet is taut before moving the patient to prevent jerking the patient. •Draw sheets can be left under the patient
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  •Reduces the forcesrequired to move patients •Reduces awkward postures if used correctly •More comfortable for patients than transfer boards
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  Transfer belts TRANSFER BELTS •Transfer belts do not reduce the patient’s 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 patient’s clothing and may deteriorate rapidly if not carefully laundered.
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  USES Transfer belts canbe used: •During assisted walking •To guide patients along transfer boards during seated transfers ADVANTAGES Transfer belts have the following advantages: •They provide a secure grip. •Caregivers do not need to grip the patient’s clothing or limbs. •Caregivers can guide a falling patient to the floor. •NOTE Do not use transfer belts to catch or support a falling patient’s weight. •Caregivers can work in a more upright posture.
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  DISADVANTAGES Transfer belts havethe following disadvantages: •Belts that are too wide may affect a patient’s ability to lean forward. Narrow, unpadded belts may dig into the patient’s waist. •Using a belt to lift all or most of a patient’s body weight is not an acceptable practice. •Belts without handles encourage the caregiver to grip the belt with a clenched fist. This generally causes the knuckles to press into the patient’s side, resulting in discomfort.
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  •Caregivers should notplace 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 caregiver’s neck. Caregivers can avoid this situation by placing their arms outside Never place your those of the patient when providing arm through transfer belt assistance. handles
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  TIPS Follow these tipswhen using transfer belts: •As long as it is safe to do so, place the transfer belt on the patientvwith the bed in a raised position to avoid awkward bending. •Ensure that the belt is fairly snug (you should only be able to place two fingers in between the belt and the patient) to reduce the chances of the belt sliding up the patient during the transfer.
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  •When performing thetransfer, caregivers should shift their body weight from one leg to the other and perform a gentle pulling motion, using the legs to do the work. Avoid lifting during the transfer movement. •Get the patient to assist as much as possible.
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  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
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  •These boards aresuitable only for those patients who can power themselves by sliding or rolling along the board with guidance from a knowledgeable caregiver. Some procedures require the caregiver to push or pull the board to accomplish the transfer. •Others involve pushing the patient or pulling a draw sheet across the transfer board. Large patients and patients with sensitive skin may find slide/transfer boards uncomfortable. If possible the use of a mechanical lift is recommended over a slide/transfer board.
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  Banana board SMALLER 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 a Smaller slide/transfer wheelchair or commode. Patients with good to boards with 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.
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  USES •Slide/transfer boards canbe used to bridge gaps between two surfaces to facilitate patient transfer, such as between: •Bed and wheelchair •Wheelchair and toilet •Chair and wheelchair •Wheelchair and car •Rolling slide boards can be used when transferring supine patients between bed and stretcher.
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  Roller sheet on transferboard ADVANTAGES Slide/transfer boards have the following advantages: •Caregivers do not need to lift manually. •Some patients may be able to transfer themselves, avoiding the need for caregivers to perform certain transfers. •When used appropriately, slide/transfer boards allow 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 to transfer around fixed armrests.
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  DISADVANTAGES Slide/transfer boards havethe following disadvantages: •Inappropriate use (for example, with patients who cannot offer sufficient assistance) may put caregivers at a high risk of MSI. •Some slide/transfer boards do not sufficiently reduce friction. •Two equal-height surfaces are needed for easy transfer. For seated transfers, patients must have some degree of sitting balance.
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  •Many boards haveno handles for positioning or carrying the board. •Caregivers must be careful not to twist during the transfer. •Caregivers may still apply horizontal forces in awkward postures. •Fingers may be trapped under board edges.
