UNIT 16 Patients Mobility Transfer Skills text pages

UNIT 16 Patient’s Mobility: Transfer Skills text pages 289 - 314

SWBA T by: Describe, Analyze and Investigate the assistant’s role in providing patient mobility and transfer skills Reading, Lecture/Discussion, Practical Application, Collaborative Reflection, Formative Assessment

• Spell and define terms • List factors to consider before moving or transferring • Apply principles of body mechanics • List guidelines for safe transfers • Difference between standing and sitting transfer • Guidelines for sling and pivot transfer • Demonstrate application and use of transfer belt • Demonstrate: • Applying transfer belt • Transfer from bed to wheelchair • Transfer from wheelchair to bed • Transfer to and from bed to stretcher • Transfer using a mechanical lift • Transfer on and off toilet

• Contraindication • Full weight bearing (FWB) • Gait belt • Manual patient handling • Mechanical lift • Nonweight bearing (NWB) • Paralysis • Paresis • Partial weight bearing (PWB) • Pivot • Sitting (lateral) transfer • Sliding board • Standing transfer • Transfer belt • Weight bearing (WB)

• Nurse Assistants have high incidence of work-related musculoskeletal injuries • Patient lifts and transfers are the tasks with the highest risk of injury

• Due to awkward positions, bending, lifting, and pulling, nurse assistants increase the risk of injury • Other Risk Factors: • Patient weight • Transfer distance • Confined space • Lateral transfers • Unpredictable patient behavior • Stooping, bending, reaching • To avoid injury: • Use lifting devices • Get assistance from co-workers • Use safe lifting techniques

Manual Patient Handling • Moving a patient by hand or bodily force • Pulling • Carrying • Holding • Supporting

Moving from one surface to another • To reduce Risk of Injury: • Use an assistive device • Know your limits • Get assistance • Use proper body mechanics • And Safe Patient Handling procedures

Two Types of Transfers • Standing Transfer • Patient stands during the transfer with the help of one or two assistants • Sitting (Lateral) Transfer • Patient sits throughout the transfer using a sliding board

Slide Board • Plastic • Wooden • 2 feet long • Slippery surface • Used for a Sitting (Lateral) Transfer

Mechanical Lift • Used for sitting patients for vertical moves • Manually operated by hydraulic lift • Electrically or battery operated • Ceiling-mounted • Used to transfer a dependent or heavy patient from one surface to another

Transfer Method depends on: • Patient’s physical condition • • Paralysis – inability to move an extremity Paresis – weakness of an extremity Amputation – absence of an extremity Recent hip surgery

Transfer Method depends on: • Patient’s strength, endurance, and balance • • • May be affected by: Respiratory (lung) disease Cardiac (heart) disease Neurological (nerve) disease Ability to stand on one or both legs Presence of amputations, contractures, paralysis, or structural deformities Whether patient needs to stand or sit during transfer Patient’s mental condition and ability to cooperate Patient’s size • Tall or large patient requires two or more assistants or a mechanical lift

Weight Bearing • Ability to stand on one or both legs • WB – Weight Bearing • FWB – Full Weight Bearing – place full weight on both legs • PWB – Partial Weight Bearing – place full weight on one leg • NWB – Non-Weight Bearing – no weight on either leg • For a standing transfer patient must have FWB or PWB

At time of Transfer – Consider: • Patient’s ability to assist with the transfer • Patient’s ability to bear weight • Patient’s upper extremity strength • Patient’s ability to cooperate and follow directions • Patient’s size • Height • Weight • Special circumstances • Wounds, surgical sites, catheters, IVs, tubes, contractures, medical devices

Patient Independence • Transfers and mobility device use are listed in the patient care plan • Observations to make and report about the patient’s ability to transfer: • • Independent Requires assistance – when and for what reason Requires 1 or 2 assistants • Weight and need for special equipment Assist device(s) used • Weight limits of equipment Cooperative? • Physical condition (amputee) Able to follow directions • Ability to balance Level of dependence • Sensory deficits

Guidelines for Safe Transfers • Know method of transfer ordered • Know patient’s ability • Know patients’ capabilities • Use good body mechanics • Bed in lowest position • Never allow patient to place their hands on your body during transfer

Guidelines for Safe Transfer • Never place your hands under patient’s arms or shoulders • Use transfer belt • Make sure patient is wearing shoes • Be aware of tubes, support devices, loose clothing • Transfer towards strongest side • Explain procedure • Determine patient’s understanding • Encourage patient to keep head up and focus on transfer surface • Stand close during transfer • Brace knee of weak side • Allow independence • Lock brakes of bed and wheelchair

Transfer Belt • Assistive and safety device used to transfer and ambulate patients who need assistance • Webbed belt with buckle • 1 ½ to 2 inches wide • 54 to 60 inches long

Transfer Belt • Bariatric belt is 72 inches long • Bariatrics is the branch of medicine that deals with the causes, prevention, and treatment of obesity.

