Patient Mobility and Transfer Techniques

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Questions and Answers

What is the correct initial step before transferring a patient from bed to a chair?

Use a transfer belt that is loose.

Move obstacles and place the chair beside the bed. (correct)

Ensure the patient is not wearing any footwear.

Have the patient stand up immediately.

When should a patient use a transfer belt during the bed to chair transfer?

It can be loose to provide comfort.

It should be snug and not buckle over the spine. (correct)

It's optional if the patient is able to walk unaided.

Only when the patient is standing.

What is the recommended technique for lowering a patient into a chair?

Lower the patient by bending at the back.

Lift the patient quickly to reduce time in transition.

Instruct the patient to jump into the chair.

Flex hips and knees while supporting the patient’s weaker leg. (correct)

What action should the patient take just before sitting down in the chair?

Reach for the armrests to lower themselves into the chair. Signup and view all the answers

When is it advisable for a caregiver to use a sit to stand device?

When a caregiver needs to lift more than 115.9 kg of patient weight. Signup and view all the answers

What is the primary goal when assisting a patient who is about to fall?

To protect the patient’s head during the fall Signup and view all the answers

How should the proper size of a walker be determined for a patient?

The top of the walker should align with the patient's waist crease Signup and view all the answers

Which statement about using canes is accurate?

The correct cane length is determined by measuring from the greater trochanter to the floor Signup and view all the answers

What is the correct distance to maintain between the crutch pad and the axilla?

Two to three fingerwidths Signup and view all the answers

When teaching a patient to use a cane, where should the cane be placed?

On the stronger side of the body Signup and view all the answers

When positioning a wheelchair, where should it be placed relative to the patient?

On the patient's strong side Signup and view all the answers

What is a key feature of a walker with wheels for patients?

It allows for easier lifting and advancing Signup and view all the answers

What position should the handgrips of axillary crutches be set to avoid supporting the patient's body weight?

At palm level Signup and view all the answers

What should be done before transferring a patient to minimize strain on the caregiver?

Use maximum patient involvement Signup and view all the answers

Which of the following statements is true regarding ambulation with crutches?

Crutches provide more support than a cane but less than a walker Signup and view all the answers

What is the recommended angle for elbow flexion when standing inside a walker?

15 to 30 degrees Signup and view all the answers

Which of the following actions is appropriate when maneuvering a wheelchair in an elevator?

Back the wheelchair into and out of the elevator Signup and view all the answers

In ascending stairs with crutches, what is the first step the patient should take?

Advance the unaffected leg between the crutches and stairs Signup and view all the answers

What is an important assessment before transferring a patient?

Physiological capacity to transfer Signup and view all the answers

What should patients wear to ensure safety when using crutches?

Slip-resistant shoes Signup and view all the answers

What initial step should a patient follow when using a cane?

Place the cane forward 15 cm to 25 cm Signup and view all the answers

What is a safety consideration when moving a patient on a ramp or incline with a wheelchair?

Turn the wheelchair so it pushes against your body Signup and view all the answers

How far should crutch tips be positioned from the feet of the patient?

5 cm lateral and 10 to 15 cm anterior Signup and view all the answers

What is a potential risk associated with using axillary crutches?

Excess pressure on the axilla Signup and view all the answers

Which of the following factors should be assessed for patient transfer?

Joint mobility and range of motion Signup and view all the answers

Which sign could indicate a patient's potential difficulty in transferring?

Orthostatic hypotension Signup and view all the answers

What stance should a patient adopt when using crutches?

Erect head, straight vertebrae, extended hips and knees Signup and view all the answers

What is the primary purpose of using patient-handling equipment in a healthcare setting?

To reduce the risk of injuries during patient handling Signup and view all the answers

What should be done before using crutches to ensure safety?

Inspect rubber crutch tips Signup and view all the answers

When transferring to a chair using crutches, what is a critical step?

Position the crutches at the strong side Signup and view all the answers

Which strategy is recommended to ensure safe patient handling?

Assess patient weight before repositioning Signup and view all the answers

What should be aligned to prevent back injuries during patient handling?

Abdomen, neck, pelvis, and feet Signup and view all the answers

How does aging affect muscle tissue in older adults?

Muscle fibers shrink and have reduced tone and contractility Signup and view all the answers

What characterizes the impact of bone loss in older individuals?

Softening of vertebrae and decreased resistance of long bones to bending Signup and view all the answers

When is a second person always needed during patient handling?

For operating mechanical lifts Signup and view all the answers

What is a common consequence of improper bending and lifting in healthcare settings?

Higher rates of back injuries Signup and view all the answers

What does a no lift policy in healthcare advocate for?

Using alternative patient handling methods Signup and view all the answers

What are common risk factors associated with impaired mobility?

Muscle weakness and poor balance Signup and view all the answers

What is the primary goal of a no-lift policy in healthcare?

To minimize work-related injuries for healthcare providers Signup and view all the answers

Which equipment is typically used for safe patient handling?

