1. 11 Positioning, Moving, and Lifting 1. Define important words in this chapter (con’t) ergonomics: the science of designing equipment and setting up areas to make them safer and to suit the worker’s abilities. Fowler’s: position with the person lying on his or her back with the head of bed elevated about 45 to 60 degrees. gait belt: a belt made of canvas or other heavy material used to help residents walk; also called a transfer belt. lateral: position with person on his or her side.

2. 11 Positioning, Moving, and Lifting 1. Define important words in this chapter (con’t) logrolling: moving a person as a unit, without disturbing the alignment of the body. mechanical lift: special equipment used to lift and move or lift and weigh a person. MSDs: acronym that stands for work-related musculoskeletal disorders. positioning: helping people into positions that will be comfortable and healthy for them.

3. 11 Positioning, Moving, and Lifting 1. Define important words in this chapter (con’t) prone: position with person lying on his or her stomach.. shearing: rubbing or friction resulting from the skin moving one way and the bone underneath it remaining fixed or moving in the opposite direction. Sims’: position with person lying on his or her left side with one leg drawn up. supine: position with person lying flat on his or her back.

4. 11 Positioning, Moving, and Lifting 1. Define important words in this chapter (con’t) transfer: moving a resident from one place to another. transfer belt: a belt made of canvas or other heavy material used to assist residents who are weak, unsteady, or uncoordinated; also called a gait belt.

5. 11 Positioning, Moving, and Lifting 2. Explain body alignment and review the principles of body mechanics Body alignment is also known as posture. Use these guidelines for proper body alignment: Assess the load. Think ahead, plan, and communicate the load. Check you base of support and be sure you have firm footing. Face what you are lifting. Keep your back straight.

6. 11 Positioning, Moving, and Lifting 2. Explain body alignment and review the principles of body mechanics Use these guidelines for proper body alignment (con’t): Begin in a squatting position, and lift with your legs. Tighten your stomach muscles when beginning the lift. Keep the object close to your body. Do not twist. Push or pull when possible, rather than lifting.

7. 11 Positioning, Moving, and Lifting 3. Explain why position changes are important for bedbound residents and describe basic body positions Positioning means helping residents into positions that promote comfort and good health. Five basic body positions are: Supine Lateral/Side Prone Fowler’s Sims’

8. 11 Positioning, Moving, and Lifting Transparency 11-1: Five Basic Positions Lateral Supine Prone Fowler’s Sims’

9. Locking arms with a resident and raising head and shoulders 1.Identify yourself by name. Identify the resident. Greet the resident by name. 2.Wash your hands. 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Encourage resident to assist if possible. 4.Provide for the resident’s privacy with a curtain, screen, or door.

10. Locking arms with a resident and raising head and shoulders 5.Practice good body mechanics. Adjust the bed to a safe level, usually waist high. Lock the bed wheels. 6.Place pillow at the head of bed against the headboard. 7.Lower the side rail (if bed has one and if it is not already lowered) on side nearest you. 8.Stand at the side of the bed and face the head of bed.

11. Locking arms with a resident and raising head and shoulders 9.Spread feet shoulder- width apart and slightly bend the knees to protect your back. 10.Avoid trauma or pain to the resident throughout the procedure. 11.Gently slide one hand under the resident’s closest shoulder. 12.Gently slide the other hand under the resident’s upper back.

12. Locking arms with a resident and raising head and shoulders 13.At the count of three, slowly raise the resident’s head and shoulders. Give necessary care (Fig. 11-10). 14.Replace pillow under the resident’s head. 15.Make resident comfortable. 16.Return bed to low position if raised. Ensure resident’s safety. Return side rails to ordered position. Remove privacy measures. Fig. 11-10.

13. Locking arms with a resident and raising head and shoulders 17.Leave call light within resident’s reach. 18.Wash your hands. 19.Be courteous and respectful at all times. 20.Report any changes in the resident to the nurse. Document procedure using facility guidelines.

14. Assisting a resident to move up in bed Identify yourself by name. Identify the resident. Greet the resident by name. 1.Wash your hands. 2.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Encourage resident to assist if possible. 3.Provide for the resident’s privacy with a curtain, screen, or door.

15. Assisting a resident to move up in bed 4.Practice good body mechanics. Adjust the bed to a safe level, usually waist high. Lock the bed wheels. 5.Lower the head of bed. Move the pillow to the head of bed. 6.Lower the side rail (if bed has one and if it is not already lowered) on side nearest you.

16. Assisting a resident to move up in bed 7.Stand by bed with feet shoulder-width apart. Face the resident. Point foot closest to the head of the bed towards the head of the bed. 8.Avoid trauma or pain to the resident throughout the procedure. 9.Place one arm under the resident’s shoulder blades. Place the other arm under the resident’s thighs.

