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Transferring clients: Clinical skills notes

Notes

Notes

Basic Client Care Skills

Transferring Clients

Introduction

Transfer is defined as the process of moving a person from one surface to another one. Clients that typically require 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. 

Common Care Tips

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, line up the front swivel wheels with the back wheels when transferring clients
  • 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
  • During the transfer, clients 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; most importantly, spread your feet shoulder-width apart and keep your back straight

Transfer (Gait) Belt

When your client is unable to sit, stand up, or walk, you can use a transfer belt, also called a gait 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. Clients who 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. 

Applying the Belt

To apply the transfer belt:
  1. Assist the client to a sitting position. Help them reposition their legs so that they are hanging over the edge of the bed.
  2. Put the transfer belt around the person's waist over their clothing.
    • The belt should not cause discomfort or impair the person's breathing, and you should be able to slide your fingers under the belt.
    • Make sure that a client's breasts are not caught under the belt.
  3. 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. 

Figure 1: Applying the transfer belt.

Bed-to-Wheelchair Transfer: Without an Assistant

Supplies

Supplies that are needed to perform this procedure include:
  • a wheelchair
  • a transfer belt
  • the person's robe
  • slippers, or shoes
  • a lap blanket (optional)

Procedure

First, let's focus on the transfer without the help of an assistant, or in other words, on your own.
  1. 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.
  2. Help them put on a robe and shoes, then apply the transfer belt.
  3. Position yourself facing the client with your back straight, knees bent, and feet shoulder-width apart.
  4. Have the person lean forward as you firmly grasp the belt from underneath. Don't forget to prevent your client from sliding and falling by placing your knees against their knees and by blocking their feet with your feet.
  5. Use a gentle rocking motion to reduce the effort needed to lift the client. Do this by moving the person back-and-forth; make sure that your bodies are moving in the same direction at the same time.
  6. Tell the client 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.
  7. 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. 
  8. Assist them until they reach the armrest and the backs of their legs touch the edge of the wheelchair.
  9. By bending your knees, lower the person into the wheelchair. At the same time, the client can use the armrests for support. 
  10. 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.
    • Cover the person's lap and legs with a blanket.

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

Figure 2: Bed-to-Wheelchair transfer.

Bed-to-Wheelchair Transfer: With an Assistant

Some clients might be too large or too uncooperative for you to transfer alone, so you need to know how to transfer clients with the help of an assistant.

Supplies

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

Procedure

  1. Make sure that the height of the bed promotes good body mechanics.
  2. Place the wheelchair next to the bed facing the foot of the bed and lock the brakes.
  3. Position yourself behind the wheelchair and next to the bed. 
  4. Pass your arms under the client’s arms and firmly grasp their forearms. At the same time, the assistant should grasp the client’s thighs and calves.
  5. Together, on the count of “three,” lift the person from the bed and lower them into the wheelchair.
  6. Check that the person is comfortable, then
    • Place the person's feet on the footrests.
    • Buckle the wheelchair safety belt.
    • Cover the person's lap and legs with a blanket.

Figure 3: Bed-to-Wheelchair transfer with assistant.

Bed-to-Stretcher Transfer

Stretchers are also known as trolleys, and they are typically used to transport people to surgery rooms or diagnostic testings, but they can also be used to transport comatose or severely ill people. This type of transfer requires at least two other assistants.

Supplies

Supplies to perform this procedure include:
  • a stretcher
  • a lift sheet
  • a blanket

Procedure

  1. Raise the bed to its highest level and lock the wheels.
  2. Make sure that the lift sheet is positioned under the person’s shoulders and hips. If the lift sheet is not on the bed, you have to place one. To do this,
    • Cross the client’s arms on their chest and bend the client’s knee that’s closest to you.
    • Fold the lift sheet in half and place it next to the person.
    • Push the client’s shoulder and hip and roll them away from you.
    • Tuck the lift sheet as far as you can under the person’s body. Again, make sure that it’s positioned under their shoulders and hips.
    • Roll the client back and go to the opposite side of the bed. Pull the folded part out and make sure that you have enough sheet on both sides to perform the transfer.
    • Additionally, to make the transfer easier and safer, you can also use a slide board.
  3. Once the lift sheet is in place, cross the person’s arms on their chest. You should stand on one side of the bed while the other two assistants stand on the other side, holding the side of the sheet furthest from them.
  4. On the count of three, the other two assistants should pull on the sheet, rolling the person toward them, while you help push the client into the lateral position.
  5. Place the slide board on the bed and gently roll the client back into the supine position.
  6. Place the stretcher next to the bed, lock the wheels, and make sure that the stretcher is slightly lower than the bed. One assistant should stand at one side of the bed while the other two should position themselves on the outside edge of the stretcher. For a better grip, fanfold the lift sheet as close as possible to the client’s body.
  7. On the count of three, with the help of the assistant that’s next to you, pull the sheet with the client onto the stretcher, while the other assistant holds the slide board.
  8. Finally, make sure that the person is in good body alignment.
  9. If you are not using a slide board, on the count of three, simultaneously lift up the sheet and move the client on the stretcher.
To perform stretcher-to-bed transfer, reverse the order of previously described steps!

Figure 4: Bed-to-Stretcher transfer.

Mechanical Lift

Some facilities have mechanical lifts, which are assistive devices to help move clients that are too heavy, can’t bear weight, or require assistance of more than one person to transfer.

Supplies

To complete this procedure, you must have:
  • a wheelchair
  • mechanical lift
  • sling in a proper size
  • lap restraint (if ordered)
  • a lap blanket (optional)

Before the transfer, be sure that the sling, straps, hooks, and chains are in good condition. Next, confirm that the person’s weight does not exceed the lift’s capacity. 

Procedure

This transfer requires two assistants.
  1. Make sure that the height of the bed is at a comfortable working position.
  2. Position the wheelchair next to the bed facing the foot of the bed and lock the brakes. Make sure the lift and the wheelchair are on the same side of the bed.
  3. Place the sling under the client using the same technique as described with a lift sheet. Center the sling under the person so that the lower edge of the sling is positioned under the client’s knees, while the upper edge is positioned under their shoulders.
  4. Attach the straps to the sling, pass them under the client’s arms, and bring them to the front of the chest.
  5. Position the wheelbase of the lift under the bed, widen the lift’s base to increase its stability, and lock the lift’s wheels.
  6. Bring the swivel bar over the client and attach the sling to it.
    • The short chains or straps that support the upper body hook into the top holes, and the long chains or straps that support legs hook into the bottom holes.
  7. Ask the person to cross their arms over their chest and explain that they must not hold onto the swivel bar during the transfer; instead, they can hold onto the straps.
  8. Lift the client off the bed and release the brakes. During the transfer, your assistant should support the person’s legs. As you move, the client’s back should be toward the seat.
  9. Lower the client into the wheelchair and unhook the sling.

Figure 5: Using a mechanical lift.

Documentation

While performing a transfer, you must report any urgent or emergent findings to the healthcare provider.

Document:
  • if the transfer belt was used
  • the nature of the transfer and who assisted you
  • the appearance of the skin on the buttocks after transferring the client from a wheelchair to a bed
  • how the client tolerated the transfer

If the bed-to-stretcher transfer is performed, also write down:
  • whether or not you used transfer aids, side rails, or safety straps
  • the time of transfer
  • where the client is being transported

If the mechanical lift is used, also note if you used any special positioning aids.