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  TIPS Follow these tipswhen using slide/transfer boards: •When transferring a patient between two surfaces, ensure the receiving surface is a little bit lower (no more than 2.5 centimetres or one inch) to allow gravity to assist. Avoid a difference of more than 2.5 centimetres as this may be too jarring for the patient. •Use of a flat sheet directly under the patient will increase the ease of the transfer because it will provide the caregivers with something to grasp onto when pulling the patient onto the bed/stretcher
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  •If the patientis lying on a fitted sheet, do not use the sheet for the transfer. It’s difficult to keep the sheet taut during the transfer, and it creates more friction with the slide/transfer board, thereby increasing the force required by the caregiver. •When applicable, place the receiving surface to the patient’s stronger side.
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  TURNING DISCS •Turning or pivot discs come in various sizes and may be flexible or solid. They consist of two circular discs that rotate against each other. The inner surfaces are made of low- friction material, while the outer surfaces are typically high-friction material. Turning discs are often used with transfer boards or transfer belts. Turning discs
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  FLEXIBLE TURNING DISCS •Flexibleturning discs conform to the contours of a surface and are most useful for pivoting seated patients (for example, when transferring patients into vehicles). The inner surfaces are typically low-friction plastic or other synthetic material. The top is often made of quilted or padded fabric for comfort.
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  SOLID TURNING DISCS •Solidturning discs are more durable and are used for pivoting patients who are weight bearing and can stand. Solid turning discs are usually made of wood or moulded plastic and may contain bearings. Patients who are weight bearing and can balance when standing may be guided to a standing position and swivelled around without having to adjust their feet.
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  Patients must havethe strength to stand, or this procedure will require the caregiver to exert excessive force in an awkward posture. Use transfer belts with handles to pivot patients standing on flexible or solid turning discs. Use turning discs only for patients who can stand up independently. Patients who are unable to independently rise to a standing position require a sit-stand or total body lift.
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  USES Turning discs assistwith rotation of patients during a transfer between: •Wheelchair and bed •Wheelchair and chair •Wheelchair and car
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  ADVANTAGES Turning discs havethe following advantages: •The patient’s feet do not need to be turned or adjusted after the transfer. •Some discs have a small handle that makes positioning and storing easier. •Turning discs reduce the forces required to rotate or pivot patients.
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  DISADVANTAGES Turning discs havethe following disadvantages: •The larger the disc, the greater the risk that the disc will be in the way of the caregiver’s feet. •Some solid discs have ball bearings in their swivel mechanism. •Choose and use these discs with care. They can be difficult to control, especially with light patients.
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  •Do not useturning discs to transfer unpredictable patients or dependent, non-weight-bearing patients. •The greater the profile (thickness) of a solid disc, the greater the tripping hazard it presents to the patient and caregiver. •A patient’s support base is narrowed while standing on a turning disc. •Some patients may become disoriented when they are turned on the disc. •Heavy patients may still require excessive force to move them.
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  TIPS Follow these tipswhen using turning discs: •For standing pivots, only one of the patient’s feet should be placed on the solid disc. The patient must be able to use the other leg to guide the pivot motion. •For standing pivots, the patient’s foot should be placed in the centre of the disc. •Remove obstacles. •Place caregivers’ feet shoulder-width apart for a good base of support.
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  Assessment Prior to liftingany object or materials an assessment of the most appropriate method of lifting should be completed. Plan the lift in your mind - organize the lift so that it will be best for you and your co-workers. • If you are uncertain about your ability to lift an object safely, get help! Never “go it alone.” Try the heft test. Get an idea if you can manage the lift. • Always consider proper positioning of the spine and upper extremity to prevent injury. • If you have an idea how the lift or environment could be improved, talk to your manager. Taking a few seconds to consciously prepare for the lift may prevent you or a co-worker from days, months or years of pain.