17. Assisting a resident to move up in bed 10.Ask resident to bend knees, brace feet on the mattress, and push feet on the count of three. 11.Keep your back straight. At the count of three, shift body weight to move resident while resident pushes with her feet (Fig. 11-12). 12.Replace pillow under the resident’s head. 13.Make resident comfortable. Fig. 11-12. Keep your back straight and your knees bent.

18. Assisting a resident to move up in bed 14.Return bed to low position if raised. Ensure resident’s safety. Return side rails to ordered position. Remove privacy measures. 15.Leave call light within resident’s reach. 16.Wash your hands. 17.Be courteous and respectful at all times.

19. Assisting a resident to move up in bed 18.Report any changes in the resident to the nurse. Document procedure using facility guidelines.

20. Assisting a resident to move up in bed with assistance (using draw sheet) Equipment: draw sheet 1.Identify yourself by name. Identify the resident. Greet the resident by name. 2.Wash your hands. 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Encourage resident to assist if possible.

21. Assisting a resident to move up in bed with assistance (using draw sheet) 4.Provide for the resident’s privacy with a curtain, screen, or door. 5.Practice good body mechanics. Adjust the bed to a safe level, usually waist high. Lock the bed wheels. 6.Lower the head of bed. Move the pillow to the head of bed. 7.Lower the side rail (if bed has one and if it is not already lowered) on side nearest you.

22. Assisting a resident to move up in bed with assistance (using draw sheet) 8.Stand on the opposite side of the bed from your helper. Each of you should be turned slightly toward the head of the bed. For each of you, the foot that is closest to the head of the bed should be pointed in that direction. Stand with feet about 12 inches apart. Bend your knees. Keep your back straight. 9.Avoid trauma or pain to the resident throughout the procedure.

23. Assisting a resident to move up in bed with assistance (using draw sheet) 10.Roll the draw sheet up to the resident’s side. Have your helper do the same on his side of the bed. Grasp the sheet with your palms up at the resident’s shoulders and hips. Have your helper do the same. 11.Shift your weight to your back foot (the foot closer to the foot of the bed). Have your helper do the same (Fig. 11-13). On the count of three, both shift your weight to your forward feet. Fig. 11-13. Both workers shift their weight to their back feet and prepare to move.

24. Assisting a resident to move up in bed with assistance (using draw sheet) (con’t) Slide the resident toward the head of the bed (Fig. 11-14). Replace pillow under the resident’s head. Make resident comfortable. Unroll the draw sheet. Leave it in place for the next repositioning. Return bed to low position if raised. Ensure resident’s safety. Return side rails to ordered position. Remove privacy measures. Fig. 11-14. Both workers shift their weight to their back feet and prepare to move.

25. Assisting a resident to move up in bed with assistance (using draw sheet) 12.Leave call light within resident’s reach. 13.Wash your hands. 14.Be courteous and respectful at all times. 15.Report any changes in the resident to the nurse. Document procedure using facility guidelines.

26. Moving a resident to the side of the bed 1.Identify yourself by name. Identify the resident. Greet the resident by name. 2.Wash your hands. 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Encourage resident to assist if possible. 4.Provide for the resident’s privacy with a curtain, screen, or door.

27. Moving a resident to the side of the bed 5.Practice good body mechanics. Adjust the bed to a safe level, usually waist high. Lock the bed wheels. 6.Lower the head of bed. Move the pillow to the head of bed. 7.Stand on one side of the bed. Lower the side rail (if bed has one and if it is not already lowered) on side nearest you.

28. Moving a resident to the side of the bed 8.Stand with feet about 12 inches apart. Bend your knees. Keep your back straight. 9.Avoid trauma or pain to the resident throughout the procedure. 10.Gently slide your hands under the resident’s head and shoulders and move toward you (Fig. 11-15). Fig. 11-15. Gently move the head and shoulders toward you.

29. Moving a resident to the side of the bed 11.Gently slide your hands under the resident’s midsection and move toward you. 12.Gently slide your hands under the resident’s hips and legs and move toward you (Fig. 11-16). 13.Make resident comfortable. Reposition pillow under head. Fig. 11-16. Gently move the hips and legs toward you.

30. Moving a resident to the side of the bed 14.Return bed to low position if raised. Ensure resident’s safety. Return side rails to ordered position. Remove privacy measures. 15.Leave call light within resident’s reach. 16.Wash your hands. 17.Be courteous and respectful at all times.

31. Moving a resident to the side of the bed 18.Report any changes in the resident to the nurse. Document procedure using facility guidelines.