Gait Belt • When a Transfer Belt is used to assist with ambulation it is called a Gait Belt • Transfer / Gait belt avoids the need to grasp a patient under the arms or around the ribcage, which could cause serious injury • The belt allows more control with directing the transfer

Transfer / Gait Belt • Transfer or Gait belts are not used to lift patients • If the patient cannot bear weight an alternative lifting device should be used

When not to use a Transfer / Gait Belt • Contraindications • Situations when something is not indicated, inappropriate, or potentially dangerous

When not to use a Transfer / Gait Belt • Abdominal, back, or rib injuries, fractures, or recent surgery • Abdominal pacemakers • Advanced heart and lung disease • Abdominal aneurysms • Pregnancy • Colostomy • Gastric feeding tube • Abdominal or spinal medication pump • Spinal catheter or stimulator

Assistive Devices • Avoid pulling on patients body during transfers, moving, and positioning • Use assistive devices – sheets, transfer belt, sliding board • Goal is to keep patients moving and out of wheelchairs

Rollator Handlebars Seat, if needed Merry Walker Allows independent walking and resting Merry Motivator Seated walker Uses legs to walk Pull back on bar Merry Stand By Me Sitting to standing positioning Standing Lifter Assists to standing, to chair, to sitting

Swivel Disks • Swivel Disk, Turning Disk, Transfer Disk, Pivot Disk • Round disks that turn, enabling patient to pivot • Seated or standing pivot transfer • Reduces force needed for pivoting • Flexible disk mused for seated transfer • Solid disk used for standing transfer • Maximum weight capacity: 250 to 300 pounds

Swivel Disk Precautions • Use the disk only when there is enough room to use it safely • Ensure good body mechanics • Maintain a wide base of support • Patient must be wearing shoes • Center patient’s feet on the disk • Secure disk when patient is stepping on • Instruct patient to remain still • Control the turn and patient • Risk of Injury with unpredictable, dependent, combative, inability to stand for patient and staff

Manual Handling Sling • Fabric or plastic sling • 20 inches by 8 inches • Handles on the long ends • Eliminates pulling and tugging on patient’s body

Manual Handling Sling uses • Move up in bed • Move hips to one side of bed for turning • Move extremities • Move from supine to sitting position • Move from sitting to standing • Transfer from bed to wheelchair

Manual Sling Advantages • Reduces the risk of injury • Spine stays straighter • Provides more control of patient movement • Eliminates • Bending • Twisting • Reaching • Two handgrips on the sides of the sling enable the assistant to grip the device securely and maintain control

Manual Slings not Recommended for • Heavy patients • Totally dependent patients • Patients who cannot follow instructions • Patients who are uncooperative • Patients who are combative

Sliding Board Transfer • Used for patients who have good upper body strength and balance while sitting • Used for patients with paraplegia or weakness in both legs • Patient will push up with hands and lock elbows • Patient must be able to lift their buttocks off the bed and onto the slide board • Patients can use the board independently • If patient requires assistance a transfer belt is required

Sliding Board Transfer • Wheelchair must have removable sides and foot rest • Bare skin will stick to the board; patient should wear clothing • Jeans do not slide well • May use a pillow case for easier sliding • Wooden boards may be waxed to increase slippery surface

Beasy board – transfer board with movable round seat that runs through a track in the center of the board -helpful for dependent patients or moving patients up in bed Short wooden board – close transfers – bed to wheelchair Long Beasy board – long distances transfer – car transfers Short Beasy board – close transfers – bed to wheelchair Curved Beasy board – close transfers – wheelchair to toilet, car transfers

Transferring from Bed to Stretcher • Equipment: • Slide board • Bath blanket • Three or four assistants (depending on patient size) • Roll patient • Place slide board under patient • Blanket on top of slide board • One person on side of bed away from transfer • Two or three on side toward transfer • Coordinate transfer

Mechanical Lift • Used for moving heavy and dependent patients who have little or no ability to assist • Used when belt transfer is difficult or impossible • Manual hydraulic lift • Electric lift • Ceiling lift