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  Assessment before startinga lift or transfer is essential. A good assessment • Ensures that the transfer/lift is appropriate for the caregiver and patient • Aids in preventing back and shoulder strain/injury to the caregiver • Reduces the risk to the patient and/or caregiver
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  An appropriate transfer/lift •Is safe for the caregiver and patient • Enables the patient to be as independent as possible • Is comfortable for the patient • Provides the least wear and tear on the back and shoulders of the caregiver
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  Why is consistencyimportant? • Unexpected incidences or lack of patient cooperation are often contributing factors in injuries to caregivers. When the lifting technique is consistent the patient is more likely to cooperate and be less anxious. Who should do the assessment? • The nurse is responsible for assessing the patients transfer/lift needs. • Physiotherapists and/or Occupational Therapists are available for consultation concerning complex cases. A referral may be required if intervention to improve transfers is indicated.
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  When should theinitial assessment be done? • The admitting nurse should do the assessment of the most appropriate lift/transfer at the time of admission. • The accepted lift/transfer should be noted on the admission history and the Kardex. What should be included in the initial assessment? • Caregiver status • Assess the patients abilities (strength, ROM, balance, etc) • The environment • Equipment available
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  When are lifts/transfersreassessed? • A brief reassessment must be done every time, before a caregiver intends to lift/transfer a patient • Reassessment is important because a patient’s ability to assist and cooperate may vary from day to day, or even at different times during the same day because of medication, fatigue, stress or pain
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  •Reassessment may helpto prevent those unexpected incidents • More formal reassessments are necessary when a patient’s condition improves or deteriorates. This ensure the procedure listed on the kardex is most appropriate • Reassessment also helps to maintain a high level of awareness about patient handling
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  What needs tobe reassessed? • Change in medical status • Patients ability to communicate • Level of cognition • Level of aggression • Physical Abilities (ROM, strength) • Environment • Availability of Equipment Caregiver Ability
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  FACTORS TO CONSIDERWHEN ASSESSING PATIENT HANDLING TASKS
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  PREPARATION Preparing for thelift/transfer 1. Prepare the equipment • Adjust position of the equipment (bed, stretcher, wheelchair, etc) • Adjustments to the chair include locking brakes, checking cushion position (if available), removing arm rests if necessary for transfer/lift, positioning chair at appropriate angle.
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  •Adjustments to thebed include locking brakes, putting down side rails, adjusting bed height (hip height if standing, mid thigh height if knee on bed, level with chair if using sliding board or hemi transfer) • Ensure all devices are in good working order including belts, lifts, slings
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  2. Prepare thepatient • Explain what you are about to do with the patient • A well-prepared patient can make your workload easier! • Ensure the patient places their hands on the appropriate place to assist with the lift i.e. the side rail. DO NOT ALLOW THE PATIENT
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  TO GRAB AROUND THE CAREGIVERS NECK. This could lead to neck injury or strain. • Position the IV tubing/poles, catheter bags and other appliances so that they do not interfere with the transfer • Maintain the patient’s dignity
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  3. Prepare theCaregiver • Complete a brief reassessment to ensure appropriate lift • Position the caregiver so the patient feels safe, the patient can hear and see the caregiver, and with appropriate body mechanics (the feet apart and knees bent slightly) • Discuss the plan with lifting partners • Explain the plan to the patient including their role in the transfer/lift • Use simple instructions/one step commands • Tighten abdominal muscles (core) before you lift. Maintain normal spinal alignment by keeping a slight inward curve just above the pelvis. Use the powerful leg muscles to help with the handling procedure
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  • Use bothhands and hold the patient as close to your body as possible. Never grasp the patient under the arms. This can lead to injury or subluxation • Count with lifting partners so everyone moves at same time “1,2,3,lift” • Be prepared for the unexpected. • If the load starts to slip or the patient starts to fall, go with it. Try not to rotate. Protect the patient’s head • If the patient falls assess their condition before returning them to bed • Postpone the lift/transfer if the patient is resistive, uncooperative or aggressive (if non emergent)
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  4. The Environment •Clear a working area • Eliminate any obstacles • Ensure adequate lighting • Dry floor • Minimize distracting noises
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  THE PRINCIPLES OFSAFER PATIENT HANDLING Before the task: • Wear the right clothes: Make sure your clothing and footwear are appropriate – clothes should allow free movement and shoes should be non- slip, supportive and stable • Never lift: Never plan to lift manually – always use a hoist to lift a patient • Know your limits: Know your own capabilities and don’t exceed them – for instance, if you need training in the technique to be used, tell your manager
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  • Do onething at a time: Don’t try to do two things at once – for instance, don’t try to adjust the patient’s clothing during the transfer • Prepare for the task: Make sure everything is ready before you start – for instance, check other carers are available if needed, equipment is ready and the handling environment is prepared • Choose a lead carer: The lead carer checks the patient profi le and co-ordinates the move. You should also try to match the height of carers if possible to avoid awkward postures
• 79.