32. Moving a resident to the side of the bed with assistance (using draw sheet) Equipment: draw sheet 1.Identify yourself by name. Identify the resident. Greet the resident by name. 2.Wash your hands. 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Encourage resident to assist if possible.

33. Moving a resident to the side of the bed with assistance (using draw sheet) 4.Provide for the resident’s privacy with a curtain, screen, or door. 5.Practice good body mechanics. Adjust the bed to a safe level, usually waist high. Lock the bed wheels. 6.Lower the head of bed. Move the pillow to the head of bed. 7.Stand on the opposite side of the bed from your helper. Each of you should be facing each other.

34. Moving a resident to the side of the bed with assistance (using draw sheet) –(con’t) Lower both side rails (if bed has them). Stand up straight facing the side of the bed with feet about 12 inches apart. Point feet toward the side of the bed. Bend your knees. 8.Avoid trauma or pain to the resident throughout the procedure.

35. Moving a resident to the side of the bed with assistance (using draw sheet) 9.Roll the draw sheet up to the resident’s side. Have your helper do the same on his side of the bed. Grasp the sheet with your palms up at the resident’s shoulders and hips. Have your helper do the same (Fig. 11-17). 10.On the count of three, slide the resident toward the side of the bed. Your weight should be equal on each foot because you are moving the person to the side of the bed, not the head of the bed. Fig. 11-17. Both workers grasp the draw sheet at the resident’s shoulders and hips and prepare to move.

36. Moving a resident to the side of the bed with assistance (using draw sheet) 11.Make resident comfortable. Unroll the draw sheet. Leave it in place for the next repositioning. Reposition pillow under head. 12.Return bed to low position if raised. Ensure resident’s safety. Return side rails to ordered position. Remove privacy measures. 13.Leave call light within resident’s reach.

37. Moving a resident to the side of the bed with assistance (using draw sheet) 14.Wash your hands. 15.Be courteous and respectful at all times. 16.Report any changes in the resident to the nurse. Document procedure using facility guidelines.

38. Turning a resident away from you 1.Identify yourself by name. Identify the resident. Greet the resident by name. 2.Wash your hands. 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Encourage resident to assist if possible. 4.Provide for the resident’s privacy with a curtain, screen, or door.

39. Turning a resident away from you 5.Practice good body mechanics. Adjust the bed to a safe level, usually waist high. Lock the bed wheels. 6.Lower the head of bed. 7.Stand on side of bed opposite to where person will be turned. The far side rail should be raised (if bed has one). 8.Lower side rail nearest you if it is up.

40. Turning a resident away from you 9.Avoid trauma or pain to the resident throughout the procedure. 10.Move resident to side of bed nearest you using previous procedure. 11.Cross resident’s arm over his or her chest. Move arm out of the way on side toward which resident is being turned. Cross leg nearest you over the far leg (Fig. 11- 18). Fig. 11-18. Cross leg nearest you over the far leg.

41. Turning a resident away from you 12.Stand with feet about 12 inches apart. Bend your knees. 13.Place one hand on the resident’s shoulder. Place the other hand on the resident’s nearest hip. 14.While supporting the body, gently push resident toward other side of bed. Shift your weight from your back leg to your front leg (Fig. 11-19). Make sure resident’s face is not covered by the pillow. Fig. 11-19. Gently push resident toward other side of bed while shifting your weight from your back leg to your front leg.

42. Turning a resident away from you 15.Position resident properly in good alignment: head supported by pillow shoulder adjusted so resident is not lying on arm top arm supported by pillow back supported by supportive device hips properly aligned top knee flexed supportive device between legs with top knee flexed; knee and ankle supported.

43. Turning a resident away from you 16.Cover resident with top linens and straighten. Make resident comfortable. 17.Return bed to low position if raised. Ensure resident’s safety. Return side rails to ordered position. Remove privacy measures. 18.Leave call light within resident’s reach. 19.Wash your hands. 20.Be courteous and respectful at all times.

44. Turning a resident away from you 21.Report any changes in the resident to the nurse. Document procedure using facility guidelines.

45. Turning a resident toward you 1.Identify yourself by name. Identify the resident. Greet the resident by name. 2.Wash your hands. 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Encourage resident to assist if possible. 4.Provide for the resident’s privacy with a curtain, screen, or door.

46. Turning a resident toward you 5.Practice good body mechanics. Adjust the bed to a safe level, usually waist high. Lock the bed wheels. 6.Lower the head of bed. 7.Stand on side of bed opposite to where person will be turned. The far side rail should be raised (if bed has one). 8.Lower side rail nearest you if it is up.

47. Turning a resident toward you 9.Avoid trauma or pain to the resident throughout the procedure. 10.Move resident to side of bed nearest you using previous procedure. Put side rail up and go to the opposite side of the bed. Lower the side rail. 11.Cross resident’s arm over his or her chest. Move arm out of the way on side toward which resident is being turned.