Hoyer lifts and sit-to-stand lifts Signup and view all the answers

What physiological effects can immobilization cause?

Emotional hazards and restricted mobility Signup and view all the answers

What is an essential aspect of transferring a patient safely?

Use of proper body mechanics Signup and view all the answers

How should healthcare providers assess for correct body alignment?

By checking positions while sitting, lying, and standing Signup and view all the answers

In which situation is two-person assist particularly necessary?

When transferring a patient who is overweight or uncoordinated Signup and view all the answers

What is the primary focus of an ergonomic assessment in safe patient handling?

Assessing work-related risks and optimizing body mechanics Signup and view all the answers

Study Notes

Lifts, Transfers, Body Mechanics & Mobility Aids

Impaired Mobility: Muscle weakness, paralysis, or poor coordination/balance are major factors in patient falls. Immobilization creates additional physiological and emotional hazards, reducing mobility and independence.
Safe Patient Handling: Nurses face hazards when lifting and transferring patients. Most healthcare facilities have no-lift policies to reduce work-related musculoskeletal problems and back injuries.
Safe Patient Handling Programs: Often include ergonomic assessments, patient assessment criteria, specialized equipment (transfer belts), no-lift policies. Nurses are responsible for implementing and advocating for improvements to safety policies.

Overview

Impaired mobility discussion and demonstration of proper body mechanics.
Importance of no-lift policies for patients and healthcare providers.
Equipment for safe client handling like walkers, canes, and crutches.
Demonstrating client assistance with gait belts and assistive devices.
Risk factors for nurses and patients related to positioning and transfers.
Transfer techniques from bed to wheelchair, and wheelchair to bed (one and two-person assists).
Patient positioning and moving in bed.
Safe use of hoyer lifts and sit-to-stand assistance.
Assessment of body alignment and mobility (lying, sitting, and standing).

Impaired Mobility

Impaired mobility is caused by muscle weakness, paralysis, or poor coordination/balance.
Immobilization increases physiological and emotional hazards.
This results in further restriction of mobility and independence.

Safe Patient Handling

Nurses are at risk from hazards related to lifting and transferring patients.
Most healthcare settings have no-lift policies in place.
Manual lifting contributes to high musculoskeletal problems and back injuries.

Safe Patient Handling Programs

Ergonomics assessments.
Patient assessment criteria and algorithms for safe patient handling and movement.
Special equipment for patient transfers (transfer belts).
No-lift policies.
Nurse responsibility for implementing safe handling policies and advocating for improvements.

Safe Client Handling for Health Care Workers

Arrange adequate assistance (height adjustable beds, ceiling lifts, friction-reducing slide sheets).
Encourage patient participation in transfers (lifting).
Proper body mechanics: Tighten abdominal muscles, keep back, neck, pelvis and feet aligned, avoid twisting, use arms and legs not back for moving patients. Maintain posture as much as possible.
Team coordination (count to 3 before moving).
Use appropriate equipment like pull sheets or slider boards.

Body Mechanics

More than half of back pain is health-care related.
Improper bending and lifting are common causes of back injuries.
Before repositioning a patient, assess weight and determine assistance needed.
Never attempt to lift a patient alone.

Mechanical Lifts

Second person assistance is always needed for mechanical lifts.
Organization-specific education is often required for mechanical lifts.
One person spots and a second person operates mechanical lift.

Factors Influencing Activity & Exercise - Older Person

Progressive loss of bone mass due to decreased activity, hormonal changes, increased osteoclastic activity.
This leads to weaker bone density, making bones less resistant to bending.
Muscle tissue changes with reduced muscle tone and contractility.
Strength and endurance decrease. Older adults tend to walk more slowly.

Fall Prevention Protocol

Orientation Strategies: Clear communication, sensory aids (glasses, hearing aids), comfort rounds, teaching patients and families about fall risk and prevention.
Assess Patient needs: Ensure call bell and walking aids are within reach. Assess comprehension of call bell use. Remind patients when transferring, ambulating and toileting. Assess if the patient is using assistive devices correctly. Provide non-slip footwear and avoid any obstructions/trip hazards.

Principles of Body Mechanics, Safe Pt transfers & Positioning Techniques

Using proper transfer and positioning principles during routine activities reduces work effort and minimizes strain on musculoskeletal structures.

Body Alignment - Standing

Assess head position (erect and midline).
Assess body parts for symmetry.
Assess patient's center of gravity (midline).
Assess arm position (hanging comfortably at the sides).
Assess feet position (planted flat on the floor, wide base of support).
Identify deviations from expected findings.

Helping a Patient to Walk

Assess patient's strength, coordination, baseline vital signs, balance to determine the assistance needed.
Assess the patient's awareness/orientation and if any distress is present.
Assess the environment for safety, ensuring non-slip footwear.
Assist patient to a sitting position. If lying in bed, dangle their legs over the side of the bed for 2 minutes before assisting them to stand. Check for orthostatic hypotension.