  Apply safe principles:Always use safe biomechanical principles – and use rhythm and timing to aid the task. caution – High risk. The patient shouldn’t hold on to you or your clothing, because it is diffi cult for you to disengage and the patient could pull you off balance. It is unsafe for carers and patients.
• 80.
  Safe biomechanical principles Here’sthe safe way to hold your body: • Stand in a stable position: Your feet should be shoulder distance apart, with one leg slightly forward to help you balance – you may need to move your feet to maintain a stable posture • Avoid twisting: Make sure your shoulders and pelvis stay in line with each other • Bend your knees: Bend your knees slightly, but maintain your natural spinal curve – avoid stooping by bending slightly at the hips (bottom out)
• 81.
  • Elbows in:Keep your elbows tucked in and avoid reaching – the further away from the body the load is, the greater the potential for harm • Tighten abdominal muscles: Tighten your abdominal muscles to support your spine • Head up: Keep your head raised, with your chin tucked in during the movement • Move smoothly: Move smoothly throughout the technique and avoid fixed holds.
• 82.
  Carrying out thetask: • Check patient profi le: Decide if the task is still necessary and that the handling plan is still appropriate. Check it still matches the clinical pathway and physician’s orders • Seek advice: Talk to your manager or the patient handling adviser if you need advice on the techniques and equipment you should be using • Check equipment: Ensure equipment is available in good order with all components in place and ready to use (eg. batteries charged). Always follow the manufacturer’s instructions
• 83.
  Prepare handling environment:Position furniture correctly, check route and access ways are clear, and check the destination is available • Explain the task: Explain the task to the patient and other carers who will be helping • Prepare the patient: Ensure the patient’s clothes and footwear are appropriate for the task, and they have any aids they need. Adjust their clothes, aids and position – for instance, encourage the patient to lean forward • Give precise instructions: The lead carer directs the move and gives clear instructions, eg. “Ready, steady, stand”. This helps carer/s and patient work together.
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  After the task: •Correct your posture: Stand up straight to correct your spinal alignment. Hold your chest open, shoulders back and abdominal muscles in so your lower body aligns properly with your upper body • Re-evaluate the task: Could the task have been done better? How? Mark the patient profile with your comments • Report any issues: If you identify issues that affect patient handling, report them to your manager and add them to the workplace control plan for action.
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  MOVING PATIENTS FROMBED TO WHEELCHAIR Remember: When patients are weak, brace your knees against theirs to keep their legs from buckling. Also, transfer toward patient’s stronger side if possible.
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  1 .Sit the Patient Up •Position and lock the wheelchair close to the bed. Remove armrest nearest bed and swing away both leg rests. •Help the patient turn over. •Put an arm under the patient’s neck with your hand supporting the •Swing legs over shoulder blade; put your the edge of the other hand under the bed, helping the knees. patient to sit up.
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  2.Stand the PatientUp •Have the patient scoot to the edge of the bed. •Put your arms around the patient’s chest and clasp your hands behind his or her back. Or, you may also use a transfer belt to provide a firm handhold. •Supporting the leg farthest from the wheelchair between your legs, lean back, shift your weight, and lift.