48. Turning a resident toward you –(con’t) Cross leg furthest from you over the near leg. 12.Stand with feet about 12 inches apart. Bend your knees. 13.Place one hand on the resident’s far shoulder. Place the other hand on the resident’s far hip. 14.While supporting the body, gently roll the resident toward you (Fig. 11-20). Make sure resident’s face is not covered by the pillow. Fig. 11-20. Gently roll the resident toward you.

49. Turning a resident toward you 15.Position resident properly in good alignment: head supported by pillow shoulder adjusted so resident is not lying on arm top arm supported by pillow back supported by supportive device hips properly aligned top knee flexed supportive device between legs with top knee flexed; knee and ankle supported

50. Turning a resident toward you 16.Cover resident with top linens and straighten. Make resident comfortable. 17.Return bed to low position if raised. Ensure resident’s safety. Return side rails to ordered position. Remove privacy measures. 18.Leave call light within resident’s reach. 19.Wash your hands.

51. Turning a resident toward you 20.Be courteous and respectful at all times. 21.Report any changes in the resident to the nurse. Document procedure using facility guidelines.

52. Logrolling a resident with assistance Equipment: draw sheet 1.Identify yourself by name. Identify the resident. Greet the resident by name. 2.Wash your hands. 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Encourage resident to assist if possible.

53. Logrolling a resident with assistance 4.Provide for the resident’s privacy with a curtain, screen, or door. 5.Practice good body mechanics. Adjust the bed to a safe level, usually waist high. Lock the bed wheels. 6.Lower the head of bed. 7.Both co-workers stand on the same side of the bed. Lower the side rail (if bed has one and if it is not already lowered) on side nearest you.

54. Logrolling a resident with assistance –(con’t) One person stands at the resident’s head and shoulders. The other stands near the resident’s midsection. 8.Avoid trauma or pain to the resident throughout the procedure. 9.Place a pillow under the resident’s head to support the neck during the move.

55. Logrolling a resident with assistance 10.Place the resident’s arms across his or her chest. Place a pillow between the knees. 11.Stand with feet about 12 inches apart. Bend your knees. 12.Grasp the draw sheet on the far side (Fig. 11-21). Fig. 11-21. Both workers should grasp the draw sheet on the far side.

56. Logrolling a resident with assistance 13.On the count of three, gently roll the resident toward you. Turn the resident as a unit (Fig. 11-22). 14.Reposition resident comfortably in good alignment. Place pillow under head. Cover resident with top linens and straighten. 15.Return bed to low position if raised. Ensure resident’s safety. Return side rails to ordered position. Remove privacy measures. Fig. 11-22. On the count of three, both workers should roll the resident towards them, turning the person as a unit.

57. Logrolling a resident with assistance 16.Leave call light within resident’s reach. 17.Wash your hands. 18.Be courteous and respectful at all times. 19.Report any changes in the resident to the nurse. Document procedure using facility guidelines.

58. Assisting a resident to sit up on side of bed: dangling 1.Identify yourself by name. Identify the resident. Greet the resident by name. 2.Wash your hands. 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Encourage resident to assist if possible. 4.Provide for the resident’s privacy with a curtain, screen, or door.

59. Assisting a resident to sit up on side of bed: dangling 5.Practice good body mechanics. Adjust the bed to the lowest safe working level. Lock the bed wheels. 6.Avoid trauma or pain to the resident throughout the procedure. 7.Raise the head of bed to sitting position. Fold linen to the foot of the bed. Lower the side rail (if bed has one and if it is not already lowered) on side nearest you.

60. Assisting a resident to sit up on side of bed: dangling 8.Stand at the side of the bed with feet about 12 inches apart. Bend your knees. Keep your back straight. Help resident slowly move toward the side of the bed on which you are standing. 9.Place one arm under resident’s shoulder blades. Place the other arm under resident’s thighs (Fig. 11-23). Fig. 11-23. One arm should be under the resident’s shoulder blades, and the other arm should be under the thighs.

61. Assisting a resident to sit up on side of bed: dangling 10.On the count of three, gently and slowly turn resident into sitting position with legs dangling over the side of bed (Fig. 11-24). 11.Ask resident to sit up straight and push both fists into the edge of mattress. Assist resident to put on robe. Fig. 11-24. The resident should remain sitting with legs dangling over the side of bed for as long as ordered.

62. Assisting a resident to sit up on side of bed: dangling 12.Have resident dangle as long as ordered. Place a pillow or other supporting device behind resident’s back during dangle. Stay with the resident at all times. Check for dizziness. If resident feels dizzy or faint, help her lie down again and make sure she is secure. Tell the nurse at once. 13.Take vital signs as ordered (Chapter 13).

