Safely Moving and Transferring the Person Chapter 17 Safely Moving and Transferring the Person Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Safely Moving and Transferring Persons During these and other tasks, you must use your body correctly. Turning and repositioning persons Moving persons in bed Transferring persons to and from beds, chairs, wheelchairs, stretchers, and toilets To transfer a person means moving the person from one place to another. Review the Focus on Communication: Safely Moving and Transferring Persons Box on p. 254 in the Textbook. Review the Promoting Safety and Comfort: Safely Moving and Transferring Persons Box on p. 255 in the Textbook. Review the Teamwork and Time Management: Safely Moving and Transferring Persons Box on p. 255 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Preventing Work- Related Injuries You must prevent work-related injuries when moving and transferring patients and residents. The Occupational Safety and Health Administration (OSHA) recommends: Minimizing manual lifting in all cases Eliminating manual lifting when possible Review the rules in Box 17-1 on pp. 255-256 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Preventing Work- Related Injuries (cont’d) To safely move and transfer the person, the nurse and health team determine: The person’s dependence level The amount of assistance needed What procedure to use The equipment needed Follow the rules in Box 17-2 on p. 257 in the Textbook. The amount of assistance needed depends on the person’s height, weight, cognitive function, and dependence level. The nurse and the care plan tell you what procedure to use. Always follow the manufacturer’s instructions for assist equipment and devices. Ask for any needed training. Review the Focus on Children and Older Persons: Preventing Work-Related Injuries Box on p. 258 in the Textbook. Review the Teamwork and Time Management: Preventing Work-Related Injuries Box on p. 258 in the Textbook. Review the Delegation Guidelines: Preventing Work-Related Injuries Box on p. 258 in the Textbook. Review the Promoting Safety and Comfort: Preventing Work-Related Injuries Box on p. 258 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Moving Persons in Bed Those who are weak, unconscious, paralyzed, or in casts need help moving in bed. Code 4: Total Dependence—mechanical lift or friction-reducing device and at least 2 staff members Code 3: Extensive Assistance—mechanical lift or friction-reducing device and at least 2 staff members The person weighs less than 200 pounds—2 to 3 staff members and a friction-reducing device The person weighs more than 200 pounds—at least 3 staff members and a friction-reducing device Some persons can move and turn in bed. Others need help from at least 1 person. Sometimes 2 or 3 people or a mechanical lift is needed. Review the Delegation Guidelines: Moving Persons in Bed Box on p. 259 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Moving Persons in Bed (cont’d) Protecting the skin Protect the person’s skin during moving and transfer procedures. Friction is the rubbing of one surface against another. Shearing is when the skin sticks to a surface while muscles slide in the direction the body is moving. Reduce friction and shearing when moving the person in bed by: Rolling the person Using friction-reducing devices Friction and shearing injure the skin. Both cause infection and pressure ulcers. Shearing occurs when the person slides down in bed or is moved in bed. Friction-reducing devices include a lift sheet (turning sheet), a cotton drawsheet, turning pads, large incontinence products, sliding boards, and slide sheets. Review the Focus on Children and Older Persons: Protecting the Skin Box on p. 259 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Moving Persons in Bed (cont’d) Raising the person’s head and shoulders You can raise the person’s head and shoulders easily and safely by locking arms with the person. Do not pull on the person’s arm or shoulder. It is best to have help with older persons and with those who are heavy or hard to move. Asking for help protects the person and you from injury. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Moving Persons in Bed (cont’d) Moving the person up in bed The person is moved up in bed for good alignment and comfort. You can sometimes move lightweight adults up in bed alone if they can assist using a trapeze. It is best to have help and to use an assist device. Two or more staff members are needed to move heavy, weak, and very old persons up in bed. Always protect the person and yourself from injury. Review the Promoting Safety and Comfort: Moving the Person Up in Bed Box on p. 261 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Moving Persons in Bed (cont’d) Moving the person up in bed with an assist device The person is moved more evenly. Shearing and friction are reduced. At least two staff members are needed. This