Patient Mobility- Transfer Skills p. 268Unit 2

CNA Safety & Transfers p. 268 Manual patient handling: moving a pt by hand or bodily force, including

pushing, pulling, carrying, holding etc

Types of transfers: Standing transfer: Pt stands during transfer with help of 1 or 2 assistants Sitting transfer: Pt sits throughout transfer ex. With sliding board Sliding board: a plastic or wooden board, about 2 feet long with slippery surface,

used for sitting, lateral transfer Mechanical lift: manually operated lift used for sitting, vertical movements

CNA Safety & Transfers p. 268 Which transfer to use? Nurse or physical therapist determines; depends

on: Pt’s physical condition:

Paralysis: inability to move 1 or more extremity; ex. Paraplegia, hemiplegia Paresis: weakness of 1 or more extremity Amputation: absence of an extremity Recent hip surgery etc

Pt’s strength, endurance, balance: Respiratory disease Cardiac disease Neurological diseases ex. Multiple sclerosis, CVA, Parkinson's Ability to bear weight = stand on own feet

Non weight-bearing: no weight allowed on that leg or both legs Partial weight-bearing: some weight allowed on that leg or both legs Full weight-bearing: full weight allowed Has to have at least partial weight-bearing on 1 leg for standing transfer!

Pt’s mental condition: can pt understand and follow instructions? Pt’s size: height and weight

Key elements to consider p. 270

Pt’s ability to assist

Pt’s ability to bear weight

Pt’s upper-extremity strength

Pt’s ability to cooperate/follow directions

Pt’s size: if pt is larger than you, you definitely will need help, if pt smaller, depends on situation

Special circumstances: wounds, surgical sites, IVs, tubes, contractures; transfer must never pull or displace a tube during transfer!!

Physician or therapy orders, ex. Hip surgery, partial- or non-weight bearing etc

See Figure 16.3 p. 270

Guidelines for Safe Pt Transfers p. 269

Read and know them, especially Never allow pt to place their hands on your body during transfers Never transfer pt by placing your hands under pt’s arms or shoulders Always lock all wheels Pt needs shoes or non-skid socks Brace the knee of the weak or paralyzed leg with your knee or leg Support weak or paralyzed arm, no dangling or pulling WC: always position large part of small front caster facing forward and lock

breaks = more stable All the others on that page…

Transfer Belt p. 271 Assistive device, 1.5-2inches wide, 54-60inches long, for transfer and ambulation

Transfer belt: when used to help transfer pt

Gait belt: when used to help ambulate pt

Avoids grasping pt under arms or around rib cage

NOT used to “lift” pt, if pt unable to bear weight – sitting transfer!

Contraindications: Injuries along abdomen, back, ribs including surgery Abdominal pacemaker, Advanced heart or lung disease, Abdominal aneurysms Pregnancy, Colostomy, Gastrostomy or feeding tube

Always, applied OVER pt clothing or gown, never directly on skin, use towel if necessary Applied at waist level, no twists in it Buckled in front Needs to be snug but not too tight: able to fit 3 fingers from each hand under it

Procedure 18 p. 271!!

Sliding-Board p. 276

Pt must have good upper body strength, sitting balance, be able to lift buttocks off bed

Used for paraplegia or weakness in both legs = sitting transfer

Use transfer belt

Arms from chair must be removable

Procedure 21 p. 276

Stretcher transfers p. 280

Frightening for pt, ensure it’s safe

Procedures 25, 26 for unconscious/ semiconscious pt

Procedure 25 and 26 p. 280-282

Mechanical lift p. 282

Sitting transfer for heavy pt, pt unable to assist

Best used with 2 or more CNAs

Procedure 27 p. 283-284

(video)

Toilet transfers p. 285

Assisting pt onto and off the toilet

Procedure 28 p. 285-286

Transfer pt from bed to chair p. 272

Skill # 4!!

Procedure 18+19 p. 271-274

Step   P/F

1 Performs beginning standards  2 Explains procedure to resident before care  

3 Provides privacy  4 Positions wheelchair beside bed, folds up/removes foot rests, locks wheels  

5 Positions bed at an appropriate height, locks wheels  

6 Assists resident safely to sitting position with feet flat on floor, puts on shoes or non-skid socks  

7 Gives resident time to adjust to position change, asks if ok  

8 Applies transfer belt correctly and securely over clothing at waste  

9 Provides instructions to enable resident to assist in transfer including prearranged signal and to use hands to push off from mattress if able

 

10 Stands facing resident, positioning self to ensure safety for self and resident during transfer  

11 On signal, gradually assists resident to stand by using transfer belt on both sides with upward grasp maintaining stability of resident’s legs

 

12 Transfers resident as a pivot to stand before wheelchair with back of resident’s legs against wheelchair  

13 Lowers resident slowly into wheelchair  

14 Positions resident with hips touching back of wheelchair  

15 Removes transfer belt correctly  16 Positions feet on footrests  17 Puts call bell within reach  18 Washes hands  19 End procedures  

Transfer pt from bed to chair -2 people assist p. 274

Procedure 20 p. 274-275

Difference to one person assist: 1 assistant on each side of pt, facing pt Each assistant grabs transfer belt at front and back with underhand grasps Assistant closest to chair pivots around smoothly, stands with outside leg further

back Assistant closest to bed uses inside knee to brace pt’s weaker leg Everyone moves together on 3…

Transfer pt from chair to bed p. 277

Procedure 22 p. 277-278 : assist of 1

Place chair so pt moves towards his strongest side

Procedure 23 p. 278-279 : assist of 2

Procedure 24 p. 279 : Independent transfer = standby assist

Practice!!!

Homework (besides practice)

Textbook: read Unit 16

Workbook: read p.100 unit summary, Nursing assistant alert, complete “Corrections” and True/False questions, Look at “Identification” to find things wrong in pictures