63. Assisting a resident to sit up on side of bed: dangling 14.Gently assist resident back into bed. Place one arm around resident’s shoulders. Place the other arm under resident’s knees. Slowly swing resident’s legs onto bed. 15.Make resident comfortable. Cover resident with top linens and straighten. Replace pillow under the resident’s head.

64. Assisting a resident to sit up on side of bed: dangling 15.Return bed to low position if raised. Ensure resident’s safety. Return side rails to ordered position. Remove privacy measures. 16.Leave call light within resident’s reach. 17.Wash your hands. 18.Be courteous and respectful at all times. 19.Report any changes in the resident to the nurse. Document procedure using facility guidelines.

65. 11 Positioning, Moving, and Lifting 4. Describe how to safely transfer residents Ergonomics is the science of designing equipment and setting up areas to make them safer and to suit the worker’s abilities. A transfer belt is a safety device used to transfer residents who are weak, unsteady, or uncoordinated. A transfer belt is called a gait belt when it is used to help residents walk.

66. Applying a transfer belt Equipment: transfer belt 1.Identify yourself by name. Identify the resident. Greet the resident by name. 2.Wash your hands. 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Encourage resident to assist if possible.

67. Applying a transfer belt 4.Provide for the resident’s privacy with a curtain, screen, or door. 5.Practice good body mechanics. Adjust bed to low, flat position. Lock bed wheels. 6.Supporting the back and hips, assist resident to a sitting position with feet flat on the floor. 7.Put on and properly fasten non-skid footwear on resident.

68. Applying a transfer belt 8.Place the belt over the resident’s clothing below the rib cage and above the waist. Do not put it over bare skin. 9.Tighten the buckle until it is snug. Leave enough room to insert three fingers into the belt. The fingers should fit comfortably under the belt. The belt must not interfere with circulation or breathing.

69. Applying a transfer belt 10.Check to make sure that breasts are not caught under the belt. 11.Position the buckle slightly off-center in the front or back for comfort.

70. Transferring a resident from bed to a chair or wheelchair Equipment: wheelchair, transfer belt, non-skid footwear 1.Identify yourself by name. Identify the resident. Greet the resident by name. 2.Wash your hands. 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Encourage resident to assist if possible.

71. Transferring a resident from bed to a chair or wheelchair 4.Provide for the resident’s privacy with a curtain, screen, or door. 5.Practice good body mechanics. 6.Remove wheelchair footrests close to the bed. 7.Place wheelchair near the head of the bed with arm of the wheelchair almost touching the bed.

72. Transferring a resident from bed to a chair or wheelchair –(con’t) Wheelchair should be placed on resident’s stronger, or unaffected, side. Lower the side rail (if bed has one and if it is not already lowered) on side nearest you. 8.Lock wheelchair wheels. 9.Raise the head of the bed. Adjust bed level. The height of the bed should be equal to or slightly higher than the chair. Lock bed wheels.

73. Transferring a resident from bed to a chair or wheelchair 10.Avoid trauma or pain to the resident throughout the procedure. 11.Assist resident to sitting position with feet flat on the floor. Let resident sit for a few minutes. 12.Put non-skid footwear on resident and securely fasten.

74. Transferring a resident from bed to a chair or wheelchair 13.With transfer (gait) belt: a.Stand in front of resident. b.Stand with feet about 12 inches apart. Bend your knees. Keep your back straight. c.Place belt below the rib cage and above the waist. Do not put it over bare skin. Grasp belt securely on both sides.

75. Transferring a resident from bed to a chair or wheelchair –Without transfer belt: a.Stand in front of resident. b.Stand with feet about 12 inches apart. Bend your knees. Keep your back straight. c.Place your arms around the resident’s torso under the arms, but not in the armpits (axilla).

76. Transferring a resident from bed to a chair or wheelchair –(con’t) Repeated pressure in the axilla may cause nerve damage. Do not allow resident to grasp your shoulders or around your neck. This may cause you to lose your balance. 14.Provide instructions to allow resident to help with transfer. Instructions may include: “When you start to stand, push with your hands against the bed.”

77. Transferring a resident from bed to a chair or wheelchair –(con’t) “Once standing, if you’re able, you can take small steps in the direction of the chair.” “Once standing, reach for the chair with your stronger hand.” 15.With your legs, brace resident’s lower legs to prevent slipping (Fig. 11-29). 16.Count to three to alert resident. 17.On three, slowly help resident to stand. Fig. 11-29. Bracing the resident’s lower legs with your legs helps prevent slipping.

