Chapter 20: "Transferring the Person" (PART I; pp. 286-296)

Part I: pp. 286-296 CHO (Mr. Major & Mrs. Mercado)

Chapter 20:

Transferring the Person

(pp. 286-288)

Transfer -> how a person moves to and from a surface.

​ * Amount of help needed & method

used vary with person's ability

* CNAs assist with transfers often

​

Rules for body mechanics & safety measures for preventing work-related injuries apply

* Ch. 18: Body Mechanics (pp. 255-66)

* Ch. 19: Moving the Person (pp. 267-85)

​

​Introduction

W/c are useful for persons who:​

* Cannot walk

* Have severe difficulty walking

​

W/c are moved by:

* Person - using hand rims or feet

* Person - using hand, chin, mouth,

or other controls on motorized w/c

* Another - hand grips/push handles​​

​

(pp. 288-291)

Wheelchair (w/c) & Stretcher Safety​

​

Stretchers - used to transport pts who:

* Cannot sit up

​ * Must remain in lying position

* Are seriously ill

The stretcher should be covered

* Fitted stretcher sheet; folded flat

sheet; bath blanket

* Pillow & extra blankets on hand

* Head in Fowler's/Semi-Fowler's for

comfort​

(pp. 288-291)

​Wheelchair (w/c) & Stretcher Safety (continued...)

​

W/c & Stretcher Safety (continued...)

(pp. 288-291)

Multiple Choice

TRUE or FALSE:

When a person is on a stretcher, safety straps are utilized.

• TRUE

• FALSE

Pivot -> to turn one's body from a set,

standing position.

​

Stand & pivot transfers are used if:

* Legs strong enough to bear some or

all of weight

* Person can cooperate & follow

directions

* Person can assist with the transfer​

​

​

(p. 291)

​Stand & Pivot Transfers

Discussed in Ch. 14

* Preventing Falls (pp. 191-203)

Used to:

* Support pts/residents during

transfer

* Re-position persons in chair & w/c

* Assist with ambulation (Ch. 34)

​

​

​

​

​(p. 291)

​Transfer Belts

Multiple Choice

To prevent injuries during a stand-pivot transfer, the CNA needs to:

• keep his/her feet at least shoulder width apart.

• raise the bed to waist level.

• have the person move his or her weak side first.

• ask a co-worker to assist him/her.

Help person out of bed on his/her strong side

* E.g. If pt has weak left side -> get

pt out of bed on right side!

* Strong side moves first -> pulls

weaker side along

​

Transfers from weak side are awkward and unsafe!​

​

(pp. 292-294)

Bed to Chair or Wheelchair Transfers

Chair or w/c is placed beside bed at head -or- foot of bed -> Armrest nearly touches the bed.

​

If @ HOB -> seat faces foot of bed!

​If @ FOB -> seat faces head of bed!

​

See procedure (pp. 292-293)​!

​

​

​

(pp. 292-294)

​Bed to Chair or W/C Transfers (continued...)

Bed to Chair or W/c Transfers (continued...)

(Figures found on p. 294)

Bed to Chair or W/c Transfers (continued...)

(Figures found on p. 294)

Multiple Choice

The CNA is helping a patient transfer from the bed to the chair. Which is correct?

• The person wears socks or slippers.

• The person is helped out of bed on his weak side.

• The bed is in the highest horizontal position.

• Make sure his feet touch the floor.

Same rules as bed to chair transfers

* If pt is weak on 1 side --> transfer so strong side

moves first

* Position pt with strong side near bed

-> May have to move chair/wheelchair

E.g. Resident with right-sided weakness needs to be transferred from bed to chair:

* Chair placed on left (strong) side of bed --> pt

moves left (strong) side first

* CNA must move chair to opposite side of bed (or

turn chair around) to transfer pt back to bed!​

​

​

​

​(pp. 295-296)

Chair or W/c to Bed Transfers

Multiple Choice

TRUE or FALSE:

When transferring a person, the weak side moves first.

• TRUE

• FALSE

Using bathroom for elimination promotes:

• Privacy

• Dignity

• Self-esteem

• Independence

​

However, bathrooms are often small = little room for CNA & w/c

• Falls & work-related injury are risks

Transferring the Person to and from the Toilet

Multiple Choice

The CNA is transferring a patient from the wheelchair to the toilet. Which is correct?

• The CNA should make sure the toilet has a short toilet seat.

• The CNA should not transfer the person if the grab bars by the toilet are not secure.

• The person should wear soft, warm, and comfortable bedroom slippers.

• The CNA should unlock the w/c wheels right before transferring the person.

Lateral Transfer -> moves person between 2 horizontal surfaces.

• E.g. Transfer from bed to stretcher

• E.g. Transfer from bed to shower trolley (Ch. 24)

​

Friction-reducting devices protect pt's skin during lateral transfers & staff from injury

• Friction & shearing (Ch. 19) of skin

• Infection & pressure injuries (Ch. 41)

​

Lateral Transfers

Lateral transfer devices include:

• Lift, turning, or drawsheet

• Turning pad

• Large, re-usable waterproof under-pad

• Slide sheet or other lateral sliding aid (Fig. 20-13; previous slide)

Transfer ("sliding") board​ used for seated lateral transfers if: (Fig. 20-14)

• Person has upper body strength

• Person has good sitting balance

• Enough room to position 2 surfaces close together​.

​

Friction-reducing devices + at least 2-3 staff members required for safe transfer to/from stretchers

If pt weighs less than 200 lbs, use:

• ​Friction-reducing device -or-

• Lateral transfer device ("sliding aid")

If pt weighs more than 200 lbs, use:

• Lateral transfer device, mechanical ceiling lift (p. 300), or other device

• At least 3 staff members!​

​

​Moving the Person to a Stretcher

If pt has bariatric needs, RN & care plan may direct staff to:

• Use bariatric stretcher & check for EC ("expanded capacity")

• Position stretcher 1/2 inch lower than bed

• Use lateral transfer device, bariatric ceiling lift (p. 300), or other as directed​

• Transfer pt from his/her strong side​

• Apply abdominal binder if pt's abdomen is in the way (Ch. 40)​

Multiple Choice

You need to laterally transfer a resident to a stretcher. Which is correct?

• Ask one co-worker to help you.

• Lower the bed to its lowest level.

• Use a friction-reducing device.

• Make sure bed rails are raised.

Multiple Choice

TRUE or FALSE:

A transfer board may be used for a seated lateral transfer if the person has good upper body strength.

• TRUE

• FALSE