If the patient gets dizzy

Return to bed/chair nearby.
If the patient has a wheelchair, have someone follow behind with the wheelchair to facilitate quick seating.
If a fall is imminent, widen the base of support by placing one foot in front of the other.
Protect patient's head by extending their front leg and sliding them down to the floor.

Helping a Pt to Walk

Use a gait belt to support the patient at the waist so the center of gravity remains midline.
Ensure the gait belt is securely fastened around the patient's waist.
The nurse should hold the back of the belt to provide support behind the patient.

Assistive Devices for Walking

Teach proper cane, walker, or crutch usage.
Walkers (lightweight, movable devices that stand waist high provide great stability).
Walkers with wheels are useful for patients with difficulty lifting and advancing the walker.
To determine if walker size is correct, have the patient relax their arms by their side, stand straight, and note where the top of the walker should line up to the crease in their waist.
Elbows should be slightly flexed at 15-30 degrees when using a walker.
To use a walker, the patient holds the handgrips, steps, and moves the walker forward with each step.

Canes

Canes provide less support than walkers and are less stable.
Measure cane length from greater trochanter to the floor for correct placement.
Straight-legged cane is typically used for patients with decreased leg strength to balance them.

Walking With a Cane

Keep the cane on the stronger side of the body.
Teach a three-step process: Place the cane forward, keep body weight balanced, and move forward with the weaker leg toward the cane. The stronger leg follows past the cane.

Crutches

Crutches are often needed for increased temporary mobility.
There are two types of crutches: adjustable or forearm crutches (wood or metal).
Metal band and handgrips need to be adjusted based on the client's height.
Axillary crutches have a padded curved surface on the top. A handgrip is present at the palms to support the body.

Patient Teaching: Crutches

Basic stance for crutches provides a wider base of support.
Patients need to maintain an upright posture (head, neck, and spine).
Ensure the patient's hips and knees are extended.
Ensure use of non-slip shoes, and ensure rubber crutch tips are monitored.
Teach patients to use stairs safely.

Sitting in a Chair with Crutches

Position the patient in the center of the chair with the posterior legs touching the chair.
Transfer the crutches to the strong side.
Reach for the armrest of the chair.
Lower yourself into the chair with the support of both hands and the strong leg.
Reverse the steps to stand back up.

Ascending Stairs - Crutches

Patient uses a modified 3-point gait when ascending.
Stand at the bottom, and shift weight to crutches.
Advance unaffected leg between crutches and stairs.
Finish by aligning both crutches on stairs.

Descending Stairs

A three-point sequence for descending stairs, moving affected leg forward.

Measuring Crutches

Axillary crutch measurement includes height, elbow flexion angle and distance between crutch pad and axilla.
Crutch length is 2-3 finger widths from axilla and tips 5cm lateral and 10-15cm anterior to the shoes.
Position handgrips to avoid axilla support. The distance from the crutch pad to the patient's axilla should be 2-3 finger widths.

Wheelchairs

Position wheelchair on patient's strong side.
Ensure brakes are on, and footplates are raised.
Maneuver wheelchairs into and out of elevators.
Turn wheelchair so that the chair pushes against the patient’s body on a ramp or incline.
Assess comfort and alignment in the wheelchair.

Patient Transfers

Nurses assist with immobilized patients’ bed positioning, wheelchair transfers, and stretcher movements.
Encourage patient involvement in transfers to maximize their strength.
Use correct transfer technique to reduce strain on musculoskeletal structures.

Transfer Techniques

Evaluate the patient's physiological capacity (joint mobility, range of motion, contractures, paralysis, bone integrity).
Assess patient for weakness, dizziness, orthostatic hypotension, activity tolerance and fatigue.
Assess proprioceptive function, sensory status, level of comfort, VS, motivation, and risk for falling.
Select appropriate transfer equipment.

Moving Patients Up in Bed

Drawsheet extends from shoulders to thighs to transfer patients.
Ensure palms face up when holding the sheets.
Feet should be apart with one slightly in front of the other.
Flex the knees and hips to prepare for the lift.
Shift weight to the front leg when a count of 3 is reached.
Move the patient toward the head of the bed while lifting.

Turning Pads & Sliders

Sliding pads, turning sheets, transfer sheets, and lift pads (sometimes incorrectly called drawsheets).
Some are waterproof.
Use for moving and repositioning patients.

Planning

Gather the equipment.
Determine the number of people needed to assist.
Ensure hand hygiene is completed for the procedure.
Ensure bed brakes are on if applicable.
Explain the procedure to the patient.

Assisting to a Sitting Position in Bed

Raise the head of the bed to a waist level.
Place the patient in a supine position.
Adjust the head of the bed to a 45-degree angle.
Support the head and neck and remove pillows.

Bed to Chair

Ensure the patient is able to assist.
Move obstacles out of the way.
Place chair beside the bed.
Use a transfer belt (snag free).
Have the patient sit on the side of the bed and stand before transferring.
Transfer toward the unaffected side or unaffected leg.