78. Transferring a resident from bed to a chair or wheelchair 18.Help resident to pivot to front of wheelchair with back of resident’s legs against wheelchair (Fig. 11-30). 19.Ask resident to put hands on wheelchair armrests if able. 20.Gently lower resident into wheelchair. 21.Reposition resident with hips touching back of wheelchair. See previous guidelines on how to do this. Remove transfer belt, if used. Fig. 11-30. Pivoting is safer than twisting.

79. Transferring a resident from bed to a chair or wheelchair 22.Attach footrests. Place resident’s feet on footrests. 23.Make resident comfortable. 24.Remove privacy measures. 25.Leave call light within resident’s reach. 26.Wash your hands. 27.Be courteous and respectful at all times.

80. Transferring a resident from bed to a chair or wheelchair 28.Report any changes in the resident to the nurse. Document procedure using facility guidelines. To Transfer Back To Bed From Wheelchair, Follow These Steps: 1.Perform steps 1 through 8 above. 2.Adjust bed level to a low position. The height of the bed should be equal to or slightly lower than the chair. Lock bed wheels.

81. Transferring a resident from bed to a chair or wheelchair 3.Avoid trauma or pain to the resident throughout the procedure. 4.Perform steps 13 through 17 above. 5.The resident should be allowed to stand until he feels stable enough to move toward the bed. If the transfer belt is used, do not let go of it during this time.

82. Transferring a resident from bed to a chair or wheelchair 6.Help resident to pivot to bed with back of resident’s legs against bed. When he feels the bed, he should slowly sit down on the side of the bed. 7.Make resident comfortable. Remove transfer belt, if used. 8.Return bed to low position if raised. Ensure resident’s safety. Return side rails to ordered position. Remove privacy measures.

83. Transferring a resident from bed to a chair or wheelchair 9.Leave call light within resident’s reach. 10.Wash your hands. 11.Be courteous and respectful at all times. 12.Report any changes in the resident to the nurse. Document procedure using facility guidelines.

84. Transferring a resident from bed to stretcher with assistance Equipment: stretcher, bath blanket 1.Identify yourself by name. Identify the resident. Greet the resident by name. 2.Wash your hands. 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Encourage resident to assist if possible.

85. Transferring a resident from bed to stretcher with assistance 4.Provide for the resident’s privacy with a curtain, screen, or door. 5.Practice good body mechanics. Lower the head of bed so that it is flat. Lock bed wheels. 6.Fold linens to foot of the bed. Cover resident with bath blanket. Do not expose resident during the procedure. 7.Lower the side rail on side to which you will move resident (if in use for resident).

86. Transferring a resident from bed to stretcher with assistance 8.Avoid trauma or pain to the resident throughout the procedure. 9.Move the resident to the side of the bed. Have your co-workers help you do this. Refer back to the procedure “Moving a resident to the side of the bed” earlier in this chapter. 10.Place stretcher solidly against the bed. Lock stretcher wheels. Bed height should be equal to or slightly above the height of the stretcher. Move stretcher safety belts out of the way.

87. Transferring a resident from bed to stretcher with assistance 11.Two workers should be on the side of the bed opposite the stretcher. Two more workers should be on the outside of the stretcher. 12.Each worker should roll up the sides of the draw sheet and prepare to move the resident (Fig. 11-31). Protect the resident’s arms and legs during the transfer. If facility policy permits, two workers may actually get up on the bed on their knees to protect their backs. Fig. 11-31. With two workers on each side, roll up the sides of the draw sheet and prepare to move the resident.

88. Transferring a resident from bed to stretcher with assistance 13.On the count of three, the workers should lift and move the resident to the stretcher. All should move at once (Fig. 11- 32). Make sure the resident is centered on the stretcher. 14.Raise the head of the stretcher or place a pillow under the resident’s head if allowed. Make sure bath blanket still covers the resident. Fig. 11-32. On the count of three, all workers should lift and move at once.

89. Transferring a resident from bed to stretcher with assistance 15.Place safety straps across the resident. Raise side rails on stretcher. 16.Unlock stretcher’s wheels. Take resident to appropriate site. Stay with the resident until another team member takes over. 17.Wash your hands. 18.Be courteous and respectful at all times.

90. Transferring a resident from bed to stretcher with assistance 19.Report any changes in the resident to the nurse. Document procedure using facility guidelines. To Transfer Back To Bed From Stretcher: The bed height should be equal to or slightly below the stretcher when transferring the resident back to bed.

91. Transferring a resident using a mechanical lift with assistance Equipment: wheelchair or chair, mechanical or hydraulic lift, washcloth Before performing this procedure, check the weight limit of the lift to make sure the resident is within the weight limit. Make sure you know how to use this lift. 1.Identify yourself by name. Identify the resident. Greet the resident by name. 2.Wash your hands.

