Patient Mobility- Transfer Skills p. 268 Unit 2

CNA Safety & Transfers p. 268 Manual patient handling: moving a pt by hand or bodily force, including pushing, pulling, carrying, holding etc Types of transfers: Standing transfer: Pt stands during transfer with help of 1 or 2 assistants Sitting transfer: Pt sits throughout transfer ex. With sliding board Sliding board: a plastic or wooden board, about 2 feet long with slippery surface, used for sitting, lateral transfer Mechanical lift: manually operated lift used for sitting, vertical movements

CNA Safety & Transfers p. 268 Which transfer to use? Nurse or physical therapist determines; depends on: Pt’s physical condition: Paralysis: inability to move 1 or more extremity; ex. Paraplegia, hemiplegia Paresis: weakness of 1 or more extremity Amputation: absence of an extremity Recent hip surgery etc Pt’s strength, endurance, balance: Respiratory disease Cardiac disease Neurological diseases ex. Multiple sclerosis, CVA, Parkinson's Ability to bear weight = stand on own feet Non weight-bearing: no weight allowed on that leg or both legs Partial weight-bearing: some weight allowed on that leg or both legs Full weight-bearing: full weight allowed Has to have at least partial weight-bearing on 1 leg for standing transfer! Pt’s mental condition: can pt understand and follow instructions? Pt’s size: height and weight

Key elements to consider p. 270 Pt’s ability to assist Pt’s ability to bear weight Pt’s upper-extremity strength Pt’s ability to cooperate/follow directions Pt’s size: if pt is larger than you, you definitely will need help, if pt smaller, depends on situation Special circumstances: wounds, surgical sites, IVs, tubes, contractures; transfer must never pull or displace a tube during transfer!! Physician or therapy orders, ex. Hip surgery, partial- or non- weight bearing etc See Figure 16.3 p. 270

Guidelines for Safe Pt Transfers p. 269 Read and know them, especially Never allow pt to place their hands on your body during transfers Never transfer pt by placing your hands under pt’s arms or shoulders Always lock all wheels Pt needs shoes or non-skid socks Brace the knee of the weak or paralyzed leg with your knee or leg Support weak or paralyzed arm, no dangling or pulling WC: always position large part of small front caster facing forward and lock breaks = more stable All the others on that page…

Transfer Belt p. 271 Procedure 18 p. 271!! Assistive device, 1.5-2inches wide, 54-60inches long, for transfer and ambulation Transfer belt: when used to help transfer pt Gait belt: when used to help ambulate pt Avoids grasping pt under arms or around rib cage NOT used to “lift” pt, if pt unable to bear weight – sitting transfer! Contraindications: Injuries along abdomen, back, ribs including surgery Abdominal pacemaker, Advanced heart or lung disease, Abdominal aneurysms Pregnancy, Colostomy, Gastrostomy or feeding tube Always, applied OVER pt clothing or gown, never directly on skin, use towel if necessary Applied at waist level, no twists in it Buckled in front Needs to be snug but not too tight: able to fit 3 fingers from each hand under it Procedure 18 p. 271!!

Sliding-Board p. 276 Pt must have good upper body strength, sitting balance, be able to lift buttocks off bed Used for paraplegia or weakness in both legs = sitting transfer Use transfer belt Arms from chair must be removable Procedure 21 p. 276

Stretcher transfers p. 280 Frightening for pt, ensure it’s safe Procedures 25, 26 for unconscious/ semiconscious pt Procedure 25 and 26 p. 280-282

Mechanical lift p. 282 Sitting transfer for heavy pt, pt unable to assist Best used with 2 or more CNAs Procedure 27 p. 283-284 (video)

Toilet transfers p. 285 Assisting pt onto and off the toilet Procedure 28 p. 285-286

Transfer pt from bed to chair p. 272 Step   P/F 1 Performs beginning standards 2 Explains procedure to resident before care 3 Provides privacy 4 Positions wheelchair beside bed, folds up/removes foot rests, locks wheels 5 Positions bed at an appropriate height, locks wheels 6 Assists resident safely to sitting position with feet flat on floor, puts on shoes or non-skid socks 7 Gives resident time to adjust to position change, asks if ok 8 Applies transfer belt correctly and securely over clothing at waste 9 Provides instructions to enable resident to assist in transfer including prearranged signal and to use hands to push off from mattress if able 10 Stands facing resident, positioning self to ensure safety for self and resident during transfer 11 On signal, gradually assists resident to stand by using transfer belt on both sides with upward grasp maintaining stability of resident’s legs 12 Transfers resident as a pivot to stand before wheelchair with back of resident’s legs against wheelchair 13 Lowers resident slowly into wheelchair 14 Positions resident with hips touching back of wheelchair 15 Removes transfer belt correctly 16 Positions feet on footrests 17 Puts call bell within reach 18 Washes hands 19 End procedures Skill # 4!! Procedure 18+19 p. 271-274

Transfer pt from bed to chair -2 people assist p. 274 Procedure 20 p. 274-275 Difference to one person assist: 1 assistant on each side of pt, facing pt Each assistant grabs transfer belt at front and back with underhand grasps Assistant closest to chair pivots around smoothly, stands with outside leg further back Assistant closest to bed uses inside knee to brace pt’s weaker leg Everyone moves together on 3…

Transfer pt from chair to bed p. 277 Procedure 22 p. 277-278 : assist of 1 Place chair so pt moves towards his strongest side Procedure 23 p. 278-279 : assist of 2 Procedure 24 p. 279 : Independent transfer = standby assist

Practice!!! Homework (besides practice) Textbook: read Unit 16 Workbook: read p.100 unit summary, Nursing assistant alert, complete “Corrections” and True/False questions, Look at “Identification” to find things wrong in pictures