procedure is used for: Most patients and residents Persons recovering from spinal cord surgery or spinal cord injuries Older persons Such assist devices include a drawsheet (lift sheet), flat sheet folded in half, turning pad, slide sheet, and a large incontinence product. The device is placed under the person from the head to above the knees or lower. Follow the guidelines for “Moving Persons in Bed” on p. 258 in the Textbook. Review the Promoting Safety and Comfort: Moving the Person Up in Bed With an Assist Device Box on p. 263 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Moving Persons in Bed (cont’d) Moving the person to the side of the bed The person is moved to the side of the bed: For repositioning and care procedures Before turning To limit the need to reach over the person One method involves moving the person in segments. With at least co-worker, use a mechanical lift or an assist device: Following guidelines For older persons For persons with arthritis For persons recovering from spinal cord injuries or spinal cord surgery Using an assist device helps prevent: Pain and skin damage Injury to bones, joints, and spinal cord Review the Promoting Safety and Comfort: Moving the Person to the Side of the Bed Box on p. 265 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Turning Persons Persons are turned onto their sides: To help prevent complications from bed rest For certain procedures and care measures The person is turned toward you or away from you. The direction depends on the person’s condition and the situation. After turning the person, position him or her in good alignment. Use pillows to support the person in the side-lying position. Some persons turn and re-position themselves in bed. Others need help. Some totally depend on the nursing staff for care. Review the Delegation Guidelines: Turning Persons Box on p. 267 in the Textbook. Review the Promoting Safety and Comfort: Turning Persons Box on p. 267 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Turning Persons (cont’d) Logrolling is turning the person as a unit, in alignment, with one motion. The spine is kept straight. The procedure is used to turn: Older persons with arthritic spines or knees Persons recovering from hip fractures Persons with spinal cord injuries Persons recovering from spinal surgery The spine is kept straight at all times after spinal cord injury and after spinal surgery. Review the Promoting Safety and Comfort: Logrolling Box on p. 269 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Sitting on the Side of the Bed (Dangling) Patients and residents sit on the side of the bed (dangle) for many reasons. While dangling the legs, the person: Coughs and deep breathes Moves the legs back and forth in circles Two staff members may be needed. Persons with balance and coordination problems need support. If dizziness or fainting occurs, lay the person down. Many older persons become dizzy or faint when getting out of bed too fast. Some persons increase activity in stages. Review the Focus on Children and Older Persons: Dangling Box on p. 270 in the Textbook. Review the Delegation Guidelines: Dangling Box on p. 270 in the Textbook. Review the Promoting Safety and Comfort: Dangling Box on p. 271 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Transferring Persons The amount of help needed and the method used vary with the person’s dependency level. For a safe transfer, the: Room must be arranged so there is enough space. Chair, wheelchair, or other device must be placed correctly. Transfer belts/gait belts are used to: Support patients and residents during transfers. Reposition persons in chairs and wheelchairs. Patients and residents are moved to and from beds, chairs, wheelchairs, shower chairs, commodes, toilets, and stretchers. The rules of body mechanics apply to transfers (Chapter 16). The guidelines in Box 17-1 on pp. 255-256 in the Textbook apply. Review the contents of Box 17-2 on p. 257 in the Textbook. Review the Delegation Guidelines: Transferring Persons Box on p. 273 in the Textbook. Review the Promoting Safety and Comfort: Transferring Persons Box on p. 273 in the Textbook. Review the Teamwork and Time Management: Transferring Persons Box on p. 273 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Transferring Persons (cont’d) Bed to chair or wheelchair transfers Help the person out of bed on his or her strong side. In transferring, the strong side moves first. Stand and pivot transfers are used if the: Person’s legs are strong enough to bear some or all of his or her weight Person is cooperative and can follow directions Person can assist with the transfer Chair or wheelchair to bed transfers have the same rules as bed to chair transfers. Safety is important for chair, wheelchair, commode, and shower chair transfers. Transfers from the weak side are awkward and unsafe. Review the Promoting Safety and Comfort: Bed to Chair or Wheelchair Transfers Box on p. 274 in the Textbook. If the person is weak on one side, transfer the person so that the strong side moves first or position the chair or wheelchair so the person’s strong side is near the bed. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Transferring Persons (cont’d) Mechanical lifts Mechanical lifts are used to transfer persons who: Cannot help themselves Are too heavy for the staff to transfer Slings The type of sling used depends on the person’s size, condition, and other needs. Follow agency policy and the manufacturer’s instructions for washing slings. Follow agency policy for handling and washing contaminated slings. Mechanical lifts are used for transfers to and from beds, chairs, stretchers, tubs, shower chairs, toilets, commodes, whirlpools, or vehicles. There are manual, battery-operated, and electric lifts. Some lifts are mounted on the ceiling. Slings are padded, unpadded, or made of mesh. A sling is considered contaminated if it: Has any visible sign of blood, body fluids, secretions, or excretions Is used on a person’s bare skin Is used to bathe a person A bathing sling is used to transfer the person directly from the bed or chair into a bathtub. For infection control, each person has his or her own toileting sling. An amputee sling is used for the person who has had both legs amputated. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Transferring Persons (cont’d) Before using a mechanical lift: You must be trained in its use. It must work. The sling, straps, hooks, and chains must be in good repair. The person’s weight must not exceed the lift’s capacity. At least two staff members are needed. Always follow the manufacturer’s instructions. Review the Delegation Guidelines: Using a Mechanical Lift Box on p. 279 in the Textbook. Review the Promoting Safety and Comfort: Using a Mechanical Lift Box on p. 279 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Transferring Persons (cont’d) Transferring the person to and from the toilet Transfers involving wheelchairs and toilets are often hard. Falls and work-related injuries are risks. Sometimes mechanical lifts are used. A sliding board may be used if: The wheelchair armrests can be removed. The person has upper body strength. The person has good sitting balance. There is enough room to position the wheelchair next to the toilet. Using the bathroom for elimination: Promotes dignity, self-esteem, and independence Is more private than using a bedpan, urinal, or bedside commode Review the Promoting Safety and Comfort: Transferring the Person to and From the Toilet Box on p. 282 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Transferring Persons (cont’d) Moving the person to a stretcher Stretchers (gurneys) are used to transport persons to other areas who: Cannot sit up Must stay in a lying position Are seriously ill The stretcher is covered with a folded flat sheet or bath blanket. A drawsheet, turning pad, large incontinence underpad, slide sheet, or lateral transfer device with slide board is used. At least 2 or 3 staff members are needed for a safe transfer. With the nurse’s permission, raise the head of the stretcher to a Fowler’s or semi-Fowler’s position to increase the person’s comfort. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Transferring Persons (cont’d) OSHA recommends the following: If the person weighs less than 100 pounds, use a lateral sliding aid and 2 staff members. If the person weighs 100 to 200 pounds, use a lateral sliding aid or a friction-reducing device and 2 staff members. If the person weighs more than 200 pounds, use one of the following: A lateral sliding aid and 3 staff members A friction-reducing device or lateral transfer device and 2 staff members A mechanical lateral transfer device with a built-in slide board Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Transferring Persons (cont’d) When the person is on the stretcher: Safety straps are used. The stretcher side rails are kept up during the transport. The stretcher is moved feet first. The staff member at the head of the stretcher can watch the person’s breathing and color during the transport. Never leave the person alone. Review the Delegation Guidelines: Moving the Person to a Stretcher Box on p. 283 in the Textbook. Review the Promoting Safety and Comfort: Moving the Person to a Stretcher Box on p. 283 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Re-Positioning in a Chair or Wheelchair For good alignment and safety, the person’s back and buttocks must be against the back of the chair. Follow the nurse’s directions and the care plan for the best way to re-position a person in a chair or wheelchair. Do not pull the person from behind the chair or wheelchair. Some persons can help with repositioning. Others need help. If the person cannot help with repositioning, use a mechanical lift. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.