92. Transferring a resident using a mechanical lift with assistance 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Encourage resident to assist if possible. 4.Provide for the resident’s privacy with a curtain, screen, or door. 5.Practice good body mechanics. Lower bed to proper position for the move. Lock bed wheels.

93. Transferring a resident using a mechanical lift with assistance 6.Remove wheelchair footrests close to the bed. 7.Position wheelchair next to bed. Lower the side rail (if bed has one and if it is not already lowered) on side nearest you. Lock wheelchair brakes. 8.Avoid trauma or pain to the resident throughout the procedure.

94. Transferring a resident using a mechanical lift with assistance 9.Help the resident turn to one side of the bed. Pad the sling where the neck will rest with a washcloth for resident’s comfort. A sheet may be used over the sling to protect it from soiling. Position the sling under the resident, with the edge next to the resident’s back. Fanfold if possible. Fanfolding means folding several times into pleats. Make the bottom of the sling even with the resident’s knees (some slings only come to the top of the buttocks).

95. Transferring a resident using a mechanical lift with assistance –(con’t) Help the resident roll to his opposite side. Spread out the fanfolded edge of the sling, then roll back to the middle of the bed. 10.Roll the mechanical lift to bedside. Make sure the base is opened to its widest point. Push the base of the lift under the bed. Lock lift wheels. 11.Place the overhead bar directly over the resident. Be careful so the swing does not hit anyone.

96. Transferring a resident using a mechanical lift with assistance 12.With the resident lying on her back, attach one set of straps to each side of the sling. Attach one set of straps to the overhead bar (Fig. 11-34). If available, have a co- worker support the resident at the head, shoulders, and knees while being lifted. The resident’s arms should be folded across her chest. If the device has “S” hooks, they should face away from resident. Make sure all straps are connected properly. Fig. 11-34. Attach straps to overhead bar.

97. Transferring a resident using a mechanical lift with assistance 13.Following manufacturer’s instructions, raise the resident two inches above the bed. Pause a moment for the resident to gain balance. 14.If available, a lifting partner can help support and guide the resident’s body (Fig. 11-35). You can then move the lift so that the resident is positioned over the chair or wheelchair. Fig. 11-35. Make sure that one person supports and guides the resident’s body to help prevent injury.

98. Transferring a resident using a mechanical lift with assistance 15.Slowly lower the resident into the chair or wheelchair. Push down gently on the resident’s knees to help the resident into a sitting position. 16.Undo the straps from the overhead bar. Leave the sling in place for transfer back to bed (some slings can be easily removed when resident is seated).

99. Transferring a resident using a mechanical lift with assistance 16.Be sure the resident is seated comfortably and correctly in the chair or wheelchair. Put non-skid footwear on resident and fasten. Replace footrests. Cover the resident with a lap cover or robe if he requests it. 17.Remove privacy measures. 18.Leave call light within resident’s reach. 19.Wash your hands.

100. Transferring a resident using a mechanical lift with assistance 20.Be courteous and respectful at all times. 21.Report any changes in the resident to the nurse. Document procedure using facility guidelines.

101. Transferring a resident onto and off a toilet Equipment: disposable gloves, toilet tissue, wheelchair, transfer belt, non-skid shoes 1.Identify yourself by name. Identify the resident. Greet the resident by name. 2.Wash your hands. 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Encourage resident to assist if possible.

102. Transferring a resident onto and off a toilet 4.Provide for the resident’s privacy with a curtain, screen, or door. 5.Practice good body mechanics. 6.Position wheelchair at a right angle to the toilet to face the hand bar/wall rail. Place wheelchair on the resident’s stronger side, if possible.

103. Transferring a resident onto and off a toilet 7.Remove wheelchair footrests. Lock wheels. Put on and properly fasten non-skid footwear on resident. 8.Avoid trauma or pain to the resident throughout the procedure. 9.Apply a transfer belt around the resident’s waist. Grasp the belt. Put one of your hands toward the resident’s back and one toward the resident’s front.

104. Transferring a resident onto and off a toilet 10.Ask resident to push against the armrests of the wheelchair and stand, reaching for and grasping the hand bar with his stronger arm (Fig. 11-36). Fig. 11-36. Ask the resident to push up using the armrests of the wheelchair, stand and grasp the hand bar.

105. Transferring a resident onto and off a toilet 11.Ask resident to pivot her feet and back up so that she can feel the front of the toilet with the back of her legs (Fig. 11-37). 12.Help resident to pull down underwear and pants. You may need to keep one hand on the transfer belt while helping to remove clothing. Fig. 11-37. Have the resident pivot and feel the toilet with the back of her legs.