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  3. Pivot TowardChair •Have the patient pivot toward the chair, as you continue to clasp your hands around the patient. •A helper can support the wheelchair or patient from behind.
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  4. Sit thePatient Down •As the patient bends toward you, bend your knees and lower the patient into the back of the wheelchair. •A helper may position the patient’s buttocks and support the chair.
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  PULLING A PATIENTUP IN BED 1. Grasp the Draw- Sheet •Put the head of the bed down and adjust the top of the bed to waist- or hip- level of the shorter person. •Grasp the draw- sheet, pointing one foot in the direction you’re moving the patient.
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  •Lean in thedirection of the move, using your legs and body weight. •On the count of three, lift and pull the patient up. Repeat this step as many times as needed to position the patient. •Also, patients can bend their knees, push down with their feet, and pull up with a trapeze (a device overhead) to help
• 92.
  Remember: Puttinga pillow under your patients’ feet helps them push down, making it easier for you to pull them up. Never clasp the underarm to move the patient. This may cause injury to the shoulder (i.e., dislocation).
• 93.
  TURNING PATIENTS OVERIN BED 1.Cross Arms •Put the bed rail and head of the bed down; adjust the top of the bed to waist- or hip-level. •Cross the patient’s arms on his or her chest; bend the leg farther away from you.
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  2.Turn the Patient •Put one hand behind the patient’s far shoulder. •Put your other hand behind the patient’s hip. •Turn the patient, supporting the patient’s leg with your knee. Remember: Putting one knee on the bed gets you closer to the patient, so you pull more with you
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  MOVING PATIENTS FROMBED TO STRETCHER (GURNEY) Remember: If you move patient’s legs first, you can decrease the stress on your back by as much as a third. •Patient safety is often the main concern when moving patients from bed. But remember not to lift at the expense of your own back. And, never move a patient by yourself. Two people usually can do this move safely. The leader, who pulls, should be the stronger of the two. The helper holds the draw-sheet, neither pushing nor lifting.
• 96.
  1 The leader should have one foot forward with knees bent. 1.Prepare to Move •Put the head of the bed down and adjust the bed height. •Move the patient’s legs closer to the edge •Put a garbage bag or of the bed. plastic slide board •Instruct patient to between the sheet and cross arms across chest draw-sheet, beneath and explain move to one edge of the patient. patient’s torso.
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  2. Pull toEdge of Bed Grasp the draw-sheet on both sides of the bed. •On the count of three, lean back and shift your weight, sliding the patient to the edge of the bed. The helper holds the sheet, keeping it from slipping. 3.Position Stretcher •Have the helper “cradle” the patient in the draw-sheet while you retrieve a stretcher. •Adjust the bed to be slightly higher than the stretcher. Then, position the stretcher, locking it in place. •Move the patient’s legs onto the stretcher.
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  4. Slide onto Stretcher •Havethe helper kneel on the bed, holding on to the draw-sheet. •On the count of three, grasp the draw-sheet and slide the patient onto the stretcher. You may need to repeat this step.
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  TRANSFERRING USING ATRANSFER BOARD A caregiver may use a gait belt to help you move across the transfer board. Using a Transfer Board 1. Place the wheelchair as close to the bed as possible, and position it at about a 30-degree angle with the bed. 2. Lock the brakes on the wheelchair, move the footrests out of the way, and remove the armrest on the side closest to the patient.
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  3. Help thepatient to sit on the edge of the bed with his feet flat on the floor. 4. Help the patient to lean over slightly away from the wheelchair, and carefully slide one end of the transfer board under the thigh that is closest to the wheelchair. Point the end of the board down into the bed as you do this, to avoid pinching the patient's skin. 5. Place the other end of the transfer board flat on the seat of the wheelchair with the end of the board pointed at the back seat corner farthest from the bed.