1. Patient Mobility- Transfer Skills p. 268
Unit 2

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

3. 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

4. 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

5. 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…

6. 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!!

7. 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

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

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

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

11. 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 p

12. Transfer pt from bed to chair -2 people assist p. 274
Procedure 20 p
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…

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

14. 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