Transferring clients

Transfer is defined as the process of moving a person from one surface to another one. Clients that typically require a nursing assistant’s help with transferring include those who are weak or paralyzed, have recently had surgeries, or are injured.

The most common hospital transfers include bed to wheelchair transfer, wheelchair to bed, bed to stretcher, and vice versa.

Regardless of the type of transfer, you should always keep in mind some safety measures to protect yourself and your clients.

Plan the transfer and explain the procedure to the client. Adjust the bed height to a comfortable level for work and lower the side rails if they are up.

When using wheelchairs, don’t forget to line up the front swivel wheels with the back wheels when transferring clients.

As far as clothing measures go, a person's clothing should fit them well, while their shoes must provide a good grip and have non-skid soles.

During the transfer, clients should always lead with their stronger side, but they should not hold onto you around your neck. Instead, they can use your arm or the arm of the chair for support.

Don’t put your hands under the client’s arms to support them because, if they fall, this can lead to more injuries.

Protect yourself by using correct body mechanics, and most importantly, spread your feet shoulder-width apart and keep your back straight!

Now let’s focus on a transfer belt, also called a gait belt! When your client is unable to sit, stand up, or walk, you can use a transfer belt to make the whole process easier and safer.

When used to help a person walk, this belt is usually made from canvas, nylon, or leather with a buckle at the end. Some belts also have loops that the caregiver can hold onto.

The transfer belt is put around the client’s waist, and it can be used to maintain the stability of the client, reposition individuals in chairs and wheelchairs, and assist with ambulation.

It’s important to note that these belts can be used only in individuals that can bear weight. Weight bearing refers to a person’s ability to stand on one or both legs.

On the other hand, clients that are unable to bear weight require mechanical lifts for transfer.

But, even if the client can bear weight, transfer belts cannot be used in individuals that are recovering from abdominal surgery or in individuals that have severe cardiac or respiratory diseases.

If you are not sure if the transfer belt is a good choice for the client, check the nursing care plan or simply ask the nurse.

Now, to apply the transfer belt, first assist the client to a sitting position. Help them reposition their legs so that they are hanging over the edge of the bed.

Put the transfer belt around the person’s waist over the clothing. The belt should not cause discomfort or impair the person’s breathing, and remember, you should be able to slide your fingers under the belt.

Also, make sure that a client’s breasts are not caught under the belt. Once you apply the transfer belt, tuck in any excess strap. For greater safety during the transfer, use the underhand grasp when holding the belt.

Moving on to bed-to-wheelchair transfer. Supplies that are needed to perform this procedure include a wheelchair; a transfer belt; the person’s robe, slippers, or shoes; and a lap blanket which is optional.

First, let’s focus on the transfer with the help of one assistant, or in other words, on your own.

Place the wheelchair on the client’s stronger side, lock the brakes, and lower the bed to its lowest position.

Assist your client to a sitting position and watch for signs of dizziness or fainting. Do not leave clients unsupervised in this position because they can fall off the bed.

Make sure that the person’s feet are flat on the floor and their hands are holding the edge of the bed. Help them put on a robe and shoes; and finally, apply the transfer belt.

Next, position yourself facing the client with your back straight, knees bent, and feet shoulder-width apart. Have the person lean forward as you firmly grasp the belt from underneath.

Don’t forget to prevent sliding and falling of your client by placing your knees against their knees and by blocking their feet with your feet. Use a gentle rocking motion to reduce the effort needed to lift the client.

Do this by moving the person back-and-forth, but make sure that the movement is simultaneous and that your bodies are moving in the same direction at the same time.

Tell them that on the count of three, they should push down on the bed with their hands.

At the same time, you should pull on the transfer belt as you straighten your knees and lift up the client. Alternatively, if the client is weak, they can rest their arms on your arms.

Once you are in the standing position, move towards the wheelchair by taking small steps in a slow shuffle. This movement is also referred to as pivoting.

Continue to support the person in the standing position by holding the transfer belt as they turn. Also, continue to block their knees and feet to prevent falling.

Assist them until they reach the armrest and the backs of their legs touch the edge of the wheelchair.

Finally, by bending your knees, lower the person into the wheelchair. At the same time, the client can use the armrests for support.

Once you make sure that the person is comfortable, remove the transfer belt, place the client’s feet on the footrests, buckle the wheelchair safety belt, and cover the person’s lap and legs with a blanket.

To perform wheelchair-to-bed transfer, reverse the order of the previously described steps!

Now some clients might be too large or too uncooperative for you to transfer alone, so you need to know how to transfer clients with two assistants.

To perform this transfer, you need a wheelchair; the person's robe, slippers, or shoes; and a lap blanket, if desired.

First, make sure that the height of the bed is promoting good body mechanics. Next, place the wheelchair next to the bed facing the foot of the bed and lock the brakes.

Position yourself behind the wheelchair and next to the bed. Pass your arms under the client’s arms and firmly grasp their forearms.

At the same time, the other assistant should grasp their thighs and calves. Together, on the count of “three,” lift the person from the bed and lower them into the wheelchair.