106. Transferring a resident onto and off a toilet 13.Help resident to slowly sit down onto the toilet. Remove transfer belt. Allow privacy unless resident cannot be left alone. Ask resident to pull on the emergency cord if she needs help. Close bathroom door. Stay near the door until resident is finished. 14.When the resident is finished, apply gloves. Assist with perineal care as necessary (see Chapters 12 and 16). Reapply transfer belt if removed. Ask her to stand and reach for the hand bar.

107. Transferring a resident onto and off a toilet 15.Use toilet tissue or damp cloth to clean the resident. Make sure he or she is clean and dry before pulling up clothing. Remove and dispose of gloves. 16.Pull up resident’s clothing. Help resident to the sink to wash hands. Wash your hands. 17.Help resident back into wheelchair. Be sure the resident is seated comfortably and correctly in the chair or wheelchair. Replace footrests.

108. Transferring a resident onto and off a toilet 18.Help resident to leave the bathroom. 19.Leave call light within resident’s reach. 20.Wash your hands. 21.Be courteous and respectful at all times. 22.Report any changes in the resident to the nurse. Document procedure using facility guidelines.

109. Transferring a resident into a car Equipment: car, wheelchair 1.Identify yourself by name. Identify the resident. Greet the resident by name. 2.Wash your hands. 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Encourage resident to assist if possible.

110. Transferring a resident into a car 5.Practice good body mechanics. 6.Place wheelchair close to the car at a 45-degree angle. Open the door on the resident’s stronger side. 7.Lock wheelchair. 8.Ask the resident to push against the arm rests of the wheelchair and stand.

111. Transferring a resident into a car 9.Ask the resident to stand, grasp the car or dashboard, and pivot his foot so the side of the car seat touches the back of the legs. 10.The resident should then sit in the seat and lift one leg, and then the other, into the vehicle (Fig. 11-38). 11.Carefully position the resident comfortably in the car. Help secure seat belt. Fig. 11-38. After resident sits in the car seat, he should put his legs in one at a time.

112. Transferring a resident into a car 12.See that door can be safely shut. Shut the door. 13.Return the wheelchair to the appropriate place for cleaning. 14.Wash your hands. 15.Document procedure using facility guidelines.

113. 11 Positioning, Moving, and Lifting 5. Discuss ambulation Regular ambulation and exercise help improve these things: quality and health of the skin circulation strength sleep and relaxation appetite elimination oxygen level

114. Assisting a resident to ambulate 1.Identify yourself by name. Identify the resident. Greet the resident by name. 2.Wash your hands. 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Encourage resident to assist if possible. 4.Provide for the resident’s privacy with a curtain, screen, or door.

115. Assisting a resident to ambulate 5.Avoid trauma or pain to the resident throughout the procedure. 6.Help resident move to a dangling position as described in earlier procedure. 7.Practice good body mechanics. Adjust bed to a low position so that the resident’s feet are flat on the floor. Lock bed wheels. 8.Put on and properly fasten non-skid footwear for resident.

116. Assisting a resident to ambulate 9.Stand in front of and face the resident. 10.Brace the resident’s lower extremities. Bend your knees. If resident has a weak knee, brace it against your knee. 11.With transfer (gait) belt: –Place belt around resident’s waist. Grasp the belt while assisting resident to stand.

117. Assisting a resident to ambulate –Without transfer belt: –Place arms around the resident’s torso under the arms, but not in the armpits (axillae), while assisting resident to stand. 12.With transfer belt: –Walk slightly behind and to one side of resident for the full distance, while holding onto the transfer belt (Fig. 11-39). If the resident has a weaker side, stand on the weaker side. Fig. 11-39. Walk slightly behind, standing on the weaker side, when assisting a resident to ambulate. Hold onto the transfer belt, if used, for the full distance.

118. Assisting a resident to ambulate –(con’t): Ask resident to look forward, not down at floor, during ambulation. If resident becomes dizzy or faint, help him to a nearby seat and call nurse for help.

119. Assisting a resident to ambulate –Without transfer belt: –Walk slightly behind and to one side of resident for the full distance. Support resident’s back with your arm. Ask resident to look forward, not down at floor, during ambulation. If resident becomes dizzy or faint, help him to a nearby seat and call nurse for help.

120. Assisting a resident to ambulate 13.After ambulation, make resident comfortable. Remove transfer belt, if used. 14.Return bed to low position if raised. Ensure resident’s safety. Remove privacy measures. 15.Leave call light within resident’s reach. 16.Wash your hands. 17.Be courteous and respectful at all times.

121. Assisting a resident to ambulate 18.Report any changes in the resident to the nurse. Document procedure using facility guidelines.