1. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Methods of Transfer (See HO 1.) Active-assistive – Resident needs assistance in moving from place to place. NOTE: In moving a resident to or from a chair, be sure to check the resident’s hands before lifting him/her. You may have to loosen the resident’s fingers to avoid lifting both the resident and the chair. CAUTION: Avoid twisting a resident’s hips during a pivot transfer. Hip fractures may occur when the resident is unable to move his/her feet during the pivot. Always follow your facility’s policy and the care plan when performing resident transfers.

2. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Standing transfers – Resident stands and pivots or takes steps to transfer. Chair to bed; bed to chair Chair to ambulation device Chair to toilet Methods of Transfer Sitting transfers – Resident remains in sitting position when transferred. Lying transfer – bed to stretcher; stretcher to bed

3. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Methods of Transfer Passive Resident does not assist with transfer. Lying transfer – Resident uses mechanical lift.

4. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Safety Measures CAUTION: NEVER transfer a resident by lifting him/her under the arms! This can cause nerve damage, fractures, and shoulder dislocation. Have all equipment ready and checked for safety before beginning procedures. When transferring a resident who has a weak side, position the chair on his/her strong side. For a resident who is weak, you must have control of the shoulders and hips during transfer. Do not attempt to transfer a resident who cannot bear any of his/her own body weight by yourself. Determine beforehand how many people are needed for the transfer. If it takes more than two persons to transfer the resident, use a mechanical lift. All wheelchairs or geri-chairs should have locks that are locked during transfer; a slight movement of the W/C or G/C could cause a fall. Wheels should be unlocked after transfer is complete.

5. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Safety Measures Wheelchair footrests should be up and out of the way or removed during transfer to prevent the nurse assistant and resident from tripping or stepping on the rests and falling. Give the resident a simple explanation of how he/she is to assist. Give resident encouragement and praise when he/she assists with the transfer. Resident should wear footwear with nonskid soles. Resident’s feet should be flat on the floor approximately 12 inches apart. Use proper body mechanics. Do not allow the resident to hold you around the neck. During the transfer, you may have to move or reposition any objects on the body that may injure the resident (e.g., name tags, stethoscopes, pins).

6. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Equipment for Transfer Activities Gait belt (See Figures 3.1 and 3.2.) The gait belt is a special belt that is placed around the resident’s waist and provides the nurse assistant with a “handle” to hold onto for those who require assistance during transfers, ambulation, or repositioning in the chair. The gait belt is a minimum of 1 ½ inches wide and is made of a durable, washable material, usually canvas, nylon, or leather, with a sturdy slideproof buckle. Although some gait belts are made of nylon, it is not recommended to use this type because the buckles do not grip firmly and the belt may slip while transferring. Figure 3.1 – Gait Belt

7. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Equipment for Transfer Activities The purpose of using a gait belt To ensure optimum safety and comfort for the resident To minimize the risk of injury to the resident and/or nurse assistant(s) To facilitate proper body mechanics of the nurse assistant. It allows for better control of the resident while transferring. The nurse assistant should not transfer or ambulate residents by grasping their upper arms or under their arms. Such a transfer could result in skin tears, damage to nerves and arteries, and possible dislocation of the shoulder. The gait belt increases the comfort and safety of the resident during the transfer procedure and prevents injury to the resident that could be caused by pulling on his/her arms, shoulders, or wrist.

8. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Equipment for Transfer Activities The gait belt is applied over the resident’s clothing to avoid injury from the buckle and possible pinching the skin. Because you never know when you may need a gait belt, you should have a gait belt with you at all times while on duty. It is convenient to wear the belt around your waist so that it is readily available. If you wear the gait belt, the buckle should be turned toward your back to prevent injuries to residents. Under no circumstances should you instruct a resident to hold onto a gait belt while you are wearing it. Figure 3.2 – Using a Gait Belt

9. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Equipment for Transfer Activities The tip of the belt is threaded between the hinged part of the buckle and the toothed edge. The belt is pulled snugly around the resident’s waist and then threaded through the stationary part of the buckle. The nurse assistant grasps the belt on both sides of the resident’s waist. Palms should be inserted between the belt and resident with fingertips pointing upward. The CNA or facility laundry should launder the gait belt according to manufacturer’s directions. The belt is to be applied snugly around the resident’s waist over clothing below the ribs so that the nurse assistant’s fingers may grasp the belt securely. Be aware that as the resident stands, a shift in the abdominal bulk occurs, causing the belt to loosen. The belt must be applied securely to prevent the belt from sliding above the resident’s waist. CAUTION: To avoid injury, do not apply a gait belt to bare skin.

10. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Equipment for Transfer Activities Remember good body mechanics when lifting. Bend knees and lift with arms and legs, not the back. Do not allow the resident to grasp you around the neck. Pivot; do not twist from the waist. Set the resident gently in the chair or bed. Gait belts are required for all residents when performing transfers, ambulation, or repositioning in a chair. To avoid injury to the resident, check the care plan for contraindications that may cause injury to the resident if he/she has one of the following conditions: a colostomy, an acute rib or vertebra fracture, an abdominal aneurysm, a gastrostomy tube, or postabdominal surgery.

11. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Equipment for Transfer Activities Mechanical lift (See Figure 3.3.) A mechanical lift is a device used to lift and move residents who are unable to do so on their own. If the resident is nonweight bearing, the nurse assistant should transfer him/her using a mechanical lift. Two people are needed to use this device safely. There are many types of lifts. Follow manufacturer’s directions regarding safe use. Parts commonly found on lifts are the following: A sling in which the resident sits An arm and frame that support the sling A crank or lever that raises or lowers the arm of the frame

12. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Figure 3.3 – Mechanical Lift

13. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Equipment for Transfer Activities Sling A device to cradle or position an arm or hand that may be injured or paralyzed. Supporting the paralyzed extremity in a sling makes it easier for the resident to balance in transfer and ambulation activities. Custom designed for each resident’s special needs

14. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Check for Proper Body Alignment Head should be erect; control of head is necessary to maintain an upright position. Arms should be supported with pillows. Back should be straight against the back of the chair. Place a small pillow at the lower back for comfort and support if resident’s sitting balance is good. Hips and buttocks should be against the back of the chair. The backs of the knees should be free of pressure from the edge of the chair. There should be room for two or three fingers between the back of the knees and the front of the chair. Feet should be positioned flat on the footrests or the floor; they should not be left to dangle. Resident should be wearing nonskid footwear.

15. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Check for Proper Body Alignment Position still needs to be changed at least every 2 hours and the resident must be exercised. If possible, resident should stand and walk at 2-hour intervals. Have the resident shift his/her weight from one side of the buttocks to the other by leaning to the right side and then to the left side every 15-20 minutes.

16. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Positioning the Resident in a Chair The weight of the resident should be supported by the upper legs and buttocks when sitting in a chair, W/C, or G/C. For the resident who slides forward in the chair: Apply gait belt. Use two people. They should stand on opposite sides of the resident. Each grasps the belt in back and places one hand under the thigh in front. On the count of three, lift and move resident back in chair. NOTE: Be aware of the position of a male resident’s scrotum when repositioning. The resident should not be sitting on his scrotum.

17. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Positioning the Resident in a Chair An alternative method uses two people, as follows: One should stand in front of the resident and one behind the resident. The nurse assistant in front of the resident places his/her hands under the resident’s thighs. The nurse assistant behind the resident places his/her arms around the resident and grasps the gait belt in the front. On the count of three, they lift and move the resident back in the chair.

18. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Conclusion Because most residents need to get out of their beds at various times during the day, you must plan ahead and think through the steps before you start. It can be very frightening for some residents who do not get out of bed very often. They may be scared that you may drop them or that they may fall. Take your time and encourage the resident to help as much as possible.

19. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Steps of Procedure for Demonstrating One-Person Pivot Transfer from Bed to Chair 1.Gather necessary equipment. 2.Wash your hands. 3.Identify and greet resident. Identify self. 4.Explain what you are going to do. 5.Provide privacy. 6.Adjust bed height to low position. Lock brakes of bed. 7.May raise head of bed to bring resident to sitting position. 8.Assist resident to move over in bed to within 5 or 6 inches of the edge of the bed. CAUTION: Avoid twisting a resident’s hips during a pivot transfer. Hip fracture may occur when the resident is unable to move his/her feet during the pivot. Always follow your facility's policy and the care plan when performing resident transfers.

20. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Steps of Procedure for Demonstrating One-Person Pivot Transfer from Bed to Chair 10.Position W/C or G/C or commode on resident’s strong side if indicated; if not, position chair as desired. 11.Place side of chair parallel to the bed. Chair should be touching the bed. 12.Lock the wheels of the chair. 13.Cover W/C or G/C with pressure-relieving device per the care plan. Raise footrests and remove if possible. If possible, remove the armrest on the side next to the bed. 14.Position your body facing foot of bed. 15.Put one forearm under resident’s shoulders and the other behind the knees. 9.Assist in putting on socks and nonskid shoes.

21. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Steps of Procedure for Demonstrating One-Person Pivot Transfer from Bed to Chair 17.Straighten your hips and knees while shifting weight from front foot to back foot. At the same time, lift resident’s head with one arm while pulling the legs over the side of bed with other arm. 18.Apply gait belt. 19.Allow the resident time for his/her circulation to adjust to being in a sitting position before you proceed. Assist the resident in maintaining a sitting position as needed. 20.Stand directly in front of the resident; grasp the back of the belt. 16.Bend your knees, keep your back straight, and stand with feet about 18 inches apart.

22. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Steps of Procedure for Demonstrating One-Person Pivot Transfer from Bed to Chair 22.Have the resident lean forward while sitting on the edge of the bed. 23.On the count of three, have the resident push up as much as possible while you pull him/her up by straightening your legs and hips and holding onto the belt. 24.Pivot your entire body as well as the resident’s. 25.Lower the resident into the chair by bending at your knees and hips as the resident sits down. 26.Adjust footrest for resident; cover with a lap robe. 21.Support the resident’s knees and feet with your knees and feet, either knee-to-knee or your knees on the sides of the resident’s knees, whatever is comfortable for you and the resident.

23. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Steps of Procedure for Demonstrating One-Person Pivot Transfer from Bed to Chair 27.Place positioning devices for proper body alignment per care plan. 28.Make resident comfortable and place call signal within reach. 29.Wash your hands.

24. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Steps of Procedure for Demonstrating One-Person Pivot Transfer from Chair to Bed 1.Gather necessary equipment. 2.Wash your hands. 3.Identify and greet resident. Identify self. 4.Explain what you are going to do. 5.Provide privacy. 6.Adjust bed height to low position. Lock brakes of bed. 7.Raise head of bed and fanfold bedclothes to end of bed. Make sure opposite side rail is raised. 8.Position chair/wheelchair/geri-chair at side of bed, facing head of bed. CAUTION: Avoid twisting a resident’s hips during a pivot transfer. Hip fracture may occur when the resident is unable to move his/her feet during the pivot. Always follow your facility's policy and the care plan when performing resident transfers.

25. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Steps of Procedure for Demonstrating One-Person Pivot Transfer from Chair to Bed 10.Place/assist resident’s feet on floor. 11.Remove lap robe/blanket. 12.Apply gait belt. 13.Stand in front of resident with feet about 18 inches apart. 14.Place your hands underneath belt. If resident is able, have him/her place hands on arms of wheelchair and push. If the resident is unable to push off the chair, resident may place his/her arms on nurse assistant’s arms. 9.Lock wheels, raise footrests, and remove if possible. If possible, remove the armrest on the side next to the bed.

26. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Steps of Procedure for Demonstrating One-Person Pivot Transfer from Chair to Bed 15.Assist resident to stand. 16.Pivot your body and the resident’s body toward the bed. 17.Slowly lower resident to sitting position on the bed. 18.Remove gait belt. CAUTION: Do not allow resident to hold you around your neck or shoulders. 19.Position your body facing the head of the bed. One foot should be in front of the other foot. 20.Place one forearm around resident’s shoulders and the other behind the resident’s knees.

27. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Steps of Procedure for Demonstrating One-Person Pivot Transfer from Chair to Bed 21.Swing/assist resident’s legs onto the bed as you pivot the resident’s body. 22.Lower head of bed. 23.Move/assist resident to center of bed. 24.Remove slippers. 25.Cover resident, position pillows, and straighten bed clothes. 26.Make resident comfortable; place call signal within reach. Lower opposite side rail after transfer per care plan. 27.Wash your hands.

28. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Steps of Procedure for Demonstrating Two-Person Pivot Transfer from Chair to Bed 2.Wash your hands. 3.Gather the necessary equipment. 4.Identify and greet resident. Identify self and assistant. 5.Explain what you are going to do. 6.Provide privacy. 7.Adjust bed height to low position. Lock brakes of bed. 1.Secure the assistance of another nurse assistant. CAUTION: Avoid twisting a resident’s hips during a pivot transfer. Hip fracture may occur when the resident is unable to move his/her feet during the pivot. Always follow your facility's policy and the care plan when performing resident transfers.

29. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Steps of Procedure for Demonstrating Two-Person Pivot Transfer from Chair to Bed 9.With one nursing assistant standing in front of resident and one nursing assistant standing behind wheelchair, apply gait belt around resident’s neck. 10.Prepare for moving resident’s buttocks to front area of wheelchair. a.Nursing assistant behind the wheelchair – Hold handles of wheelchair and press legs into wheels to provide stability. 8.Position wheelchair near bed with armrest parallel to bed. Allow enough room for movement around wheelchair for positioning resident. b.Nursing assistant in front of wheelchair – Stand to one side of wheelchair with one foot parallel to side of wheelchair and one foot at 90° to resident’s feet in front of chair.

30. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Steps of Procedure for Demonstrating Two-Person Pivot Transfer from Chair to Bed 11.Nursing assistant in front of resident – Move resident’s buttocks to front area of wheelchair by following steps a. through e. below. a.While bending at knees and keeping back straight, wrap one arm around resident’s upper back and gently hold area below arm and upper back. b.Gently tip resident’s upper body toward you. CAUTION: Do not pull on shoulder or neck. c.Place other hand on resident’s thigh and rock hip toward front of chair seat. d.Move to other side of chair and repeat steps a. through c. e.Continue until resident is positioned safely near front of wheelchair seat.

31. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Steps of Procedure for Demonstrating Two-Person Pivot Transfer from Chair to Bed 13.Nursing assistant in front of resident – Grasp gait belt with palms up. 12.Nursing assistant in front of resident – Secure resident by holding upper body and legs and positioning wheelchair with armrest parallel and close to bed. Allow enough room for nursing assistant at back of wheelchair to position one foot between wheelchair and bed. CAUTION: If resident is unable to assist, both arms should be positioned between nursing assistant’s arms to prevent injury to weak extremities. 14.Nursing assistant behind resident – Should be prepared to grasp gait belt. a.Place your knee nearest the bed on bed with foot off the bed.

32. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Steps of Procedure for Demonstrating Two-Person Pivot Transfer from Chair to Bed b.Position other foot on floor between wheelchair and bed with toes pointed toward front of chair. c.Move close to resident and squat on bed, keeping back straight. 15.Nursing assistant behind resident – Grasp gait belt behind resident’s back with hand farthest from bed, palm down. With other hand, grasp gait belt at resident’s side with palm up. 16.On the count of three, both nursing assistants help resident to stand. The nursing assistant in back helps by moving from squatting to standing position while keeping back straight and using legs and arms for lifting. 17.Move resident over bed by following steps a. and b. below. a.Nursing assistant in front of resident – Pivot on balls of feet, being certain not to twist back.

33. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Steps of Procedure for Demonstrating Two-Person Pivot Transfer from Chair to Bed b.Nursing assistant in back of resident – Guide resident’s buttocks over the bed. 18.Lower resident to sitting position by following steps a. and b. below. 19.If resident is sitting too far forward on side of bed, follow steps a. through c. below. a.Nursing assistant in front of resident – Bend at your hips and knees. b.Nursing assistant in back of resident – Return to squatting position on bed. a.Nursing assistant in front of resident – Grasp the gait belt with palms up and position your knees to brace resident’s knees.

34. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Steps of Procedure for Demonstrating Two-Person Pivot Transfer from Chair to Bed b.Nursing assistant in back – Move behind resident, squat on both knees with feet over opposite side of bed, and grasp gait belt with both palms up. 20.Remove the gait belt. c.On the count of three, both nursing assistants position the resident’s buttocks safely on bed. 21.Assist resident to lying position by placing one arm around shoulders and the other under knees. Swing resident’s legs onto bed. 22.Position resident In center of bed. 23.Remove slippers. 24.Position with pillows, straighten bed clothes, and cover resident.

35. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Steps of Procedure for Demonstrating Two-Person Pivot Transfer from Chair to Bed 25.Make resident comfortable. Place call light within reach. 26.Raise side rails of bed if noted in care plan. 27.Wash hands.

36. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Steps of Procedure for Demonstrating Two-Person Pivot Transfer to Chair with a Mechanical Lift 2.Gather necessary equipment. 3.Wash your hands. 4.Identify and greet resident. Identify self and other nurse assistant. 5.Explain what you are going to do. 6.Provide privacy. 7.Adjust bed height to low position. Lock brakes of bed. 1.Secure the assistance of another nurse assistant. CAUTION: Avoid twisting a resident’s hips during a pivot transfer. Hip fracture may occur when the resident is unable to move his/her feet during the pivot. Always follow your facility's policy and the care plan when performing resident transfers. NOTE: This procedure may have to be adjusted for the type of devices at your facility. See manufacturer’s instructions.

37. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Steps of Procedure for Demonstrating Two-Person Pivot Transfer to Chair with a Mechanical Lift 9.By turning the resident from side to side on the bed, you can position the sling under the resident. 10.Wheel the lift into place over the resident with the base beneath the bed and be sure to lock the wheels of the lift. Widen the base of the lift. 11.Open support legs of the lift with the control lever. 8.Position chair next to bed with the back of chair in line with the headboard of the bed. NOTE: Make sure the top of the sling is at the crest of the shoulders and the bottom is above the bend of the knees. CAUTION: Never close the support legs while transporting residents.

38. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Steps of Procedure for Demonstrating Two-Person Pivot Transfer to Chair with a Mechanical Lift 13.Have the resident fold both arms across chest, if possible. 14.Using the crank, lift the resident until the buttocks are clear of the bed. Make sure the resident is aligned in the sling and is securely suspended in a sitting position with legs dangling over the bottom of the sling. 12.Attach the sling to the mechanical lift with the hooks in place under the metal frame. NOTE: Be sure to apply hooks with open, sharp ends away from the resident. 15.One nurse assistant should guide the resident’s legs over the edge of the bed; release brakes on mechanical lift. 16.Move the lift away from the bed, turn the resident so that he/she faces you while the other nurse assistant guides the resident’s body toward the chair by standing behind the resident.

39. Nurse Assistant In a Long-Term Care Facility Unit VII: Restorative Nursing Lesson Plan 3: Transferring Residents Steps of Procedure for Demonstrating Two-Person Pivot Transfer to Chair with a Mechanical Lift 18.Release the control knob slowly so that the resident will gradually be lowered into chair. The second nurse assistant should guide the resident’s hips into the chair for proper alignment. 17.Bring the lift into position so that the resident is over the seat of the chair. 20.Cover resident with lap robe. 21.Make the resident comfortable; place call signal within reach. CAUTION: Never close the support legs while transporting resident. 22.Store lift properly until time to transfer resident again. 23.Wash your hands. 19.Remove the hooks from the frame of the lift.