3 OBJECTIVES Differentiate between manual and assistive technique . Enumerate the common purposes for moving client.Assess client`s status needs and environment .Mention required equipment.Demonstrate the steps of each procedure .
4 OUTLINE: Introduction Purpose of moving client Needed assessment Required equipmentTypes of transferProcedure transferConclusionReffrance
5 Introduction*ill people usually have difficulty moving in bed. How much assistance clients required depends on? *Nurse should be sensitive to both the need of people to function independtly and their need for assistance to move.
6 Purpose Maintains body alignment Maintains skin integrity and facilitates pressure distributionprevent friction and shear on tissuePromote comfortPromote optimal lung expansionPrevent injury and deformities of musculoskeletal systemPosition clients for a variety of clinical procedures
7 Before moving a client assess the following : Clients weight, age and medical diagnosis.Client physical abilities (e.g. muscle strength ,presence of paralysis).Clients ability to understand instructions.
8 Assessments cont: Integumentary and musculoskeletal assessment. Doctor orders for specific restrictions in positioning clientsurrounding area and attached equipment such as( IV-urinary catheter-drain etc)Nurse strength and types for assistance
9 EQUIPMENTS: Support devices required by clients(e.g. Draw sheetSliding sheetFoot boardSandbagsHand rollsFoam wedgesPillows for head ,extra pillowsGloves
10 Slide sheet ( made from low friction material ) Bed pole (trapeze) and leaderTransfer ( walking) beltWedges
12 Types of transfer DEPENDENT TRANSFERS Before specially adapted equipment for transfers was introduced, hospitals had to rely on dependent manual techniques to get the patient in and out of bed.DEPENDENT TRANSFERS
13 Assisted transfer Overhead lifts. Manual lifts Overhead lifts can be used to aid in the transfer of medically fragile patients. Often they are permanently mounted to the ceiling with a secure rail system.
15 Assist client to sit on side of bed Assist client to move up in bed Transferring between bed and chairLogrolling clientTransferring between bed and stretcher
16 Moving client up in bed Equipment :pull sheet or sliding bar. Purposes: clients slide down or being pulled by tractionPreparation :determine(assistive device-attached IV or heavy cast-medications-assisted personal)
17 Moving client up in bed Performance: Explain to the client and listen for his questionsWash hands and provide privacyLower head of the bed and raise the bed to your center of gravitylock the wheels and raise the side rail opposite to you
18 Performance cont:Remove the pillows and place one only against the head of the bedAsk client to flex hips and knees and position feet so that they can be used for pushingAsk client to :-Grasp the head of the bed with both hands and pull during move orRaise upper part of body on elbows and push with hands and forearm during the move
19 Two nurses using a hand interlock Two people required to move clients who are unable to assist because of their condition or weight.The second staff member on the opposite side of bed, both of you interlock your forearm under clients thighs and shoulders and lift client up in bed
21 Other methods for moving client up in bed Upper extremities:Flex hips and kneesArms across chestFlex neck during movementPlace one arm under clients back and shoulders and other under clients thighShift your weighttwo nurses using turn sheet.
22 ASSISTING CLIENT TO SIT ON SIDE OF BED Purpose: before walking, moving to chair, eating or performing other activatesPerformance :Assist client to lateral position facing youRaise head of bed slowly to highest position
23 Assisting client to sit on side of bed Stand beside clients hips and face far corner of bedLean your trunk forward and flex your hips , knees and anklesMove client to sitting position (place one arm around client shoulder and other beneath both clients thigh near kneesTighten your muscles and lift client thighs slightly
25 continuePivot on balls of your feet in desired direction facing foot of bed while pulling client feet and legs off bed ( prevent twisting of nurse supine)Support client well ( this movement may cause some clients to faint )Assess vital signs as indicated by clients health status
26 Logrolling clientPurpose: to turn client whose body most all times be kept in straight alignmentPerformance:Stand on the same side of bed and broad base of support with on foot ahead of otherPlace clients arms across chestLean your trunk and flex your hips knees and ankles
27 Logrolling Place your arm under client Pull client to the side of the bedMove to the other side and place supportive devicesRoll and position clients in proper alignment
31 TRANSFARING BETWEEN BED AND CHAIR Equipment : appropriate clothes and slipper –transfer beltPreparation :Plan of what to do and how to do itObtain equipment and check for function wellRemove obstacles from areasPerformance:Place wheelchair parallel to bed as close as possible and lock the wheels and raise the foot plate .
33 continue Assist client to sitting position on side of bed Place transfer belt around the waist of clientsAsk client tomove forward and sit on the edge of bedlean forward slightly from hipsPlace strong foot beneath edge of bed and the other forwardPlace client hands on bed surface or on your shoulders( so they can push while standing )Mirror the placement of the clients feet (prevent loss of balance during transfer)
34 continueEncircle clients waist with your arms and grasp the belt at client backAssist the client to stand, and then move together toward the wheelchairAssist the client to sit.
36 Transferring from bed to chair Ask the client to:Back up to the wheelchair and place the legs against the seatPlace the foot of the stronger leg slightly behind the otherKeep the other foot forwardPlace both hands on the wheelchair arms or on your shouldersAsk the client to push back into the wheelchair seat.Lower the footplates, and place the client’s feet on them
37 TRANSFERRING BETWEEN BED AND STRETCHER Performance:Lower the head of the bedRaise the bed slightly higher than the stretcher (easier for client to move down )Pull draw sheet out from both sides of bedPlace the stretcher parallel to bed and fill the gap with blanketsRoll the sheet against client ,flex hips and pull onto stretcherAsk client to flex neck and place arms across chestEnsure clients comfort and raise the side rails of stretcher
38 Documentation Document all relevant information:- Time and change of position moved from and position moved toAny signs of pressure areasUse of support devicesAbility of client to assist in moving and turningResponse of client to moving and turning
41 ReferencesFundamentals of nursing concepts ,process and practice,7th edition written by kozier 2005Nurses guide to clinical procedures 5th edition written by jean smith temple and Joyce young Johnson 2007